Method of Preventing or Treating Obesity With

an EmclO Inhibitor

Introduction

[0001] This application claims benefit of priority to U.S. Provisional Patent Application Serial No. 62/209,108, filed August 24, 2015, the content of which is incorporated herein by reference in its entirety.

Background

[0002] Obesity is the result of an imbalance between energy intake and energy expenditure resulting in the storage of excess energy as fat, primarily in adipose tissue. In addition to its own specific morbidities, obesity is a major risk factor for metabolic conditions, such as insulin resistance, type 2 diabetes mellitus, cardiovascular diseases, and certain type of cancers. Therefore, identifying a therapeutic strategy to favorably tilt the energy balance is desirable.

[0003] It has been demonstrated that, in addition to being an energy-storage organ, visceral/subcutaneous white adipose tissue is also a hormone-secreting endocrine tissue that has an active role in the regulation of whole body metabolic homeostasis. Adipokines may play both positive and negative roles to fine-tune and achieve metabolic balance (e.g., adiponectin is a positive regulator of insulin sensitivity, whereas leptin is a negative regulator of satiety) . The dysregulation of adipokine secretion

(e.g., adiponectin, leptin, RBP4, resistin) is associated with the development of metabolic diseases. Due to intrinsic properties, fat accumulation in visceral or subcutaneous fat during obesity has been well established to result in differential metabolic risks in part due to differences in insulin sensitivity, adipogenesis , adipokine secretion, and beige adipocyte induction potential.

[0004] Unlike visceral fat, subcutaneous fat plays a protective role partly due to its ability to be less inflammatory, secrete higher levels of protective adipokines, and be metabolically flexible (i.e., its ability to form beige adipocytes) . In addition to subcutaneous fat, brown fat has been classically known to play a protective role on energy homeostasis due to its role in uncoupling respiration and adaptive thermogenesis . Therefore, simultaneous modulation of brown fat and subcutaneous fat could be an important therapeutic strategy .

[0005] WO 2014/111458 describes the use of inhibitors of Cl90rf63, termed Factor 2, for treating or preventing a disease in which angiogenesis contributes to disease development or progression. Proliferative diseases such as cancer, psoriasis, atherosclerosis, scleroderma, and ulcers are described. Further, while CN 101985475 suggests the use of polyclonal antibodies against EmclO in the treatment of diabetes mellitus, a correlation between diabetes and the expression of EmclO has provided no significant results.

Summary of the Invention

[0006] This invention provides a method for preventing or treating obesity by administering to a subject in need of treatment an effective amount of an EmclO inhibitor. In one embodiment, the subject is overweight. In some embodiments, the EmclO inhibitor inhibits the expression of EmclO. In other embodiments, the EmclO inhibitor inhibits the activity of EmclO. In certain embodiments, the EmclO inhibitor is an antibody or antigen-binding fragment thereof. Administration of the EmclO inhibitor intravenously, subcutaneously, or intraperitoneally is provided as is a method for modulating the inhibitory effect of EmclO on adipocyte energy metabolism by contacting an adipocyte with an effective amount of an anti-EmclO antibody, or antigen-binding fragment thereof, that specifically binds to EmclO and neutralizes the activity of EmclO.

Brief Description of the Drawings

[0007] Figure 1 shows that EmclO is down-regulated in overweight and obese human subcutaneous but not visceral fat. Quantitative PCR analysis in subcutaneous and visceral fat from lean (<25) , overweight (>25-29.9) or obese (>29.9) patients. (n=75-100 per group). Mean ± SEM. ***P<0.001.

[0008] Figure 2 shows western blot analysis of proteins from differentiated adipocytes treated with control (carrier), EmclO (1 mg/ml) or EmclO (1 mg/ml) with polyclonal anti-EmclO antibody (10 mg/ml) for 1 hour at 37°C.

Detailed Description of the Invention

[0009] ER Membrane Protein Complex Subunit 10 is a protein shown to be widely expressed in pancreatic islets, testis, and bladder tissues (Wang, et al. (2009) J. Endocrinol. 202 (3) : 355-64) . It has now been found that EmclO is also produced by adipocytes and is involved in energy homeostasis. In particular, it was observed that the expression of EmclO is down-regulated in white adipose tissues, specifically the inguinal subcutaneous (SQ) fat in obese mice. Consistent with a decrease in EmclO expression in adipose tissues, the circulating level of EmclO is also down-regulated in the obese mice. However, in a cohort of lean, overweight and obese human volunteers, it was observed that EmclO expression was significantly down- regulated in subcutaneous fat from overweight and obese patients, but not in the visceral fat from the same patients. To investigate the role of EmclO on metabolic homeostasis, EmclO global knockout (KO) mice were generated. Surprisingly, it was observed that the disruption of EmclO protected the mice from diet-induced obesity and metabolic dysfunction. Accordingly, the present invention provides compositions and methods for inhibiting EmclO and preventing, treating, or delaying the onset of metabolic diseases such obesity.

[0010] EmclO, also known as INM02, cl9orf63, or hHSSl, is encoded by a transcript, the sequence of which is provided under GENBANK Accession No. NM_175063 or NM_206538. The open-reading frame encodes a protein having the following amino acid sequence set forth in SEQ ID NO:l, which is available under GENBANK Accession No. NP_778233, or SEQ ID NO: 2, which is available under GENBANK Accession No. NP_996261.

