U.S. patent application number 15/895023 was filed with the patent office on 2018-07-05 for methods and compositions for treating a proprotein convertase subtilisin kexin (pcsk9) gene-associated disorder.
The applicant listed for this patent is Alnylam Pharmaceuticals, Inc.. Invention is credited to Kevin Fitzgerald.
Application Number | 20180187198 15/895023 |
Document ID | / |
Family ID | 56855841 |
Filed Date | 2018-07-05 |
United States Patent
Application |
20180187198 |
Kind Code |
A1 |
Fitzgerald; Kevin |
July 5, 2018 |
METHODS AND COMPOSITIONS FOR TREATING A PROPROTEIN CONVERTASE
SUBTILISIN KEXIN (PCSK9) GENE-ASSOCIATED DISORDER
Abstract
The invention relates to methods of inhibiting the expression of
a PCSK9 gene in a subject, as well as therapeutic and prophylactic
methods for treating subjects having a lipid disorder, such as a
hyperlipidemia using RNAi agents, e.g., double-stranded RNAi
agents, targeting the PCSK9 gene.
Inventors: |
Fitzgerald; Kevin;
(Brookline, MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Alnylam Pharmaceuticals, Inc. |
Cambridge |
MA |
US |
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|
Family ID: |
56855841 |
Appl. No.: |
15/895023 |
Filed: |
February 13, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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PCT/US2016/048666 |
Aug 25, 2016 |
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15895023 |
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62209526 |
Aug 25, 2015 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 31/7115 20130101;
A61K 39/3955 20130101; A61K 45/06 20130101; A61P 3/06 20180101;
A61K 31/713 20130101; A61K 9/0019 20130101; C12N 2310/321 20130101;
C12N 15/1137 20130101; C12N 2310/14 20130101; C12N 2310/315
20130101 |
International
Class: |
C12N 15/113 20060101
C12N015/113; A61K 31/7115 20060101 A61K031/7115; A61P 3/06 20060101
A61P003/06; A61K 45/06 20060101 A61K045/06; A61K 39/395 20060101
A61K039/395; A61K 9/00 20060101 A61K009/00 |
Claims
1. A method of inhibiting the expression of a PCSK9 gene in a
subject, comprising administering to the subject a fixed dose of
about 25 mg to about 800 mg of a double-stranded ribonucleic acid
(RNAi) agent, wherein the double-stranded RNAi agent comprises a
sense strand and an antisense strand forming a double stranded
region, the antisense strand comprising a region of complementarity
which comprises at least 15 contiguous nucleotides differing by no
more than 3 nucleotides from nucleotides 3544-3623 of the
nucleotide sequence of SEQ ID NO:1, thereby inhibiting the
expression of the PCSK9 gene in the subject.
2. A method of treating a subject having a disorder that would
benefit from reduction in PCSK9 expression, comprising
administering to the subject a fixed dose of about 25 mg to about
800 mg of a double-stranded ribonucleic acid (RNAi) agent, wherein
the double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1, thereby treating the subject having a disorder that
would benefit from reduction in PCSK9 expression.
3. The method of claim 1 or 2, wherein the fixed dose is
administered to the subject at an interval of once a week.
4. The method of claim 1 or 2, wherein the fixed dose is
administered to the subject at an interval of once every two
weeks.
5. The method of claim 1 or 2, wherein the fixed dose is
administered to the subject at an interval of once a month.
6. The method of claim 1 or 2, wherein the fixed dose is
administered to the subject at an interval of once a quarter.
7. The method of claim 1 or 2, wherein the fixed dose is
administered to the subject at an interval of biannually.
8. The method of claim 3, wherein the subject is administered a
fixed dose of about 25 mg to about 50 mg once a week.
9. The method of claim 4, wherein the subject is administered a
fixed dose of about 50 mg to about 100 mg once every two weeks.
10. The method of claim 5, wherein the subject is administered a
fixed dose of about 100 mg to about 200 mg once a month.
11. The method of claim 6, wherein the subject is administered a
fixed dose of about 200 mg to about 800 mg once a quarter.
12. The method of claim 7, wherein the subject is administered a
fixed dose of about 200 mg to about 800 mg biannually.
13. The method of claim 1 or 2, wherein the RNAi agent is
administered to the subject in a dosing regimen that includes a
loading phase followed by a maintenance phase.
14. The method of claim 13, wherein the dose administered to the
subject during the loading phase is the same as the dose
administered to the subject during the maintenance phase.
15. The method of claim 1 or 2, further comprising administering an
additional therapeutic agent to the subject.
16. The method of claim 15, wherein the additional therapeutic
agent is a statin.
17. The method of claim 15, wherein the additional therapeutic
agent is an anti-PCSK9 antibody.
18. The method of claim 17, wherein the anti-PCSK9 antibody is
selected from the group consisting of alirocumab (Praluent),
evolocumab (Repatha), and bococizumab.
19. The method of claim 1 or 2, wherein the antisense strand
comprises the nucleotide sequence 5'-ACAAAAGCAAAACAGGUCUAGAA-3'(SEQ
ID NO: 685).
20. The method of claim 1 or 2, wherein the sense strand comprises
the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ ID NO:
686).
21. The method of claim 1 or 2, wherein the double-stranded
ribonucleic acid RNAi agent comprises at least one modified
nucleotide.
22. The method of claim 1 or 2, wherein substantially of the
nucleotides of the sense strand are modified nucleotides;
substantially all of the nucleotides of the antisense strand are
modified nucleotides; all of the nucleotides of the sense strand
are modified nucleotides; or all of the nucleotides of the
antisense strand are modified nucleotides.
23. The method of claim 1 or 2, wherein the double-stranded RNAi
agent comprises a sense strand and an antisense strand forming a
double stranded region, wherein the antisense strand comprises the
nucleotide sequence 5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685)
and the sense strand comprises the nucleotide sequence
5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ ID NO: 686).
24. The method of claim 23, wherein the sense strand comprises the
nucleotide sequence of 5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO:
687) and the antisense strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
and U; Af, Gf, Cf and Uf are 2'-fluoro A, G, C and U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage.
25. The method of claim 1 or 2, wherein the double-stranded
ribonucleic acid RNAi agent further comprises a ligand.
26. The method of claim 1 or 2, wherein the subject is a human.
27. The method of claim 26, wherein the human subject has a
disorder that would benefit from reduction in PCSK9 expression.
28. The method of claim 2 or 27, wherein the disorder that would
benefit from reduction in PCSK9 expression is hyperlipidemia.
29. The method of claim 28, wherein the hyperlipidemia is
hypercholesterolemia.
30. The method of claim 1 or 2, wherein the double stranded RNAi
agent is administered to the subject subcutaneously; or
intramuscularly.
31. The method of claim 1 or 2, wherein PCSK9 expression is
inhibited by at least about 30%.
32. The method of claim 1 or 2, wherein the RNAi agent is
administered in a pharmaceutical composition.
33. A kit for performing the method of claim 1 or 2, comprising a)
the RNAi agent, and b) instructions for use, and c) optionally,
means for administering the RNAi agent to the subject.
Description
RELATED APPLICATIONS
[0001] This application is a 35 .sctn. U.S.C. 111(a) continuation
application which claims the benefit of priority to
PCT/US2016/048666, filed on Aug. 25, 2016, which claims the benefit
of priority to U.S. Provisional Patent Application No. 62/209,526,
filed on Aug. 25, 2015. The entire contents of each of the
foregoing patent applications are incorporated herein by
reference.
[0002] This application is related to U.S. Provisional Application
No. 61/733,518, filed on Dec. 5, 2012; U.S. Provisional Application
No. 61/793,530, filed on Mar. 15, 2013; U.S. Provisional
Application No. 61/886,916, filed on Oct. 4, 2013; U.S. Provisional
Application No. 61/892,188, filed on Oct. 17, 2013; PCT Application
No. PCT/US2013/073349, filed on Dec. 5, 2013; and U.S. patent
application Ser. No. 14/650,128, filed on Jun. 5, 2015. The entire
contents of each of the foregoing patent applications are hereby
incorporated herein by reference.
SEQUENCE LISTING
[0003] The instant application contains a Sequence Listing which
has been submitted electronically in ASCII format and is hereby
incorporated by reference in its entirety. Said ASCII copy, created
on Feb. 12, 2018, is named 121301-04403_SL.txt and is 188,232 bytes
in size.
BACKGROUND OF THE INVENTION
[0004] Proprotein convertase subtilisin kexin 9 (PCSK9) is a member
of the subtilisin serine protease family. The other eight mammalian
subtilisin proteases, PCSK1-PCSK8 (also called PC1/3, PC2, furin,
PC4, PC5/6, PACE4, PC7, and S1P/SKI-1) are proprotein convertases
that process a wide variety of proteins in the secretory pathway
and play roles in diverse biological processes (Bergeron, F. (2000)
J. Mol. Endocrinol. 24, 1-22, Gensberg, K., (1998) Semin. Cell Dev.
Biol. 9, 11-17, Seidah, N. G. (1999) Brain Res. 848, 45-62, Taylor,
N. A., (2003) FASEB J. 17, 1215-1227, and Zhou, A., (1999) J. Biol.
Chem. 274, 20745-20748).
[0005] PCSK9 has been proposed to play a role in cholesterol
metabolism. PCSK9 mRNA expression is down-regulated by dietary
cholesterol feeding in mice (Maxwell, K. N., (2003) J. Lipid Res.
44, 2109-2119), up-regulated by statins in HepG2 cells (Dubuc, G.,
(2004) Arterioscler. Thromb. Vasc. Biol. 24, 1454-1459), and
up-regulated in sterol regulatory element binding protein (SREBP)
transgenic mice (Horton, J. D., (2003) Proc. Natl. Acad. Sci. USA
100, 12027-12032), similar to the cholesterol biosynthetic enzymes
and the low-density lipoprotein receptor (LDLR). Furthermore, PCSK9
missense mutations have been found to be associated with a form of
autosomal dominant hypercholesterolemia (Hchola3) (Abifadel, M., et
al. (2003) Nat. Genet. 34, 154-156, Timms, K. M., (2004) Hum.
Genet. 114, 349-353, Leren, T. P. (2004) Clin. Genet. 65, 419-422).
PCSK9 may also play a role in determining LDL cholesterol levels in
the general population, because single-nucleotide polymorphisms
(SNPs) have been associated with cholesterol levels in a Japanese
population (Shioji, K., (2004) J. Hum. Genet. 49, 109-114).
[0006] Autosomal dominant hypercholesterolemias (ADHs) are
monogenic diseases in which patients exhibit elevated total and LDL
cholesterol levels, tendon xanthomas, and premature atherosclerosis
(Rader, D. J., (2003) J. Clin. Invest. 111, 1795-1803). The
pathogenesis of ADHs and a recessive form, autosomal recessive
hypercholesterolemia (ARH) (Cohen, J. C., (2003) Curr. Opin.
Lipidol. 14, 121-127), is due to defects in LDL uptake by the
liver. ADH may be caused by LDLR mutations, which prevent LDL
uptake, or by mutations in the protein on LDL, apolipoprotein B,
which binds to the LDLR. ARH is caused by mutations in the ARH
protein that are necessary for endocytosis of the LDLR-LDL complex
via its interaction with clathrin. Therefore, if PCSK9 mutations
are causative in Hchola3 families, it seems likely that PCSK9 plays
a role in receptor-mediated LDL uptake.
[0007] Overexpression studies point to a role for PCSK9 in
controlling LDLR levels and, hence, LDL uptake by the liver
(Maxwell, K. N. (2004) Proc. Natl. Acad. Sci. USA 101, 7100-7105,
Benjannet, S., et al. (2004) J. Biol. Chem. 279, 48865-48875, Park,
S. W., (2004) J. Biol. Chem. 279, 50630-50638). Adenoviral-mediated
overexpression of mouse or human PCSK9 for 3 or 4 days in mice
results in elevated total and LDL cholesterol levels; this effect
is not seen in LDLR knockout animals (Maxwell, K. N. (2004) Proc.
Natl. Acad. Sci. USA 101, 7100-7105, Benjannet, S., et al. (2004)
J. Biol. Chem. 279, 48865-48875, Park, S. W., (2004) J. Biol. Chem.
279, 50630-50638). In addition, PCSK9 overexpression results in a
severe reduction in hepatic LDLR protein, without affecting LDLR
mRNA levels, SREBP protein levels, or SREBP protein nuclear to
cytoplasmic ratio.
[0008] While hypercholesterolemia itself is asymptomatic,
longstanding elevation of serum cholesterol can lead to
atherosclerosis. Over a period of decades, chronically elevated
serum cholesterol contributes to formation of atheromatous plaques
in the arteries which can lead to progressive stenosis or even
complete occlusion of the involved arteries. In addition, smaller
plaques may rupture and cause a clot to form and obstruct blood
flow resulting in, for example, myocardial infarction and/or
stroke. If the formation of the stenosis or occlusion is gradual,
blood supply to the tissues and organs slowly diminishes until
organ function becomes impaired.
[0009] Accordingly, there is a need in the art for effective
treatments for PCSK9-associated diseases, such as a hyperlipidemia,
e.g., hypercholesterolemia.
SUMMARY OF THE INVENTION
[0010] The present invention is based, at least in part, on the
surprising discovery that a single dose of a double-stranded RNAi
agent comprising chemical modifications shows an exceptional
potency and durability to inhibit expression of PCSK9.
Specifically, a single fixed dose, e.g., a fixed dose of about 300
mg to about 500 mg, of RNAi agents targeting a human PCSK9 gene,
e.g., nucleotides 3544-3623 of a human PCSK9 gene (nucleotides
3544-3623 of SEQ ID NO:1), e.g., nucleotides 3601-3623 of SEQ ID
NO:1, including a GalNAc ligand are shown herein to be
exceptionally effective and durable in silencing the activity of a
PCSK9 gene.
[0011] Accordingly, the present invention provides methods for
inhibiting expression of a PCSK9 gene in a subject and methods for
treating a subject having a disorder that would benefit from
inhibiting or reducing the expression of a PCSK9 gene, e.g., a
disorder mediated by PCSK9 expression, such as a hyperlipidemia,
e.g., hypercholesterolemia, using iRNA compositions which effect
the RNA-induced silencing complex (RISC)-mediated cleavage of RNA
transcripts of a PCSK9 gene.
[0012] In one aspect, the methods of the present invention for
inhibiting expression of a PCSK9 gene in a subject and methods for
treating a subject having a disorder that would benefit from
inhibiting or reducing the expression of a PCSK9 gene, e.g., a
disorder mediated by PCSK9 expression, such as a hyperlipidemia,
e.g., hypercholesterolemia, include administering to a subject a
fixed dose of about 25 mg to about 800 mg of a double-stranded
ribonucleic acid (RNAi) agent, wherein the double-stranded RNAi
agent comprises a sense strand and an antisense strand forming a
double stranded region, wherein the sense strand comprises at least
15 contiguous nucleotides differing by no more than 3 nucleotides
from the nucleotide sequence of SEQ ID NO:1 and the antisense
strand comprises at least 15 contiguous nucleotides differing by no
more than 3 nucleotides from the nucleotide sequence of SEQ ID
NO:2, wherein substantially all of the nucleotides of the sense
strand and substantially all of the nucleotides of the antisense
strand are modified nucleotides, and wherein the sense strand is
conjugated to a ligand attached at the 3'-terminus.
[0013] In one aspect, the present invention provides methods of
inhibiting the expression of a PCSK9 gene in a subject. The methods
include comprising administering to the subject a fixed dose of
about 25 mg to about 800 mg of a double-stranded ribonucleic acid
(RNAi) agent, wherein the double-stranded RNAi agent comprises a
sense strand and an antisense strand forming a double stranded
region, the antisense strand comprising a region of complementarity
which comprises at least 15 contiguous nucleotides differing by no
more than 3 nucleotides from nucleotides 3544-3623 of the
nucleotide sequence of SEQ ID NO:1, thereby inhibiting the
expression of the PCSK9 gene in the subject.
[0014] In another aspect, the present invention provides methods of
decreasing the level of low density lipoprotein (LDLc) in a
subject, comprising administering to the subject a fixed dose of
about 25 mg to about 800 mg of a double-stranded ribonucleic acid
(RNAi) agent, wherein the double-stranded RNAi agent comprises a
sense strand and an antisense strand forming a double stranded
region, the antisense strand comprising a region of complementarity
which comprises at least 15 contiguous nucleotides differing by no
more than 3 nucleotides from nucleotides 3544-3623 of the
nucleotide sequence of SEQ ID NO:1, thereby decreasing the level of
LDLc in the subject.
[0015] In another aspect, the present invention provides methods of
treating a subject having a disorder that would benefit from
reduction in PCSK9 expression. The methods include administering to
the subject a fixed dose of about 25 mg to about 800 mg of a
double-stranded ribonucleic acid (RNAi) agent, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1 thereby treating the subject having a disorder that
would benefit from reduction in PCSK9 expression.
[0016] In yet another aspect, the present invention provides
methods of treating a subject having hyperlipidemia. The methods
include administering to the subject a fixed dose of about 25 mg to
about 800 mg of a double-stranded ribonucleic acid (RNAi) agent,
wherein the double-stranded RNAi agent comprises a sense strand and
an antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1, thereby treating the subject having
hypercholesterolemia.
[0017] The fixed dose may administered to the subject at an
interval of once a week, once every two weeks, once a month, once a
quarter, or biannually.
[0018] In one embodiment, the subject is administered a fixed dose
of about 25 mg to about 50 mg once a week. In another embodiment,
the subject is administered a fixed dose of about 50 mg to about
100 mg once every two weeks. In another embodiment, the subject is
administered a fixed dose of about 100 mg to about 200 mg once a
month. In yet another embodiment, the subject is administered a
fixed dose of about 300 mg to about 800 mg once a quarter. In
another embodiment, the subject is administered a fixed dose of
about 300 mg to about 800 mg biannually.
[0019] The present invention also provides methods in which the
RNAi agent is administered in a dosing regimen that includes a
loading phase and a maintenance phase.
[0020] Accordingly, in one aspect, the present invention provides
methods of inhibiting the expression of a PCSK9 gene in a subject.
The methods include administering to the subject a double-stranded
ribonucleic acid (RNAi) agent in a dosing regimen that includes a
loading phase followed by a maintenance phase, wherein the loading
phase comprises administering affixed dose of about 200 mg to about
600 mg of the RNAi agent to the subject, and wherein the
maintenance phase comprises administering a fixed dose of about 25
mg to about 100 mg of the RNAi agent to the subject about once a
month, wherein the double-stranded RNAi agent comprises a sense
strand and an antisense strand forming a double stranded region,
the antisense strand comprising a region of complementarity which
comprises at least 15 contiguous nucleotides differing by no more
than 3 nucleotides from nucleotides 3544-3623 of the nucleotide
sequence of SEQ ID NO:1, thereby inhibiting the expression of the
PCSK9 gene in the subject.
[0021] In another aspect, the present invention provides methods of
decreasing the level of low density lipoprotein (LDLc) in a
subject. The methods include administering to the subject a
double-stranded ribonucleic acid (RNAi) agent in a dosing regimen
that includes a loading phase followed by a maintenance phase,
wherein the loading phase comprises administering to the subject a
fixed dose of about 200 mg to about 600 mg of the RNAi agent, and
wherein the maintenance phase comprises administering to the
subject a fixed dose of about 25 mg to about 100 mg of the RNAi
agent once a month, wherein the double-stranded RNAi agent
comprises a sense strand and an antisense strand forming a double
stranded region, the antisense strand comprising a region of
complementarity which comprises at least 15 contiguous nucleotides
differing by no more than 3 nucleotides from nucleotides 3544-3623
of the nucleotide sequence of SEQ ID NO:1, thereby decreasing the
level of LDLc in the subject.
[0022] In another aspect, the present invention provides methods of
treating a subject having a disorder that would benefit from
reduction in PCSK9 expression. The methods include administering to
the subject a double-stranded ribonucleic acid (RNAi) agent in a
dosing regimen that includes a loading phase followed by a
maintenance phase, wherein the loading phase comprises
administering to the subject a fixed dose of about 200 mg to about
600 mg of the RNAi agent, and wherein the maintenance phase
comprises administering to the subject a fixed dose of about 25 mg
to about 100 mg of the RNAi agent once a month, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1, thereby treating the subject having a disorder that
would benefit from reduction in PCSK9 expression.
[0023] In yet another aspect, the present invention provides
methods of treating a subject having hyperlipidemia. The methods
include administering to the subject a double-stranded ribonucleic
acid (RNAi) agent in a dosing regimen that includes a loading phase
followed by a maintenance phase, wherein the loading phase
comprises administering to the subject a fixed dose of about 200 mg
to about 600 mg of the RNAi agent, and wherein the maintenance
phase comprises administering to the subject a fixed dose of about
25 mg to about 100 mg of the RNAi agent once a month, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1, thereby treating the subject having
hyperlipidemia.
[0024] The double stranded RNAi agent may be administered to the
subject subcutaneously, e.g., by subcutaneous injection, or
intramuscularly.
[0025] In one embodiment, the antisense strand comprises a
nucleotide sequence selected from the group consisting of any one
of the unmodified nucleotide sequences provided in Table 1. In one
embodiment, the double-stranded RNAi agent targets nucleotides
3601-3623 of SEQ ID NO:1. In one embodiment, the agent targeting
nucleotides 3601-3623 of SEQ ID NO:1 is AD-60212.
[0026] In one embodiment, the antisense strand comprises the
nucleotide sequence 5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO:
685).
[0027] In one embodiment, the sense strand comprises the nucleotide
sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ ID NO: 686).
[0028] In one embodiment, the double-stranded ribonucleic acid RNAi
agent comprises at least one modified nucleotide.
[0029] In one embodiment, substantially of the nucleotides of the
sense strand are modified nucleotides. In another embodiment,
substantially all of the nucleotides of the antisense strand are
modified nucleotides. In yet another embodiment, substantially of
the nucleotides of the sense strand and substantially all of the
nucleotides of the antisense strand are modified nucleotides.
[0030] In one embodiment, all of the nucleotides of the sense
strand are modified nucleotides. In another embodiment, all of the
nucleotides of the antisense strand are modified nucleotides. In
yet another embodiment, all of the nucleotides of the sense strand
and all of the nucleotides of the antisense strand are modified
nucleotides.
[0031] In one aspect, the present invention provides methods of
inhibiting the expression of a PCSK9 gene in a subject. The methods
include administering to the subject a fixed dose of about 25 mg to
about 800 mg of a double-stranded ribonucleic acid (RNAi) agent,
wherein the double-stranded RNAi agent comprises a sense strand and
an antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, thereby inhibiting
expression of the PCSK9 gene in the subject.
[0032] In another aspect, the present invention provides methods of
decreasing the level of low density lipoprotein (LDLc) in a
subject. The methods include administering to the subject a fixed
dose of about 25 mg to about 800 mg of a double-stranded
ribonucleic acid (RNAi) agent, wherein the double-stranded RNAi
agent comprises a sense strand and an antisense strand forming a
double stranded region, wherein the antisense strand comprises the
nucleotide sequence 5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685)
and the sense strand comprises the nucleotide sequence
5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ ID NO: 686), wherein substantially
all of the nucleotides of the sense strand and substantially all of
the nucleotides of the antisense strand are modified nucleotides,
thereby decreasing the level of LDLc in the subject.
[0033] In another aspect, the present invention provides methods of
treating a subject having a disorder that would benefit from
reduction in PCSK9 expression, comprising administering to the
subject a fixed dose of about 25 mg to about 800 mg of a
double-stranded ribonucleic acid (RNAi) agent, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, thereby treating the
subject having a disorder that would benefit from reduction in
PCSK9 expression.
[0034] In yet another aspect, the present invention provides
methods of treating a subject having hyperlipidemia. The methods
include administering to the subject a fixed dose of about 25 mg to
about 800 mg of a double-stranded ribonucleic acid (RNAi) agent,
wherein the double-stranded RNAi agent comprises a sense strand and
an antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, thereby treating the
subject having hyperlipidemia.
[0035] In one aspect, the present invention provides methods of
inhibiting the expression of a PCSK9 gene in a subject. The methods
include administering to the subject a fixed dose of about 25 mg to
about 800 mg of a double-stranded ribonucleic acid (RNAi) agent,
wherein the double-stranded RNAi agent comprises a sense strand and
an antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, and administering to the
subject a therapeutically effective amount of an anti-PCSK9
antibody, or antigen-binding fragment thereof, thereby inhibiting
expression of the PCSK9 gene in the subject.
[0036] In another aspect, the present invention provides methods of
decreasing the level of low density lipoprotein (LDLc) in a
subject. The methods include administering to the subject a fixed
dose of about 25 mg to about 800 mg of a double-stranded
ribonucleic acid (RNAi) agent, wherein the double-stranded RNAi
agent comprises a sense strand and an antisense strand forming a
double stranded region, wherein the antisense strand comprises the
nucleotide sequence 5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685)
and the sense strand comprises the nucleotide sequence
5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ ID NO: 686), wherein substantially
all of the nucleotides of the sense strand and substantially all of
the nucleotides of the antisense strand are modified nucleotides,
and administering to the subject a therapeutically effective amount
of an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby decreasing the level of LDLc in the subject.
[0037] In another aspect, the present invention provides methods of
treating a subject having a disorder that would benefit from
reduction in PCSK9 expression, comprising administering to the
subject a fixed dose of about 25 mg to about 800 mg of a
double-stranded ribonucleic acid (RNAi) agent, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3'(SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, and administering to the
subject a therapeutically effective amount of an anti-PCSK9
antibody, or antigen-binding fragment thereof, thereby treating the
subject having a disorder that would benefit from reduction in
PCSK9 expression.
[0038] In yet another aspect, the present invention provides
methods of treating a subject having hyperlipidemia. The methods
include administering to the subject a fixed dose of about 25 mg to
about 800 mg of a double-stranded ribonucleic acid (RNAi) agent,
wherein the double-stranded RNAi agent comprises a sense strand and
an antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, and administering to the
subject a therapeutically effective amount of an anti-PCSK9
antibody, or antigen-binding fragment thereof, thereby treating the
subject having hyperlipidemia.
[0039] The fixed dose may administered to the subject at an
interval of once a week, once every two weeks, once a month, once a
quarter, or biannually.
[0040] In one embodiment, the subject is administered a fixed dose
of about 25 mg to about 50 mg once a week. In another embodiment,
the subject is administered a fixed dose of about 50 mg to about
100 mg once every two weeks. In another embodiment, the subject is
administered a fixed dose of about 100 mg to about 200 mg once a
month. In yet another embodiment, the subject is administered a
fixed dose of about 300 mg to about 800 mg once a quarter. In
another embodiment, the subject is administered a fixed dose of
about 300 mg to about 800 mg biannually.
[0041] In one aspect, the present invention provide methods of
inhibiting the expression of a PCSK9 gene in a subject. The methods
include administering to the subject a double-stranded ribonucleic
acid (RNAi) agent in a dosing regimen that includes a loading phase
followed by a maintenance phase, wherein the loading phase
comprises administering affixed dose of about 200 mg to about 600
mg of the RNAi agent to the subject, and wherein the maintenance
phase comprises administering to the subject a fixed dose of about
25 mg to about 100 mg of the RNAi agent once a quarter, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, thereby inhibiting
expression of the PCSK9 gene in the subject.
[0042] In another aspect, the present invention provides methods of
decreasing the level of low density lipoprotein (LDLc) in a
subject. The methods include administering to the subject a
double-stranded ribonucleic acid (RNAi) agent in a dosing regimen
that includes a loading phase followed by a maintenance phase,
wherein the loading phase comprises administering affixed dose of
about 200 mg to about 600 mg of the RNAi agent to the subject, and
wherein the maintenance phase comprises administering to the
subject a fixed dose of about 25 mg to about 100 mg of the RNAi
agent once a quarter, wherein the double-stranded RNAi agent
comprises a sense strand and an antisense strand forming a double
stranded region, wherein the antisense strand comprises the
nucleotide sequence 5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685)
and the sense strand comprises the nucleotide sequence
5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ ID NO: 686), wherein substantially
all of the nucleotides of the sense strand and substantially all of
the nucleotides of the antisense strand are modified nucleotides,
thereby decreasing the level of LDLc in the subject.
[0043] In another aspect, the present invention provides methods of
treating a subject having a disorder that would benefit from
reduction in PCSK9 expression. The methods include administering to
the subject a double-stranded ribonucleic acid (RNAi) agent in a
dosing regimen that includes a loading phase followed by a
maintenance phase, wherein the loading phase comprises
administering affixed dose of about 200 mg to about 600 mg of the
RNAi agent to the subject, and wherein the maintenance phase
comprises administering to the subject a fixed dose of about 25 mg
to about 100 mg of the RNAi agent once a quarter, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, thereby treating the
subject having a disorder that would benefit from reduction in
PCSK9 expression.
[0044] In yet another aspect, the present invention provides
methods of treating a subject having hyperlipidemia. The methods
include administering to the subject a double-stranded ribonucleic
acid (RNAi) agent in a dosing regimen that includes a loading phase
followed by a maintenance phase, wherein the loading phase
comprises administering affixed dose of about 200 mg to about 600
mg of the RNAi agent to the subject, and wherein the maintenance
phase comprises administering to the subject a fixed dose of about
25 mg to about 100 mg of the RNAi agent once a quarter, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, thereby treating the
subject having hyperlipidemia.
[0045] In one aspect, the present invention provide methods of
inhibiting the expression of a PCSK9 gene in a subject. The methods
include administering to the subject a double-stranded ribonucleic
acid (RNAi) agent in a dosing regimen that includes a loading phase
followed by a maintenance phase, wherein the loading phase
comprises administering affixed dose of about 200 mg to about 600
mg of the RNAi agent to the subject, and wherein the maintenance
phase comprises administering to the subject a fixed dose of about
25 mg to about 100 mg of the RNAi agent once a quarter, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, and administering to the
subject a therapeutically effective amount of an anti-PCSK9
antibody, or antigen-binding fragment thereof, thereby inhibiting
expression of the PCSK9 gene in the subject.
[0046] In another aspect, the present invention provides methods of
decreasing the level of low density lipoprotein (LDLc) in a
subject. The methods include administering to the subject a
double-stranded ribonucleic acid (RNAi) agent in a dosing regimen
that includes a loading phase followed by a maintenance phase,
wherein the loading phase comprises administering affixed dose of
about 200 mg to about 600 mg of the RNAi agent to the subject, and
wherein the maintenance phase comprises administering to the
subject a fixed dose of about 25 mg to about 100 mg of the RNAi
agent once a quarter, wherein the double-stranded RNAi agent
comprises a sense strand and an antisense strand forming a double
stranded region, wherein the antisense strand comprises the
nucleotide sequence 5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685)
and the sense strand comprises the nucleotide sequence
5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ ID NO: 686), wherein substantially
all of the nucleotides of the sense strand and substantially all of
the nucleotides of the antisense strand are modified nucleotides,
and administering to the subject a therapeutically effective amount
of an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby decreasing the level of LDLc in the subject.
[0047] In another aspect, the present invention provides methods of
treating a subject having a disorder that would benefit from
reduction in PCSK9 expression. The methods include administering to
the subject a double-stranded ribonucleic acid (RNAi) agent in a
dosing regimen that includes a loading phase followed by a
maintenance phase, wherein the loading phase comprises
administering affixed dose of about 200 mg to about 600 mg of the
RNAi agent to the subject, and wherein the maintenance phase
comprises administering to the subject a fixed dose of about 25 mg
to about 100 mg of the RNAi agent once a quarter, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, and administering to the
subject a therapeutically effective amount of an anti-PCSK9
antibody, or antigen-binding fragment thereof, thereby treating the
subject having a disorder that would benefit from reduction in
PCSK9 expression.
[0048] In yet another aspect, the present invention provides
methods of treating a subject having hyperlipidemia. The methods
include administering to the subject a double-stranded ribonucleic
acid (RNAi) agent in a dosing regimen that includes a loading phase
followed by a maintenance phase, wherein the loading phase
comprises administering affixed dose of about 200 mg to about 600
mg of the RNAi agent to the subject, and wherein the maintenance
phase comprises administering to the subject a fixed dose of about
25 mg to about 100 mg of the RNAi agent once a quarter, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
antisense strand comprises the nucleotide sequence
5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685) and the sense strand
comprises the nucleotide sequence 5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ
ID NO: 686), wherein substantially all of the nucleotides of the
sense strand and substantially all of the nucleotides of the
antisense strand are modified nucleotides, and administering to the
subject a therapeutically effective amount of an anti-PCSK9
antibody, or antigen-binding fragment thereof, thereby treating the
subject having hyperlipidemia.
[0049] In one embodiment, the subject is a human.
[0050] In one embodiment, the disorder that would benefit from
reduction in PCSK9 expression is hyperlipidemia, such as
hypercholesterolemia.
[0051] In one embodiment, the hyperlipidemia is
hypercholesterolemia.
[0052] The double stranded RNAi agent may be administered to the
subject subcutaneously, e.g., by subcutaneous injection, or
intramuscularly.
[0053] In one embodiment, the sense strand comprises the nucleotide
sequence of 5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO: 687) and
the antisense strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
or U; Af, Gf, Cf or Uf are 2'-fluoro A, G, C or U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage.
[0054] In one embodiment, the double-stranded ribonucleic acid RNAi
agent further comprises a ligand.
[0055] In one embodiment, the ligand is conjugated to the 3' end of
the sense strand of the double-stranded ribonucleic acid RNAi
agent.
[0056] In one embodiment, the ligand is an N-acetylgalactosamine
(GalNAc) derivative.
[0057] In one embodiment, the ligand is
##STR00001##
[0058] In one embodiment, the double-stranded ribonucleic acid RNAi
agent is conjugated to the ligand as shown in the following
schematic
and, wherein X is O or S. In one embodiment, the X is O.
[0059] In one embodiment, PCSK9 expression is inhibited by at least
about 30%.
[0060] In one embodiment, the methods of the invention further
comprise determining an LDLR genotype or phenotype of the
subject.
[0061] In one embodiment, administering the double-stranded RNAi
agent results in a decrease in serum cholesterol in the subject
and/or a decrease in PCSK9 protein accumulation.
[0062] In one embodiment, the methods of the invention further
comprise determining the serum cholesterol level in the
subject.
[0063] In one embodiment, the methods of the invention further
comprise comprising administering an additional therapeutic agent
to the subject, e.g., a statin and/or an anti-PCSK9 antibody. In
one embodiment, the anti-PCSK9 antibody is selected from the group
consisting of alirocumab (Praluent), evolocumab (Repatha), and
bococizumab.
[0064] In one embodiment, the RNAi agent is administered as a
pharmaceutical composition.
[0065] The RNAi agent may be administered in an unbuffered
solution, such as saline or water, or administered with a buffer
solution. In one embodiment, the buffer solution comprises acetate,
citrate, prolamine, carbonate, or phosphate or any combination
thereof. In another embodiment, the buffer solution is phosphate
buffered saline (PBS).
[0066] In one aspect, the present invention provides methods of
inhibiting the expression of a PCSK9 gene in a subject. The methods
include administering to the subject a single fixed dose of about
25 mg to about 800 mg of a double-stranded ribonucleic acid (RNAi)
agent, wherein the double-stranded RNAi agent comprises a sense
strand and an antisense strand forming a double stranded region,
wherein the sense strand comprises the nucleotide sequence of
5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO: 687) and the antisense
strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
or U; Af, Gf, Cf or Uf are 2'-fluoro A, G, C or U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage, and
administering to the subject a therapeutically effective amount of
an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby inhibiting expression of the PCSK9 gene in the subject.
[0067] In another aspect, the present invention provides methods of
decreasing the level of low density lipoprotein (LDLc) in a
subject. The methods include administering to the subject a fixed
dose of about 25 mg to about 800 mg of a double-stranded
ribonucleic acid (RNAi) agent, wherein the double-stranded RNAi
agent comprises a sense strand and an antisense strand forming a
double stranded region, wherein the sense strand comprises the
nucleotide sequence of 5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO:
687) and the antisense strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
or U; Af, Gf, Cf or Uf are 2'-fluoro A, G, C or U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage, and
administering to the subject a therapeutically effective amount of
an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby decreasing the level of LDLc in the subject.
[0068] In another aspect, the present invention provides methods of
treating a subject having a disorder that would benefit from
reduction in PCSK9 expression. The methods include administering to
the subject a fixed dose of about 25 mg to about 800 mg of a
double-stranded ribonucleic acid (RNAi) agent, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
sense strand comprises the nucleotide sequence of
5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO: 687) and the antisense
strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
or U; Af, Gf, Cf or Uf are 2'-fluoro A, G, C or U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage, and
administering to the subject a therapeutically effective amount of
an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby treating the subject having a disorder that would benefit
from reduction in PCSK9 expression.
[0069] In yet another aspect, the present invention provides
methods of treating a subject having hyperlipidemia. The methods
include administering to the subject a fixed dose of about 25 mg to
about 800 mg of a double-stranded ribonucleic acid (RNAi) agent,
wherein the double-stranded RNAi agent comprises a sense strand and
an antisense strand forming a double stranded region, wherein the
sense strand comprises the nucleotide sequence of
5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO: 687) and the antisense
strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
or U; Af, Gf, Cf or Uf are 2'-fluoro A, G, C or U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage, and
administering to the subject a therapeutically effective amount of
an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby treating the subject having hyperlipidemia.
[0070] In one embodiment, the subject is administered a fixed dose
of about 200 mg to about 800 mg once a quarter. In another
embodiment, the subject is administered a fixed dose of about 200
mg to about 800 mg biannually.
[0071] In one aspect, the present invention provides methods of
inhibiting the expression of a PCSK9 gene in a subject. The methods
include administering to the subject a double-stranded ribonucleic
acid (RNAi) agent in a dosing regimen that includes a loading phase
followed by a maintenance phase, wherein the loading phase
comprises administering a fixed dose of about 200 mg to about 600
mg of the RNAi agent to the subject, and wherein the maintenance
phase comprises administering to the subject a fixed dose of about
25 mg to about 800 mg of the RNAi agent once a quarter, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
sense strand comprises the nucleotide sequence of
5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO: 687) and the antisense
strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
or U; Af, Gf, Cf or Uf are 2'-fluoro A, G, C or U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage, and
administering to the subject a therapeutically effective amount of
an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby inhibiting expression of the PCSK9 gene in the subject.
[0072] In another aspect, the present invention provides methods of
decreasing the level of low density lipoprotein (LDLc) in a
subject. The methods include administering to the subject a
double-stranded ribonucleic acid (RNAi) agent in a dosing regimen
that includes a loading phase followed by a maintenance phase,
wherein the loading phase comprises administering a fixed dose of
about 200 mg to about 600 mg of the RNAi agent to the subject, and
wherein the maintenance phase comprises administering to the
subject a fixed dose of about 25 mg to about 100 mg of the RNAi
agent once a quarter, wherein the double-stranded RNAi agent
comprises a sense strand and an antisense strand forming a double
stranded region, wherein the sense strand comprises the nucleotide
sequence of 5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO: 687) and
the antisense strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
or U; Af, Gf, Cf or Uf are 2'-fluoro A, G, C or U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage, and
administering to the subject a therapeutically effective amount of
an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby decreasing the level of LDLc in the subject.
[0073] In yet another aspect, the present invention provides
methods of treating a subject having a disorder that would benefit
from reduction in PCSK9 expression. The methods include
administering to the subject a double-stranded ribonucleic acid
(RNAi) agent in a dosing regimen that includes a loading phase
followed by a maintenance phase, wherein the loading phase
comprises administering a fixed dose of about 200 mg to about 600
mg of the RNAi agent to the subject, and wherein the maintenance
phase comprises administering to the subject a fixed dose of about
25 mg to about 100 mg of the RNAi agent once a quarter, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
sense strand comprises the nucleotide sequence of
5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO: 687) and the antisense
strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
or U; Af, Gf, Cf or Uf are 2'-fluoro A, G, C or U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage, and
administering to the subject a therapeutically effective amount of
an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby treating the subject having a disorder that would benefit
from reduction in PCSK9 expression.
[0074] In another aspect, the present invention provides methods of
treating a subject having hyperlipidemia. The methods include
administering to the subject a double-stranded ribonucleic acid
(RNAi) agent in a dosing regimen that includes a loading phase
followed by a maintenance phase, wherein the loading phase
comprises administering a fixed dose of about 200 mg to about 600
mg of the RNAi agent to the subject, and wherein the maintenance
phase comprises administering to the subject a fixed dose of about
25 mg to about 100 mg of the RNAi agent once a quarter, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, wherein the
sense strand comprises the nucleotide sequence of
5'-csusagacCfuGfudTuugcuuuugu-3' (SEQ ID NO: 687) and the antisense
strand comprises the nucleotide sequence of
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3' (SEQ ID NO: 688)
(AD-60212), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C,
or U; Af, Gf, Cf or Uf are 2'-fluoro A, G, C or U; dT is
2'-deoxythymidine; and s is a phosphorothioate linkage, and
administering to the subject a therapeutically effective amount of
an anti-PCSK9 antibody, or antigen-binding fragment thereof,
thereby treating the subject having hyperlipidemia.
[0075] In one embodiment, the subject is administered the
maintenance does as a fixed dose of about 200 mg to about 800 mg
once a quarter. In another embodiment, the subject is administered
the maintenance does as a fixed dose of about 200 mg to about 800
mg biannually.
[0076] In one embodiment, the double-stranded ribonucleic acid RNAi
agent further comprises a ligand.
[0077] In one embodiment, the ligand is conjugated to the 3' end of
the sense strand of the double-stranded ribonucleic acid RNAi
agent.
[0078] In one embodiment, the ligand is an N-acetylgalactosamine
(GalNAc) derivative.
[0079] In one embodiment, the ligand is
##STR00002##
[0080] In one embodiment, the double-stranded ribonucleic acid RNAi
agent is conjugated to the ligand as shown in the following
schematic
and, wherein X is O or S. In one embodiment, the X is O.
[0081] In one embodiment, the anti-PCSK9 antibody, or
antigen-binding fragment thereof, is selected from the group
consisting of alirocumab (Praluent), evolocumab (Repatha), and
bococizumab.
[0082] In one embodiment, the methods further include administering
an additional therapeutic agent, e.g., a statin, to the
subject.
[0083] In one aspect, the present invention provides kits for
performing the method of the invention. The kits include the RNAi
agent, and instructions for use, and optionally, means for
administering the RNAi agent to the subject.
[0084] The present invention is further illustrated by the
following detailed description and drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0085] FIG. 1 is a graph showing the knockdown of PCSK9 protein
levels, shown as a percent mean PCSK9 knockdown relative to
baseline, in subjects receiving a single fixed dose of
AD-60212.
[0086] FIG. 2 is a graph showing the lowering of LDL-c levels,
shown as a percent mean LCL-C lowering relative to baseline, in
subjects receiving a single fixed dose of AD-60212.
[0087] FIG. 3 is a graph showing the knockdown of PCSK9 protein
levels, shown as a percent mean PCSK9 knockdown relative to
baseline, in subjects receiving multiple fixed doses of
AD-60212.
[0088] FIG. 4 is a graph showing the lowering of LDL-c levels,
shown as a percent mean LCL-C lowering relative to baseline, in
subjects receiving multiple fixed doses of AD-60212.
DETAILED DESCRIPTION OF THE INVENTION
[0089] The present invention is based, at least in part, on the
surprising discovery that a single dose of a double-stranded RNAi
agent comprising chemical modifications shows an exceptional
potency and durability to inhibit expression of PCSK9.
Specifically, a single fixed dose, e.g., a fixed dose of about 300
mg to about 500 mg, of RNAi agents targeting a human PCSK9 gene,
e.g., nucleotides 3544-3623 of a human PCSK9 gene (nucleotides
3544-3623 of SEQ ID NO:1), e.g., nucleotides 3601-3623 of SEQ ID
NO:1, including a GalNAc ligand are shown herein to be
exceptionally effective and durable in silencing the activity of a
PCSK9 gene.
[0090] Accordingly, the present invention provides methods for
inhibiting expression of a PCSK9 gene and methods for treating a
subject having a disorder that would benefit from inhibiting or
reducing the expression of a PCSK9 gene, e.g., a disorder mediated
by PCSK9 expression, such as a hyperlipidemia, e.g.,
hypercholesterolemia, using iRNA compositions which effect the
RNA-induced silencing complex (RISC)-mediated cleavage of RNA
transcripts of a PCSK9 gene.
[0091] The following detailed description discloses how to make and
use compositions containing iRNAs to inhibit the expression of a
PCSK9 gene, as well as compositions, uses, and methods for treating
subjects having diseases and disorders that would benefit from
inhibition and/or reduction of the expression of this gene.
I. Definitions
[0092] In order that the present invention may be more readily
understood, certain terms are first defined. In addition, it should
be noted that whenever a value or range of values of a parameter
are recited, it is intended that values and ranges intermediate to
the recited values are also intended to be part of this
invention.
[0093] The articles "a" and "an" are used herein to refer to one or
to more than one (i.e., to at least one) of the grammatical object
of the article. By way of example, "an element" means one element
or more than one element, e.g., a plurality of elements.
[0094] The term "including" is used herein to mean, and is used
interchangeably with, the phrase "including but not limited
to".
[0095] The term "or" is used herein to mean, and is used
interchangeably with, the term "and/or," unless context clearly
indicates otherwise. For example, "sense strand or antisense
strand" is understood as "sense strand or antisense strand or sense
strand and antisense strand."
[0096] The term "about" is used herein to mean within the typical
ranges of tolerances in the art. For example, "about" can be
understood as about 2 standard deviations from the mean. In certain
embodiments, about means +10%. In certain embodiments, about means
+5%. When about is present before a series of numbers or a range,
it is understood that "about" can modify each of the numbers in the
series or range.
[0097] The term "at least" prior to a number or series of numbers
is understood to include the number adjacent to the term "at
least", and all subsequent numbers or integers that could logically
be included, as clear from context. For example, the number of
nucleotides in a nucleic acid molecule must be an integer. For
example, "at least 18 nucleotides of a 21 nucleotide nucleic acid
molecule" means that 18, 19, 20, or 21 nucleotides have the
indicated property. When at least is present before a series of
numbers or a range, it is understood that "at least" can modify
each of the numbers in the series or range.
[0098] As used herein, "no more than" or "less than" is understood
as the value adjacent to the phrase and logical lower values or
integers, as logical from context, to zero. For example, a duplex
with an overhang of "no more than 2 nucleotides" has a 2, 1, or 0
nucleotide overhang. When "no more than" is present before a series
of numbers or a range, it is understood that "no more than" can
modify each of the numbers in the series or range.
[0099] As used herein, "PCSK9" refers to the proprotein convertase
subtilisin kexin 9 gene or protein. PCSK9 is also known as FH3,
HCHOLA3, NARC-1, or NARC1. The term PCSK9 includes human PCSK9, the
amino acid and nucleotide sequence of which may be found in, for
example, GenBank Accession No. GI:299523249 (SEQ ID NO:1); mouse
PCSK9, the amino acid and nucleotide sequence of which may be found
in, for example, GenBank Accession No. GI:163644257; rat PCSK9, the
amino acid and nucleotide sequence of which may be found in, for
example, GenBank Accession No. GI:77020249.
[0100] Additional examples of PCSK9 mRNA sequences are readily
available using publicly available databases, e.g., GenBank,
UniProt, and OMIM.
[0101] In one embodiment, the subject is a human, such as a human
being treated or assessed for a disease, disorder or condition that
would benefit from reduction in PCSK9 expression; a human at risk
for a disease, disorder or condition that would benefit from
reduction in PCSK9 expression; a human having a disease, disorder
or condition that would benefit from reduction in PCSK9 expression;
and/or human being treated for a disease, disorder or condition
that would benefit from reduction in PCSK9 expression as described
herein.
[0102] As used herein, the terms "treating" or "treatment" refer to
a beneficial or desired result including, but not limited to,
alleviation or amelioration of one or more symptoms associated with
a disorder that would benefit from reduction in PCSK9 expression,
or slowing or reversing the progression of such a disorder, whether
detectable or undetectable. For example, in the context of
hyperlipidemia, treatment may include a decrease in serum lipid
levels, e.g., a decrease in low density lipoprotein cholesterol
(LDLc). "Treatment" can also mean prolonging survival as compared
to expected survival in the absence of treatment.
[0103] As used herein, "prevention" or "preventing," when used in
reference to a disease, disorder or condition thereof, that would
benefit from a reduction in expression of a PCSK9 gene, refers to a
reduction in the likelihood that a subject will develop a symptom
associated with a disease, disorder, or condition mediated by PCSK9
expression, e.g., a symptom such as cardiovascular disease, e.g.,
coronary artery disease (CAD) (also known as coronary heart disease
(CHD)), or transient ischemic attack (TIA) or stroke. The
likelihood of developing a such a symptom is reduced, for example,
when an individual having one or more risk factors (e.g., diabetes,
previous personal history of CHD or noncoronary atherosclerosis
(e.g., abdominal aortic aneurysm, peripheral artery disease, and
carotid artery stenosis), family history of cardiovascular disease,
e.g., in male relatives younger than 50 years or in female
relatives younger than age 60 years, tobacco use, hypertension,
and/or obesity (BMI .gtoreq.30)) for a disease, disorder, or
condition mediated by PCSK9 expression, e.g., hypercholesterolemia,
either fails to develop, for example, coronary artery disease, or
develops, e.g., coronary artery disease, with less severity
relative to a population having the same risk factors and not
receiving treatment as described herein. The failure to develop a
disease, disorder or condition, or the reduction in the development
of a symptom associated with such a disease, disorder or condition
(e.g., by at least about 10% on a clinically accepted scale for
that disease or disorder), or the exhibition of delayed symptoms
delayed (e.g., by days, weeks, months or years) is considered
effective prevention. Prevention can require administration of more
than one dose.
[0104] The interchangeably used terms "PCSK9-associated disease"
and "disorder that would benefit from a reduction in PCSK9
expression," as used herein, are intended to include any disease,
disorder, or condition associated with the PCSK9 gene or protein.
Such a disease may be caused, for example, by excess production of
the PCSK9 protein, by PCSK9 gene mutations, by abnormal cleavage of
the PCSK9 protein, by abnormal interactions between PCSK9 and other
proteins or other endogenous or exogenous substances. Exemplary
PCSK9-associated diseases include lipidemias, e.g., a
hyperlipidemia, and other forms of lipid imbalance such as
hypercholesterolemia, hypertriglyceridemia and the pathological
conditions associated with these disorders, e.g., CHD and
atherosclerosis.
[0105] As used herein the term "hypercholesterolemia" refers to a
form of hyperlipidemia (elevated levels of lipids in the blood) in
which there are high levels of cholesterol in the serum of a
subject, e.g., at least about 240 mg/dL of total cholesterol.
[0106] As used herein, the term "cardiovascular disease" refers to
a disease affecting the heart or blood vessels, which includes, for
example, arteriosclerosis, coronary artery disease (or narrowing of
the arteries), heart valve disease, arrhythmia, heart failure,
hypertension, orthostatic hypotension, shock, endocarditis,
diseases of the aorta and its branches, disorders of the peripheral
vascular system, heart attack, cardiomyopathy, and congenital heart
disease.
[0107] "Therapeutically effective amount," as used herein, is
intended to include the amount of an RNAi agent that, when
administered to a patient for treating a PCSK9 associated disease,
is sufficient to effect treatment of the disease (e.g., by
diminishing, ameliorating or maintaining the existing disease or
one or more symptoms of disease). The "therapeutically effective
amount" may vary depending on the RNAi agent, how the agent is
administered, the disease and its severity and the history, age,
weight, family history, genetic makeup, stage of pathological
processes mediated by PCSK9 expression, the types of preceding or
concomitant treatments, if any, and other individual
characteristics of the patient to be treated.
[0108] "Prophylactically effective amount," as used herein, is
intended to include the amount of an RNAi agent that, when
administered to a subject who does not yet experience or display
symptoms of a PCSK9-associated disease, but who may be predisposed
to the disease, is sufficient to prevent or ameliorate the disease
or one or more symptoms of the disease. Ameliorating the disease
includes slowing the course of the disease or reducing the severity
of later-developing disease. The "prophylactically effective
amount" may vary depending on the RNAi agent, how the agent is
administered, the degree of risk of disease, and the history, age,
weight, family history, genetic makeup, the types of preceding or
concomitant treatments, if any, and other individual
characteristics of the patient to be treated.
