WO2018104559A1

WO2018104559A1 - Glp-1/glp-2 dual agonists

Info

Publication number: WO2018104559A1
Application number: PCT/EP2017/082288
Authority: WO
Inventors: Bjarne Due Larsen
Original assignee: Zealand Pharma AS
Current assignee: Zealand Pharma AS
Priority date: 2016-12-09
Filing date: 2017-12-11
Publication date: 2018-06-14
Anticipated expiration: 2019-06-09

Abstract

The invention relates to compounds having agonist activity at the GLP-1 (glucagon- like-peptide 1) and GLP-2 (glucagon-like peptide 2) receptors. The compounds find use, inter alia, in the prophylaxis or treatment of intestinal damage and dysfunction, regulation of body weight, and prophylaxis or treatment of metabolic dysfunction.

Description

GLP-1/GLP-2 DUAL AGONISTS

Field of the Invention

The present invention relates to compounds having agonist activity at the GLP-1 (glucagon-like-peptide 1 ) and GLP-2 (glucagon-like peptide 2) receptors. The compounds find use, inter alia, in the prophylaxis or treatment of intestinal damage and dysfunction, regulation of body weight, and prophylaxis or treatment of metabolic dysfunction.

Background to the Invention

Intestinal tissue is responsible for the production of both human glucagon-like peptide 1 (GLP-1 (7-36)) and human glucagon-like peptide 2 (GLP-2 (1 -33)) as they are produced by the same cells. Human GLP-2 is a 33-amino-acid peptide with the following sequence: Hy-His-Ala-Asp-Gly-Ser-Phe-Ser-Asp-Glu-Met-Asn-Thr-lle-Leu- Asp-Asn-Leu-Ala-Ala-Arg-Asp-Phe-lle-Asn-Trp-Leu-lle-Gln-Thr-Lys-lle-Thr-Asp-OH (SEQ ID NO 1 ). It is derived from specific posttranslational processing of proglucagon in the enteroendocrine L cells of the intestine and in specific regions of the brainstem. GLP-2 binds to a single G-protein-coupled receptor belonging to the class II glucagon secretin family. GLP-2 is co-secreted with GLP-1 , oxyntomodulin and glicentin, in response to nutrient ingestion. Human GLP-1 is produced as a 30-amino acid peptide with the following sequence: Hy-His-Ala-Glu-Gly-Thr-Phe-Thr-Ser-Asp-Val- Ser-Ser-Tyr-Leu-Glu-Gly-Gln-Ala-Ala-Lys-Glu-Phe-lle-Ala-Trp-Leu-Val-Lys-Gly-Arg- Gly-NH₂ (SEQ ID NO 2).

GLP-2 has been reported to induce significant growth of the small intestinal mucosal epithelium via the stimulation of stem cell proliferation in the crypts, and by inhibition of apoptosis in the villi (Drucker et al., 1996, Proc. Natl. Acad. Sci. USA 93: 791 1 - 7916). GLP-2 also has growth effects on the colon. Furthermore, GLP-2 inhibits gastric emptying and gastric acid secretion (Wojdemann et al., 1999, J. Clin.

Endocrinol. Metab. 84: 2513-2517), enhances intestinal barrier function (Benjamin et al., 2000, Gut 47: 1 12-1 19), stimulates intestinal hexose transport via the upregulation of glucose transporters (Cheeseman, 1997, Am. J. Physiol. R1965-71 ), and increases intestinal blood flow (Guan et al., 2003, Gastroenterology, 125: 136-147).

GLP-1 has been described as a physiological incretin hormone and has thus been mostly reported to augment an insulin response after an oral intake of glucose or fat. It is, however, generally understood that GLP-1 lowers glucagon concentrations, has beneficial effects on inhibition of fast bowel movements (Tolessa et al., 1998, Dig. Dis. Sci. 43(10): 2284-90), and slows gastric emptying.

WO2013/164484 discloses GLP-2 analogues which comprise one or more

substitutions compared to h[Gly2]GLP-2 and which may have the property of an altered GLP-1 activity, and their medical use.

WO2016/066818 describes peptides having dual agonist activity at the GLP-1 and GLP-2 receptors, and proposes medical uses thereof. However, there remains a need for further compounds which combine effective agonist activities at both receptors.

All patents, published patent applications and non-patent publications cited herein are expressly incorporated herein by reference in their entirety.

Summary of the Invention

Broadly, the present invention relates to compounds which have agonist activity at the GLP-1 (glucagon-like peptide 1 ) and GLP-2 (glucagon-like peptide 2) receptors, e.g. as assessed in in vitro potency assays. Such compounds are referred to in this specification as "GLP-1/GLP-2 dual agonists", or simply "dual agonists". Thus, the compounds of the present invention have activities of both GLP-1 (7-36) and GLP-2 (1 -33).

In a first aspect there is provided a GLP-1/GLP-2 dual agonist represented by the formula

R¹-X^*-U-R²

wherein:

R¹ is hydrogen (Hy), C1-4 alkyl (e.g. methyl), acetyl, formyl, benzoyl or trifluoroacetyl;

X^* is a peptide having the formula I

H-X2-DG-X5-F-X7-X8-E-X10-X1 1 -TIL-X15-X16-X17-A-X19-X20-X21 -FI-X24-WL-X27- X28-X29-KIT-X33

wherein:

X2 is G or Aib;

X5 is S or T;

X7 is S or T;

X8 is E, S or D;

X10 is L, V or M; X11 is N, A or S;

X15isDorE;

X16 is E, AorG;

X17 is Q, E, Lor K;

X19isA, VorS;

X20 is R or K;

X21 is D, L or E;

X24 is N, S or A;

X27 is I, H, Q, KorY;

X28 isQ, E, H, Y, L, K, RorA;

X29 is H, Q, KorY;

X33 is D or E;

U is absent or a sequence of 1-15 Lys residues, each independently selected from K and k;

or a pharmaceutically acceptable salt or solvate thereof.

The various amino acid positions in peptide X of the formulae provided here are numbered according to their linear position from N- to C-terminus in the amino acid chain.

It was found that by substituting the T in position 29 in a GLP-1/GLP-2 dual agonist with an amino acid selected from the group consisting of H, Y, K and Q the potency on both the GLP-1 receptor and the GLP-2 receptor can be improved.

In some embodiments of X^*:

X2 is G or Aib;

X5 is S orT;

X7isSorT;

X8 is E, S or D;

X10 is Lor M

X11 is N, AorS;

X15isDorE;

X16isEorG;

X17isQor K;

X19 is AorS;

X20 is R;

X21 is D or E; X24 is N or A;

X27 is I, H, Q or Y;

X28 is Q or A;

X29 is H, Q or Y; and

X33 is D or E.

X^* may be a peptide having the formula II:

H-X2-DG-X5-FS-X8-E-X10-X11 -Tl LD-X16-X17-A-X19-R-DFI-X24-WL-X27-Q-X29- KITD

wherein:

X2 is G or Aib;

X5 is S orT;

X8 is E, S or D;

X10 is Lor M

X1 is ,AorS;

X16 is E or G;

X17isQor K;

X 9 is A or S;

X24 is N or A;

X27 is I, H, QorY

X29 isH,Qor Y;

U is absent or a sequence of 1-15 Lys residues, each independently selected from K and k.

X^* may be a peptide having the formula III:

H-X2-DG-X5-FS-X8-E-X 0-X -Tl LD-X 6-X17-A-X19-R-DFI-X24-WLIQ-X29-KITD wherein:

X2 is G or Aib;

X5 is S or T;

X8 is E, S or D;

X10 is Lor M;

X11 is N, AorS;

X16 is E orG;

X17isQor K; X19 is A or S;

X24 is N or A;

X29 is H, Q or Y.

In some embodiments of Formulae I to III, X16 is E and X29 is H, Q or Y; or X17 is Q and X29 is H, Q or Y.

In some embodiments of Formulae I to III, X29 is H. In some embodiments of Formula I to III, X 1 1 is A. In some embodiments of Formulae I to III, X2 is Aib. In some embodiments of Formula I to III, X2 is G.

In some embodiments of Formulae I to III

X27 is Q and X29 is Q;

X28 is A and X29 is H;

X28 is E and X29 is H;

X10 is L, X16 is E and X17 is Q;

X16 is E, X17 is Q and X24 is A;

X16 is E, X17 is Q and X19 is A;

X10 is L, X16 is E, X17 is Q and X29 is H;

X10 is L, X1 1 is A, X16 is E, X17 is Q and X29 is H; or

X10 is L, X1 1 is A, X16 is E, X17 is Q, X19 is A, X24 is A and X29 is H.

In some embodiments of Formulae I to III

X10 is L, X1 1 is A, X16 is E, X17 is Q, X27 is I and X29 is H;

X2 is Aib, X5 is S, X1 1 is A, X24 is A and X29 is H;

X2 is Aib, X5 is T, X1 1 is A, X24 is A and X29 is H;

X2 is G, X5 is S, X1 1 is A, X24 is A and X29 is H;

X2 is G, X5 is S, X24 is A and X29 is Q;

X2 is G, X5 is S, X24 is A and X29 is H;

X2 is G, X5 is S, X24 is A and X29 is Y;

X2 is Aib, X5 is S, X1 1 is S, X24 is A and X29 is H;

X2 is Aib, X5 is S, X1 1 is A, X16 is E, X17 is Q and X24 is A;

X2 is G, X5 is S, X1 1 is A, X16 is E, X17 is Q and X24 is A;

X2 is Aib, X5 is S, X1 1 is A, X16 is G, X17 is K, X24 is A and X29 is H;

X2 is G, X5 is S, X1 1 is S, X24 is A and X29 is H;

X2 is Aib, X5 is S, X1 1 is S, X24 is A and X29 is H;

X5 is S and X24 is A;

X5 is S, and X24 is A; X5 is S and X16 is E;;

X5 is S and X17 is Q;

X5 is T, X8 is S and X24 is A;

X8 is D and X24 is N;

X16 is E, X17 is Q and X29 is H;

X16 is E, X17 is Q, X24 is A and X29 is H;

X2 is G, X16 is E, X17 is Q, X24 is A and X29 is H;

X2 is Aib, X16 is E, X17 is Q, X24 is A and X29 is H;

X5 is T, X16 is E, X17 is Q, X24 is A and X29 is H; or

X5 is S, X16 is E, X17 is Q, X24 is A and X29 is H.

In some embodiments of Formulae I to III

X8 is D or S, X9 is E, X10 is L and X1 1 is A or S;

X8 is D or S, X9 is E, X10 is L and X1 1 is A; or

X8 is D or S, X9 is E, X10 is L and X1 1 is S. The dual agonist of the invention may have no more than 5 amino acid changes, e.g. no more than 4, no more than 3, no more than 2 or no more than 1 change relative to the amino acid sequence

H[Aib]DGSFSDELATILDGKAARDFIAWLIQHKITD;

HGDGTFSSELATILDEQAARDFIAWLIQHKITD;

HGDGSFSSELATILDEQAARDFIAWLIQHKITD;

H[Aib]DGTFTSELATILDEQAARDFIAWLIAHKITD; or

HGDGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK.

The peptide X^* may have the sequence:

H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITD;

HGDGSFSSELATILDEQAARDFIAWLIQHKITD;

H[Aib]DGSFSDELATILDEQAARDFIAWLIQHKITD;

H[Aib]DGTFSSELATILDEQAARDFIAWLIQHKITD;

H[Aib]DGSFSDELATILDEQAARDFINWLIQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK;

H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITDkkkkkk;

H[Aib]DGSFSDELATILDGKAARDFIAWLIQHKITD;

HGDGTFSSELATILDEQAARDFIAWLIQHKITD;

HGDGSFSSELATILDEQAARDFIAWLIQQKITD;

HGDGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK; HGDGSFSSELSTILDEQAARDFIAWLIQHKITD;

HGDGSFSSELATILDEQAARDFIAWLIQYKITD; or

HGDGSFSSELATILDEQASRDFIAWLIQHKITD.

The dual agonist may be:

Cpd 1 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITD-OH;

Cpd 2 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITD-[NH₂];

Cpd 3 Hy-H[Aib]DGSFSDELATILDEQAARDFIAWLIQHKITD-OH;

Cpd 4 Hy-H[Aib]DGTFSSELATILDEQAARDFIAWLIQHKITD-OH;

Cpd 5 Hy-H[Aib]DGSFSDELATILDEQAARDFINWLIQHKITD-OH;

Cpd 6 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK-[NH₂];

Cpd 7 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITDkkkkkk-[NH₂];

Cpd 8 Hy-H[Aib]DGSFSDELATILDGKAARDFIAWLIQHKITD-OH;

Cpd 9 Hy-HGDGTFSSELATILDEQAARDFIAWLIQHKITD-OH;

Cpd 10 Hy-HGDGSFSSELATILDEQAARDFIAWLIQQKITD-[NH₂];

Cpd 1 1 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK-[NH₂];

Cpd 12 Hy-HGDGSFSSELSTILDEQAARDFIAWLIQHKITD-OH;

Cpd 13 Hy-HGDGSFSSELATILDEQAARDFIAWLIQYKITD-[NH₂];

Cpd 14 Hy-HGDGSFSSELATILDEQASRDFIAWLIQHKITD-OH;

Cpd 15 Hy-HGDGSFSSELATILDEQAARDFIAWLIQYKITD-OH; or

Cpd 33 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITD-OH.

In some embodiments of formula I or II, X8 is E, X10 is L and X1 1 is A; X5 is S and X8 is E; or X2 is Aib, X5 is S and X8 is E. The dual agonist of the invention may have no more than 5 amino acid changes, e.g. no more than 4, no more than 3, no more than 2 or no more than 1 change relative to the amino acid sequence

H[Aib]DGSFSEELATILDGKAARDFIAWLIQHKITD; or

H[Aib]DGSFSEELATILDEQAARDFIAWLIQHKITD. The peptide X^* may have the sequence:

H[Aib]DGSFSEELATILDGKAARDFIAWLIQHKITD; or

H[Aib]DGSFSEELATILDEQAARDFIAWLIQHKITD.

The dual agonist may be: Cpd 16 Hy-H[Aib]DGSFSEELATILDGKAARDFIAWLIQHKITD-OH; or

Cpd 17 Hy-H[Aib]DGSFSEELATILDEQAARDFIAWLIQHKITD-OH.

In some embodiments of formula I or II,

X1 1 is N;

X10 is M or l_ and X1 1 is N;

X10 is M and X1 1 is N;

X10 is L and X1 1 is N;

X10 is M, X1 1 is N and X24 is A;

X2 is Aib, X10 is M, X24 is A and X29 is H;

X2 is Aib, X10 is M and X24 is A;

X2 is Aib, X10 is M, X24 is A and X29 is H;

X2 is Aib, X10 is L and X24 is A; or

X2 is Aib, X10 is L, X24 is A and X29 is H.