[0011] Preferably, "EmclO" refers to a protein, which comprises, essentially consists or consists of a core segment of human EmclO having an amino acid sequence according to SEQ ID NO: 3. In some embodiments, EmclO is the full-length protein having the amino acid sequence according to SEQ ID NO:l or SEQ ID NO: 2. In other embodiments, EmclO is a fragment of SEQ ID NO:l or SEQ ID NO: 2. In certain embodiments, a fragment of EmclO lacks the N-terminal signal sequence MAAASAGATRLLLLLLMAVAAPSRARG (SEQ ID NO: 4). In this respect, it is most preferred that the EmclO protein of this invention is the secreted form of EmclO having an amino acid sequence according to SEQ ID NO: 5 or SEQ ID NO: 6. T/US2016/048271

[0012] Other fragments of EmclO include an N-terminal deletion, which in addition to the N-terminal signal sequence, may lack one or more amino acids from amino acid position 27 to 73 (based on SEQ ID NO:l or SEQ ID NO:2). Accordingly, the N-terminus of a fragment of EmclO may be at position 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, or 56. Additionally, or alternatively, a fragment of EmclO may lack one or more amino acids at positions 190 to 254 based on SEQ ID NO:l, or one or more amino acids at positions 190 to 262 based on SEQ ID NO: 2. Accordingly, the C-terminus of a fragment of EmclO may be at position 189, 190, 191, 192, 193, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 210, 211, 212, 213, 214, 215, 216, 217, 218, 219, 220, 221, 222, 223, 224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 234, 235, 236, 237, 238, 239, 240, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250, 251, 252, or 253 (based on SEQ ID NO:l or SEQ ID NO:2) or at position 254, 255, 256, 257, 258, 259, 260, or 261 (based on SEQ ID NO:2) .

[0013] Variants of SEQ ID NO:l or SEQ ID NO: 2 are also encompassed by this invention. Variants of SEQ ID NO:l or SEQ ID NO:2 preferably have at least 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% sequence identity to SEQ ID NO:l or SEQ ID NO : 2 and include mammalian homologues, in particular from mouse EmclO or rat EmclO.

[0014] Agents of use in inhibiting EmclO are referred to herein as EmclO inhibitors or inhibitory ligands . EmclO inhibitors include nucleic acids, small organic molecules, peptides or proteins that block, inhibit or reduce the expression or activity of EmclO. In this respect, an inhibitor may act on the transcription and/or translation of mRNA encoding EmclO thereby preventing its cellular production and, thus secretion into the circulation and/or at the site of disease development or progression. In accordance with this embodiment, the EmclO inhibitor can be an inhibitory RNA (e.g., miRNA, siRNA or combination thereof), antisense RNA or ribozyme molecule. Such inhibitory molecules can be readily designed based upon the nucleic acid sequence of EmclO {i.e., found under GENBANK Accession No. NM_175063 or NM_206538) . Nucleic acid-based inhibitory molecules can be administered by conventional methods including, e.g., via synthetic cationic polymer- based nanoparticles or expressed by recombinant vectors {e.g., a retrovirus, AAV or lentivirus vector). Further, in some embodiments, expression is restricted to adipocytes using an adipocyte-specific promoter such as the adiponectin promoter (O'Neill, et al . (2014) Gene Therapy 21:653-61) or human adipocyte fatty acid binding protein (aP2) promoter (Rival, et al. (2004) J. Pharmacol . Exp. Ther. 311: 467-75) .

[0015] An emclO inhibitor may also act by specifically binding to EmclO protein or to cellular proteins to which EmclO specifically binds, preferably their cellular receptors. Such binding may prevent or disrupt the natural interaction of EmclO with other cellular proteins, preferably their respective cellular receptors. In accordance with this embodiment, an EmclO inhibitor may be a small organic molecule, peptide or protein that specifically binds to EmclO or a cellular to which EmclO binds (e.g., a receptor) and blocks, inhibits or reduces EmclO activity. In specific embodiments, an EmclO inhibitor is antibody or antigen-binding fragment that specifically binds to EmclO and neutralizes EmclO activity.

[0016] Approaches for interfering with the binding between a receptor and its ligand or between proteins of a complex are known in the art and can be used to design suitable inhibitors of EmclO. Furthermore, an inhibitor can be derived from EmclO itself by deleting or mutating those parts of EmclO protein that exert the obesity-associated function of EmclO. Such inactive mutated or deleted EmclO will compete with wild-type EmclO for its natural binding partners. An agent that interferes with the obesity- associated activity of EmclO reduces the activity by at least 20%, preferably by at least 30%, more preferably by at least 40%. In the context of inhibitors that specifically bind to EmclO or that comprise, essentially consist or consist of mutants or fragments of EmclO, it is preferred that they exert this level of inhibition of EmclO protein at an equimolar concentration. To determine whether a given inhibitor has this activity at an equimolar amount, the molar amounts of EmclO and of the respective inhibitor has to be determined. EmclO according to SEQ ID NO:l has a W of 21.57 kD and an IgG has a molecular weight of approx. 150 kD. Thus, 100 ng EmclO and 695 ng EmclO-specific IgG are approximately equimolar.

[0017] In the context of inhibitors that interfere with transcription and/or translation of mRNA encoding EmclO, the level of inhibition is preferably measured on the basis of the protein produced in a cell naturally producing EmclO. The skilled person is well aware of a large number of methods to measure the amounts of mRNA encoding EmclO as well as of EmclO protein, which can be used when assessing the ability of a compound to interfere with transcription and/or translation of EmclO encoding mRNA.

[0018] In some embodiments, the inhibitor is a ligand, specifically binding to the amino acid sequence according to SEQ ID NO:l or 2 or a variant thereof, which has at least 80% sequence identity to the amino acid sequence according to SEQ ID NO : 1 or 2 or to the receptor that naturally interact with EmclO or a variant thereof, which has at least 80% sequence identity to the amino acid sequence according to SEQ ID NO:l or 2.

[0019] The term "ligand" is used herein to refer to a chemical moiety that specifically binds to the specified antigen. Preferred ligands are amino acid-based ligands such as immunoglobulins, preferably antibodies or antigen- binding fragments thereof and antibody-like proteins. Alternatively, ligands may be peptidomimetics .