[0109] A "therapeutically-effective amount" or "prophylactically
effective amount" also includes an amount of an RNAi agent that
produces some desired local or systemic effect at a reasonable
benefit/risk ratio applicable to any treatment. RNAi gents employed
in the methods of the present invention may be administered in a
sufficient amount to produce a reasonable benefit/risk ratio
applicable to such treatment.
[0110] As used herein, "target sequence" refers to a contiguous
portion of the nucleotide sequence of an mRNA molecule formed
during the transcription of a PCSK9 gene, including mRNA that is a
product of RNA processing of a primary transcription product. In
one embodiment, the target portion of the sequence will be at least
long enough to serve as a substrate for iRNA-directed cleavage at
or near that portion of the nucleotide sequence of an mRNA molecule
formed during the transcription of a PCSK9 gene.
[0111] The target sequence may be from about 9-36 nucleotides in
length, e.g., about 15-30 nucleotides in length. For example, the
target sequence can be from about 15-30 nucleotides, 15-29, 15-28,
15-27, 15-26, 15-25, 15-24, 15-23, 15-22, 15-21, 15-20, 15-19,
15-18, 15-17, 18-30, 18-29, 18-28, 18-27, 18-26, 18-25, 18-24,
18-23, 18-22, 18-21, 18-20, 19-30, 19-29, 19-28, 19-27, 19-26,
19-25, 19-24, 19-23, 19-22, 19-21, 19-20, 20-30, 20-29, 20-28,
20-27, 20-26, 20-25, 20-24, 20-23, 20-22, 20-21, 21-30, 21-29,
21-28, 21-27, 21-26, 21-25, 21-24, 21-23, or 21-22 nucleotides in
length. In some embodiments, the target sequence is about 19 to
about 30 nucleotides in length. In other embodiments, the target
sequence is about 19 to about 25 nucleotides in length. In still
other embodiments, the target sequence is about 19 to about 23
nucleotides in length. In some embodiments, the target sequence is
about 21 to about 23 nucleotides in length. Ranges and lengths
intermediate to the above recited ranges and lengths are also
contemplated to be part of the invention.
[0112] As used herein, the term "strand comprising a sequence"
refers to an oligonucleotide comprising a chain of nucleotides that
is described by the sequence referred to using the standard
nucleotide nomenclature.
[0113] "G," "C," "A," "T" and "U" each generally stand for a
nucleotide that contains guanine, cytosine, adenine, thymidine and
uracil as a base, respectively. However, it will be understood that
the term "ribonucleotide" or "nucleotide" can also refer to a
modified nucleotide, as further detailed below, or a surrogate
replacement moiety (see, e.g., Table B). The skilled person is well
aware that guanine, cytosine, adenine, and uracil can be replaced
by other moieties without substantially altering the base pairing
properties of an oligonucleotide comprising a nucleotide bearing
such replacement moiety. For example, without limitation, a
nucleotide comprising inosine as its base can base pair with
nucleotides containing adenine, cytosine, or uracil. Hence,
nucleotides containing uracil, guanine, or adenine can be replaced
in the nucleotide sequences of dsRNA featured in the invention by a
nucleotide containing, for example, inosine. In another example,
adenine and cytosine anywhere in the oligonucleotide can be
replaced with guanine and uracil, respectively to form G-U Wobble
base pairing with the target mRNA. Sequences containing such
replacement moieties are suitable for the compositions and methods
featured in the invention.
[0114] The terms "iRNA", "RNAi agent," "iRNA agent," "RNA
interference agent" as used interchangeably herein, refer to an
agent that contains RNA as that term is defined herein, and which
mediates the targeted cleavage of an RNA transcript via an
RNA-induced silencing complex (RISC) pathway. iRNA directs the
sequence-specific degradation of mRNA through a process known as
RNA interference (RNAi). The iRNA modulates, e.g., inhibits, the
expression of PCSK9 in a cell, e.g., a cell within a subject, such
as a mammalian subject.
[0115] In one embodiment, an RNAi agent of the invention includes a
single stranded RNA that interacts with a target RNA sequence,
e.g., a PCSK9 target mRNA sequence, to direct the cleavage of the
target RNA. Without wishing to be bound by theory it is believed
that long double stranded RNA introduced into cells is broken down
into siRNA by a Type III endonuclease known as Dicer (Sharp et al.
(2001) Genes Dev. 15:485). Dicer, a ribonuclease-Ill-like enzyme,
processes the dsRNA into 19-23 base pair short interfering RNAs
with characteristic two base 3' overhangs (Bernstein, et al.,
(2001) Nature 409:363). The siRNAs are then incorporated into an
RNA-induced silencing complex (RISC) where one or more helicases
unwind the siRNA duplex, enabling the complementary antisense
strand to guide target recognition (Nykanen, et al., (2001) Cell
107:309). Upon binding to the appropriate target mRNA, one or more
endonucleases within the RISC cleave the target to induce silencing
(Elbashir, et al., (2001) Genes Dev. 15:188). Thus, in one aspect
the invention relates to a single stranded RNA (siRNA) generated
within a cell and which promotes the formation of a RISC complex to
effect silencing of the target gene, i.e., a PCSK9 gene.
Accordingly, the term "siRNA" is also used herein to refer to an
RNAi as described above.
[0116] In another embodiment, the RNAi agent may be a
single-stranded siRNA that is introduced into a cell or organism to
inhibit a target mRNA. Single-stranded RNAi agents bind to the RISC
endonuclease, Argonaute 2, which then cleaves the target mRNA. The
single-stranded siRNAs are generally 15-30 nucleotides and are
chemically modified. The design and testing of single-stranded
siRNAs are described in U.S. Pat. No. 8,101,348 and in Lima et al.,
(2012) Cell 150: 883-894, the entire contents of each of which are
hereby incorporated herein by reference. Any of the antisense
nucleotide sequences described herein may be used as a
single-stranded siRNA as described herein or as chemically modified
by the methods described in Lima et al., (2012) Cell
150:883-894.
[0117] In another embodiment, an "iRNA" for use in the
compositions, uses, and methods of the invention is a
double-stranded RNA and is referred to herein as a "double stranded
RNAi agent," "double-stranded RNA (dsRNA) molecule," "dsRNA agent,"
or "dsRNA". The term "dsRNA" refers to a complex of ribonucleic
acid molecules, having a duplex structure comprising two
anti-parallel and substantially complementary nucleic acid strands,
referred to as having "sense" and "antisense" orientations with
respect to a target RNA, i.e., a PCSK9 gene. In some embodiments of
the invention, a double-stranded RNA (dsRNA) triggers the
degradation of a target RNA, e.g., an mRNA, through a
post-transcriptional gene-silencing mechanism referred to herein as
RNA interference or RNAi.
[0118] In general, the majority of nucleotides of each strand of a
dsRNA molecule are ribonucleotides, but as described in detail
herein, each or both strands can also include one or more
non-ribonucleotides, e.g., a deoxyribonucleotide and/or a modified
nucleotide. In addition, as used in this specification, an "RNAi
agent" may include ribonucleotides with chemical modifications; an
RNAi agent may include substantial modifications at multiple
nucleotides. Such modifications may include all types of
modifications disclosed herein or known in the art. Any such
modifications, as used in a siRNA type molecule, are encompassed by
"RNAi agent" for the purposes of this specification and claims.
[0119] The duplex region may be of any length that permits specific
degradation of a desired target RNA through a RISC pathway, and may
range from about 9 to 36 base pairs in length, e.g., about 15-30
base pairs in length, for example, about 9, 10, 11, 12, 13, 14, 15,
16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32,
33, 34, 35, or 36 base pairs in length, such as about 15-30, 15-29,
15-28, 15-27, 15-26, 15-25, 15-24, 15-23, 15-22, 15-21, 15-20,
15-19, 15-18, 15-17, 18-30, 18-29, 18-28, 18-27, 18-26, 18-25,
18-24, 18-23, 18-22, 18-21, 18-20, 19-30, 19-29, 19-28, 19-27,
19-26, 19-25, 19-24, 19-23, 19-22, 19-21, 19-20, 20-30, 20-29,
20-28, 20-27, 20-26, 20-25, 20-24, 20-23, 20-22, 20-21, 21-30,
21-29, 21-28, 21-27, 21-26, 21-25, 21-24, 21-23, or 21-22 base
pairs in length. Ranges and lengths intermediate to the above
recited ranges and lengths are also contemplated to be part of the
invention.
[0120] The two strands forming the duplex structure may be
different portions of one larger RNA molecule, or they may be
separate RNA molecules. Where the two strands are part of one
larger molecule, and therefore are connected by an uninterrupted
chain of nucleotides between the 3'-end of one strand and the
5'-end of the respective other strand forming the duplex structure,
the connecting RNA chain is referred to as a "hairpin loop." A
hairpin loop can comprise at least one unpaired nucleotide. In some
embodiments, the hairpin loop can comprise at least 2, at least 3,
at least 4, at least 5, at least 6, at least 7, at least 8, at
least 9, at least 10, at least 20, at least 23 or more unpaired
nucleotides. In some embodiments, the hairpin loop can be 10 or
fewer nucleotides. In some embodiments, the hairpin loop can be 8
or fewer unpaired nucleotides. In some embodiments, the hairpin
loop can be 4-10 unpaired nucleotides. In some embodiments, the
hairpin loop can be 4-8 nucleotides.
[0121] Where the two substantially complementary strands of a dsRNA
are comprised by separate RNA molecules, those molecules need not,
but can be covalently connected. Where the two strands are
connected covalently by means other than an uninterrupted chain of
nucleotides between the 3'-end of one strand and the 5'-end of the
respective other strand forming the duplex structure, the
connecting structure is referred to as a "linker." The RNA strands
may have the same or a different number of nucleotides. The maximum
number of base pairs is the number of nucleotides in the shortest
strand of the dsRNA minus any overhangs that are present in the
duplex. In addition to the duplex structure, an RNAi may comprise
one or more nucleotide overhangs. In one embodiment of the RNAi
agent, at least one strand comprises a 3' overhang of at least 1
nucleotide. In another embodiment, at least one strand comprises a
3' overhang of at least 2 nucleotides, e.g., 2, 3, 4, 5, 6, 7, 9,
10, 11, 12, 13, 14, or 15 nucleotides. In other embodiments, at
least one strand of the RNAi agent comprises a 5' overhang of at
least 1 nucleotide. In certain embodiments, at least one strand
comprises a 5' overhang of at least 2 nucleotides, e.g., 2, 3, 4,
5, 6, 7, 9, 10, 11, 12, 13, 14, or 15 nucleotides. In still other
embodiments, both the 3' and the 5' end of one strand of the RNAi
agent comprise an overhang of at least 1 nucleotide.
[0122] In one embodiment, an RNAi agent of the invention is a dsRNA
agent, each strand of which comprises 19-23 nucleotides that
interacts with a target RNA sequence, i.e., a PCSK9 target mRNA
sequence. Without wishing to be bound by theory, long double
stranded RNA introduced into cells is broken down into siRNA by a
Type III endonuclease known as Dicer (Sharp et al. (2001) Genes
Dev. 15:485). Dicer, a ribonuclease-III-like enzyme, processes the
dsRNA into 19-23 base pair short interfering RNAs with
characteristic two base 3' overhangs (Bernstein, et al., (2001)
Nature 409:363). The siRNAs are then incorporated into an
RNA-induced silencing complex (RISC) where one or more helicases
unwind the siRNA duplex, enabling the complementary antisense
strand to guide target recognition (Nykanen, et al., (2001) Cell
107:309). Upon binding to the appropriate target mRNA, one or more
endonucleases within the RISC cleave the target to induce silencing
(Elbashir, et al., (2001) Genes Dev. 15:188).
[0123] In another embodiment, an RNAi agent of the invention is a
dsRNA of 24-30 nucleotides that interacts with a target RNA
sequence, e.g., a PCSK9 target mRNA sequence, to direct the
cleavage of the target RNA. Without wishing to be bound by theory,
long double stranded RNA introduced into cells is broken down into
siRNA by a Type III endonuclease known as Dicer (Sharp et al.
(2001) Genes Dev. 15:485). Dicer, a ribonuclease-III-like enzyme,
processes the dsRNA into 19-23 base pair short interfering RNAs
with characteristic two base 3' overhangs (Bernstein, et al.,
(2001) Nature 409:363). The siRNAs are then incorporated into an
RNA-induced silencing complex (RISC) where one or more helicases
unwind the siRNA duplex, enabling the complementary antisense
strand to guide target recognition (Nykanen, et al., (2001) Cell
107:309). Upon binding to the appropriate target mRNA, one or more
endonucleases within the RISC cleave the target to induce silencing
(Elbashir, et al., (2001) Genes Dev. 15:188).
[0124] As used herein, the term "nucleotide overhang" refers to at
least one unpaired nucleotide that protrudes from the duplex
structure of an iRNA, e.g., a dsRNA. For example, when a 3'-end of
one strand of a dsRNA extends beyond the 5'-end of the other
strand, or vice versa, there is a nucleotide overhang. A dsRNA can
comprise an overhang of at least one nucleotide; alternatively the
overhang can comprise at least two nucleotides, at least three
nucleotides, at least four nucleotides, at least five nucleotides
or more. A nucleotide overhang can comprise or consist of a
nucleotide/nucleoside analog, including a
deoxynucleotide/nucleoside. The overhang(s) can be on the sense
strand, the antisense strand or any combination thereof.
Furthermore, the nucleotide(s) of an overhang can be present on the
5'-end, 3'-end or both ends of either an antisense or sense strand
of a dsRNA.
[0125] In one embodiment of the dsRNA, at least one strand
comprises a 3' overhang of at least 1 nucleotide. In another
embodiment, at least one strand comprises a 3' overhang of at least
2 nucleotides, e.g., 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, or 15
nucleotides. In other embodiments, at least one strand of the RNAi
agent comprises a 5' overhang of at least 1 nucleotide. In certain
embodiments, at least one strand comprises a 5' overhang of at
least 2 nucleotides, e.g., 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14,
or 15 nucleotides. In still other embodiments, both the 3' and the
5' end of one strand of the RNAi agent comprise an overhang of at
least 1 nucleotide. In certain embodiments, the antisense strand of
a dsRNA has a 1-10 nucleotide, e.g., 0-3, 1-3, 2-4, 2-5, 4-10,
5-10, e.g., a 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 nucleotide, overhang
at the 3'-end and/or the 5'-end. In one embodiment, the sense
strand of a dsRNA has a 1-10 nucleotide, e.g., a 1, 2, 3, 4, 5, 6,
7, 8, 9, or 10 nucleotide, overhang at the 3'-end and/or the
5'-end. In another embodiment, one or more of the nucleotides in
the overhang is replaced with a nucleoside thiophosphate.
[0126] In certain embodiments, the overhang on the sense strand or
the antisense strand, or both, can include extended lengths longer
than 10 nucleotides, e.g., 1-30 nucleotides, 2-30 nucleotides,
10-30 nucleotides, or 10-15 nucleotides in length. In certain
embodiments, an extended overhang is on the sense strand of the
duplex. In certain embodiments, an extended overhang is present on
the 3'end of the sense strand of the duplex. In certain
embodiments, an extended overhang is present on the 5'end of the
sense strand of the duplex. In certain embodiments, an extended
overhang is on the antisense strand of the duplex. In certain
embodiments, an extended overhang is present on the 3'end of the
antisense strand of the duplex. In certain embodiments, an extended
overhang is present on the 5'end of the antisense strand of the
duplex. In certain embodiments, one or more of the nucleotides in
the overhang is replaced with a nucleoside thiophosphate. In
certain embodiments, the overhang includes a self-complementary
portion such that the overhang is capable of forming a hairpin
structure that is stable under physiological conditions.
[0127] "Blunt" or "blunt end" means that there are no unpaired
nucleotides at that end of the double stranded RNAi agent, i.e., no
nucleotide overhang. A "blunt ended" RNAi agent is a dsRNA that is
double-stranded over its entire length, i.e., no nucleotide
overhang at either end of the molecule. The RNAi agents of the
invention include RNAi agents with nucleotide overhangs at one end
(i.e., agents with one overhang and one blunt end) or with
nucleotide overhangs at both ends.
[0128] The term "antisense strand" or "guide strand" refers to the
strand of an iRNA, e.g., a dsRNA, which includes a region that is
substantially complementary to a target sequence, e.g., a PCSK9
mRNA. As used herein, the term "region of complementarity" refers
to the region on the antisense strand that is substantially
complementary to a sequence, for example a target sequence, e.g., a
PCSK9 nucleotide sequence, as defined herein. Where the region of
complementarity is not fully complementary to the target sequence,
the mismatches can be in the internal or terminal regions of the
molecule. Generally, the most tolerated mismatches are in the
terminal regions, e.g., within 5, 4, 3, 2, or 1 nucleotides of the
5'- and/or 3'-terminus of the iRNA. In one embodiment, a double
stranded RNAi agent of the invention include a nucleotide mismatch
in the antisense strand. In another embodiment, a double stranded
RNAi agent of the invention include a nucleotide mismatch in the
sense strand. In one embodiment, the nucleotide mismatch is, for
example, within 5, 4, 3, 2, or 1 nucleotides from the 3'-terminus
of the iRNA. In another embodiment, the nucleotide mismatch is, for
example, in the 3'-terminal nucleotide of the iRNA.
[0129] The term "sense strand," or "passenger strand" as used
herein, refers to the strand of an iRNA that includes a region that
is substantially complementary to a region of the antisense strand
as that term is defined herein.
[0130] As used herein, the term "cleavage region" refers to a
region that is located immediately adjacent to the cleavage site.
The cleavage site is the site on the target at which cleavage
occurs.
[0131] In some embodiments, the cleavage region comprises three
bases on either end of, and immediately adjacent to, the cleavage
site. In some embodiments, the cleavage region comprises two bases
on either end of, and immediately adjacent to, the cleavage site.
In some embodiments, the cleavage site specifically occurs at the
site bound by nucleotides 10 and 11 of the antisense strand, and
the cleavage region comprises nucleotides 11, 12 and 13. As used
herein, and unless otherwise indicated, the term "complementary,"
when used to describe a first nucleotide sequence in relation to a
second nucleotide sequence, refers to the ability of an
oligonucleotide or polynucleotide comprising the first nucleotide
sequence to hybridize and form a duplex structure under certain
conditions with an oligonucleotide or polynucleotide comprising the
second nucleotide sequence, as will be understood by the skilled
person. Such conditions can, for example, be stringent conditions,
where stringent conditions can include: 400 mM NaCl, 40 mM PIPES pH
6.4, 1 mM EDTA, 50.degree. C. or 70.degree. C. for 12-16 hours
followed by washing (see, e.g., "Molecular Cloning: A Laboratory
Manual, Sambrook, et al. (1989) Cold Spring Harbor Laboratory
Press). Other conditions, such as physiologically relevant
conditions as can be encountered inside an organism, can apply. The
skilled person will be able to determine the set of conditions most
appropriate for a test of complementarity of two sequences in
accordance with the ultimate application of the hybridized
nucleotides.
[0132] Complementary sequences within an iRNA, e.g., within a dsRNA
as described herein, include base-pairing of the oligonucleotide or
polynucleotide comprising a first nucleotide sequence to an
oligonucleotide or polynucleotide comprising a second nucleotide
sequence over the entire length of one or both nucleotide
sequences. Such sequences can be referred to as "fully
complementary" with respect to each other herein. However, where a
first sequence is referred to as "substantially complementary" with
respect to a second sequence herein, the two sequences can be fully
complementary, or they can form one or more, but generally not more
than 5, 4, 3 or 2 mismatched base pairs upon hybridization for a
duplex up to 30 base pairs, while retaining the ability to
hybridize under the conditions most relevant to their ultimate
application, e.g., inhibition of gene expression via a RISC
pathway. However, where two oligonucleotides are designed to form,
upon hybridization, one or more single stranded overhangs, such
overhangs shall not be regarded as mismatches with regard to the
determination of complementarity. For example, a dsRNA comprising
one oligonucleotide 21 nucleotides in length and another
oligonucleotide 23 nucleotides in length, wherein the longer
oligonucleotide comprises a sequence of 21 nucleotides that is
fully complementary to the shorter oligonucleotide, can yet be
referred to as "fully complementary" for the purposes described
herein.
[0133] "Complementary" sequences, as used herein, can also include,
or be formed entirely from, non-Watson-Crick base pairs and/or base
pairs formed from non-natural and modified nucleotides, in so far
as the above requirements with respect to their ability to
hybridize are fulfilled. Such non-Watson-Crick base pairs include,
but are not limited to, G:U Wobble or Hoogstein base pairing.
[0134] The terms "complementary," "fully complementary" and
"substantially complementary" herein can be used with respect to
the base matching between the sense strand and the antisense strand
of a dsRNA, or between the antisense strand of an iRNA agent and a
target sequence, as will be understood from the context of their
use.
[0135] As used herein, a polynucleotide that is "substantially
complementary to at least part of" a messenger RNA (mRNA) refers to
a polynucleotide that is substantially complementary to a
contiguous portion of the mRNA of interest (e.g., an mRNA encoding
PCSK9). For example, a polynucleotide is complementary to at least
a part of a PCSK9 mRNA if the sequence is substantially
complementary to a non-interrupted portion of an mRNA encoding
PCSK9.
[0136] In general, the majority of nucleotides of each strand are
ribonucleotides, but as described in detail herein, each or both
strands can also include one or more non-ribonucleotides, e.g., a
deoxyribonucleotide and/or a modified nucleotide. In addition, an
"iRNA" may include ribonucleotides with chemical modifications.
Such modifications may include all types of modifications disclosed
herein or known in the art. Any such modifications, as used in an
iRNA molecule, are encompassed by "iRNA" for the purposes of this
specification and claims.
[0137] In one aspect of the invention, an agent for use in the
methods and compositions of the invention is a single-stranded
antisense RNA molecule that inhibits a target mRNA via an antisense
inhibition mechanism. The single-stranded antisense RNA molecule is
complementary to a sequence within the target mRNA. The
single-stranded antisense oligonucleotides can inhibit translation
in a stoichiometric manner by base pairing to the mRNA and
physically obstructing the translation machinery, see Dias, N. et
al., (2002) Mol Cancer Ther 1:347-355. The single-stranded
antisense RNA molecule may be about 15 to about 30 nucleotides in
length and have a sequence that is complementary to a target
sequence. For example, the single-stranded antisense RNA molecule
may comprise a sequence that is at least about 15, 16, 17, 18, 19,
20, or more contiguous nucleotides from any one of the antisense
sequences described herein.
II. Methods of the Invention
[0138] The present invention provides methods of inhibiting the
expression of a Proprotein Convertase Subtilisin Kexin 9 (PCSK9)
gene in a subject. The present invention also provides therapeutic
and prophylactic methods for treating or preventing diseases and
conditions that can be modulated by down regulating PCSK9 gene
expression. For example, the compositions described herein can be
used to treat lipidemia, e.g., a hyperlipidemia and other forms of
lipid imbalance such as hypercholesterolemia, hypertriglyceridemia
and the pathological conditions associated with these disorders
such as heart and circulatory diseases. Other diseases and
conditions that can be modulated by down regulating PCSK9 gene
expression include lysosomal storage diseases including, but not
limited to, Niemann-Pick disease, Tay-Sachs disease, Lysosomal acid
lipase deficiency, and Gaucher Disease. The methods include
administering to the subject a therapeutically effective amount or
prophylactically effective amount of an RNAi agent of the
invention. In some embodiments, the method includes administering
an effective amount of a PCSK9 iRNA agent to a patient having a
heterozygous LDLR genotype.
[0139] As PCSK9 regulates the levels of the LDL receptor, which in
turn removes cholesterol-rich LDL particles from the plasma, the
effect of the decreased expression of a PCSK9 gene preferably
results in a decrease in LDLc (low density lipoprotein cholesterol)
levels in the blood, and more particularly in the serum, of the
mammal. In some embodiments, LDLc levels are decreased by at least
10%, 15%, 20%, 25%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or more, as
compared to pretreatment levels. Accordingly, the present invention
also provides methods for lowering the level of low density
cholesterol (LDLc) in the serum of a subject.
[0140] In certain embodiments of the invention, the double-stranded
RNAi agent is administered to a subject as a fixed dose. A "fixed
dose" (e.g., a dose in mg) means that one dose of an iRNA agent is
used for all subjects regardless of any specific subject-related
factors, such as weight. In other embodiments, an iRNA agent of the
invention is administered to a subject as a weight-based dose. A
"weight-based dose" (e.g., a dose in mg/kg) is a dose of the iRNA
agent that will change depending on the subject's weight.
[0141] In certain embodiments of an RNAi agent is administered to
the subject as a fixed dose of about 100 mg to about 700 mg, about
150 mg to about 700 mg, about 200 mg to about 700 mg, about 250 mg
to about 700 mg, about 300 mg to about 700 mg, about 350 mg to
about 700 mg, about 400 mg to about 700 mg, about 450 mg to about
700 mg, about 500 mg to about 700 mg, about 550 mg to about 700 mg,
about 600 to about 700 mg, about 650 to about 700 mg, about 100 mg
to about 650 mg, about 150 mg to about 650 mg, about 200 mg to
about 650 mg, about 250 mg to about 650 mg, about 300 mg to about
650 mg, about 350 mg to about 650 mg, about 400 mg to about 650 mg,
about 450 mg to about 650 mg, about 500 mg to about 650 mg, about
550 mg to about 650 mg, about 600 to about 650 mg, about 100 mg to
about 600 mg, about 150 mg to about 600 mg, about 200 mg to about
600 mg, about 250 mg to about 600 mg, about 300 mg to about 600 mg,
about 350 mg to about 600 mg, about 400 mg to about 600 mg, about
450 mg to about 600 mg, about 500 mg to about 600 mg, about 550 mg
to about 600 mg, about 100 mg to about 550 mg, about 150 mg to
about 550 mg, about 200 mg to about 550 mg, about 250 mg to about
550 mg, about 300 mg to about 550 mg, about 350 mg to about 550 mg,
about 400 mg to about 550 mg, about 450 mg to about 550 mg, about
500 mg to about 550 mg, about 100 mg to about 500 mg, about 150 mg
to about 500 mg, about 200 mg to about 500 mg, about 250 mg to
about 500 mg, about 300 mg to about 500 mg, about 350 mg to about
500 mg, about 400 mg to about 500 mg, or about 450 mg to about 500
mg, e.g., a fixed dose of about 100 mg, about 125 mg, about 150 mg,
about 175 mg, 200 mg, about 225 mg, about 250 mg, about 275 mg,
about 300 mg, about 325 mg, about 350 mg, about 375 mg, about 400
mg, about 425 mg, about 450 mg, about 475 mg, about 500 mg, about
525 mg, about 550 mg, about 575 mg, about 600 mg, about 625 mg,
about 650 mg, about 675 mg, or about 700 mg. Values and ranges
intermediate to the foregoing recited values are also intended to
be part of this invention.
[0142] The administration may be repeated, for example, on a
regular basis. For example, the fixed dose may administered to the
subject at an interval of once a week, once every two weeks, once a
month, once a quarter, or biannually for six months or a year or
longer, i.e., chronic administration.
[0143] In one embodiment, the subject is administered a fixed dose
of about 25 mg to about 50 mg once a week. In another embodiment,
the subject is administered a fixed dose of about 50 mg to about
100 mg once every two weeks. In another embodiment, the subject is
administered a fixed dose of about 100 mg to about 200 mg once a
month. In yet another embodiment, the subject is administered a
fixed dose of about 300 mg to about 600 mg once a quarter. In
another embodiment, the subject is administered a fixed dose of
about 300 mg to about 600 mg biannually (i.e., twice a year).
[0144] Accordingly, in one aspect, the present invention provides
methods of inhibiting the expression of a PCSK9 gene in a subject.
The methods include administering to the subject a double-stranded
ribonucleic acid (RNAi) agent, e.g., a dsRNA, of the invention
(e.g., a pharmaceutical composition comprising a dsRNA of the
invention), wherein a total of about 200 mg to about 600 mg of the
double-stranded RNAi agent is administered to the subject every
quarter or biannually, and wherein the double-stranded RNAi agent
comprises a sense strand and an antisense strand forming a double
stranded region, the antisense strand comprising a region of
complementarity which comprises at least 15 contiguous nucleotides
differing by no more than 3 nucleotides from nucleotides 3544-3623
of the nucleotide sequence of SEQ ID NO:1.
[0145] In another aspect, the present invention provides methods of
decreasing the level of low density lipoprotein (LDLc) in a
subject. The methods include administering to the subject a
double-stranded ribonucleic acid (RNAi) agent, wherein a total of
about 200 mg to about 600 mg of the double-stranded RNAi agent is
administered to the subject every quarter or biannually, and
wherein the double-stranded RNAi agent comprises a sense strand and
an antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1, thereby decreasing the level of LDLc in the
subject.
[0146] In another aspect, the present invention provides methods of
treating a subject having a disorder that would benefit from
reduction in PCSK9 expression, such as a hyperlipidemia, e.g.,
hypercholesterolemia. The methods include administering to the
subject a double-stranded ribonucleic acid (RNAi) agent, e.g., a
dsRNA, of the invention (e.g., a pharmaceutical composition
comprising a dsRNA of the invention), wherein a total of about 200
mg to about 600 mg of the double-stranded RNAi agent is
administered to the subject every quarter or biannually, and
wherein the double-stranded RNAi agent comprises a sense strand and
an antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1.
[0147] In yet another aspect, the present invention provides
methods of treating a subject having hyperlipidemia, such as
hypercholesterolemia. The methods include administering to the
subject a double-stranded ribonucleic acid (RNAi) agent, e.g., a
dsRNA, of the invention (e.g., a pharmaceutical composition
comprising a dsRNA of the invention), wherein a total of about 200
mg to about 600 mg of the double-stranded RNAi agent is
administered to the subject every quarter or biannually, and
wherein the double-stranded RNAi agent comprises a sense strand and
an antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1.
[0148] As indicated above, the administration of the RNAi agents to
a subject may be repeated on a regular basis, for example, at an
interval of once a week, once every two weeks, once a month, once a
quarter, or biannually.
[0149] Accordingly, in some embodiments, the RNAi agent is
administered in a dosing regimen that includes a "loading phase" of
closely spaced administrations that may be followed by a
"maintenance phase", in which the RNAi agent is administered at
longer spaced intervals. For example, after administration weekly
or biweekly for one month, administration can be repeated once per
month, for six months or a year or longer, i.e., chronic
administration.
[0150] In one embodiment, the loading phase comprises a single
administration of the RNAi agent during the first week. In another
embodiment, the loading phase comprises a single administration of
the RNAi agent during the first two weeks. In yet another
embodiment, the loading phase comprises a single administration of
the RNAi agent during the first month.
[0151] In certain embodiments of an RNAi agent is administered to
the subject during a loading phase as a fixed dose of about 100 mg
to about 700 mg, about 150 mg to about 700 mg, about 200 mg to
about 700 mg, about 250 mg to about 700 mg, about 300 mg to about
700 mg, about 350 mg to about 700 mg, about 400 mg to about 700 mg,
about 450 mg to about 700 mg, about 500 mg to about 700 mg, about
550 mg to about 700 mg, about 600 to about 700 mg, about 650 to
about 700 mg, about 100 mg to about 650 mg, about 150 mg to about
650 mg, about 200 mg to about 650 mg, about 250 mg to about 650 mg,
about 300 mg to about 650 mg, about 350 mg to about 650 mg, about
400 mg to about 650 mg, about 450 mg to about 650 mg, about 500 mg
to about 650 mg, about 550 mg to about 650 mg, about 600 to about
650 mg, about 100 mg to about 600 mg, about 150 mg to about 600 mg,
about 200 mg to about 600 mg, about 250 mg to about 600 mg, about
300 mg to about 600 mg, about 350 mg to about 600 mg, about 400 mg
to about 600 mg, about 450 mg to about 600 mg, about 500 mg to
about 600 mg, about 550 mg to about 600 mg, about 100 mg to about
550 mg, about 150 mg to about 550 mg, about 200 mg to about 550 mg,
about 250 mg to about 550 mg, about 300 mg to about 550 mg, about
350 mg to about 550 mg, about 400 mg to about 550 mg, about 450 mg
to about 550 mg, about 500 mg to about 550 mg, about 100 mg to
about 500 mg, about 150 mg to about 500 mg, about 200 mg to about
500 mg, about 250 mg to about 500 mg, about 300 mg to about 500 mg,
about 350 mg to about 500 mg, about 400 mg to about 500 mg, or
about 450 mg to about 500 mg, e.g., a fixed dose of about 100 mg,
about 125 mg, about 150 mg, about 175 mg, 200 mg, about 225 mg,
about 250 mg, about 275 mg, about 300 mg, about 325 mg, about 350
mg, about 375 mg, about 400 mg, about 425 mg, about 450 mg, about
475 mg, about 500 mg, about 525 mg, about 550 mg, about 575 mg,
about 600 mg, about 625 mg, about 650 mg, about 675 mg, or about
700 mg. Values and ranges intermediate to the foregoing recited
values are also intended to be part of this invention.
[0152] In one embodiment, the maintenance phase comprises
administration of a dose of the RNAi agent to the subject once a
month, once every two months, once every three months, once every
four months, once every five months, or once every six months. In
one particular embodiment, the maintenance dose is administered to
the subject once a month.
[0153] The maintenance dose or doses can be the same or lower than
the initial dose, e.g., one-half of the initial dose. For example,
a maintenance dose may be about 25 mg to about 100 mg administered
to the subject monthly, for example about 25 mg to about 75 mg,
about 25 mg to about 50 mg, or about 50 mg to about 75 mg, e.g.,
about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg,
about 50 mg, about 55 mg, about 60 mg, about 65 mg, about 70 mg,
about 75 mg, about 80 mg, about 85 mg, about 90 mg, about 95 mg, or
about 100 mg. Values and ranges intermediate to the foregoing
recited values are also intended to be part of this invention.
[0154] Any of these schedules may optionally be repeated for one or
more iterations. The number of iterations may depend on the
achievement of a desired effect, e.g., the suppression of a PCSK9
gene, and/or the achievement of a therapeutic or prophylactic
effect, e.g., reducing serum cholesterol levels or reducing a
symptom of hypercholesterolemia. Following treatment, the patient
can be monitored for changes in his/her condition. The dosage of
the RNAi agent may either be increased in the event the patient
does not respond significantly to current dosage levels, or the
dose may be decreased if an alleviation of the symptoms of the
disease state is observed, if the disease state has been ablated,
or if undesired side-effects are observed.
[0155] Accordingly, in one aspect, the present invention provides
methods of inhibiting the expression of a PCSK9 gene in a subject.
The methods include administering to the subject a double-stranded
ribonucleic acid (RNAi) agent in a dosing regimen that includes a
loading phase followed by a maintenance phase, wherein the loading
phase comprises administering affixed dose of about 200 mg to about
600 mg of the RNAi agent to the subject, and wherein the
maintenance phase comprises administering a fixed dose of about 25
mg to about 100 mg of the RNAi agent to the subject about once a
month, wherein the double-stranded RNAi agent comprises a sense
strand and an antisense strand forming a double stranded region,
the antisense strand comprising a region of complementarity which
comprises at least 15 contiguous nucleotides differing by no more
than 3 nucleotides from nucleotides 3544-3623 of the nucleotide
sequence of SEQ ID NO:1, thereby inhibiting the expression of the
PCSK9 gene in the subject.
[0156] In another aspect, the present invention provides method s
of decreasing the level of low density lipoprotein (LDLc) in a
subject. The methods include administering to the subject a
double-stranded ribonucleic acid (RNAi) agent in a dosing regimen
that includes a loading phase followed by a maintenance phase,
wherein the loading phase comprises administering to the subject a
fixed dose of about 200 mg to about 600 mg of the RNAi agent, and
wherein the maintenance phase comprises administering to the
subject a fixed dose of about 25 mg to about 100 mg of the RNAi
agent once a month, wherein the double-stranded RNAi agent
comprises a sense strand and an antisense strand forming a double
stranded region, the antisense strand comprising a region of
complementarity which comprises at least 15 contiguous nucleotides
differing by no more than 3 nucleotides from nucleotides 3544-3623
of the nucleotide sequence of SEQ ID NO:1, thereby decreasing the
level of LDLc in the subject.
[0157] In another aspect, the present invention provides methods of
treating a subject having a disorder that would benefit from
reduction in PCSK9 expression. The methods include administering to
the subject a double-stranded ribonucleic acid (RNAi) agent in a
dosing regimen that includes a loading phase followed by a
maintenance phase, wherein the loading phase comprises
administering to the subject a fixed dose of about 200 mg to about
600 mg of the RNAi agent, and wherein the maintenance phase
comprises administering to the subject a fixed dose of about 25 mg
to about 100 mg of the RNAi agent once a month, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1, thereby treating the subject having a disorder that
would benefit from reduction in PCSK9 expression.
[0158] In yet another aspect, the present invention provides
methods of treating a subject having hyperlipidemia. The methods
include administering to the subject a double-stranded ribonucleic
acid (RNAi) agent in a dosing regimen that includes a loading phase
followed by a maintenance phase, wherein the loading phase
comprises administering to the subject a fixed dose of about 200 mg
to about 600 mg of the RNAi agent, and wherein the maintenance
phase comprises administering to the subject a fixed dose of about
25 mg to about 100 mg of the RNAi agent once a month, wherein the
double-stranded RNAi agent comprises a sense strand and an
antisense strand forming a double stranded region, the antisense
strand comprising a region of complementarity which comprises at
least 15 contiguous nucleotides differing by no more than 3
nucleotides from nucleotides 3544-3623 of the nucleotide sequence
of SEQ ID NO:1, thereby treating the subject having
hyperlipidemia.
[0159] In one embodiment, the double-stranded ribonucleic acid
(RNAi) agent for use in the methods of the present invention
comprises a sense strand and an antisense strand forming a double
stranded region, wherein the antisense strand comprises the
nucleotide sequence 5'-ACAAAAGCAAAACAGGUCUAGAA-3' (SEQ ID NO: 685)
and the sense strand comprises the nucleotide sequence
5'-CUAGACCUGUTUUGCUUUUGU-3' (SEQ ID NO: 686), wherein substantially
all of the nucleotides of the sense strand and substantially all of
the nucleotides of the antisense strand are modified
nucleotides.
[0160] As used herein, a "subject" includes a human or non-human
animal, preferably a vertebrate, and more preferably a mammal. A
subject may include a transgenic organism. Most preferably, the
subject is a human, such as a human suffering from or predisposed
to developing a PCSK9-associated disease.
[0161] The methods and uses of the invention include administering
a composition described herein such that expression of the target
PCSK9 gene is decreased, for an extended period of time, such as,
for about 80 days, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92,
93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107,
108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120,
121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133,
134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146,
147, 148, 149, 150, 151, 152, 153, 154, 155, 156, 157, 158, 159,
160, 161, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172,
173, 174, 175, 176, 177, 178, 179, or about 180 days, or
longer.
[0162] Reduction in gene expression can be assessed by any methods
known in the art. For example, a reduction in the expression of
PCSK9 may be determined by determining the mRNA expression level of
PCSK9 using methods routine to one of ordinary skill in the art,
e.g., Northern blotting, qRT-PCR, by determining the protein level
of PCSK9 using methods routine to one of ordinary skill in the art,
such as Western blotting, immunological techniques, and/or by
determining a biological activity of PCSK9, such as the effect on
one or more serum lipid parameters, such as, for example, total
cholesterol levels, high density lipoprotein cholesterol (HDL)
levels, non-HDL levels, very low density lipoprotein cholesterol
(VLDL) levels, triglyceride levels, Lp(a) levels, and lipoprotein
particle size.
[0163] Administration of the dsRNA according to the methods and
uses of the invention may result in a reduction of the severity,
signs, symptoms, and/or markers of such diseases or disorders in a
patient with a disorder that would benefit from reduction in PCSK9
expression. By "reduction" in this context is meant a statistically
significant decrease in such level. The reduction can be, for
example, at least about 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%,
50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, or about
100%.
[0164] Efficacy of treatment or prevention of disease can be
assessed, for example by measuring disease progression, disease
remission, symptom severity, serum lipid levels (e.g., LDLc
levels), quality of life, dose of a medication required to sustain
a treatment effect, level of a disease marker or any other
measurable parameter appropriate for a given disease being treated
or targeted for prevention. It is well within the ability of one
skilled in the art to monitor efficacy of treatment or prevention
by measuring any one of such parameters, or any combination of
parameters. For example, efficacy of treatment of a hyperlipidemia
may be assessed, for example, by periodic monitoring of LDLc
levels. Comparisons of the later readings with the initial readings
provide a physician an indication of whether the treatment is
effective. It is well within the ability of one skilled in the art
to monitor efficacy of treatment or prevention by measuring any one
of such parameters, or any combination of parameters.
[0165] A treatment or preventive effect is evident when there is a
statistically significant improvement in one or more parameters of
disease status, or by a failure to worsen or to develop symptoms
where they would otherwise be anticipated. As an example, a
favorable change of at least 10% in a measurable parameter of
disease, and preferably at least 20%, 30%, 40%, 50% or more can be
indicative of effective treatment. Efficacy for a given iRNA drug
or formulation of that drug can also be judged using an
experimental animal model for the given disease as known in the
art. When using an experimental animal model, efficacy of treatment
is evidenced when a statistically significant reduction in a marker
or symptom is observed.
[0166] Alternatively, the efficacy can be measured by a reduction
in the severity of disease as determined by one skilled in the art
of diagnosis based on a clinically accepted disease severity
grading scale. Any positive change resulting in e.g., lessening of
severity of disease measured using the appropriate scale,
represents adequate treatment using an iRNA or iRNA formulation as
described herein.
[0167] In general, the iRNA agent does not activate the immune
system, e.g., it does not increase cytokine levels, such as
TNF-alpha or IFN-alpha levels. For example, when measured by an
assay, such as an in vitro PBMC assay, such as described herein,
the increase in levels of TNF-alpha or IFN-alpha, is less than 30%,
20%, or 10% of control cells treated with a control dsRNA, such as
a dsRNA that does not target PCSK9.
[0168] In another embodiment, administration can be provided when
Low Density Lipoprotein cholesterol (LDLc) levels reach or surpass
a predetermined minimal level, such as greater than 70 mg/dL, 130
mg/dL, 150 mg/dL, 200 mg/dL, 300 mg/dL, or 400 mg/dL.
[0169] The effect of the decreased PCSK9 gene preferably results in
a decrease in LDLc (low density lipoprotein cholesterol) levels in
the blood, and more particularly in the serum, of the mammal. In
some embodiments, LDLc levels are decreased by at least 10%, 15%,
20%, 25%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or more, as compared to
pretreatment levels.
[0170] In some embodiments of the methods of the invention, PCSK9
expression is decreased for an extended duration, e.g., at least
one week, two weeks, three weeks, or four weeks or longer. For
example, in certain instances, expression of the PCSK9 gene is
suppressed by at least about 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%,
45%, or 50% by administration of an iRNA agent described herein. In
some embodiments, the PCSK9 gene is suppressed by at least about
60%, 70%, or 80% by administration of the iRNA agent. In some
embodiments, the PCSK9 gene is suppressed by at least about 85%,
90%, or 95% by administration of the double-stranded
oligonucleotide.
[0171] The RNAi agents of the invention may be administered to a
subject using any mode of administration known in the art,
including, but not limited to subcutaneous, intravenous,
intramuscular, intraocular, intrabronchial, intrapleural,
intraperitoneal, intraarterial, lymphatic, cerebrospinal, and any
combinations thereof. In preferred embodiments, the agents are
administered subcutaneously.
[0172] In some embodiments, the administration is via a depot
injection. A depot injection may release the RNAi agent in a
consistent way over a prolonged time period. Thus, a depot
injection may reduce the frequency of dosing needed to obtain a
desired effect, e.g., a desired inhibition of PCSK9, or a
therapeutic or prophylactic effect. A depot injection may also
provide more consistent serum concentrations. Depot injections may
include subcutaneous injections or intramuscular injections. In
preferred embodiments, the depot injection is a subcutaneous
injection.
[0173] In some embodiments, the administration is via a pump. The
pump may be an external pump or a surgically implanted pump. In
certain embodiments, the pump is a subcutaneously implanted osmotic
pump. In other embodiments, the pump is an infusion pump. An
infusion pump may be used for intravenous, subcutaneous, arterial,
or epidural infusions. In preferred embodiments, the infusion pump
is a subcutaneous infusion pump. In other embodiments, the pump is
a surgically implanted pump that delivers the RNAi agent to the
liver.
[0174] Other modes of administration include epidural,
intracerebral, intracerebroventricular, nasal administration,
intraarterial, intracardiac, intraosseous infusion, intrathecal,
and intravitreal, and pulmonary. The mode of administration may be
chosen based upon whether local or systemic treatment is desired
and based upon the area to be treated. The route and site of
administration may be chosen to enhance targeting.
[0175] The iRNA can be administered by intravenous infusion over a
period of time, such as over a 5, 6, 7, 8, 9, 10, 11, 12, 13, 14,
15, 16, 17, 18, 19, 20, 21, 22, 23, 24, or about a 25 minute
period. The administration may be repeated, for example, on a
regular basis, such as weekly, biweekly (i.e., every two weeks) for
one month, two months, three months, four months or longer. After
an initial treatment regimen, the treatments can be administered on
a less frequent basis. For example, after administration weekly or
biweekly for three months, administration can be repeated once per
month, for six months or a year or longer.
[0176] Administration of the iRNA can reduce PCSK9 levels, e.g., in
a cell, tissue, blood, urine or other compartment of the patient by
at least about 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%,
16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25%, 26%, 27%, 28%,
29%, 30%, 31%, 32%, 33%, 34%, 35%, 36%, 37%, 38%, 39%, 40%, 41%,
42%, 43%, 44%, 45%, 46%, 47%, 48%, 49%, 50%, 51%, 52%, 53%, 54%,
55%, 56%, 57%, 58%, 59%, 60%, 61%, 62%, 63%, 64%, 65%, 66%, 67%,
68%, 69%, 70%, 71%, 72%, 73%, 74%, 75%, 76%, 77%, 78%, 79%, 80%,
81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%,
94%, 95%, 96%, 97%, 98%, or at least about 99% or more.
[0177] Before administration of a full dose of the iRNA, patients
can be administered a smaller dose, such as a 5% infusion, and
monitored for adverse effects, such as an allergic reaction. In
another example, the patient can be monitored for unwanted
immunostimulatory effects, such as increased cytokine (e.g.,
TNF-alpha or INF-alpha) levels.
[0178] Owing to the inhibitory effects on PCSK9 expression, a
composition according to the invention or a pharmaceutical
composition prepared therefrom can enhance the quality of life. An
iRNA of the invention may be administered in "naked" form, or as a
"free iRNA." A naked iRNA is administered in the absence of a
pharmaceutical composition. The naked iRNA may be in a suitable
buffer solution. The buffer solution may comprise acetate, citrate,
prolamine, carbonate, or phosphate, or any combination thereof. In
one embodiment, the buffer solution is phosphate buffered saline
(PBS). The pH and osmolarity of the buffer solution containing the
iRNA can be adjusted such that it is suitable for administering to
a subject.
[0179] Alternatively, an iRNA of the invention may be administered
as a pharmaceutical composition, such as a dsRNA liposomal
formulation.
[0180] The invention further provides methods and uses for the use
of an iRNA or a pharmaceutical composition thereof, e.g., for
treating a subject that would benefit from reduction and/or
inhibition of PCSK9 expression, e.g., a subject having
hyperlipidemia, e.g., hypercholesterolemia, in combination with
other pharmaceuticals and/or other therapeutic methods, e.g., with
known pharmaceuticals and/or known therapeutic methods, such as,
for example, those which are currently employed for treating these
disorders. The siRNA and an additional therapeutic agent can be
administered in combination in the same composition, e.g.,
parenterally, or the additional therapeutic agent can be
administered as part of a separate composition or by another method
described herein.
[0181] Examples of additional therapeutic agents include those
known to treat an agent known to treat a lipid disorders, such as
hypercholesterolemia, atherosclerosis or dyslipidemia. For example,
a siRNA featured in the invention can be administered with, e.g.,
an HMG-CoA reductase inhibitor (e.g., a statin), a fibrate, a bile
acid sequestrant, niacin, an antiplatelet agent, an angiotensin
converting enzyme inhibitor, an angiotensin II receptor antagonist
(e.g., losartan potassium, such as Merck & Co.'s Cozaar.RTM.),
an acylCoA cholesterol acetyltransferase (ACAT) inhibitor, a
cholesterol absorption inhibitor, a cholesterol ester transfer
protein (CETP) inhibitor, a microsomal triglyceride transfer
protein (MTTP) inhibitor, a cholesterol modulator, a bile acid
modulator, a peroxisome proliferation activated receptor (PPAR)
agonist, a gene-based therapy, a composite vascular protectant
(e.g., AGI-1067, from Atherogenics), a glycoprotein IIb/IIIa
inhibitor, aspirin or an aspirin-like compound, an IBAT inhibitor
(e.g., S-8921, from Shionogi), a squalene synthase inhibitor, or a
monocyte chemoattractant protein (MCP)-I inhibitor. Exemplary
HMG-CoA reductase inhibitors include atorvastatin (Pfizer's
Lipitor.RTM./Tahor/Sortis/Torvast/Cardyl), pravastatin
(Bristol-Myers Squibb's Pravachol, Sankyo's Mevalotin/Sanaprav),
simvastatin (Merck's Zocor.RTM./Sinvacor, Boehringer Ingelheim's
Denan, Banyu's Lipovas), lovastatin (Merck's Mevacor/Mevinacor,
Bexal's Lovastatina, Cepa; Schwarz Pharma's Liposcler), fluvastatin
(Novartis' Lescol.RTM./Locol/Lochol, Fujisawa's Cranoc, Solvay's
Digaril), cerivastatin (Bayer's Lipobay/GlaxoSmithKline's Baycol),
rosuvastatin (AstraZeneca's Crestor.RTM.), and pitivastatin
(itavastatin/risivastatin) (Nissan Chemical, Kowa Kogyo, Sankyo,
and Novartis). Exemplary fibrates include, e.g., bezafibrate (e.g.,
Roche's Befizal.RTM./Cedur.RTM./Bezalip.RTM., Kissei's Bezatol),
clofibrate (e.g., Wyeth's Atromid-S.RTM.), fenofibrate (e.g.,
Fournier's Lipidil/Lipantil, Abbott's Tricor.RTM., Takeda's
Lipantil, generics), gemfibrozil (e.g., Pfizer's Lopid/Lipur) and
ciprofibrate (Sanofi-Synthelabo's Modalim.RTM.). Exemplary bile
acid sequestrants include, e.g., cholestyramine (Bristol-Myers
Squibb's Questran.RTM. and Questran Light.TM.), colestipol (e.g.,
Pharmacia's Colestid), and colesevelam (Genzyme/Sankyo's
WelChol.TM.). Exemplary niacin therapies include, e.g., immediate
release formulations, such as Aventis' Nicobid, Upsher-Smith's
Niacor, Aventis' Nicolar, and Sanwakagaku's Perycit. Niacin
extended release formulations include, e.g., Kos Pharmaceuticals'
Niaspan and Upsher-Smith's SIo-Niacin. Exemplary antiplatelet
agents include, e.g., aspirin (e.g., Bayer's aspirin), clopidogrel
(Sanofi-Synthelabo/Bristol-Myers Squibb's Plavix), and ticlopidine
(e.g., Sanofi-Synthelabo's Ticlid and Daiichi's Panaldine). Other
aspirin-like compounds useful in combination with a dsRNA targeting
PCSK9 include, e.g., Asacard (slow-release aspirin, by Pharmacia)
and Pamicogrel (Kanebo/Angelini Ricerche/CEPA). Exemplary
angiotensin-converting enzyme inhibitors include, e.g., ramipril
(e.g., Aventis' Altace) and enalapril (e.g., Merck & Co.'s
Vasotec). Exemplary acyl CoA cholesterol acetyltransferase (AC AT)
inhibitors include, e.g., avasimibe (Pfizer), eflucimibe
(BioMsrieux Pierre Fabre/Eli Lilly), CS-505 (Sankyo and Kyoto), and
SMP-797 (Sumito). Exemplary cholesterol absorption inhibitors
include, e.g., ezetimibe (Merck/Schering-Plough Pharmaceuticals
Zetia.RTM.) and Pamaqueside (Pfizer). Exemplary CETP inhibitors
include, e.g., Torcetrapib (also called CP-529414, Pfizer), JTT-705
(Japan Tobacco), and CETi-I (Avant Immunotherapeutics). Exemplary
microsomal triglyceride transfer protein (MTTP) inhibitors include,
e.g., implitapide (Bayer), R-103757 (Janssen), and CP-346086
(Pfizer). Other exemplary cholesterol modulators include, e.g.,
NO-1886 (Otsuka/TAP Pharmaceutical), CI-1027 (Pfizer), and
WAY-135433 (Wyeth-Ayerst).