The dual agonist of the invention may have no more than 5 amino acid changes, e.g. no more than 4, no more than 3, no more than 2 or no more than 1 change relative to the amino acid sequence

H[Aib]DGSFSDEMNTILDEQAARDFIAWLIQHKITD or

H[Aib]DGSFSDELNTILDEQAARDFIAWLIQHKITD.

The peptide X^* may have the sequence:

H[Aib]DGSFSDEMNTILDEQAARDFIAWLIQHKITD; or

H[Aib]DGSFSDELNTILDEQAARDFIAWLIQHKITD. The dual agonist may be:

Cpd 18 Hy-H[Aib]DGSFSDEMNTILDEQAARDFIAWLIQHKITD-OH; or

Cpd 19 Hy-H[Aib]DGSFSDELNTILDEQAARDFIAWLIQHKITD-OH.

X^* may be a peptide having the formula IV

H-X2-DG-X5-FS-X8-EL-X1 1 -Tl LD-X16-X17-AA-R-DFI-X24-WL-X27-Q-X29-KITD wherein:

X2 is G or Aib;

X5 is S or T;

X8 is S, D or E;

X1 1 is A or N;

X16 is E or G; X17 is Q or K;

X24 is N or A;

X27 is H, Q or Y;

X29 is H, Q or Y. In some embodiments of formula IV,

X2 is Aib, X8 is S or D and X1 1 is A;

X2 is Aib, X5 is S, X1 1 is A, X24 is A and X29 is H; or

X2 is Aib, X5 is S and X24 is A.

In some embodiments of formula IV

X2 is Aib and X8 is S;

X8 is S, X27 is H, Y or Q and X29 is H;

X8 is S, X27 is H, Y or Q and X29 is Q;

X8 is S, X27 is H, Y or Q and X29 is Y;

X8 is S, X27 is H and X29 is H, Y or Q;

X8 is S, X27 is Y and X29 is H, Y or Q; or

X8 is S, X27 is Q and X29 is H, Y or Q.

The dual agonist may have no more than 5 amino acid changes, e.g. no more than 4, no more than 3, no more than 2 or no more than 1 change relative to the amino acid sequence

H[Aib]DGSFSSELATILDEQAARDFIAWLQQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLHQHKITD; or

H[Aib]DGSFSSELATILDEQAARDFIAWLQQQKITD.

In some embodiments, the amino acid sequence of the dual agonist of the invention comprises a motif selected from the group consisting of FIAWLHQT, FIAWLYQT, FIAWLQQT, FIAWLKQT, FINWLHQT, FINWLYQT, FINWLQQT and FINWLKQT.

In some embodiments, the amino acid sequence of the dual agonist of the invention comprises a motif selected from the group consisting of FIAWLHQH, FIAWLYQH, FIAWLQQH, FIAWLKQH, FIAWLHQQ, FIAWLYQQ, FIAWLQQQ, FIAWLKQQ, FIAWLHQK, FIAWLYQK, FIAWLQQK, FIAWLKQK, FIAWLHQY, FIAWLYQY, FIAWLQQY, FIAWLKQY, FINWLHQH, FINWLYQH, FINWLQQH, FINWLKQH, FINWLHQQ, FINWLYQQ, FINWLQQQ, FINWLKQQ, FINWLHQK, FINWLYQK, FINWLQQK, FINWLKQK, FINWLHQY, FINWLYQY, FINWLQQY and FINWLKQY.

The peptide X^* may have the sequence: H[Aib]DGSFSSELATILDEQAARDFIAWLYQQKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLQQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLQQQKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLYQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLHQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLHQQKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLQQYKITD; or

H[Aib]DGSFSSELATILDEQAARDFIAWLHQYKITD.

The dual agonist may be:

Cpd 20 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLYQQKITD-OH;

Cpd 21 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLQQHKITD-OH;

Cpd 22 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLQQQKITD-OH;

Cpd 23 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLYQHKITD-OH;

Cpd 24 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLHQHKITD-OH;

Cpd 25 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLYQYKITD-OH;

Cpd 26 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLHQQKITD-OH;

Cpd 27 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLQQYKITD-OH; or

Cpd 28 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLHQYKITD-OH. In some embodiments of formula IV:

X2 is Aib and X8 is D or E;

X2 is Aib and X27 is H and X29 is H;

X8 is D or E, X27 is H, Y or Q and X29 is H;

X8 is D or E, X27 is H, Y or Q and X29 is Q;

X8 is D or E, X27 is H, Y or Q and X29 is Y;

X8 is D or E, X27 is H and X29 is H, Y or Q;

X8 is D or E, X27 is Y and X29 is H, Y or Q;

X8 is D or E, X27 is Q and X29 is H, Y or Q;

X2 is Aib, X1 1 is N, X24 is A, X27 is H and X29 is H; or

X2 is Aib, X1 1 is N, X24 is A, X27 is H.

H[Aib]DGSFSDELATILDEQAARDFIAWLHQHKITD,

H[Aib]DGSFSDELATILDGKAARDFIAWLHQHKITD.

H[Aib]DGSFSEELATILDEQAARDFIAWLHQHKITD; or H[Aib]DGSFSDELNTILDEQAARDFINWLHQHKITD.

In some embodiments, the amino acid sequence of the dual agonist of the invention comprises a motif selected from the group consisting of FIAWLHQT, FIAWLYQT, FIAWLQQT, FIAWLKQT, FINWLHQT, FINWLYQT, FINWLQQT and FINWLKQT. In some embodiments, the amino acid sequence of the dual agonist of the invention comprises a motif selected from the group consisting of FIAWLHQH, FIAWLYQH, FIAWLQQH, FIAWLKQH, FIAWLHQQ, FIAWLYQQ, FIAWLQQQ, FIAWLKQQ, FIAWLHQK, FIAWLYQK, FIAWLQQK, FIAWLKQK, FIAWLHQY, FIAWLYQY, FIAWLQQY, FIAWLKQY, FINWLHQH, FINWLYQH, FINWLQQH, FINWLKQH, FINWLHQQ, FINWLYQQ, FINWLQQQ, FINWLKQQ, FINWLHQK, FINWLYQK, FINWLQQK, FINWLKQK, FINWLHQY, FINWLYQY, FINWLQQY and FINWLKQY.

The peptide X^* may have the sequence

H[Aib]DGSFSDELATILDEQAARDFIAWLHQHKITD;

H[Aib]DGSFSDELATILDGKAARDFIAWLHQHKITD;

H[Aib]DGSFSEELATILDEQAARDFIAWLHQHKITD; or

H[Aib]DGSFSDELNTILDEQAARDFINWLHQHKITD.

The dual agonist may be:

Cpd 29 Hy-H[Aib]DGSFSDELATILDEQAARDFIAWLHQHKITD-OH;

Cpd 30 Hy-H[Aib]DGSFSDELATILDGKAARDFIAWLHQHKITD-OH;

Cpd 31 Hy-H[Aib]DGSFSEELATILDEQAARDFIAWLHQHKITD-OH; or

Cpd 32 Hy-H[Aib]DGSFSDELNTILDEQAARDFINWLHQHKITD-OH.

X^* may be a peptide having the formula V

HGDGSFSSELATIL-X15-EQAAR-X21 -FIAWLIQHKIT-X33

wherein:

X15 is D or E;

X21 is D or E;

X33 is D or E.

The peptide X may have the sequence:

HGDGSFSSELATILDEQAARDFIAWLIQHKITE

HGDGSFSSELATILDEQAAREFIAWLIQHKITD

HGDGSFSSELATILEEQAARDFIAWLIQHKITD

HGDGSFSSELATILEEQAAREFIAWLIQHKITE HGDGSFSSELATILEEQAAREFIAWLIQHKITD

The dual agonist may be:

Cpd 34 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITE-NH₂

Cpd 35 Hy-HGDGSFSSELATILDEQAAREFIAWLIQHKITD-NH₂

Cpd 36 Hy-HGDGSFSSELATILEEQAARDFIAWLIQHKITD-NH₂

Cpd 37 Hy-HGDGSFSSELATILEEQAAREFIAWLIQHKITE-NH₂

Cpd 38 Hy-HGDGSFSSELATILEEQAAREFIAWLIQHKITD-NH₂

X^* may be a peptide having the formula VI:

H-X2-DG-X5-F-X7-X8-E-X10-A-TI LD-X16-X17-A-X19-R-DFIAWLIQ-X29-KITD wherein:

X2 is G or Aib;

X5 is S orT;

X7 is S orT;

X8isE,SorD;

X10 is Lor M;

X16 is E orG;

X17isQor K;

X19 is AorS;

X29isH,QorY.

X^* may be a peptide having the formula VII:

HGDG-X5-F-X7-SELATILDEQAARDFIAWLIAHKIT-X33

wherein:

X5 is S orT;

X7isSorT;

X33 is D or E.

The peptide X^* may have the sequence:

H[Aib]DGTFTSELATILDEQAARDFIAWLIAHKITD

H[Aib]DGTFSSELATILDEQAARDFIAWLIAHKITD

H[Aib]DGSFTSELATILDEQAARDFIAWLIAHKITD The dual agonist may be:

Cpd 39 Hy-H[Aib]DGTFTSELATILDEQAARDFIAWLIAHKITD-OH

Cpd 40 Hy-H[Aib]DGTFSSELATILDEQAARDFIAWLIAHKITD-OH

Cpd 41 Hy-H[Aib]DGSFTSELATILDEQAARDFIAWLIAHKITD-OH

When present, U represents a peptide sequence of 1 -15 lysine residues, e.g. 1 -10 lysine residues, Each of the amino acid residues in the peptide sequence U may independently have either D-configuration (designated "k") or L-configuration

(designated "K"). In certain embodiments, all have an L-configuration or all D- configuration. Examples include K1-15, KMO and Ki_-7, e.g., K3, K₄, K₅, Κβ and K₇, especially K₅ and Κβ. Further examples include ki-i₅, ki-io and ki_-7, e.g. k3, k₄, k₅, k6 and k₇, especially k₅ and k6.

In some embodiments R¹ is Hy and/or R² is OH.

The dual agonist may be in the form of a pharmaceutically acceptable salt or solvate, such as a pharmaceutically acceptable acid addition salt.

The invention also provides a composition comprising a dual agonist of the invention, or a pharmaceutically acceptable salt or solvate thereof, together with a carrier, excipient or vehicle. The carrier may be a pharmaceutically acceptable carrier.

The composition may be a pharmaceutical composition. The pharmaceutical composition may be formulated as a liquid suitable for administration by injection or infusion. It may be formulated to achieve slow release of the dual agonist. The present invention further provides a dual agonist of the invention for use in therapy. In yet another aspect there is provided a dual agonist of the present invention for use as a medicament. Also provided is a dual agonist of the invention for use in a method of medical treatment.

The invention also provides a dual agonist of the invention for use in a method of increasing intestinal mass, improving intestinal function (especially intestinal barrier function), increasing intestinal blood flow, or repairing intestinal damage or dysfunction, e.g. damage to the intestinal epithelium.

The invention also provides a dual agonist of the invention for use in a method of prophylaxis or treatment of malabsorption, ulcers (e.g. peptic ulcers, Zollinger-Ellison Syndrome, drug-induced ulcers, and ulcers related to infections or other pathogens), short-bowel syndrome, cul-de-sac syndrome, inflammatory bowel disease (Crohns disease and ulcerative colitis), irritable bowel syndrome (IBS), pouchitis, celiac sprue (for example arising from gluten induced enteropathy or celiac disease), tropical sprue, hypogammaglobulinemic sprue, mucositis induced by chemotherapy or radiation therapy, diarrhea induced by chemotherapy or radiation therapy, low grade inflammation, metabolic endotoxemia, necrotising enterocolitis, primary biliary cirrhosis, hepatitis, fatty liver disease (including parental nutrition associated gut atrophy, PNALD (Parenteral Nutrition-Associated Liver Disease), NAFLD (Non- Alcoholic Fatty Liver Disease) and NASH (Non-Alcoholic Steatohepatitis)), or gastrointestinal side-effects of inflammatory conditions such as pancreatitis or graft versus host disease (GVHD).

The invention also provides a dual agonist of the invention for use in a method of reducing or inhibiting weight gain, reducing gastric emptying or intestinal transit, reducing food intake, reducing appetite, or promoting weight loss.

The invention also provides a dual agonist of the invention for use in a method of prophylaxis or treatment of obesity, morbid obesity, obesity-linked gallbladder disease, obesity-induced sleep apnea, inadequate glucose control, glucose tolerance, dyslipidaemia (e.g. elevated LDL levels or reduced HDL/LDL ratio), diabetes (e.g. Type 2 diabetes, gestational diabetes), pre-diabetes, metabolic syndrome or hypertension.

The invention also provides a method of increasing intestinal mass, improving intestinal function (especially intestinal barrier function), increasing intestinal blood flow, or repairing intestinal damage or dysfunction in a subject in need thereof, the method comprising administering a dual agonist of the invention to the subject.

The invention also provides a method of prophylaxis or treatment of malabsorption, ulcers (e.g. peptic ulcers, Zollinger-Ellison Syndrome, drug-induced ulcers, and ulcers related to infections or other pathogens), short-bowel syndrome, cul-de-sac syndrome, inflammatory bowel disease (Crohns disease and ulcerative colitis), irritable bowel syndrome (IBS), pouchitis, celiac sprue (for example arising from gluten induced enteropathy or celiac disease), tropical sprue,

hypogammaglobulinemic sprue, mucositis induced by chemotherapy or radiation therapy, diarrhea induced by chemotherapy or radiation therapy,, low grade inflammation, metabolic endotoxemia, necrotising enterocolitis, primary biliary cirrhosis, hepatitis, fatty liver disease (including parental nutrition associated gut atrophy, PNALD (Parenteral Nutrition-Associated Liver Disease), NAFLD (Non- Alcoholic Fatty Liver Disease) and NASH (Non-Alcoholic Steatohepatitis)), or gastrointestinal side-effects of inflammatory conditions such as pancreatitis or graft versus host disease (GVHD) in a subject in need thereof, the method comprising administering a dual agonist of the invention to the subject.

The invention also provides a method of reducing or inhibiting weight gain, reducing gastric emptying or intestinal transit, reducing food intake, reducing appetite, or promoting weight loss in a subject in need thereof, the method comprising administering a dual agonist of the invention to the subject.

The invention also provides a method of prophylaxis or treatment of obesity, morbid obesity, obesity-linked gallbladder disease, obesity-induced sleep apnea, inadequate glucose control, glucose tolerance, dyslipidaemia (e.g. elevated LDL levels or reduced HDL/LDL ratio), diabetes (e.g. Type 2 diabetes, gestational diabetes), pre- diabetes, metabolic syndrome or hypertension in a subject in need thereof, the method comprising administering a dual agonist of the invention to the subject.