[0020] The term "immunoglobulin (Ig)" refers to immunity conferring glycoproteins of the immunoglobulin superfamily. Typically, the term "antibody" refers to secreted immunoglobulins which lack the transmembrane region and can thus, be released into the bloodstream and body cavities. Antibodies are grouped into different isotypes based on the heavy chain they possess. There are five types of human Ig heavy chains denoted by the Greek letters: α, δ, ε, γ, and μ. The type of heavy chain present defines the class of antibody, i.e., these chains are found in IgA, IgD, IgE, IgG, and IgM antibodies, respectively, each performing different roles, and directing the appropriate immune response against different types of antigens. Distinct heavy chains differ in size and composition; a and γ are composed of approximately 450 amino acids, while μ and ε have approximately 550 amino acids (Janeway, et al. (2001) Immunobiology, Garland Science) . Antibodies include four polypeptide chains, namely two heavy (H) chains and two light (L) chains inter-connected by disulfide bonds. Each heavy chain is composed of a heavy chain variable region (abbreviated herein as HCVR or V _H ) and a heavy chain constant region. The heavy chain constant region is composed of three domains, CHI, CH2 and CH3. Each light chain is composed of a light chain variable region (abbreviated herein as LCVR or V _L ) and a light chain constant region. The light chain constant region is composed of one domain, CL. The V _H and V _L regions can be further subdivided into regions of hypervariability, termed complementarity determining regions (CDR) , interspersed with regions that are more conserved, termed framework regions (FR) . Each V _H and V _L is composed of three CDRs and four FRs, arranged from amino-terminus to carboxy-terminus in the following order: FRl, CDRl, FR2, CDR2, FR3, CDR3, FR4. CDRs for heavy and light chains can be determined as known in the art .

[0021] The term "human antibody" is intended to include antibodies having variable and constant regions derived from human germline immunoglobulin sequences. Human monoclonal antibodies may include amino acid residues not encoded by human germline immunoglobulin sequences (e.g., mutations introduced by random or site-specific mutagenesis in vitro or by somatic mutation in vivo) , for example in the CDRs. However, the term "human antibody" is not intended to include "humanized antibodies," in which the CDR sequences derived from the germline of another mammalian species (e.g., mouse), have been grafted onto human FR sequences. Human antibodies also include antibodies isolated from human immunoglobulin libraries or from animals transgenic for one or more human immunoglobulin and that do not express endogenous immunoglobulins .

[0022] The term "monoclonal antibody" refers to a preparation of antibody molecules of single molecular composition. A monoclonal antibody displays a single binding specificity and affinity for a particular epitope. In one embodiment, a monoclonal antibody is produced by a hybridoma, which includes a B cell obtained from a non- human animal, e.g., mouse, fused to an immortalized cell. See, e.g., Kohler & Milstein (1975) Nature 256:495-97 or derivative methods thereof. Detailed procedures for monoclonal antibody production are described, for example, by Harlow & Lane (1999) Using Antibodies : A Laboratory Manual, CSHL, New York.

[0023] The term "recombinant antibody" includes all antibodies that are prepared, expressed, created or isolated by recombinant means, such as antibodies isolated from an animal (e.g., a mouse) that is transgenic or transchromosomal with respect to the immunoglobulin genes or a hybridoma prepared therefrom; antibodies isolated from a host cell transformed to express the antibody (e.g. from a transfectoma) ; antibodies isolated from a recombinant, combinatorial antibody library; and antibodies prepared, expressed, created or isolated by any other means that involve splicing of immunoglobulin gene sequences to other DNA sequences.

[0024] The term "antigen-binding fragments" refers to fragments of an antibody, which retain the function of specifically binding an antigen or antigenic protein but that lack some or all other structural features of an antibody or artificial constructs that include parts of antibodies. Preferred examples of antigen-binding fragments include, but are not limited to, Fab fragments, Fc fragment, Fab' fragment, F(ab') ₂ , single domain antibodies (sdAb) , nanobodies, single chain Fv, bivalent single-chain variable fragments (bi-scFvs) , tandem scFvs, diabodies, single-chain diabodies (scDB) , triabodies, bi-specific T- cell engagers (BiTEs) , or dual affinity retargeting molecules (DART molecules). [ 002 5 ] "Fab fragments" (also referred to as "Fab portion" or "Fab region") include a single antigen binding site, whereas "Fc fragments" (also referred to as "Fc portion" or

"Fc region") reflect the ability of this portion to crystallize readily. "Fab' fragment" refers to a Fab fragment additionally including the hinge region of an Ig molecule, while "F(ab') ₂ fragments" are understood to include two Fab' fragments being either chemically linked or connected via a disulfide bond. While nanobodies only include a single V _H domain, "single chain Fv (scFv) " fragments include the heavy chain variable domain joined via a short linker peptide to the light chain variable domain. Bi-scFvs can be engineered by linking two scFvs

( scFvA-scFvB) . This can be done by producing a single peptide chain with two VH and two VL regions, yielding "tandem scFvs" ( V _H A-V _L A-V _H B-V _L B) . Another possibility is the creation of scFvs with linkers that are too short for the two variable regions to fold together, forcing scFvs to dimerize. Usually linkers with a length of five residues are used to generate these dimers . This type is known as "diabodies." Still shorter linkers (one or two amino acids) between a V _H and V _L domain lead to the formation of monospecific trimers, so-called "triabodies" or "tribodies." Bispecific diabodies are formed by expressing to chains with the arrangement V _H A-V _L B and HB -V _L A or V _L A-V _H B and LB -VHA, respectively. Single-chain diabodies (scDb) include a V _H A-V _L B and a V _H B-V _L A fragment, which are linked by a linker peptide (P) of 12-20 amino acids, preferably 14 amino acids, ( V _H A-V _L B-P-V _H B-V _L A) . "Bi-specific T-cell engagers (BiTEs)" are fusion proteins composed of two scFvs of different antibodies wherein one of the scFvs binds to T cells via the CD3 receptor, and the other to a tumor cell via a tumor specific molecule. Dual affinity retargeting molecules (DART molecules) are diabodies additionally stabilized through a C-terminal disulfide bridge.