[0182] Exemplary bile acid modulators include, e.g., HBS-107
(Hisamitsu/Banyu), Btg-511 (British Technology Group), BARI-1453
(Aventis), S-8921 (Shionogi), SD-5613 (Pfizer), and AZD-7806
(AstraZeneca). Exemplary peroxisome proliferation activated
receptor (PPAR) agonists include, e.g., tesaglitazar (AZ-242)
(AstraZeneca), Netoglitazone (MCC-555) (Mitsubishi/Johnson &
Johnson), GW-409544 (Ligand Pharmaceuticals/GlaxoSmithKline),
GW-501516 (Ligand Pharmaceuticals/GlaxoSmithKline), LY-929 (Ligand
Pharmaceuticals and Eli Lilly), LY-465608 (Ligand Pharmaceuticals
and Eli Lilly), LY-518674 (Ligand Pharmaceuticals and Eli Lilly),
and MK-767 (Merck and Kyorin). Exemplary gene-based therapies
include, e.g., AdGWEGF 121.10 (GenVec), ApoA1 (UCB Pharma/Groupe
Fournier), EG-004 (Trinam) (Ark Therapeutics), and ATP-binding
cassette transporter-A1 (ABCA1) (CV Therapeutics/Incyte, Aventis,
Xenon). Exemplary Glycoprotein Ilb/IIIa inhibitors include, e.g.,
roxifiban (also called DMP754, Bristol-Myers Squibb), Gantofiban
(Merck KGaA/Yamanouchi), and Cromafiban (Millennium
Pharmaceuticals). Exemplary squalene synthase inhibitors include,
e.g., BMS-1884941 (Bristol-Myers Squibb), CP-210172 (Pfizer),
CP-295697 (Pfizer), CP-294838 (Pfizer), and TAK-475 (Takeda). An
exemplary MCP-I inhibitor is, e.g., RS-504393 (Roche Bioscience).
The anti-atherosclerotic agent BO-653 (Chugai Pharmaceuticals), and
the nicotinic acid derivative Nyclin (Yamanouchi Pharmaceuticals)
are also appropriate for administering in combination with a dsRNA
featured in the invention. Exemplary combination therapies suitable
for administration with a dsRNA targeting PCSK9 include, e.g.,
advicor (Niacin/lovastatin from Kos Pharmaceuticals),
amlodipine/atorvastatin (Pfizer), and ezetimibe/simvastatin (e.g.,
Vytorin.RTM. 10/10, 10/20, 10/40, and 10/80 tablets by
Merck/Schering-Plough Pharmaceuticals). Agents for treating
hypercholesterolemia, and suitable for administration in
combination with a dsRNA targeting PCSK9 include, e.g., lovastatin,
niacin Altoprev.RTM. Extended-Release Tablets (Andrx Labs),
lovastatin Caduet.RTM. Tablets (Pfizer), amlodipine besylate,
atorvastatin calcium Crestor.RTM. Tablets (AstraZeneca),
rosuvastatin calcium Lescol.RTM. Capsules (Novartis), fluvastatin
sodium Lescol.RTM. (Reliant, Novartis), fluvastatin sodium
Lipitor.RTM. Tablets (Parke-Davis), atorvastatin calcium
Lofibra.RTM. Capsules (Gate), Niaspan Extended-Release Tablets
(Kos), niacin Pravachol Tablets (Bristol-Myers Squibb), pravastatin
sodium TriCor.RTM. Tablets (Abbott), fenofibrate Vytorin.RTM. 10/10
Tablets (Merck/Schering-Plough Pharmaceuticals), ezetimibe,
simvastatin WelChol.TM. Tablets (Sankyo), colesevelam hydrochloride
Zetia.RTM. Tablets (Schering), ezetimibe Zetia.RTM. Tablets
(Merck/Schering-Plough Pharmaceuticals), and ezetimibe Zocor.RTM.
Tablets (Merck).
[0183] In one embodiment, an iRNA agent is administered in
combination with an ezetimibe/simvastatin combination (e.g.,
Vytorin.RTM. (Merck/Schering-Plough Pharmaceuticals)).
[0184] In another embodiment, an iRNA agent is administered in
combination with an anti-PCSK9 antibody. Exemplary anti-PCSK9
antibodies for use in the combination therapies of the invention
include, for example, alirocumab (Praluent), evolocumab (Repatha),
bococizumab (PF-04950615, RN316, RN-316, L1L3; Pfizer, Rinat),
lodelcizumab (LFU720, pJG04; Novartis), ralpancizumab (RN317,
PF-05335810; Pfizer, Rinat), RG7652 (MPSK3169A, YW508.20.33b;
Genentech), LY3015014 (Lilly), LPD1462 (h1F11; Schering-Plough),
AX1 (AX189, 1B20, 1D05; Merck & Co), ALD306 (Alder); mAb1
(Boehringer), and Ig1-PA4 (Nanjing Normal U.).
[0185] In one embodiment, the iRNA agent is administered to the
patient, and then the additional therapeutic agent is administered
to the patient (or vice versa). In another embodiment, the iRNA
agent and the additional therapeutic agent are administered at the
same time.
[0186] In another aspect, the invention features, a method of
instructing an end user, e.g., a caregiver or a subject, on how to
administer an iRNA agent described herein. The method includes,
optionally, providing the end user with one or more doses of the
iRNA agent, and instructing the end user to administer the iRNA
agent on a regimen described herein, thereby instructing the end
user.
[0187] In one aspect, the invention provides a method of treating a
patient by selecting a patient on the basis that the patient is in
need of LDL lowering, LDL lowering without lowering of HDL, ApoB
lowering, or total cholesterol lowering. The method includes
administering to the patient a siRNA in an amount sufficient to
lower the patient's LDL levels or ApoB levels, e.g., without
substantially lowering HDL levels.
[0188] Genetic predisposition plays a role in the development of
target gene associated diseases, e.g., hyperlipidemia. Therefore, a
patient in need of a siRNA can be identified by taking a family
history, or, for example, screening for one or more genetic markers
or variants. Examples of genes involved in hyperlipidemia include
but are not limited to, e.g., LDL receptor (LDLR), the
apoliproteins (ApoA1, ApoB, ApoE, and the like), Cholesteryl ester
transfer protein (CETP), Lipoprotein lipase (LPL), hepatic lipase
(LIPC), Endothelial lipase (EL), Lecithinxholesteryl
acyltransferase (LCAT).
[0189] A healthcare provider, such as a doctor, nurse, or family
member, can take a family history before prescribing or
administering an iRNA agent of the invention. In addition, a test
may be performed to determine a genotype or phenotype. For example,
a DNA test may be performed on a sample from the patient, e.g., a
blood sample, to identify the PCSK9 genotype and/or phenotype
before a PCSK9 dsRNA is administered to the patient. In another
embodiment, a test is performed to identify a related genotype
and/or phenotype, e.g., a LDLR genotype. Example of genetic
variants with the LDLR gene can be found in the art, e.g., in the
following publications which are incorporated by reference:
Costanza et al (2005) Am J Epidemiol. 15; 161(8):714-24; Yamada et
al. (2008) J Med Genet. January; 45(1):22-8, Epub 2007 Aug. 31; and
Boes et al (2009) Exp. Gerontol 44: 136-160, Epub 2008 Nov. 17.
[0190] The present invention further provides methods of inhibiting
expression of a Proprotein Convertase Subtilisin Kexin 9 (PCSK9) in
a cell, such as a cell within a subject, e.g., a human subject.
[0191] Accordingly, the present invention provides methods of
inhibiting expression of a PCSK9 gene in a cell. The methods
include contacting a cell with an RNAi agent, e.g., a double
stranded RNAi agent, in an amount effective to inhibit expression
of the PCSK9 gene in the cell, thereby inhibiting expression of the
PCSK9 in the cell.
[0192] Contacting of a cell with a double stranded RNAi agent may
be done in vitro or in vivo. Contacting a cell in vivo with the
RNAi agent includes contacting a cell or group of cells within a
subject, e.g., a human subject, with the RNAi agent. Combinations
of in vitro and in vivo methods of contacting are also possible.
Contacting may be direct or indirect, as discussed above.
Furthermore, contacting a cell may be accomplished via a targeting
ligand, including any ligand described herein or known in the art.
In preferred embodiments, the targeting ligand is a carbohydrate
moiety, e.g., a GalNAc.sub.3 ligand, or any other ligand that
directs the RNAi agent to a site of interest, e.g., the liver of a
subject.
[0193] The term "inhibiting," as used herein, is used
interchangeably with "reducing," "silencing," "downregulating" and
other similar terms, and includes any level of inhibition.
[0194] The phrase "inhibiting expression of a PCSK9" is intended to
refer to inhibition of expression of any PCSK9 gene (such as, e.g.,
a mouse PCSK9 gene, a rat PCSK9 gene, a monkey PCSK9 gene, or a
human PCSK9 gene) as well as variants or mutants of a PCSK9 gene.
Thus, the PCSK9 gene may be a wild-type PCSK9 gene, a mutant PCSK9
gene, or a transgenic PCSK9 gene in the context of a genetically
manipulated cell, group of cells, or organism.
[0195] "Inhibiting expression of a PCSK9 gene" includes any level
of inhibition of a PCSK9 gene, e.g., at least partial suppression
of the expression of a PCSK9 gene. The expression of the PCSK9 gene
may be assessed based on the level, or the change in the level, of
any variable associated with PCSK9 gene expression, e.g., PCSK9
mRNA level, PCSK9 protein level, or lipid levels. This level may be
assessed in an individual cell or in a group of cells, including,
for example, a sample derived from a subject.
[0196] Inhibition may be assessed by a decrease in an absolute or
relative level of one or more variables that are associated with
PCSK9 expression compared with a control level. The control level
may be any type of control level that is utilized in the art, e.g.,
a pre-dose baseline level, or a level determined from a similar
subject, cell, or sample that is untreated or treated with a
control (such as, e.g., buffer only control or inactive agent
control).
[0197] In some embodiments of the methods of the invention,
expression of a PCSK9 gene is inhibited by at least about 5%, at
least about 10%, at least about 15%, at least about 20%, at least
about 25%, at least about 30%, at least about 35%, at least about
40%, at least about 45%, at least about 50%, at least about 55%, at
least about 60%, at least about 65%, at least about 70%, at least
about 75%, at least about 80%, at least about 85%, at least about
90%, at least about 91%, at least about 92%, at least about 93%, at
least about 94%. at least about 95%, at least about 96%, at least
about 97%, at least about 98%, or at least about 99%.
[0198] Inhibition of the expression of a PCSK9 gene may be
manifested by a reduction of the amount of mRNA expressed by a
first cell or group of cells (such cells may be present, for
example, in a sample derived from a subject) in which a PCSK9 gene
is transcribed and which has or have been treated (e.g., by
contacting the cell or cells with an RNAi agent of the invention,
or by administering an RNAi agent of the invention to a subject in
which the cells are or were present) such that the expression of a
PCSK9 gene is inhibited, as compared to a second cell or group of
cells substantially identical to the first cell or group of cells
but which has not or have not been so treated (control cell(s)). In
preferred embodiments, the inhibition is assessed by expressing the
level of mRNA in treated cells as a percentage of the level of mRNA
in control cells, using the following formula:
( mRNA in control cells ) - ( mRNA in treated cells ) ( mRNA in
control cells ) 100 % ##EQU00001##
[0199] Alternatively, inhibition of the expression of a PCSK9 gene
may be assessed in terms of a reduction of a parameter that is
functionally linked to PCSK9 gene expression, e.g., PCSK9 protein
expression, such as lipid levels, cholesterol levels, e.g., LDLc
levels. PCSK9 gene silencing may be determined in any cell
expressing PCSK9, either constitutively or by genomic engineering,
and by any assay known in the art. The liver is the major site of
PCSK9 expression. Other significant sites of expression include the
pancreas, kidney, and intestines.
[0200] Inhibition of the expression of a PCSK9 protein may be
manifested by a reduction in the level of the PCSK9 protein that is
expressed by a cell or group of cells (e.g., the level of protein
expressed in a sample derived from a subject). As explained above
for the assessment of mRNA suppression, the inhibition of protein
expression levels in a treated cell or group of cells may similarly
be expressed as a percentage of the level of protein in a control
cell or group of cells.
[0201] A control cell or group of cells that may be used to assess
the inhibition of the expression of a PCSK9 gene includes a cell or
group of cells that has not yet been contacted with an RNAi agent
of the invention. For example, the control cell or group of cells
may be derived from an individual subject (e.g., a human or animal
subject) prior to treatment of the subject with an RNAi agent.
[0202] The level of PCSK9 mRNA that is expressed by a cell or group
of cells may be determined using any method known in the art for
assessing mRNA expression. In one embodiment, the level of
expression of PCSK9 in a sample is determined by detecting a
transcribed polynucleotide, or portion thereof, e.g., mRNA of the
PCSK9 gene. RNA may be extracted from cells using RNA extraction
techniques including, for example, using acid phenol/guanidine
isothiocyanate extraction (RNAzol B; Biogenesis), RNeasy RNA
preparation kits (Qiagen) or PAXgene (PreAnalytix, Switzerland).
Typical assay formats utilizing ribonucleic acid hybridization
include nuclear run-on assays, RT-PCR, RNase protection assays
(Melton et al., Nuc. Acids Res. 12:7035), Northern blotting, in
situ hybridization, and microarray analysis.
[0203] In one embodiment, the level of expression of PCSK9 is
determined using a nucleic acid probe. The term "probe", as used
herein, refers to any molecule that is capable of selectively
binding to a specific PCSK9. Probes can be synthesized by one of
skill in the art, or derived from appropriate biological
preparations. Probes may be specifically designed to be labeled.
Examples of molecules that can be utilized as probes include, but
are not limited to, RNA, DNA, proteins, antibodies, and organic
molecules.
[0204] Isolated mRNA can be used in hybridization or amplification
assays that include, but are not limited to, Southern or Northern
analyses, polymerase chain reaction (PCR) analyses and probe
arrays. One method for the determination of mRNA levels involves
contacting the isolated mRNA with a nucleic acid molecule (probe)
that can hybridize to PCSK9 mRNA. In one embodiment, the mRNA is
immobilized on a solid surface and contacted with a probe, for
example by running the isolated mRNA on an agarose gel and
transferring the mRNA from the gel to a membrane, such as
nitrocellulose. In an alternative embodiment, the probe(s) are
immobilized on a solid surface and the mRNA is contacted with the
probe(s), for example, in an Affymetrix gene chip array. A skilled
artisan can readily adapt known mRNA detection methods for use in
determining the level of PCSK9 mRNA.
[0205] An alternative method for determining the level of
expression of PCSK9 in a sample involves the process of nucleic
acid amplification and/or reverse transcriptase (to prepare cDNA)
of for example mRNA in the sample, e.g., by RT-PCR (the
experimental embodiment set forth in Mullis, 1987, U.S. Pat. No.
4,683,202), ligase chain reaction (Barany (1991) Proc. Natl. Acad.
Sci. USA 88:189-193), self sustained sequence replication (Guatelli
et al. (1990) Proc. Natl. Acad. Sci. USA 87:1874-1878),
transcriptional amplification system (Kwoh et al. (1989) Proc.
Natl. Acad. Sci. USA 86:1173-1177), Q-Beta Replicase (Lizardi et
al. (1988) Bio/Technology 6:1197), rolling circle replication
(Lizardi et al., U.S. Pat. No. 5,854,033) or any other nucleic acid
amplification method, followed by the detection of the amplified
molecules using techniques well known to those of skill in the art.
These detection schemes are especially useful for the detection of
nucleic acid molecules if such molecules are present in very low
numbers. In particular aspects of the invention, the level of
expression of PCSK9 is determined by quantitative fluorogenic
RT-PCR (i.e., the TaqMan.TM. System).
[0206] The expression levels of PCSK9 mRNA may be monitored using a
membrane blot (such as used in hybridization analysis such as
Northern, Southern, dot, and the like), or microwells, sample
tubes, gels, beads or fibers (or any solid support comprising bound
nucleic acids). See U.S. Pat. Nos. 5,770,722, 5,874,219, 5,744,305,
5,677,195 and 5,445,934, which are incorporated herein by
reference. The determination of PCSK9 expression level may also
comprise using nucleic acid probes in solution.
[0207] In preferred embodiments, the level of mRNA expression is
assessed using branched DNA (bDNA) assays or real time PCR (qPCR).
The use of these methods is described and exemplified in the
Examples presented herein.
[0208] The level of PCSK9 protein expression may be determined
using any method known in the art for the measurement of protein
levels. Such methods include, for example, electrophoresis,
capillary electrophoresis, high performance liquid chromatography
(HPLC), thin layer chromatography (TLC), hyperdiffusion
chromatography, fluid or gel precipitin reactions, absorption
spectroscopy, a colorimetric assays, spectrophotometric assays,
flow cytometry, immunodiffusion (single or double),
immunoelectrophoresis, Western blotting, radioimmunoassay (RIA),
enzyme-linked immunosorbent assays (ELISAs), immunofluorescent
assays, electrochemiluminescence assays, and the like.
[0209] The term "sample" as used herein refers to a collection of
similar fluids, cells, or tissues isolated from a subject, as well
as fluids, cells, or tissues present within a subject. Examples of
biological fluids include blood, serum and serosal fluids, plasma,
lymph, urine, cerebrospinal fluid, saliva, ocular fluids, and the
like. Tissue samples may include samples from tissues, organs or
localized regions. For example, samples may be derived from
particular organs, parts of organs, or fluids or cells within those
organs. In certain embodiments, samples may be derived from the
liver (e.g., whole liver or certain segments of liver or certain
types of cells in the liver, such as, e.g., hepatocytes). In
preferred embodiments, a "sample derived from a subject" refers to
blood or plasma drawn from the subject. In further embodiments, a
"sample derived from a subject" refers to liver tissue derived from
the subject.
[0210] In some embodiments of the methods of the invention, the
RNAi agent is administered to a subject such that the RNAi agent is
delivered to a specific site within the subject. The inhibition of
expression of PCSK9 may be assessed using measurements of the level
or change in the level of PCSK9 mRNA or PCSK9 protein in a sample
derived from fluid or tissue from the specific site within the
subject. In preferred embodiments, the site is the liver. The site
may also be a subsection or subgroup of cells from any one of the
aforementioned sites. The site may also include cells that express
a particular type of receptor.
III. iRNAs for Use in the Methods of the Invention
[0211] Described herein are methods for the use of double-stranded
RNAi agents which inhibit the expression of a PCSK9 gene in a cell,
such as a cell within a subject, e.g., a mammal, such as a human
having a PCSK9-associated disorder, e.g., a hyperlipidemia, e.g.,
hypercholesterolemia.
[0212] Accordingly, the invention provides double-stranded RNAi
agents capable of inhibiting the expression of a target gene (i.e.,
a PCSK9 gene) in vivo for use in the claimed methods.
[0213] In one embodiment, the RNA of the iRNA of the invention
e.g., a dsRNA, is un-modified, and does not comprise, e.g.,
chemical modifications and/or conjugations known in the art and
described herein. In another embodiment, the RNA of an iRNA of the
invention, e.g., a dsRNA, is chemically modified to enhance
stability or other beneficial characteristics. In certain aspects
of the invention, substantially all of the nucleotides of an iRNA
of the invention are modified. For example substantially all of the
nucleotides of the sense strand are modified nucleotides, and/or
substantially all of the nucleotides of the antisense strand are
modified nucleotides and/or substantially all of the nucleotides of
both the sense strand and the antisense strand are modified
nucleotides. In other embodiments of the invention, all of the
nucleotides of an iRNA of the invention are modified. For example
all of the nucleotides of the sense strand are modified
nucleotides, and/or all of the nucleotides of the antisense strand
are modified nucleotides and/or all of the nucleotides of both the
sense strand and the antisense strand are modified nucleotides.
iRNAs of the invention in which "substantially all of the
nucleotides are modified" are largely but not wholly modified and
can include not more than 5, 4, 3, 2, or 1 unmodified
nucleotides.
[0214] The dsRNA includes an antisense strand having a region of
complementarity which is complementary to at least a part of an
mRNA formed in the expression of a PCSK9 gene. The region of
complementarity is about 30 nucleotides or less in length (e.g.,
about 30, 29, 28, 27, 26, 25, 24, 23, 22, 21, 20, 19, or 18
nucleotides or less in length). Upon contact with a cell expressing
the PCSK9 gene, the iRNA inhibits the expression of the PCSK9 gene
(e.g., a human PCSK9 gene) by at least about 10% as assayed by, for
example, a PCR or branched DNA (bDNA)-based method, or by a
protein-based method, such as by immunofluorescence analysis,
using, for example, Western Blotting or flowcytometric
techniques.
[0215] A dsRNA includes two RNA strands that are complementary and
hybridize to form a duplex structure under conditions in which the
dsRNA will be used. One strand of a dsRNA (the antisense strand)
includes a region of complementarity that is substantially
complementary, and generally fully complementary, to a target
sequence. The target sequence can be derived from the sequence of
an mRNA formed during the expression of a PCSK9 gene. The other
strand (the sense strand) includes a region that is complementary
to the antisense strand, such that the two strands hybridize and
form a duplex structure when combined under suitable conditions. As
described elsewhere herein and as known in the art, the
complementary sequences of a dsRNA can also be contained as
self-complementary regions of a single nucleic acid molecule, as
opposed to being on separate oligonucleotides.
[0216] Generally, the duplex structure is between 15 and 30 base
pairs in length, e.g., between, 15-29, 15-28, 15-27, 15-26, 15-25,
15-24, 15-23, 15-22, 15-21, 15-20, 15-19, 15-18, 15-17, 18-30,
18-29, 18-28, 18-27, 18-26, 18-25, 18-24, 18-23, 18-22, 18-21,
18-20, 19-30, 19-29, 19-28, 19-27, 19-26, 19-25, 19-24, 19-23,
19-22, 19-21, 19-20, 20-30, 20-29, 20-28, 20-27, 20-26, 20-25,
20-24, 20-23, 20-22, 20-21, 21-30, 21-29, 21-28, 21-27, 21-26,
21-25, 21-24, 21-23, or 21-22 base pairs in length. Ranges and
lengths intermediate to the above recited ranges and lengths are
also contemplated to be part of the invention.
[0217] Similarly, the region of complementarity to the target
sequence is between 15 and 30 nucleotides in length, e.g., between
15-29, 15-28, 15-27, 15-26, 15-25, 15-24, 15-23, 15-22, 15-21,
15-20, 15-19, 15-18, 15-17, 18-30, 18-29, 18-28, 18-27, 18-26,
18-25, 18-24, 18-23, 18-22, 18-21, 18-20, 19-30, 19-29, 19-28,
19-27, 19-26, 19-25, 19-24, 19-23, 19-22, 19-21, 19-20, 20-30,
20-29, 20-28, 20-27, 20-26, 20-25, 20-24, 20-23, 20-22, 20-21,
21-30, 21-29, 21-28, 21-27, 21-26, 21-25, 21-24, 21-23, or 21-22
nucleotides in length. Ranges and lengths intermediate to the above
recited ranges and lengths are also contemplated to be part of the
invention.
[0218] In some embodiments, the dsRNA is about 15 to about 20
nucleotides in length, or between about 25 and about 30 nucleotides
in length. In general, the dsRNA is long enough to serve as a
substrate for the Dicer enzyme. For example, it is well-known in
the art that dsRNAs longer than about 21-23 nucleotides in length
may serve as substrates for Dicer. As the ordinarily skilled person
will also recognize, the region of an RNA targeted for cleavage
will most often be part of a larger RNA molecule, often an mRNA
molecule. Where relevant, a "part" of an mRNA target is a
contiguous sequence of an mRNA target of sufficient length to allow
it to be a substrate for RNAi-directed cleavage (i.e., cleavage
through a RISC pathway).
[0219] In certain embodiments, a dsRNA agent of the invention may
include an RNA strand (the antisense strand) which can include
longer lengths, for example up to 66 nucleotides, e.g., 36-66,
26-36, 25-36, 31-60, 22-43, 27-53 nucleotides in length with a
region of at least 19 contiguous nucleotides that is substantially
complementary to at least a part of an mRNA transcript of a PCSK9
gene. These dsRNA agents with the longer length antisense strands
preferably include a second RNA strand (the sense strand) of 20-60
nucleotides in length wherein the sense and antisense strands form
a duplex of 18-30 contiguous nucleotides.
[0220] One of skill in the art will also recognize that the duplex
region is a primary functional portion of a dsRNA, e.g., a duplex
region of about 9 to 36 base pairs, e.g., about 10-36, 11-36,
12-36, 13-36, 14-36, 15-36, 9-35, 10-35, 11-35, 12-35, 13-35,
14-35, 15-35, 9-34, 10-34, 11-34, 12-34, 13-34, 14-34, 15-34, 9-33,
10-33, 11-33, 12-33, 13-33, 14-33, 15-33, 9-32, 10-32, 11-32,
12-32, 13-32, 14-32, 15-32, 9-31, 10-31, 11-31, 12-31, 13-32,
14-31, 15-31, 15-30, 15-29, 15-28, 15-27, 15-26, 15-25, 15-24,
15-23, 15-22, 15-21, 15-20, 15-19, 15-18, 15-17, 18-30, 18-29,
18-28, 18-27, 18-26, 18-25, 18-24, 18-23, 18-22, 18-21, 18-20,
19-30, 19-29, 19-28, 19-27, 19-26, 19-25, 19-24, 19-23, 19-22,
19-21, 19-20, 20-30, 20-29, 20-28, 20-27, 20-26, 20-25, 20-24,
20-23, 20-22, 20-21, 21-30, 21-29, 21-28, 21-27, 21-26, 21-25,
21-24, 21-23, or 21-22 base pairs.
[0221] Thus, in one embodiment, to the extent that it becomes
processed to a functional duplex, of e.g., 15-30 base pairs, that
targets a desired RNA for cleavage, an RNA molecule or complex of
RNA molecules having a duplex region greater than 30 base pairs is
a dsRNA. Thus, an ordinarily skilled artisan will recognize that in
one embodiment, a miRNA is a dsRNA. In another embodiment, a dsRNA
is not a naturally occurring miRNA. In another embodiment, an iRNA
agent useful to target PCSK9 expression is not generated in the
target cell by cleavage of a larger dsRNA.
[0222] A dsRNA as described herein can further include one or more
single-stranded nucleotide overhangs e.g., 1, 2, 3, or 4
nucleotides. dsRNAs having at least one nucleotide overhang can
have unexpectedly superior inhibitory properties relative to their
blunt-ended counterparts. A nucleotide overhang can comprise or
consist of a nucleotide/nucleoside analog, including a
deoxynucleotide/nucleoside. The overhang(s) can be on the sense
strand, the antisense strand or any combination thereof.
Furthermore, the nucleotide(s) of an overhang can be present on the
5'-end, 3'-end or both ends of either an antisense or sense strand
of a dsRNA. In certain embodiments, longer, extended overhangs are
possible.
[0223] A dsRNA can be synthesized by standard methods known in the
art as further discussed below, e.g., by use of an automated DNA
synthesizer, such as are commercially available from, for example,
Biosearch, Applied Biosystems, Inc.
[0224] iRNA compounds of the invention may be prepared using a
two-step procedure. First, the individual strands of the
double-stranded RNA molecule are prepared separately. Then, the
component strands are annealed. The individual strands of the siRNA
compound can be prepared using solution-phase or solid-phase
organic synthesis or both. Organic synthesis offers the advantage
that the oligonucleotide strands comprising unnatural or modified
nucleotides can be easily prepared. Single-stranded
oligonucleotides of the invention can be prepared using
solution-phase or solid-phase organic synthesis or both.
[0225] In one aspect, a dsRNA of the invention includes at least
two nucleotide sequences, a sense sequence and an anti-sense
sequence. The sense strand is selected from the group of sequences
provided in Table 1, and the corresponding antisense strand of the
sense strand is selected from the group of sequences of Table 1. In
this aspect, one of the two sequences is complementary to the other
of the two sequences, with one of the sequences being substantially
complementary to a sequence of an mRNA generated in the expression
of a PCSK9 gene. As such, in this aspect, a dsRNA will include two
oligonucleotides, where one oligonucleotide is described as the
sense strand in Table 1, and the second oligonucleotide is
described as the corresponding antisense strand of the sense strand
in Table 1. In one embodiment, the substantially complementary
sequences of the dsRNA are contained on separate oligonucleotides.
In another embodiment, the substantially complementary sequences of
the dsRNA are contained on a single oligonucleotide.
[0226] It will be understood that, although some of the sequences
in Table 1 are described as modified and/or conjugated sequences,
the RNA of the iRNA of the invention e.g., a dsRNA of the
invention, may comprise any one of the sequences set forth in Table
1 that is un-modified, un-conjugated, and/or modified and/or
conjugated differently than described therein.
[0227] The skilled person is well aware that dsRNAs having a duplex
structure of between about 20 and 23 base pairs, e.g., 21, base
pairs have been hailed as particularly effective in inducing RNA
interference (Elbashir et al., EMBO 2001, 20:6877-6888). However,
others have found that shorter or longer RNA duplex structures can
also be effective (Chu and Rana (2007) RNA 14:1714-1719; Kim et al.
(2005) Nat Biotech 23:222-226). In the embodiments described above,
by virtue of the nature of the oligonucleotide sequences provided
in Table 1, dsRNAs described herein can include at least one strand
of a length of minimally 21 nucleotides. It can be reasonably
expected that shorter duplexes having one of the sequences of any
one of Table 1 minus only a few nucleotides on one or both ends can
be similarly effective as compared to the dsRNAs described above.
Hence, dsRNAs having a sequence of at least 15, 16, 17, 18, 19, 20,
or more contiguous nucleotides derived from one of the sequences of
any one of Tables 3, 4, 5, 6, 18, 19, 20, 21, and 23, and differing
in their ability to inhibit the expression of a PCSK9 gene by not
more than about 5, 10, 15, 20, 25, or 30% inhibition from a dsRNA
comprising the full sequence, are contemplated to be within the
scope of the present invention.
[0228] In addition, the RNAs provided in Table 1 identify a site(s)
in a PCSK9 transcript that is susceptible to RISC-mediated
cleavage. As such, the present invention further features iRNAs
that target within one of these sites. As used herein, an iRNA is
said to target within a particular site of an RNA transcript if the
iRNA promotes cleavage of the transcript anywhere within that
particular site. Such an iRNA will generally include at least about
15 contiguous nucleotides from one of the sequences provided in
Table 1 coupled to additional nucleotide sequences taken from the
region contiguous to the selected sequence in a PCSK9 gene.
[0229] While a target sequence is generally about 15-30 nucleotides
in length, there is wide variation in the suitability of particular
sequences in this range for directing cleavage of any given target
RNA. Various software packages and the guidelines set out herein
provide guidance for the identification of optimal target sequences
for any given gene target, but an empirical approach can also be
taken in which a "window" or "mask" of a given size (as a
non-limiting example, 21 nucleotides) is literally or figuratively
(including, e.g., in silico) placed on the target RNA sequence to
identify sequences in the size range that can serve as target
sequences. By moving the sequence "window" progressively one
nucleotide upstream or downstream of an initial target sequence
location, the next potential target sequence can be identified,
until the complete set of possible sequences is identified for any
given target size selected. This process, coupled with systematic
synthesis and testing of the identified sequences (using assays as
described herein or as known in the art) to identify those
sequences that perform optimally can identify those RNA sequences
that, when targeted with an iRNA agent, mediate the best inhibition
of target gene expression. Thus, while the sequences identified,
for example, in a Table 1 represent effective target sequences, it
is contemplated that further optimization of inhibition efficiency
can be achieved by progressively "walking the window" one
nucleotide upstream or downstream of the given sequences to
identify sequences with equal or better inhibition
characteristics.
[0230] Further, it is contemplated that for any sequence
identified, e.g., in Table 1, further optimization could be
achieved by systematically either adding or removing nucleotides to
generate longer or shorter sequences and testing those sequences
generated by walking a window of the longer or shorter size up or
down the target RNA from that point. Again, coupling this approach
to generating new candidate targets with testing for effectiveness
of iRNAs based on those target sequences in an inhibition assay as
known in the art and/or as described herein can lead to further
improvements in the efficiency of inhibition. Further still, such
optimized sequences can be adjusted by, e.g., the introduction of
modified nucleotides as described herein or as known in the art,
addition or changes in overhang, or other modifications as known in
the art and/or discussed herein to further optimize the molecule
(e.g., increasing serum stability or circulating half-life,
increasing thermal stability, enhancing transmembrane delivery,
targeting to a particular location or cell type, increasing
interaction with silencing pathway enzymes, increasing release from
endosomes) as an expression inhibitor.
[0231] An iRNA as described herein can contain one or more
mismatches to the target sequence. In one embodiment, an iRNA as
described herein contains no more than 3 mismatches. If the
antisense strand of the iRNA contains mismatches to a target
sequence, it is preferable that the area of mismatch is not located
in the center of the region of complementarity. If the antisense
strand of the iRNA contains mismatches to the target sequence, it
is preferable that the mismatch be restricted to be within the last
5 nucleotides from either the 5'- or 3'-end of the region of
complementarity. For example, for a 23 nucleotide iRNA agent the
strand which is complementary to a region of a PCSK9 gene,
generally does not contain any mismatch within the central 13
nucleotides. The methods described herein or methods known in the
art can be used to determine whether an iRNA containing a mismatch
to a target sequence is effective in inhibiting the expression of a
PCSK9 gene. Consideration of the efficacy of iRNAs with mismatches
in inhibiting expression of a PCSK9 gene is important, especially
if the particular region of complementarity in a PCSK9 gene is
known to have polymorphic sequence variation within the
population.
[0232] The nucleic acids featured in the invention can be
synthesized and/or modified by methods well established in the art,
such as those described in "Current protocols in nucleic acid
chemistry," Beaucage, S. L. et al. (Edrs.), John Wiley & Sons,
Inc., New York, N.Y., USA, which is hereby incorporated herein by
reference. Modifications include, for example, end modifications,
e.g., 5'-end modifications (phosphorylation, conjugation, inverted
linkages) or 3'-end modifications (conjugation, DNA nucleotides,
inverted linkages, etc.); base modifications, e.g., replacement
with stabilizing bases, destabilizing bases, or bases that base
pair with an expanded repertoire of partners, removal of bases (a
basic nucleotides), or conjugated bases; sugar modifications (e.g.,
at the 2'-position or 4'-position) or replacement of the sugar;
and/or backbone modifications, including modification or
replacement of the phosphodiester linkages. Specific examples of
iRNA compounds useful in the embodiments described herein include,
but are not limited to RNAs containing modified backbones or no
natural internucleoside linkages. RNAs having modified backbones
include, among others, those that do not have a phosphorus atom in
the backbone. For the purposes of this specification, and as
sometimes referenced in the art, modified RNAs that do not have a
phosphorus atom in their internucleoside backbone can also be
considered to be oligonucleosides. In some embodiments, a modified
iRNA will have a phosphorus atom in its internucleoside
backbone.
[0233] Modified RNA backbones include, for example,
phosphorothioates, chiral phosphorothioates, phosphorodithioates,
phosphotriesters, aminoalkylphosphotriesters, methyl and other
alkyl phosphonates including 3'-alkylene phosphonates and chiral
phosphonates, phosphinates, phosphoramidates including 3'-amino
phosphoramidate and aminoalkylphosphoramidates,
thionophosphoramidates, thionoalkylphosphonates,
thionoalkylphosphotriesters, and boranophosphates having normal
3'-5' linkages, 2'-5'-linked analogs of these, and those having
inverted polarity wherein the adjacent pairs of nucleoside units
are linked 3'-5' to 5'-3' or 2'-5' to 5'-2'. Various salts, mixed
salts and free acid forms are also included.
[0234] Representative U.S. patents that teach the preparation of
the above phosphorus-containing linkages include, but are not
limited to, U.S. Pat. Nos. 3,687,808; 4,469,863; 4,476,301;
5,023,243; 5,177,195; 5,188,897; 5,264,423; 5,276,019; 5,278,302;
5,286,717; 5,321,131; 5,399,676; 5,405,939; 5,453,496; 5,455,233;
5,466,677; 5,476,925; 5,519,126; 5,536,821; 5,541,316; 5,550,111;
5,563,253; 5,571,799; 5,587,361; 5,625,050; 6,028,188; 6,124,445;
6,160,109; 6,169,170; 6,172,209; 6,239,265; 6,277,603; 6,326,199;
6,346,614; 6,444,423; 6,531,590; 6,534,639; 6,608,035; 6,683,167;
6,858,715; 6,867,294; 6,878,805; 7,015,315; 7,041,816; 7,273,933;
7,321,029; and U.S. Pat. RE39464, the entire contents of each of
which are hereby incorporated herein by reference.
[0235] Modified RNA backbones that do not include a phosphorus atom
therein have backbones that are formed by short chain alkyl or
cycloalkyl internucleoside linkages, mixed heteroatoms and alkyl or
cycloalkyl internucleoside linkages, or one or more short chain
heteroatomic or heterocyclic internucleoside linkages. These
include those having morpholino linkages (formed in part from the
sugar portion of a nucleoside); siloxane backbones; sulfide,
sulfoxide and sulfone backbones; formacetyl and thioformacetyl
backbones; methylene formacetyl and thioformacetyl backbones;
alkene containing backbones; sulfamate backbones; methyleneimino
and methylenehydrazino backbones; sulfonate and sulfonamide
backbones; amide backbones; and others having mixed N, O, S and
CH.sub.2 component parts.
[0236] Representative U.S. patents that teach the preparation of
the above oligonucleosides include, but are not limited to, U.S.
Pat. Nos. 5,034,506; 5,166,315; 5,185,444; 5,214,134; 5,216,141;
5,235,033; 5,64,562; 5,264,564; 5,405,938; 5,434,257; 5,466,677;
5,470,967; 5,489,677; 5,541,307; 5,561,225; 5,596,086; 5,602,240;
5,608,046; 5,610,289; 5,618,704; 5,623,070; 5,663,312; 5,633,360;
5,677,437; and, 5,677,439, the entire contents of each of which are
hereby incorporated herein by reference.
[0237] In other embodiments, suitable RNA mimetics are contemplated
for use in iRNAs, in which both the sugar and the internucleoside
linkage, i.e., the backbone, of the nucleotide units are replaced
with novel groups. The base units are maintained for hybridization
with an appropriate nucleic acid target compound. One such
oligomeric compound, an RNA mimetic that has been shown to have
excellent hybridization properties, is referred to as a peptide
nucleic acid (PNA). In PNA compounds, the sugar backbone of an RNA
is replaced with an amide containing backbone, in particular an
aminoethylglycine backbone. The nucleobases are retained and are
bound directly or indirectly to aza nitrogen atoms of the amide
portion of the backbone. Representative U.S. patents that teach the
preparation of PNA compounds include, but are not limited to, U.S.
Pat. Nos. 5,539,082; 5,714,331; and 5,719,262, the entire contents
of each of which are hereby incorporated herein by reference.
Additional PNA compounds suitable for use in the iRNAs of the
invention are described in, for example, in Nielsen et al.,
Science, 1991, 254, 1497-1500.
[0238] Some embodiments featured in the invention include RNAs with
phosphorothioate backbones and oligonucleosides with heteroatom
backbones, and in particular --CH.sub.2--NH--CH.sub.2--,
--CH.sub.2--N(CH.sub.3)--O--CH.sub.2-- [known as a methylene
(methylimino) or MMI backbone],
--CH.sub.2--O--N(CH.sub.3)--CH.sub.2--,
--CH.sub.2--N(CH.sub.3)--N(CH.sub.3)--CH.sub.2-- and
--N(CH.sub.3)--CH.sub.2--CH.sub.2-- [wherein the native
phosphodiester backbone is represented as --O--P--O--CH.sub.2--] of
the above-referenced U.S. Pat. No. 5,489,677, and the amide
backbones of the above-referenced U.S. Pat. No. 5,602,240. In some
embodiments, the RNAs featured herein have morpholino backbone
structures of the above-referenced U.S. Pat. No. 5,034,506.
[0239] Modified RNAs can also contain one or more substituted sugar
moieties. The iRNAs, e.g., dsRNAs, featured herein can include one
of the following at the 2'-position: OH; F; O--, S--, or N-alkyl;
O--, S--, or N-alkenyl; O--, S- or N-alkynyl; or O-alkyl-O-alkyl,
wherein the alkyl, alkenyl and alkynyl can be substituted or
unsubstituted C.sub.1 to C.sub.10 alkyl or C.sub.2 to C.sub.10
alkenyl and alkynyl. Exemplary suitable modifications include
O[(CH.sub.2).sub.nO].sub.mCH.sub.3, O(CH.sub.2).sub..nOCH.sub.3,
O(CH.sub.2).sub.nNH.sub.2, O(CH.sub.2).sub.nCH.sub.3,
O(CH.sub.2).sub.nONH.sub.2, and
O(CH.sub.2).sub.nON[(CH.sub.2).sub.nCH.sub.3)].sub.2, where n and m
are from 1 to about 10. In other embodiments, dsRNAs include one of
the following at the 2' position: C.sub.1 to C.sub.10 lower alkyl,
substituted lower alkyl, alkaryl, aralkyl, O-alkaryl or O-aralkyl,
SH, SCH.sub.3, OCN, Cl, Br, CN, CF.sub.3, OCF.sub.3, SOCH.sub.3,
SO.sub.2CH.sub.3, ONO.sub.2, NO.sub.2, N.sub.3, NH.sub.2,
heterocycloalkyl, heterocycloalkaryl, aminoalkylamino,
polyalkylamino, substituted silyl, an RNA cleaving group, a
reporter group, an intercalator, a group for improving the
pharmacokinetic properties of an iRNA, or a group for improving the
pharmacodynamic properties of an iRNA, and other substituents
having similar properties. In some embodiments, the modification
includes a 2'-methoxyethoxy (2'-O--CH.sub.2CH.sub.2OCH.sub.3, also
known as 2'-O-(2-methoxyethyl) or 2'-MOE) (Martin et al., Helv.
Chin. Acta, 1995, 78:486-504) i.e., an alkoxy-alkoxy group. Another
exemplary modification is 2'-dimethylaminooxyethoxy, i.e., a
O(CH.sub.2).sub.2ON(CH.sub.3).sub.2 group, also known as 2'-DMAOE,
as described in examples herein below, and
2'-dimethylaminoethoxyethoxy (also known in the art as
2'-O-dimethylaminoethoxyethyl or 2'-DMAEOE), i.e.,
2'-O--CH.sub.2--O--CH.sub.2--N(CH.sub.2).sub.2.
[0240] Other modifications include 2'-methoxy (2'-OCH.sub.3),
2'-aminopropoxy (2'-OCH.sub.2CH.sub.2CH.sub.2NH.sub.2) and
2'-fluoro (2'-F) Similar modifications can also be made at other
positions on the RNA of an iRNA, particularly the 3' position of
the sugar on the 3' terminal nucleotide or in 2'-5' linked dsRNAs
and the 5' position of 5' terminal nucleotide. iRNAs can also have
sugar mimetics such as cyclobutyl moieties in place of the
pentofuranosyl sugar. Representative U.S. patents that teach the
preparation of such modified sugar structures include, but are not
limited to, U.S. Pat. Nos. 4,981,957; 5,118,800; 5,319,080;
5,359,044; 5,393,878; 5,446,137; 5,466,786; 5,514,785; 5,519,134;
5,567,811; 5,576,427; 5,591,722; 5,597,909; 5,610,300; 5,627,053;
5,639,873; 5,646,265; 5,658,873; 5,670,633; and 5,700,920, certain
of which are commonly owned with the instant application. The
entire contents of each of the foregoing are hereby incorporated
herein by reference.
[0241] The RNA of an iRNA can also include nucleobase (often
referred to in the art simply as "base") modifications or
substitutions. As used herein, "unmodified" or "natural"
nucleobases include the purine bases adenine (A) and guanine (G),
and the pyrimidine bases thymine (T), cytosine (C) and uracil (U).
Modified nucleobases include other synthetic and natural
nucleobases such as deoxy-thymine (dT).sub.r, 5-methylcytosine
(5-me-C), 5-hydroxymethyl cytosine, xanthine, hypoxanthine,
2-aminoadenine, 6-methyl and other alkyl derivatives of adenine and
guanine, 2-propyl and other alkyl derivatives of adenine and
guanine, 2-thiouracil, 2-thiothymine and 2-thiocytosine,
5-halouracil and cytosine, 5-propynyl uracil and cytosine, 6-azo
uracil, cytosine and thymine, 5-uracil (pseudouracil),
4-thiouracil, 8-halo, 8-amino, 8-thiol, 8-thioalkyl, 8-hydroxyl
anal other 8-substituted adenines and guanines, 5-halo,
particularly 5-bromo, 5-trifluoromethyl and other 5-substituted
uracils and cytosines, 7-methylguanine and 7-methyladenine,
8-azaguanine and 8-azaadenine, 7-deazaguanine and 7-daazaadenine
and 3-deazaguanine and 3-deazaadenine. Further nucleobases include
those disclosed in U.S. Pat. No. 3,687,808, those disclosed in
Modified Nucleosides in Biochemistry, Biotechnology and Medicine,
Herdewijn, P. ed. Wiley-VCH, 2008; those disclosed in The Concise
Encyclopedia Of Polymer Science And Engineering, pages 858-859,
Kroschwitz, J. L, ed. John Wiley & Sons, 1990, these disclosed
by Englisch et al., Angewandte Chemie, International Edition, 1991,
30, 613, and those disclosed by Sanghvi, Y S., Chapter 15, dsRNA
Research and Applications, pages 289-302, Crooke, S. T. and Lebleu,
B., Ed., CRC Press, 1993. Certain of these nucleobases are
particularly useful for increasing the binding affinity of the
oligomeric compounds featured in the invention. These include
5-substituted pyrimidines, 6-azapyrimidines and N-2, N-6 and 0-6
substituted purines, including 2-aminopropyladenine,
5-propynyluracil and 5-propynylcytosine. 5-methylcytosine
substitutions have been shown to increase nucleic acid duplex
stability by 0.6-1.2.degree. C. (Sanghvi, Y. S., Crooke, S. T. and
Lebleu, B., Eds., dsRNA Research and Applications, CRC Press, Boca
Raton, 1993, pp. 276-278) and are exemplary base substitutions,
even more particularly when combined with 2'-O-methoxyethyl sugar
modifications.
[0242] Representative U.S. patents that teach the preparation of
certain of the above noted modified nucleobases as well as other
modified nucleobases include, but are not limited to, the above
noted U.S. Pat. Nos. 3,687,808, 4,845,205; 5,130,30; 5,134,066;
5,175,273; 5,367,066; 5,432,272; 5,457,187; 5,459,255; 5,484,908;
5,502,177; 5,525,711; 5,552,540; 5,587,469; 5,594,121, 5,596,091;
5,614,617; 5,681,941; 5,750,692; 6,015,886; 6,147,200; 6,166,197;
6,222,025; 6,235,887; 6,380,368; 6,528,640; 6,639,062; 6,617,438;
7,045,610; 7,427,672; and 7,495,088, the entire contents of each of
which are hereby incorporated herein by reference.
[0243] The RNA of an iRNA can also be modified to include one or
more bicyclic sugar moities. A "bicyclic sugar" is a furanosyl ring
modified by the bridging of two atoms. A "bicyclic nucleoside"
("BNA") is a nucleoside having a sugar moiety comprising a bridge
connecting two carbon atoms of the sugar ring, thereby forming a
bicyclic ring system. In certain embodiments, the bridge connects
the 4'-carbon and the 2'-carbon of the sugar ring. Thus, in some
embodiments an agent of the invention may include the RNA of an
iRNA can also be modified to include one or more locked nucleic
acids (LNA). A locked nucleic acid is a nucleotide having a
modified ribose moiety in which the ribose moiety comprises an
extra bridge connecting the 2' and 4' carbons. In other words, an
LNA is a nucleotide comprising a bicyclic sugar moiety comprising a
4'-CH2-O-2' bridge. This structure effectively "locks" the ribose
in the 3'-endo structural conformation. The addition of locked
nucleic acids to siRNAs has been shown to increase siRNA stability
in serum, and to reduce off-target effects (Elmen, J. et al.,
(2005) Nucleic Acids Research 33(1):439-447; Mook, O R. et al.,
(2007) Mol Canc Ther 6(3):833-843; Grunweller, A. et al., (2003)
Nucleic Acids Research 31(12):3185-3193).
[0244] Examples of bicyclic nucleosides for use in the
polynucleotides of the invention include without limitation
nucleosides comprising a bridge between the 4' and the 2' ribosyl
ring atoms. In certain embodiments, the antisense polynucleotide
agents of the invention include one or more bicyclic nucleosides
comprising a 4' to 2' bridge. Examples of such 4' to 2' bridged
bicyclic nucleosides, include but are not limited to 4'-(CH2)-O-2'
(LNA); 4'-(CH2)-S-2'; 4'-(CH2)2-0-2' (ENA); 4'-CH(CH3)-O-2' (also
referred to as "constrained ethyl" or "cEt") and
4'-CH(CH2OCH3)-O-2' (and analogs thereof; see, e.g., U.S. Pat. No.
7,399,845); 4'-C(CH3)(CH3)-O-2' (and analogs thereof; see e.g.,
U.S. Pat. No. 8,278,283); 4'-CH2-N(OCH3)-2' (and analogs thereof;
see e.g., U.S. Pat. No. 8,278,425); 4'-CH2-O--N(CH3)-2' (see, e.g.,
U.S. Patent Publication No. 2004/0171570); 4'-CH2-N(R)--O-2',
wherein R is H, C1-C12 alkyl, or a protecting group (see, e.g.,
U.S. Pat. No. 7,427,672); 4'-CH2-C(H)(CH3)-2' (see, e.g.,
Chattopadhyaya et al., J. Org. Chem., 2009, 74, 118-134); and
4'-CH2-C(.dbd.CH2)-2' (and analogs thereof; see, e.g., U.S. Pat.
No. 8,278,426). The entire contents of each of the foregoing are
hereby incorporated herein by reference.
[0245] Additional representative U.S. patents and US patent
Publications that teach the preparation of locked nucleic acid
nucleotides include, but are not limited to, the following: U.S.
Pat. Nos. 6,268,490; 6,525,191; 6,670,461; 6,770,748; 6,794,499;
6,998,484; 7,053,207; 7,034,133; 7,084,125; 7,399,845; 7,427,672;
7,569,686; 7,741,457; 8,022,193; 8,030,467; 8,278,425; 8,278,426;
8,278,283; US 2008/0039618; and US 2009/0012281, the entire
contents of each of which are hereby incorporated herein by
reference.
[0246] Any of the foregoing bicyclic nucleosides can be prepared
having one or more stereochemical sugar configurations including
for example .alpha.-L-ribofuranose and .beta.-D-ribofuranose (see
WO 99/14226).
[0247] The RNA of an iRNA can also be modified to include one or
more constrained ethyl nucleotides. As used herein, a "constrained
ethyl nucleotide" or "cEt" is a locked nucleic acid comprising a
bicyclic sugar moiety comprising a 4'-CH(CH3)-0-2' bridge. In one
embodiment, a constrained ethyl nucleotide is in the S conformation
referred to herein as "S-cEt."
[0248] An iRNA of the invention may also include one or more
"conformationally restricted nucleotides" ("CRN"). CRN are
nucleotide analogs with a linker connecting the C2' and C4' carbons
of ribose or the C3 and -C5' carbons of ribose. CRN lock the ribose
ring into a stable conformation and increase the hybridization
affinity to mRNA. The linker is of sufficient length to place the
oxygen in an optimal position for stability and affinity resulting
in less ribose ring puckering.