The invention also provides the use of a dual agonist of the invention in the preparation of a medicament for increasing intestinal mass, improving intestinal function (especially intestinal barrier function), increasing intestinal blood flow, or repairing intestinal damage or dysfunction, e.g. damage to the intestinal epithelium.

The invention also provides the use of a dual agonist of the invention in the preparation of a medicament for prophylaxis or treatment of malabsorption, ulcers (e.g. peptic ulcers, Zollinger-Ellison Syndrome, drug-induced ulcers, and ulcers related to infections or other pathogens), short-bowel syndrome, cul-de-sac syndrome, inflammatory bowel disease (Crohns disease and ulcerative colitis), pouchitis, irritable bowel syndrome, celiac sprue (for example arising from gluten induced enteropathy or celiac disease), tropical sprue, hypogammaglobulinemic sprue, mucositis induced by chemotherapy or radiation therapy, diarrhea induced by chemotherapy or radiation therapy,, low grade inflammation, metabolic endotoxemia, necrotising enterocolitis, primary biliary cirrhosis, hepatitis, fatty liver disease

(including parental nutrition associated gut atrophy, PNALD (Parenteral Nutrition- Associated Liver Disease), NAFLD (Non-Alcoholic Fatty Liver Disease) and NASH (Non-Alcoholic Steatohepatitis)), or gastrointestinal side-effects of inflammatory conditions such as pancreatitis or graft versus host disease (GVHD). The invention also provides the use of a dual agonist of the invention in the preparation of a medicament for reducing or inhibiting weight gain, reducing gastric emptying or intestinal transit, reducing food intake, reducing appetite, or promoting weight loss. The invention also provides the use of a dual agonist of the invention in the preparation of a medicament for prophylaxis or treatment of obesity, morbid obesity, obesity-linked gallbladder disease, obesity-induced sleep apnea, inadequate glucose control, glucose tolerance, dyslipidaemia (e.g. elevated LDL levels or reduced HDL/LDL ratio), diabetes (e.g. Type 2 diabetes, gestational diabetes), pre-diabetes, metabolic syndrome or hypertension.

A further aspect provides a therapeutic kit comprising a dual agonist, or a

pharmaceutically acceptable salt or solvate thereof, according to the invention.

Detailed Description of the Invention

Unless otherwise defined herein, scientific and technical terms used in this application shall have the meanings that are commonly understood by those of ordinary skill in the art. Generally, nomenclature used in connection with, and techniques of, chemistry, molecular biology, cell and cancer biology, immunology, microbiology, pharmacology, and protein and nucleic acid chemistry, described herein, are those well known and commonly used in the art.

All patents, published patent applications and non-patent publications referred to in this application are specifically incorporated by reference herein. In case of conflict, the present specification, including its specific definitions, will control.

Each embodiment of the invention described herein may be taken alone or in combination with one or more other embodiments of the invention. Definitions

Unless specified otherwise, the following definitions are provided for specific terms which are used in the present written description.

Throughout this specification, the word "comprise", and grammatical variants thereof, such as "comprises" or "comprising", will be understood to imply the inclusion of a stated integer or component, or group of integers or components, but not the exclusion of any other integer or component, or group of integers or components. The singular forms "a," "an," and "the" include the plurals unless the context clearly dictates otherwise.

The term "including" is used to mean "including but not limited to". "Including" and "including but not limited to" may be used interchangeably.

The terms "patient", "subject" and "individual" may be used interchangeably and refer to either a human or a non-human animal. These terms include mammals such as humans, primates, livestock animals (e.g., bovines and porcines), companion animals (e.g., canines and felines) and rodents (e.g., mice and rats).

The term "solvate" in the context of the present invention refers to a complex of defined stoichiometry formed between a solute (in casu, a peptide or

pharmaceutically acceptable salt thereof according to the invention) and a solvent. The solvent in this connection may, for example, be water, ethanol or another pharmaceutically acceptable, typically small-molecular organic species, such as, but not limited to, acetic acid or lactic acid. When the solvent in question is water, such a solvate is normally referred to as a hydrate.

The term "agonist" as employed in the context of the invention refers to a substance (ligand) that activates the receptor type in question.

Throughout the present description and claims the conventional three-letter and one- letter codes for naturally occurring amino acids are used, i.e.

A (Ala), G (Gly), L (Leu), I (lie), V (Val), F (Phe), W (Trp), S (Ser), T (Thr), Y (Tyr), N (Asn), Q (Gin), D (Asp), E (Glu), K (Lys), R (Arg), H (His), M (Met), C (Cys) and P (Pro);

as well as generally accepted three-letter codes for other oarmino acids, such as sarcosine (Sar), norleucine (Nle), a-aminoisobutyric acid (Aib), 2,3-diaminopropanoic acid (Dap), 2,4-diaminobutanoic acid (Dab) and 2,5-diaminopentanoic acid (ornithine; Orn). Such other oarmino acids may be shown in square brackets "[ ]" (e.g. "[Aib]") when used in a general formula or sequence in the present specification, especially when the rest of the formula or sequence is shown using the single letter code.

Unless otherwise specified, amino acid residues in peptides of the invention are of the L-configuration. However, D-configuration amino acids may be incorporated. In the present context, an amino acid code written with a small letter represents the D- configuration of said amino acid, e.g. "k" represents the D-configuration of lysine (K).

Among sequences disclosed herein are sequences incorporating a "Hy-"moiety at the amino terminus (N-terminus) of the sequence, and either an "-OH" moiety or an "- NH2" moiety at the carboxy terminus (C-terminus) of the sequence. In such cases, and unless otherwise indicated, a "Hy-" moiety at the N-terminus of the sequence in question indicates a hydrogen atom [i.e. R¹ = hydrogen = Hy in the general formulas; corresponding to the presence of a free primary or secondary amino group at the N- terminus], while an "-OH" or an "-IMH2" moiety at the C-terminus of the sequence indicates a hydroxy group [e.g. R² = OH in general formulas; corresponding to the presence of a carboxy (COOH) group at the C-terminus] or an amino group [e.g. R² = [NH2] in the general formulas; corresponding to the presence of an amido (CONH2) group at the C-terminus], respectively. In each sequence of the invention, a C- terminal "-OH" moiety may be substituted for a C-terminal "-IMH2" moiety, and vice- versa.

"Percent (%) amino acid sequence identity" with respect to the GLP-2 polypeptide sequences is defined as the percentage of amino acid residues in a candidate sequence that are identical to the amino acid residues in the wild-type (human) GLP-2 sequence, after aligning the sequences and introducing gaps, if necessary, to achieve the maximum percent sequence identity, and not considering any conservative substitutions as part of the sequence identity. Sequence alignment can be carried out by the skilled person using techniques well known in the art, for example using publicly available software such as BLAST, BLAST2 or Align software. For examples, see Altschul et al., Methods in Enzymology 266: 460-480 (1996) or Pearson et al., Genomics 46: 24-36, 1997.

The percentage sequence identities used herein in the context of the present invention may be determined using these programs with their default settings. More generally, the skilled worker can readily determine appropriate parameters for determining alignment, including any algorithms needed to achieve maximal alignment over the full length of the sequences being compared.

Dual agonist compounds

In accordance with the present invention, the dual agonist has at least one GLP-1 and at least one GLP-2 biological activity. Exemplary GLP-1 physiological activities include reducing rate of intestinal transit, reducing rate of gastric emptying, reducing appetite, food intake or body weight, and improving glucose control and glucose tolerance. Exemplary GLP-2 physiological activities include causing an increase in intestinal mass (e.g. of small intestine or colon), intestinal repair, and improving intestinal barrier function (i.e. reducing permeability of the intestine). These parameters can be assessed in in vivo assays in which the mass and the permeability of the intestine, or a portion thereof, is determined after a test animal has been treated with a dual agonist.

The dual agonists have agonist activity at the GLP-1 and GLP-2 receptors, e.g. the human GLP-1 and GLP-2 receptors. EC50 values for in vitro receptor agonist activity may be used as a numerical measure of agonist potency at a given receptor. An EC50 value is a measure of the concentration (e.g. mol/L) of a compound required to achieve half of that compound's maximal activity in a particular assay. A compound having a numerical EC50 at a particular receptor which is lower than the EC50 of a reference compound in the same assay may be considered to have higher potency at that receptor than the reference compound.

GLP-1 activity

In some embodiments, the dual agonist has an EC50 at the GLP-1 receptor (e.g. the human GLP-1 receptor) which is below 14 nM, below 13 nM, below 10 nM, below 2.0 nM, below 1 .5 nM, below 1 .0 nM, below 0.9 nM, below 0.8 nM, below 0.7 nM, below 0.6 nM, below 0.5 nM, below 0.4 nM, below 0.3 nM, below 0.2 nM, below 0.1 nM, below 0.09 nM, below 0.08 nM, below 0.07 nM, below 0.06 nM, below 0.05 nM, below 0.04 nM, below 0.03, below 0.02, below 0.01 nM, below 0.009 nM, below 0.008 nM, below 0.007 nM, below 0.006 nM, or below 0.005 nM, e.g. when assessed using the GLP-1 receptor potency assay described in the Examples below. In some embodiments, the dual agonist has an EC50 at the GLP-1 receptor which is between 0.005 and 14 nM, between 0.01 nM and 13 nM, between 0.025 and 2.5 nM, between 0.005 and 10 nM, between 0.01 nM and 2.0 nM, between 0.025 and 2.0 nM, between 0.005 and 2.0 nM, between 0.01 nM and 1 .5 nM, between 0.025 and 1 .5 nM, between 0.005 and 1.0 nM, between 0.01 nM and 1.0 nM, between 0.025 and 1 .0 nM, between 0.005 and 0.5 nM, between 0.01 nM and 0.5 nM, between 0.025 and 0.5 nM, between 0.005 and 0.25 nM, between 0.01 nM and 0.25 nM, between 0.025 and 0.25 nM, e.g. when assessed using the GLP-1 receptor potency assay described in the Examples below.

In some embodiments, the dual agonist has an EC50 at the GLP-1 receptor which is below 1.0 nM, below 0.9 nM, below 0.8 nM, below 0.7 nM, below 0.6 nM, below 0.5 nM, below 0.4 nM, below 0.3 nM, below 0.2 nM, below 0.1 nM, below 0.09 nM, below 0.08 nM, below 0.07 nM, below 0.06 nM, below 0.05 nM, below 0.04 nM, below 0.03 nM, below 0.02 nM, below 0.01 nM, below 0.009 nM, below 0.008 nM, below 0.007 nM, below 0.006 nM, or below 0.005 nM, e.g. when assessed using the GLP-1 receptor potency assay described in the Examples below

In some embodiments, the dual agonist has an EC50 at the GLP-1 receptor which is between 0.005 nM and 1.0 nM, between 0.006 nM and 0.9 nM, between 0.007 nM and 0.8 nM, between 0.008 nM and 0.85 nM, between 0.009 nM and 0.7 nM, between 0.01 nM and 0.65 nM, between 0.02 nM and 0.6 nM, between 0.023 nM and 0.59 nM between 0.03 nM and 0.55 nM, between 0.04 nM and 0.5 nM, between 0.05 nM and 0.45 nM, between 0.06 nM and 0.4 nM, between 0.62 nM and 0.888 nM, between 0.07 nM and 0.35 nM, between 0.08 nM and 0.3 nM, between 0.09 nM and 0.25 nM, between 0.1 nM and 0.2 nM, between 0.13 nM and 0.95 nM, between 0.2 nM and 0.95 nM, between 0.3 nM and 0.96 nM, between 0.4 nM and 0.5 nM, between 0.5 nM and 1 .0 nM, between 0.6 nM and 1.0 nM, between 0.7 nM and 1 .0 nM, between 0.8 nM and 1.0 nM, e.g. when assessed using the GLP-1 receptor potency assay described in the Examples below.

In some embodiments, the dual agonist has an EC50 at the GLP-1 receptor which is between 1 .001 nM and 10 nM, between 1 .01 nM and 10 nM, 1.1 nM and 10 nM, between 1 .2 nM and 9.0 nM, between 1 .5 nM and 8.0 nM, between 1.6 nM and 6.0 nM, between 1 .7 nM and 5.0 nM, between 1.8 nM and 2.0 nM, between 1.9 nM and 10.0 nM, between 2.0 nM and 9.5 nM, between 2.5 nM and 8.5 nM, between 3.0 nM and 7.5 nM, between 3.5 nM and 8.5 nM, between 4.0 nM and 5.0 nM, between 1 .1 nM and 1 .9 nM, between 1 .2 nM and 1.8 nM, between 1.3 nM and 1.7 nM, between 1.4 nM and 1 .6 nM, between 1.2 nM and 1.7 nM, between 1 .1 nM and 1 .7 nM, e.g. when assessed using the GLP-1 receptor potency assay described in the Examples below.

In some embodiments, the dual agonist has an EC50 at the GLP-1 receptor which is above 10.0 nM, above 10.001 nM, above 10.01 nM, above 10.5 nM, above 1 1 .0 nM, above 1 1 .5 nM, above 12.0 nM, above 12.5 nM, above 13.0 nM, above 13.5 nM, above 14.0 nM, above 14.5 nM, above 15 nM, above 15.5 nM, above 16 nM, above 20 nM, above 25 nM, above 50 nM, above 100 nM, above 200 nM, above 300 nM, above 400 nM, above 500 nM, e.g. when assessed using the GLP-1 receptor potency assay described in the Examples below

In some embodiments, the dual agonist has an EC50 at the GLP-1 receptor which is between 10.0 nM and 500 nM, between 10.001 nM and 500 nM, between 10.01 nM and 500 nM between 12.0 nM and 400 nM, between 14.0 nM and 200 nM, between 15.0 nM and 100 nM, between 20 nM and 50 nM, between 30 nM and 40 nM, between 1 1.0 nM and 75 nM, between 12.0 nM and 60 nM, between 13.0 nM and 50 nM, between 14.0 nM and 40 nM, between 12.0 nM and 13.0 nM, between 1 1.0 nM and 13.5 nM, e.g. when assessed using the GLP-1 receptor potency assay described in the Examples below. An alternative measure of GLP-1 agonist activity may be derived by comparing the potency of a dual agonist with the potency of a known (or reference) GLP-1 agonist when both are measured in the same assay. Thus the relative potency at the GLP-1 receptor may be defined as:

[EC5o(reference agonist)] / [ECso(dual agonist)]. Thus a value of 1 indicates that the dual agonist and reference agonist have equal potency, a value of >1 indicates that the dual agonist has higher potency (i.e. lower EC50) than the reference agonist, and a value of <1 indicates that the dual agonist has lower potency (i.e. higher EC50) than the reference agonist.