[0026] The term "antibody-like protein" refers to a protein having similar properties as an antibody in that it binds to an antigen or antigenic protein without necessarily having the structural features of an antibody. Antibody ^¬ like proteins may occur naturally or may be designed artificially, e.g., via biotechnologically . Examples of naturally occurring antibody-like proteins include but are not limited to antigen-binding proteins such as, e.g., the family of lipocalins, which represent a family of diverse proteins which normally serve for the storage or transport of physiologically important compounds. They share a conserved barrel of eight antiparallel β-strands as their central folding motif and include at one end of this barrel structure six hypervariable loops which are connect to each pair of β-strands. These loops form the entrance to the binding pocket. The structural diversity among the members of the lipocalin family reflects the differing shapes and chemical properties' of their binding partner. Thus, although being composed of a single polypeptide chain and being much smaller than immunoglobulins, they exhibit a vast potential to bind antigens of differing specificities. Examples of artificially designed antibody-like protein include scaffold-based proteins which are generated by fusing peptides with known affinity towards a certain target or by inserting said peptides into, a scaffold protein to combine the binding properties of the peptide with the desired favorable characteristics of the scaffold carrier. The skilled person is aware of a large number of such scaffold-based proteins.

[0027] The term "scaffold protein" as used herein refers to a protein which possesses structural rigidity, i.e., folds into a stable tertiary structure. The amino acids of a scaffold protein are likely to occupy a defined three- dimensional position within the scaffold protein. Thus, if one or more of the amino acids of a scaffold protein are replaced by a polypeptide of a suitable length the polypeptide will occupy similar positions as those replaced. This allows positioning a given polypeptide at a defined three-dimensional location and/or orientation within the scaffold protein. Accordingly, scaffold proteins can be used as an alternative to antibodies for molecular recognition (see, e.g., Skerra (2007) Curr. Opin . Biotechnol. 18:295-304; Skerra (2000) J. Mol Recognit. 13:167-187) . An example of such a scaffold protein is the Fyn SH3 domain, which includes two domains that may be mutated to transfer novel binding specificity to the SH3 domain. Methods to select Fyn SH3 domains that specifically bind to a given antigen are disclosed in, e.g., WO 2000/072742 and WO 2008/022759.

[0028] In the context of the present invention the term "peptidomimetics" is used to refer to any molecule whose essential elements (pharmacophore) mimic a natural peptide or protein in 3D space and which retain the ability to interact with the biological target and produce the same biological effect. Peptidomimetics include small protein ^¬ like chain designed to mimic a peptide which may typically be obtained either by modifying an existing peptide, or by designing similar systems that mimic peptides, such as, e.g., peptoids and β-peptides. Irrespective of the approach, the altered chemical structure is designed to adjust the molecular properties advantageously in that, e.g., the stability or biological activity is increased or decreased. According modifications involve changes to the peptide that will not occur naturally including but not limited to altered backbones and the incorporation of non- natural amino acids .

[0029] The terms "specific binding" or "specifically binding" to an antigen, in this case EmclO, refers to the ability of a ligand to bind to an antigenic determinant of an antigen with high affinity. In this context, "high affinity" means that the Kd for the interaction is below 1 x lCT ⁵ M, preferably below 1 x 10 ^~6 M, more preferably below 1 x 10 ^~7 , even more preferably below 1 x 10 ^~8 M and most preferably below 1 x 1CT ⁹ M.

[0030] Preferred EmclO inhibitors of this invention include antibodies or antigen-binding fragments that specifically bind to EmclO and neutralize the activity of EmclO. Antibodies can be monoclonal or polyclonal. However, in certain embodiments, the antibodies are monoclonal antibodies, preferably human or humanized antibodies. In other embodiments, an antibody or antigen-binding fragment of EmclO binds to an epitope of EmclO located between residues 181 and 195 of SEQ ID NO:l. Exemplary antibodies are disclosed in, for example, WO 2014/111485 and CN 101985475. EmclO antibodies are also commercially available from a variety of sources. By way of illustration, Lifespan Biosciences provides anti-EmclO antibodies that specifically bind to the C-terminus, amino acid residues 27-57 and amino acid residues 19-48 of EmclO; MyBioSource provides an anti-EmclO antibody that specifically binds to the N-terminus of EmclO; and Creative Diagnostics provides antibodies that specifically bind to amino acid residues 144-215 of EmclO.

[0031] EmclO inhibitors can be formulated with a suitable carrier for administration to subjects in need of such treatment. The term "carrier" refers to a pharmacologically inactive substance such as but not limited to a diluent, excipient, surfactants, stabilizers, physiological buffer solutions or vehicles with which the therapeutically active ingredient is administered. Such pharmaceutical carriers can be liquid or solid. Liquid carrier include but are not limited to sterile liquids, such as saline solutions in water and oils, including but not limited to those of petroleum, animal, vegetable or synthetic origin, such as peanut oil, soybean oil, mineral oil, sesame oil and the like. Saline solutions and aqueous dextrose and glycerol solutions can also be employed as liquid carriers, particularly for injectable solutions. A saline solution is a preferred carrier when the pharmaceutical composition is administered intravenously. Examples of suitable pharmaceutical carriers are described in "Remington's Pharmaceutical Sciences" by E. W. Martin. In a preferred embodiment of the invention, the carrier is a suitable pharmaceutical excipient . Suitable pharmaceutical

"excipients" include starch, glucose, lactose, sucrose, gelatine, malt, rice, flour, chalk, silica gel, sodium stearate, glycerol monostearate, talc, sodium chloride, dried skim milk, glycerol, propylene, glycol, water, ethanol and the like. Such suitable pharmaceutical excipients are preferably pharmaceutically acceptable.