[0249] Representative publications that teach the preparation of
certain of the above noted CRN include, but are not limited to, US
Patent Publication No. 2013/0190383; and PCT publication WO
2013/036868, the entire contents of each of which are hereby
incorporated herein by reference.
[0250] One or more of the nucleotides of an iRNA of the invention
may also include a hydroxymethyl substituted nucleotide. A
"hydroxymethyl substituted nucleotide" is an acyclic
2'-3'-seco-nucleotide, also referred to as an "unlocked nucleic
acid" ("UNA") modification
[0251] Representative U.S. publications that teach the preparation
of UNA include, but are not limited to, U.S. Pat. No. 8,314,227;
and US Patent Publication Nos. 2013/0096289; 2013/0011922; and
2011/0313020, the entire contents of each of which are hereby
incorporated herein by reference.
[0252] Other modifications of the nucleotides of an iRNA of the
invention include a 5' phosphate or 5' phosphate mimic, e.g., a
5'-terminal phosphate or phosphate mimic on the antisense strand of
an RNAi agent. Suitable phosphate mimics are disclosed in, for
example US Patent Publication No. 2012/0157511, the entire contents
of which are incorporated herein by reference.
[0253] Potentially stabilizing modifications to the ends of RNA
molecules can include N-(acetylaminocaproyl)-4-hydroxyprolinol
(Hyp-C6-NHAc), N-(caproyl-4-hydroxyprolinol (Hyp-C6),
N-(acetyl-4-hydroxyprolinol (Hyp-NHAc),
thymidine-2'-O-deoxythymidine (ether),
N-(aminocaproyl)-4-hydroxyprolinol (Hyp-C6-amino),
2-docosanoyl-uridine-3''-phosphate, inverted base dT(idT) and
others. Disclosure of this modification can be found in PCT
Publication No. WO 2011/005861.
[0254] A. Modified iRNAs Comprising Motifs
[0255] In certain aspects of the invention, the double-stranded
RNAi agents of the invention include agents with chemical
modifications as disclosed, for example, in U.S. Patent Publication
No. 2014/0315835 and PCT Publication No. WO 2013/075035, the entire
contents of each of which are incorporated herein by reference, the
entire contents of each of which are incorporated herein by
reference. As shown herein and in U.S. Patent Publication No.
2014/0315835 and PCT Publication No. WO 2013/075035, a superior
result may be obtained by introducing one or more motifs of three
identical modifications on three consecutive nucleotides into a
sense strand and/or antisense strand of an RNAi agent, particularly
at or near the cleavage site. In some embodiments, the sense strand
and antisense strand of the RNAi agent may otherwise be completely
modified. The introduction of these motifs interrupts the
modification pattern, if present, of the sense and/or antisense
strand. The RNAi agent may be optionally conjugated with a GalNAc
derivative ligand, for instance on the sense strand. The resulting
RNAi agents present superior gene silencing activity.
[0256] More specifically, it has been surprisingly discovered that
when the sense strand and antisense strand of the double-stranded
RNAi agent are completely modified to have one or more motifs of
three identical modifications on three consecutive nucleotides at
or near the cleavage site of at least one strand of an RNAi agent,
the gene silencing activity of the RNAi agent was superiorly
enhanced.
[0257] Accordingly, the invention provides double-stranded RNAi
agents capable of inhibiting the expression of a target gene (i.e.,
a PCSK9 gene) in vivo. The RNAi agent comprises a sense strand and
an antisense strand. Each strand of the RNAi agent may range from
12-30 nucleotides in length. For example, each strand may be
between 14-30 nucleotides in length, 17-30 nucleotides in length,
25-30 nucleotides in length, 27-30 nucleotides in length, 17-23
nucleotides in length, 17-21 nucleotides in length, 17-19
nucleotides in length, 19-25 nucleotides in length, 19-23
nucleotides in length, 19-21 nucleotides in length, 21-25
nucleotides in length, or 21-23 nucleotides in length.
[0258] The sense strand and antisense strand typically form a
duplex double stranded RNA ("dsRNA"), also referred to herein as an
"RNAi agent." The duplex region of an RNAi agent may be 12-30
nucleotide pairs in length. For example, the duplex region can be
between 14-30 nucleotide pairs in length, 17-30 nucleotide pairs in
length, 27-30 nucleotide pairs in length, 17-23 nucleotide pairs in
length, 17-21 nucleotide pairs in length, 17-19 nucleotide pairs in
length, 19-25 nucleotide pairs in length, 19-23 nucleotide pairs in
length, 19-21 nucleotide pairs in length, 21-25 nucleotide pairs in
length, or 21-23 nucleotide pairs in length. In another example,
the duplex region is selected from 15, 16, 17, 18, 19, 20, 21, 22,
23, 24, 25, 26, and 27 nucleotides in length.
[0259] In one embodiment, the RNAi agent may contain one or more
overhang regions and/or capping groups at the 3'-end, 5'-end, or
both ends of one or both strands. The overhang can be 1-6
nucleotides in length, for instance 2-6 nucleotides in length, 1-5
nucleotides in length, 2-5 nucleotides in length, 1-4 nucleotides
in length, 2-4 nucleotides in length, 1-3 nucleotides in length,
2-3 nucleotides in length, or 1-2 nucleotides in length. The
overhangs can be the result of one strand being longer than the
other, or the result of two strands of the same length being
staggered. The overhang can form a mismatch with the target mRNA or
it can be complementary to the gene sequences being targeted or can
be another sequence. The first and second strands can also be
joined, e.g., by additional bases to form a hairpin, or by other
non-base linkers.
[0260] In one embodiment, the nucleotides in the overhang region of
the RNAi agent can each independently be a modified or unmodified
nucleotide including, but no limited to 2'-sugar modified, such as,
2-F, 2'-Omethyl, thymidine (T), 2'-O-methoxyethyl-5-methyluridine
(Teo), 2'-O-methoxyethyladenosine (Aeo),
2'-O-methoxyethyl-5-methylcytidine (m5Ceo), and any combinations
thereof. For example, TT can be an overhang sequence for either end
on either strand. The overhang can form a mismatch with the target
mRNA or it can be complementary to the gene sequences being
targeted or can be another sequence.
[0261] The 5'- or 3'-overhangs at the sense strand, antisense
strand or both strands of the RNAi agent may be phosphorylated. In
some embodiments, the overhang region(s) contains two nucleotides
having a phosphorothioate between the two nucleotides, where the
two nucleotides can be the same or different. In one embodiment,
the overhang is present at the 3'-end of the sense strand,
antisense strand, or both strands. In one embodiment, this
3'-overhang is present in the antisense strand. In one embodiment,
this 3'-overhang is present in the sense strand.
[0262] The RNAi agent may contain only a single overhang, which can
strengthen the interference activity of the RNAi, without affecting
its overall stability. For example, the single-stranded overhang
may be located at the 3'-terminal end of the sense strand or,
alternatively, at the 3'-terminal end of the antisense strand. The
RNAi may also have a blunt end, located at the 5'-end of the
antisense strand (or the 3'-end of the sense strand) or vice versa.
Generally, the antisense strand of the RNAi has a nucleotide
overhang at the 3'-end, and the 5'-end is blunt. While not wishing
to be bound by theory, the asymmetric blunt end at the 5'-end of
the antisense strand and 3'-end overhang of the antisense strand
favor the guide strand loading into RISC process.
[0263] In one embodiment, the RNAi agent is a double ended bluntmer
of 19 nucleotides in length, wherein the sense strand contains at
least one motif of three 2'-F modifications on three consecutive
nucleotides at positions 7, 8, 9 from the 5'end. The antisense
strand contains at least one motif of three 2'-O-methyl
modifications on three consecutive nucleotides at positions 11, 12,
13 from the 5'end.
[0264] In another embodiment, the RNAi agent is a double ended
bluntmer of 20 nucleotides in length, wherein the sense strand
contains at least one motif of three 2'-F modifications on three
consecutive nucleotides at positions 8, 9, 10 from the 5'end. The
antisense strand contains at least one motif of three 2'-O-methyl
modifications on three consecutive nucleotides at positions 11, 12,
13 from the 5'end.
[0265] In yet another embodiment, the RNAi agent is a double ended
bluntmer of 21 nucleotides in length, wherein the sense strand
contains at least one motif of three 2'-F modifications on three
consecutive nucleotides at positions 9, 10, 11 from the 5'end. The
antisense strand contains at least one motif of three 2'-O-methyl
modifications on three consecutive nucleotides at positions 11, 12,
13 from the 5'end.
[0266] In one embodiment, the RNAi agent comprises a 21 nucleotide
sense strand and a 23 nucleotide antisense strand, wherein the
sense strand contains at least one motif of three 2'-F
modifications on three consecutive nucleotides at positions 9, 10,
11 from the 5'end; the antisense strand contains at least one motif
of three 2'-O-methyl modifications on three consecutive nucleotides
at positions 11, 12, 13 from the 5'end, wherein one end of the RNAi
agent is blunt, while the other end comprises a 2 nucleotide
overhang. Preferably, the 2 nucleotide overhang is at the 3'-end of
the antisense strand. When the 2 nucleotide overhang is at the
3'-end of the antisense strand, there may be two phosphorothioate
internucleotide linkages between the terminal three nucleotides,
wherein two of the three nucleotides are the overhang nucleotides,
and the third nucleotide is a paired nucleotide next to the
overhang nucleotide. In one embodiment, the RNAi agent additionally
has two phosphorothioate internucleotide linkages between the
terminal three nucleotides at both the 5'-end of the sense strand
and at the 5'-end of the antisense strand. In one embodiment, every
nucleotide in the sense strand and the antisense strand of the RNAi
agent, including the nucleotides that are part of the motifs are
modified nucleotides. In one embodiment each residue is
independently modified with a 2'-O-methyl or 3'-fluoro, e.g., in an
alternating motif. Optionally, the RNAi agent further comprises a
ligand (preferably GalNAc.sub.3).
[0267] In one embodiment, the RNAi agent comprises a sense and an
antisense strand, wherein the sense strand is 25-30 nucleotide
residues in length, wherein starting from the 5' terminal
nucleotide (position 1) positions 1 to 23 of the first strand
comprise at least 8 ribonucleotides; the antisense strand is 36-66
nucleotide residues in length and, starting from the 3' terminal
nucleotide, comprises at least 8 ribonucleotides in the positions
paired with positions 1-23 of sense strand to form a duplex;
wherein at least the 3 ` terminal nucleotide of antisense strand is
unpaired with sense strand, and up to 6 consecutive 3` terminal
nucleotides are unpaired with sense strand, thereby forming a 3'
single stranded overhang of 1-6 nucleotides; wherein the 5'
terminus of antisense strand comprises from 10-30 consecutive
nucleotides which are unpaired with sense strand, thereby forming a
10-30 nucleotide single stranded 5' overhang; wherein at least the
sense strand 5' terminal and 3' terminal nucleotides are base
paired with nucleotides of antisense strand when sense and
antisense strands are aligned for maximum complementarity, thereby
forming a substantially duplexed region between sense and antisense
strands; and antisense strand is sufficiently complementary to a
target RNA along at least 19 ribonucleotides of antisense strand
length to reduce target gene expression when the double stranded
nucleic acid is introduced into a mammalian cell; and wherein the
sense strand contains at least one motif of three 2'-F
modifications on three consecutive nucleotides, where at least one
of the motifs occurs at or near the cleavage site. The antisense
strand contains at least one motif of three 2'-O-methyl
modifications on three consecutive nucleotides at or near the
cleavage site.
[0268] In one embodiment, the RNAi agent comprises sense and
antisense strands, wherein the RNAi agent comprises a first strand
having a length which is at least 25 and at most 29 nucleotides and
a second strand having a length which is at most 30 nucleotides
with at least one motif of three 2'-O-methyl modifications on three
consecutive nucleotides at position 11, 12, 13 from the 5' end;
wherein the 3' end of the first strand and the 5' end of the second
strand form a blunt end and the second strand is 1-4 nucleotides
longer at its 3' end than the first strand, wherein the duplex
region which is at least 25 nucleotides in length, and the second
strand is sufficiently complementary to a target mRNA along at
least 19 nucleotide of the second strand length to reduce target
gene expression when the RNAi agent is introduced into a mammalian
cell, and wherein dicer cleavage of the RNAi agent preferentially
results in an siRNA comprising the 3' end of the second strand,
thereby reducing expression of the target gene in the mammal.
Optionally, the RNAi agent further comprises a ligand.
[0269] In one embodiment, the sense strand of the RNAi agent
contains at least one motif of three identical modifications on
three consecutive nucleotides, where one of the motifs occurs at
the cleavage site in the sense strand.
[0270] In one embodiment, the antisense strand of the RNAi agent
can also contain at least one motif of three identical
modifications on three consecutive nucleotides, where one of the
motifs occurs at or near the cleavage site in the antisense
strand
[0271] For an RNAi agent having a duplex region of 17-23 nucleotide
in length, the cleavage site of the antisense strand is typically
around the 10, 11 and 12 positions from the 5'-end. Thus the motifs
of three identical modifications may occur at the 9, 10, 11
positions; 10, 11, 12 positions; 11, 12, 13 positions; 12, 13, 14
positions; or 13, 14, 15 positions of the antisense strand, the
count starting from the 1.sup.st nucleotide from the 5'-end of the
antisense strand, or, the count starting from the 1.sup.st paired
nucleotide within the duplex region from the 5'-end of the
antisense strand. The cleavage site in the antisense strand may
also change according to the length of the duplex region of the
RNAi from the 5'-end.
[0272] The sense strand of the RNAi agent may contain at least one
motif of three identical modifications on three consecutive
nucleotides at the cleavage site of the strand; and the antisense
strand may have at least one motif of three identical modifications
on three consecutive nucleotides at or near the cleavage site of
the strand. When the sense strand and the antisense strand form a
dsRNA duplex, the sense strand and the antisense strand can be so
aligned that one motif of the three nucleotides on the sense strand
and one motif of the three nucleotides on the antisense strand have
at least one nucleotide overlap, i.e., at least one of the three
nucleotides of the motif in the sense strand forms a base pair with
at least one of the three nucleotides of the motif in the antisense
strand. Alternatively, at least two nucleotides may overlap, or all
three nucleotides may overlap.
[0273] In one embodiment, the sense strand of the RNAi agent may
contain more than one motif of three identical modifications on
three consecutive nucleotides. The first motif may occur at or near
the cleavage site of the strand and the other motifs may be a wing
modification. The term "wing modification" herein refers to a motif
occurring at another portion of the strand that is separated from
the motif at or near the cleavage site of the same strand. The wing
modification is either adjacent to the first motif or is separated
by at least one or more nucleotides. When the motifs are
immediately adjacent to each other then the chemistry of the motifs
are distinct from each other and when the motifs are separated by
one or more nucleotide than the chemistries can be the same or
different. Two or more wing modifications may be present. For
instance, when two wing modifications are present, each wing
modification may occur at one end relative to the first motif which
is at or near cleavage site or on either side of the lead
motif.
[0274] Like the sense strand, the antisense strand of the RNAi
agent may contain more than one motifs of three identical
modifications on three consecutive nucleotides, with at least one
of the motifs occurring at or near the cleavage site of the strand.
This antisense strand may also contain one or more wing
modifications in an alignment similar to the wing modifications
that may be present on the sense strand.
[0275] In one embodiment, the wing modification on the sense strand
or antisense strand of the RNAi agent typically does not include
the first one or two terminal nucleotides at the 3'-end, 5'-end or
both ends of the strand.
[0276] In another embodiment, the wing modification on the sense
strand or antisense strand of the RNAi agent typically does not
include the first one or two paired nucleotides within the duplex
region at the 3'-end, 5'-end or both ends of the strand.
[0277] When the sense strand and the antisense strand of the RNAi
agent each contain at least one wing modification, the wing
modifications may fall on the same end of the duplex region, and
have an overlap of one, two or three nucleotides.
[0278] When the sense strand and the antisense strand of the RNAi
agent each contain at least two wing modifications, the sense
strand and the antisense strand can be so aligned that two
modifications each from one strand fall on one end of the duplex
region, having an overlap of one, two or three nucleotides; two
modifications each from one strand fall on the other end of the
duplex region, having an overlap of one, two or three nucleotides;
two modifications one strand fall on each side of the lead motif,
having an overlap of one, two or three nucleotides in the duplex
region.
[0279] In one embodiment, every nucleotide in the sense strand and
antisense strand of the RNAi agent, including the nucleotides that
are part of the motifs, may be modified. Each nucleotide may be
modified with the same or different modification which can include
one or more alteration of one or both of the non-linking phosphate
oxygens and/or of one or more of the linking phosphate oxygens;
alteration of a constituent of the ribose sugar, e.g., of the 2'
hydroxyl on the ribose sugar; wholesale replacement of the
phosphate moiety with "dephospho" linkers; modification or
replacement of a naturally occurring base; and replacement or
modification of the ribose-phosphate backbone.
[0280] As nucleic acids are polymers of subunits, many of the
modifications occur at a position which is repeated within a
nucleic acid, e.g., a modification of a base, or a phosphate
moiety, or a non-linking 0 of a phosphate moiety. In some cases the
modification will occur at all of the subject positions in the
nucleic acid but in many cases it will not. By way of example, a
modification may only occur at a 3' or 5' terminal position, may
only occur in a terminal region, e.g., at a position on a terminal
nucleotide or in the last 2, 3, 4, 5, or 10 nucleotides of a
strand. A modification may occur in a double strand region, a
single strand region, or in both. A modification may occur only in
the double strand region of a RNA or may only occur in a single
strand region of a RNA. For example, a phosphorothioate
modification at a non-linking 0 position may only occur at one or
both termini, may only occur in a terminal region, e.g., at a
position on a terminal nucleotide or in the last 2, 3, 4, 5, or 10
nucleotides of a strand, or may occur in double strand and single
strand regions, particularly at termini. The 5' end or ends can be
phosphorylated.
[0281] It may be possible, e.g., to enhance stability, to include
particular bases in overhangs, or to include modified nucleotides
or nucleotide surrogates, in single strand overhangs, e.g., in a 5'
or 3' overhang, or in both. For example, it can be desirable to
include purine nucleotides in overhangs. In some embodiments all or
some of the bases in a 3' or 5' overhang may be modified, e.g.,
with a modification described herein. Modifications can include,
e.g., the use of modifications at the 2' position of the ribose
sugar with modifications that are known in the art, e.g., the use
of deoxyribonucleotides, 2'-deoxy-2'-fluoro (2'-F) or 2'-O-methyl
modified instead of the ribosugar of the nucleobase, and
modifications in the phosphate group, e.g., phosphorothioate
modifications. Overhangs need not be homologous with the target
sequence. In one embodiment, each residue of the sense strand and
antisense strand is independently modified with LNA, HNA, CeNA,
2'-methoxyethyl, 2'-O-methyl, 2'-O-allyl, 2'-C-allyl, 2'-deoxy,
2'-hydroxyl, or 2'-fluoro. The strands can contain more than one
modification. In one embodiment, each residue of the sense strand
and antisense strand is independently modified with 2'-O-methyl or
2'-fluoro.
[0282] At least two different modifications are typically present
on the sense strand and antisense strand. Those two modifications
may be the 2'-O-methyl or 2'-fluoro modifications, or others.
[0283] In one embodiment, the N.sub.a and/or N.sub.b comprise
modifications of an alternating pattern. The term "alternating
motif" as used herein refers to a motif having one or more
modifications, each modification occurring on alternating
nucleotides of one strand. The alternating nucleotide may refer to
one per every other nucleotide or one per every three nucleotides,
or a similar pattern. For example, if A, B and C each represent one
type of modification to the nucleotide, the alternating motif can
be "ABABABABABAB . . . ," "AABBAABBAABB . . . ," "AABAABAABAAB . .
. ," "AAABAAABAAAB . . . ," "AAABBBAAABBB . . . ," or "ABCABCABCABC
. . . ," etc.
[0284] The type of modifications contained in the alternating motif
may be the same or different. For example, if A, B, C, D each
represent one type of modification on the nucleotide, the
alternating pattern, i.e., modifications on every other nucleotide,
may be the same, but each of the sense strand or antisense strand
can be selected from several possibilities of modifications within
the alternating motif such as "ABABAB . . . ", "ACACAC . . . "
"BDBDBD . . . " or "CDCDCD . . . ," etc.
[0285] In one embodiment, the RNAi agent of the invention comprises
the modification pattern for the alternating motif on the sense
strand relative to the modification pattern for the alternating
motif on the antisense strand is shifted. The shift may be such
that the modified group of nucleotides of the sense strand
corresponds to a differently modified group of nucleotides of the
antisense strand and vice versa. For example, the sense strand when
paired with the antisense strand in the dsRNA duplex, the
alternating motif in the sense strand may start with "ABABAB" from
5'-3' of the strand and the alternating motif in the antisense
strand may start with "BABABA" from 5'-3' of the strand within the
duplex region. As another example, the alternating motif in the
sense strand may start with "AABBAABB" from 5'-3' of the strand and
the alternating motif in the antisense strand may start with
"BBAABBAA" from 5'-3' of the strand within the duplex region, so
that there is a complete or partial shift of the modification
patterns between the sense strand and the antisense strand.
[0286] In one embodiment, the RNAi agent comprises the pattern of
the alternating motif of 2'-O-methyl modification and 2'-F
modification on the sense strand initially has a shift relative to
the pattern of the alternating motif of 2'-O-methyl modification
and 2'-F modification on the antisense strand initially, i.e., the
2'-O-methyl modified nucleotide on the sense strand base pairs with
a 2'-F modified nucleotide on the antisense strand and vice versa.
The 1 position of the sense strand may start with the 2'-F
modification, and the 1 position of the antisense strand may start
with the 2'-O-methyl modification.
[0287] The introduction of one or more motifs of three identical
modifications on three consecutive nucleotides to the sense strand
and/or antisense strand interrupts the initial modification pattern
present in the sense strand and/or antisense strand. This
interruption of the modification pattern of the sense and/or
antisense strand by introducing one or more motifs of three
identical modifications on three consecutive nucleotides to the
sense and/or antisense strand surprisingly enhances the gene
silencing activity to the target gene.
[0288] In one embodiment, when the motif of three identical
modifications on three consecutive nucleotides is introduced to any
of the strands, the modification of the nucleotide next to the
motif is a different modification than the modification of the
motif. For example, the portion of the sequence containing the
motif is " . . . N.sub.aYYYN.sub.b . . . ," where "Y" represents
the modification of the motif of three identical modifications on
three consecutive nucleotide, and "N.sub.a" and "N.sub.b" represent
a modification to the nucleotide next to the motif "YYY" that is
different than the modification of Y, and where N.sub.a and N.sub.b
can be the same or different modifications. Alternatively, N.sub.a
and/or N.sub.b may be present or absent when there is a wing
modification present.
[0289] The RNAi agent may further comprise at least one
phosphorothioate or methylphosphonate internucleotide linkage. The
phosphorothioate or methylphosphonate internucleotide linkage
modification may occur on any nucleotide of the sense strand or
antisense strand or both strands in any position of the strand. For
instance, the internucleotide linkage modification may occur on
every nucleotide on the sense strand and/or antisense strand; each
internucleotide linkage modification may occur in an alternating
pattern on the sense strand and/or antisense strand; or the sense
strand or antisense strand may contain both internucleotide linkage
modifications in an alternating pattern. The alternating pattern of
the internucleotide linkage modification on the sense strand may be
the same or different from the antisense strand, and the
alternating pattern of the internucleotide linkage modification on
the sense strand may have a shift relative to the alternating
pattern of the internucleotide linkage modification on the
antisense strand. In one embodiment, a double-stranded RNAi agent
comprises 6-8phosphorothioate internucleotide linkages. In one
embodiment, the antisense strand comprises two phosphorothioate
internucleotide linkages at the 5'-terminus and two
phosphorothioate internucleotide linkages at the 3'-terminus, and
the sense strand comprises at least two phosphorothioate
internucleotide linkages at either the 5'-terminus or the
3'-terminus.
[0290] In one embodiment, the RNAi comprises a phosphorothioate or
methylphosphonate internucleotide linkage modification in the
overhang region. For example, the overhang region may contain two
nucleotides having a phosphorothioate or methylphosphonate
internucleotide linkage between the two nucleotides.
Internucleotide linkage modifications also may be made to link the
overhang nucleotides with the terminal paired nucleotides within
the duplex region. For example, at least 2, 3, 4, or all the
overhang nucleotides may be linked through phosphorothioate or
methylphosphonate internucleotide linkage, and optionally, there
may be additional phosphorothioate or methylphosphonate
internucleotide linkages linking the overhang nucleotide with a
paired nucleotide that is next to the overhang nucleotide. For
instance, there may be at least two phosphorothioate
internucleotide linkages between the terminal three nucleotides, in
which two of the three nucleotides are overhang nucleotides, and
the third is a paired nucleotide next to the overhang nucleotide.
These terminal three nucleotides may be at the 3'-end of the
antisense strand, the 3'-end of the sense strand, the 5'-end of the
antisense strand, and/or the 5'end of the antisense strand.
[0291] In one embodiment, the 2 nucleotide overhang is at the
3'-end of the antisense strand, and there are two phosphorothioate
internucleotide linkages between the terminal three nucleotides,
wherein two of the three nucleotides are the overhang nucleotides,
and the third nucleotide is a paired nucleotide next to the
overhang nucleotide. Optionally, the RNAi agent may additionally
have two phosphorothioate internucleotide linkages between the
terminal three nucleotides at both the 5'-end of the sense strand
and at the 5'-end of the antisense strand.
[0292] In one embodiment, the RNAi agent comprises mismatch(es)
with the target, within the duplex, or combinations thereof. The
mismatch may occur in the overhang region or the duplex region. The
base pair may be ranked on the basis of their propensity to promote
dissociation or melting (e.g., on the free energy of association or
dissociation of a particular pairing, the simplest approach is to
examine the pairs on an individual pair basis, though next neighbor
or similar analysis can also be used). In terms of promoting
dissociation: A:U is preferred over G:C; G:U is preferred over G:C;
and I:C is preferred over G:C (I=inosine). Mismatches, e.g.,
non-canonical or other than canonical pairings (as described
elsewhere herein) are preferred over canonical (A:T, A:U, G:C)
pairings; and pairings which include a universal base are preferred
over canonical pairings.
[0293] In one embodiment, the RNAi agent comprises at least one of
the first 1, 2, 3, 4, or 5 base pairs within the duplex regions
from the 5'-end of the antisense strand independently selected from
the group of: A:U, G:U, I:C, and mismatched pairs, e.g.,
non-canonical or other than canonical pairings or pairings which
include a universal base, to promote the dissociation of the
antisense strand at the 5'-end of the duplex.
[0294] In one embodiment, the nucleotide at the 1 position within
the duplex region from the 5'-end in the antisense strand is
selected from the group consisting of A, dA, dU, U, and dT.
Alternatively, at least one of the first 1, 2 or 3 base pair within
the duplex region from the 5'-end of the antisense strand is an AU
base pair. For example, the first base pair within the duplex
region from the 5'-end of the antisense strand is an AU base
pair.
[0295] In another embodiment, the nucleotide at the 3'-end of the
sense strand is deoxy-thymine (dT). In another embodiment, the
nucleotide at the 3'-end of the antisense strand is deoxy-thymine
(dT). In one embodiment, there is a short sequence of deoxy-thymine
nucleotides, for example, two dT nucleotides on the 3'-end of the
sense and/or antisense strand.
[0296] In one embodiment, the sense strand sequence may be
represented by formula (I):
TABLE-US-00001 (I) 5'
n.sub.p-N.sub.a-(XXX).sub.i-N.sub.b-YYY-N.sub.b-(ZZZ).sub.j-N.sub.a-n.-
sub.q 3'
[0297] wherein:
[0298] i and j are each independently 0 or 1;
[0299] p and q are each independently 0-6;
each N.sub.a independently represents an oligonucleotide sequence
comprising 0-25 modified nucleotides, each sequence comprising at
least two differently modified nucleotides; each N.sub.b
independently represents an oligonucleotide sequence comprising
0-10 modified nucleotides; each n.sub.p and n.sub.q independently
represent an overhang nucleotide; wherein Nb and Y do not have the
same modification; and XXX, YYY and ZZZ each independently
represent one motif of three identical modifications on three
consecutive nucleotides. Preferably YYY is all 2'-F modified
nucleotides. In one embodiment, the N.sub.a and/or N.sub.b comprise
modifications of alternating pattern.
[0300] In one embodiment, the YYY motif occurs at or near the
cleavage site of the sense strand. For example, when the RNAi agent
has a duplex region of 17-23 nucleotides in length, the YYY motif
can occur at or the vicinity of the cleavage site (e.g.: can occur
at positions 6, 7, 8, 7, 8, 9, 8, 9, 10, 9, 10, 11, 10, 11, 12 or
11, 12, 13) of--the sense strand, the count starting from the 1st
nucleotide, from the 5'-end; or optionally, the count starting at
the 1.sup.st paired nucleotide within the duplex region, from the
5'-end.
[0301] In one embodiment, i is 1 and j is 0, or i is 0 and j is 1,
or both i and j are 1. The sense strand can therefore be
represented by the following formulas:
TABLE-US-00002 (Ib) 5'
n.sub.p-N.sub.a-YYY-N.sub.b-ZZZ-N.sub.a-n.sub.q 3'; (Ic) 5'
n.sub.p-N.sub.a-XXX-N.sub.b-YYY-N.sub.a-n.sub.q 3'; or (Id) 5'
n.sub.p-N.sub.a-XXX-N.sub.b-YYY-N.sub.b-ZZZ-N.sub.a-n.sub.q 3'.
[0302] When the sense strand is represented by formula (Ib),
N.sub.b represents an oligonucleotide sequence comprising 0-10,
0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides. Each N.sub.a
independently can represent an oligonucleotide sequence comprising
2-20, 2-15, or 2-10 modified nucleotides.
[0303] When the sense strand is represented as formula (Ic),
N.sub.b represents an oligonucleotide sequence comprising 0-10,
0-7, 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides. Each
N.sub.a can independently represent an oligonucleotide sequence
comprising 2-20, 2-15, or 2-10 modified nucleotides.
[0304] When the sense strand is represented as formula (Id), each
N.sub.b independently represents an oligonucleotide sequence
comprising 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides.
Preferably, N.sub.b is 0, 1, 2, 3, 4, 5 or 6 Each N.sub.a can
independently represent an oligonucleotide sequence comprising
2-20, 2-15, or 2-10 modified nucleotides.
Each of X, Y and Z may be the same or different from each other. In
other embodiments, i is 0 and j is 0, and the sense strand may be
represented by the formula:
TABLE-US-00003 (Ia) 5' n.sub.p-N.sub.a-YYY-N.sub.a-n.sub.q 3'.
When the sense strand is represented by formula (Ia), each N.sub.a
independently can represent an oligonucleotide sequence comprising
2-20, 2-15, or 2-10 modified nucleotides.
[0305] In one embodiment, the antisense strand sequence of the RNAi
may be represented by formula (II):
TABLE-US-00004 (II) 5'
n.sub.q'-N.sub.a'-(Z'Z'Z').sub.k-N.sub.b'-Y'Y'Y'-N.sub.b'-(X'X'X').sub.-
l-N'.sub.a- n.sub.p' 3'
[0306] wherein:
[0307] k and 1 are each independently 0 or 1;
[0308] p' and q' are each independently 0-6;
each N.sub.a' independently represents an oligonucleotide sequence
comprising 0-25 modified nucleotides, each sequence comprising at
least two differently modified nucleotides; each N.sub.b'
independently represents an oligonucleotide sequence comprising
0-10 modified nucleotides; each n.sub.p' and n.sub.q' independently
represent an overhang nucleotide; wherein N.sub.b' and Y' do not
have the same modification; and X'X'X', Y'Y'Y' and Z'Z'Z' each
independently represent one motif of three identical modifications
on three consecutive nucleotides.
[0309] In one embodiment, the N.sub.a' and/or N.sub.b' comprise
modifications of alternating pattern.
[0310] The Y'Y'Y' motif occurs at or near the cleavage site of the
antisense strand. For example, when the RNAi agent has a duplex
region of 17-23 nucleotide in length, the Y'Y'Y' motif can occur at
positions 9, 10, 11; 10, 11, 12; 11, 12, 13; 12, 13, 14; or 13, 14,
15 of the antisense strand, with the count starting from the
1.sup.st nucleotide, from the 5'-end; or optionally, the count
starting at the 1.sup.st paired nucleotide within the duplex
region, from the 5'-end. Preferably, the Y'Y'Y' motif occurs at
positions 11, 12, 13.
[0311] In one embodiment, Y'Y'Y' motif is all 2'-OMe modified
nucleotides.
[0312] In one embodiment, k is 1 and 1 is 0, or k is 0 and 1 is 1,
or both k and 1 are 1.
[0313] The antisense strand can therefore be represented by the
following formulas:
TABLE-US-00005 (IIb) 5'
n.sub.q'-N.sub.a'-Z'Z'Z'-N.sub.b'-Y'Y'Y'-N.sub.a'-n.sub.p' 3';
(IIc) 5' n.sub.q'-N.sub.a'-Y'Y'Y'-N.sub.b'-X'X'X'-n.sub.p' 3'; or
(IId) 5'
n.sub.q'-N.sub.a'-Z'Z'Z'-N.sub.b'-Y'Y'Y'-N.sub.b'-X'X'X'-N.sub.a'-n.sub-
.p' 3'.
[0314] When the antisense strand is represented by formula (IIb),
N.sub.b' represents an oligonucleotide sequence comprising 0-10,
0-7, 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides. Each
N.sub.a' independently represents an oligonucleotide sequence
comprising 2-20, 2-15, or 2-10 modified nucleotides.
[0315] When the antisense strand is represented as formula (IIc),
N.sub.b' represents an oligonucleotide sequence comprising 0-10,
0-7, 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides. Each
N.sub.a' independently represents an oligonucleotide sequence
comprising 2-20, 2-15, or 2-10 modified nucleotides.
[0316] When the antisense strand is represented as formula (IId),
each N.sub.b' independently represents an oligonucleotide sequence
comprising 0-10, 0-7, 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified
nucleotides. Each N.sub.a' independently represents an
oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified
nucleotides. Preferably, N.sub.b is 0, 1, 2, 3, 4, 5 or 6. In other
embodiments, k is 0 and 1 is 0 and the antisense strand may be
represented by the formula:
TABLE-US-00006 (Ia) 5' n.sub.p'-N.sub.a'-Y'Y'Y'-N.sub.a'-n.sub.q'
3'.
[0317] When the antisense strand is represented as formula (IIa),
each N.sub.a' independently represents an oligonucleotide sequence
comprising 2-20, 2-15, or 2-10 modified nucleotides.
Each of X', Y' and Z' may be the same or different from each other.
Each nucleotide of the sense strand and antisense strand may be
independently modified with LNA, HNA, CeNA, 2'-methoxyethyl,
2'-O-methyl, 2'-O-allyl, 2'-C-allyl, 2'-hydroxyl, or 2'-fluoro. For
example, each nucleotide of the sense strand and antisense strand
is independently modified with 2'-O-methyl or 2'-fluoro. Each X, Y,
Z, X', Y' and Z', in particular, may represent a 2'-O-methyl
modification or a 2'-fluoro modification.
[0318] In one embodiment, the sense strand of the RNAi agent may
contain YYY motif occurring at 9, 10 and 11 positions of the strand
when the duplex region is 21 nt, the count starting from the
1.sup.st nucleotide from the 5'-end, or optionally, the count
starting at the 1.sup.st paired nucleotide within the duplex
region, from the 5'-end; and Y represents 2'-F modification. The
sense strand may additionally contain XXX motif or ZZZ motifs as
wing modifications at the opposite end of the duplex region; and
XXX and ZZZ each independently represents a 2'-OMe modification or
2'-F modification.
[0319] In one embodiment the antisense strand may contain Y'Y'Y'
motif occurring at positions 11, 12, 13 of the strand, the count
starting from the 1.sup.st nucleotide from the 5'-end, or
optionally, the count starting at the 1.sup.st paired nucleotide
within the duplex region, from the 5'-end; and Y' represents
2'-O-methyl modification. The antisense strand may additionally
contain X'X'X' motif or Z'Z'Z' motifs as wing modifications at the
opposite end of the duplex region; and X'X'X' and Z'Z'Z' each
independently represents a 2'-OMe modification or 2'-F
modification. The sense strand represented by any one of the above
formulas (Ia), (Ib), (Ic), and (Id) forms a duplex with a antisense
strand being represented by any one of formulas (IIa), (IIb),
(IIc), and (IId), respectively.
[0320] Accordingly, the RNAi agents for use in the methods of the
invention may comprise a sense strand and an antisense strand, each
strand having 14 to 30 nucleotides, the RNAi duplex represented by
formula (III):
TABLE-US-00007 (III) sense: 5'
n.sub.p-N.sub.a-(XXX).sub.i-N.sub.b-YYY-N.sub.b-(ZZZ).sub.j-N.sub.a-n.s-
ub.q 3' antisense: 3'
n.sub.p.sup.'-N.sub.a.sup.'-(X'X'X').sub.k-N.sub.b.sup.'-Y'Y'Y'-N.sub.b-
.sup.'-(Z'Z'Z').sub.l-N.sub.a.sup.'-n.sub.q.sup.'
[0321] wherein:
[0322] i, j, k, and 1 are each independently 0 or 1;
[0323] p, p', q, and q' are each independently 0-6;
each N.sub.a and N.sub.a' independently represents an
oligonucleotide sequence comprising 0-25 modified nucleotides, each
sequence comprising at least two differently modified nucleotides;
each N.sub.b and N.sub.b' independently represents an
oligonucleotide sequence comprising 0-10 modified nucleotides;
wherein each n.sub.p', n.sub.p, n.sub.q', and n.sub.q, each of
which may or may not be present, independently represents an
overhang nucleotide; and XXX, YYY, ZZZ, X'X'X', Y'Y'Y', and Z'Z'Z'
each independently represent one motif of three identical
modifications on three consecutive nucleotides.
[0324] In one embodiment, i is 0 and j is 0; or i is 1 and j is 0;
or i is 0 and j is 1; or both i and j are 0; or both i and j are 1.
In another embodiment, k is 0 and 1 is 0; or k is 1 and 1 is 0; k
is 0 and 1 is 1; or both k and 1 are 0; or both k and 1 are 1.
[0325] Exemplary combinations of the sense strand and antisense
strand forming a RNAi duplex include the formulas below:
TABLE-US-00008 (IIIa) 5' n.sub.p-N.sub.a-Y Y Y-N.sub.a-n.sub.q 3'
3' n.sub.p.sup.'-N.sub.a.sup.'-Y'Y'Y-N.sub.a.sup.'n.sub.q.sup.' 5'
(IIb) 5' n.sub.p-N.sub.a-YYY-N.sub.b-ZZZ-N.sub.a-n.sub.q 3' 3'
n.sub.p.sup.'-N.sub.a.sup.'-Y'Y'Y'-N.sub.b.sup.'-Z'Z'Z'-N.sub.a.sup.'n-
.sub.q.sup.' 5' (IIIc) 5'
n.sub.p-N.sub.a-XXX-N.sub.b-YYY-N.sub.a-n.sub.q 3' 3'
n.sub.p.sup.'-N.sub.a.sup.'-X'X'X'-N.sub.b.sup.'-Y'Y'Y'-N.sub.a'-n.sub-
.q.sup.' 5' (IId) 5'
n.sub.p-N.sub.a-XXX-N.sub.b-YYY-N.sub.b-ZZZ-N.sub.a-n.sub.q 3' 3'
n.sub.p.sup.'-N.sub.a.sup.'-X'X'X'-N.sub.b.sup.'-Y'Y'Y'-N.sub.b.sup.'--
Z'Z'Z'-N.sub.a-n.sub.q.sup.' 5'
[0326] When the RNAi agent is represented by formula (IIIa), each
N.sub.a independently represents an oligonucleotide sequence
comprising 2-20, 2-15, or 2-10 modified nucleotides.
[0327] When the RNAi agent is represented by formula (IIIb), each
N.sub.b independently represents an oligonucleotide sequence
comprising 1-10, 1-7, 1-5 or 1-4 modified nucleotides. Each N.sub.a
independently represents an oligonucleotide sequence comprising
2-20, 2-15, or 2-10 modified nucleotides.
[0328] When the RNAi agent is represented as formula (IIIc), each
N.sub.b, N.sub.b' independently represents an oligonucleotide
sequence comprising 0-10, 0-7, 0-10, 0-7, 0-5, 0-4, 0-2 or 0
modified nucleotides. Each N.sub.a independently represents an
oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified
nucleotides.
[0329] When the RNAi agent is represented as formula (IIId), each
N.sub.b, N.sub.b' independently represents an oligonucleotide
sequence comprising 0-10, 0-7, 0-10, 0-7, 0-5, 0-4, 0-2 or 0
modified nucleotides.
Each N.sub.a, N.sub.a' independently represents an oligonucleotide
sequence comprising 2-20, 2-15, or 2-10 modified nucleotides. Each
of N.sub.a, N.sub.a', N.sub.b and N.sub.b' independently comprises
modifications of alternating pattern. Each of X, Y and Z in
formulas (III), (IIIa), (IIIb), (IIIc), and (IIId) may be the same
or different from each other.
[0330] When the RNAi agent is represented by formula (III), (IIIa),
(IIIb), (IIIc), and (IIId), at least one of the Y nucleotides may
form a base pair with one of the Y' nucleotides. Alternatively, at
least two of the Y nucleotides form base pairs with the
corresponding Y' nucleotides; or all three of the Y nucleotides all
form base pairs with the corresponding Y' nucleotides.
[0331] When the RNAi agent is represented by formula (IIIb) or
(IIId), at least one of the Z nucleotides may form a base pair with
one of the Z' nucleotides. Alternatively, at least two of the Z
nucleotides form base pairs with the corresponding Z' nucleotides;
or all three of the Z nucleotides all form base pairs with the
corresponding Z' nucleotides.
[0332] When the RNAi agent is represented as formula (IIIc) or
(IIId), at least one of the X nucleotides may form a base pair with
one of the X' nucleotides. Alternatively, at least two of the X
nucleotides form base pairs with the corresponding X' nucleotides;
or all three of the X nucleotides all form base pairs with the
corresponding X' nucleotides.
[0333] In one embodiment, the modification on the Y nucleotide is
different than the modification on the Y' nucleotide, the
modification on the Z nucleotide is different than the modification
on the Z' nucleotide, and/or the modification on the X nucleotide
is different than the modification on the X' nucleotide.
[0334] In one embodiment, when the RNAi agent is represented by
formula (IIId), the N.sub.a modifications are 2'-O-methyl or
2'-fluoro modifications. In another embodiment, when the RNAi agent
is represented by formula (IIId), the N.sub.a modifications are
2'-O-methyl or 2'-fluoro modifications and n.sub.p'>0 and at
least one n.sub.p' is linked to a neighboring nucleotide a via
phosphorothioate linkage. In yet another embodiment, when the RNAi
agent is represented by formula (IIId), the N.sub.a modifications
are 2'-O-methyl or 2'-fluoro modifications, n.sub.p'>0 and at
least one n.sub.p' is linked to a neighboring nucleotide via
phosphorothioate linkage, and the sense strand is conjugated to one
or more GalNAc derivatives attached through a bivalent or trivalent
branched linker (described below). In another embodiment, when the
RNAi agent is represented by formula (IIId), the N.sub.a
modifications are 2'-O-methyl or 2'-fluoro modifications,
n.sub.p'>0 and at least one n.sub.p' is linked to a neighboring
nucleotide via phosphorothioate linkage, the sense strand comprises
at least one phosphorothioate linkage, and the sense strand is
conjugated to one or more GalNAc derivatives attached through a
bivalent or trivalent branched linker.
[0335] In one embodiment, when the RNAi agent is represented by
formula (IIIa), the N.sub.a modifications are 2'-O-methyl or
2'-fluoro modifications, n.sub.p'>0 and at least one n.sub.p' is
linked to a neighboring nucleotide via phosphorothioate linkage,
the sense strand comprises at least one phosphorothioate linkage,
and the sense strand is conjugated to one or more GalNAc
derivatives attached through a bivalent or trivalent branched
linker.
[0336] In one embodiment, the RNAi agent is a multimer containing
at least two duplexes represented by formula (III), (IIIa), (IIIb),
(IIIc), and (IIId), wherein the duplexes are connected by a linker.
The linker can be cleavable or non-cleavable. Optionally, the
multimer further comprises a ligand. Each of the duplexes can
target the same gene or two different genes; or each of the
duplexes can target same gene at two different target sites.
[0337] In one embodiment, the RNAi agent is a multimer containing
three, four, five, six or more duplexes represented by formula
(III), (IIIa), (IIIb), (IIIc), and (IIId), wherein the duplexes are
connected by a linker. The linker can be cleavable or
non-cleavable. Optionally, the multimer further comprises a ligand.
Each of the duplexes can target the same gene or two different
genes; or each of the duplexes can target same gene at two
different target sites.
[0338] In one embodiment, two RNAi agents represented by formula
(III), (IIIa), (IIIb), (IIIc), and (IIId) are linked to each other
at the 5' end, and one or both of the 3' ends and are optionally
conjugated to a ligand. Each of the agents can target the same gene
or two different genes; or each of the agents can target same gene
at two different target sites.
[0339] Various publications describe multimeric RNAi agents that
can be used in the methods of the invention. Such publications
include WO2007/091269, U.S. Pat. No. 7,858,769, WO2010/141511,
WO2007/117686, WO2009/014887 and WO2011/031520 the entire contents
of each of which are hereby incorporated herein by reference.
[0340] As described in more detail below, the RNAi agent that
contains conjugations of one or more carbohydrate moieties to a
RNAi agent can optimize one or more properties of the RNAi agent.
In many cases, the carbohydrate moiety will be attached to a
modified subunit of the RNAi agent. For example, the ribose sugar
of one or more ribonucleotide subunits of a dsRNA agent can be
replaced with another moiety, e.g., a non-carbohydrate (preferably
cyclic) carrier to which is attached a carbohydrate ligand. A
ribonucleotide subunit in which the ribose sugar of the subunit has
been so replaced is referred to herein as a ribose replacement
modification subunit (RRMS). A cyclic carrier may be a carbocyclic
ring system, i.e., all ring atoms are carbon atoms, or a
heterocyclic ring system, i.e., one or more ring atoms may be a
heteroatom, e.g., nitrogen, oxygen, sulfur. The cyclic carrier may
be a monocyclic ring system, or may contain two or more rings, e.g.
fused rings. The cyclic carrier may be a fully saturated ring
system, or it may contain one or more double bonds.
[0341] The ligand may be attached to the polynucleotide via a
carrier. The carriers include (i) at least one "backbone attachment
point," preferably two "backbone attachment points" and (ii) at
least one "tethering attachment point." A "backbone attachment
point" as used herein refers to a functional group, e.g. a hydroxyl
group, or generally, a bond available for, and that is suitable for
incorporation of the carrier into the backbone, e.g., the
phosphate, or modified phosphate, e.g., sulfur containing,
backbone, of a ribonucleic acid. A "tethering attachment point"
(TAP) in some embodiments refers to a constituent ring atom of the
cyclic carrier, e.g., a carbon atom or a heteroatom (distinct from
an atom which provides a backbone attachment point), that connects
a selected moiety. The moiety can be, e.g., a carbohydrate, e.g.
monosaccharide, disaccharide, trisaccharide, tetrasaccharide,
oligosaccharide and polysaccharide. Optionally, the selected moiety
is connected by an intervening tether to the cyclic carrier. Thus,
the cyclic carrier will often include a functional group, e.g., an
amino group, or generally, provide a bond, that is suitable for
incorporation or tethering of another chemical entity, e.g., a
ligand to the constituent ring.
[0342] The RNAi agents may be conjugated to a ligand via a carrier,
wherein the carrier can be cyclic group or acyclic group;
preferably, the cyclic group is selected from pyrrolidinyl,
pyrazolinyl, pyrazolidinyl, imidazolinyl, imidazolidinyl,
piperidinyl, piperazinyl, [1,3]dioxolane, oxazolidinyl,
isoxazolidinyl, morpholinyl, thiazolidinyl, isothiazolidinyl,
quinoxalinyl, pyridazinonyl, tetrahydrofuryl and decalin;
preferably, the acyclic group is selected from serinol backbone or
diethanolamine backbone.
[0343] In certain specific embodiments, the RNAi agent for use in
the methods of the invention is an agent selected from the group of
agents listed in any one of Tables 3, 4, 5, 6, 18, 19, 20, 21, and
23. These agents may further comprise a ligand.
IV. iRNAs Conjugated to Ligands
[0344] Another modification of the RNA of an iRNA suitable for use
in the methods of the invention involves chemically linking to the
RNA one or more ligands, moieties or conjugates that enhance the
activity, cellular distribution or cellular uptake of the iRNA.
Such moieties include but are not limited to lipid moieties such as
a cholesterol moiety (Letsinger et al., Proc. Natl. Acid. Sci. USA,
1989, 86: 6553-6556), cholic acid (Manoharan et al., Biorg. Med.
Chem. Let., 1994, 4:1053-1060), a thioether, e.g.,
beryl-S-tritylthiol (Manoharan et al., Ann. N.Y. Acad. Sci., 1992,
660:306-309; Manoharan et al., Biorg. Med. Chem. Let., 1993,
3:2765-2770), a thiocholesterol (Oberhauser et al., Nucl. Acids
Res., 1992, 20:533-538), an aliphatic chain, e.g., dodecandiol or
undecyl residues (Saison-Behmoaras et al., EMBO J, 1991,
10:1111-1118; Kabanov et al., FEBS Lett., 1990, 259:327-330;
Svinarchuk et al., Biochimie, 1993, 75:49-54), a phospholipid,
e.g., di-hexadecyl-rac-glycerol or triethyl-ammonium
1,2-di-O-hexadecyl-rac-glycero-3-phosphonate (Manoharan et al.,
Tetrahedron Lett., 1995, 36:3651-3654; Shea et al., Nucl. Acids
Res., 1990, 18:3777-3783), a polyamine or a polyethylene glycol
chain (Manoharan et al., Nucleosides & Nucleotides, 1995,
14:969-973), or adamantane acetic acid (Manoharan et al.,
Tetrahedron Lett., 1995, 36:3651-3654), a palmityl moiety (Mishra
et al., Biochim. Biophys. Acta, 1995, 1264:229-237), or an
octadecylamine or hexylamino-carbonyloxycholesterol moiety (Crooke
et al., J. Pharmacol. Exp. Ther., 1996, 277:923-937).
[0345] In one embodiment, a ligand alters the distribution,
targeting or lifetime of an iRNA agent into which it is
incorporated. In preferred embodiments a ligand provides an
enhanced affinity for a selected target, e.g., molecule, cell or
cell type, compartment, e.g., a cellular or organ compartment,
tissue, organ or region of the body, as, e.g., compared to a
species absent such a ligand. Preferred ligands will not take part
in duplex pairing in a duplexed nucleic acid.
[0346] Ligands can include a naturally occurring substance, such as
a protein (e.g., human serum albumin (HSA), low-density lipoprotein
(LDL), or globulin); carbohydrate (e.g., a dextran, pullulan,
chitin, chitosan, inulin, cyclodextrin, N-acetylgalactosamine, or
hyaluronic acid); or a lipid. The ligand can also be a recombinant
or synthetic molecule, such as a synthetic polymer, e.g., a
synthetic polyamino acid. Examples of polyamino acids include
polyamino acid is a polylysine (PLL), poly L-aspartic acid, poly
L-glutamic acid, styrene-maleic acid anhydride copolymer,
poly(L-lactide-co-glycolide) copolymer, divinyl ether-maleic
anhydride copolymer, N-(2-hydroxypropyl)methacrylamide copolymer
(HMPA), polyethylene glycol (PEG), polyvinyl alcohol (PVA),
polyurethane, poly(2-ethylacrylic acid), N-isopropylacrylamide
polymers, or polyphosphazine. Example of polyamines include:
polyethylenimine, polylysine (PLL), spermine, spermidine,
polyamine, pseudopeptide-polyamine, peptidomimetic polyamine,
dendrimer polyamine, arginine, amidine, protamine, cationic lipid,
cationic porphyrin, quaternary salt of a polyamine, or an alpha
helical peptide.