The reference GLP-1 agonist may, for example, be human GLP-1 (7-37), liraglutide (NN221 1 ; Victoza), or Exendin-4, but is preferably liraglutide.

Typically the relative potency will be between 0.00005 and 100, e.g. between 0.001 and 10, between 0.001 and 5, between 0.001 and 1 , between 0.001 and 0.5, between 0.001 and 0.1 , between 0.001 and 0.05, or between 0.001 and 0.01 ; between 0.003 and 10, between 0.003 and 5, between 0.003 and 1 , between 0.001 and 0.5, between 0.003 and 0.1 , between 0.003 and 0.05, or between 0.003 and 0.01 ; between 0.01 and 10, between 0.01 and 5, between 0.01 and 1 , between 0.01 and 0.5, between 0.01 and 0.1 , or between 0.01 and 0.05; between 0.05 and 10, between 0.05 and 5, between 0.05 and 1 , between 0.05 and 0.5, or between 0.05 and 0.1 ; between 0.1 and 10, between 0.1 and 5, between 0.1 and 1 , or between 0.1 and 0.5; between 0.5 and 10, between 0.5 and 5, or between 0.5 and 1 ; between 1 and 10, or between 1 and 5; or between 5 and 10. The dual agonists described in the examples below may have a relative potency (using liraglutide as a reference) between 0.0005 and 3, between 0.001 and 2;

between 0.01 and 0.1 , or between 0.01 and 0.05.

By contrast, the dual agonists of the invention have higher potency at the GLP-1 receptor (e.g. the human GLP-1 receptor) than wild type human GLP-2 (hGLP-2 (1 - 33)) or [Gly2]-hGLP-2 (1 -33) (i.e. human GLP-2 having glycine at position 2, also known as teduglutide). Thus, the relative potency of the dual agonists at the GLP-1 receptor compared to hGLP-2 (1 -33) or teduglutide is greater than 1 , typically greater than 5 or greater than 10, and may be up to 100, up to 500, or even higher. GLP-2 activity

In some embodiments, the dual agonist has an EC50 at the GLP-2 receptor (e.g. the human GLP-2 receptor) which is below 1.0 nM, below 0.9 nM, below 0.8 nM, below 0.7 nM, below 0.6 nM, below 0.5 nM, below 0.4 nM, below 0.3 nM, below 0.2 nM, below 0.1 nM, below 0.09 nM, below 0.08 nM, below 0.07 nM, below 0.06 nM, below 0.05 nM, below 0.04 nM, below 0.03 nM, below 0.02 nM, or below 0.01 nM, e.g. when assessed using the GLP-1 receptor potency assay described in the Examples below.

In some embodiments, the dual agonist has an EC50 at the GLP-2 receptor which is between 0.005 and 1 .0 nM, between 0.01 nM and 2.0 nM, between 0.025 and 2.0 nM, between 0.005 and 1.5 nM, between 0.01 nM and 1.5 nM, between 0.025 and 1 .5 nM, between 0.005 and 0.9 nM, between 0.01 nM and 1 .0 nM, between 0.025 and 1 .0 nM, between 0.005 and 0.5 nM, between 0.01 nM and 0.3 nM, between 0.025 and 0.5 nM, between 0.005 and 0.25 nM, between 0.01 nM and 0.25 nM, between 0.025 and 0.25 nM, e.g. when assessed using the GLP-2 receptor potency assay described in the Examples below. In some embodiments, the dual agonist has an EC50 at the GLP-2 receptor which is below 2nM or more preferably below 1 .0 nM, below 0.9 nM, below 0.8 nM, below 0.7 nM, below 0.6 nM, below 0.5 nM, below 0.4 nM, below 0.3 nM, below 0.2 nM, below 0.1 nM, below 0.09 nM, below 0.08 nM, below 0.07 nM, below 0.06 nM, below 0.05 nM, below 0.04 nM, below 0.03 nM, below 0.02 nM, below 0.015, below 0.01 nM, below 0.009 nM, below 0.008 nM, below 0.007 nM, below 0.006 nM, or below 0.005 nM, e.g. when assessed using the GLP-2 receptor potency assay described in the Examples below.

In some embodiments, the dual agonist has an EC50 at the GLP-2 receptor which is between 0.005 nM and 2 nM, between 0.006 nM and 1.7 nM, between 0.007 nM and 1 .5 nM, between 0.009 nM and 1.3 nM, 0.01 nM and 1.2 nM, between 0.005 nM and 1 .0 nM, between 0.006 nM and 0.9 nM, between 0.007 nM and 0.8 nM, between 0.008 nM and 0.85 nM, between 0.009 nM and 0.7 nM, between 0.01 nM and 0.65 nM, between 0.02 nM and 0.6 nM, between 0.023 nM and 0.59 nM between 0.03 nM and 0.55 nM, between 0.04 nM and 0.5 nM, between 0.05 nM and 0.45 nM, between 0.06 nM and 0.4 nM, between 0.62 nM and 0.888 nM, between 0.07 nM and 0.35 nM, between 0.08 nM and 0.3 nM, between 0.09 nM and 0.25 nM, between 0.1 nM and 0.2 nM, between 0.13 nM and 0.95 nM, between 0.2 nM and 0.95 nM, between 0.3 nM and 0.96 nM, between 0.4 nM and 0.5 nM, between 0.5 nM and 1.0 nM, between 0.6 nM and 1 .1 nM, between 0.7 nM and 1.2 nM, between 0.8 nM and 1 .0 nM, e.g. when assessed using the GLP-2 receptor potency assay described in the Examples below.

In some embodiments, the dual agonist has an EC50 at the GLP-2 receptor which is below 2nM or more preferably below 1.0 nM, below 0.9 nM, below 0.8 nM, below 0.7 nM, below 0.6 nM, below 0.5 nM, below 0.4 nM, below 0.3 nM, below 0.2 nM, below 0.1 nM, below 0.09 nM, below 0.08 nM, below 0.07 nM, below 0.06 nM, below 0.05 nM, below 0.04 nM, below 0.03 nM, below 0.02 nM, below 0.015, below 0.01 nM, below 0.009 nM, below 0.008 nM, below 0.007 nM, below 0.006 nM, or below 0.005 nM, e.g. when assessed using the GLP-2 receptor potency assay described in the Examples below.

In some embodiments, the dual agonist has an EC50 at the GLP-2 receptor which is between 0.005 nM and 2 nM, between 0.006 nM and 1.7 nM, between 0.007 nM and 1 .5 nM, between 0.009 nM and 1.3 nM, 0.01 nM and 1.2 nM, between 0.005 nM and 1 .0 nM, between 0.006 nM and 0.9 nM, between 0.007 nM and 0.8 nM, between 0.008 nM and 0.85 nM, between 0.009 nM and 0.7 nM, between 0.01 nM and 0.65 nM, between 0.02 nM and 0.6 nM, between 0.023 nM and 0.59 nM between 0.03 nM and 0.55 nM, between 0.04 nM and 0.5 nM, between 0.05 nM and 0.45 nM, between 0.06 nM and 0.4 nM, between 0.62 nM and 0.888 nM, between 0.07 nM and 0.35 nM, between 0.08 nM and 0.3 nM, between 0.09 nM and 0.25 nM, between 0.1 nM and 0.2 nM, between 0.13 nM and 0.95 nM, between 0.2 nM and 0.95 nM, between 0.3 nM and 0.96 nM, between 0.4 nM and 0.5 nM, between 0.5 nM and 1.0 nM, between 0.6 nM and 1 .1 nM, between 0.7 nM and 1.2 nM, between 0.8 nM and 1.0 nM, e.g. when assessed using the GLP-2 receptor potency assay described in the Examples below. An alternative measure of GLP-2 agonist activity may be derived by comparing the potency of a dual agonist with the potency of a known (or reference) GLP-2 agonist when both are measured in the same assay. Thus the relative potency at the GLP-2 receptor may be defined as: [EC5o(reference agonist)] / [ECso(dual agonist)].

Thus a value of 1 indicates that the dual agonist and reference agonist have equal potency, a value of >1 indicates that the dual agonist has higher potency (i.e. lower EC50) than the reference agonist, and a value of <1 indicates that the dual agonist has lower potency (i.e. higher EC50) than the reference agonist. The reference GLP-2 agonist may, for example, be human GLP-2(1 -33) or teduglutide ([Gly2]-hGLP-2 (1 -33)). Typically the relative potency will be between 0.001 and 100, e.g. between 0.001 and 10, between 0.001 and 5, between 0.001 and 1 , between 0.001 and 0.5, between 0.001 and 0.1 , between 0.001 and 0.05, or between 0.001 and 0.01 ; between 0.01 and 10, between 0.01 and 5, between 0.01 and 1 , between 0.01 and 0.5, between 0.01 and 0.1 , or between 0.01 and 0.05; between 0.05 and 10, between 0.05 and 5, between 0.05 and 1 , between 0.05 and 0.5, or between 0.05 and 0.1 ; between 0.1 and 10, between 0.1 and 5, between 0.1 and 1 , or between 0.1 and 0.5; between 0.5 and 10, between 0.5 and 5, or between 0.5 and 1 ; between 1 and 10, or between 1 and 5; or between 5 and 10.

The dual agonists described in the examples below may have a relative potency (using teduglutide as a reference) a relative potency between 0.1 and 1 , between 0.1 and 0.5, or between 0.1 and 0.25, between 0.1 and 0.3, between 0.25 and 1 , or between 0.25 and 0.5;

By contrast, the dual agonists of the invention have higher potency at the GLP-2 receptor (e.g. the human GLP-2 receptor) than human GLP-1 (7-37), liraglutide (NN221 1 ; Victoza), or Exendin-4. Thus, the relative potency of the dual agonists at the GLP-1 receptor compared to human GLP-1 (7-37), liraglutide (NN221 1 ; Victoza), or Exendin-4 is greater than 1 , typically greater than 5 or greater than 10, and may be up to 100, up to 500, or even higher.

Synthesis of dual agonists

It is preferred to synthesize dual agonists of the invention by means of solid-phase or liquid-phase peptide synthesis methodology. In this context, reference may be made to WO 98/1 1 125 and, among many others, Fields, G.B. et al., 2002, "Principles and practice of solid-phase peptide synthesis". In: Synthetic Peptides (2nd Edition), and the Examples herein.

In accordance with the present invention, a dual agonist of the invention may be synthesized or produced in a number of ways, including for example, a method which comprises

(a) synthesizing the dual agonist by means of solid-phase or liquid-phase peptide synthesis methodology and recovering the synthesized dual agonist thus obtained; or

(b) expressing a precursor peptide sequence from a nucleic acid construct that encodes the precursor peptide, recovering the expression product, and modifying the precursor peptide to yield a compound of the invention.

Expression is typically performed from a nucleic acid encoding the precursor peptide, which may be performed in a cell or a cell-free expression system comprising such a nucleic acid.

It is preferred to synthesize the analogues of the invention by means of solid-phase or liquid-phase peptide synthesis. In this context, reference is made to WO 98/1 1 125 and, among many others, Fields, GB et al., 2002, "Principles and practice of solid- phase peptide synthesis". In: Synthetic Peptides (2nd Edition), and the Examples herein.

For recombinant expression, the nucleic acid fragments encoding the precursor peptide will normally be inserted in suitable vectors to form cloning or expression vectors. The vectors can, depending on purpose and type of application, be in the form of plasmids, phages, cosmids, mini-chromosomes, or virus, but also naked DNA which is only expressed transiently in certain cells is an important vector. Preferred cloning and expression vectors (plasmid vectors) are capable of autonomous replication, thereby enabling high copy-numbers for the purposes of high-level expression or high-level replication for subsequent cloning.

In general outline, an expression vector comprises the following features in the 5'→3' direction and in operable linkage: a promoter for driving expression of the nucleic acid fragment, optionally a nucleic acid sequence encoding a leader peptide enabling secretion (to the extracellular phase or, where applicable, into the periplasma), the nucleic acid fragment encoding the precursor peptide, and optionally a nucleic acid sequence encoding a terminator. They may comprise additional features such as selectable markers and origins of replication. When operating with expression vectors in producer strains or cell lines it may be preferred that the vector is capable of integrating into the host cell genome. The skilled person is very familiar with suitable vectors and is able to design one according to their specific requirements. The vectors of the invention are used to transform host cells to produce the precursor peptide. Such transformed cells can be cultured cells or cell lines used for propagation of the nucleic acid fragments and vectors, and/or used for recombinant production of the precursor peptides. Preferred transformed cells are micro-organisms such as bacteria [such as the species Escherichia (e.g. E. coli), Bacillus (e.g. Bacillus subtilis), Salmonella, or Mycobacterium (preferably non-pathogenic, e.g. M. bovis BCG), yeasts (e.g., Saccharomyces cerevisiae and Pichia pastoris), and protozoans. Alternatively, the transformed cells may be derived from a multicellular organism, i.e. it may be fungal cell, an insect cell, an algal cell, a plant cell, or an animal cell such as a mammalian cell. For the purposes of cloning and/or optimised expression it is preferred that the transformed cell is capable of replicating the nucleic acid fragment of the invention. Cells expressing the nucleic fragment can be used for small-scale or large-scale preparation of the peptides of the invention.

When producing the precursor peptide by means of transformed cells, it is convenient, although far from essential, that the expression product is secreted into the culture medium. Pharmaceutical Compositions and Administration

An aspect of the present invention relates to a composition comprising a dual agonist according to the invention, or a pharmaceutically acceptable salt or solvate thereof, together with a carrier. In one embodiment of the invention, the composition is a pharmaceutical composition and the carrier is a pharmaceutically acceptable carrier. The present invention also relates to a pharmaceutical composition comprising a dual agonist according to the invention, or a salt or solvate thereof, together with a carrier, excipient or vehicle. Accordingly, the dual agonist of the present invention, or salts or solvates thereof, especially pharmaceutically acceptable salts or solvates thereof, may be formulated as compositions or pharmaceutical compositions prepared for storage or administration, and which comprise a therapeutically effective amount of a dual agonist of the present invention, or a salt or solvate thereof.

Suitable salts formed with bases include metal salts, such as alkali metal or alkaline earth metal salts, for example sodium, potassium or magnesium salts; ammonia salts and organic amine salts, such as those formed with morpholine, thiomorpholine, piperidine, pyrrolidine, a lower mono-, di- or tri-alkylamine (e.g., ethyl-tert-butyl-, diethyl-, diisopropyl-, triethyl-, tributyl- or dimethylpropylamine), or a lower mono-, di- or tri-(hydroxyalkyl)amine (e.g., mono-, di- or triethanolamine). Internal salts may also be formed. Similarly, when a compound of the present invention contains a basic moiety, salts can be formed using organic or inorganic acids. For example, salts can be formed from the following acids: formic, acetic, propionic, butyric, valeric, caproic, oxalic, lactic, citric, tartaric, succinic, fumaric, maleic, malonic, mandelic, malic, phthalic, hydrochloric, hydrobromic, phosphoric, nitric, sulphuric, benzoic, carbonic, uric, methanesulphonic, naphthalenesulphonic, benzenesulphonic, toluenesulphonic, p-toluenesulphonic (i.e. 4-methylbenzene-sulphonic), camphorsulphonic, 2- aminoethanesulphonic, aminomethylphosphonic and trifluoromethanesulphonic acid (the latter also being denoted triflic acid), as well as other known pharmaceutically acceptable acids. Amino acid addition salts can also be formed with amino acids, such as lysine, glycine, or phenylalanine.