[ 0032 ] In some embodiments, the EmclO inhibitor is formulated with an encapsulating material as a carrier. Such formulations provide a capsule in which the active component with or without other carriers, is surrounded by a carrier, which is thus in association with the active compound. Encapsulating materials are known in the art and include biodegradable polymers/lipids conventionally used in the preparation of nanoparticles , microparticles , micelles, and liposomes. See, e.g., Singh & Lillar, Jr. (2009) Exp. Mol. Pathol. 86:215-223. [0033] As demonstrated herein, EmclO is down-regulated in inguinal fat at the onset of obesity. Further, EmclO KO mice are protected from diet-induced obesity and metabolic dysfunction. Accordingly, this invention provides a method for preventing or treating obesity in a subject by administering to a subject in need of such treatment an effective amount of an EmclO inhibitor. An "effective amount" is an amount of an active ingredient sufficient to achieve the intended purpose. The effective amount of a given active ingredient will vary with parameters such as the nature of the ingredient, the route of administration, the size and species of the individual to receive the active ingredient, and the purpose of the administration. The effective amount in each individual case may be determined empirically by a skilled artisan according to established methods in the art.

[0034] As used herein, "treat," "treating" or "treatment" of a disease or disorder means accomplishing one or more of the following: (a) reducing the severity of the disorder;

(b) limiting or preventing development of symptoms characteristic of the disorder (s) being treated; (c) inhibiting worsening of symptoms characteristic of the disorder (s) being treated; (d) limiting or preventing recurrence of the disorder (s) in patients that have previously had the disorder (s); (e) limiting or preventing recurrence of symptoms in patients that were previously symptomatic for the disorder (s); (f) reduction of mortality after occurrence of a disease or a disorder; (g) healing; and (h) prophylaxis of a disease. As used herein, "prevent," "preventing," "prevention," or "prophylaxis" of a disease or disorder means preventing that such disease or disorder occurs in patient. [0035] In accordance with the method of this invention, administration of an EmclO inhibitor can delay the onset, reduce the severity, or limit or prevent obesity in a subject at risk or predisposed to obesity. Such subjects includes with a family history of obesity, subjects who eat a high fat (e.g., >80 g/day) , high carbohydrate (e.g., >300 g/day) or high sugar (e.g., >25 g/day) diet, subjects who have lost weight and are at risk of gaining the weight back, subjects who are overweight and subjects with a metabolic disorder or dysfunction such as Metabolic Syndrome. In particular embodiments, administration of an EmclO inhibitor is carried out prior to onset of obesity, i.e., in subjects that are overweight. As is conventional in the art, body mass index (BMI) can be used to assess whether a subject is normal, overweight or obese. In particular, subjects with a BMI of 18.5 to <25 are considered normal, subjects with a BMI of 25.0 to <29.9-30 are considered overweight and subjects with a BMI of 29.9- 30.0 or higher are considered obese.

[0036] In particular embodiments, this invention provides a method for preventing or treating obesity in a subject by administering to a subject in need of such treatment an effective amount of an anti-EmclO antibody, or antigen- binding fragment thereof, that specifically binds to EmclO and neutralizes the activity of EmclO.

[0037] In other embodiments, this invention provides a method for modulating the inhibitory effect of EmclO on adipocyte energy metabolism by contacting an adipocyte with an effective amount of an anti-EmclO antibody, or antigen- binding fragment thereof, that specifically binds to EmclO and neutralizes the activity of EmclO.

[0038] In yet other embodiments, the present invention provides the use of an EmclO inhibitor in the manufacture of a medicament for use in the prevention or treatment of obesity in mammals including humans. In a particular embodiment, this invention provides the use of an anti- EmclO antibody, or antigen-binding fragment thereof, in the manufacture of a medicament for use in the prevention or treatment of obesity in mammals including humans.

[0039] Depending on the route of administration, the EmclO inhibitor can be formulated in various ways well-known to one of skill in the art. For example, the EmclO inhibitor can be in liquid form such as in the form of solutions, emulsions, or suspensions. Preferably, the EmclO inhibitor is formulated for parenteral administration, preferably for intravenous, intraarterial, intramuscular, subcutaneous, transdermal, intrapulmonary, intraperitoneal intracoronary, intracardiac administration, or administration via mucous membranes, preferably for intravenous, subcutaneous, or intraperitoneal administration. A preparation for oral or anal administration is also possible. Preferably, the EmclO inhibitor is in the form of a sterile aqueous solution which may contain other substances, for example, enough salts or glucose to make the solution isotonic with blood. The aqueous solutions should be suitably buffered (preferably to a pH of from 3 to 9, more preferably to a pH of from 5 to 7), if necessary. The EmclO inhibitor is preferably in unit dosage form. In such form the EmclO inhibitor is subdivided into unit doses containing appropriate quantities of the active component. The unit dosage form can be a packaged preparation, the package containing discrete quantities of EmclO inhibitor such as vials or ampoules.

[0040] The administration of the EmclO inhibitor is preferably administered through the intravenous, intraarterial, intramusculuar, subcutaneous, or transdermal routes. A single dose of the EmclO inhibitor can, independently from the overall amount of administered doses or the respective time span of administration, be administered as one or more bolus injection (s) and/or infusion ( s ) .

[ 0041 ] In certain embodiments, the EmclO inhibitor is provided in the form of a kit that includes one or more doses of EmclO inhibitor and instructions for administering the EmclO inhibitor to effective prevent or treat obesity. In certain embodiments, the kit includes a container, a composition containing an effective amount of an EmclO inhibitor, in combination with a carrier, and instructions for using the composition to prevent or treat obesity. The kit may further include a description of selecting an individual suitable for treatment based on identifying whether that individual is overweight or at risk of obesity .

[ 0042 ] Instructions relating to the use of the EmclO inhibitor generally include information as to dosage, dosing schedule, and route of administration for the intended treatment. The containers may be unit doses, bulk packages (e.g., multi-dose packages) or sub-unit doses. Instructions supplied in the kits of the invention are typically written instructions on a label or package insert (e.g., a paper sheet included in the kit), but machine- readable instructions (e.g., instructions carried on a magnetic or optical storage disk) are also acceptable. The label or package insert indicates that the composition is used for treating a disease described herein (such as obesity) . Instructions may be provided for practicing any of the methods described herein.