[0347] Ligands can also include targeting groups, e.g., a cell or
tissue targeting agent, e.g., a lectin, glycoprotein, lipid or
protein, e.g., an antibody, that binds to a specified cell type
such as a kidney cell. A targeting group can be a thyrotropin,
melanotropin, lectin, glycoprotein, surfactant protein A, Mucin
carbohydrate, multivalent lactose, monovalent or multivalent
galactose, N-acetyl-galactosamine, N-acetyl-glucosamine multivalent
mannose, multivalent fucose, glycosylated polyaminoacids,
transferrin, bisphosphonate, polyglutamate, polyaspartate, a lipid,
cholesterol, a steroid, bile acid, folate, vitamin B12, vitamin A,
biotin, or an RGD peptide or RGD peptide mimetic. In certain
embodiments, ligands include monovalent or multivalent galactose.
In certain embodiments, ligands include cholesterol.
[0348] Other examples of ligands include dyes, intercalating agents
(e.g. acridines), cross-linkers (e.g. psoralen, mitomycin C),
porphyrins (TPPC4, texaphyrin, Sapphyrin), polycyclic aromatic
hydrocarbons (e.g., phenazine, dihydrophenazine), artificial
endonucleases (e.g. EDTA), lipophilic molecules, e.g., cholesterol,
cholic acid, adamantane acetic acid, 1-pyrene butyric acid,
dihydrotestosterone, 1,3-Bis-O(hexadecyl)glycerol, geranyloxyhexyl
group, hexadecylglycerol, borneol, menthol, 1,3-propanediol,
heptadecyl group, palmitic acid, myristic acid,
O3-(oleoyl)lithocholic acid, O3-(oleoyl)cholenic acid,
dimethoxytrityl, or phenoxazine) and peptide conjugates (e.g.,
antennapedia peptide, Tat peptide), alkylating agents, phosphate,
amino, mercapto, PEG (e.g., PEG-40K), MPEG, [MPEG].sub.2,
polyamino, alkyl, substituted alkyl, radiolabeled markers, enzymes,
haptens (e.g. biotin), transport/absorption facilitators (e.g.,
aspirin, vitamin E, folic acid), synthetic ribonucleases (e.g.,
imidazole, bisimidazole, histamine, imidazole clusters,
acridine-imidazole conjugates, Eu3+ complexes of
tetraazamacrocycles), dinitrophenyl, HRP, or AP.
[0349] Ligands can be proteins, e.g., glycoproteins, or peptides,
e.g., molecules having a specific affinity for a co-ligand, or
antibodies e.g., an antibody, that binds to a specified cell type
such as a hepatic cell. Ligands can also include hormones and
hormone receptors. They can also include non-peptidic species, such
as lipids, lectins, carbohydrates, vitamins, cofactors, multivalent
lactose, multivalent galactose, N-acetyl-galactosamine,
N-acetyl-glucosamine multivalent mannose, or multivalent fucose.
The ligand can be, for example, a lipopolysaccharide, an activator
of p38 MAP kinase, or an activator of NF-.kappa.B.
[0350] The ligand can be a substance, e.g., a drug, which can
increase the uptake of the iRNA agent into the cell, for example,
by disrupting the cell's cytoskeleton, e.g., by disrupting the
cell's microtubules, microfilaments, and/or intermediate filaments.
The drug can be, for example, taxon, vincristine, vinblastine,
cytochalasin, nocodazole, jasplakinolide, latrunculin A,
phalloidin, swinholide A, indanocine, or myoservin.
[0351] In some embodiments, a ligand attached to an iRNA as
described herein acts as a pharmacokinetic modulator (PK
modulator). PK modulators include lipophiles, bile acids, steroids,
phospholipid analogues, peptides, protein binding agents, PEG,
vitamins etc. Exemplary PK modulators include, but are not limited
to, cholesterol, fatty acids, cholic acid, lithocholic acid,
dialkylglycerides, diacylglyceride, phospholipids, sphingolipids,
naproxen, ibuprofen, vitamin E, biotin etc. Oligonucleotides that
comprise a number of phosphorothioate linkages are also known to
bind to serum protein, thus short oligonucleotides, e.g.,
oligonucleotides of about 5 bases, 10 bases, 15 bases or 20 bases,
comprising multiple of phosphorothioate linkages in the backbone
are also amenable to the present invention as ligands (e.g. as PK
modulating ligands). In addition, aptamers that bind serum
components (e.g. serum proteins) are also suitable for use as PK
modulating ligands in the embodiments described herein.
[0352] Ligand-conjugated oligonucleotides of the invention may be
synthesized by the use of an oligonucleotide that bears a pendant
reactive functionality, such as that derived from the attachment of
a linking molecule onto the oligonucleotide (described below). This
reactive oligonucleotide may be reacted directly with
commercially-available ligands, ligands that are synthesized
bearing any of a variety of protecting groups, or ligands that have
a linking moiety attached thereto.
[0353] The oligonucleotides used in the conjugates of the present
invention may be conveniently and routinely made through the
well-known technique of solid-phase synthesis. Equipment for such
synthesis is sold by several vendors including, for example,
Applied Biosystems (Foster City, Calif.). Any other means for such
synthesis known in the art may additionally or alternatively be
employed. It is also known to use similar techniques to prepare
other oligonucleotides, such as the phosphorothioates and alkylated
derivatives.
[0354] In the ligand-conjugated oligonucleotides and
ligand-molecule bearing sequence-specific linked nucleosides of the
present invention, the oligonucleotides and oligonucleosides may be
assembled on a suitable DNA synthesizer utilizing standard
nucleotide or nucleoside precursors, or nucleotide or nucleoside
conjugate precursors that already bear the linking moiety,
ligand-nucleotide or nucleoside-conjugate precursors that already
bear the ligand molecule, or non-nucleoside ligand-bearing building
blocks.
[0355] When using nucleotide-conjugate precursors that already bear
a linking moiety, the synthesis of the sequence-specific linked
nucleosides is typically completed, and the ligand molecule is then
reacted with the linking moiety to form the ligand-conjugated
oligonucleotide. In some embodiments, the oligonucleotides or
linked nucleosides of the present invention are synthesized by an
automated synthesizer using phosphoramidites derived from
ligand-nucleoside conjugates in addition to the standard
phosphoramidites and non-standard phosphoramidites that are
commercially available and routinely used in oligonucleotide
synthesis.
[0356] A. Lipid Conjugates
[0357] In one embodiment, the ligand or conjugate is a lipid or
lipid-based molecule. Such a lipid or lipid-based molecule
preferably binds a serum protein, e.g., human serum albumin (HSA).
An HSA binding ligand allows for distribution of the conjugate to a
target tissue, e.g., a non-kidney target tissue of the body. For
example, the target tissue can be the liver, including parenchymal
cells of the liver. Other molecules that can bind HSA can also be
used as ligands. For example, naproxen or aspirin can be used. A
lipid or lipid-based ligand can (a) increase resistance to
degradation of the conjugate, (b) increase targeting or transport
into a target cell or cell membrane, and/or (c) can be used to
adjust binding to a serum protein, e.g., HSA.
[0358] A lipid based ligand can be used to inhibit, e.g., control
the binding of the conjugate to a target tissue. For example, a
lipid or lipid-based ligand that binds to HSA more strongly will be
less likely to be targeted to the kidney and therefore less likely
to be cleared from the body. A lipid or lipid-based ligand that
binds to HSA less strongly can be used to target the conjugate to
the kidney.
[0359] In a preferred embodiment, the lipid based ligand binds HSA.
Preferably, it binds HSA with a sufficient affinity such that the
conjugate will be preferably distributed to a non-kidney tissue.
However, it is preferred that the affinity not be so strong that
the HSA-ligand binding cannot be reversed.
[0360] In another preferred embodiment, the lipid based ligand
binds HSA weakly or not at all, such that the conjugate will be
preferably distributed to the kidney. Other moieties that target to
kidney cells can also be used in place of or in addition to the
lipid based ligand.
[0361] In another aspect, the ligand is a moiety, e.g., a vitamin,
which is taken up by a target cell, e.g., a proliferating cell.
These are particularly useful for treating disorders characterized
by unwanted cell proliferation, e.g., of the malignant or
non-malignant type, e.g., cancer cells. Exemplary vitamins include
vitamin A, E, and K. Other exemplary vitamins include are B
vitamin, e.g., folic acid, B12, riboflavin, biotin, pyridoxal or
other vitamins or nutrients taken up by target cells such as liver
cells. Also included are HSA and low density lipoprotein (LDL).
[0362] B. Cell Permeation Agents
[0363] In another aspect, the ligand is a cell-permeation agent,
preferably a helical cell-permeation agent. Preferably, the agent
is amphipathic. An exemplary agent is a peptide such as tat or
antennopedia. If the agent is a peptide, it can be modified,
including a peptidylmimetic, invertomers, non-peptide or
pseudo-peptide linkages, and use of D-amino acids. The helical
agent is preferably an alpha-helical agent, which preferably has a
lipophilic and a lipophobic phase.
[0364] The ligand can be a peptide or peptidomimetic. A
peptidomimetic (also referred to herein as an oligopeptidomimetic)
is a molecule capable of folding into a defined three-dimensional
structure similar to a natural peptide. The attachment of peptide
and peptidomimetics to iRNA agents can affect pharmacokinetic
distribution of the iRNA, such as by enhancing cellular recognition
and absorption. The peptide or peptidomimetic moiety can be about
5-50 amino acids long, e.g., about 5, 10, 15, 20, 25, 30, 35, 40,
45, or 50 amino acids long.
[0365] A peptide or peptidomimetic can be, for example, a cell
permeation peptide, cationic peptide, amphipathic peptide, or
hydrophobic peptide (e.g., consisting primarily of Tyr, Trp or
Phe). The peptide moiety can be a dendrimer peptide, constrained
peptide or crosslinked peptide. In another alternative, the peptide
moiety can include a hydrophobic membrane translocation sequence
(MTS). An exemplary hydrophobic MTS-containing peptide is RFGF
having the amino acid sequence AAVALLPAVLLALLAP (SEQ ID NO: 3). An
RFGF analogue (e.g., amino acid sequence AALLPVLLAAP (SEQ ID NO: 4)
containing a hydrophobic MTS can also be a targeting moiety. The
peptide moiety can be a "delivery" peptide, which can carry large
polar molecules including peptides, oligonucleotides, and protein
across cell membranes. For example, sequences from the HIV Tat
protein (GRKKRRQRRRPPQ (SEQ ID NO: 5) and the Drosophila
Antennapedia protein (RQIKIWFQNRRMKWKK (SEQ ID NO: 6) have been
found to be capable of functioning as delivery peptides. A peptide
or peptidomimetic can be encoded by a random sequence of DNA, such
as a peptide identified from a phage-display library, or
one-bead-one-compound (OBOC) combinatorial library (Lam et al.,
Nature, 354:82-84, 1991). Examples of a peptide or peptidomimetic
tethered to a dsRNA agent via an incorporated monomer unit for cell
targeting purposes is an arginine-glycine-aspartic acid
(RGD)-peptide, or RGD mimic. A peptide moiety can range in length
from about 5 amino acids to about 40 amino acids. The peptide
moieties can have a structural modification, such as to increase
stability or direct conformational properties. Any of the
structural modifications described below can be utilized.
[0366] An RGD peptide for use in the compositions and methods of
the invention may be linear or cyclic, and may be modified, e.g.,
glycosylated or methylated, to facilitate targeting to a specific
tissue(s). RGD-containing peptides and peptidiomimemtics may
include D-amino acids, as well as synthetic RGD mimics. In addition
to RGD, one can use other moieties that target the integrin ligand.
Preferred conjugates of this ligand target PECAM-1 or VEGF.
[0367] A "cell permeation peptide" is capable of permeating a cell,
e.g., a microbial cell, such as a bacterial or fungal cell, or a
mammalian cell, such as a human cell. A microbial cell-permeating
peptide can be, for example, a .alpha.-helical linear peptide
(e.g., LL-37 or Ceropin P1), a disulfide bond-containing peptide
(e.g., .alpha.-defensin, .beta.-defensin or bactenecin), or a
peptide containing only one or two dominating amino acids (e.g.,
PR-39 or indolicidin). A cell permeation peptide can also include a
nuclear localization signal (NLS). For example, a cell permeation
peptide can be a bipartite amphipathic peptide, such as MPG, which
is derived from the fusion peptide domain of HIV-1 gp41 and the NLS
of SV40 large T antigen (Simeoni et al., Nucl. Acids Res.
31:2717-2724, 2003).
[0368] C. Carbohydrate Conjugates
[0369] In some embodiments of the compositions and methods of the
invention, an iRNA oligonucleotide further comprises a
carbohydrate. The carbohydrate conjugated iRNA are advantageous for
the in vivo delivery of nucleic acids, as well as compositions
suitable for in vivo therapeutic use, as described herein. As used
herein, "carbohydrate" refers to a compound which is either a
carbohydrate per se made up of one or more monosaccharide units
having at least 6 carbon atoms (which can be linear, branched or
cyclic) with an oxygen, nitrogen or sulfur atom bonded to each
carbon atom; or a compound having as a part thereof a carbohydrate
moiety made up of one or more monosaccharide units each having at
least six carbon atoms (which can be linear, branched or cyclic),
with an oxygen, nitrogen or sulfur atom bonded to each carbon atom.
Representative carbohydrates include the sugars (mono-, di-, tri-
and oligosaccharides containing from about 4, 5, 6, 7, 8, or 9
monosaccharide units), and polysaccharides such as starches,
glycogen, cellulose and polysaccharide gums. Specific
monosaccharides include C5 and above (e.g., C5, C6, C7, or C8)
sugars; di- and trisaccharides include sugars having two or three
monosaccharide units (e.g., C5, C6, C7, or C8).
[0370] In one embodiment, a carbohydrate conjugate for use in the
compositions and methods of the invention is a monosaccharide. In
another embodiment, a carbohydrate conjugate for use in the
compositions and methods of the invention is selected from the
group consisting of:
##STR00003## ##STR00004## ##STR00005## ##STR00006##
[0371] In one embodiment, the monosaccharide is an
N-acetylgalactosamine, such as
##STR00007##
[0372] Another representative carbohydrate conjugate for use in the
embodiments described herein includes, but is not limited to,
##STR00008##
[0373] (Formula XXIII), when one of X or Y is an oligonucleotide,
the other is a hydrogen.
[0374] In certain embodiments of the invention, the GalNAc or
GalNAc derivative is attached to an iRNA agent of the invention via
a monovalent linker. In some embodiments, the GalNAc or GalNAc
derivative is attached to an iRNA agent of the invention via a
bivalent linker. In yet other embodiments of the invention, the
GalNAc or GalNAc derivative is attached to an iRNA agent of the
invention via a trivalent linker.
[0375] In one embodiment, the double stranded RNAi agents of the
invention comprise one GalNAc or GalNAc derivative attached to the
iRNA agent. In another embodiment, the double stranded RNAi agents
of the invention comprise a plurality (e.g., 2, 3, 4, 5, or 6)
GalNAc or GalNAc derivatives, each independently attached to a
plurality of nucleotides of the double stranded RNAi agent through
a plurality of monovalent linkers.
[0376] In some embodiments, for example, when the two strands of an
iRNA agent of the invention are part of one larger molecule
connected by an uninterrupted chain of nucleotides between the
3'-end of one strand and the 5'-end of the respective other strand
forming a hairpin loop comprising, a plurality of unpaired
nucleotides, each unpaired nucleotide within the hairpin loop may
independently comprise a GalNAc or GalNAc derivative attached via a
monovalent linker. The hairpin loop may also be formed by an
extended overhang in one strand of the duplex.
[0377] In some embodiments, the carbohydrate conjugate further
comprises one or more additional ligands as described above, such
as, but not limited to, a PK modulator and/or a cell permeation
peptide.
[0378] Additional carbohydrate conjugates suitable for use in the
present invention include those described in PCT Publication Nos.
WO 2014/179620 and WO 2014/179627, the entire contents of each of
which are incorporated herein by reference.
[0379] D. Linkers
[0380] In some embodiments, the conjugate or ligand described
herein can be attached to an iRNA oligonucleotide with various
linkers that can be cleavable or non-cleavable.
[0381] The term "linker" or "linking group" means an organic moiety
that connects two parts of a compound, e.g., covalently attaches
two parts of a compound. Linkers typically comprise a direct bond
or an atom such as oxygen or sulfur, a unit such as NRB, C(O),
C(O)NH, SO, SO.sub.2, SO.sub.2NH or a chain of atoms, such as, but
not limited to, substituted or unsubstituted alkyl, substituted or
unsubstituted alkenyl, substituted or unsubstituted alkynyl,
arylalkyl, arylalkenyl, arylalkynyl, heteroarylalkyl,
heteroarylalkenyl, heteroarylalkynyl, heterocyclylalkyl,
heterocyclylalkenyl, heterocyclylalkynyl, aryl, heteroaryl,
heterocyclyl, cycloalkyl, cycloalkenyl, alkylarylalkyl,
alkylarylalkenyl, alkylarylalkynyl, alkenylarylalkyl,
alkenylarylalkenyl, alkenylarylalkynyl, alkynylarylalkyl,
alkynylarylalkenyl, alkynylarylalkynyl, alkylheteroarylalkyl,
alkylheteroarylalkenyl, alkylheteroarylalkynyl,
alkenylheteroarylalkyl, alkenylheteroarylalkenyl,
alkenylheteroarylalkynyl, alkynylheteroarylalkyl,
alkynylheteroarylalkenyl, alkynylheteroarylalkynyl,
alkylheterocyclylalkyl, alkylheterocyclylalkenyl,
alkylhererocyclylalkynyl, alkenylheterocyclylalkyl,
alkenylheterocyclylalkenyl, alkenylheterocyclylalkynyl,
alkynylheterocyclylalkyl, alkynylheterocyclylalkenyl,
alkynylheterocyclylalkynyl, alkylaryl, alkenylaryl, alkynylaryl,
alkylheteroaryl, alkenylheteroaryl, alkynylhereroaryl, which one or
more methylenes can be interrupted or terminated by O, S, S(O),
SO.sub.2, N(8), C(O), substituted or unsubstituted aryl,
substituted or unsubstituted heteroaryl, substituted or
unsubstituted heterocyclic; where R8 is hydrogen, acyl, aliphatic
or substituted aliphatic. In one embodiment, the linker is between
about 1-24 atoms, 2-24, 3-24, 4-24, 5-24, 6-24, 6-18, 7-18, 8-18
atoms, 7-17, 8-17, 6-16, 7-16, or 8-16 atoms.
[0382] A cleavable linking group is one which is sufficiently
stable outside the cell, but which upon entry into a target cell is
cleaved to release the two parts the linker is holding together. In
a preferred embodiment, the cleavable linking group is cleaved at
least about 10 times, 20, times, 30 times, 40 times, 50 times, 60
times, 70 times, 80 times, 90 times or more, or at least about 100
times faster in a target cell or under a first reference condition
(which can, e.g., be selected to mimic or represent intracellular
conditions) than in the blood of a subject, or under a second
reference condition (which can, e.g., be selected to mimic or
represent conditions found in the blood or serum).
[0383] Cleavable linking groups are susceptible to cleavage agents,
e.g., pH, redox potential or the presence of degradative molecules.
Generally, cleavage agents are more prevalent or found at higher
levels or activities inside cells than in serum or blood. Examples
of such degradative agents include: redox agents which are selected
for particular substrates or which have no substrate specificity,
including, e.g., oxidative or reductive enzymes or reductive agents
such as mercaptans, present in cells, that can degrade a redox
cleavable linking group by reduction; esterases; endosomes or
agents that can create an acidic environment, e.g., those that
result in a pH of five or lower; enzymes that can hydrolyze or
degrade an acid cleavable linking group by acting as a general
acid, peptidases (which can be substrate specific), and
phosphatases.
[0384] A cleavable linkage group, such as a disulfide bond can be
susceptible to pH. The pH of human serum is 7.4, while the average
intracellular pH is slightly lower, ranging from about 7.1-7.3.
Endosomes have a more acidic pH, in the range of 5.5-6.0, and
lysosomes have an even more acidic pH at around 5.0. Some linkers
will have a cleavable linking group that is cleaved at a preferred
pH, thereby releasing a cationic lipid from the ligand inside the
cell, or into the desired compartment of the cell.
[0385] A linker can include a cleavable linking group that is
cleavable by a particular enzyme. The type of cleavable linking
group incorporated into a linker can depend on the cell to be
targeted. For example, a liver-targeting ligand can be linked to a
cationic lipid through a linker that includes an ester group. Liver
cells are rich in esterases, and therefore the linker will be
cleaved more efficiently in liver cells than in cell types that are
not esterase-rich. Other cell-types rich in esterases include cells
of the lung, renal cortex, and testis.
[0386] Linkers that contain peptide bonds can be used when
targeting cell types rich in peptidases, such as liver cells and
synoviocytes.
[0387] In general, the suitability of a candidate cleavable linking
group can be evaluated by testing the ability of a degradative
agent (or condition) to cleave the candidate linking group. It will
also be desirable to also test the candidate cleavable linking
group for the ability to resist cleavage in the blood or when in
contact with other non-target tissue. Thus, one can determine the
relative susceptibility to cleavage between a first and a second
condition, where the first is selected to be indicative of cleavage
in a target cell and the second is selected to be indicative of
cleavage in other tissues or biological fluids, e.g., blood or
serum. The evaluations can be carried out in cell free systems, in
cells, in cell culture, in organ or tissue culture, or in whole
animals. It can be useful to make initial evaluations in cell-free
or culture conditions and to confirm by further evaluations in
whole animals. In preferred embodiments, useful candidate compounds
are cleaved at least about 2, 4, 10, 20, 30, 40, 50, 60, 70, 80,
90, or about 100 times faster in the cell (or under in vitro
conditions selected to mimic intracellular conditions) as compared
to blood or serum (or under in vitro conditions selected to mimic
extracellular conditions).
[0388] i. Redox Cleavable Linking Groups
[0389] In one embodiment, a cleavable linking group is a redox
cleavable linking group that is cleaved upon reduction or
oxidation. An example of reductively cleavable linking group is a
disulphide linking group (-S-S-). To determine if a candidate
cleavable linking group is a suitable "reductively cleavable
linking group," or for example is suitable for use with a
particular iRNA moiety and particular targeting agent one can look
to methods described herein. For example, a candidate can be
evaluated by incubation with dithiothreitol (DTT), or other
reducing agent using reagents know in the art, which mimic the rate
of cleavage which would be observed in a cell, e.g., a target cell.
The candidates can also be evaluated under conditions which are
selected to mimic blood or serum conditions. In one, candidate
compounds are cleaved by at most about 10% in the blood. In other
embodiments, useful candidate compounds are degraded at least about
2, 4, 10, 20, 30, 40, 50, 60, 70, 80, 90, or about 100 times faster
in the cell (or under in vitro conditions selected to mimic
intracellular conditions) as compared to blood (or under in vitro
conditions selected to mimic extracellular conditions). The rate of
cleavage of candidate compounds can be determined using standard
enzyme kinetics assays under conditions chosen to mimic
intracellular media and compared to conditions chosen to mimic
extracellular media.
[0390] ii. Phosphate-Based Cleavable Linking Groups
[0391] In another embodiment, a cleavable linker comprises a
phosphate-based cleavable linking group. A phosphate-based
cleavable linking group is cleaved by agents that degrade or
hydrolyze the phosphate group. An example of an agent that cleaves
phosphate groups in cells are enzymes such as phosphatases in
cells. Examples of phosphate-based linking groups are
--O--P(O)(ORk)-O--, --O--P(S)(ORk)-O--, --O--P(S)(SRk)-O--,
--S--P(O)(ORk)-O--, --O--P(O)(ORk)-S--, --S--P(O)(ORk)-S--,
--O--P(S)(ORk)-S--, --S--P(S)(ORk)-O--, --O--P(O)(Rk)-O--,
--O--P(S)(Rk)-O--, --S--P(O)(Rk)-O--, --S--P(S)(Rk)-O--,
--S--P(O)(Rk)-S--, --O--P(S)(Rk)-S--. Preferred embodiments are
--O--P(O)(OH)--O--, --O--P(S)(OH)--O--, --O--P(S)(SH)--O--,
--S--P(O)(OH)--O--, --O--P(O)(OH)--S--, --S--P(O)(OH)--S--,
--O--P(S)(OH)--S--, --S--P(S)(OH)--O--, --O--P(O)(H)--O--,
--O--P(S)(H)--O--, --S--P(O)(H)--O, --S--P(S)(H)--O--,
--S--P(O)(H)--S--, --O--P(S)(H)--S--. A preferred embodiment is
--O--P(O)(OH)--O--. These candidates can be evaluated using methods
analogous to those described above.
[0392] iii. Acid Cleavable Linking Groups
[0393] In another embodiment, a cleavable linker comprises an acid
cleavable linking group. An acid cleavable linking group is a
linking group that is cleaved under acidic conditions. In preferred
embodiments acid cleavable linking groups are cleaved in an acidic
environment with a pH of about 6.5 or lower (e.g., about 6.0, 5.75,
5.5, 5.25, 5.0, or lower), or by agents such as enzymes that can
act as a general acid. In a cell, specific low pH organelles, such
as endosomes and lysosomes can provide a cleaving environment for
acid cleavable linking groups. Examples of acid cleavable linking
groups include but are not limited to hydrazones, esters, and
esters of amino acids. Acid cleavable groups can have the general
formula --C.dbd.NN--, C(O)O, or --OC(O). A preferred embodiment is
when the carbon attached to the oxygen of the ester (the alkoxy
group) is an aryl group, substituted alkyl group, or tertiary alkyl
group such as dimethyl pentyl or t-butyl. These candidates can be
evaluated using methods analogous to those described above.
[0394] iv. Ester-Based Linking Groups
[0395] In another embodiment, a cleavable linker comprises an
ester-based cleavable linking group. An ester-based cleavable
linking group is cleaved by enzymes such as esterases and amidases
in cells. Examples of ester-based cleavable linking groups include
but are not limited to esters of alkylene, alkenylene and
alkynylene groups. Ester cleavable linking groups have the general
formula --C(O)O--, or --OC(O)--. These candidates can be evaluated
using methods analogous to those described above.
[0396] v. Peptide-Based Cleaving Groups
[0397] In yet another embodiment, a cleavable linker comprises a
peptide-based cleavable linking group. A peptide-based cleavable
linking group is cleaved by enzymes such as peptidases and
proteases in cells. Peptide-based cleavable linking groups are
peptide bonds formed between amino acids to yield oligopeptides
(e.g., dipeptides, tripeptides etc.) and polypeptides.
Peptide-based cleavable groups do not include the amide group
(--C(O)NH--). The amide group can be formed between any alkylene,
alkenylene or alkynylene. A peptide bond is a special type of amide
bond formed between amino acids to yield peptides and proteins. The
peptide based cleavage group is generally limited to the peptide
bond (i.e., the amide bond) formed between amino acids yielding
peptides and proteins and does not include the entire amide
functional group. Peptide-based cleavable linking groups have the
general formula --NHCHRAC(O)NHCHRBC(O)--, where RA and RB are the R
groups of the two adjacent amino acids. These candidates can be
evaluated using methods analogous to those described above.
[0398] In one embodiment, an iRNA of the invention is conjugated to
a carbohydrate through a linker. Non-limiting examples of iRNA
carbohydrate conjugates with linkers of the compositions and
methods of the invention include, but are not limited to,
##STR00009## ##STR00010## ##STR00011##
when one of X or Y is an oligonucleotide, the other is a
hydrogen.
[0399] In certain embodiments of the compositions and methods of
the invention, a ligand is one or more GalNAc
(N-acetylgalactosamine) derivatives attached through a bivalent or
trivalent branched linker.
[0400] In one embodiment, a dsRNA of the invention is conjugated to
a bivalent or trivalent branched linker selected from the group of
structures shown in any of formula (XXXII)-(XXXV):
##STR00012##
wherein: q2A, q2B, q3A, q3B, q4A, q4B, q5A, q5B and q5C represent
independently for each occurrence 0-20 and wherein the repeating
unit can be the same or different; P.sup.2A, P.sup.2B, P.sup.3A,
P.sup.3B, P.sup.4A, P.sup.4B, P.sup.5A, P.sup.5B, P.sup.5C,
T.sup.2A, T.sup.2B, T.sup.3A, T.sup.3B, T.sup.4A, T.sup.4B,
T.sup.4A, T.sup.5B, T.sup.5C, are each independently for each
occurrence absent, CO, NH, O, S, OC(O), NHC(O), CH.sub.2,
CH.sub.2NH or CH.sub.2O;
[0401] Q.sup.2A, Q.sup.2B, Q.sup.3A, Q.sup.3B, Q.sup.4A, Q.sup.4B,
Q.sup.5A, Q.sup.5B, Q.sup.5C are independently for each occurrence
absent, alkylene, substituted alkylene wherein one or more
methylenes can be interrupted or terminated by one or more of O, S,
S(O), SO.sub.2, N(R.sup.N), C(R').dbd.C(R''), CC or C(O); R.sup.2A,
R.sup.2B, R.sup.3A, R.sup.3B, R.sup.4A, R.sup.4B, R.sup.5A,
R.sup.5B, R.sup.5C are each independently for each occurrence
absent, NH, O, S, CH.sub.2, C(O)O, C(O)NH, NHCH(R.sup.a)C(O),
--C(O)--CH(R.sup.a)--NH--, CO, CH.dbd.N--O,
##STR00013##
or heterocyclyl;
[0402] L.sup.2A, L.sup.2B, L.sup.3A, L.sup.3B, L.sup.4A, L.sup.4B,
L.sup.5A, L.sup.5B and L.sup.5C represent the ligand; i.e. each
independently for each occurrence a monosaccharide (such as
GalNAc), disaccharide, trisaccharide, tetrasaccharide,
oligosaccharide, or polysaccharide; and R.sup.a is H or amino acid
side chain. Trivalent conjugating GalNAc derivatives are
particularly useful for use with RNAi agents for inhibiting the
expression of a target gene, such as those of formula (XXXVI):
##STR00014##
[0403] wherein L.sup.5A, L.sup.5B and L.sup.5C represent a
monosaccharide, such as GalNAc derivative.
[0404] Examples of suitable bivalent and trivalent branched linker
groups conjugating GalNAc derivatives include, but are not limited
to, the structures recited above as formulas II, VII, XI, X, and
XIII
[0405] Representative U.S. patents that teach the preparation of
RNA conjugates include, but are not limited to, U.S. Pat. Nos.
4,828,979; 4,948,882; 5,218,105; 5,525,465; 5,541,313; 5,545,730;
5,552,538; 5,578,717, 5,580,731; 5,591,584; 5,109,124; 5,118,802;
5,138,045; 5,414,077; 5,486,603; 5,512,439; 5,578,718; 5,608,046;
4,587,044; 4,605,735; 4,667,025; 4,762,779; 4,789,737; 4,824,941;
4,835,263; 4,876,335; 4,904,582; 4,958,013; 5,082,830; 5,112,963;
5,214,136; 5,082,830; 5,112,963; 5,214,136; 5,245,022; 5,254,469;
5,258,506; 5,262,536; 5,272,250; 5,292,873; 5,317,098; 5,371,241,
5,391,723; 5,416,203, 5,451,463; 5,510,475; 5,512,667; 5,514,785;
5,565,552; 5,567,810; 5,574,142; 5,585,481; 5,587,371; 5,595,726;
5,597,696; 5,599,923; 5,599,928 and 5,688,941; 6,294,664;
6,320,017; 6,576,752; 6,783,931; 6,900,297; 7,037,646; 8,106,022,
the entire contents of each of which are hereby incorporated herein
by reference.
[0406] It is not necessary for all positions in a given compound to
be uniformly modified, and in fact more than one of the
aforementioned modifications can be incorporated in a single
compound or even at a single nucleoside within an iRNA. The present
invention also includes iRNA compounds that are chimeric
compounds.
[0407] "Chimeric" iRNA compounds or "chimeras," in the context of
this invention, are iRNA compounds, preferably dsRNAs, which
contain two or more chemically distinct regions, each made up of at
least one monomer unit, i.e., a nucleotide in the case of a dsRNA
compound. These iRNAs typically contain at least one region wherein
the RNA is modified so as to confer upon the iRNA increased
resistance to nuclease degradation, increased cellular uptake,
and/or increased binding affinity for the target nucleic acid. An
additional region of the iRNA can serve as a substrate for enzymes
capable of cleaving RNA:DNA or RNA:RNA hybrids. By way of example,
RNase H is a cellular endonuclease which cleaves the RNA strand of
an RNA:DNA duplex. Activation of RNase H, therefore, results in
cleavage of the RNA target, thereby greatly enhancing the
efficiency of iRNA inhibition of gene expression. Consequently,
comparable results can often be obtained with shorter iRNAs when
chimeric dsRNAs are used, compared to phosphorothioate deoxy dsRNAs
hybridizing to the same target region. Cleavage of the RNA target
can be routinely detected by gel electrophoresis and, if necessary,
associated nucleic acid hybridization techniques known in the
art.
[0408] In certain instances, the RNA of an iRNA can be modified by
a non-ligand group. A number of non-ligand molecules have been
conjugated to iRNAs in order to enhance the activity, cellular
distribution or cellular uptake of the iRNA, and procedures for
performing such conjugations are available in the scientific
literature. Such non-ligand moieties have included lipid moieties,
such as cholesterol (Kubo, T. et al., Biochem. Biophys. Res. Comm.,
2007, 365(1):54-61; Letsinger et al., Proc. Natl. Acad. Sci. USA,
1989, 86:6553), cholic acid (Manoharan et al., Bioorg. Med. Chem.
Lett., 1994, 4:1053), a thioether, e.g., hexyl-S-tritylthiol
(Manoharan et al., Ann. N.Y. Acad. Sci., 1992, 660:306; Manoharan
et al., Bioorg. Med. Chem. Let., 1993, 3:2765), a thiocholesterol
(Oberhauser et al., Nucl. Acids Res., 1992, 20:533), an aliphatic
chain, e.g., dodecandiol or undecyl residues (Saison-Behmoaras et
al., EMBO J., 1991, 10:111; Kabanov et al., FEBS Lett., 1990,
259:327; Svinarchuk et al., Biochimie, 1993, 75:49), a
phospholipid, e.g., di-hexadecyl-rac-glycerol or triethylammonium
1,2-di-O-hexadecyl-rac-glycero-3-H-phosphonate (Manoharan et al.,
Tetrahedron Lett., 1995, 36:3651; Shea et al., Nucl. Acids Res.,
1990, 18:3777), a polyamine or a polyethylene glycol chain
(Manoharan et al., Nucleosides & Nucleotides, 1995, 14:969), or
adamantane acetic acid (Manoharan et al., Tetrahedron Lett., 1995,
36:3651), a palmityl moiety (Mishra et al., Biochim. Biophys. Acta,
1995, 1264:229), or an octadecylamine or
hexylamino-carbonyl-oxycholesterol moiety (Crooke et al., J.
Pharmacol. Exp. Ther., 1996, 277:923). Representative United States
patents that teach the preparation of such RNA conjugates have been
listed above. Typical conjugation protocols involve the synthesis
of an RNAs bearing an aminolinker at one or more positions of the
sequence. The amino group is then reacted with the molecule being
conjugated using appropriate coupling or activating reagents. The
conjugation reaction can be performed either with the RNA still
bound to the solid support or following cleavage of the RNA, in
solution phase. Purification of the RNA conjugate by HPLC typically
affords the pure conjugate.
IV. Delivery of an iRNA of the Invention
[0409] The delivery of an iRNA of the invention to a cell e.g., a
cell within a subject, such as a human subject (e.g., a subject in
need thereof, such as a subject having a disorder that would
benefit from reduction in PCSK9 expression) can be achieved in a
number of different ways. For example, delivery may be performed by
contacting a cell with an iRNA of the invention either in vitro or
in vivo. In vivo delivery may also be performed directly by
administering a composition comprising an iRNA, e.g., a dsRNA, to a
subject. Alternatively, in vivo delivery may be performed
indirectly by administering one or more vectors that encode and
direct the expression of the iRNA. These alternatives are discussed
further below.
[0410] In general, any method of delivering a nucleic acid molecule
(in vitro or in vivo) can be adapted for use with an iRNA of the
invention (see e.g., Akhtar S. and Julian R L. (1992) Trends Cell.
Biol. 2(5):139-144 and WO94/02595, which are incorporated herein by
reference in their entireties). For in vivo delivery, factors to
consider in order to deliver an iRNA molecule include, for example,
biological stability of the delivered molecule, prevention of
non-specific effects, and accumulation of the delivered molecule in
the target tissue. The non-specific effects of an iRNA can be
minimized by local administration, for example, by direct injection
or implantation into a tissue or topically administering the
preparation. Local administration to a treatment site maximizes
local concentration of the agent, limits the exposure of the agent
to systemic tissues that can otherwise be harmed by the agent or
that can degrade the agent, and permits a lower total dose of the
iRNA molecule to be administered. Several studies have shown
successful knockdown of gene products when an iRNA is administered
locally. For example, intraocular delivery of a VEGF dsRNA by
intravitreal injection in cynomolgus monkeys (Tolentino, M J., et
al (2004) Retina 24:132-138) and subretinal injections in mice
(Reich, S J., et al (2003) Mol. Vis. 9:210-216) were both shown to
prevent neovascularization in an experimental model of age-related
macular degeneration. In addition, direct intratumoral injection of
a dsRNA in mice reduces tumor volume (Pille, J., et al (2005) Mol.
Ther. 11:267-274) and can prolong survival of tumor-bearing mice
(Kim, W J., et al (2006) Mol. Ther. 14:343-350; Li, S., et al
(2007) Mol. Ther. 15:515-523). RNA interference has also shown
success with local delivery to the CNS by direct injection (Dorn,
G., et al. (2004) Nucleic Acids 32:e49; Tan, P H., et al (2005)
Gene Ther. 12:59-66; Makimura, H., et al (2002) BMC Neurosci. 3:18;
Shishkina, G T., et al (2004) Neuroscience 129:521-528; Thakker, E
R., et al (2004) Proc. Natl. Acad. Sci. U.S.A. 101:17270-17275;
Akaneya, Y., et al (2005) J. Neurophysiol. 93:594-602) and to the
lungs by intranasal administration (Howard, K A., et al (2006) Mol.
Ther. 14:476-484; Zhang, X., et al (2004) J. Biol. Chem.
279:10677-10684; Bitko, V., et al (2005) Nat. Med. 11:50-55). For
administering an iRNA systemically for the treatment of a disease,
the RNA can be modified or alternatively delivered using a drug
delivery system; both methods act to prevent the rapid degradation
of the dsRNA by endo- and exo-nucleases in vivo. Modification of
the RNA or the pharmaceutical carrier can also permit targeting of
the iRNA composition to the target tissue and avoid undesirable
off-target effects. iRNA molecules can be modified by chemical
conjugation to lipophilic groups such as cholesterol to enhance
cellular uptake and prevent degradation. For example, an iRNA
directed against ApoB conjugated to a lipophilic cholesterol moiety
was injected systemically into mice and resulted in knockdown of
apoB mRNA in both the liver and jejunum (Soutschek, J., et al
(2004) Nature 432:173-178). Conjugation of an iRNA to an aptamer
has been shown to inhibit tumor growth and mediate tumor regression
in a mouse model of prostate cancer (McNamara, J O., et al (2006)
Nat. Biotechnol. 24:1005-1015). In an alternative embodiment, the
iRNA can be delivered using drug delivery systems such as a
nanoparticle, a dendrimer, a polymer, liposomes, or a cationic
delivery system. Positively charged cationic delivery systems
facilitate binding of an iRNA molecule (negatively charged) and
also enhance interactions at the negatively charged cell membrane
to permit efficient uptake of an iRNA by the cell. Cationic lipids,
dendrimers, or polymers can either be bound to an iRNA, or induced
to form a vesicle or micelle (see e.g., Kim S H., et al (2008)
Journal of Controlled Release 129(2):107-116) that encases an iRNA.
The formation of vesicles or micelles further prevents degradation
of the iRNA when administered systemically. Methods for making and
administering cationic-iRNA complexes are well within the abilities
of one skilled in the art (see e.g., Sorensen, D R., et al (2003)
J. Mol. Biol 327:761-766; Verma, U N., et al (2003) Clin. Cancer
Res. 9:1291-1300; Arnold, A S et al (2007) J. Hypertens.
25:197-205, which are incorporated herein by reference in their
entirety). Some non-limiting examples of drug delivery systems
useful for systemic delivery of iRNAs include DOTAP (Sorensen, D
R., et al (2003), supra; Verma, U N., et al (2003), supra),
Oligofectamine, "solid nucleic acid lipid particles" (Zimmermann, T
S., et al (2006) Nature 441:111-114), cardiolipin (Chien, P Y., et
al (2005) Cancer Gene Ther. 12:321-328; Pal, A., et al (2005) Int
J. Oncol. 26:1087-1091), polyethyleneimine (Bonnet M E., et al
(2008) Pharm. Res. August 16 Epub ahead of print; Aigner, A. (2006)
J. Biomed. Biotechnol. 71659), Arg-Gly-Asp (RGD) peptides (Liu, S.
(2006) Mol. Pharm. 3:472-487), and polyamidoamines (Tomalia, D A.,
et al (2007) Biochem. Soc. Trans. 35:61-67; Yoo, H., et al (1999)
Pharm. Res. 16:1799-1804). In some embodiments, an iRNA forms a
complex with cyclodextrin for systemic administration. Methods for
administration and pharmaceutical compositions of iRNAs and
cyclodextrins can be found in U.S. Pat. No. 7,427,605, which is
herein incorporated by reference in its entirety.
[0411] A. Vector Encoded iRNAs of the Invention
[0412] iRNA targeting the PCSK9 gene can be expressed from
transcription units inserted into DNA or RNA vectors (see, e.g.,
Couture, A, et al., TIG. (1996), 12:5-10; Skillern, A., et al.,
International PCT Publication No. WO 00/22113, Conrad,
International PCT Publication No. WO 00/22114, and Conrad, U.S.
Pat. No. 6,054,299). Expression can be transient (on the order of
hours to weeks) or sustained (weeks to months or longer), depending
upon the specific construct used and the target tissue or cell
type. These transgenes can be introduced as a linear construct, a
circular plasmid, or a viral vector, which can be an integrating or
non-integrating vector. The transgene can also be constructed to
permit it to be inherited as an extrachromosomal plasmid (Gassmann,
et al., Proc. Natl. Acad. Sci. USA (1995) 92:1292).
[0413] The individual strand or strands of an iRNA can be
transcribed from a promoter on an expression vector. Where two
separate strands are to be expressed to generate, for example, a
dsRNA, two separate expression vectors can be co-introduced (e.g.,
by transfection or infection) into a target cell. Alternatively
each individual strand of a dsRNA can be transcribed by promoters
both of which are located on the same expression plasmid. In one
embodiment, a dsRNA is expressed as inverted repeat polynucleotides
joined by a linker polynucleotide sequence such that the dsRNA has
a stem and loop structure.
[0414] iRNA expression vectors are generally DNA plasmids or viral
vectors. Expression vectors compatible with eukaryotic cells,
preferably those compatible with vertebrate cells, can be used to
produce recombinant constructs for the expression of an iRNA as
described herein. Eukaryotic cell expression vectors are well known
in the art and are available from a number of commercial sources.
Typically, such vectors are provided containing convenient
restriction sites for insertion of the desired nucleic acid
segment. Delivery of iRNA expressing vectors can be systemic, such
as by intravenous or intramuscular administration, by
administration to target cells ex-planted from the patient followed
by reintroduction into the patient, or by any other means that
allows for introduction into a desired target cell.
[0415] iRNA expression plasmids can be transfected into target
cells as a complex with cationic lipid carriers (e.g.,
Oligofectamine) or non-cationic lipid-based carriers (e.g.,
Transit-TKO.TM.). Multiple lipid transfections for iRNA-mediated
knockdowns targeting different regions of a target RNA over a
period of a week or more are also contemplated by the invention.
Successful introduction of vectors into host cells can be monitored
using various known methods. For example, transient transfection
can be signaled with a reporter, such as a fluorescent marker, such
as Green Fluorescent Protein (GFP). Stable transfection of cells ex
vivo can be ensured using markers that provide the transfected cell
with resistance to specific environmental factors (e.g.,
antibiotics and drugs), such as hygromycin B resistance.
[0416] Viral vector systems which can be utilized with the methods
and compositions described herein include, but are not limited to,
(a) adenovirus vectors; (b) retrovirus vectors, including but not
limited to lentiviral vectors, moloney murine leukemia virus, etc.;
(c) adeno-associated virus vectors; (d) herpes simplex virus
vectors; (e) SV 40 vectors; (f) polyoma virus vectors; (g)
papilloma virus vectors; (h) picornavirus vectors; (i) pox virus
vectors such as an orthopox, e.g., vaccinia virus vectors or
avipox, e.g. canary pox or fowl pox; and (j) a helper-dependent or
gutless adenovirus. Replication-defective viruses can also be
advantageous. Different vectors will or will not become
incorporated into the cells' genome. The constructs can include
viral sequences for transfection, if desired. Alternatively, the
construct can be incorporated into vectors capable of episomal
replication, e.g. EPV and EBV vectors. Constructs for the
recombinant expression of an iRNA will generally require regulatory
elements, e.g., promoters, enhancers, etc., to ensure the
expression of the iRNA in target cells. Other aspects to consider
for vectors and constructs are further described below.
[0417] Vectors useful for the delivery of an iRNA will include
regulatory elements (promoter, enhancer, etc.) sufficient for
expression of the iRNA in the desired target cell or tissue. The
regulatory elements can be chosen to provide either constitutive or
regulated/inducible expression.
[0418] Expression of the iRNA can be precisely regulated, for
example, by using an inducible regulatory sequence that is
sensitive to certain physiological regulators, e.g., circulating
glucose levels, or hormones (Docherty et al., 1994, FASEB J.
8:20-24). Such inducible expression systems, suitable for the
control of dsRNA expression in cells or in mammals include, for
example, regulation by ecdysone, by estrogen, progesterone,
tetracycline, chemical inducers of dimerization, and
isopropyl-beta-D1-thiogalactopyranoside (IPTG). A person skilled in
the art would be able to choose the appropriate regulatory/promoter
sequence based on the intended use of the iRNA transgene.
[0419] Viral vectors that contain nucleic acid sequences encoding
an iRNA can be used. For example, a retroviral vector can be used
(see Miller et al., Meth. Enzymol. 217:581-599 (1993)). These
retroviral vectors contain the components necessary for the correct
packaging of the viral genome and integration into the host cell
DNA. The nucleic acid sequences encoding an iRNA are cloned into
one or more vectors, which facilitate delivery of the nucleic acid
into a patient. More detail about retroviral vectors can be found,
for example, in Boesen et al., Biotherapy 6:291-302 (1994), which
describes the use of a retroviral vector to deliver the mdr1 gene
to hematopoietic stem cells in order to make the stem cells more
resistant to chemotherapy. Other references illustrating the use of
retroviral vectors in gene therapy are: Clowes et al., J. Clin.
Invest. 93:644-651 (1994); Kiem et al., Blood 83:1467-1473 (1994);
Salmons and Gunzberg, Human Gene Therapy 4:129-141 (1993); and
Grossman and Wilson, Curr. Opin. in Genetics and Devel. 3:110-114
(1993). Lentiviral vectors contemplated for use include, for
example, the HIV based vectors described in U.S. Pat. Nos.
6,143,520; 5,665,557; and 5,981,276, which are herein incorporated
by reference.
[0420] Adenoviruses are also contemplated for use in delivery of
iRNAs of the invention. Adenoviruses are especially attractive
vehicles, e.g., for delivering genes to respiratory epithelia.
Adenoviruses naturally infect respiratory epithelia where they
cause a mild disease. Other targets for adenovirus-based delivery
systems are liver, the central nervous system, endothelial cells,
and muscle. Adenoviruses have the advantage of being capable of
infecting non-dividing cells. Kozarsky and Wilson, Current Opinion
in Genetics and Development 3:499-503 (1993) present a review of
adenovirus-based gene therapy. Bout et al., Human Gene Therapy
5:3-10 (1994) demonstrated the use of adenovirus vectors to
transfer genes to the respiratory epithelia of rhesus monkeys.
Other instances of the use of adenoviruses in gene therapy can be
found in Rosenfeld et al., Science 252:431-434 (1991); Rosenfeld et
al., Cell 68:143-155 (1992); Mastrangeli et al., J. Clin. Invest.
91:225-234 (1993); PCT Publication WO94/12649; and Wang, et al.,
Gene Therapy 2:775-783 (1995). A suitable AV vector for expressing
an iRNA featured in the invention, a method for constructing the
recombinant AV vector, and a method for delivering the vector into
target cells, are described in Xia H et al. (2002), Nat. Biotech.
20: 1006-1010.
[0421] Adeno-associated virus (AAV) vectors may also be used to
delivery an iRNA of the invention (Walsh et al., Proc. Soc. Exp.
Biol. Med. 204:289-300 (1993); U.S. Pat. No. 5,436,146). In one
embodiment, the iRNA can be expressed as two separate,
complementary single-stranded RNA molecules from a recombinant AAV
vector having, for example, either the U6 or H1 RNA promoters, or
the cytomegalovirus (CMV) promoter. Suitable AAV vectors for
expressing the dsRNA featured in the invention, methods for
constructing the recombinant AV vector, and methods for delivering
the vectors into target cells are described in Samulski R et al.
(1987), J. Virol. 61: 3096-3101; Fisher K J et al. (1996), J.
Virol, 70: 520-532; Samulski R et al. (1989), J. Virol. 63:
3822-3826; U.S. Pat. No. 5,252,479; U.S. Pat. No. 5,139,941;
International Patent Application No. WO 94/13788; and International
Patent Application No. WO 93/24641, the entire disclosures of which
are herein incorporated by reference.
[0422] Another viral vector sui for delivery of an iRNA of the
invention is a pox virus such as a vaccinia virus, for example an
attenuated vaccinia such as Modified Virus Ankara (MVA) or NYVAC,
an avipox such as fowl pox or canary pox.
[0423] The tropism of viral vectors can be modified by pseudotyping
the vectors with envelope proteins or other surface antigens from
other viruses, or by substituting different viral capsid proteins,
as appropriate. For example, lentiviral vectors can be pseudotyped
with surface proteins from vesicular stomatitis virus (VSV),
rabies, Ebola, Mokola, and the like. AAV vectors can be made to
target different cells by engineering the vectors to express
different capsid protein serotypes; see, e.g., Rabinowitz J E et
al. (2002), J Virol 76:791-801, the entire disclosure of which is
herein incorporated by reference.
[0424] The pharmaceutical preparation of a vector can include the
vector in an acceptable diluent, or can include a slow release
matrix in which the gene delivery vehicle is imbedded.
Alternatively, where the complete gene delivery vector can be
produced intact from recombinant cells, e.g., retroviral vectors,
the pharmaceutical preparation can include one or more cells which
produce the gene delivery system.
V. Pharmaceutical Compositions of the Invention
[0425] The present invention also includes pharmaceutical
compositions and formulations which include the iRNAs of the
invention. In one embodiment, provided herein are pharmaceutical
compositions containing an iRNA, as described herein, and a
pharmaceutically acceptable carrier.
[0426] The phrase "pharmaceutically acceptable" is employed herein
to refer to those compounds, materials, compositions, and/or dosage
forms which are, within the scope of sound medical judgment,
suitable for use in contact with the tissues of human subjects and
animal subjects without excessive toxicity, irritation, allergic
response, or other problem or complication, commensurate with a
reasonable benefit/risk ratio.