In one embodiment, a pharmaceutical composition of the invention is one wherein the dual agonist is in the form of a pharmaceutically acceptable acid addition salt.

As will be apparent to one skilled in the medical art, a "therapeutically effective amount" of a dual agonist compound or pharmaceutical composition thereof of the present invention will vary depending upon, inter alia, the age, weight and/or gender of the subject (patient) to be treated. Other factors that may be of relevance include the physical characteristics of the specific patient under consideration, the patient's diet, the nature of any concurrent medication, the particular compound(s) employed, the particular mode of administration, the desired pharmacological effect(s) and the particular therapeutic indication. Because these factors and their relationship in determining this amount are well known in the medical arts, the determination of therapeutically effective dosage levels, the amount necessary to achieve the desired result of treating and/or preventing and/or remedying malabsorption and/or low-grade inflammation described herein, as well as other medical indications disclosed herein, will be within the ambit of the skilled person.

As used herein, the term "a therapeutically effective amount" refers to an amount which reduces symptoms of a given condition or pathology, and preferably which normalizes physiological responses in an individual with that condition or pathology. Reduction of symptoms or normalization of physiological responses can be determined using methods routine in the art and may vary with a given condition or pathology. In one aspect, a therapeutically effective amount of one or more dual agonists, or pharmaceutical compositions thereof, is an amount which restores a measurable physiological parameter to substantially the same value (preferably to within 30%, more preferably to within 20%, and still more preferably to within 10% of the value) of the parameter in an individual without the condition or pathology in question.

In one embodiment of the invention, administration of a compound or pharmaceutical composition of the present invention is commenced at lower dosage levels, with dosage levels being increased until the desired effect of preventing/treating the relevant medical indication is achieved. This would define a therapeutically effective amount. For the dual agonists of the present invention, alone or as part of a pharmaceutical composition, such human doses of the active dual agonist may be between about 0.01 pmol/kg and 500 μηΊθΙ/kg body weight, between about 0.01 pmol/kg and 300 μηΊθΙ/kg body weight, between 0.01 pmol/kg and 100 μηΊθΙ/kg body weight, between 0.1 pmol/kg and 50 μηΊθΙ/kg body weight, between 1 pmol/kg and 10 μηΊθΙ/kg body weight, between 5 pmol/kg and 5 μηΊθΙ/kg body weight, between 10 pmol/kg and 1 μηΊθΙ/kg body weight, between 50 pmol/kg and 0.1 μηΊθΙ/kg body weight, between 100 pmol/kg and 0.01 μηΊθΙ/kg body weight, between 0.001 μηΊθΙ/kg and 0.5 μηΊθΙ/kg body weight, between 0.05 μηΊθΙ/kg and 0.1 μηΊθΙ/kg body weight.

The therapeutic dosing and regimen most appropriate for patient treatment will of course vary with the disease or condition to be treated, and according to the patient's weight and other parameters. Without wishing to be bound by any particular theory, it is expected that doses, in the μ9 Ι<9 range, and shorter or longer duration or frequency of treatment may produce therapeutically useful results, such as a statistically significant increase particularly in small bowel mass. In some instances, the therapeutic regimen may include the administration of maintenance doses appropriate for preventing tissue regression that occurs following cessation of initial treatment. The dosage sizes and dosing regimen most appropriate for human use may be guided by the results obtained by the present invention, and may be confirmed in properly designed clinical trials.

An effective dosage and treatment protocol may be determined by conventional means, starting with a low dose in laboratory animals and then increasing the dosage while monitoring the effects, and systematically varying the dosage regimen as well. Numerous factors may be taken into consideration by a clinician when determining an optimal dosage for a given subject. Such considerations are known to the skilled person.

Medical Conditions

In a broad aspect, the present invention provides a dual agonist of the invention for use as a medicament.

In a further aspect, the present invention relates to a dual agonist of the invention for use in therapy.

The dual agonists described in this specification have biological activities of both GLP-1 and GLP-2.

GLP-2 induces significant growth of the small intestinal mucosal epithelium via the stimulation of stem cell proliferation in the crypts and inhibition of apoptosis on the villi (Drucker et al. Proc Natl Acad Sci U S A. 1996, 93:791 1 -6). GLP-2 also has growth effects on the colon. GLP-2 also inhibits gastric emptying and gastric acid secretion (Wojdemann et al. J Clin Endocrinol Metab. 1999, 84:2513-7), enhances intestinal barrier function (Benjamin et al.Gut. 2000, 47:1 12-9.), stimulates intestinal hexose transport via the upregulation of glucose transporters (Cheeseman, Am J Physiol. 1997, R1965-71 ), and increases intestinal blood flow (Guan et al. Gastroenterology. 2003, 125, 136-47).

The beneficial effects of GLP-2 in the small intestine have raised considerable interest as to the use of GLP-2 in the treatment of intestinal disease or injury (Sinclair and Drucker, Physiology 2005: 357-65). Furthermore, GLP-2 has been shown to prevent or reduce mucosal epithelial damage in a wide number of preclinical models of gut injury, including chemotherapy-induced enteritis, ischemia-reperfusion injury, dextran sulfate-induced colitis and genetic models of inflammatory bowel disease (Sinclair and Drucker Physiology 2005: 357-65). The GLP-2 analogue teduglutide (Gly2- hGLP-2) is approved for treatment of short bowel syndrome under the trade names Gattex and Revestive.

GLP-1 is a peptide hormone known for its important role in glucose homeostasis. When secreted from the gastrointestinal tract in response to nutrient ingestion, GLP-1 potentiates glucose-stimulated insulin secretion from the β-cells (Kim and Egan, 2008, Pharmacol. Rev. 470-512). Furthermore, GLP-1 or it analogues has been shown to increase somatostatin secretion and suppress glucagon secretion (Hoist JJ, 2007, Physiol Rev. 1409-1439).

Besides the primary actions of GLP-1 on glucose-stimulated insulin secretion, GLP-1 is also known as a key regulator of appetite, food intake, and body weight. Moreover, GLP-1 can inhibit gastric emptying and gastrointestinal motility in both rodents and humans, most likely through GLP-1 receptors present in the gastrointestinal tract (Hoist JJ, 2007, Physiol Rev. 1409-1439; Hellstrom et al., 2008, Neurogastroenterol Motil. Jun; 20(6):649-659). In addition, GLP-1 seems to have insulin-like effects in major extrapancreatic tissues, participating in glucose homeostasis and lipid metabolism in tissues such as muscle, liver, and adipose tissues (Kim and Egan, 2008, Pharmacol. Rev. 470-512).

Thus the dual agonist compounds of the present invention may be used to increase intestinal mass, improve intestinal function (especially intestinal barrier function), increase intestinal blood flow, or repair intestinal damage or dysfunction (whether structural or functional), e.g. damage to the intestinal epithelium. They may also be used in the prophylaxis or treatment of conditions which may be ameliorated by these effects, and in reducing the morbidity related to gastrointestinal damage.

The dual agonists therefore find use in many gastrointestinal disorders. The term "gastrointestinal" is used here to include the entire gastrointestinal tract, including oesophagus, stomach, small intestine (duodenum, jejunum, ileum) and large intestine (cecum, colon, rectum), but especially the small intestine and colon. Thus, conditions in which the dual agonists may be of benefit include malabsorption, ulcers (which may be of any aetiology, e.g., peptic ulcers, Zollinger-Ellison Syndrome, drug-induced ulcers, and ulcers related to infections or other pathogens), short-bowel syndrome, cul-de-sac syndrome, inflammatory bowel disease (Crohn's disease and ulcerative colitis), irritable bowel syndrome, pouchitis, celiac sprue (for example arising from gluten induced enteropathy or celiac disease), tropical sprue,

hypogammaglobulinemic sprue and mucositis or diarrhea induced by chemotherapy or radiation therapy.

The dual agonists may also find use in certain conditions which do not primarily affect gastrointestinal tissue but which may be caused or exacerbated by factors arising from intestinal dysfunction. For example, impaired intestinal barrier function (which may be referred to as "leakiness" of the intestine or gut) can lead to transit of materials from the lumen of the gut directly into the bloodstream and thus to the kidney, lung and/or liver. These materials may include food molecules such as fats, which contribute to hepatitis and/or fatty liver diseases, including parenteral nutrition associated gut atrophy, PNALD (Parenteral Nutrition-Associated Liver Disease), NAFLD (Non-Alcoholic Fatty Liver Disease) and NASH (Non-Alcoholic

Steatohepatitis).

The materials crossing into the bloodstream may also include pathogens such as bacteria, and toxins such as bacterial lipopolysaccharide (LPS), which may contribute to systemic inflammation (e.g. vascular inflammation). Such inflammation is often referred to as "low grade inflammation" and is a contributing factor to the

pathogenesis of metabolic endotoxemia (a condition seen in both diabetes and obesity, discussed further below), primary biliary cirrhosis and hepatitis. Entry of pathogens to the bloodstream may also result in conditions such as necrotising enterocolitis.

Low grade inflammation is not characterised by the normal symptoms of acute inflammation such as pain, fever and redness, but can be detected via the presence of inflammatory markers in the blood, such as C-reactive protein and pro- inflammatory cytokines including TNF-alpha (tumour necrosis factor alpha).

The dual agonists may also find use in conditions which primarily affect other tissues but have gastrointestinal side-effects. For example, inflammatory conditions such as pancreatitis result in elevated levels of circulating inflammatory mediators which may in turn induce intestinal damage or intestinal dysfunction, such as impairment of barrier function. In some circumstances, this may lead to more severe systemic inflammatory conditions such as sepsis, or to surgical procedures or mechanical injuries (volvulus) where blood supply to the intestine is interrupted, ultimately leading to ischaemia-reperfusion injuries. Similarly, graft versus host disease (GVHD) may result in substantial tissue damage to the gastrointestinal tract, resulting in impaired barrier function and other side effects such as diarrhea. Thus, the dual agonists described may be useful for the

prophylaxis or treatment of intestinal dysfunction or damage caused by or associated with GVHD, as well as prophylaxis or treatment of side effects such as diarrhea caused by or associated with GVHD.

The dual agonist compounds described herein also find use, inter alia, in reducing or inhibiting weight gain, reducing rate of gastric emptying or intestinal transit, reducing food intake, reducing appetite, or promoting weight loss. The effect on body weight may be mediated in part or wholly via reducing food intake, appetite or intestinal transit.

Thus the dual agonists of the invention can be used for the prophylaxis or treatment of obesity, morbid obesity, obesity-linked gallbladder disease and obesity-induced sleep apnea.

Independently of their effect on body weight, the dual agonists of the invention may have a beneficial effect on glucose tolerance and/or glucose control. They may also be used to modulate (e.g. improve) circulating cholesterol levels, being capable of lowering circulating triglyceride or LDL levels, and increasing HDL/LDL ratio.

Thus, they may be used for the prophylaxis or treatment of inadequate glucose control, glucose tolerance or dyslipidaemia (e.g. elevated LDL levels or reduced HDL/LDL ratio) and associated conditions, including diabetes (e.g. Type 2 diabetes, gestational diabetes), pre-diabetes, metabolic syndrome and hypertension.

Many of these conditions are also associated with obesity or overweight. The effects of the dual agonists on these conditions may therefore follow from their effect on body weight, in whole or in part, or may be independent thereof. Effects on body weight may be therapeutic or cosmetic. The dual agonist activity of the compounds described herein may be particularly beneficial in many of the conditions described, as the two activities may complement one another.

For example, malabsorption is a condition arising from abnormality in the absorption of water and/or food nutrients, such as amino acids, sugars, fats, vitamins or minerals, via the gastrointestinal (Gl) tract, leading to malnutrition and/or dehydration. Malabsorption may be a result of physical (e.g. traumatic) or chemical damage to the intestinal tract. Dual agonists as described in this specification may be capable of improving intestinal barrier function, reducing gastric empting, and increasing intestinal absorption while at the same time normalising intestinal transit time. This would not only help patients to increase the absorption of nutrients and liquid, but would also alleviate patients' social problems related to meal- stimulated bowel movements.

Furthermore, intestinal function and metabolic disorders may be closely inter-related, with each contributing to the development or symptoms of the other.

As mentioned above, obesity is linked with low grade inflammation (sometimes designated "obesity-linked inflammation"). It is also generally recognised that obesity (along with other syndromes) causes an increased vascular permeability which allows pathogens and toxins such as LPS to enter the cell wall of the intestinal tract and thereby initiate inflammation. The changes that result from the inflammatory response are essentially the same regardless of the cause and regardless of where the insult arises. The inflammatory response may be acute (short lived) or chronic (longer lasting).

It has been demonstrated that, e.g., obese mice (ob/ob and db/db mice) have a disrupted mucosal barrier function and exhibit increased low-grade inflammation

(Brun et al., 2007, Am. J. Physiol. Gastrointest. Liver Physiol., 292: G518-G525, Epub 5 Oct 2006). These observations were further extended to C57BL6/J mice maintained on a high-fat diet (Cani et al., 2008, Diabetes, vol. 57, 1470-1481 ) and to non-obese diabetic mice (Hadjiyanni et al., 2009, Endocrinology, 150(2): 592-599). Cani and colleagues (Gut; 2009, 58:1091 -1 103,) reported that in ob/ob mice, the modulation of the gut microbiota resulted in decreased intestinal barrier dysfunction and reduced systemic inflammation via a GLP-2 dependent pathway. Further, the increased intestinal permeability observed in obese and diabetic patients is likely to play a more vital role in the disease progression than previously anticipated.

Increased intestinal permeability leads to increased bacterial lipopolysaccharide (LPS) transport across the intestinal barrier. This increased LPS activates immune cells, such as circulating macrophages and macrophages residing in organs in the body, causing low-grade chronic inflammation that may be involved in the

pathogenesis of many diseases. This phenomenon is called metabolic endotoxemia (ME).

The inflammatory process may also play a role in causing metabolic dysfunction in obese individuals, such as insulin resistance and other metabolic disturbances. Thus the dual agonist compounds of the invention may be particularly useful for prophylaxis or treatment of low grade inflammation, especially in obese or overweight individuals, exerting beneficial effects via the GLP-1 agonist component of their activity and/or the GLP-2 component of their activity.