[ 0043 ] The kits of this invention are in suitable packaging. Suitable packaging includes, but is not limited to, vials, bottles, jars, flexible packaging (e.g., sealed MYLAR or plastic bags), and the like. Also contemplated are packages for use in combination with a specific device, such as an inhaler, nasal administration device (e.g., an atomizer) or an infusion device such as a minipump. A kit may have a sterile access port (for example the container may be an intravenous solution bag or a vial having a stopper pierceable by a hypodermic injection needle) . The container may also have a sterile access port (for example the container may be an intravenous solution bag or a vial having a stopper pierceable by a hypodermic injection needle) . At least one active agent in the composition is an EmclO inhibitor. The container may further include a second pharmaceutically active agent.

[0044] The following non-limiting examples are provided to further illustrate the present invention.

Example 1: EmclO KO Mice

[0045] EmclO was identified as a differentially expressed gene in adipose tissues of obese vs. lean mice. It was observed that the EmclO transcript is significantly and consistently down-regulated in inguinal (SQ) fat (approximately a 2-fold decrease) , but either not significantly down-regulated in gonadal (visceral) adipose tissue or unchanged in other metabolic organs in C57BL/6J male mice after 12 weeks of being fed a high fat diet (HFD) compared to mice fed a chow diet. Similarly, down- regulation of EmclO expression in inguinal fat is also observed in obese ob/ob male mice compared with lean controls. Interestingly, it was also found that the down- regulation of EmclO expression in inguinal fat is predominantly contributed by the down-regulation of EmclO in mature adipocytes, but not the stroma-vascular fraction. Consistent with a decrease in EmclO transcript expression, a decrease in EmclO protein levels was further observed in the inguinal fat from HFD-fed mice. Based on these findings, it was posited that EmclO has a role in adipocyte biology and energy homeostasis.

[0046] To elucidate the physiological role of EmclO, whole- body EmclO knock-out (KO) mice were generated. In preliminary studies, it was surprisingly found that the KO mice were significantly leaner than control littermates

(-40 g vs. -50 g body weight, respectively, n=4-5) and had lower fat mass (-27% vs. -40%, respectively, n=4-5) after 12 weeks of HFD feeding (D12492, Research Diets) . KO mice given the chow diet (CD; 7912, Harlan) were also leaner, but this did not reach statistical significance. In addition, ablation of EmclO also prevented mice from becoming glucose intolerant and insulin resistant after being fed HFD.

[0047] To determine whether changes in energy intake contributed to the lean phenotype observed, food intake of wild-type and KO mice was measured. It was found that the absolute food intake between the wild-type and KO mice was unchanged. However, when the data were normalized by body weight, the EmclO KO mice actually consumed more food than the T controls (-0.24 vs -0.1 g per day/g body weight, respectively, on HFD) . Given that EmclO KO mice had higher energy intake, to stay lean, the KO mice were expected to have higher energy expenditures. To confirm this, the wild- type and KO mice were subjected to metabolic measurements in metabolic cages. Consistent with the protection in body weight gain after being fed HFD, the EmclO KO mice showed higher rates of oxygen consumption compared to wild-type mice (-3500 vs. 2250 ml/kg/min, respectively) and higher rates of heat production (-17.5 vs. -10 kcal/h, respectively) , but no change in physical activity. Importantly, the EmclO KO mice fed chow diets also showed a trend of increasing oxygen consumption and heat production compared with the wild-type controls, indicating that increasing energy expenditure might be the primary mechanism contributing to the diet-induced obesity protection observed in the EmclO KO mice.

[ 0048 ] Brown fat (BAT) and inguinal fat and both known to play protective roles in obesity. Therefore, to determine cellular processes affected by EmclO ablation, expression levels of markers for adipocyte differentiation, lipolysis (ATGL, HSL, Adrb3), lipogenesis (Glut4, FASN, SREBP-lc) , and thermogenesis (PGCla, UCPl, Tfam) in both brown fat and inguinal fat were measured. Samples from HFD-fed mice were first examined and it was observed that ablation of EmclO upregulated lipolysis, lipogenesis, and thermogenesis in BAT and lipolysis and thermogenesis in inguinal fat. As HFD/obesity alone is known to have an impact on the expression of many of these markers, BAT and inguinal fat harvested from the chow diet-fed mice were examined to further determine which adipocyte function is the primary mechanism contributing to the obesity-resistant phenotype. As expected, not all markers identified in the HFD-fed mice showed similar changes with the exception of markers for thermogenesis. To confirm these findings, primary adipocytes from wild-type and EmclO KO brown fat were isolated, differentiated and stimulated with CL316,243. CL316,243 is a highly specific beta 3-adrenoceptor agonist known to increase serum levels of free fatty acids and insulin, increase energy expenditure and reduced food intake (Susulic, et al . (1995) J. Biol. Chem. 270:29483- 29492) . The results of this analysis confirmed the in vivo findings that ablation of EmclO significantly upregulated both basal and CL316, 243-stimulated thermogenic gene expression in brown adipocytes.

[0049] Taken together, these data indicate that the absence of EmclO promoted thermogenesis in adipocytes. However, the upregulation of thermogenesis alone was not sufficient to significantly reduce body weight under normal chow diet conditions, as additional data showed that the KO mice remained insignificantly leaner even up to 52 weeks compared with wild-type mice. Overall, these analyses demonstrated that EmclO KO mice were resistant to diet- induced obesity. Therefore, additional regulation of lipolysis and lipogenesis in adipose tissues in the EmclO KO mice together with thermogenesis are essential to maintain leanness in the mice fed HFD.

Example 2: Ablation of EmclO protects Female Mice from Diet-Induced Obesity and Metabolic Dysfunction

[0050] Due to the differences in sex hormonal levels and regulation, it is known that significant differences exist between the sexes in the regulation of metabolic homeostasis. Analysis of female mice indicated that, similar to male mice, EmclO expression is also down- regulated in inguinal fat from female mice after HFD feeding (~2~fold decrease) . To further examine the role of EmclO in female mice, 6-week-old wild-type and KO female mice are subjected to either chow diet or HFD feeding for 12 weeks (n=20 per diet per group) with weekly body weight measurements. Following 12 weeks of the dietary treatment, glucose and insulin tolerance tests are performed prior to subjecting one-half of the animals from each condition to CLAMS to measure energy expenditures, food consumption, and physical activity. In addition, body composition (fat and lean masses) is assessed by DEXA. If significant differences between the wild-type and KO mice are observed, then ex vivo physiological assays and molecular characterization are performed to characterize the metabolic processes altered in the absence of EmclO in female mice. In addition, the remaining animals are used to determine the level of adaptive thermogenesis . It is expected that these results will demonstrate that EmclO protects female mice from diet-induced obesity and metabolic dysfunction.