[0427] The phrase "pharmaceutically-acceptable carrier" as used
herein means a pharmaceutically-acceptable material, composition or
vehicle, such as a liquid or solid filler, diluent, excipient,
manufacturing aid (e.g., lubricant, talc magnesium, calcium or zinc
stearate, or steric acid), or solvent encapsulating material,
involved in carrying or transporting the subject compound from one
organ, or portion of the body, to another organ, or portion of the
body. Each carrier must be "acceptable" in the sense of being
compatible with the other ingredients of the formulation and not
injurious to the subject being treated. Some examples of materials
which can serve as pharmaceutically-acceptable carriers include:
(1) sugars, such as lactose, glucose and sucrose; (2) starches,
such as corn starch and potato starch; (3) cellulose, and its
derivatives, such as sodium carboxymethyl cellulose, ethyl
cellulose and cellulose acetate; (4) powdered tragacanth; (5) malt;
(6) gelatin; (7) lubricating agents, such as magnesium state,
sodium lauryl sulfate and talc; (8) excipients, such as cocoa
butter and suppository waxes; (9) oils, such as peanut oil,
cottonseed oil, safflower oil, sesame oil, olive oil, corn oil and
soybean oil; (10) glycols, such as propylene glycol; (11) polyols,
such as glycerin, sorbitol, mannitol and polyethylene glycol; (12)
esters, such as ethyl oleate and ethyl laurate; (13) agar; (14)
buffering agents, such as magnesium hydroxide and aluminum
hydroxide; (15) alginic acid; (16) pyrogen-free water; (17)
isotonic saline; (18) Ringer's solution; (19) ethyl alcohol; (20)
pH buffered solutions; (21) polyesters, polycarbonates and/or
polyanhydrides; (22) bulking agents, such as polypeptides and amino
acids (23) serum component, such as serum albumin, HDL and LDL; and
(22) other non-toxic compatible substances employed in
pharmaceutical formulations.
[0428] The pharmaceutical compositions containing the iRNA are
useful for treating a disease or disorder associated with the
expression or activity of a PCSK9, e.g. a disease or disorder that
would benefit from reduction in PCSK9 expression. Such
pharmaceutical compositions are formulated based on the mode of
delivery. One example is compositions that are formulated for
systemic administration via parenteral delivery, e.g., by
subcutaneous (SC), intramuscular (IM), or intravenous (IV)
delivery. Another example is compositions that are formulated for
direct delivery into the brain parenchyma, e.g., by infusion into
the brain, such as by continuous pump infusion. The pharmaceutical
compositions of the invention may be administered in dosages
sufficient to inhibit expression of a PCSK9 gene.
[0429] Preferably, in the methods of the invention an iRNA agent is
administered to a subject as a fixed dose. In one particular
embodiment, a fixed dose of an iRNA agent of the invention is based
on a predetermined weight or age.
[0430] In some embodiments, the RNAi agent is administered as a
fixed dose of between about 200 mg to about 850 mg, between about
200 mg to about 500 mg, between about 200 mg to about 400 mg,
between about 200 mg to about 300 mg, between about 100 mg to about
800 mg, between about 100 mg to about 750 mg, between about 100 mg
to about 700 mg, between about 100 mg to about 650 mg, between
about 100 mg to about 600 mg, between about 100 mg to about 550 mg,
between about 100 mg to about 500 mg, between about 200 mg to about
850 mg, between about 200 mg to about 800 mg, between about 200 mg
to about 750 mg, between about 200 mg to about 700 mg, between
about 200 mg to about 650 mg, between about 200 mg to about 600 mg,
between about 200 mg to about 550 mg, between about 200 mg to about
500 mg, between about 300 mg to about 850 mg, between about 300 mg
to about 800 mg, between about 300 mg to about 750 mg, between
about 300 mg to about 700 mg, between about 300 mg to about 650 mg,
between about 300 mg to about 600 mg, between about 300 mg to about
550 mg, between about 300 mg to about 500 mg, between about 400 mg
to about 850 mg, between about 400 mg to about 800 mg, between
about 400 mg to about 750 mg, between about 400 mg to about 700 mg,
between about 400 mg to about 650 mg, between about 400 mg to about
600 mg, between about 400 mg to about 550 mg, or between about 400
mg to about 500 mg.
[0431] In some embodiments, the RNAi agent is administered as a
fixed dose of about 100 mg, about 125 mg, about 150 mg, about 175
mg, 200 mg, about 225 mg, about 250 mg, about 275 mg, about 300 mg,
about 325 mg, about 350 mg, about 375 mg, about 400 mg, about 425
mg, about 450 mg, about 475 mg, about 500 mg, about 525 mg, about
550 mg, about 575 mg, about 600 mg, about 625 mg, about 650 mg,
about 675 mg, about 700 mg, about 725 mg, about 750 mg, about 775
mg, about 800 mg, about 825 mg, or about 850 mg.
[0432] In some embodiments, subjects are administered, e.g.,
subcutaneously or intramuscularly, multiple doses of a therapeutic
amount of iRNA.
[0433] The iRNA may be formulated in a pharmaceutical composition
at a suitable concentration such that a suitable volume of the
composition is administered to the subject, such as about 1.0 mls,
1.1 ails, 1.2 ails, 1.3 ails, 1.4 ails, 1.5 ails, 1.6 ails, 1.7
ails, 1.8 ails, 1.9 ails, or about 2.0 mls of a pharmaceutical
composition. For example, in one embodiment, an iRNA agent of the
invention is formulated in a suitable pharmaceutical formulation at
about 200 mg/ml such that administration of about 1.5 mls of the
formulation to a subject provides a 300 mg fixed dose of the
agent.
[0434] As described herein, a single dose of the iRNA agents or
pharmaceutical compositions comprising such agents can be long
lasting, such that subsequent doses are administered at not more
than 1 week, 2 weeks, 1 month, 2 month, 3 month, 4 month, 5 month,
or 6 month intervals.
[0435] In some embodiments, subjects are administered, e.g.,
subcutaneously or intramuscularly, a repeat dose of a therapeutic
amount of iRNA. A repeat-dose regimen may include administration of
a therapeutic amount of iRNA on a regular basis, such as once a
month, once every two months, once a quarter, once every four
months, once every five months, or biannually. In some embodiments
of the invention, a single dose of the pharmaceutical compositions
of the invention is administered once per quarter (qQ). In other
embodiments of the invention, a single dose of the pharmaceutical
compositions of the invention is administered bi-annually (i.e.,
every six months). Administration can be repeated, e.g., once every
quarter for 6 months, one year, two years or longer, e.g.,
administered chronically.
[0436] In some embodiments, the RNAi agent is administered in a
dosing regimen that includes a loading phase followed by a
maintenance phase.
[0437] The loading phase may include a single administration of the
RNAi agent during the first week, a single administration of the
RNAi agent during the first two weeks, or a single administration
of the RNAi agent during the first month at a fixed dose of, for
example, about 100 mg to about 700 mg, about 150 mg to about 700
mg, about 200 mg to about 700 mg, about 250 mg to about 700 mg,
about 300 mg to about 700 mg, about 350 mg to about 700 mg, about
400 mg to about 700 mg, about 450 mg to about 700 mg, about 500 mg
to about 700 mg, about 550 mg to about 700 mg, about 600 to about
700 mg, about 650 to about 700 mg, about 100 mg to about 650 mg,
about 150 mg to about 650 mg, about 200 mg to about 650 mg, about
250 mg to about 650 mg, about 300 mg to about 650 mg, about 350 mg
to about 650 mg, about 400 mg to about 650 mg, about 450 mg to
about 650 mg, about 500 mg to about 650 mg, about 550 mg to about
650 mg, about 600 to about 650 mg, about 100 mg to about 600 mg,
about 150 mg to about 600 mg, about 200 mg to about 600 mg, about
250 mg to about 600 mg, about 300 mg to about 600 mg, about 350 mg
to about 600 mg, about 400 mg to about 600 mg, about 450 mg to
about 600 mg, about 500 mg to about 600 mg, about 550 mg to about
600 mg, about 100 mg to about 550 mg, about 150 mg to about 550 mg,
about 200 mg to about 550 mg, about 250 mg to about 550 mg, about
300 mg to about 550 mg, about 350 mg to about 550 mg, about 400 mg
to about 550 mg, about 450 mg to about 550 mg, about 500 mg to
about 550 mg, about 100 mg to about 500 mg, about 150 mg to about
500 mg, about 200 mg to about 500 mg, about 250 mg to about 500 mg,
about 300 mg to about 500 mg, about 350 mg to about 500 mg, about
400 mg to about 500 mg, or about 450 mg to about 500 mg, e.g., a
fixed dose of about 100 mg, about 125 mg, about 150 mg, about 175
mg, 200 mg, about 225 mg, about 250 mg, about 275 mg, about 300 mg,
about 325 mg, about 350 mg, about 375 mg, about 400 mg, about 425
mg, about 450 mg, about 475 mg, about 500 mg, about 525 mg, about
550 mg, about 575 mg, about 600 mg, about 625 mg, about 650 mg,
about 675 mg, or about 700 mg. Values and ranges intermediate to
the foregoing recited values are also intended to be part of this
invention.
[0438] The maintenance phase may include administration of a dose
of the RNAi agent to the subject once a month, once every two
months, once every three months, once every four months, once every
five months, or once every six months. In one particular
embodiment, the maintenance dose is administered to the subject
once a month.
[0439] The maintenance dose or doses can be the same or lower than
the initial dose, e.g., one-half of the initial dose. For example,
a maintenance dose may be about 25 mg to about 100 mg administered
to the subject monthly, for example about 25 mg to about 75 mg,
about 25 mg to about 50 mg, or about 50 mg to about 75 mg, e.g.,
about 25 mg, about 30 mg, about 35 mg, about 40 mg, about 45 mg,
about 50 mg, about 55 mg, about 60 mg, about 65 mg, about 70 mg,
about 75 mg, about 80 mg, about 85 mg, about 90 mg, about 95 mg, or
about 100 mg. Values and ranges intermediate to the foregoing
recited values are also intended to be part of this invention.
[0440] The pharmaceutical composition can be administered by
intravenous infusion over a period of time, such as over a 5, 6, 7,
8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, and 21, 22, 23,
24, or about a 25 minute period. The administration may be
repeated, for example, on a regular basis, such as weekly, biweekly
(i.e., every two weeks) for one month, two months, three months,
four months or longer. After an initial treatment regimen, the
treatments can be administered on a less frequent basis. For
example, after administration weekly or biweekly for three months,
administration can be repeated once per month, for six months or a
year or longer.
[0441] The skilled artisan will appreciate that certain factors can
influence the dosage and timing required to effectively treat a
subject, including but not limited to the severity of the disease
or disorder, previous treatments, the general health and/or age of
the subject, and other diseases present. Moreover, treatment of a
subject with a therapeutically effective amount of a composition
can include a single treatment or a series of treatments. Estimates
of effective dosages and in vivo half-lives for the individual
iRNAs encompassed by the invention can be made using conventional
methodologies or on the basis of in vivo testing using an
appropriate animal model, as described elsewhere herein.
[0442] The pharmaceutical compositions of the present invention can
be administered in a number of ways depending upon whether local or
systemic treatment is desired and upon the area to be treated.
Administration can be topical (e.g., by a transdermal patch),
pulmonary, e.g., by inhalation or insufflation of powders or
aerosols, including by nebulizer; intratracheal, intranasal,
epidermal and transdermal, oral or parenteral. Parenteral
administration includes intravenous, intraarterial, subcutaneous,
intraperitoneal or intramuscular injection or infusion; subdermal,
e.g., via an implanted device; or intracranial, e.g., by
intraparenchymal, intrathecal or intraventricular,
administration.
[0443] The iRNA can be delivered in a manner to target a particular
tissue, such as the liver (e.g., the hepatocytes of the liver).
[0444] Pharmaceutical compositions and formulations for topical
administration can include transdermal patches, ointments, lotions,
creams, gels, drops, suppositories, sprays, liquids and powders.
Conventional pharmaceutical carriers, aqueous, powder or oily
bases, thickeners and the like can be necessary or desirable.
Coated condoms, gloves and the like can also be useful. Suitable
topical formulations include those in which the iRNAs featured in
the invention are in admixture with a topical delivery agent such
as lipids, liposomes, fatty acids, fatty acid esters, steroids,
chelating agents and surfactants. Suitable lipids and liposomes
include neutral (e.g., dioleoylphosphatidyl DOPE ethanolamine,
dimyristoylphosphatidyl choline DMPC, distearolyphosphatidyl
choline) negative (e.g., dimyristoylphosphatidyl glycerol DMPG) and
cationic (e.g., dioleoyltetramethylaminopropyl DOTAP and
dioleoylphosphatidyl ethanolamine DOTMA). iRNAs featured in the
invention can be encapsulated within liposomes or can form
complexes thereto, in particular to cationic liposomes.
Alternatively, iRNAs can be complexed to lipids, in particular to
cationic lipids. Suitable fatty acids and esters include but are
not limited to arachidonic acid, oleic acid, eicosanoic acid,
lauric acid, caprylic acid, capric acid, myristic acid, palmitic
acid, stearic acid, linoleic acid, linolenic acid, dicaprate,
tricaprate, monoolein, dilaurin, glyceryl 1-monocaprate,
1-dodecylazacycloheptan-2-one, an acylcarnitine, an acylcholine, or
a C.sub.1-20 alkyl ester (e.g., isopropylmyristate IPM),
monoglyceride, diglyceride or pharmaceutically acceptable salt
thereof). Topical formulations are described in detail in U.S. Pat.
No. 6,747,014, which is incorporated herein by reference.
[0445] Compositions and formulations for oral administration
include powders or granules, microparticulates, nanoparticulates,
suspensions or solutions in water or non-aqueous media, capsules,
gel capsules, sachets, tablets or minitablets. Thickeners,
flavoring agents, diluents, emulsifiers, dispersing aids or binders
can be desirable. In some embodiments, oral formulations are those
in which dsRNAs featured in the invention are administered in
conjunction with one or more penetration enhancer surfactants and
chelators. Suitable surfactants include fatty acids and/or esters
or salts thereof, bile acids and/or salts thereof. Suitable bile
acids/salts include chenodeoxycholic acid (CDCA) and
ursodeoxychenodeoxycholic acid (UDCA), cholic acid, dehydrocholic
acid, deoxycholic acid, glucholic acid, glycholic acid,
glycodeoxycholic acid, taurocholic acid, taurodeoxycholic acid,
sodium tauro-24,25-dihydro-fusidate and sodium
glycodihydrofusidate. Suitable fatty acids include arachidonic
acid, undecanoic acid, oleic acid, lauric acid, caprylic acid,
capric acid, myristic acid, palmitic acid, stearic acid, linoleic
acid, linolenic acid, dicaprate, tricaprate, monoolein, dilaurin,
glyceryl 1-monocaprate, 1-dodecylazacycloheptan-2-one, an
acylcarnitine, an acylcholine, or a monoglyceride, a diglyceride or
a pharmaceutically acceptable salt thereof (e.g., sodium). In some
embodiments, combinations of penetration enhancers are used, for
example, fatty acids/salts in combination with bile acids/salts.
One exemplary combination is the sodium salt of lauric acid, capric
acid and UDCA. Further penetration enhancers include
polyoxyethylene-9-lauryl ether, polyoxyethylene-20-cetyl ether.
DsRNAs featured in the invention can be delivered orally, in
granular form including sprayed dried particles, or complexed to
form micro or nanoparticles. DsRNA complexing agents include
poly-amino acids; polyimines; polyacrylates; polyalkylacrylates,
polyoxethanes, polyalkylcyanoacrylates; cationized gelatins,
albumins, starches, acrylates, polyethyleneglycols (PEG) and
starches; polyalkylcyanoacrylates; DEAE-derivatized polyimines,
pollulans, celluloses and starches. Suitable complexing agents
include chitosan, N-trimethylchitosan, poly-L-lysine,
polyhistidine, polyornithine, polyspermines, protamine,
polyvinylpyridine, polythiodiethylaminomethylethylene P(TDAE),
polyaminostyrene (e.g., p-amino), poly(methylcyanoacrylate),
poly(ethylcyanoacrylate), poly(butylcyanoacrylate),
poly(isobutylcyanoacrylate), poly(isohexylcynaoacrylate),
DEAE-methacrylate, DEAE-hexylacrylate, DEAE-acrylamide,
DEAE-albumin and DEAE-dextran, polymethylacrylate,
polyhexylacrylate, poly(D,L-lactic acid),
poly(DL-lactic-co-glycolic acid (PLGA), alginate, and
polyethyleneglycol (PEG). Oral formulations for dsRNAs and their
preparation are described in detail in U.S. Pat. No. 6,887,906, US
Publn. No. 20030027780, and U.S. Pat. No. 6,747,014, each of which
is incorporated herein by reference.
[0446] Compositions and formulations for parenteral,
intraparenchymal (into the brain), intrathecal, intraventricular or
intrahepatic administration can include sterile aqueous solutions
which can also contain buffers, diluents and other suitable
additives such as, but not limited to, penetration enhancers,
carrier compounds and other pharmaceutically acceptable carriers or
excipients.
[0447] Pharmaceutical compositions of the present invention
include, but are not limited to, solutions, emulsions, and
liposome-containing formulations. These compositions can be
generated from a variety of components that include, but are not
limited to, preformed liquids, self-emulsifying solids and
self-emulsifying semisolids. Particularly preferred are
formulations that target the liver when treating hepatic disorders
such as hepatic carcinoma.
[0448] The pharmaceutical formulations of the present invention,
which can conveniently be presented in unit dosage form, can be
prepared according to conventional techniques well known in the
pharmaceutical industry. Such techniques include the step of
bringing into association the active ingredients with the
pharmaceutical carrier(s) or excipient(s). In general, the
formulations are prepared by uniformly and intimately bringing into
association the active ingredients with liquid carriers or finely
divided solid carriers or both, and then, if necessary, shaping the
product.
[0449] The compositions of the present invention can be formulated
into any of many possible dosage forms such as, but not limited to,
tablets, capsules, gel capsules, liquid syrups, soft gels,
suppositories, and enemas. The compositions of the present
invention can also be formulated as suspensions in aqueous,
non-aqueous or mixed media. Aqueous suspensions can further contain
substances which increase the viscosity of the suspension
including, for example, sodium carboxymethylcellulose, sorbitol
and/or dextran. The suspension can also contain stabilizers.
[0450] A. Additional Formulations
[0451] i. Emulsions
[0452] The compositions of the present invention can be prepared
and formulated as emulsions. Emulsions are typically heterogeneous
systems of one liquid dispersed in another in the form of droplets
usually exceeding 0.1 .mu.m in diameter (see e.g., Ansel's
Pharmaceutical Dosage Forms and Drug Delivery Systems, Allen, L V.,
Popovich N G., and Ansel H C., 2004, Lippincott Williams &
Wilkins (8th ed.), New York, N.Y.; Idson, in Pharmaceutical Dosage
Forms, Lieberman, Rieger and Banker (Eds.), 1988, Marcel Dekker,
Inc., New York, N.Y., volume 1, p. 199; Rosoff, in Pharmaceutical
Dosage Forms, Lieberman, Rieger and Banker (Eds.), 1988, Marcel
Dekker, Inc., New York, N.Y., Volume 1, p. 245; Block in
Pharmaceutical Dosage Forms, Lieberman, Rieger and Banker (Eds.),
1988, Marcel Dekker, Inc., New York, N.Y., volume 2, p. 335;
Higuchi et al., in Remington's Pharmaceutical Sciences, Mack
Publishing Co., Easton, Pa., 1985, p. 301). Emulsions are often
biphasic systems comprising two immiscible liquid phases intimately
mixed and dispersed with each other. In general, emulsions can be
of either the water-in-oil (w/o) or the oil-in-water (o/w) variety.
When an aqueous phase is finely divided into and dispersed as
minute droplets into a bulk oily phase, the resulting composition
is called a water-in-oil (w/o) emulsion. Alternatively, when an
oily phase is finely divided into and dispersed as minute droplets
into a bulk aqueous phase, the resulting composition is called an
oil-in-water (o/w) emulsion. Emulsions can contain additional
components in addition to the dispersed phases, and the active drug
which can be present as a solution in either the aqueous phase,
oily phase or itself as a separate phase. Pharmaceutical excipients
such as emulsifiers, stabilizers, dyes, and anti-oxidants can also
be present in emulsions as needed. Pharmaceutical emulsions can
also be multiple emulsions that are comprised of more than two
phases such as, for example, in the case of oil-in-water-in-oil
(o/w/o) and water-in-oil-in-water (w/o/w) emulsions. Such complex
formulations often provide certain advantages that simple binary
emulsions do not. Multiple emulsions in which individual oil
droplets of an o/w emulsion enclose small water droplets constitute
a w/o/w emulsion. Likewise a system of oil droplets enclosed in
globules of water stabilized in an oily continuous phase provides
an o/w/o emulsion.
[0453] Emulsions are characterized by little or no thermodynamic
stability. Often, the dispersed or discontinuous phase of the
emulsion is well dispersed into the external or continuous phase
and maintained in this form through the means of emulsifiers or the
viscosity of the formulation. Either of the phases of the emulsion
can be a semisolid or a solid, as is the case of emulsion-style
ointment bases and creams. Other means of stabilizing emulsions
entail the use of emulsifiers that can be incorporated into either
phase of the emulsion. Emulsifiers can broadly be classified into
four categories: synthetic surfactants, naturally occurring
emulsifiers, absorption bases, and finely dispersed solids (see
e.g., Ansel's Pharmaceutical Dosage Forms and Drug Delivery
Systems, Allen, L V., Popovich N G., and Ansel H C., 2004,
Lippincott Williams & Wilkins (8th ed.), New York, N.Y.; Idson,
in Pharmaceutical Dosage Forms, Lieberman, Rieger and Banker
(Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1, p.
199).
[0454] Synthetic surfactants, also known as surface active agents,
have found wide applicability in the formulation of emulsions and
have been reviewed in the literature (see e.g., Ansel's
Pharmaceutical Dosage Forms and Drug Delivery Systems, Allen, L V.,
Popovich N G., and Ansel H C., 2004, Lippincott Williams &
Wilkins (8th ed.), New York, N.Y.; Rieger, in Pharmaceutical Dosage
Forms, Lieberman, Rieger and Banker (Eds.), 1988, Marcel Dekker,
Inc., New York, N.Y., volume 1, p. 285; Idson, in Pharmaceutical
Dosage Forms, Lieberman, Rieger and Banker (Eds.), Marcel Dekker,
Inc., New York, N.Y., 1988, volume 1, p. 199). Surfactants are
typically amphiphilic and comprise a hydrophilic and a hydrophobic
portion. The ratio of the hydrophilic to the hydrophobic nature of
the surfactant has been termed the hydrophile/lipophile balance
(HLB) and is a valuable tool in categorizing and selecting
surfactants in the preparation of formulations. Surfactants can be
classified into different classes based on the nature of the
hydrophilic group: nonionic, anionic, cationic and amphoteric (see
e.g., Ansel's Pharmaceutical Dosage Forms and Drug Delivery
Systems, Allen, L V., Popovich N G., and Ansel H C., 2004,
Lippincott Williams & Wilkins (8th ed.), New York, N.Y. Rieger,
in Pharmaceutical Dosage Forms, Lieberman, Rieger and Banker
(Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1, p.
285).
[0455] Naturally occurring emulsifiers used in emulsion
formulations include lanolin, beeswax, phosphatides, lecithin and
acacia. Absorption bases possess hydrophilic properties such that
they can soak up water to form w/o emulsions yet retain their
semisolid consistencies, such as anhydrous lanolin and hydrophilic
petrolatum. Finely divided solids have also been used as good
emulsifiers especially in combination with surfactants and in
viscous preparations. These include polar inorganic solids, such as
heavy metal hydroxides, nonswelling clays such as bentonite,
attapulgite, hectorite, kaolin, montmorillonite, colloidal aluminum
silicate and colloidal magnesium aluminum silicate, pigments and
nonpolar solids such as carbon or glyceryl tristearate.
[0456] A large variety of non-emulsifying materials are also
included in emulsion formulations and contribute to the properties
of emulsions. These include fats, oils, waxes, fatty acids, fatty
alcohols, fatty esters, humectants, hydrophilic colloids,
preservatives and antioxidants (Block, in Pharmaceutical Dosage
Forms, Lieberman, Rieger and Banker (Eds.), 1988, Marcel Dekker,
Inc., New York, N.Y., volume 1, p. 335; Idson, in Pharmaceutical
Dosage Forms, Lieberman, Rieger and Banker (Eds.), 1988, Marcel
Dekker, Inc., New York, N.Y., volume 1, p. 199).
[0457] Hydrophilic colloids or hydrocolloids include naturally
occurring gums and synthetic polymers such as polysaccharides (for
example, acacia, agar, alginic acid, carrageenan, guar gum, karaya
gum, and tragacanth), cellulose derivatives (for example,
carboxymethylcellulose and carboxypropylcellulose), and synthetic
polymers (for example, carbomers, cellulose ethers, and
carboxyvinyl polymers). These disperse or swell in water to form
colloidal solutions that stabilize emulsions by forming strong
interfacial films around the dispersed-phase droplets and by
increasing the viscosity of the external phase.
[0458] Since emulsions often contain a number of ingredients such
as carbohydrates, proteins, sterols and phosphatides that can
readily support the growth of microbes, these formulations often
incorporate preservatives. Commonly used preservatives included in
emulsion formulations include methyl paraben, propyl paraben,
quaternary ammonium salts, benzalkonium chloride, esters of
p-hydroxybenzoic acid, and boric acid. Antioxidants are also
commonly added to emulsion formulations to prevent deterioration of
the formulation. Antioxidants used can be free radical scavengers
such as tocopherols, alkyl gallates, butylated hydroxyanisole,
butylated hydroxytoluene, or reducing agents such as ascorbic acid
and sodium metabisulfite, and antioxidant synergists such as citric
acid, tartaric acid, and lecithin.
[0459] The application of emulsion formulations via dermatological,
oral and parenteral routes and methods for their manufacture have
been reviewed in the literature (see e.g., Ansel's Pharmaceutical
Dosage Forms and Drug Delivery Systems, Allen, L V., Popovich N G.,
and Ansel H C., 2004, Lippincott Williams & Wilkins (8th ed.),
New York, N.Y.; Idson, in Pharmaceutical Dosage Forms, Lieberman,
Rieger and Banker (Eds.), 1988, Marcel Dekker, Inc., New York,
N.Y., volume 1, p. 199). Emulsion formulations for oral delivery
have been very widely used because of ease of formulation, as well
as efficacy from an absorption and bioavailability standpoint (see
e.g., Ansel's Pharmaceutical Dosage Forms and Drug Delivery
Systems, Allen, L V., Popovich N G., and Ansel H C., 2004,
Lippincott Williams & Wilkins (8th ed.), New York, N.Y.;
Rosoff, in Pharmaceutical Dosage Forms, Lieberman, Rieger and
Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1,
p. 245; Idson, in Pharmaceutical Dosage Forms, Lieberman, Rieger
and Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y.,
volume 1, p. 199). Mineral-oil base laxatives, oil-soluble vitamins
and high fat nutritive preparations are among the materials that
have commonly been administered orally as o/w emulsions.
[0460] ii. Microemulsions
[0461] In one embodiment of the present invention, the compositions
of iRNAs and nucleic acids are formulated as microemulsions. A
microemulsion can be defined as a system of water, oil and
amphiphile which is a single optically isotropic and
thermodynamically stable liquid solution (see e.g., Ansel's
Pharmaceutical Dosage Forms and Drug Delivery Systems, Allen, L V.,
Popovich N G., and Ansel H C., 2004, Lippincott Williams &
Wilkins (8th ed.), New York, N.Y.; Rosoff, in Pharmaceutical Dosage
Forms, Lieberman, Rieger and Banker (Eds.), 1988, Marcel Dekker,
Inc., New York, N.Y., volume 1, p. 245). Typically microemulsions
are systems that are prepared by first dispersing an oil in an
aqueous surfactant solution and then adding a sufficient amount of
a fourth component, generally an intermediate chain-length alcohol
to form a transparent system. Therefore, microemulsions have also
been described as thermodynamically stable, isotropically clear
dispersions of two immiscible liquids that are stabilized by
interfacial films of surface-active molecules (Leung and Shah, in:
Controlled Release of Drugs: Polymers and Aggregate Systems,
Rosoff, M., Ed., 1989, VCH Publishers, New York, pages 185-215).
Microemulsions commonly are prepared via a combination of three to
five components that include oil, water, surfactant, cosurfactant
and electrolyte. Whether the microemulsion is of the water-in-oil
(w/o) or an oil-in-water (o/w) type is dependent on the properties
of the oil and surfactant used and on the structure and geometric
packing of the polar heads and hydrocarbon tails of the surfactant
molecules (Schott, in Remington's Pharmaceutical Sciences, Mack
Publishing Co., Easton, Pa., 1985, p. 271).
[0462] The phenomenological approach utilizing phase diagrams has
been extensively studied and has yielded a comprehensive knowledge,
to one skilled in the art, of how to formulate microemulsions (see
e.g., Ansel's Pharmaceutical Dosage Forms and Drug Delivery
Systems, Allen, L V., Popovich N G., and Ansel H C., 2004,
Lippincott Williams & Wilkins (8th ed.), New York, N.Y.;
Rosoff, in Pharmaceutical Dosage Forms, Lieberman, Rieger and
Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1,
p. 245; Block, in Pharmaceutical Dosage Forms, Lieberman, Rieger
and Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y.,
volume 1, p. 335). Compared to conventional emulsions,
microemulsions offer the advantage of solubilizing water-insoluble
drugs in a formulation of thermodynamically stable droplets that
are formed spontaneously.
[0463] Surfactants used in the preparation of microemulsions
include, but are not limited to, ionic surfactants, non-ionic
surfactants, Brij 96, polyoxyethylene oleyl ethers, polyglycerol
fatty acid esters, tetraglycerol monolaurate (ML310), tetraglycerol
monooleate (MO310), hexaglycerol monooleate (PO310), hexaglycerol
pentaoleate (PO500), decaglycerol monocaprate (MCA750),
decaglycerol monooleate (MO750), decaglycerol sesquioleate (SO750),
decaglycerol decaoleate (DAO750), alone or in combination with
cosurfactants. The cosurfactant, usually a short-chain alcohol such
as ethanol, 1-propanol, and 1-butanol, serves to increase the
interfacial fluidity by penetrating into the surfactant film and
consequently creating a disordered film because of the void space
generated among surfactant molecules. Microemulsions can, however,
be prepared without the use of cosurfactants and alcohol-free
self-emulsifying microemulsion systems are known in the art. The
aqueous phase can typically be, but is not limited to, water, an
aqueous solution of the drug, glycerol, PEG300, PEG400,
polyglycerols, propylene glycols, and derivatives of ethylene
glycol. The oil phase can include, but is not limited to, materials
such as Captex 300, Captex 355, Capmul MCM, fatty acid esters,
medium chain (C8-C12) mono, di, and tri-glycerides,
polyoxyethylated glyceryl fatty acid esters, fatty alcohols,
polyglycolized glycerides, saturated polyglycolized C8-C10
glycerides, vegetable oils and silicone oil.
[0464] Microemulsions are particularly of interest from the
standpoint of drug solubilization and the enhanced absorption of
drugs. Lipid based microemulsions (both o/w and w/o) have been
proposed to enhance the oral bioavailability of drugs, including
peptides (see e.g., U.S. Pat. Nos. 6,191,105; 7,063,860; 7,070,802;
7,157,099; Constantinides et al., Pharmaceutical Research, 1994,
11, 1385-1390; Ritschel, Meth. Find. Exp. Clin. Pharmacol., 1993,
13, 205). Microemulsions afford advantages of improved drug
solubilization, protection of drug from enzymatic hydrolysis,
possible enhancement of drug absorption due to surfactant-induced
alterations in membrane fluidity and permeability, ease of
preparation, ease of oral administration over solid dosage forms,
improved clinical potency, and decreased toxicity (see e.g., U.S.
Pat. Nos. 6,191,105; 7,063,860; 7,070,802; 7,157,099;
Constantinides et al., Pharmaceutical Research, 1994, 11, 1385; Ho
et al., J. Pharm. Sci., 1996, 85, 138-143). Often microemulsions
can form spontaneously when their components are brought together
at ambient temperature. This can be particularly advantageous when
formulating thermolabile drugs, peptides or iRNAs. Microemulsions
have also been effective in the transdermal delivery of active
components in both cosmetic and pharmaceutical applications. It is
expected that the microemulsion compositions and formulations of
the present invention will facilitate the increased systemic
absorption of iRNAs and nucleic acids from the gastrointestinal
tract, as well as improve the local cellular uptake of iRNAs and
nucleic acids.
[0465] Microemulsions of the present invention can also contain
additional components and additives such as sorbitan monostearate
(Grill 3), Labrasol, and penetration enhancers to improve the
properties of the formulation and to enhance the absorption of the
iRNAs and nucleic acids of the present invention. Penetration
enhancers used in the microemulsions of the present invention can
be classified as belonging to one of five broad
categories--surfactants, fatty acids, bile salts, chelating agents,
and non-chelating non-surfactants (Lee et al., Critical Reviews in
Therapeutic Drug Carrier Systems, 1991, p. 92). Each of these
classes has been discussed above.
[0466] iii. Microparticles
[0467] an RNAi agent of the invention may be incorporated into a
particle, e.g., a microparticle. Microparticles can be produced by
spray-drying, but may also be produced by other methods including
lyophilization, evaporation, fluid bed drying, vacuum drying, or a
combination of these techniques.
[0468] iv. Penetration Enhancers
[0469] In one embodiment, the present invention employs various
penetration enhancers to effect the efficient delivery of nucleic
acids, particularly iRNAs, to the skin of animals. Most drugs are
present in solution in both ionized and nonionized forms. However,
usually only lipid soluble or lipophilic drugs readily cross cell
membranes. It has been discovered that even non-lipophilic drugs
can cross cell membranes if the membrane to be crossed is treated
with a penetration enhancer. In addition to aiding the diffusion of
non-lipophilic drugs across cell membranes, penetration enhancers
also enhance the permeability of lipophilic drugs.
[0470] Penetration enhancers can be classified as belonging to one
of five broad categories, i.e., surfactants, fatty acids, bile
salts, chelating agents, and non-chelating non-surfactants (see
e.g., Malmsten, M. Surfactants and polymers in drug delivery,
Informa Health Care, New York, N.Y., 2002; Lee et al., Critical
Reviews in Therapeutic Drug Carrier Systems, 1991, p. 92). Each of
the above mentioned classes of penetration enhancers are described
below in greater detail.
[0471] Surfactants (or "surface-active agents") are chemical
entities which, when dissolved in an aqueous solution, reduce the
surface tension of the solution or the interfacial tension between
the aqueous solution and another liquid, with the result that
absorption of iRNAs through the mucosa is enhanced. In addition to
bile salts and fatty acids, these penetration enhancers include,
for example, sodium lauryl sulfate, polyoxyethylene-9-lauryl ether
and polyoxyethylene-20-cetyl ether) (see e.g., Malmsten, M.
Surfactants and polymers in drug delivery, Informa Health Care, New
York, N.Y., 2002; Lee et al., Critical Reviews in Therapeutic Drug
Carrier Systems, 1991, p. 92); and perfluorochemical emulsions,
such as FC-43. Takahashi et al., J. Pharm. Pharmacol., 1988, 40,
252).
[0472] Various fatty acids and their derivatives which act as
penetration enhancers include, for example, oleic acid, lauric
acid, capric acid (n-decanoic acid), myristic acid, palmitic acid,
stearic acid, linoleic acid, linolenic acid, dicaprate, tricaprate,
monoolein (1-monooleoyl-rac-glycerol), dilaurin, caprylic acid,
arachidonic acid, glycerol 1-monocaprate,
1-dodecylazacycloheptan-2-one, acylcarnitines, acylcholines,
C.sub.1-20 alkyl esters thereof (e.g., methyl, isopropyl and
t-butyl), and mono- and di-glycerides thereof (i.e., oleate,
laurate, caprate, myristate, palmitate, stearate, linoleate, etc.)
(see e.g., Touitou, E., et al. Enhancement in Drug Delivery, CRC
Press, Danvers, Mass., 2006; Lee et al., Critical Reviews in
Therapeutic Drug Carrier Systems, 1991, p. 92; Muranishi, Critical
Reviews in Therapeutic Drug Carrier Systems, 1990, 7, 1-33; El
Hariri et al., J. Pharm. Pharmacol., 1992, 44, 651-654).
[0473] The physiological role of bile includes the facilitation of
dispersion and absorption of lipids and fat-soluble vitamins (see
e.g., Malmsten, M. Surfactants and polymers in drug delivery,
Informa Health Care, New York, N.Y., 2002; Brunton, Chapter 38 in:
Goodman & Gilman's The Pharmacological Basis of Therapeutics,
9th Ed., Hardman et al. Eds., McGraw-Hill, New York, 1996, pp.
934-935). Various natural bile salts, and their synthetic
derivatives, act as penetration enhancers. Thus the term "bile
salts" includes any of the naturally occurring components of bile
as well as any of their synthetic derivatives. Suitable bile salts
include, for example, cholic acid (or its pharmaceutically
acceptable sodium salt, sodium cholate), dehydrocholic acid (sodium
dehydrocholate), deoxycholic acid (sodium deoxycholate), glucholic
acid (sodium glucholate), glycholic acid (sodium glycocholate),
glycodeoxycholic acid (sodium glycodeoxycholate), taurocholic acid
(sodium taurocholate), taurodeoxycholic acid (sodium
taurodeoxycholate), chenodeoxycholic acid (sodium
chenodeoxycholate), ursodeoxycholic acid (UDCA), sodium
tauro-24,25-dihydro-fusidate (STDHF), sodium glycodihydrofusidate
and polyoxyethylene-9-lauryl ether (POE) (see e.g., Malmsten, M.
Surfactants and polymers in drug delivery, Informa Health Care, New
York, N.Y., 2002; Lee et al., Critical Reviews in Therapeutic Drug
Carrier Systems, 1991, page 92; Swinyard, Chapter 39 In:
Remington's Pharmaceutical Sciences, 18th Ed., Gennaro, ed., Mack
Publishing Co., Easton, Pa., 1990, pages 782-783; Muranishi,
Critical Reviews in Therapeutic Drug Carrier Systems, 1990, 7,
1-33; Yamamoto et al., J. Pharm. Exp. Ther., 1992, 263, 25;
Yamashita et al., J. Pharm. Sci., 1990, 79, 579-583).
[0474] Chelating agents, as used in connection with the present
invention, can be defined as compounds that remove metallic ions
from solution by forming complexes therewith, with the result that
absorption of iRNAs through the mucosa is enhanced. With regards to
their use as penetration enhancers in the present invention,
chelating agents have the added advantage of also serving as DNase
inhibitors, as most characterized DNA nucleases require a divalent
metal ion for catalysis and are thus inhibited by chelating agents
(Jarrett, J. Chromatogr., 1993, 618, 315-339). Suitable chelating
agents include but are not limited to disodium
ethylenediaminetetraacetate (EDTA), citric acid, salicylates (e.g.,
sodium salicylate, 5-methoxysalicylate and homovanilate), N-acyl
derivatives of collagen, laureth-9 and N-amino acyl derivatives of
beta-diketones (enamines)(see e.g., Katdare, A. et al., Excipient
development for pharmaceutical, biotechnology, and drug delivery,
CRC Press, Danvers, Mass., 2006; Lee et al., Critical Reviews in
Therapeutic Drug Carrier Systems, 1991, page 92; Muranishi,
Critical Reviews in Therapeutic Drug Carrier Systems, 1990, 7,
1-33; Buur et al., J. Control Rel., 1990, 14, 43-51).
[0475] As used herein, non-chelating non-surfactant penetration
enhancing compounds can be defined as compounds that demonstrate
insignificant activity as chelating agents or as surfactants but
that nonetheless enhance absorption of iRNAs through the alimentary
mucosa (see e.g., Muranishi, Critical Reviews in Therapeutic Drug
Carrier Systems, 1990, 7, 1-33). This class of penetration
enhancers includes, for example, unsaturated cyclic ureas, 1-alkyl-
and 1-alkenylazacyclo-alkanone derivatives (Lee et al., Critical
Reviews in Therapeutic Drug Carrier Systems, 1991, page 92); and
non-steroidal anti-inflammatory agents such as diclofenac sodium,
indomethacin and phenylbutazone (Yamashita et al., J. Pharm.
Pharmacol., 1987, 39, 621-626).
[0476] Agents that enhance uptake of iRNAs at the cellular level
can also be added to the pharmaceutical and other compositions of
the present invention. For example, cationic lipids, such as
lipofectin (Junichi et al, U.S. Pat. No. 5,705,188), cationic
glycerol derivatives, and polycationic molecules, such as
polylysine (Lollo et al., PCT Application WO 97/30731), are also
known to enhance the cellular uptake of dsRNAs. Examples of
commercially available transfection reagents include, for example
Lipofectamine.TM. (Invitrogen; Carlsbad, Calif.),
Lipofectamine2000.TM. (Invitrogen; Carlsbad, Calif.), 293fectin.TM.
(Invitrogen; Carlsbad, Calif.), Cellfectin.TM. (Invitrogen;
Carlsbad, Calif.), DMRIE-C.TM. (Invitrogen; Carlsbad, Calif.),
FreeStyle.TM. MAX (Invitrogen; Carlsbad, Calif.), Lipofectamine.TM.
2000 CD (Invitrogen; Carlsbad, Calif.), Lipofectamine.TM.
(Invitrogen; Carlsbad, Calif.), RNAiMAX (Invitrogen; Carlsbad,
Calif.), Oligofectamine.TM. (Invitrogen; Carlsbad, Calif.),
Optifect.TM. (Invitrogen; Carlsbad, Calif.), X-tremeGENE Q2
Transfection Reagent (Roche; Grenzacherstrasse, Switzerland), DOTAP
Liposomal Transfection Reagent (Grenzacherstrasse, Switzerland),
DOSPER Liposomal Transfection Reagent (Grenzacherstrasse,
Switzerland), or Fugene (Grenzacherstrasse, Switzerland),
Transfectam.RTM. Reagent (Promega; Madison, Wis.), TransFast.TM.
Transfection Reagent (Promega; Madison, Wis.), Tfx.TM.-20 Reagent
(Promega; Madison, Wis.), Tfx.TM.-50 Reagent (Promega; Madison,
Wis.), DreamFect.TM. (OZ Biosciences; Marseille, France),
EcoTransfect (OZ Biosciences; Marseille, France), TransPass.sup.a
D1 Transfection Reagent (New England Biolabs; Ipswich, Mass., USA),
LyoVec.TM./LipoGen.TM. (Invitrogen; San Diego, Calif., USA),
PerFectin Transfection Reagent (Genlantis; San Diego, Calif., USA),
NeuroPORTER Transfection Reagent (Genlantis; San Diego, Calif.,
USA), GenePORTER Transfection reagent (Genlantis; San Diego,
Calif., USA), GenePORTER 2 Transfection reagent (Genlantis; San
Diego, Calif., USA), Cytofectin Transfection Reagent (Genlantis;
San Diego, Calif., USA), BaculoPORTER Transfection Reagent
(Genlantis; San Diego, Calif., USA), TroganPORTER.TM. transfection
Reagent (Genlantis; San Diego, Calif., USA), RiboFect (Bioline;
Taunton, Mass., USA), PlasFect (Bioline; Taunton, Mass., USA),
UniFECTOR (B-Bridge International; Mountain View, Calif., USA),
SureFECTOR (B-Bridge International; Mountain View, Calif., USA), or
HiFect.TM. (B-Bridge International, Mountain View, Calif., USA),
among others.
[0477] Other agents can be utilized to enhance the penetration of
the administered nucleic acids, including glycols such as ethylene
glycol and propylene glycol, pyrrols such as 2-pyrrol, azones, and
terpenes such as limonene and menthone.
[0478] v. Carriers
[0479] Certain compositions of the present invention also
incorporate carrier compounds in the formulation. As used herein,
"carrier compound" or "carrier" can refer to a nucleic acid, or
analog thereof, which is inert (i.e., does not possess biological
activity per se) but is recognized as a nucleic acid by in vivo
processes that reduce the bioavailability of a nucleic acid having
biological activity by, for example, degrading the biologically
active nucleic acid or promoting its removal from circulation. The
coadministration of a nucleic acid and a carrier compound,
typically with an excess of the latter substance, can result in a
substantial reduction of the amount of nucleic acid recovered in
the liver, kidney or other extracirculatory reservoirs, presumably
due to competition between the carrier compound and the nucleic
acid for a common receptor. For example, the recovery of a
partially phosphorothioate dsRNA in hepatic tissue can be reduced
when it is coadministered with polyinosinic acid, dextran sulfate,
polycytidic acid or
4-acetamido-4'isothiocyano-stilbene-2,2'-disulfonic acid (Miyao et
al., DsRNA Res. Dev., 1995, 5, 115-121; Takakura et al., DsRNA
& Nucl. Acid Drug Dev., 1996, 6, 177-183.
[0480] vi. Excipients
[0481] In contrast to a carrier compound, a "pharmaceutical
carrier" or "excipient" is a pharmaceutically acceptable solvent,
suspending agent or any other pharmacologically inert vehicle for
delivering one or more nucleic acids to an animal. The excipient
can be liquid or solid and is selected, with the planned manner of
administration in mind, so as to provide for the desired bulk,
consistency, etc., when combined with a nucleic acid and the other
components of a given pharmaceutical composition. Typical
pharmaceutical carriers include, but are not limited to, binding
agents (e.g., pregelatinized maize starch, polyvinylpyrrolidone or
hydroxypropyl methylcellulose, etc.); fillers (e.g., lactose and
other sugars, microcrystalline cellulose, pectin, gelatin, calcium
sulfate, ethyl cellulose, polyacrylates or calcium hydrogen
phosphate, etc.); lubricants (e.g., magnesium stearate, talc,
silica, colloidal silicon dioxide, stearic acid, metallic
stearates, hydrogenated vegetable oils, corn starch, polyethylene
glycols, sodium benzoate, sodium acetate, etc.); disintegrants
(e.g., starch, sodium starch glycolate, etc.); and wetting agents
(e.g., sodium lauryl sulphate, etc).
[0482] Pharmaceutically acceptable organic or inorganic excipients
suitable for non-parenteral administration which do not
deleteriously react with nucleic acids can also be used to
formulate the compositions of the present invention. Suitable
pharmaceutically acceptable carriers include, but are not limited
to, water, salt solutions, alcohols, polyethylene glycols, gelatin,
lactose, amylose, magnesium stearate, talc, silicic acid, viscous
paraffin, hydroxymethylcellulose, polyvinylpyrrolidone and the
like.
[0483] Formulations for topical administration of nucleic acids can
include sterile and non-sterile aqueous solutions, non-aqueous
solutions in common solvents such as alcohols, or solutions of the
nucleic acids in liquid or solid oil bases. The solutions can also
contain buffers, diluents and other suitable additives.
Pharmaceutically acceptable organic or inorganic excipients
suitable for non-parenteral administration which do not
deleteriously react with nucleic acids can be used.
[0484] Suitable pharmaceutically acceptable excipients include, but
are not limited to, water, salt solutions, alcohol, polyethylene
glycols, gelatin, lactose, amylose, magnesium stearate, talc,
silicic acid, viscous paraffin, hydroxymethylcellulose,
polyvinylpyrrolidone and the like.
[0485] vii. Other Components
[0486] The compositions of the present invention can additionally
contain other adjunct components conventionally found in
pharmaceutical compositions, at their art-established usage levels.
Thus, for example, the compositions can contain additional,
compatible, pharmaceutically-active materials such as, for example,
antipruritics, astringents, local anesthetics or anti-inflammatory
agents, or can contain additional materials useful in physically
formulating various dosage forms of the compositions of the present
invention, such as dyes, flavoring agents, preservatives,
antioxidants, opacifiers, thickening agents and stabilizers.
However, such materials, when added, should not unduly interfere
with the biological activities of the components of the
compositions of the present invention. The formulations can be
sterilized and, if desired, mixed with auxiliary agents, e.g.,
lubricants, preservatives, stabilizers, wetting agents,
emulsifiers, salts for influencing osmotic pressure, buffers,
colorings, flavorings and/or aromatic substances and the like which
do not deleteriously interact with the nucleic acid(s) of the
formulation.
[0487] Aqueous suspensions can contain substances which increase
the viscosity of the suspension including, for example, sodium
carboxymethylcellulose, sorbitol and/or dextran. The suspension can
also contain stabilizers.
[0488] In some embodiments, pharmaceutical compositions featured in
the invention include (a) one or more iRNA compounds and (b) one or
more agents which function by a non-RNAi mechanism and which are
useful in treating a hemolytic disorder. Examples of such agents
include, but are not limited to an anti-inflammatory agent,
anti-steatosis agent, anti-viral, and/or anti-fibrosis agent. In
addition, other substances commonly used to protect the liver, such
as silymarin, can also be used in conjunction with the iRNAs
described herein. Other agents useful for treating liver diseases
include telbivudine, entecavir, and protease inhibitors such as
telaprevir and other disclosed, for example, in Tung et al., U.S.
Application Publication Nos. 2005/0148548, 2004/0167116, and
2003/0144217; and in Hale et al., U.S. Application Publication No.
2004/0127488.
[0489] Toxicity and therapeutic efficacy of such compounds can be
determined by standard pharmaceutical procedures in cell cultures
or experimental animals, e.g., for determining the LD50 (the dose
lethal to 50% of the population) and the ED50 (the dose
therapeutically effective in 50% of the population). The dose ratio
between toxic and therapeutic effects is the therapeutic index and
it can be expressed as the ratio LD50/ED50. Compounds that exhibit
high therapeutic indices are preferred.
[0490] The data obtained from cell culture assays and animal
studies can be used in formulating a range of dosage for use in
humans. The dosage of compositions featured herein in the invention
lies generally within a range of circulating concentrations that
include the ED50 with little or no toxicity. The dosage can vary
within this range depending upon the dosage form employed and the
route of administration utilized. For any compound used in the
methods featured in the invention, the therapeutically effective
dose can be estimated initially from cell culture assays. A dose
can be formulated in animal models to achieve a circulating plasma
concentration range of the compound or, when appropriate, of the
polypeptide product of a target sequence (e.g., achieving a
decreased concentration of the polypeptide) that includes the IC50
(i.e., the concentration of the test compound which achieves a
half-maximal inhibition of symptoms) as determined in cell culture.
Such information can be used to more accurately determine useful
doses in humans. Levels in plasma can be measured, for example, by
high performance liquid chromatography.
[0491] In addition to their administration, as discussed above, the
iRNAs featured in the invention can be administered in combination
with other known agents effective in treatment of pathological
processes mediated by PCSK9 expression. In any event, the
administering physician can adjust the amount and timing of iRNA
administration on the basis of results observed using standard
measures of efficacy known in the art or described herein.
VI. Kits
[0492] The present invention also provides kits for using any of
the iRNA agents and/or performing any of the methods of the
invention. Such kits include one or more RNAi agent(s) and
instructions for use, e.g., instructions for inhibiting expression
of a PCSK9 in a cell by contacting the cell with the RNAi agent(s)
in an amount effective to inhibit expression of the PCSK9. The kits
may optionally further comprise means for contacting the cell with
the RNAi agent (e.g., an injection device), or means for measuring
the inhibition of PCSK9 (e.g., means for measuring the inhibition
of PCSK9 mRNA protein). Such means for measuring the inhibition of
PCSK9 may comprise a means for obtaining a sample from a subject,
such as, e.g., a plasma sample. The kits of the invention may
optionally further comprise means for administering the RNAi
agent(s) to a subject or means for determining the therapeutically
effective or prophylactically effective amount.
[0493] Unless otherwise defined, all technical and scientific terms
used herein have the same meaning as commonly understood by one of
ordinary skill in the art to which this invention belongs. Although
methods and materials similar or equivalent to those described
herein can be used in the practice or testing of the iRNAs and
methods featured in the invention, suitable methods and materials
are described below. All publications, patent applications,
patents, and other references mentioned herein, as well as the
Sequence Listing and Figures, are incorporated by reference in
their entirety. In case of conflict, the present specification,
including definitions, will control. In addition, the materials,
methods, and examples are illustrative only and not intended to be
limiting.
EXAMPLES
Example 1. Synthesis of GalNAc-Conjugated Oligonucleotides
[0494] A series of siRNA duplexes targeting nucleotides 3544-3623
of the human PCSK9 gene (SEQ ID NO:1) were designed, synthesized.
These same sequences were also synthesized with various nucleotide
modifications and conjugated with a trivalent GalNAc. The sense and
antisense strand sequences of the modified duplexes are shown in
Table 1.