The therapeutic efficacy of treatment with a dual agonist of the invention may be monitored by enteric biopsy to examine the villus morphology, by biochemical assessment of nutrient absorption, by non-invasive determination of intestinal permeability, by patient weight gain, or by amelioration of the symptoms associated with these conditions.

In a further aspect there is provided a therapeutic kit comprising a dual agonist of the invention, or a pharmaceutically acceptable salt or solvate thereof.

The following examples are provided to illustrate preferred aspects of the invention and are not intended to limit the scope of the invention in any way.

Examples The following examples are provided to illustrate preferred aspects of the invention and are not intended to limit the scope of the invention.

MATERIAL AND METHODS

General Peptide Synthesis

List of abbreviations and suppliers are provided in the table below List of abbreviations and suppliers

Abbreviation Name Brand / Supplyer

Resins

TentaGel™ PHB AA(Proct)- Fmoc Rapp Polymere

TentaGel™ SRAM Rapp Polymere

Amino

acids

Pseudoprolines (E.g. QT,

AT, FS) Jupiter Bioscience Ltd.

Fmoc-L-AA-OH Senn Chemicals AG

Coupling

reagents

(1 -Cyano-2-ethoxy-2- oxoethylidenaminooxy)dime

thylamino-morpholino- carbenium

COMU hexafluorophosphate Watson International Ltd.

DIC Diisopropylcarbodiimide Fluka / Sigma Aldrich Co.

N-[(dimethylamino)-1 H- 1 ,2,3-triazol[4,5-b]pyridine- 1 -ylmethylene]-N- methylmethanaminium

hexafluorophosphate N-

HATU oxide ChemPep Inc.

HOBt Hydroxybenzotriazole Sigma-Aldrich Co.

Solvents

reagents

Boc₂0 Di-tert-butyl pyrocarbonate Advanced ChemTech

DCM Dichloromethane Prolabo (VWR)

DIPEA Diisopropylethylamine Fluka / Sigma Aldrich Co.

DMF N,N-dimethylformamide Taminco

DODT 3,6-dioxa-1 ,8-octanedithiol Sigma-Aldrich Co.

Et₂0 Diethyl ether Prolabo (VWR)

EtOH Ethanol CCS Healthcare AB

Formic acid (HPLC) Sigma-Aldrich Co.

H₂0 Water, Milli-Q water Millipore

MeCN Acetonitrile (HPLC) Sigma-Aldrich Co.

NMP N-methylpyrrolidone Sigma-Aldrich Co.

Piperidine Jubliant Life Sciences Ltd.

Chemicals Raw Materials

TFA Trifluoroacetic acid (HPLC) Ltd.

TIS Triisopropylsilane Sigma-Aldrich Co.

MeOH Methanol Sigma-Aldrich Co. Apparatus and synthetic strategy

Peptides were synthesized batchwise on a peptide synthezier, such as a CEM Liberty Peptide Synthesizer or a Symphony X Synthesizer, according to solid phase peptide synthetic procedures using 9-fluorenylmethyloxycarbonyl (Fmoc) as N-oarmino protecting group and suitable common protection groups for side-chain functionalities.

As polymeric support based resins, such as e.g. TentaGel™, was used. The synthesizer was loaded with resin that prior to usage was swelled in DMF.

Coupling

CEM Liberty Peptide Synthesizer A solution of Fmoc-protected amino acid (4 equiv.) was added to the resin together with a coupling reagent solution (4 equiv.) and a solution of base (8 equiv.). The mixture was either heated by the microwave unit to 70-75°C and coupled for 5 minutes or coupled with no heat for 60 minutes. During the coupling nitrogen was bubbled through the mixture. Symphony X Synthesizer

The coupling solutions were transferred to the reaction vessels in the following order: amino acid (4 equiv.), HATU (4 equiv.) and DIPEA (8 equiv.). The coupling time was 10 min at room temperature (RT) unless otherwise stated. The resin was washed with DMF (5 x 0,5 min). In case of repeated couplings the coupling time was in all cases 45 min at RT.

Deprotection

CEM Liberty Peptide Synthesizer

The Fmoc group was deprotected using piperidine in DMF or other suitable solvents. The deprotection solution was added to the reaction vessel and the mixture was heated for 30 sec. reaching approx. 40°C. The reaction vessel was drained and fresh deprotection solution was added and subsequently heated to 70-75°C for 3 min. After draining the reaction vessel the resin was washed with DMF or other suitable solvents. Symphony X Synthesizer

Fmoc deprotection was performed for 2,5 minutes using 40% piperidine in DMF and repeated using the same conditions. The resin was washed with DMF (5 x 0,5 min).

Cleavage

The dried peptide resin was treated with TFA and suitable scavengers for

approximately 2 hours. The volume of the filtrate was reduced and the crude peptide was precipitated after addition of diethylether. The crude peptide precipitate was washed several times with diethylether and finally dried.

HPLC purification of the crude peptide

The crude peptide was purified by preparative reverse phase HPLC using a conventional HPLC apperatus, such as a Gilson GX-281 with 331/332 pump combination, for binary gradient application equipped with a column, such as 5 x 25 cm Gemini NX 5u C18 1 10A column, and a fraction collector using a flow 20-40 ml/min with a suitable gradient of buffer A (0.1 % Fomic acid, aq.) or A (0.1 % TFA, aq.) and buffer B (0.1 % Formic acid, 90% MeCN, aq.) or B (0.1 % TFA, 90% MeCN, aq.). Fractions were analyzed by analytical HPLC and MS and selected fractions were pooled and lyophilized. The final product was characterized by HPLC and MS.

Analytical HPLC

Final purities were determined by analytic HPLC (Agilent 1 100/1200 series) equipped with auto sampler, degasser, 20 μΙ flow cell and Chromeleon software. The HPLC was operated with a flow of 1.2 ml/min at 40°C using an analytical column, such as Kinetex 2.6 μηη XB-C18 100A 100x4,6 mm column. The compound was detected and quantified at 215 nm. Buffers A (0.1 % TFA, aq.) and buffer B (0.1 % TFA, 90% MeCN, aq.).

Mass spectroscopy

Final MS analysis were determined on a conventionial mass spectroscopy, e.g.

Waters Xevo G2 Tof, equipped with electrospray detector with lock-mass calibration and MassLynx software. It was operated in positive mode using direct injection and a cone voltage of 15V (1 TOF), 30 V (2 TOF) or 45 V (3 TOF) as specified on the chomatogram. Precision was 5 ppm with a typical resolution of 15,000-20,000.

GLP-1 and GLP-2 receptor potency assays Peptides of the present invention act as both GLP-1 and GLP-2 agonists and thus activate the GLP-1 receptor and GLP-2 receptor, respectively. One useful in vitro assay for measuring GLP-1 receptor (GLP-1 R) and GLP-2 receptor (GLP-2 R) activation is quantification of cAMP, i.e. 3'-5'-cyclic adenosine monophosphate, which is a second messenger essential in many biological processes, and one of the most ubiquitous mechanisms for regulating cellular functions. An example is the cAMP AlphaScreen^® assay from Perkin Elmer which has been used to quantify the cAMP response upon GLP-1 and GLP-2 receptor activation in HEK293 cells stably expressing GLP-1 R or GLP-2 R. Test compounds eliciting an increase in the intracellular level of cAMP can be tested in these assays and the response normalized relative to a positive and negative control (vehicle) to calculate the EC50 and maximal response from the concentration - response curve using the 4- parameter logistic (4PL) nonlinear model for curve fitting. Example 1 : Synthesis of the compounds

Compounds Synthesised

The compounds of Table 1.1 were synthesized using the above techniques.

Table 1.1 : Compounds synthesized

Cpd. 17 Hy-H[Aib]DGSFSEELATILDEQAARDFIAWLIQHKITD-OH;

Cpd. 18 Hy-H[Aib]DGSFSDEMNTILDEQAARDFIAWLIQHKITD-OH;

Cpd. 19 Hy-H[Aib]DGSFSDELNTILDEQAARDFIAWLIQHKITD-OH;

Cpd. 20 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLYQQKITD-OH

Cpd. 21 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLQQHKITD-OH

Cpd. 22 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLQQQKITD-OH

Cpd. 23 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLYQHKITD-OH

Cpd. 24 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLHQHKITD-OH

Cpd. 25 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLYQYKITD-OH;

Cpd. 26 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLHQQKITD-OH

Cpd. 27 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLQQYKITD-OH

Cpd. 28 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLHQYKITD-OH

Cpd. 29 Hy-H[Aib]DGSFSDELATILDEQAARDFIAWLHQHKITD-OH

Cpd. 30 Hy-H[Aib]DGSFSDELATILDGKAARDFIAWLHQHKITD-OH

Cpd. 31 Hy-H[Aib]DGSFSEELATILDEQAARDFIAWLHQHKITD-OH

Cpd. 32 Hy-H[Aib]DGSFSDELNTILDEQAARDFINWLHQHKITD-OH.;

Cpd. 33 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITD-OH

Cpd. 34 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITE-NH₂

Cpd. 35 Hy-HGDGSFSSELATILDEQAAREFIAWLIQHKITD-NH₂

Cpd. 36 Hy-HGDGSFSSELATILEEQAARDFIAWLIQHKITD-NH₂

Cpd. 37 Hy-HGDGSFSSELATILEEQAAREFIAWLIQHKITE-NH₂

Cpd. 38 Hy-HGDGSFSSELATILEEQAAREFIAWLIQHKITD-NH₂

Cpd. 39 Hy-H[Aib]DGTFTSELATILDEQAARDFIAWLIAHKITD-OH

Cpd. 40 Hy-H[Aib]DGTFSSELATILDEQAARDFIAWLIAHKITD-OH

Cpd. 41 Hy-H[Aib]DGSFTSELATILDEQAARDFIAWLIAHKITD-OH

The following reference compounds A and B were also synthesized:

A Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLIQTKITD-OH

B Hy-HGDGSFSSELATILDEQAARDFIAWLIQTKITD-OH

For illustration purpose only, the synthesis of two selected compounds is described in detail below. Synthesis of Compound 8

Hy-H[Aib]DGSFSDELATILDGKAARDFIAWLIQHKITD-OH Solid phase peptide synthesis was performed on a Symphony X Synthesizer using standard Fmoc chemistry. TentaGel S PHB Asp(tBu)Fmoc (1 .15 g; 0.24 mmol/g) was swelled in DMF (10 ml) prior to use and the Fmoc-group was deprotected according to the procedure described above. Coupling

Suitable protected Fmoc-amino acids according to the sequence were coupled as described above using HATU as coupling reagent. All couplings were performed at R.T. In order to facilitate the synthesis, a pseudoproline were used: in position 6 and 7 Fmoc-Phe-Ser(psi Me,Mepro)-OH.

Deprotection

Fmoc deprotection was performed according to the procedure described above. Cleavage of the peptide from the solid support

The peptide-resin was washed with EtOH (3 x 10 ml) and Et20 (3 x 10 ml) and dried to constant weight at room temperature (r.t.). The peptide was cleaved from the resin by treatment with TFA TIS/H₂0 (95/2,5/2,5; 40 ml, 2 h; r.t.). The volume of the filtrate was reduced and the crude peptide was precipitated after addition of diethylether. The crude peptide precipitate was washed several times with diethylether and finally dried to constant weight at room temperature yield 850 mg crude peptide product (purity -45%).

HPLC purification of the crude peptide

The crude peptide was purified by preparative reverse phase HPLC using a Gilson GX-281with 331/332 pump combination for binary gradient application equipped with a 5 x 25 cm Gemini NX 5u C18 1 10A, column and a fraction collector and run at 30 ml/min with a gradient of buffer A (0.1 % TFA, aq.) and buffer B (0.1 % TFA, 90% MeCN, aq.) gradient from 30%B to 60%B in 47 min. Fractions were analyzed by analytical HPLC and MS and relevant fractions were pooled and lyophilized to yield 185,3 mg, with a purity of 95% as characterized by HPLC and MS as described above. Calculated monoisotopic MW = 3667.86, found 3667.86. Synthesis of Compound 11

Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK-[NH₂]

Solid phase peptide synthesis was performed on a Symphony X Synthesizer using standard Fmoc chemistry. TentaGel S-Ram (1 .23 g; 0.23 mmol/g) was swelled in DMF (10 ml) prior to use and the Fmoc-group was deprotected according to the procedure described above.

Coupling

Suitable protected Fmoc-amino acids according to the sequence were coupled as described above using HATU as coupling reagent. All couplings were performed at R.T. In order to facilitate the synthesis, a pseudoproline were used: in position 6 and 7 Fmoc-Phe-Ser(psi Me,Mepro)-OH, in position 1 1 -12 Fmoc-Ala-Thr(psi Me, Me pro)- OH. Deprotection

The peptide-resin was washed with EtOH (3 x 10 ml) and Et20 (3 x 10 ml) and dried to constant weight at room temperature (r.t.). The peptide was cleaved from the resin by treatment with TFA TIS/H₂0 (95/2,5/2,5; 40 ml, 2 h; r.t.). The volume of the filtrate was reduced and the crude peptide was precipitated after addition of diethylether. The crude peptide precipitate was washed several times with diethylether and finally dried to constant weight at room temperature yield 1000 mg crude peptide product (purity -30%). HPLC purification of the crude peptide

The crude peptide was purified by preparative reverse phase HPLC using a Gilson GX-281with 331/332 pump combination for binary gradient application equipped with a 5 x 25 cm Gemini NX 5u C18 1 10A, column and a fraction collector and run at 35 ml/min with a gradient of buffer A (0.1 % TFA, aq.) and buffer B (0.1 % TFA, 90% MeCN, aq.) gradient from 20%B to 45%B in 47 min. Fractions were analyzed by analytical HPLC and MS and relevant fractions were pooled and lyophilized to yield 83,9 mg, with a purity of 90% as characterized by HPLC and MS as described above. Calculated monoisotopic MW = 4451 ,41 , found 4451 ,72. Example 2: GLP-1 R and GLP-2R EC₅o measurements

Generation of cell line expressing human GLP-1 receptors

The cDNA encoding the human glucagon-like peptide 1 receptor (GLP-1 R) (primary accession number P43220) was cloned from the cDNA BC1 12126

(MGC:138331/IMAGE:8327594). The DNA encoding the GLP-1 -R was amplified by PCR using primers encoding terminal restriction sites for subcloning. The 5'-end primers additionally encoded a near Kozak consensus sequence to ensure efficient translation. The fidelity of the DNA encoding the GLP-1 -R was confirmed by DNA sequencing. The PCR products encoding the GLP-1 -R were subcloned into a mammalian expression vector containing a neomycin (G418) resistance marker. The mammalian expression vectors encoding the GLP-1 -R were transfected into HEK293 cells by a standard calcium phosphate transfection method. 48 hours post- transfection, cells were seeded for limited dilution cloning and selected with 1 mg/ml G418 in the culture medium. Following 3 weeks in G418 selection clones were picked and tested in a functional GLP-1 receptor potency assay as described below. One clone was selected for use in compound profiling.