Example 3: Absence of EmclO Promotes White Fat Browning

[0051] To determine whether the ablation of EmclO would promote susceptibility to browning induction, 8-week-old wild-type and KO mice were subjected to 1 day of cold exposure and subsequently imaged with a thermal imager. Interestingly, it was observed that the KO mice had higher skin temperatures compared with the wild-type mice. To further assess the role of EmclO on browning, 8-week-old wild-type and KO mice were subjected to 7 days of CL316,243 injections (n=4 pre group) . After treatment, the mice were sacrificed and their tissues (visceral [gonadal, retroperitoneal], SQ [inguinal] fat, and BAT) were harvested to measure changes in thermogenic marker expression, including UCP1, PGCla, Dio2, and Tfam using quantitative PCR. This analysis indicate differentiated primary inguinal adipocytes expressed significantly higher levels of thermogenic marker genes upon treatment with the beta-agonist, CL316,243.

Example 4 : EmclO Expression in Human Adipose Tissues

[0052] To determine whether EmclO is also regulated in human adipose tissues, EmclO expression was measured in visceral and subcutaneous fat from cohorts of lean, overweight, and obese volunteers. Consistent with the mouse model data, it was found that EmclO expression was significantly down-regulated in subcutaneous fat from overweight and obese patients, but not in the visceral fat from the same patients (Figure 1) . To further assess the expression of EmclO, it is determined whether type 2 diabetes mellitus and insulin sensitivity impacts the expression of EmclO in both human visceral and SQ fat. It is expected that type 2 diabetes mellitus and insulin sensitivity impacts the expression of EmclO in both human visceral and SQ fat.

Example 5 : Circulating EmclO

[0053] The first 81 base pairs of the mouse EmclO coding seguence is predicted in silico to encode for a signal peptide. To confirm that EmclO is a secreted factor, full- length EmclO or EmclO with a signal peptide replaced by an Ig K chain signal peptide (positive control) were expressed in 293T cells. The results of this analysis showed that EmclO, with either endogenous or known secretable signal peptides, is detectable in the culture media, thereby confirming that EmclO is a secreted protein. As indicated herein, expression of EmclO is significantly down-regulated in inguinal fat in mice after being fed an HFD. To determine whether decreases in EmclO tissue expression correlate with a decrease in circulating EmclO, the levels of EmclO were examined in plasma harvested from C57BL/6 male mice fed either a chow diet or HFD. Consistent with the tissue expression results, circulating EmclO was also down-regulated in mice fed an HFD. In contrast, it was observed that levels of EmclO in BAT and inguinal fat were reversed in HFD mice after vertical sleeve gastractomy (VSG) treatment. From quantitative PCR analysis, it was known that EinclO is expressed in a variety of tissues. Thus, to determine which tissue was the dominant contributor to the circulating EmclO under basal conditions, proteins from whole liver, gonadal, retroperitoneal, inguinal, and brown fats, as well as skeletal muscle were isolated for western blot analysis. Tissues were dissected from 10-week-old C57BL/6 mice fed a chow diet and subsequently incubated in media for 24 hours. To ensure that the dissected tissues were free from plasma EmclO contamination, mice were first perfused with culture media before dissection. Western blot analyses of tissue- conditioned media indicated that the conditioned media from inguinal fat contained the highest levels of EmclO. However, secreted EmclO levels normalized with tissue weights indicated that the amount of EmclO secreted by BAT was comparable to the inguinal fat.

[ 0054 ] As EmclO is present in the circulation, as well as inside the cell, it may play differential roles on cellular processes and metabolism. Based upon the results herein, it was posited that circulating EmclO is an important regulator of energy metabolism. This is supported by the fact that, even with unchanged EmclO levels in BAT from mice fed an HFD, significant changes in BAT metabolism were detected in the KO mice. In addition, when differentiated adipocytes were treated with recombinant EmclO for 48 hours, down-regulation of thermogenesis markers was observed, including PGCla and Tfam. Therefore, to determine the role of circulating EmclO on systemic energy homeostasis, particularly in adipose tissues, secretable EmclO was recombinantly expressed in the liver of EmclO KO mice via adeno-associated virus (AAV) . To confirm that the EmclO encoded by AAV was secreted from hepatocytes and to determine the levels of circulating EmclO after AAV transduction, 7-week-old C57BL/6 male mice were tail-vein- injected with either control AAV-GFP or high and low amounts of AAV-EmclO virus. These data showed that the injected AAV-EmclO could reconstitute circulating EmclO in the KO mice. In particular, with the two AAV-EmclO doses, basal (EmclO ^Hi ) and down-regulated (EmclO ^Low ) levels of EmclO were observed during obesity. Further, short-term reconstitution (2 weeks after AAV injection) of circulating EmclO did not affect body weight, fasting blood glucose levels, or glucose tolerance, but did lower the expression of PGCla, Tfam, and UCP1 in BAT.