TABLE-US-00009 TABLE B Abbreviations of nucleotide monomers used in
nucleic acid sequence representation. Abbreviation Nucleotide(s) A
Adenosine-3'-phosphate Ab beta-L-adenosine-3'-phosphate Af
2'-fluoroadenosine-3'-phosphate Afs
2'-fluoroadenosine-3'-phosphorothioate As
adenosine-3'-phosphorothioate C cytidine-3'-phosphate Cb
beta-L-cytidine-3'-phosphate Cf 2'-fluorocytidine-3'-phosphate Cfs
2'-fluorocytidine-3'-phosphorothioate Cs
cytidine-3'-phosphorothioate G guanosine-3'-phosphate Gb
beta-L-guanosine-3'-phosphate Gbs
beta-L-guanosine-3'-phosphorothioate Gf
2'-fluoroguanosine-3'-phosphate Gfs
2'-fluoroguanosine-3'-phosphorothioate Gs
guanosine-3'-phosphorothioate T 5'-methyluridine-3'-phosphate Tf
2'-fluoro-5-methyluridine-3'-phosphate Tfs
2'-fluoro-5-methyluridine-3'-phosphorothioate Ts
5-methyluridine-3'-phosphorothioate U Uridine-3'-phosphate Uf
2'-fluorouridine-3'-phosphate Ufs
2'-fluorouridine-3'-phosphorothioate Us uridine-3'-phosphorothioate
N any nucleotide (G, A, C, T or U) a
2'-O-methyladenosine-3'-phosphate as
2'-O-methyladenosine-3'-phosphorothioate c
2'-O-methylcytidine-3'-phosphate cs
2'-O-methylcytidine-3'-phosphorothioate g
2'-O-methylguanosine-3'-phosphate gs
2'-O-methylguanosine-3'-phosphorothioate t
2'-O-methyl-5-methyluridine-3'-phosphate ts
2'-O-methyl-5-methyluridine-3'-phosphorothioate u
2'-O-methyluridine-3'-phosphate us
2'-O-methyluridine-3'-phosphorothioate dT
2'-deoxythymidine-3'-phosphate dTs
2'-deoxythymidine-3'-phosphorothioate dU
2'-deoxyuridine-3'-phosphate dUs
2'-deoxyuridine-3'-phosphorothioate s phosphorothioate linkage L96
N-[tris(GalNAc-alkyl)-amidodecanoyl)]-4-hydroxyprolinol
Hyp-(GalNAc-alkyl)3 (Aeo) 2'-O-methoxyethyladenosine-3'-phosphate
(Aeos) 2'-O-methoxyethyladenosine-3'-phosphorothioate (Geo)
2'-O-methoxyethylguanosine-3'-phosphate (Geos)
2'-O-methoxyethylguanosine-3'-phosphorothioate (Teo)
2'-O-methoxyethyl-5-methyluridine-3'-phosphate (Teos)
2'-O-methoxyethyl-5-methyluridine-3'-phosphorothioate (m5Ceo)
2'-O-methoxyethyl-5-methylcytidine-3'-phosphate (m5Ceos)
2'-O-methoxyethyl-5-methylcytidine-3'-phosphorothioate (A3m)
3'-O-methyladenosine-2'-phosphate (A3mx)
3'-O-methyl-xylofuranosyladenosine-2'-phosphate (G3m)
3'-O-methylguanosine-2'-phosphate (G3mx)
3'-O-methyl-xylofuranosylguanosine-2'-phosphate (C3m)
3'-O-methylcytidine-2'-phosphate (C3mx)
3'-O-methyl-xylofuranosylcytidine-2'-phosphate (U3m)
3'-O-methyluridine-2'-phosphate (U3mx)
3'-O-methylxylouridine-2'-phosphate (Chd)
2'-O-hexadecyl-cytidine-3'-phosphate (pshe)
Hydroxyethylphosphorothioate (Uhd)
2'-O-hexadecyl-uridine-3'-phosphate (Tgn) Thymidine-glycol nucleic
acid (GNA) S-Isomer (Cgn) Cytidine-glycol nucleic acid (GNA) (Chd)
2'-O-hexadecyl-cytidine-3'-phosphate (Ggn)
2'-O-hexadecyl-cytidine-3'-phosphate (Agn) Adenosine-glycol nucleic
acid (GNA) P 5'-phosphate (m5Cam)
2'-O-(N-methylacetamide)-5-methylcytidine-3'-phosphate (m5Cams)
2'-O-(N-methylacetamide)-5-methylcytidine-3'- phosphorothioate
(Tam) 2'-O-(N-methylacetamide)thymidine-3'-phosphate (Tams)
2'-O-(N-methylacetamide)thymidine-3'-phosphorothioate (Aam)
2'-O-(N-methylacetamide)adenosine-3'-phosphate (Aams)
2'-O-(N-methylacetamide)adenosine-3'-phosphorothioate (Gam)
2'-O-(N-methylacetamide)guanosine-3'-phosphate (Gams)
2'-O-(N-methylacetamide)guanosine-3'-phosphorothioate (Uyh)
2'-O-(1-hexyl-4-methylene-1,2,3-triazolyl)-uridine-3'- phosphate
(Ayh) 2'-O-(1-hexyl-4-methylene-1,2,3-triazolyl)-adenosine-3'-
phosphate (Gyh)
2'-O-(1-hexyl-4-methylene-1,2,3-triazolyl)-guanosine-3'- phosphate
(Cyh) 2'-O-(1-hexyl-4-methylene-1,2,3-triazolyl)-cytidine-3'-
phosphate (iA) inverted adenosine-5'-phosphate (iC) inverted
cytidine-5'-phosphate
TABLE-US-00010 TABLE 1 Double-Stranded Ribonucleic Acid (RNAi)
Agents Targeting Nucleotides 3544-3623 of Human PCSK9 (SEQ ID NO:
1). Duplex SEQ ID Start In Antisense SEQ ID ID Sense ID NO: Sense
Sequence (5' to 3') NM_174936.3 ID NO: Antisense Sequence (5' to
3') AD-53806 A-110717 7 CfaAfgCfaGfaCfAfUfuUfaUfcUfuUfuUfL96 3544
A-109589 8 aAfaAfaGfaUfaAfaugUfcUfgCfuUfgsCfsu AD-53806 A-110717 9
CfaAfgCfaGfaCfAfUfuUfaUfcUfuUfuUfL96 3544 A-109589 10
aAfaAfaGfaUfaAfaugUfcUfgCfuUfgsCfsu AD-53806 A-110717 11
CfaAfgCfaGfaCfAfUfuUfaUfcUfuUfuUfL96 3544 A-109589 12
aAfaAfaGfaUfaAfaugUfcUfgCfuUfgsCfsu AD-53806 A-110717 13
CfaAfgCfaGfaCfAfUfuUfaUfcUfuUfuUfL96 3544 A-109589 14
aAfaAfaGfaUfaAfaugUfcUfgCfuUfgsCfsu AD-53806 A-110717 15
CfaAfgCfaGfaCfAfUfuUfaUfcUfuUfuUfL96 3544 A-109589 16
aAfaAfaGfaUfaAfaugUfcUfgCfuUfgsCfsu AD-53806 A-110717 17
CfaAfgCfaGfaCfAfUfuUfaUfcUfuUfuUfL96 3544 A-109589 18
aAfaAfaGfaUfaAfaugUfcUfgCfuUfgsCfsu AD-53806 A-110717.6 19
CfaAfgCfaGfaCfAfUfuUfaUfcUfuUfuUfL96 3544 A-109589 20
aAfaAfaGfaUfaAfaugUfcUfgCfuUfgsCfsu AD-53806 A-110717.7 21
CfaAfgCfaGfaCfAfUfuUfaUfcUfuUfuUfL96 3544 A-109589 22
aAfaAfaGfaUfaAfaugUfcUfgCfuUfgsCfsu AD-53806 A-110717.8 23
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CfUfAfGfAfCfCfuGfUfUfuUfGfCfUfUfUfUfGfUf 3603 A-115548 504
aCfaAfAfAfgCfaAfaacAfgGfUfCfuAfgsAfsa L96 AD-56650 A-115547 505
CfUfAfGfAfCfCfUfGfUfUfUfUfGfCfUfUfUfUfGf 3603 A-115548 506
aCfaAfAfAfgCfaAfaacAfgGfUfCfuAfgsAfsa UfL96 AD-56656 A-110695 507
CfuAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115549 508
aCfaAfAfAfGfCfaAfaacAfgGfUfCfuAfgsAfsa AD-56662 A-115542 509
CfuAfGfAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115549 510
aCfaAfAfAfGfCfaAfaacAfgGfUfCfuAfgsAfsa AD-56668 A-115543 511
CfuAfGfAfcCfuGfUfUfuUfGfCfuUfuUfgUfL96 3603 A-115549 512
aCfaAfAfAfGfCfaAfaacAfgGfUfCfuAfgsAfsa AD-56673 A-115544 513
CfuAfGfAfcCfuGfUfUfuUfGfCfuUfUfUfgUfL96 3603 A-115549 514
aCfaAfAfAfGfCfaAfaacAfgGfUfCfuAfgsAfsa AD-56678 A-115545 515
CfuAfGfAfCfCfuGfUfUfuUfGfCfuUfUfUfGfUfL 3603 A-115549 516
aCfaAfAfAfGfCfaAfaacAfgGfUfCfuAfgsAfsa 96 AD-56683 A-115546 517
CfUfAfGfAfCfCfuGfUfUfuUfGfCfUfUfUfUfGfUf 3603 A-115549 518
aCfaAfAfAfGfCfaAfaacAfgGfUfCfuAfgsAfsa L96 AD-56688 A-115547 519
CfUfAfGfAfCfCfUfGfUfUfUfUfGfCfUfUfUfUfGf 3603 A-115549 520
aCfaAfAfAfGfCfaAfaacAfgGfUfCfuAfgsAfsa UfL96 AD-56657 A-115550 521
CfuAfgAfcCfuGfUfUfuUfgCfuUfuugUfL96 3603 A-115551 522
aCfAfAfaAfgCfaAfaacAfgGfuCfuAfgsAfsa AD-56663 A-115552 523
CfuAfgAfcCfuGfUfUfuUfgCfuuuUfgUfL96 3603 A-115553 524
aCfaAfAfAfgCfaAfaacAfgGfuCfuAfgsAfsa AD-56669 A-115554 525
CfuAfgAfcCfuGfUfUfuUfgcuUfuUfgUfL96 3603 A-115555 526
aCfaAfaAfGfCfaAfaacAfgGfuCfuAfgsAfsa AD-56674 A-115556 527
CfuAfgAfcCfuGfUfUfuugCfuUfuUfgUfL96 3603 A-115557 528
aCfaAfaAfgCfAfAfaacAfgGfuCfuAfgsAfsa AD-56679 A-115558 529
CfuAfgAfccuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115559 530
aCfaAfaAfgCfaAfaacAfGfGfuCfuAfgsAfsa AD-56684 A-115560 531
CfuAfgacCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115561 532
aCfaAfaAfgCfaAfaacAfgGfUfCfuAfgsAfsa AD-56689 A-115535 533
CfuagAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115562 534
aCfaAfaAfgCfaAfaacAfgGfuCfUfAfgsAfsa AD-56693 A-115520 535
cuAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115563 536
aCfaAfaAfgCfaAfaacAfgGfuCfuAfGfsAfsa AD-56658 A-115564 537
CfuAfgAfcCfuGfUfUfuUfgCfuUfUfUfgUfL96 3603 A-115565 538
aCfaaaAfgCfaAfaacAfgGfuCfuAfgsAfsa AD-56664 A-115566 539
CfuAfgAfcCfuGfUfUfuUfgCfUfUfuUfgUfL96 3603 A-115567 540
aCfaAfaagCfaAfaacAfgGfuCfuAfgsAfsa AD-56670 A-115568 541
CfuAfgAfcCfuGfUfUfuUfGfCfuUfuUfgUfL96 3603 A-115569 542
aCfaAfaAfgcaAfaacAfgGfuCfuAfgsAfsa AD-56680 A-115572 543
CfuAfgAfcCfUfGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115573 544
aCfaAfaAfgCfaAfaacagGfuCfuAfgsAfsa AD-56685 A-115574 545
CfuAfgAfCfCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115575 546
aCfaAfaAfgCfaAfaacAfgguCfuAfgsAfsa AD-56690 A-115542 547
CfuAfGfAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115576 548
aCfaAfaAfgCfaAfaacAfgGfucuAfgsAfsa AD-56694 A-115577 549
CfUfAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115578 550
aCfaAfaAfgCfaAfaacAfgGfuCfuagsAfsa AD-56659 A-110695 551
CfuAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 A-115579 552
aCfaAfaAfgCfaAfaacAfgGfuCfuAfgsasa AD-59214 553
AsGsAccuGuuuuGcuuuuGuL96 3603 554 AscsAAAAGcAAAAcAGGucusAsG
AD-59251 555 CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 556
asCfsaAfaAfgCfaAfaacAfgGfuCfusAfsg AD-59261 557
AfsgsAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 558
asCfsaAfaAfgCfaAfaacAfgGfuCfusasg AD-59262 559
usAfsgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 560
asCfsaAfaAfgCfaAfaacAfgGfuCfusasg AD-59265 561
csusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3603 562
asCfsaAfaAfgCfaAfaacAfgGfuCfusasg AD-53821 A-110696 563
UfaGfaCfcUfgUfUfUfuGfcUfuUfuGfuAfL96 3604 A-109547 564
uAfcAfaAfaGfcAfaaaCfaGfgUfcUfasGfsa AD-59256 565
usAfsgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3604 566
asCfsaAfaAfgCfaAfaacAfgGfuCfsusAf AD-59247 567
gsAfscCfuGfUfUfuUfgCfuUfuUfgUfL96 3604 568
asCfsaAfaAfgCfaAfaacAfgGfuCfsusa AD-59252 569
AfsgsAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3604 570
asCfsaAfaAfgCfaAfaacAfgGfuCfsusa AD-59257 571
usAfsgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3604 572
asCfsaAfaAfgCfaAfaacAfgGfuCfsusa AD-56665 A-115580 573
AfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3605 A-115581 574
aCfaAfaAfgCfaAfaacAfgGfuCfusAfsg AD-56671 A-115582 575
AfgAfcCfuGfUfUfuUfgCfuUfuugUfL96 3605 A-115583 576
aCfAfAfaAfgCfaAfaacAfgGfuCfusAfsg AD-56676 A-115584 577
AfgAfcCfuGfUfUfuUfgCfuuuUfgUfL96 3605 A-115585 578
aCfaAfAfAfgCfaAfaacAfgGfuCfusAfsg AD-56681 A-115586 579
AfgAfcCfuGfUfUfuUfgcuUfuUfgUfL96 3605 A-115587 580
aCfaAfaAfGfCfaAfaacAfgGfuCfusAfsg AD-56686 A-115588 581
AfgAfcCfuGfUfUfuugCfuUfuUfgUfL96 3605 A-115589 582
aCfaAfaAfgCfAfAfaacAfgGfuCfusAfsg AD-56691 A-115590 583
AfgAfccuGfUfUfuUfgCfuUfuUfgUfL96 3605 A-115591 584
aCfaAfaAfgCfaAfaacAfGfGfuCfusAfsg AD-56695 A-115592 585
AfgacCfuGfUfUfuUfgCfuUfuUfgUfL96 3605 A-115593 586
aCfaAfaAfgCfaAfaacAfgGfUfCfusAfsg AD-56660 A-115594 587
agAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3605 A-115595 588
aCfaAfaAfgCfaAfaacAfgGfuCfUfsAfsg AD-56666 A-115596 589
AfgAfcCfuGfUfUfuUfgCfuUfUfUfgUfL96 3605 A-115597 590
aCfaaaAfgCfaAfaacAfgGfuCfusAfsg AD-56672 A-115598 591
AfgAfcCfuGfUfUfuUfgCfUfUfuUfgUfL96 3605 A-115599 592
aCfaAfaagCfaAfaacAfgGfuCfusAfsg AD-56677 A-115600 593
AfgAfcCfuGfUfUfuUfGfCfuUfuUfgUfL96 3605 A-115601 594
aCfaAfaAfgcaAfaacAfgGfuCfusAfsg AD-56682 A-115602 595
AfgAfcCfuGfUfUfUfUfgCfuUfuUfgUfL96 3605 A-115603 596
aCfaAfaAfgCfaaaacAfgGfuCfusAfsg AD-56687 A-115604 597
AfgAfcCfUfGfUfUfuUfgCfuUfuUfgUfL96 3605 A-115605 598
aCfaAfaAfgCfaAfaacagGfuCfusAfsg AD-56692 A-115606 599
AfgAfCfCfuGfUfUfuUfgCfuUfuUfgUfL96 3605 A-115607 600
aCfaAfaAfgCfaAfaacAfgguCfusAfsg AD-56696 A-115608 601
AfGfAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3605 A-115609 602
aCfaAfaAfgCfaAfaacAfgGfucusAfsg AD-56661 A-115580 603
AfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3605 A-115610 604
aCfaAfaAfgCfaAfaacAfgGfuCfusasg AD-56667 A-115611 605
gAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3605 A-115612 606
aCfaAfaAfgCfaAfaacAfgGfuCfausa AD-59260 607
AfsgsAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3605 608
asCfsaAfaAfgCfaAfaacAfgGfusCfsu AD-59248 609
gsAfscCfuGfUfUfuUfgCfuUfuUfgUfL96 3605 610
asCfsaAfaAfgCfaAfaacAfgGfusCfsu AD-53826 A-110697 611
UfuUfuGfuAfaCfUfUfgAfaGfaUfaUfuUfL96 3618 A-109549 612
aAfaUfaUfcUfuCfaagUfuAfcAfaAfasGfsc AD-53832 A-110698 613
UfuUfgUfaAfcUfUfGfaAfgAfuAfuUfuAfL96 3619 A-109551 614
uAfaAfuAfuCfuUfcaaGfuUfaCfaAfasAfsg AD-53792 A-110699 615
UfuGfuAfaCfuUfGfAfaGfaUfaUfuUfaUfL96 3620 A-109553 616
aUfaAfaUfaUfcUfucaAfgUfuAfcAfasAfsa AD-53798 A-110700 617
UfgUfaAfcUfuGfAfAfgAfuAfuUfuAfuUfL96 3621 A-109555 618
aAfuAfaAfuAfuCfuucAfaGfuUfaCfasAfsa AD-53819 A-110727 619
GfuAfaCfuUfgAfAfGfaUfaUfuUfaUfuUfL96 3622 A-109609 620
aAfaUfaAfaUfaUfcuuCfaAfgUfuAfcsAfsa AD- A-117428 621
CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-117429 622
asCfsaAfaAfgCfaAfaacAfgGfuCfuAfgsasa 579285 AD-60928 A-122701 623
CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgAfL96 3602 A-122702 624
usCfsaAfaAfgCfaAfaacAfgGfuCfuAfgsasa AD-60929 A-122703 625
GfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122704 626
asCfsaAfaAfgCfaAfaacAfgGfuCfuAfcsusu AD-60930 A-122705 627
GfsasAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122706 628
asCfsaAfaAfgCfaAfaacAfgGfuCfuUfcsusu AD-60931 A-122707 629
GfsasUfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122708 630
asCfsaAfaAfgCfaAfaacAfgGfuCfaUfcsusu AD-60932 A-122707 631
GfsasUfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122709 632
asCfsaAfaAfgCfaAfaacAfgGfuCfaUfcsasa AD-60933 A-122710 633
CfsasUfcAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122711 634
asCfsaAfaAfgCfaAfaacAfgGfuGfaUfgsasa AD-60934 A-122712 635
CfsusUfcUfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122713 636
asCfsaAfaAfgCfaAfaacAfgGfaGfaAfgsasa
AD-60927 A-122714 637 CfsusAfcUfgCfuGfUfUfuUfgCfuUfuUfgUfL96 3602
A-122715 638 asCfsaAfaAfgCfaAfaacAfgCfaGfuAfgsasa AD- A-117428 639
CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-117429 640
asCfsaAfaAfgCfaAfaacAfgGfuCfuAfgsasa 579285 AD-60906 A-117428 641
CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122309 642
asCfsaAfaAfgCf(Ayh)AfaacAfgGfuCfuAfgsasa AD-60907 A-117428 643
CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122310 644
asCfsaAfaAfgCfa(Ayh)aacAfgGfuCfuAfgsasa AD-60908 A-117428 645
CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122311 646
asCfsaAfaAfgCfaAf(Ayh)acAfgGfuCfuAfgsasa AD-60909 A-117428 647
CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122312 648
asCfsaAfaAfgCfaAfa(Ayh)cAfgGfuCfuAfgsasa AD-60910 A-117428 649
CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-122313 650
asCfsaAfaAfgCf(Ayh)AfaacAf(Gyh)GfuCf(Uyh) Afgsasa AD-60911 A-122307
651 Cfsus(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-117429 652
asCfsaAfaAfgCfaAfaacAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD-60912 A-122308 653
(Cyh)u(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-117429 654
asCfsaAfaAfgCfaAfaacAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD-60913 A-122307 655
Cfsus(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122309 656
asCfsaAfaAfgCf(Ayh)AfaacAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD-60914 A-122307 657
Cfsus(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122310 658
asCfsaAfaAfgCfa(Ayh)aacAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD-60915 A-122307 659
Cfsus(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122311 660
asCfsaAfaAfgCfaAf(Ayh)acAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD- A-117428 661
CfsusAfgAfcCfuGfUfUfuUfgCfuUfuUfgUfL96 3602 A-117429 662
asCfsaAfaAfgCfaAfaacAfgGfuCfuAfgsasa 579285 AD-60916 A-122307 663
Cfsus(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122312 664
asCfsaAfaAfgCfaAfa(Ayh)cAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD-60917 A-122307 665
Cfsus(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122313 666
asCfsaAfaAfgCf(Ayh)AfaacAf(Gyh)GfuCf(Uyh)
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 Afgsasa AD-60918 A-122308 667
(Cyh)u(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122309 668
asCfsaAfaAfgCf(Ayh)AfaacAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD-60919 A-122308 669
(Cyh)u(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122310 670
asCfsaAfaAfgCfa(Ayh)aacAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD-60920 A-122308 671
(Cyh)u(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122311 672
asCfsaAfaAfgCfaAf(Ayh)acAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD-60921 A-122308 673
(Cyh)u(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122312 674
asCfsaAfaAfgCfaAfa(Ayh)cAfgGfuCfuAfgsasa
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 AD-60922 A-122308 675
(Cyh)u(Ayh)(Gyh)(Ayh)(Cyh)CfuGfUfUfuUf 3602 A-122313 676
asCfsaAfaAfgCf(Ayh)AfaacAf(Gyh)GfuCf(Uyh)
(Gyh)Cf(Uyh)Uf(Uyh)Uf(Gyh)UfL96 Afgsasa AD-58900 677
CfsasAfgCfaGfaCfAfUfuUfaUfcUfuUfuUfL96 3602 678
asAfsaAfaGfaUfaAfaugUfcUfgCfuUfgscsu AD-59849 A-121244 679
CfsusAfgAfcCfuGfUfUfuUfgcuuuuguL96 3602 680
asCfsaAfaagCfaAfaacAfgGfucuAfgsasa AD-60688 A-120188 681
csusagacCfuGfuuuugcuuuuguL96 3602 682
asCfsaAfaagCfaAfaacAfgGfucuAfgsasa AD-60212 A-122088 683
csusagacCfuGfudTuugcuuuuguL96 3602 684
asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa
Example 2: Phase I Clinical Trial of AD-60212
[0495] A Phase I, randomized, single-blind, placebo-controlled
study, including, a single ascending dose (SAD) arm and a
multi-ascending dose (MAD) arm, was conducted in subjects with
elevated low-density lipoprotein cholesterol (LDLc or LDL-C), on or
off statins, to evaluate the safety, tolerability, pharmacokinetics
and pharmacodynamics of subcutaneously administered AD-60212.
[0496] More specifically, in the SAD phase of the study, the
ability of a single subcutaneous fixed dose of 25 mg, 100 mg, 300
mg, 500 mg, or 800 mg of AD-60212 (ALN-PCSsc) to lower both PCSK9
protein and LDL-C in healthy volunteer subjects with baseline LDL-C
.gtoreq.100 mg/dl (.gtoreq.2.6 mmol/L) and fasting triglycerides
<400 mg/dl (<4.5 mmol/L) was tested. In the MAD phase of the
study, subjects with LDL-C .gtoreq.100 mg/dl, and fasting
triglycerides <400 mg/dl (<4.5 mmol/L) on and off of a stable
dose of statin for .gtoreq.30 days prior to screening were treated
with multiple subcutaneous injections of AD-60212 to test the
ability of AD-60212 to lower both PCSK9 protein and LDL-C. Subjects
in the multiple administration arm of the study were administered a
single 125 mg fixed dose of AD-60212 once every week for four weeks
(125 mg qW.times.4), or a single 250 mg fixed dose of AD-60212 once
every two weeks for one month (250 mg q2W.times.2), or a single 300
mg fixed dose of AD-60212 once every month for two months (300 mg
qM.times.2) without statin therapy, or a single 300 mg fixed dose
of AD-60212 once every month for two months (300 mg qM.times.2)
with statin therapy, or a single 500 mg fixed dose of AD-60212 once
every month for two months (500 mg qM.times.2) without statin
therapy, or a single 500 mg fixed dose of AD-60212 once every month
for two months (500 mg qM.times.2) with statin therapy.
[0497] Plasma PCSK9 protein levels were determined using an ELISA
assay and serum LDL-C levels were determined directly by
.beta.-quantification (Medpace Reference Laboratories, Leuven,
Belgium). The levels of total cholesterol, high-density lipoprotein
cholesterol (HDL-C), non-HDL-C (total cholesterol minus HDL-C),
apolipoprotein B, lipoprotein (a) and triglyceride were also
determined.
[0498] The cohort demographics and the baseline characteristics of
the subjects in the SAD phase of the study are provided in Table 2A
and the cohort demographics and the baseline characteristics of the
subjects in the MAD phase of the study are provided in Table
2B.
[0499] The unmodified sense and antisense sequences of AD-60212
are:
TABLE-US-00011 Sense- (SEQ ID NO: 686) 5'-CUAGACCUGUTUUGCUUUUGU-3';
and Antisense- (SEQ ID NO: 685) 5'-ACAAAAGCAAAACAGGUCUAGAA-3'.
[0500] The modified sense and antisense sequences of AD-60212
are:
TABLE-US-00012 Sense- (SEQ ID NO: 687)
5'-csusagacCfuGfudTuugcuuuugu-3'; and Antisense- (SEQ ID NO: 688)
5'-asCfsaAfAfAfgCfaAfaAfcAfgGfuCfuagsasa-3'.
SAD Phase
[0501] AD-60212 was well tolerated at all dose levels in the SAD
phase and there were no treatment discontinuations due to adverse
events (AEs) and no serious AEs were reported.
[0502] The knockdown of PCSK9 protein levels in the single dose
cohort, shown as a percent mean PCSK9 knockdown relative to
baseline, is shown in FIG. 1, and the lowering of LDL-C levels in
the single dose cohort, shown as a percent mean LDL-C lowering
relative to baseline, is shown in FIG. 2. Table 3 provides the mean
(SD) percent change from baseline in the protein level of PCSK9,
the level of LDL-C, the level of total cholesterol, the level of
HDL-C, the level of non-HDL-C, the level of apolipoprotein B, the
level of triglycerides, and the level of apolipoprotein a at days
84 and 180 post-dose in the SAD phase.
[0503] The data demonstrate that administration of AD-60212 reduced
PCSK9 levels in a dose-dependent manner up to 300 mg. Doses
.gtoreq.300 mg produced similar, sustained reductions in PCSK9
levels that were maintained over a period of at least 6 months.
PCSK9 levels returned to baseline (mean of last three measurements
.gtoreq.80% of baseline) by day 180 in the 25-mg and 100-mg dose
cohorts. In subjects receiving doses .gtoreq.300 mg (n=12), the
maximum individual relative reduction from baseline in PCSK9 levels
was 89% (800-mg dose, day 112). The mean maximal percent reduction
(mean percent reduction at individual nadir) was 82% and was
observed in the 800-mg dose cohort. Change from baseline in PCSK9
levels in subjects receiving ALN-PCSsc 300-800 mg (n=2-6 per dose
group), was significantly greater than in placebo-treated subjects
(P.ltoreq.0.011) for all 11 measurement points from day 7.+-.1
post-treatment through day 112 post-treatment.
[0504] The data further demonstrate that AD-60212 administration
resulted in dose-dependent LDL-C reductions up to 300 mg, at which
near maximal reductions were achieved. LDL-C reductions were
similar across the 300-800 mg dose range. In subjects receiving
these doses (n=12), the maximum individual decrease from baseline
in LDL-C was 78% (500-mg dose; day 56). The mean maximal and
maximal least-squares mean (LSM) percent reductions were 59% and
were observed in the 500 and 800-mg cohorts. LDL-C levels returned
towards baseline levels by 180 days after the last administration
of the 25-mg and 100-mg doses. LDL-C reduction was maintained until
at least day 180 after doses .gtoreq.300 mg. LDL-C reduction from
baseline in subjects receiving ALN-PCSsc 300-800 mg (n=3-6) was
statistically significant compared with placebo (P.ltoreq.0.037) in
all 10 determinations from day 14.+-.2 after treatment through day
112 after treatment.
[0505] Decreases in total cholesterol, non-HDL-C, apolipoprotein B
and lipoprotein (a) concentrations were also noted in
AD-60212-treated subjects. Reductions in these parameters were
statistically significant compared with placebo for the majority of
comparisons.
MAD Phase
[0506] AD-60212 was also well tolerated at all dose levels in the
MAD phase and there were no treatment discontinuations due to
adverse events (AEs) and no serious AEs were reported.
[0507] The knockdown of PCSK9 protein levels in the multiple dose
cohort, shown as a percent mean PCSK9 knockdown relative to
baseline, is shown in FIG. 3, and the lowering of LDL-C levels in
the multiple dose cohort, shown as a percent mean LDL-C lowering
relative to baseline, is shown in FIG. 4. Table 4 provides the mean
(SD) percent change from baseline in the protein level of PCSK9,
the level of LDL-C, the level of total cholesterol, the level of
HDL-C, the level of non-HDL-C, the level of apolipoprotein B, the
level of triglycerides, and the level of apolipoprotein a at days
84 and 180 post-dose in the SAD phase.
[0508] The data demonstrate that PCSK9 protein levels were reduced
following administration of AD-60212 with all treatment regimens
studied. Reductions were similar across all multiple dose cohorts
and the reductions were maintained for at least 6 months after the
last dose. Consistent with published literature (Khera A V, et al.
(2015) Am J Cardiol 115:178-82; Guo Y L, et al. (2013) Clin Drug
Investig 33:877-83), baseline values of PCSK9 were higher in
subjects receiving stable doses of statins. Reductions in PCSK9
were independent of baseline PCSK9 levels and similar in subjects
irrespective of statin therapy. The maximum individual reduction
from baseline in PCSK9 was 94% (500 mg QM.times.2 co-administered
with statin, day 63). The mean maximal percent reduction was 89%,
observed in subjects receiving the 500-mg dose co-treated with a
statin. Change in PCSK9 concentrations from baseline in subjects
receiving multiple doses of AD-60212 as monotherapy (i.e., without
statins; n=3-6 per dose group), was significantly greater than
placebo (P.ltoreq.0.002) for all 15 measurement points from day 4
post-treatment through day 126.
[0509] The data further demonstrate that similar sustained LDL-C
reductions were achieved with all multiple dose AD-60212 treatment
regimens. LDL-C reduction was independent of baseline LDL-C levels
and similar with and without statin co-therapy. The maximum
individual LDL-C reduction was 83% (500 mg QM.times.2
co-administered with statin, day 29). The mean maximal percent
reduction in LDL-C was 64% with a LSM reduction of 60% observed in
the cohort receiving the 300-mg dose without statin. LDL-C lowering
in all MD cohorts persisted for at least 6 months.
[0510] Change in LDL-C from baseline in AD-60212 monotherapy
subjects (n=3-6) differed significantly from placebo
(P.ltoreq.0.05) over periods ranging from .about.8 to .about.17
weeks depending on the treatment regimen.
[0511] Decreases in total cholesterol, non-HDL-C, apolipoprotein B
and lipoprotein (a) concentrations were also noted in
ALN-PCSsc-treated subjects. Reductions in these parameters were
statistically significant compared with placebo for the majority of
comparisons.
[0512] In summary, subcutaneous administration of AD-60212
targeting PCSK9 to reduce LDL-C levels, was well tolerated in
single doses of 25 to 800 mg, and in MD regimens of 2-4 doses
totaling 500-1000 mg over a 28-day period.
[0513] As shown in Figures land 2 and Table 3, a single
subcutaneous injection of a fixed dose (.gtoreq.300 mg of AD-60212
resulted in durable knockdown of PCSK9 and lowering of LDL-C for
over 6 months after a single dose. There was up to 89% maximal
PCSK9 knockdown, with a mean maximal PCSK9 reduction of 82%, and up
to 78% maximal reduction LDL-C lowering, with a mean maximal LDL-C
reduction of 59% after administration of a single fixed dose of
AD-60212. In addition, LDL-C was significantly (P<0.001) reduced
by a mean of 44% at day 140 after a single dose.
[0514] As shown in FIGS. 3 and 4 and Table 4, two monthly fixed
doses of AD-60212 resulted in up to 94% maximal knockdown of PCSK9,
with a mean maximal PCSK9 reduction of 89%, and up to 83% maximal
reduction of LDL-C, with a mean maximal LDL-C reduction of 64%,
with or without concomitant statin administration.
[0515] These data demonstrate that single doses of AD-60212
(.gtoreq.300 mg) and all multiple doses demonstrated herein were
associated with highly sustained reductions of circulating
concentrations of both PCSK9 and LDL-C. At these doses, the effect
on PCSK9 and LDL-C remained significantly reduced for at least 180
days post-treatment, such that PCSK9 reductions of up to 76%, and
LDL-C reductions of up to 48% were still apparent 6 months after
the last AD-60212 injection, and demonstrated remarkably little
variation over the 6-month post-dose period. Additive serum LDL-C
lowering was attained with AD-60212 when added to statin therapy,
and the combination therapy did not impact the safety and
tolerability of either agent.
[0516] In both the SAD and MAD phases, decreases in total
cholesterol, non-HDL-C, apolipoprotein B and lipoprotein (a)
concentrations were observed in AD-60212-treated subjects.
Reductions in these parameters were statistically significant
compared with placebo for the majority of comparisons.
TABLE-US-00013 TABLE 2A SAD Cohort Demographics and Baseline
Characteristics. Single ascending dose phase ALN-PCSsc Placebo
Placebo 25 mg 100 mg 300 mg 500 mg 800 mg Overall With Statin No
Statin (n = 6) (n = 3) (n = 3) (n = 3) (n = 3) (n = 6) (n = 24) (n
= 4) (n = 8) Age, years 48 47 48 48 39 49 47 58 51 Mean (SD) (14.2)
(14.2) (6.2) (12.7) (14.0) (6.7) (10.7) (3.0) (14.2) Sex, n (%)
Male 2 3 3 3 3 5 19 2 6 (33.3%) (100%) (100%) (100%) (100%) (83.3%)
(79.2%) (50.0%) (75.0%) Race, n (%) White 4 2 3 1 3 3 16 4 7
(66.7%) (66.7%) (100%) (33.3%) (100%) (50.0%) (66.7%) (100%)
(87.5%) Black or African 2 1 0 1 0 0 4 0 0 American (33.3%) (33.3%)
(33.3%) (16.7%) Asian 0 0 0 1 0 1 2 0 0 (33.3%) (16.7%) (8.3%)
Other 0 0 0 0 0 2 2 0 1 (33.3%) (8.3%) (12.5%) Body weight, kg 70.6
84.5 77.3 81.2 71.6 74.0 75.5 74.3 77.6 Mean (SD) (12.04) (2.11)
(6.66) (11.04) (7.93) (6.01) (9.16) (5.07) (10.31) Height, cm 168
175 174 173 175 169 172 168 171 Mean (SD) (10.6) (2.3) (5.1) (9.6)
(3.1) (5.5) (7.2) (10.5) (9.3) BMI, kg/m.sup.2 24.9 27.7 25.5 27.0
23.4 25.9 25.6 26.5 26.7 Mean (SD) (3.17) (0.21) (2.10) (1.29)
(3.01) (1.60) (2.39) (2.72) (2.64) LDL-C, mmol/L 3.4 4.6 3.9 4.2
3.1 4.1 3.8 3.7 3.4 Mean (SD) (0.50) (1.31) (0.92) (0.95) (0.44)
(0.74) (0.85) (2.32) (0.54) TG, mmol/L 0.8 1.3 2.0 1.5 1.8 1.3 1.4
1.7 1.4 Mean (SD) (0.14) (0.67) (1.16) (0.55) (0.95) (0.24) (0.65)
(0.53) (0.43) PCSK9, .mu.g/L 278.95 342.65 233.77 253.82 263.23
279.62 276.32 460.69 276.23 Mean (SD) (99.53) (67.89) (39.17)
(22.36) (24.98) (66.90) (68.28) (56.295) (58.69) BMI = body mass
index; LDL-C = low-density lipoprotein cholesterol; PCSK9 =
proprotein convertase subtilisin/kexin type 9; QMx2 = 2 monthly
doses; QWx4 = 4 weekly doses; Q2Wx2 = 2 biweekly doses; SD =
standard deviation; TG = triglycerides. To convert values for
cholesterol to mg/dL multiply by 38.67. To convert values for TG to
mg/dL multiply by 88.57.
TABLE-US-00014 TABLE 2B MAD Cohort Demographics and Baseline
Characteristics. Multiple dose phase ALN-PCSsc Placebo 300 mg 300
mg 500 mg 500 mg 125 mg 250 mg With No QMx2 QMx2 QMx2 QMx2 QWx4
Q2Wx2 Statin Statin With Statin No Statin With Statin No Statin No
Statin No Statin Overall (n = 4) (n = 8) (n = 4) (n = 6) (n = 5) (n
= 6) (n = 6) (n = 6) (n = 45) Age, years 58 51 52 47 56 42 55 61 52
Mean (SD) (3.0) (14.2) (21.6) (8.7) (11.5) (16.1) (9.4) (6.3)
(12.7) Sex, n (%) Male 2 6 2 6 2 3 4 4 29 (50.0%) (75.0%) (50.0%)
(100%) (40.0%) (50.0%) (66.7%) (66.7%) (64.4%) Race, n (%) White 4
7 3 6 3 5 5 3 36 (100%) (87.5%) (75.0%) (100%) (60.0%) (83.3%)
(83.3%) (50.0%) (80.0%) Black or African 0 0 0 0 1 0 0 1 2 American
(20.0%) (16.7%) (4.4%) Asian 0 0 1 0 1 1 1 0 4 (25.0%) (20.0%)
(16.7%) (16.7%) (8.9%) Other 0 1 0 0 0 0 0 2 3 (12.5%) (33.3%)
(6.7%) Body weight, kg 74.3 77.6 85.0 77.8 71.9 64.9 73.1 83.2 75.8
Mean (SD) (5.07) (10.31) (22.04) (15.19) (11.03) (7.86) (7.07)
(8.12) (12.03) Height, cm 168 171 176 175 167 168 167 176 171 Mean
(SD) (10.5) (9.3) (12.5) (7.4) (11.7) (5.3) (6.9) (10.1) (9.2) BMI,
kg/m.sup.2 26.5 26.7 27.1 25.2 25.7 23.0 26.2 27.0 25.9 Mean (SD)
(2.72) (2.64) (3.59) (2.95) (1.97) (2.34) (2.72) (1.93) (2.72)
LDL-C, mmol/L 3.7 3.4 3.7 3.7 2.7 3.2 3.6 3.8 3.5 Mean (SD) (2.32)
(0.54) (0.79) (0.52) (0.51) (1.29) (0.48) (0.37) (0.92) TG, mmol/L
1.7 1.4 1.5 1.5 1.1 1.0 1.0 1.8 1.4 Mean (SD) (0.53) (0.43) (0.98)
(1.02) (0.50) (0.23) (0.29) (0.78) (0.66) PCSK9, .mu.g/L 460.69
276.23 460.69 311.47 433.44 288.07 380.03 288.73 348.34 Mean (SD)
(56.295) (58.69) (209.435) (59.85) (107.28) (69.07) (50.63) (53.53)
(103.99) BMI = body mass index; LDL-C = low-density lipoprotein
cholesterol; PCSK9 = proprotein convertase subtilisin/kexin type 9;
QMx2 = 2 monthly doses; QWx4 = 4 weekly doses; Q2Wx2 = 2 biweekly
doses; SD = standard deviation; TG = triglycerides. To convert
values for cholesterol to mg/dL multiply by 38.67. To convert
values for TG to mg/dL multiply by 88.57.
TABLE-US-00015 TABLE 3 Mean (SD) percent change from baseline in
pharmacodynamic parameters in the SAD phase (Pharmacodynamic
population) ALN-PCSsc Placebo 25 mg 100 mg 300 mg 500 mg 800 mg (n
= 6) (n = 3) (n = 3) (n = 3) (n = 3) (n = 6) PCSK9 Day 84 n 5 2 3 3
3 6 Mean (SD) percent change -0.1 -47.3 -29.9 -72.6 -68.7 -72.2
(14.3) (7.2) (12.9) (12.1) (9.8) (8.5) Day 180 n NA NA 2 3 2 4 Mean
(SD) percent change NA NA -15.7 -47.8 -70.3 -74.3 (0.2) (24.8)
(6.6) (13.2) Mean (SD) percent change -29.4 -54.3 -48.9 -77.9 -75.7
-82.3 at individual nadir.sup.a (9.53) (4.75) (27.37) (3.49)
(11.75) (4.85) Mean (SD) percent change -17.5 -51.2 -41.7 -74.0
-77.7 -79.4 at group nadir.sup.b (19.56) (0.56) (21.28) (0.57)
(1.28) (3.27) Time to group nadir, days 35 42 42 42 112 98 LDL-C
Day 84 n 5 2 3 3 3 5 Mean (SD) percent change -7.5 -27.9 -36.6
-48.4 -47.6 -41.9 (15.6) (11.4) (6.1) (19.0) (15.2) (12.3) Day 180
n NA NA 2 3 2 4 Mean (SD) percent change NA NA -26.3 -47.8 -37.9
-35.2 (2.1) (0.5) (21.7) (16.8) Mean (SD) percent change -18.7
-34.5 -42.9 -55.0 -55.1 -59.2 at individual nadir.sup.a (5.61)
(8.62) (15.35) (10.03) (19.93) (12.25) Mean (SD) percent change
-8.6 -27.9 -38.7 -48.4 -55.1 -51.8 at group nadir.sup.b (18.07)
(11.43) (2.07) (18.99) (24.46) (8.44) Time to group nadir, days 98
84 140 84 98 35 Total cholesterol Day 84 -1.3 -20.2 -18.2 -30.9
-24.2 -28.1 (11.7) (9.4) (10.7) (9.4) (10.2) (11.7) Day 180 NA NA
-14.1 -30.5 -23.5 -25.0 (2.9) (5.7) (11.1) (12.2) HDL-C Day 84 11.7
8.3 19.6 50.5 6.5 1.9 (14.4) (10.3) (17.7) (71.3) (6.4) (17.0) Day
180 NA NA 18.1 12.8 -2.8 -0.2 (26.3) (42.5) (2.8) (16.4) non-HDL-C
Day 84 -6.6 -25.5 -28.8 -47.2 -34.1 -36.0 (12.2) (11.3) (7.5)
(19.2) (12.6) (12.6) Day 180 NA NA -21.2 -38.0 -29.5 -30.4 (3.6)
(12.6) (13.6) (13.4) Apolipoprotein B Day 84 -10.0 -18.2 -28.1
-45.5 -36.0 -44.5 (15.6) (9.7) (15.6) (20.5) (11.7) (11.8) Day 180
NA NA -30.5 -37.6 -29.2 -27.7 (7.6) (12.2) (18.8) (13.6)
Triglycerides Day 84 -12.4 -9.0 -9.6 -25.1 15.1 24.6 (7.9) (19.7)
(20.2) (29.2) (28.1) (48.2) Day 180 NA NA -18.7 45.0 -8.6 -7.4
(35.5) (105.8) (10.1) (23.2) Lipoprotein (a) Day 84 6.7 -2.8 -20.1
-33.8 -30.4 -22.1 (25.7) (29.0) (3.5) (46.7) (27.0) (20.8) Day 180
NA NA 6.6 -37.9 -31.1 -2.5 (23.7) (35.8) (26.7) (18.9) HDL-C =
high-density lipoprotein cholesterol; LDL-C = low-density
lipoprotein cholesterol; NA = not applicable; PCSK9 = proprotein
convertase subtilisin/kexin type 9; SD = standard deviation.
.sup.aIndividual nadir values defined as the largest post-dose
percent reduction from baseline value per subject. These values
were then summarized. .sup.bGroup nadir is defined as the largest
mean post-dose percent change from baseline value during the
study.
TABLE-US-00016 TABLE 4 Mean (SD) percent change from baseline in
pharmacodynamic parameters in the MAD phase (Pharmacodynamic
population) Placebo ALN-PCSsc With No 300 mg QMx2 300 mg QMx2 500
mg QMx2 500 mg QMx2 125 mg QWx4 250 mg Q2Wx2 Statin Statin With
Statin No Statin With Statin No Statin No Statin No Statin (n = 3)
(n = 8) (n = 3) (n = 6) (n = 5) (n = 6) (n = 6) (n = 6) PCSK9 84
days after last dose n 3 6 3 6 5 6 6 6 Mean (SD) percent change
-0.5 1.3 -78.1 -70.6 -82.6 -74.2 -75.0 -78.0 (33.4) (36.7) (3.9)
(10.9) (9.5) (8.3) (7.5) (6.8) 180 days after last dose n NA NA 1 6
4 6 6 6 Mean (SD) percent change NA NA -69.7 -62.6 -75.9 -72.3
-63.3 -67.4 (NC) (10.7) (10.8) (14.3) (14.5) (9.9) Mean (SD)
percent change -42.4 -25.3 -86.1 -80.4 -88.5 -81.5 -83.8 -82.7 at
individual nadir.sup.a (3.76) (20.51) (2.06) (4.92) (3.67) (5.73)
(2.13) (2.81) Mean (SD) percent change -21.2 -6.1 -83.6 -73.1 -85.2
-79.9 -80.3 -79.4 at group nadir.sup.b (8.9) (NC) (4.06) (6.31)
(1.83) (5.35) (4.73) (3.83) Time to group nadir, days 28 91 56 56
84 84 77 35 LDL-C 84 days after last dose n 3 5 3 6 5 6 6 6 Mean
(SD) percent change 0.9 -7.0 -44.7 -48.8 -38.9 -48.5 -41.8 -50.0
(33.3) (11.6) (21.2) (9.0) (13.6) (14.2) (8.8) (10.5) 180 days
after last dose n NA NA 1 6 4 6 6 6 Mean (SD) percent change NA NA
-30.0 -44.3 -44.2 -45.3 -34.5 -42.1 (NC) (12.8) (26.2) (16.1) (5.8)
(16.6) Mean (SD) percent change -27.7 -19.2 -53.8 -64.4 -59.9 -56.2
-52.1 -60.4 at individual nadir.sup.a (13.19) (9.68) (19.78)
(13.22) (18.14) (14.59) (4.75) (11.02) Mean (SD) percent change
-18.4 -16.3 -46.7 -55.7 -48.9 -51.9 -44.8 -54.8 at group
nadir.sup.b (17.7) (NC) (18.29) (13.20) (23.77) (14.97) (4.07)
(7.77) Time to group nadir, days 35 105 70 70 140 140 63 49 Total
cholesterol 84 days after last dose 2.9 -11.8 -24.2 -39.9 -28.6
-25.8 -25.9 -32.0 (25.1) (11.3) (13.4) (7.4) (16.1) (9.3) (5.4)
(7.4) 180 days after last dose NA NA -13.9 -26.0 -25.0 -24.2 -22.2
-26.4 (NA) (6.5) (19.6) (12.8) (4.7) (13.9) HDL-C 84 days after
last dose 10.6 -2.1 11.2 13.5 5.2 13.1 7.3 7.0 (11.8) (15.1) (9.4)
(15.6) (15.9) (15.9) (3.9) (15.8) 180 days after last dose NA NA
20.5 7.5 3.8 6.0 3.5 10.2 (NA) (7.7) (10.6) (12.7) (6.5) (11.0)
non-HDL-C 84 days after last dose 1.3 -15.1 -35.2 -55.3 -43.4 -43.6
-37.4 -42.5 (36.5) (11.2) (10.7) (12.7) (19.1) (11.8) (9.6) (9.2)
NA NA -25.5 -35.5 -36.4 -37.7 -31.1 -36.6 (NA) (8.0) (22.0) (15.4)
(4.9) (16.3) Apolipoprotein B 84 days after last dose -6.1 -15.3
-36.8 -51.5 -40.1 -45.3 -36.4 -42.7 (31.7) (11.0) (9.7) (10.7)
(14.0) (11.9) (10.1) (9.9) 180 days after last dose NA NA -24.1
-35.1 -34.9 -37.4 -24.4 -36.5 (NA) (10.1) (21.3) (14.8) (3.1)
(15.7) Triglycerides 84 days after last dose 1.5 -8.1 -8.8 -39.3
-16.6 -0.1 -7.5 -18.0 (45.7) (33.8) (6.5) (13.8) (15.2) (24.5)
(19.0) (12.0) 180 days after last dose NA NA -13.1 7.4 7.2 6.1 -0.7
21.3 (NA) (37.3) (23.1) (15.8) (28.9) (48.7) Lipoprotein (a) 84
days after last dose 3.2 -14.7 -17.9 -19.4 -28.9 -27.6 -27.4 -25.3
(20.9) (18.6) (42.5) (24.9) (28.0) (15.6) (8.9) (12.9) 180 days
after last dose NA NA -12.2 -15.9 -23.7 -27.7 -29.0 -28.9 (NA)
(26.6) (26.4) (23.7) (15.3) (12.6) HDL-C = high-density lipoprotein
cholesterol; LDL-C = low-density lipoprotein cholesterol; NA = not
applicable; NC = not calculated; PCSK9 = proprotein convertase
subtilisin/kexin type 9; QMx2 = 2 monthly doses; QWx4 = 4 weekly
doses; Q2Wx2 = 2 biweekly doses; SD = standard deviation.
.sup.aIndividual nadir values defined as the largest post-dose
percent reduction from baseline value per subject. These values
were then summarized. .sup.bGroup nadir is defined as the largest
mean post-dose percent change from baseline value during the study.