Generation of cell line expressing human GLP-2 receptors

The hGLP2-R was purchased from MRC-geneservice, Babraham, Cambridge as an Image clone: 5363415 (1 1924-117). For subcloning into a mammalian expression vector, primers for subcloning were obtained from DNA-Technology, Risskov,

Denmark. The 5' and 3' primers used for the PCR reaction include terminal restriction sites for cloning and the context of the 5' primer is modified to a Kozak consensus without changing the sequence of the product encoded by the ORF. A standard PCR reaction was run using Image clone 5363415 (1 1924-117) as a template with the above mentioned primers and Polymerase Herculase II Fusion in a total vol. of 50μΙ. The generated PCR product was purified using GFX PCR and Gel band purification kit, digested with restriction enzymes and cloned into the mammalian expression vector using Rapid DNA Ligation Kit. Ligation reaction was transformed to XL10 Gold Ultracompetent cells and colonies were picked for DNA production using Endofree Plasmid maxi kit. Subsequent sequence analysis was conducted by MWG Eurofins, Germany. The clone was confirmed to be the hGLP-2 (1 -33) receptor, splice variant rs17681684.

HEK293 cells were transfected using the Lipofectamine PLUS transfection method. The day before transfection, HEK293 cells were seeded in two T75 flasks at a density of 2x10⁶ cells / T75 flask in cell culturing medium without antibiotics. On the day of transfection, cells were washed with 1x DPBS and medium was replaced with Optimem to a volume of 5 mL / T75 flask before addition of Lipofectamine-plasmid complexes were added gently and drop wise to the cells in T75 flasks and replaced with growth medium after 3 hours and again to growth medium supplemented with 50C^g/ml_ G418 after 24 hours. Following 4 weeks in G418 selection, clones were picked and tested in a functional GLP-2 receptor potency assay as described below. One clone was selected for use in compound profiling.

GLP-1R and GLP-2 receptor potency assays

The cAMP AlphaScreen^® assay from Perkin Elmer was used to quantitate the cAMP response to activation of the GLP1 and GLP2 receptor, respectively. Exendin-4 was used as reference compound for GLP1 receptor activation and Teduglutide as reference compound for GLP2 receptor activation. Data from test compounds eliciting an increase in the intracellular level of cAMP were normalized relative to the positive and negative control (vehicle) to calculate the EC50 and maximal response from the concentration response curve. The results are listed in Table 2.1.

Table 2. EC50 measurements

Cpd 12

0.280 nM 0.100 nM

Cpd 13

0.051 nM 0.130 nM

Cpd 14

0.240 nM 0.190 nM

Cpd 15

0.057 nM 0.220 nM

Cpd 16

1 .200 nM 0.027 nM

Cpd 17

1 .700 nM 0.013 nM

Cpd 18

13.000 nM 0.009 nM

Cpd 19

12.000 nM 0.010 nM

Cpd 20

0.300 nM 0.01 1 nM

Cpd 21

0.100 nM 0.012 nM

Cpd 22

0.077 nM 0.016 nM

Cpd 23

0.330 nM 0.016 nM

Cpd 24

0.710 nM 0.019 nM

Cpd 25

0.300 nM 0.027 nM

Cpd 26

0.580 nM 0.028 nM

Cpd 27

0.062 nM 0.029 nM

Cpd 28

0.580 nM 0.049 nM

Cpd 29

9.300 nM 0.016 nM

Cpd 30

10.000 nM 0.024 nM

Cpd 31

55.000 nM 0.013 nM

Cpd 32

610.000 nM 0.019 nM

Cpd 33

0.120 nM 0.017 nM

Cpd 34

0.053 nM 0.029 nM

Cpd 35

0.054 nM 0.068 nM

Cpd 36

0.032 nM 0.065 nM

Cpd 37

0.022 nM 0.180 nM

Cpd 38

0.019 nM 0.150 nM

Cpd 39

0.004 nM 0.022 nM

Cpd 40

0.005 nM 0.021 nM

Cpd 41

0.005 nM 0.024 nM

Example 3: Effect on fasting glucose and intestinal wet weight in normal mice

Normal chow-fed C57BL/6J male mice were used. The mice were kept in standard housing conditions, light-, temperature-, and humidity-controlled room (12:12 h light- dark cycle, with lights on at 06.00-18.00 h; 20-22°C; 50-80% relative humidity). Each dosing group consisted of 6 animals. Mice were dosed twice daily with 250 nmol/kg of the test compound or vehicle for 4 days (day 0 - day3) via subcutaneous

administration.

Mice were fasted and blood glucose levels measured after a single s.c. injection with peptides. Animals were sacrificed after final dosing on day 3, and small intestinal wet weights were measured.

Results

All test compounds (250 nmol/kg) reduced fasting blood glucose levels compared to the vehicle-treated mice (Table 3).

All compounds increased small intestine wet weight as compared to the vehicle- treated mice (Table 3).

Table 3. Effects on fasting blood glucose levels and small intestinal wet weight.

Claims

1. A GLP-1/GLP-2 dual agonist represented by the formula R¹-X*-U-R²

wherein:

R¹ is hydrogen (Hy), Ci_-4 alkyl (e.g. methyl), acetyl, formyl, benzoyl or trifluoroacetyl; R² is NH₂ or OH;

X* is a peptide having the formula I

H-X2-DG-X5-F-X7-X8-E-X10-X11 -TIL-X15-X16-X17-A-X19-X20-X21 -FI-X24-WL-X27- X28-X29-KIT-X33

wherein:

X2 is G or Aib;

X5 is S orT;

X7 is S orT;

X8is E, SorD;

X10 is L, VorM

X11 is N, AorS;

X15 is DorE;

X16 is E, AorG;

X17 isQ, E, L or K;

X19 is A, VorS;

X20 is R or K;

X21 is D, L or E;

X24 is N, S or A;

X27 is I, H, Q, KorY;

X28 isQ, E, H, Y, L, K, RorA;

X29 is H, Q, KorY;

X33 is D or E;

or a pharmaceutically acceptable salt or solvate thereof.

2. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 1 wherein:

X2 is G or Aib;

X5 is S orT;

X7 is S or T;

X8 is E, S or D;

X10 is LorM

X11 is N, AorS;

X15 is D or E;

X16 is E or G;

X17 is Qor K;

X19 is AorS;

X20 is R;

X21 is D or E;

X24 is N or A;

X27 is I, H, Q or Y;

X28 is Q or A;

X29 is H, Q orY; and

X33 is DorE.

3. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 1 or claim 2 wherein X^* is a peptide having the formula II:

H-X2-DG-X5-FS-X8-E-X10-X11 -Tl LD-X16-X17-A-X19-R-DFI-X24-WL-X27-Q-X29-

KITD

wherein:

X2 is G or Aib;

X5 is S orT;

X8 is E, S or D;

X10 is LorM

X11 is N, AorS;

X16 is E or G;

X17isQor K;

X19 is AorS;

X24 is N or A;

X27 is I, H, QorY

X29 is H, Q or Y; U is absent or a sequence of 1 -15 Lys residues, each independently selected from K and k.

4. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 1 to 3 wherein X^* is a peptide having the formula III

H-X2-DG-X5-FS-X8-E-X10-X1 1 -Tl LD-X16-X17-A-X19-R-DFI-X24-WLIQ-X29-KITD wherein:

X2 is G or Aib;

X5 is S or T;

X8 is E, S or D;

X10 is L or M;

X1 1 is N, A or S;

X16 is E or G;

X17 is Q or K;

X19 is A or S;

X24 is N or A; and

X29 is H, Q or Y.

5. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein

X16 is E and X29 is H, Q or Y; and/or

X17 is Q and X29 is H, Q or Y.

6. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein X29 is H.

7. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to anyone of the preceding claims wherein X1 1 is A.

8. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein X2 is Aib.

9. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein:

X27 is Q and X29 is Q;

X28 is A and X29 is H;

X28 is E and X29 is H; X10is L, X16isEandX17isQ;

X16isE, X17isQand X24 is A;

X16isE, X17isQandX19is A;

X10 is L, X16 is E, X17 is Q and X29 is H;

XIOisL, X11 isA, X16isE, X17isQandX29isH;or

X10 is L, X11 is A, X16 is E, X17 is Q, X19 is A, X24 is A and X29 is H.

10. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein:

XIOisL, X11 isA, X16isE, X17isQ, X27isl andX29isH;

X2 is Aib, X5 is S, X11 is A, X24 is A and X29 is H;

X2 is Aib, X5 is T, X11 is A, X24 is A and X29 is H;

X2 is G, X5 is S, X11 is A, X24 is A and X29 is H;

X2 is G, X5 is S, X24 is A and X29 is Q;

X2 is G, X5 is S, X24 is A and X29 is H;

X2 is G, X5 is S, X24 is A and X29 is Y;

X2 is Aib, X5 is S, X11 is S, X24 is A and X29 is H;

X2 is Aib, X5 is S, X11 is A, X16 is E, X17 is Q and X24 is A;

X2 is G, X5 is S, X11 is A, X16 is E, X17 is Q and X24 is A;

X2 is Aib, X5 is S, X11 is A, X16 is G, X17 is K, X24 is A and X29 is H;

X2 is G, X5 is S, X11 is S, X24 is A and X29 is H;

X2 is Aib, X5 is S, X11 is S, X24 is A and X29 is H;

X5 is S and X24 is A;

X5 is S, and X24 is A;

X5 is S and X16 is E;

X5 is S and X17 is Q;

X5 is T, X8 is S and X24 is A;

X8 is D and X24 is N;

X16isE, X17isQandX29 is H;

X16 is E, X17 is Q, X24 is A and X29 is H;

X2 is G, X16 is E, X17 is Q, X24 is A and X29 is H;

X2 is Aib, X16 is E, X17 is Q, X24 is A and X29 is H;

X5 is T, X16 is E, X17 is Q, X24 is A and X29 is H; or

X5 is S, X16 is E, X17 is Q, X24 is A and X29 is H.

11. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein: X8 is D or S, X9 is E, X10 is L and X1 1 is A or S;

X8 is D or S, X9 is E, X10 is L and X1 1 is A; or

X8 is D or S, X9 is E, X10 is L and X1 1 is S.

12. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein X^* has no more than 5 amino acid changes, e.g. no more than 4, no more than 3, no more than 2 or no more than 1 change relative to the amino acid sequence:

H[Aib]DGSFSDELATILDGKAARDFIAWLIQHKITD;

HGDGTFSSELATILDEQAARDFIAWLIQHKITD;

HGDGSFSSELATILDEQAARDFIAWLIQHKITD;

H[Aib]DGTFTSELATILDEQAARDFIAWLIAHKITD; or

HGDGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK.

13. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein X^* has the sequence:

H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITD;

HGDGSFSSELATILDEQAARDFIAWLIQHKITD;

H[Aib]DGSFSDELATILDEQAARDFIAWLIQHKITD;

H[Aib]DGTFSSELATILDEQAARDFIAWLIQHKITD;

H[Aib]DGSFSDELATILDEQAARDFINWLIQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK;

H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITDkkkkkk;

H[Aib]DGSFSDELATILDGKAARDFIAWLIQHKITD;

HGDGTFSSELATILDEQAARDFIAWLIQHKITD;

HGDGSFSSELATILDEQAARDFIAWLIQQKITD;

HGDGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK;

HGDGSFSSELSTILDEQAARDFIAWLIQHKITD;

HGDGSFSSELATILDEQAARDFIAWLIQYKITD; or

HGDGSFSSELATILDEQASRDFIAWLIQHKITD.

14. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 13 which is:

Cpd 1 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITD-OH;

Cpd 2 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITD-[NH₂];

Cpd 3 Hy-H[Aib]DGSFSDELATILDEQAARDFIAWLIQHKITD-OH; Cpd 4 Hy-H[Aib]DGTFSSELATILDEQAARDFIAWLIQHKITD-OH;

Cpd 5 Hy-H[Aib]DGSFSDELATILDEQAARDFINWLIQHKITD-OH;

Cpd 6 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK-[NH₂];

Cpd 7 Hy-H[Aib]DGSFSSELATILDEQAARDFIAWLIQHKITDkkkkkk-[NH₂];

Cpd 8 Hy-H[Aib]DGSFSDELATILDGKAARDFIAWLIQHKITD-OH;

Cpd 9 Hy-HGDGTFSSELATILDEQAARDFIAWLIQHKITD-OH;

Cpd 10 Hy-HGDGSFSSELATILDEQAARDFIAWLIQQKITD-[NH₂];

Cpd 1 1 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITDKKKKKK-[NH₂];

Cpd 12 Hy-HGDGSFSSELSTILDEQAARDFIAWLIQHKITD-OH;

Cpd 13 Hy-HGDGSFSSELATILDEQAARDFIAWLIQYKITD-[NH₂];

Cpd 14 Hy-HGDGSFSSELATILDEQASRDFIAWLIQHKITD-OH;

Cpd 15 Hy-HGDGSFSSELATILDEQAARDFIAWLIQYKITD-OH; or

Cpd. 33 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITD-OH

15. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 1 to 3 wherein:

X8 is E, X10 is L and X1 1 is A;

X5 is S and X8 is E; or

X2 is Aib, X5 is S and X8 is E.

16. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 1 to 3 or 15 wherein X^* has no more than 5 amino acid changes, e.g. no more than 4, no more than 3, no more than 2 or no more than 1 change relative to the amino acid sequence

H[Aib]DGSFSEELATILDGKAARDFIAWLIQHKITD; or

H[Aib]DGSFSEELATILDEQAARDFIAWLIQHKITD.

17. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 16 wherein X^* has the sequence:

H[Aib]DGSFSEELATILDGKAARDFIAWLIQHKITD; or

H[Aib]DGSFSEELATILDEQAARDFIAWLIQHKITD.

18. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 17 which is:

Cpd 16 Hy-H[Aib]DGSFSEELATILDGKAARDFIAWLIQHKITD-OH; or

Cpd 17 Hy-H[Aib]DGSFSEELATILDEQAARDFIAWLIQHKITD-OH.

19. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 1 to 3 wherein:

X1 1 is N;

X10 is M or l_ and X1 1 is N;

X10 is M and X1 1 is N;

X10 is L and X1 1 is N;

X10 is M, X1 1 is N and X24 is A;

X2 is Aib, X10 is M, X24 is A and X29 is H;

X2 is Aib, X10 is M and X24 is A;

X2 is Aib, X10 is M, X24 is A and X29 is H;

X2 is Aib, X10 is L and X24 is A; or

X2 is Aib, X10 is L, X24 is A and X29 is H.

20. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 1 to 3 or 19 wherein X^* has no more than 5 amino acid changes, e.g. no more than 4, no more than 3, no more than 2 or no more than 1 change relative to the amino acid sequence:

H[Aib]DGSFSDEMNTILDEQAARDFIAWLIQHKITD or

H[Aib]DGSFSDELNTILDEQAARDFIAWLIQHKITD.

21 . A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 20 wherein X^* has the sequence:

H[Aib]DGSFSDEMNTILDEQAARDFIAWLIQHKITD; or

H[Aib]DGSFSDELNTILDEQAARDFIAWLIQHKITD.

22. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 21 which is:

Cpd 18 Hy-H[Aib]DGSFSDEMNTILDEQAARDFIAWLIQHKITD-OH; or

Cpd 19 Hy-H[Aib]DGSFSDELNTILDEQAARDFIAWLIQHKITD-OH.

23. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 1 to 3 wherein X^* is a peptide having the formula IV:

H-X2-DG-X5-FS-X8-EL-X1 1 -Tl LD-X16-X17-AA-R-DFI-X24-WL-X27-Q-X29-KITD wherein:

X2 is G or Aib;

X5 is S or T;

X8 is S, D or E; X1 1 is A or N;

X16 is E or G;

X17 is Q or K;

X24 is N or A;

X27 is H, Q or Y; and

X29 is H, Q or Y.

24. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 23 wherein:

X2 is Aib, X8 is S or D and X1 1 is A;

X2 is Aib, X5 is S, X1 1 is A, X24 is A and X29 is H; or

X2 is Aib, X5 is S and X24 is A.

25. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 23 or claim 24 wherein:

X2 is Aib and X8 is S;

X8 is S, X27 is H, Y or Q and X29 is H;

X8 is S, X27 is H, Y or Q and X29 is Q;

X8 is S, X27 is H, Y or Q and X29 is Y;

X8 is S, X27 is H and X29 is H, Y or Q;

X8 is S, X27 is Y and X29 is H, Y or Q; or

X8 is S, X27 is Q and X29 is H, Y or Q.

26. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 23 to 25 wherein X^* has no more than 5 amino acid changes, e.g. no more than 4, no more than 3, no more than 2 or no more than 1 change relative to the amino acid sequence:

H[Aib]DGSFSSELATILDEQAARDFIAWLQQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLHQHKITD; or

H[Aib]DGSFSSELATILDEQAARDFIAWLQQQKITD.

27. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 23 to 25 wherein X^* comprises a motif selected from the group consisting of FIAWLHQT, FIAWLYQT, FIAWLQQT, FIAWLKQT, FINWLHQT, FINWLYQT, FINWLQQT and FINWLKQT.

28. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 23 to 25 wherein X^* comprises a motif selected from the group consisting of FIAWLHQH, FIAWLYQH, FIAWLQQH, FIAWLKQH, FIAWLHQQ, FIAWLYQQ, FIAWLQQQ, FIAWLKQQ, FIAWLHQK, FIAWLYQK, FIAWLQQK, FIAWLKQK, FIAWLHQY, FIAWLYQY, FIAWLQQY, FIAWLKQY, FINWLHQH, FINWLYQH, FINWLQQH, FINWLKQH, FINWLHQQ, FINWLYQQ, FINWLQQQ, FINWLKQQ, FINWLHQK, FINWLYQK, FINWLQQK, FINWLKQK, FINWLHQY, FINWLYQY, FINWLQQY and FINWLKQY.

29. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 23 wherein X^* has the sequence:

H[Aib]DGSFSSELATILDEQAARDFIAWLYQQKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLQQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLQQQKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLYQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLHQHKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLHQQKITD;

H[Aib]DGSFSSELATILDEQAARDFIAWLQQYKITD; or

H[Aib]DGSFSSELATILDEQAARDFIAWLHQYKITD.

30. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 29 which is:

Cpd 20

Cpd 21

Cpd 22

Cpd 23

Cpd 24

Cpd 25

Cpd 26

Cpd 27 or

Cpd 28

31 . A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 23 wherein:

X2 is Aib and X8 is D or E;

X2 is Aib and X27 is H and X29 is H;

X8 is D or E, X27 is H, Y or Q and X29 is H; X8 is D or E, X27 is H, Y or Q and X29 is Q;

X8 is D or E, X27 is H, Y or Q and X29 is Y;

X8 is D or E, X27 is H and X29 is H, Y or Q;

X8 is D or E, X27 is Y and X29 is H, Y or Q;

X8 is D or E, X27 is Q and X29 is H, Y or Q;

X2 is Aib, X1 1 is N, X24 is A, X27 is H and X29 is H; or

X2 is Aib, X1 1 is N, X24 is A, X27 is H.

32. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 23 or claim 31 wherein X^* has no more than 5 amino acid changes, e.g. no more than 4, no more than 3, no more than 2 or no more than 1 change relative to the amino acid sequence:

H[Aib]DGSFSDELATILDEQAARDFIAWLHQHKITD,

H[Aib]DGSFSDELATILDGKAARDFIAWLHQHKITD.

H[Aib]DGSFSEELATILDEQAARDFIAWLHQHKITD; or

H[Aib]DGSFSDELNTILDEQAARDFINWLHQHKITD.

33. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 23 wherein X^* comprises a motif selected from the group consisting of FIAWLHQT, FIAWLYQT, FIAWLQQT, FIAWLKQT, FINWLHQT, FINWLYQT, FINWLQQT and FINWLKQT.

34. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 23 wherein X^* comprises a motif selected from the group consisting of FIAWLHQH, FIAWLYQH, FIAWLQQH, FIAWLKQH, FIAWLHQQ, FIAWLYQQ, FIAWLQQQ, FIAWLKQQ, FIAWLHQK, FIAWLYQK, FIAWLQQK, FIAWLKQK, FIAWLHQY, FIAWLYQY, FIAWLQQY, FIAWLKQY, FINWLHQH, FINWLYQH, FINWLQQH, FINWLKQH, FINWLHQQ, FINWLYQQ, FINWLQQQ, FINWLKQQ, FINWLHQK, FINWLYQK, FINWLQQK, FINWLKQK, FINWLHQY, FINWLYQY, FINWLQQY and FINWLKQY.

35. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 23 wherein X^* has the sequence

H[Aib]DGSFSDELATILDEQAARDFIAWLHQHKITD;

H[Aib]DGSFSDELATILDGKAARDFIAWLHQHKITD;

H[Aib]DGSFSEELATILDEQAARDFIAWLHQHKITD; or

H[Aib]DGSFSDELNTILDEQAARDFINWLHQHKITD.

36. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 35 which is:

Cpd 29 Hy-H[Aib]DGSFSDELATILDEQAARDFIAWLHQHKITD-OH;

Cpd 30 Hy-H[Aib]DGSFSDELATILDGKAARDFIAWLHQHKITD-OH;

Cpd 31 Hy-H[Aib]DGSFSEELATILDEQAARDFIAWLHQHKITD-OH; or

Cpd 32 Hy-H[Aib]DGSFSDELNTILDEQAARDFINWLHQHKITD-OH.

37. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 1 to 3 wherein X^* is a peptide having the formula V: HGDGSFSSELATIL-X15-EQAAR-X21 -FIAWLIQHKIT-X33

wherein:

X15 is D or E;

X21 is D or E;

X33 is D or E.

38. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 37 wherein X^* has the sequence:

HGDGSFSSELATILDEQAARDFIAWLIQHKITE HGDGSFSSELATILDEQAAREFIAWLIQHKITD HGDGSFSSELATILEEQAARDFIAWLIQHKITD HGDGSFSSELATILEEQAAREFIAWLIQHKITE HGDGSFSSELATILEEQAAREFIAWLIQHKITD

39. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 38 which is:

Cpd 34 Hy-HGDGSFSSELATILDEQAARDFIAWLIQHKITE-Nhb;

Cpd 35 Hy-HGDGSFSSELATILDEQAAREFIAWLIQHKITD-Nhb;

Cpd 36 Hy-HGDGSFSSELATILEEQAARDFIAWLIQHKITD-Nhb;

Cpd 37 Hy-HGDGSFSSELATILEEQAAREFIAWLIQHKITE-Nhb; or

Cpd 38 Hy-HGDGSFSSELATILEEQAAREFIAWLIQHKITD-NH₂.

40. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of claims 1 to 3 wherein X^* is a peptide having the formula VI: H-X2-DG-X5-F-X7-X8-E-X10-A-TI LD-X16-X17-A-X19-R-DFIAWLIQ-X29-KITD wherein:

X2 is G or Aib; X5 is S or T;

X7 is S or T;

X8 is E, S or D;

X10 is L or M;

X16 is E or G;

X17 is Q or K;

X19 is A or S;

X29 is H, Q or Y.

41 . A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 40 wherein X^* is a peptide having the formula VII:

HGDG-X5-F-X7-SELATILDEQAARDFIAWLIAHKIT-X33

wherein:

X5 is S or T;

X7 is S or T

X3 is D or E.

42. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 40 or claim 41 wherein X^* has the sequence:

H[Aib]DGTFTSELATILDEQAARDFIAWLIAHKITD

H[Aib]DGTFSSELATILDEQAARDFIAWLIAHKITD

H[Aib]DGSFTSELATILDEQAARDFIAWLIAHKITD

43. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 42 which is:

Cpd 39 Hy-H[Aib]DGTFTSELATILDEQAARDFIAWLIAHKITD-OH Cpd 40 Hy-H[Aib]DGTFSSELATILDEQAARDFIAWLIAHKITD-OH Cpd 41 Hy-H[Aib]DGSFTSELATILDEQAARDFIAWLIAHKITD-OH

44. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein U represents a peptide sequence of 1 -15 lysine residues, e.g. 1 -10 lysine residues.

45. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to claim 44 wherein U is K3, K₄, K₅, Κβ , K₇, k3, k₄, k₅, k6 or k₇.

46. A dual agonist or pharmaceutically acceptable salt or solvate thereof according to any one of the preceding claims wherein R¹ is Hy and/or R² is OH.

47. A composition comprising a dual agonist according to any one of claims 1 to 46, or a pharmaceutically acceptable salt or solvate thereof, in admixture with a carrier.

48. A composition according to claim 47 wherein the composition is a

pharmaceutical composition and the carrier is a pharmaceutically acceptable carrier.

49. A pharmaceutical composition comprising a dual agonist according to any one claims 1 to 46, or a pharmaceutically acceptable salt or solvate thereof, in admixture with a pharmaceutically acceptable carrier, excipient or vehicle.

50. A dual agonist according to any one of claims 1 to 46 for use in therapy.

51 . A dual agonist according to any one of claims 1 to 46 for use in a method of increasing intestinal mass, improving intestinal function, increasing intestinal blood flow, or repairing intestinal damage or dysfunction.

52. A dual agonist according to any one of claims 1 to 46 for use in a method of prophylaxis or treatment of malabsorption, ulcers, short-bowel syndrome, cul-de-sac syndrome, inflammatory bowel disease, irritable bowel syndrome, pouchitis, celiac sprue, tropical sprue, hypogammaglobulinemic sprue, mucositis induced by chemotherapy or radiation therapy, diarrhea induced by chemotherapy or radiation therapy, low grade inflammation, metabolic endotoxemia, necrotising enterocolitis, primary biliary cirrhosis, hepatitis, fatty liver disease, or gastrointestinal side-effects of inflammatory conditions.

53. A dual agonist according to any one of claims 1 to 46 for use in a method of reducing or inhibiting weight gain, reducing gastric emptying or intestinal transit, reducing food intake, reducing appetite, or promoting weight loss.

54. A dual agonist according to any one of claims 1 to 46 for use in a method of prophylaxis or treatment of obesity, morbid obesity, obesity-linked gallbladder disease, obesity-induced sleep apnea, inadequate glucose control, glucose tolerance, dyslipidaemia, diabetes, pre-diabetes, metabolic syndrome or hypertension.

55. A method of increasing intestinal mass, improving intestinal function, increasing intestinal blood flow, or repairing intestinal damage or dysfunction in a subject in need thereof, the method comprising administering a dual agonist according to any one of claims 1 to 46 to the subject.

56. A method of prophylaxis or treatment of malabsorption, ulcers, short-bowel syndrome, cul-de-sac syndrome, inflammatory bowel disease, irritable bowel syndrome, pouchitis, celiac sprue, tropical sprue, hypogammaglobulinemic sprue, mucositis induced by chemotherapy or radiation therapy, diarrhea induced by chemotherapy or radiation therapy, low grade inflammation, metabolic endotoxemia, necrotising enterocolitis, primary biliary cirrhosis, hepatitis, fatty liver disease, or gastrointestinal side-effects of inflammatory conditions in a subject in need thereof, the method comprising administering a dual agonist according to any one of claims 1 to 46 to the subject.

57. A method of reducing or inhibiting weight gain, reducing gastric emptying or intestinal transit, reducing food intake, reducing appetite, or promoting weight loss in a subject in need thereof, the method comprising administering a dual agonist according to any one of claims 1 to 46 to the subject.

58. A method of prophylaxis or treatment of obesity, morbid obesity, obesity-linked gallbladder disease, obesity-induced sleep apnea, inadequate glucose control, glucose tolerance, dyslipidaemia, diabetes, pre-diabetes, metabolic syndrome or hypertension in a subject in need thereof, the method comprising administering a dual agonist according to any one of claims 1 to 46 to the subject.

59. Use of a dual agonist according to any one of claims 1 to 46 in the preparation of a medicament for use in increasing intestinal mass, improving intestinal function, increasing intestinal blood flow, or repairing intestinal damage or dysfunction.

60. Use of a dual agonist according to any one of claims 1 to 46 in the preparation of a medicament for use in prophylaxis or treatment of malabsorption, ulcers, short- bowel syndrome, cul-de-sac syndrome, inflammatory bowel disease, irritable bowel syndrome, pouchitis, celiac sprue, tropical sprue, hypogammaglobulinemic sprue, mucositis induced by chemotherapy or radiation therapy, diarrhea induced by chemotherapy or radiation therapy, low grade inflammation, metabolic endotoxemia, necrotising enterocolitis, primary biliary cirrhosis, hepatitis, fatty liver disease, or gastrointestinal side-effects of inflammatory conditions.

61 . Use of a dual agonist according to any one of claims 1 to 46 in the preparation of a medicament for reducing or inhibiting weight gain, reducing gastric emptying or intestinal transit, reducing food intake, reducing appetite, or promoting weight loss.

62. Use of a dual agonist according to any one of claims 1 to 46 in the preparation of a medicament for prophylaxis or treatment of obesity, morbid obesity, obesity- linked gallbladder disease, obesity-induced sleep apnea, inadequate glucose control, glucose tolerance, dyslipidaemia, diabetes, pre-diabetes, metabolic syndrome or hypertension.