[0055] To determine the role of circulating EmclO on energy metabolism, 8-week-old WT, KO, KO-Emcl0 ^Low and KO-Emcl0 ^Hi male mice are subjected to either chow diet or HFD feeding for 12 weeks (n=16 per diet per group) with weekly body weight measurements. Following 12 weeks of the dietary treatment, glucose and insulin tolerance tests are performed prior to subjecting one-half of the animals from each condition to CLAMS to measurement energy expenditure, food consumption, and physical activity. In addition, body composition (fat and lean mass) is assessed by DEXA. At the end of the CLAMS measurement, the mice are sacrificed and their blood and tissues are collected and used for ex vivo physiologic assays as well as biochemical and molecular characterization to identify cellular processes regulated by circulating EmclO. The remaining animals are used to determine adaptive thermogenesis . Significant differences between the groups are evaluated by either Student t-test or 1-way analysis of variance and Tukey test for multiple comparisons . Example 6 : Down-regulation of EmclO During Obesity is a Compensatory Response

[0056] The obesity-resistant phenotype of EmclO KO mice was unexpected due to the lower levels of EmclO in tissues and circulating levels of EmclO in obese mice. Based upon initial observations, the down-regulation of inguinal fat EmclO expression was initiated by the onset of obesity, as observed in mice fed with chow diet or HFD for varying lengths of time (1, 2, 4, 8 and 12 weeks) . It was posited that the down-regulation of EmclO is a compensatory response of an organism to counteract obesity. To assess this, circulating EmclO levels in mice fed an HFD are maintained and/or increased by recombinantly expressing exogenous EmclO in liver via AAV-EmclO. Six-week-old C57BL/6 mice are tail-vein injected with AAV-GFP or AAV- EmclO (n=16 per group) . Following the injection, these mice are fed either a chow diet or HFD for up to 12 weeks with weekly body weight measurements taken. To ensure that the level of EmclO is maintained, mice are tail-bleed every 2 weeks to determine EmclO levels. Regardless of whether any differences in body weight are observed, glucose and insulin tolerance tests are performed following 12 weeks of dietary treatment and these mice are subjected to metabolic cages to measure energy expenditure, food intake, and physical activity. Body composition is assessed using DEXA. Ex vivo physiological assays and molecular characterization are performed to determine the metabolic processes modulated by maintaining circulating EmclO levels in mice.

Example 7 : Conditionally EmclO in Obese Mice Promotes Weight Loss

[0057] Obesity treatment primarily for individuals who are already overweight obese. To determine whether inhibition of EmclO is therapeutically relevant, EmclO KO is induced in EmclO flox mice on HFD to determine whether ablation of EmclO could prevent further weight gain or promote weight loss. Flox EmclO mice are crossed with Rosa26-CreERT2 mice (Jackson) . The optimum dose of tamoxifan required to achieve efficient EmclO deletion in adult tissues is then determined. After which, 6-week-old EmclO-flox and EmclO-flox/Cre male mice are subjected to either chow diet or HFD (n=16 per diet per group) . Following 6 weeks of dietary treatment, one half of the mice from each condition are subjected to tamoxifan injection. All animals remain on their respective diets for another 6 weeks. During the 12 weeks dietary treatment, weekly body weight measurements are performed. Circulating levels of EmclO are monitored biweekly via tail vein bleeding after the tamoxifan treatment. At the end of the dietary treatment, glucose and insulin tolerance tests are performed. Ex vivo physiological assays and molecular characterization, as described above are performed to characterize the metabolic processes altered in the inducible EmclO KO mice.

Example 8: EmclO Regulates Adipocyte Functions via Insulin and MAPK Signaling

[0058] To identify candidate pathways regulated by the absence of EmclO, BAT lysates from the HFD-fed wild-type or KO mice were incubated with the Proteome Profiler Phospho- Kinase array (R&D systems) . The results of this analysis showed that the brown fat of the EmclO KO mice had elevated levels of phospho-Akt, ERKl/2, GSK3, JNK, MSKl/2, and CREB. Akt, ERKl/2, and GSK3 protein kinases are downstream targets of insulin signaling, whereas JNK, MSKl/2 and CREB belong to the MAPK pathway. MAPK pathways, particularly the p38MAPK, are known to play important roles in thermogenesis (Collins & Bordicchia (2013) Adipocyte 2(2) : 104-8) . To confirm the array results, primary stromal vascular fraction was isolated from brown fat of 6-week-old wild- type or KO mice. At the end of the standard differentiation protocol, adipocytes were lysed and blotted with candidates identified in the phosphokinase array. Even under basal conditions, western blot analysis showed that pAkt, pCREB, and pAMPK levels were higher in EmclO KO mice adipocytes, but not pERKl/2 and pJNK levels. To assess the acute effects of EmclO on signaling pathways in brown adipocyte and to set up experimental conditions for subsequent signaling studies, immortalized wild-type brown adipocytes were differentiated and, at the end of the standard differentiation protocol, were treated with different doses of EmclO for 10 or 30 minutes. At the 30-minute time point, under acute EmclO treatment, it was observed that EmclO down-regulated pCREB, pAkt, and pAMPK, but not pERKl/2 and pJNK. At the 10-min time point, changes were more subtle but consistent.

Example 9: EmclO Antibody Blocks the Inhibitory Effect of EmclO

[0059] Brown adipocytes were differentiated on 6-well plate until day 6. Differentiated adipocytes were then treated with control (carrier) , EmclO (1 mg/ml) or EmclO (1 mg/ml) with polyclonal anti-EmclO antibody (10 mg/ml) for 1 hour at 37 °C. Western blot analysis showed that EmclO inhibits basal levels of AMPKa phosphorylation and co-incubation of EmclO with EmclO antibody prevented the inhibitory effect of EmclO on AMPKa phosphorylation (Figure 2) . Example 10: EmclO Antibody for Treating Obesity

[0060] To determine the therapeutic potential of an EmclO antibody, wild-type C57BL/6 mice on HFD are treated with weekly injections of EmclO antibody or control IgG. To determine the optimum antibody dose, 10, 20, 30, 40 and 50 mg/kg body weight EmclO antibody or control IgG is injected into wild-type mice on chow diet. Whole blood is collected from tail vein every 24 hours after antibody treatment. Circulating levels of EmclO are determined using western blot analysis. Once the optimum dose has been determined, wild-type mice on HFD are treated with weekly injection of EmclO antibody or control IgG with weekly body weight determination and tail vein blood collection. It is expected that injection of anti-EmclO antibody will protect or prevent mice from becoming obese as a result of consuming the HFD.