Sequence CWU 1
1
68813731DNAHomo sapiens 1gtccgatggg gctctggtgg cgtgatctgc
gcgccccagg cgtcaagcac ccacacccta 60gaaggtttcc gcagcgacgt cgaggcgctc
atggttgcag gcgggcgccg ccgttcagtt 120cagggtctga gcctggagga
gtgagccagg cagtgagact ggctcgggcg ggccgggacg 180cgtcgttgca
gcagcggctc ccagctccca gccaggattc cgcgcgcccc ttcacgcgcc
240ctgctcctga acttcagctc ctgcacagtc ctccccaccg caaggctcaa
ggcgccgccg 300gcgtggaccg cgcacggcct ctaggtctcc tcgccaggac
agcaacctct cccctggccc 360tcatgggcac cgtcagctcc aggcggtcct
ggtggccgct gccactgctg ctgctgctgc 420tgctgctcct gggtcccgcg
ggcgcccgtg cgcaggagga cgaggacggc gactacgagg 480agctggtgct
agccttgcgt tccgaggagg acggcctggc cgaagcaccc gagcacggaa
540ccacagccac cttccaccgc tgcgccaagg atccgtggag gttgcctggc
acctacgtgg 600tggtgctgaa ggaggagacc cacctctcgc agtcagagcg
cactgcccgc cgcctgcagg 660cccaggctgc ccgccgggga tacctcacca
agatcctgca tgtcttccat ggccttcttc 720ctggcttcct ggtgaagatg
agtggcgacc tgctggagct ggccttgaag ttgccccatg 780tcgactacat
cgaggaggac tcctctgtct ttgcccagag catcccgtgg aacctggagc
840ggattacccc tccacggtac cgggcggatg aataccagcc ccccgacgga
ggcagcctgg 900tggaggtgta tctcctagac accagcatac agagtgacca
ccgggaaatc gagggcaggg 960tcatggtcac cgacttcgag aatgtgcccg
aggaggacgg gacccgcttc cacagacagg 1020ccagcaagtg tgacagtcat
ggcacccacc tggcaggggt ggtcagcggc cgggatgccg 1080gcgtggccaa
gggtgccagc atgcgcagcc tgcgcgtgct caactgccaa gggaagggca
1140cggttagcgg caccctcata ggcctggagt ttattcggaa aagccagctg
gtccagcctg 1200tggggccact ggtggtgctg ctgcccctgg cgggtgggta
cagccgcgtc ctcaacgccg 1260cctgccagcg cctggcgagg gctggggtcg
tgctggtcac cgctgccggc aacttccggg 1320acgatgcctg cctctactcc
ccagcctcag ctcccgaggt catcacagtt ggggccacca 1380atgcccaaga
ccagccggtg accctgggga ctttggggac caactttggc cgctgtgtgg
1440acctctttgc cccaggggag gacatcattg gtgcctccag cgactgcagc
acctgctttg 1500tgtcacagag tgggacatca caggctgctg cccacgtggc
tggcattgca gccatgatgc 1560tgtctgccga gccggagctc accctggccg
agttgaggca gagactgatc cacttctctg 1620ccaaagatgt catcaatgag
gcctggttcc ctgaggacca gcgggtactg acccccaacc 1680tggtggccgc
cctgcccccc agcacccatg gggcaggttg gcagctgttt tgcaggactg
1740tatggtcagc acactcgggg cctacacgga tggccacagc cgtcgcccgc
tgcgccccag 1800atgaggagct gctgagctgc tccagtttct ccaggagtgg
gaagcggcgg ggcgagcgca 1860tggaggccca agggggcaag ctggtctgcc
gggcccacaa cgcttttggg ggtgagggtg 1920tctacgccat tgccaggtgc
tgcctgctac cccaggccaa ctgcagcgtc cacacagctc 1980caccagctga
ggccagcatg gggacccgtg tccactgcca ccaacagggc cacgtcctca
2040caggctgcag ctcccactgg gaggtggagg accttggcac ccacaagccg
cctgtgctga 2100ggccacgagg tcagcccaac cagtgcgtgg gccacaggga
ggccagcatc cacgcttcct 2160gctgccatgc cccaggtctg gaatgcaaag
tcaaggagca tggaatcccg gcccctcagg 2220agcaggtgac cgtggcctgc
gaggagggct ggaccctgac tggctgcagt gccctccctg 2280ggacctccca
cgtcctgggg gcctacgccg tagacaacac gtgtgtagtc aggagccggg
2340acgtcagcac tacaggcagc accagcgaag gggccgtgac agccgttgcc
atctgctgcc 2400ggagccggca cctggcgcag gcctcccagg agctccagtg
acagccccat cccaggatgg 2460gtgtctgggg agggtcaagg gctggggctg
agctttaaaa tggttccgac ttgtccctct 2520ctcagccctc catggcctgg
cacgagggga tggggatgct tccgcctttc cggggctgct 2580ggcctggccc
ttgagtgggg cagcctcctt gcctggaact cactcactct gggtgcctcc
2640tccccaggtg gaggtgccag gaagctccct ccctcactgt ggggcatttc
accattcaaa 2700caggtcgagc tgtgctcggg tgctgccagc tgctcccaat
gtgccgatgt ccgtgggcag 2760aatgactttt attgagctct tgttccgtgc
caggcattca atcctcaggt ctccaccaag 2820gaggcaggat tcttcccatg
gataggggag ggggcggtag gggctgcagg gacaaacatc 2880gttggggggt
gagtgtgaaa ggtgctgatg gccctcatct ccagctaact gtggagaagc
2940ccctgggggc tccctgatta atggaggctt agctttctgg atggcatcta
gccagaggct 3000ggagacaggt gcgcccctgg tggtcacagg ctgtgccttg
gtttcctgag ccacctttac 3060tctgctctat gccaggctgt gctagcaaca
cccaaaggtg gcctgcgggg agccatcacc 3120taggactgac tcggcagtgt
gcagtggtgc atgcactgtc tcagccaacc cgctccacta 3180cccggcaggg
tacacattcg cacccctact tcacagagga agaaacctgg aaccagaggg
3240ggcgtgcctg ccaagctcac acagcaggaa ctgagccaga aacgcagatt
gggctggctc 3300tgaagccaag cctcttctta cttcacccgg ctgggctcct
catttttacg ggtaacagtg 3360aggctgggaa ggggaacaca gaccaggaag
ctcggtgagt gatggcagaa cgatgcctgc 3420aggcatggaa ctttttccgt
tatcacccag gcctgattca ctggcctggc ggagatgctt 3480ctaaggcatg
gtcgggggag agggccaaca actgtccctc cttgagcacc agccccaccc
3540aagcaagcag acatttatct tttgggtctg tcctctctgt tgccttttta
cagccaactt 3600ttctagacct gttttgcttt tgtaacttga agatatttat
tctgggtttt gtagcatttt 3660tattaatatg gtgacttttt aaaataaaaa
caaacaaacg ttgtcctaac aaaaaaaaaa 3720aaaaaaaaaa a 373123731DNAHomo
sapiens 2tttttttttt tttttttttt tgttaggaca acgtttgttt gtttttattt
taaaaagtca 60ccatattaat aaaaatgcta caaaacccag aataaatatc ttcaagttac
aaaagcaaaa 120caggtctaga aaagttggct gtaaaaaggc aacagagagg
acagacccaa aagataaatg 180tctgcttgct tgggtggggc tggtgctcaa
ggagggacag ttgttggccc tctcccccga 240ccatgcctta gaagcatctc
cgccaggcca gtgaatcagg cctgggtgat aacggaaaaa 300gttccatgcc
tgcaggcatc gttctgccat cactcaccga gcttcctggt ctgtgttccc
360cttcccagcc tcactgttac ccgtaaaaat gaggagccca gccgggtgaa
gtaagaagag 420gcttggcttc agagccagcc caatctgcgt ttctggctca
gttcctgctg tgtgagcttg 480gcaggcacgc cccctctggt tccaggtttc
ttcctctgtg aagtaggggt gcgaatgtgt 540accctgccgg gtagtggagc
gggttggctg agacagtgca tgcaccactg cacactgccg 600agtcagtcct
aggtgatggc tccccgcagg ccacctttgg gtgttgctag cacagcctgg
660catagagcag agtaaaggtg gctcaggaaa ccaaggcaca gcctgtgacc
accaggggcg 720cacctgtctc cagcctctgg ctagatgcca tccagaaagc
taagcctcca ttaatcaggg 780agcccccagg ggcttctcca cagttagctg
gagatgaggg ccatcagcac ctttcacact 840caccccccaa cgatgtttgt
ccctgcagcc cctaccgccc cctcccctat ccatgggaag 900aatcctgcct
ccttggtgga gacctgagga ttgaatgcct ggcacggaac aagagctcaa
960taaaagtcat tctgcccacg gacatcggca cattgggagc agctggcagc
acccgagcac 1020agctcgacct gtttgaatgg tgaaatgccc cacagtgagg
gagggagctt cctggcacct 1080ccacctgggg aggaggcacc cagagtgagt
gagttccagg caaggaggct gccccactca 1140agggccaggc cagcagcccc
ggaaaggcgg aagcatcccc atcccctcgt gccaggccat 1200ggagggctga
gagagggaca agtcggaacc attttaaagc tcagccccag cccttgaccc
1260tccccagaca cccatcctgg gatggggctg tcactggagc tcctgggagg
cctgcgccag 1320gtgccggctc cggcagcaga tggcaacggc tgtcacggcc
ccttcgctgg tgctgcctgt 1380agtgctgacg tcccggctcc tgactacaca
cgtgttgtct acggcgtagg cccccaggac 1440gtgggaggtc ccagggaggg
cactgcagcc agtcagggtc cagccctcct cgcaggccac 1500ggtcacctgc
tcctgagggg ccgggattcc atgctccttg actttgcatt ccagacctgg
1560ggcatggcag caggaagcgt ggatgctggc ctccctgtgg cccacgcact
ggttgggctg 1620acctcgtggc ctcagcacag gcggcttgtg ggtgccaagg
tcctccacct cccagtggga 1680gctgcagcct gtgaggacgt ggccctgttg
gtggcagtgg acacgggtcc ccatgctggc 1740ctcagctggt ggagctgtgt
ggacgctgca gttggcctgg ggtagcaggc agcacctggc 1800aatggcgtag
acaccctcac ccccaaaagc gttgtgggcc cggcagacca gcttgccccc
1860ttgggcctcc atgcgctcgc cccgccgctt cccactcctg gagaaactgg
agcagctcag 1920cagctcctca tctggggcgc agcgggcgac ggctgtggcc
atccgtgtag gccccgagtg 1980tgctgaccat acagtcctgc aaaacagctg
ccaacctgcc ccatgggtgc tggggggcag 2040ggcggccacc aggttggggg
tcagtacccg ctggtcctca gggaaccagg cctcattgat 2100gacatctttg
gcagagaagt ggatcagtct ctgcctcaac tcggccaggg tgagctccgg
2160ctcggcagac agcatcatgg ctgcaatgcc agccacgtgg gcagcagcct
gtgatgtccc 2220actctgtgac acaaagcagg tgctgcagtc gctggaggca
ccaatgatgt cctcccctgg 2280ggcaaagagg tccacacagc ggccaaagtt
ggtccccaaa gtccccaggg tcaccggctg 2340gtcttgggca ttggtggccc
caactgtgat gacctcggga gctgaggctg gggagtagag 2400gcaggcatcg
tcccggaagt tgccggcagc ggtgaccagc acgaccccag ccctcgccag
2460gcgctggcag gcggcgttga ggacgcggct gtacccaccc gccaggggca
gcagcaccac 2520cagtggcccc acaggctgga ccagctggct tttccgaata
aactccaggc ctatgagggt 2580gccgctaacc gtgcccttcc cttggcagtt
gagcacgcgc aggctgcgca tgctggcacc 2640cttggccacg ccggcatccc
ggccgctgac cacccctgcc aggtgggtgc catgactgtc 2700acacttgctg
gcctgtctgt ggaagcgggt cccgtcctcc tcgggcacat tctcgaagtc
2760ggtgaccatg accctgccct cgatttcccg gtggtcactc tgtatgctgg
tgtctaggag 2820atacacctcc accaggctgc ctccgtcggg gggctggtat
tcatccgccc ggtaccgtgg 2880aggggtaatc cgctccaggt tccacgggat
gctctgggca aagacagagg agtcctcctc 2940gatgtagtcg acatggggca
acttcaaggc cagctccagc aggtcgccac tcatcttcac 3000caggaagcca
ggaagaaggc catggaagac atgcaggatc ttggtgaggt atccccggcg
3060ggcagcctgg gcctgcaggc ggcgggcagt gcgctctgac tgcgagaggt
gggtctcctc 3120cttcagcacc accacgtagg tgccaggcaa cctccacgga
tccttggcgc agcggtggaa 3180ggtggctgtg gttccgtgct cgggtgcttc
ggccaggccg tcctcctcgg aacgcaaggc 3240tagcaccagc tcctcgtagt
cgccgtcctc gtcctcctgc gcacgggcgc ccgcgggacc 3300caggagcagc
agcagcagca gcagcagtgg cagcggccac caggaccgcc tggagctgac
3360ggtgcccatg agggccaggg gagaggttgc tgtcctggcg aggagaccta
gaggccgtgc 3420gcggtccacg ccggcggcgc cttgagcctt gcggtgggga
ggactgtgca ggagctgaag 3480ttcaggagca gggcgcgtga aggggcgcgc
ggaatcctgg ctgggagctg ggagccgctg 3540ctgcaacgac gcgtcccggc
ccgcccgagc cagtctcact gcctggctca ctcctccagg 3600ctcagaccct
gaactgaacg gcggcgcccg cctgcaacca tgagcgcctc gacgtcgctg
3660cggaaacctt ctagggtgtg ggtgcttgac gcctggggcg cgcagatcac
gccaccagag 3720ccccatcgga c
3731316PRTUnknownsource/note="Description of Unknown RFGF peptide"
3Ala Ala Val Ala Leu Leu Pro Ala Val Leu Leu Ala Leu Leu Ala Pro 1
5 10 15 411PRTUnknownsource/note="Description of Unknown RFGF
analogue peptide" 4Ala Ala Leu Leu Pro Val Leu Leu Ala Ala Pro 1 5
10 513PRTHuman immunodeficiency virus 5Gly Arg Lys Lys Arg Arg Gln
Arg Arg Arg Pro Pro Gln 1 5 10 616PRTDrosophila sp. 6Arg Gln Ile
Lys Ile Trp Phe Gln Asn Arg Arg Met Lys Trp Lys Lys 1 5 10 15
721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 7caagcagaca uuuaucuuuu u
21823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 8aaaaagauaa augucugcuu gcu
23921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 9caagcagaca uuuaucuuuu u
211023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 10aaaaagauaa augucugcuu gcu
231121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 11caagcagaca uuuaucuuuu u
211223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 12aaaaagauaa augucugcuu gcu
231321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 13caagcagaca uuuaucuuuu u
211423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 14aaaaagauaa augucugcuu gcu
231521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 15caagcagaca uuuaucuuuu u
211623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 16aaaaagauaa augucugcuu gcu
231721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 17caagcagaca uuuaucuuuu u
211823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 18aaaaagauaa augucugcuu gcu
231921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 19caagcagaca uuuaucuuuu u
212023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 20aaaaagauaa augucugcuu gcu
232121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 21caagcagaca uuuaucuuuu u
212223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 22aaaaagauaa augucugcuu gcu
232321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 23caagcagaca uuuaucuuuu u
212423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 24aaaaagauaa augucugcuu gcu
232521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 25caagcagaca uuuaucuuuu u
212623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 26aaaaagauaa augucugcuu gcu
232721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 27caagcagaca uuuaucuuuu u
212823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 28aaaaagauaa augucugcuu gcu
232921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 29caagcagaca uuuaucuuuu u
213023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 30aaaaagauaa augucugcuu gcu
233121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 31caagcagaca uuuaucuuuu u
213223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 32aaaaagauaa augucugcuu gcu
233321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 33caagcagaca uuuaucuuuu u
213423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 34aaaaagauaa augucugcuu gcu
233521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 35caagcagaca uuuaucuuuu u
213623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 36aaaaagauaa augucugcuu gcu
233721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 37caagcagaca uuuaucuuuu u
213823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 38aaaaagauaa augucugcuu gcu
233921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 39caagcagaca uuuaucuuuu u
214023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 40aaaaagauaa augucugcuu gcu
234121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 41caagcagaca uuuaucuuuu u
214223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 42aaaaagauaa augucugcuu gcu
234321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 43caagcagaca uuuaucuuuu u
214423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 44aaaaagauaa augucugcuu gcu
234521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 45caagcagaca uuuaucuuuu u
214623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 46aaaaagauaa augucugcuu gcu
234721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 47caagcagaca uuuaucuuuu u
214823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 48aaaaagauaa augucugcuu gcu
234921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 49caagcagaca uuuaucuuuu u
215023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 50aaaaagauaa augucugcuu gcu
235121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 51caagcagaca uuuaucuuuu u
215223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 52aaaaagauaa augucugcuu gcu
235321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 53caagcagaca uuuaucuuuu u
215423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 54aaaaagauaa augucugcuu gcu
235521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 55caagcagaca uuuaucuuuu u
215623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 56aaaaagauaa augucugcuu gcu
235721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 57caagcagaca uuuaucuuuu u
215823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 58aaaaagauaa augucugcuu gcu
235921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 59caagcagaca uuuaucuuuu u
216023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 60aaaaagauaa augucugcuu gcu
236121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 61caagcagaca uuuaucuuuu u
216223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 62aaaaagauaa augucugcuu gcu
236321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 63caagcagaca uuuaucuuuu u
216423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 64aaaaagauaa augucugcuu gcu
236521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 65caagcagaca uuuaucuuuu u
216623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 66aaaaagauaa augucugcuu gcu
236721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 67caagcagaca uuuaucuuuu u
216823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 68aaaaagauaa augucugcuu gcu
236921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 69caagcagaca uuuaucuuuu u
217023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 70aaaaagauaa augucugcuu gcu
237121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 71caagcagaca uuuaucuuuu u
217223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 72aaaaagauaa augucugcuu gcu
237321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 73caagcagaca uuuaucuuuu u
217423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 74aaaaagauaa augucugcuu gcu
237521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 75caagcagaca uuuaucuuuu u
217623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 76aaaaagauaa augucugcuu gcu
237721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 77caagcagaca uuuaucuuuu u
217823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 78aaaaagauaa augucugcuu gcu
237921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 79caagcagaca uuuaucuuuu u
218023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 80aaaaagauaa augucugcuu gcu
238121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 81caagcagaca uuuaucuuuu u
218223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 82aaaaagauaa augucugcuu gcu
238321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 83caagcagaca uuuaucuuuu u
218423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 84aaaaagauaa augucugcuu gcu
238521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 85caagcagaca uuuaucuuuu u
218623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 86aaaaagauaa augucugcuu gcu
238721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 87caagcagaca uuuaucuuuu u
218823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 88aaaaagauaa augucugcuu gcu
238921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 89caagcagaca uuuaucuuuu u
219023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 90aaaaagauaa augucugcuu gcu
239121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 91caagcagaca uuuaucuuuu u
219223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 92aaaaagauaa augucugcuu gcu
239321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 93caagcagaca uuuaucuuuu u
219423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 94aaaaagauaa augucugcuu gcu
239521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 95caagcagaca uuuaucuuuu u
219623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 96aaaaagauaa augucugcuu gcu
239721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 97caagcagaca uuuaucuuuu u
219823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 98aaaaagauaa augucugcuu gcu
239921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 99caagcagaca uuuaucuuuu u
2110023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 100aaaaagauaa augucugcuu gcu
2310121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 101caagcagaca uuuaucuuuu u
2110223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 102aaaaagauaa augucugcuu gcu
2310321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 103caagcagaca uuuaucuuuu u
2110423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 104aaaaagauaa augucugcuu gcu
2310521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 105caagcagaca uuuaucuuuu u
2110623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 106aaaaagauaa augucugcuu gcu
2310721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 107caagcagaca uuuaucuuuu u
2110823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 108aaaaagauaa augucugcuu gcu
2310921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 109caagcagaca uuuaucuuuu u
2111023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 110aaaaagauaa augucugcuu gcu
2311121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 111caagcagaca uuuaucuuuu u
2111223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 112aaaaagauaa augucugcuu gcu
2311321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 113caagcagaca uuuaucuuuu u
2111423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 114aaaaagauaa augucugcuu gcu
2311521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 115caagcagaca uuuaucuuuu u
2111623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 116aaaaagauaa augucugcuu gcu
2311721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 117caagcagaca uuuaucuuuu u
2111823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 118aaaaagauaa augucugcuu gcu
2311921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 119caagcagaca uuuaucuuuu u
2112023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 120aaaaagauaa augucugcuu gcu
2312121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 121caagcagaca uuuaucuuuu u
2112223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 122aaaaagauaa augucugcuu gcu
2312321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 123caagcagaca uuuaucuuuu u
2112423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 124aaaaagauaa augucugcuu gcu
2312521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 125caagcagaca uuuaucuuuu u
2112623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 126aaaaagauaa augucugcuu gcu
2312721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 127caagcagaca uuuaucuuuu u
2112823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 128aaaaagauaa augucugcuu gcu
2312921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 129caagcagaca uuuaucuuuu u
2113023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 130aaaaagauaa augucugcuu gcu
2313121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 131caagcagaca uuuaucuuuu u
2113223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 132aaaaagauaa augucugcuu gcu
2313321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 133caagcagaca uuuaucuuuu u
2113423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 134aaaaagauaa augucugcuu gcu
2313521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 135caagcagaca uuuaucuuuu u
2113623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 136aaaaagauaa augucugcuu gcu
2313721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 137caagcagaca uuuaucuuuu u
2113823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 138aaaaagauaa augucugcuu gcu
2313921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 139caagcagaca uuuaucuuuu u
2114023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 140aaaaagauaa augucugcuu gcu
2314121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 141caagcagaca uuuaucuuuu u
2114223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 142aaaaagauaa augucugcuu gcu
2314321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 143caagcagaca uuuaucuuuu u
2114423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 144aaaaagauaa augucugcuu gcu 2314521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 145caagcagaca uuuaucuuuu u 2114623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 146aaaaagauaa augucugcuu gcu 2314721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 147caagcagaca uuuaucuuuu u 2114823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 148aaaaagauaa augucugcuu gcu 2314921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 149caagcagaca uuuaucuuuu u 2115023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 150aaaaagauaa augucugcuu gcu 2315121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 151caagcagaca uuuaucuuuu u 2115223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 152aaaaagauaa augucugcuu gcu 2315321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 153caagcagaca uuuaucuuuu u 2115423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 154aaaaagauaa augucugcuu gcu 2315521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 155caagcagaca uuuaucuuuu u 2115623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 156aaaaagauaa augucugcuu gcu 2315721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 157caagcagaca uuuaucuuuu u 2115823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 158aaaaagauaa augucugcuu gcu 2315921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 159caagcagaca uuuaucuuuu u 2116023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 160aaaaagauaa augucugcuu gcu 2316121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 161caagcagaca uuuaucuuuu u 2116223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 162aaaaagauaa augucugcuu gcu 2316321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 163caagcagaca uuuaucuuuu u 2116423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 164aaaaagauaa augucugcuu gcu 2316521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 165caagcagaca uuuaucuuuu u 2116623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 166aaaaagauaa augucugcuu gcu 2316721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 167caagcagaca uuuaucuuuu u 2116823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 168aaaaagauaa augucugcuu gcu 2316921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 169caagcagaca uuuaucuuuu u 2117023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 170aaaaagauaa augucugcuu gcu 2317121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 171caagcagaca uuuaucuuuu u 2117223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 172aaaaagauaa augucugcuu gcu 2317321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 173caagcagaca uuuaucuuuu u 2117423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 174aaaaagauaa augucugcuu gcu 2317521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 175caagcagaca uuuaucuuuu u 2117623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 176aaaaagauaa augucugcuu gcu 2317721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 177caagcagaca uuuaucuuuu u 2117823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 178aaaaagauaa augucugcuu gcu 2317921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 179caagcagaca uuuaucuuuu u 2118023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 180aaaaagauaa augucugcuu gcu 2318121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 181caagcagaca uuuaucuuuu u 2118223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 182aaaaagauaa augucugcuu gcu 2318321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 183caagcagaca uuuaucuuuu u 2118423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 184aaaaagauaa augucugcuu gcu 2318521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 185caagcagaca uuuaucuuuu u 2118623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 186aaaaagauaa augucugcuu gcu 2318721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 187caagcagaca uuuaucuuuu u 2118823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 188aaaaagauaa augucugcuu gcu 2318921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 189aagcagacau uuaucuuuug a 2119023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 190ucaaaagaua aaugucugcu ugc 2319121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 191agcagacauu uaucuuuugg a 2119223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 192uccaaaagau aaaugucugc uug 2319321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 193gcagacauuu aucuuuuggg u 2119423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 194acccaaaaga uaaaugucug cuu 2319521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 195agacauuuau cuuuuggguc u 2119623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 196agacccaaaa gauaaauguc ugc 2319721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 197gacauuuauc uuuugggucu u 2119823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 198aagacccaaa agauaaaugu cug 2319921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 199acauuuaucu uuugggucug u 2120023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 200acagacccaa aagauaaaug ucu 2320121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 201uuuaucuuuu gggucugucc u 2120223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 202aggacagacc caaaagauaa aug 2320321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 203uuaucuuuug ggucuguccu u 2120423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 204aaggacagac ccaaaagaua aau 2320521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 205uaucuuuugg gucuguccuc u 2120623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 206agaggacaga cccaaaagau aaa 2320721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 207aucuuuuggg ucuguccucu u 2120823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 208aagaggacag acccaaaaga uaa 2320921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 209ucuuuugggu cuguccucuc u 2121023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 210agagaggaca gacccaaaag aua 2321121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 211uuuugggucu guccucucug u 2121223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 212acagagagga cagacccaaa aga 2321321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 213uuugggucug uccucucugu u 2121423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 214aacagagagg acagacccaa aag 2321521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 215uugggucugu ccucucuguu u 2121623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 216aaacagagag gacagaccca aaa 2321721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 217ugggucuguc cucucuguug a 2121823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 218ucaacagaga ggacagaccc aaa 2321921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 219gggucugucc ucucuguugc a 2122023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 220ugcaacagag aggacagacc caa 2322121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 221ggucuguccu cucuguugcc u 2122223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 222aggcaacaga gaggacagac cca 2322321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 223gucuguccuc ucuguugccu u 2122423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 224aaggcaacag agaggacaga ccc 2322521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 225ucuguccucu cuguugccuu u 2122623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 226aaaggcaaca gagaggacag acc 2322721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 227cuguccucuc uguugccuuu u 2122823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 228aaaaggcaac agagaggaca gac 2322921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 229uguccucucu guugccuuuu u 2123023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 230aaaaaggcaa cagagaggac aga 2323121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 231guccucucug uugccuuuuu a 2123223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 232uaaaaaggca acagagagga cag 2323321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 233uuuucuagac cuguuuugcu u 2123423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 234aagcaaaaca ggucuagaaa agu 2323521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 235uuucuagacc uguuuugcuu u 2123623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 236aaagcaaaac aggucuagaa aag 2323721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 237cuagaccugu uuugcuuuug u 2123823RNAArtificial
Sequencesource/note="Description of
Artificial Sequence Synthetic oligonucleotide" 238acaaaagcaa
aacaggucua gaa 2323921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 239cuagaccugu uuugcuuuug u 2124023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 240acaaaagcaa aacaggucua gaa 2324121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 241uucuagaccu guuuugcuuu u 2124223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 242aaaagcaaaa caggucuaga aaa 2324321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 243cuagaccugu uuugcuuuug u 2124423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 244acaaaagcaa aacaggucua gaa 2324521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 245cuagaccugu uuugcuuuug u 2124623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 246acaaaagcaa aacaggucua gaa 2324721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 247cuagaccugu uuugcuuuug u 2124823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 248acaaaagcaa aacaggucua gaa 2324921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 249cuagaccugu uuugcuuuug u 2125023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 250acaaaagcaa aacaggucua gaa 2325121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 251cuagaccugu uuugcuuuug u 2125223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 252acaaaagcaa aacaggucua gaa 2325321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 253cuagaccugu uuugcuuuug u 2125423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 254acaaaagcaa aacaggucua gaa 2325521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 255cuagaccugu uuugcuuuug u 2125623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 256acaaaagcaa aacaggucua gaa 2325721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 257cuagaccugu uuugcuuuug u 2125823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 258acaaaagcaa aacaggucua gaa 2325921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 259cuagaccugu uuugcuuuug u 2126023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 260acaaaagcaa aacaggucua gaa 2326121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 261cuagaccugu uuugcuuuug u 2126223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 262acaaaagcaa aacaggucua gaa 2326321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 263cuagaccugu uuugcuuuug u 2126423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 264acaaaagcaa aacaggucua gaa 2326521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 265cuagaccugu uuugcuuuug u 2126623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 266acaaaagcaa aacaggucua gaa 2326721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 267cuagaccugu uuugcuuuug u 2126823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 268acaaaagcaa aacaggucua gaa 2326921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 269cuagaccugu uuugcuuuug u 2127023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 270acaaaagcaa aacaggucua gaa 2327121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 271cuagaccugu uuugcuuuug u 2127223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 272acaaaagcaa aacaggucua gaa 2327321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 273cuagaccugu uuugcuuuug u 2127423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 274acaaaagcaa aacaggucua gaa 2327521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 275cuagaccugu uuugcuuuug u 2127623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 276acaaaagcaa aacaggucua gaa 2327721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 277cuagaccugu uuugcuuuug u 2127823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 278acaaaagcaa aacaggucua gaa 2327921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 279cuagaccugu uuugcuuuug u 2128023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 280acaaaagcaa aacaggucua gaa 2328121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 281cuagaccugu uuugcuuuug u 2128223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 282acaaaagcaa aacaggucua gaa 2328321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 283cuagaccugu uuugcuuuug u 2128423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 284acaaaagcaa aacaggucua gaa 2328521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 285cuagaccugu uuugcuuuug u 2128623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 286acaaaagcaa aacaggucua gaa 2328721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 287cuagaccugu uuugcuuuug u 2128823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 288acaaaagcaa aacaggucua gaa 2328921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 289cuagaccugu uuugcuuuug u 2129023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 290acaaaagcaa aacaggucua gaa 2329121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 291cuagaccugu uuugcuuuug u 2129223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 292acaaaagcaa aacaggucua gaa 2329321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 293cuagaccugu uuugcuuuug u 2129423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 294acaaaagcaa aacaggucua gaa 2329521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 295cuagaccugu uuugcuuuug u 2129623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 296acaaaagcaa aacaggucua gaa 2329721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 297cuagaccugu uuugcuuuug u 2129823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 298acaaaagcaa aacaggucua gaa 2329921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 299cuagaccugu uuugcuuuug u 2130023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 300acaaaagcaa aacaggucua gaa 2330121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 301cuagaccugu uuugcuuuug u 2130223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 302acaaaagcaa aacaggucua gaa 2330321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 303cuagaccugu uuugcuuuug u 2130423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 304acaaaagcaa aacaggucua gaa 2330521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 305cuagaccugu uuugcuuuug u 2130623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 306acaaaagcaa aacaggucua gaa 2330721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 307cuagaccugu uuugcuuuug u 2130823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 308acaaaagcaa aacaggucua gaa 2330921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 309cuagaccugu uuugcuuuug u 2131023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 310acaaaagcaa aacaggucua gaa 2331121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 311cuagaccugu uuugcuuuug u 2131223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 312acaaaagcaa aacaggucua gaa 2331321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 313cuagaccugu uuugcuuuug u 2131423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 314acaaaagcaa aacaggucua gaa 2331521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 315cuagaccugu uuugcuuuug u 2131623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 316acaaaagcaa aacaggucua gaa 2331721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 317cuagaccugu uuugcuuuug u 2131823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 318acaaaagcaa aacaggucua gaa 2331921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 319cuagaccugu uuugcuuuug u 2132023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 320acaaaagcaa aacaggucua gaa 2332121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 321cuagaccugu uuugcuuuug u 2132223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 322acaaaagcaa aacaggucua gaa 2332321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 323cuagaccugu uuugcuuuug u 2132423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 324acaaaagcaa aacaggucua gaa 2332521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 325cuagaccugu uuugcuuuug u 2132623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 326acaaaagcaa aacaggucua gaa 2332721DNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide"source/note="Description of Combined DNA/RNA
Molecule Synthetic oligonucleotide" 327ctagaccugu uuugcuuuug u
2132823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 328acaaaagcaa aacaggucua gaa
2332921DNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide"source/note="Description of
Combined DNA/RNA Molecule Synthetic oligonucleotide" 329ctagaccugu
uuugcuuuug u 2133023RNAArtificial Sequencesource/note="Description
of Artificial Sequence Synthetic oligonucleotide" 330acaaaagcaa
aacaggucua gaa 2333121RNAArtificial
Sequencesource/note="Description of
Artificial Sequence Synthetic oligonucleotide" 331cuagaccugu
uuugcuuuug u 2133223RNAArtificial Sequencesource/note="Description
of Artificial Sequence Synthetic oligonucleotide" 332acaaaagcaa
aacaggucua gaa 2333321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 333cuagaccugu uuugcuuuug u 2133423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 334acaaaagcaa aacaggucua gaa 2333521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 335cuagaccugu uuugcuuuug u 2133623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 336acaaaagcaa aacaggucua gaa 2333721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 337cuagaccugu uuugcuuuug u 2133823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 338acaaaagcaa aacaggucua gaa 2333921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 339cuagaccugu uuugcuuuug u 2134023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 340acaaaagcaa aacaggucua gaa 2334121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 341cuagaccugu uuugcuuuug u 2134223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 342acaaaagcaa aacaggucua gaa 2334321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 343cuagaccugu uuugcuuuug u 2134423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 344acaaaagcaa aacaggucua gaa 2334521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 345cuagaccugu uuugcuuuug u 2134623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 346acaaaagcaa aacaggucua gaa 2334721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 347cuagaccugu uuugcuuuug u 2134823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 348acaaaagcaa aacaggucua gaa 2334921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 349cuagaccugu uuugcuuuug u 2135023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 350acaaaagcaa aacaggucua gaa 2335121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 351cuagaccugu uuugcuuuug u 2135223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 352acaaaagcaa aacaggucua gaa 2335320RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 353uagaccuguu uugcuuuugu 2035423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 354acaaaagcaa aacaggucua gaa 2335519RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 355agaccuguuu ugcuuuugu 1935623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 356acaaaagcaa aacaggucua gaa 2335722RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 357ucuagaccug uuuugcuuuu gu 2235823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 358acaaaagcaa aacaggucua gaa 2335923RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 359uucuagaccu guuuugcuuu ugu 2336023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 360acaaaagcaa aacaggucua gaa 2336121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 361cuagaccugu uuugcuuuug u 2136223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 362acaaaagcaa aacaggucua gaa 2336321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 363cuagaccugu uuugcuuuug u 2136423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 364acaaaagcaa aacaggucua gaa 2336521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 365cuagaccugu uuugcuuuug u 2136623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 366acaaaagcaa aacaggucua gaa 2336721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 367cuagaccugu uuugcuuuug u 2136823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 368acaaaagcaa aacaggucua gaa 2336921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 369cuagaccugu uuugcuuuug u 2137023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 370acaaaagcaa aacaggucua gaa 2337121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 371cuagaccugu uuugcuuuug u 2137223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 372acaaaagcaa aacaggucua gaa 2337321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 373cuagaccugu uuugcuuuug u 2137423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 374acaaaagcaa aacaggucua gaa 2337521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 375cuagaccugu uuugcuuuug u 2137623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 376acaaaagcaa aacaggucua gaa 2337721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 377cuagaccugu uuugcuuuug u 2137823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 378acaaaagcaa aacaggucua gaa 2337921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 379cuagaccugu uuugcuuuug u 2138023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 380acaaaagcaa aacaggucua gaa 2338121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 381cuagaccugu uuugcuuuug u 2138223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 382acaaaagcaa aacaggucua gaa 2338321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 383cuagaccugu uuugcuuuug u 2138423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 384acaaaagcaa aacaggucua gaa 2338521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 385cuagaccugu uuugcuuuug u 2138623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 386acaaaagcaa aacaggucua gaa 2338721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 387cuagaccugu uuugcuuuug u 2138823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 388acaaaagcaa aacaggucua gaa 2338921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 389cuagaccugu uuugcuuuug u 2139023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 390acaaaagcaa aacaggucua gaa 2339121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 391cuagaccugu uuugcuuuug u 2139223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 392acaaaagcaa aacaggucua gaa 2339321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 393cuagaccugu uuugcuuuug u 2139423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 394acaaaagcaa aacaggucua gaa 2339521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 395cuagaccugu uuugcuuuug u 2139623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 396acaaaagcaa aacaggucua gaa 2339721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 397ucuagaccug uuuugcuuuu u 2139823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 398aaaaagcaaa acaggucuag aaa 2339921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 399cuagaccugu uuugcuuuug u 2140022RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 400acaaaagcaa aacaggucua ga 2240120RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 401uagaccuguu uugcuuuugu 2040222RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 402acaaaagcaa aacaggucua ga 2240319RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 403agaccuguuu ugcuuuugu 1940422RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 404acaaaagcaa aacaggucua ga 2240520RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 405uagaccuguu uugcuuuugu 2040622RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 406acaaaagcaa aacaggucua ga 2240720RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 407uagaccuguu uugcuuuugu 2040822RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 408acaaaagcaa aacaggucua ga 2240921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 409cuagaccugu uuugcuuuug u 2141023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 410acaaaagcaa aacaggucua gaa 2341121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 411cuagaccugu uuugcuuuug u 2141223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 412acaaaagcaa aacaggucua gaa 2341321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 413cuagaccugu uuugcuuuug u 2141423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 414acaaaagcaa aacaggucua gaa 2341521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 415cuagaccugu uuugcuuuug u 2141623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 416acaaaagcaa aacaggucua gaa 2341721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 417cuagaccugu uuugcuuuug u 2141823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 418acaaaagcaa aacaggucua gaa 2341921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 419cuagaccugu uuugcuuuug u 2142023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 420acaaaagcaa aacaggucua gaa 2342121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 421cuagaccugu uuugcuuuug u 2142223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 422acaaaagcaa aacaggucua gaa 2342321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 423cuagaccugu uuugcuuuug u 2142423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 424acaaaagcaa aacaggucua gaa 2342521RNAArtificial
Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 425cuagaccugu uuugcuuuug u
2142623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 426acaaaagcaa aacaggucua gaa
2342721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 427cuagaccugu uuugcuuuug u
2142823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 428acaaaagcaa aacaggucua gaa
2342921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 429cuagaccugu uuugcuuuug u
2143023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 430acaaaagcaa aacaggucua gaa
2343121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 431cuagaccugu uuugcuuuug u
2143223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 432acaaaagcaa aacaggucua gaa
2343321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 433cuagaccugu uuugcuuuug u
2143423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 434acaaaagcaa aacaggucua gaa
2343521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 435cuagaccugu uuugcuuuug u
2143623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 436acaaaagcaa aacaggucua gaa
2343721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 437cuagaccugu uuugcuuuug u
2143823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 438acaaaagcaa aacaggucua gaa
2343921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 439cuagaccugu uuugcuuuug u
2144023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 440acaaaagcaa aacaggucua gaa
2344121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 441cuagaccugu uuugcuuuug u
2144223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 442acaaaagcaa aacaggucua gaa
2344321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 443cuagaccugu uuugcuuuug u
2144423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 444acaaaagcaa aacaggucua gaa
2344521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 445cuagaccugu uuugcuuuug u
2144623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 446acaaaagcaa aacaggucua gaa
2344721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 447cuagaccugu uuugcuuuug u
2144823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 448acaaaagcaa aacaggucua gaa
2344921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 449cuagaccugu uuugcuuuug u
2145023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 450acaaaagcaa aacaggucua gaa
2345121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 451cuagaccugu uuugcuuuug u
2145223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 452acaaaagcaa aacaggucua gaa
2345321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 453cuagaccugu uuugcuuuug u
2145423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 454acaaaagcaa aacaggucua gaa
2345521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 455cuagaccugu uuugcuuuug u
2145623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 456acaaaagcaa aacaggucua gaa
2345721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 457cuagaccugu uuugcuuuug u
2145823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 458acaaaagcaa aacaggucua gaa
2345921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 459cuagaccugu uuugcuuuug u
2146023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 460acaaaagcaa aacaggucua gaa
2346121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 461cuagaccugu uuugcuuuug u
2146223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 462acaaaagcaa aacaggucua gaa
2346321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 463cuagaccugu uuugcuuuug u
2146423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 464acaaaagcaa aacaggucua gaa
2346521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 465cuagaccugu uuugcuuuug u
2146623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 466acaaaagcaa aacaggucua gaa
2346721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 467cuagaccugu uuugcuuuug u
2146823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 468acaaaagcaa aacaggucua gaa
2346921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 469cuagaccugu uuugcuuuug u
2147023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 470acaaaagcaa aacaggucua gaa
2347121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 471cuagaccugu uuugcuuuug u
2147223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 472acaaaagcaa aacaggucua gaa
2347321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 473cuagaccugu uuugcuuuug u
2147423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 474acaaaagcaa aacaggucua gaa
2347521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 475cuagaccugu uuugcuuuug u
2147623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 476acaaaagcaa aacaggucua gaa
2347721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 477cuagaccugu uuugcuuuug u
2147823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 478acaaaagcaa aacaggucua gaa
2347921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 479cuagaccugu uuugcuuuug u
2148023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 480acaaaagcaa aacaggucua gaa
2348121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 481cuagaccugu uuugcuuuug u
2148223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 482acaaaagcaa aacaggucua gaa
2348321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 483cuagaccugu uuugcuuuug u
2148423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 484acaaaagcaa aacaggucua gaa
2348521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 485cuagaccugu uuugcuuuug u
2148623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 486acaaaagcaa aacaggucua gaa
2348721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 487cuagaccugu uuugcuuuug u
2148823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 488acaaaagcaa aacaggucua gaa
2348921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 489cuagaccugu uuugcuuuug u
2149023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 490acaaaagcaa aacaggucua gaa
2349121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 491cuagaccugu uuugcuuuug u
2149223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 492acaaaagcaa aacaggucua gaa
2349321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 493cuagaccugu uuugcuuuug u
2149423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 494acaaaagcaa aacaggucua gaa
2349521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 495cuagaccugu uuugcuuuug u
2149623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 496acaaaagcaa aacaggucua gaa
2349721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 497cuagaccugu uuugcuuuug u
2149823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 498acaaaagcaa aacaggucua gaa
2349921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 499cuagaccugu uuugcuuuug u
2150023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 500acaaaagcaa aacaggucua gaa
2350121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 501cuagaccugu uuugcuuuug u
2150223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 502acaaaagcaa aacaggucua gaa
2350321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 503cuagaccugu uuugcuuuug u
2150423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 504acaaaagcaa aacaggucua gaa
2350521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 505cuagaccugu uuugcuuuug u
2150623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 506acaaaagcaa aacaggucua gaa
2350721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 507cuagaccugu uuugcuuuug u
2150823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 508acaaaagcaa aacaggucua gaa
2350921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 509cuagaccugu uuugcuuuug u
2151023RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 510acaaaagcaa aacaggucua gaa
2351121RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 511cuagaccugu uuugcuuuug u
2151223RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 512acaaaagcaa aacaggucua gaa
2351321RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 513cuagaccugu uuugcuuuug u
2151423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 514acaaaagcaa aacaggucua gaa
2351521RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 515cuagaccugu uuugcuuuug u
2151623RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 516acaaaagcaa aacaggucua gaa
2351721RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 517cuagaccugu uuugcuuuug u
2151823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 518acaaaagcaa aacaggucua gaa
2351921RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic
oligonucleotide" 519cuagaccugu uuugcuuuug u 2152023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 520acaaaagcaa aacaggucua gaa 2352121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 521cuagaccugu uuugcuuuug u 2152223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 522acaaaagcaa aacaggucua gaa 2352321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 523cuagaccugu uuugcuuuug u 2152423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 524acaaaagcaa aacaggucua gaa 2352521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 525cuagaccugu uuugcuuuug u 2152623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 526acaaaagcaa aacaggucua gaa 2352721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 527cuagaccugu uuugcuuuug u 2152823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 528acaaaagcaa aacaggucua gaa 2352921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 529cuagaccugu uuugcuuuug u 2153023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 530acaaaagcaa aacaggucua gaa 2353121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 531cuagaccugu uuugcuuuug u 2153223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 532acaaaagcaa aacaggucua gaa 2353321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 533cuagaccugu uuugcuuuug u 2153423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 534acaaaagcaa aacaggucua gaa 2353521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 535cuagaccugu uuugcuuuug u 2153623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 536acaaaagcaa aacaggucua gaa 2353721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 537cuagaccugu uuugcuuuug u 2153823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 538acaaaagcaa aacaggucua gaa 2353921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 539cuagaccugu uuugcuuuug u 2154023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 540acaaaagcaa aacaggucua gaa 2354121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 541cuagaccugu uuugcuuuug u 2154223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 542acaaaagcaa aacaggucua gaa 2354321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 543cuagaccugu uuugcuuuug u 2154423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 544acaaaagcaa aacaggucua gaa 2354521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 545cuagaccugu uuugcuuuug u 2154623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 546acaaaagcaa aacaggucua gaa 2354721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 547cuagaccugu uuugcuuuug u 2154823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 548acaaaagcaa aacaggucua gaa 2354921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 549cuagaccugu uuugcuuuug u 2155023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 550acaaaagcaa aacaggucua gaa 2355121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 551cuagaccugu uuugcuuuug u 2155223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 552acaaaagcaa aacaggucua gaa 2355319RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 553agaccuguuu ugcuuuugu 1955421RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 554acaaaagcaa aacaggucua g 2155521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 555cuagaccugu uuugcuuuug u 2155621RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 556acaaaagcaa aacaggucua g 2155719RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 557agaccuguuu ugcuuuugu 1955821RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 558acaaaagcaa aacaggucua g 2155920RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 559uagaccuguu uugcuuuugu 2056021RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 560acaaaagcaa aacaggucua g 2156121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 561cuagaccugu uuugcuuuug u 2156221RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 562acaaaagcaa aacaggucua g 2156321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 563uagaccuguu uugcuuuugu a 2156423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 564uacaaaagca aaacaggucu aga 2356520RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 565uagaccuguu uugcuuuugu 2056620RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 566acaaaagcaa aacaggucua 2056718RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 567gaccuguuuu gcuuuugu 1856820RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 568acaaaagcaa aacaggucua 2056919RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 569agaccuguuu ugcuuuugu 1957020RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 570acaaaagcaa aacaggucua 2057120RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 571uagaccuguu uugcuuuugu 2057220RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 572acaaaagcaa aacaggucua 2057319RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 573agaccuguuu ugcuuuugu 1957421RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 574acaaaagcaa aacaggucua g 2157519RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 575agaccuguuu ugcuuuugu 1957621RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 576acaaaagcaa aacaggucua g 2157719RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 577agaccuguuu ugcuuuugu 1957821RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 578acaaaagcaa aacaggucua g 2157919RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 579agaccuguuu ugcuuuugu 1958021RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 580acaaaagcaa aacaggucua g 2158119RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 581agaccuguuu ugcuuuugu 1958221RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 582acaaaagcaa aacaggucua g 2158319RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 583agaccuguuu ugcuuuugu 1958421RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 584acaaaagcaa aacaggucua g 2158519RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 585agaccuguuu ugcuuuugu 1958621RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 586acaaaagcaa aacaggucua g 2158719RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 587agaccuguuu ugcuuuugu 1958821RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 588acaaaagcaa aacaggucua g 2158919RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 589agaccuguuu ugcuuuugu 1959021RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 590acaaaagcaa aacaggucua g 2159119RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 591agaccuguuu ugcuuuugu 1959221RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 592acaaaagcaa aacaggucua g 2159319RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 593agaccuguuu ugcuuuugu 1959421RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 594acaaaagcaa aacaggucua g 2159519RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 595agaccuguuu ugcuuuugu 1959621RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 596acaaaagcaa aacaggucua g 2159719RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 597agaccuguuu ugcuuuugu 1959821RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 598acaaaagcaa aacaggucua g 2159919RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 599agaccuguuu ugcuuuugu 1960021RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 600acaaaagcaa aacaggucua g 2160119RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 601agaccuguuu ugcuuuugu 1960221RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 602acaaaagcaa aacaggucua g 2160319RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 603agaccuguuu ugcuuuugu 1960421RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 604acaaaagcaa aacaggucua g 2160518RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 605gaccuguuuu gcuuuugu 1860621RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 606acaaaagcaa aacaggucau a 2160719RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 607agaccuguuu ugcuuuugu 1960819RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 608acaaaagcaa aacaggucu 1960918RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 609gaccuguuuu gcuuuugu 1861019RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 610acaaaagcaa aacaggucu 1961121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 611uuuuguaacu ugaagauauu u 2161223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 612aaauaucuuc aaguuacaaa agc 2361321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 613uuuguaacuu
gaagauauuu a 2161423RNAArtificial Sequencesource/note="Description
of Artificial Sequence Synthetic oligonucleotide" 614uaaauaucuu
caaguuacaa aag 2361521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 615uuguaacuug aagauauuua u 2161623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 616auaaauaucu ucaaguuaca aaa 2361721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 617uguaacuuga agauauuuau u 2161823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 618aauaaauauc uucaaguuac aaa 2361921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 619guaacuugaa gauauuuauu u 2162023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 620aaauaaauau cuucaaguua caa 2362121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 621cuagaccugu uuugcuuuug u 2162223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 622acaaaagcaa aacaggucua gaa 2362321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 623cuagaccugu uuugcuuuug a 2162423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 624ucaaaagcaa aacaggucua gaa 2362521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 625guagaccugu uuugcuuuug u 2162623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 626acaaaagcaa aacaggucua cuu 2362721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 627gaagaccugu uuugcuuuug u 2162823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 628acaaaagcaa aacaggucuu cuu 2362921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 629gaugaccugu uuugcuuuug u 2163023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 630acaaaagcaa aacaggucau cuu 2363121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 631gaugaccugu uuugcuuuug u 2163223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 632acaaaagcaa aacaggucau caa 2363321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 633caucaccugu uuugcuuuug u 2163423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 634acaaaagcaa aacaggugau gaa 2363521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 635cuucuccugu uuugcuuuug u 2163623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 636acaaaagcaa aacaggagaa gaa 2363721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 637cuacugcugu uuugcuuuug u 2163823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 638acaaaagcaa aacagcagua gaa 2363921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 639cuagaccugu uuugcuuuug u 2164023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 640acaaaagcaa aacaggucua gaa 2364121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 641cuagaccugu uuugcuuuug u 2164223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 642acaaaagcaa aacaggucua gaa 2364321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 643cuagaccugu uuugcuuuug u 2164423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 644acaaaagcaa aacaggucua gaa 2364521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 645cuagaccugu uuugcuuuug u 2164623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 646acaaaagcaa aacaggucua gaa 2364721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 647cuagaccugu uuugcuuuug u 2164823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 648acaaaagcaa aacaggucua gaa 2364921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 649cuagaccugu uuugcuuuug u 2165023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 650acaaaagcaa aacaggucua gaa 2365121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 651cuagaccugu uuugcuuuug u 2165223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 652acaaaagcaa aacaggucua gaa 2365321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 653cuagaccugu uuugcuuuug u 2165423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 654acaaaagcaa aacaggucua gaa 2365521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 655cuagaccugu uuugcuuuug u 2165623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 656acaaaagcaa aacaggucua gaa 2365721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 657cuagaccugu uuugcuuuug u 2165823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 658acaaaagcaa aacaggucua gaa 2365921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 659cuagaccugu uuugcuuuug u 2166023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 660acaaaagcaa aacaggucua gaa 2366121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 661cuagaccugu uuugcuuuug u 2166223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 662acaaaagcaa aacaggucua gaa 2366321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 663cuagaccugu uuugcuuuug u 2166423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 664acaaaagcaa aacaggucua gaa 2366521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 665cuagaccugu uuugcuuuug u 2166623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 666acaaaagcaa aacaggucua gaa 2366721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 667cuagaccugu uuugcuuuug u 2166823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 668acaaaagcaa aacaggucua gaa 2366921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 669cuagaccugu uuugcuuuug u 2167023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 670acaaaagcaa aacaggucua gaa 2367121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 671cuagaccugu uuugcuuuug u 2167223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 672acaaaagcaa aacaggucua gaa 2367321RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 673cuagaccugu uuugcuuuug u 2167423RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 674acaaaagcaa aacaggucua gaa 2367521RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 675cuagaccugu uuugcuuuug u 2167623RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 676acaaaagcaa aacaggucua gaa 2367721RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 677caagcagaca uuuaucuuuu u 2167823RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 678aaaaagauaa augucugcuu gcu 2367921RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 679cuagaccugu uuugcuuuug u 2168023RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 680acaaaagcaa aacaggucua gaa 2368121RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 681cuagaccugu uuugcuuuug u 2168223RNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide" 682acaaaagcaa aacaggucua gaa 2368321DNAArtificial
Sequencesource/note="Description of Artificial Sequence Synthetic
oligonucleotide"source/note="Description of Combined DNA/RNA
Molecule Synthetic oligonucleotide" 683cuagaccugu tuugcuuuug u
2168423RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 684acaaaagcaa aacaggucua gaa
2368523RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 685acaaaagcaa aacaggucua gaa
2368621DNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide"source/note="Description of
Combined DNA/RNA Molecule Synthetic oligonucleotide" 686cuagaccugu
tuugcuuuug u 2168721DNAArtificial Sequencesource/note="Description
of Artificial Sequence Synthetic
oligonucleotide"source/note="Description of Combined DNA/RNA
Molecule Synthetic oligonucleotide" 687cuagaccugu tuugcuuuug u
2168823RNAArtificial Sequencesource/note="Description of Artificial
Sequence Synthetic oligonucleotide" 688acaaaagcaa aacaggucua gaa
23
* * * * *