# Patent

## Title
Antisense molecules and methods for treating pathologies

## Abstract

An antisense molecule capable of binding to a selected target site to induce exon skipping in the dystrophin gene, as set forth in SEQ ID NO: 1 to 59.

## Background
RELATED APPLICATIONS
This application is a continuation of U.S. application Ser. No. 14/108,137, filed on Dec. 16, 2013, which is a continuation of U.S. application Ser. No. 13/509,331, filed on Jul. 9, 2012, now issued as U.S. Pat. No. 8,637,483, which is a 35 U.S.C. §371 U.S. National Phase application of International Patent Application No. PCT/AU2010/001520, filed on Nov. 12, 2010, claiming the benefit of priority to Australian Patent Application No. 2009905549, filed on Nov. 12, 2009. The contents of the aforementional applications are hereby incorporated by reference.


FIELD OF THE INVENTION
The present invention relates to novel antisense compounds and compositions suitable for facilitating exon skipping. It also provides methods for inducing exon skipping using the novel antisense compounds as well as therapeutic compositions adapted for use in the methods of the invention.
STATEMENT REGARDING SEQUENCE LISTING
The instant application contains a Sequence Listing which has been submitted in ASCII format via EFS-Web and is hereby incorporated by reference in its entirety. Said ASCII copy, created on Nov. 18, 2015, is named “SequenceListing.txt” and is 104 Kilobytes in size. The Sequence Listing is being submitted by EFS Web and is hereby incorporated by reference into the specification.
BACKGROUND ART
The following discussion of the background art is intended to facilitate an understanding of the present invention only. The discussion is not an acknowledgement or admission that any of the material referred to is or was part of the common general knowledge as at the priority date of the application.
Significant effort is currently being expended into researching methods for suppressing or compensating for disease-causing mutations in genes. Antisense technologies are being developed using a range of chemistries to affect gene expression at a variety of different levels (transcription, splicing, stability, translation). Much of that research has focused on the use of antisense compounds to correct or compensate for abnormal or disease-associated genes in a myriad of different conditions.
Antisense molecules are able to inhibit gene expression with exquisite specificity and because of this many research efforts concerning oligonucleotides as modulators of gene expression have focused on inhibiting the expression of targeted genes such as oncogenes or viral genes. The antisense oligonucleotides are directed either against RNA (sense strand) or against DNA where they form triplex structures inhibiting transcription by RNA polymerase II.
To achieve a desired effect in specific gene down-regulation, the oligonucleotides must either promote the decay of the targeted mRNA or block translation of that mRNA, thereby effectively preventing de novo synthesis of the undesirable target protein.
Such techniques are not useful where the object is to up-regulate production of the native protein or compensate for mutations which induce premature termination of translation such as nonsense or frame-shifting mutations.
Furthermore, in cases where a normally functional protein is prematurely terminated because of mutations therein, a means for restoring some functional protein production through antisense technology has been shown to be possible through intervention during the splicing processes (Sierakowska H, et al., (1996) Proc Natl Acad Sci USA 93, 12840-12844; Wilton S D, et al., (1999) Neuromusc Disorders 9, 330-338; van Deutekom J C et al., (2001) Human Mol Genet 10, 1547-1554). In these cases, the defective gene transcript should not be subjected to targeted degradation so the antisense oligonucleotide chemistry should not promote target mRNA decay.
In a variety of genetic diseases, the effects of mutations on the eventual expression of a gene can be modulated through a process of targeted exon skipping during the splicing process. The splicing process is directed by complex multi-particle machinery that brings adjacent exon-intron junctions in pre-mRNA into close proximity and performs cleavage of phosphodiester bonds at the ends of the introns with their subsequent reformation between exons that are to be spliced together. This complex and highly precise process is mediated by sequence motifs in the pre-mRNA that are relatively short semi-conserved RNA segments to which bind the various nuclear splicing factors that are then involved in the splicing reactions. By changing the way the splicing machinery reads or recognises the motifs involved in pre-mRNA processing, it is possible to create differentially spliced mRNA molecules. It has now been recognised that the majority of human genes are alternatively spliced during normal gene expression, although the mechanisms invoked have not been identified. Using antisense oligonucleotides, it has been shown that errors and deficiencies in a coded mRNA could be bypassed or removed from the mature gene transcripts.
In nature, the extent of genetic deletion or exon skipping in the splicing process is not fully understood, although many instances have been documented to occur, generally at very low levels (Sherrat T G, et al., (1993) Am J Hum Genet 53, 1007-1015). However, it is recognised that if exons associated with disease-causing mutations can be specifically deleted from some genes, a shortened protein product can sometimes be produced that has similar biological properties of the native protein or has sufficient biological activity to ameliorate the disease caused by mutations associated with the target exon (Lu Q L, et al., (2003) Nature Medicine 9, 1009-1014; Aartsma-Rus A et al., (2004) Am J Hum Genet 74: 83-92). This process of targeted exon skipping is likely to be particularly useful in long genes where there are many exons and introns, where there is redundancy in the genetic constitution of the exons or where a protein is able to function without one or more particular exons (e.g. with the dystrophin gene, which consists of 79 exons; or possibly some collagen genes which encode for repeated blocks of sequence or the huge nebulin or titin genes which are comprised of −80 and over 370 exons, respectively).
Efforts to redirect gene processing for the treatment of genetic diseases associated with truncations caused by mutations in various genes have focused on the use of antisense oligonucleotides that either: (1) fully or partially overlap with the elements involved in the splicing process; or (2) bind to the pre-mRNA at a position sufficiently close to the element to disrupt the binding and function of the splicing factors that would normally mediate a particular splicing reaction which occurs at that element (e.g., binds to the pre-mRNA at a position within 3, 6, or 9 nucleotides of the element to be blocked).
For example, modulation of mutant dystrophin pre-mRNA splicing with antisense oligoribonucleotides has been reported both in vitro and in vivo. In one type of dystrophin mutation reported in Japan, a 52-base pair deletion mutation causes exon 19 to be removed with the flanking introns during the splicing process (Matsuo et al., (1991) J Clin Invest. 87:2127-2131). An in vitro minigene splicing system has been used to show that a 31-mer 2′-O-methyl oligoribonucleotide complementary to the 5′ half of the deleted sequence in dystrophin Kobe exon 19 inhibited splicing of wild-type pre-mRNA (Takeshima et al. (1995), J. Clin. Invest. 95:515-520). The same oligonucleotide was used to induce exon skipping from the native dystrophin gene transcript in human cultured lymphoblastoid cells.
Dunckley et al. (1997) Nucleosides & Nucleotides, 16, 1665-1668 described in vitro constructs for analysis of splicing around exon 23 of mutated dystrophin in the mdx mouse mutant, a model for muscular dystrophy. Plans to analyse these constructs in vitro using 2′ modified oligonucleotides targeted to splice sites within and adjacent to mouse dystrophin exon 23 were discussed, though no target sites or sequences were given.
2′-O-methyl oligoribonucleotides were subsequently reported to correct dystrophin deficiency in myoblasts from the mdx mouse from this group. An antisense oligonucleotide targeted to the 3′ splice site of murine dystrophin intron 22 was reported to cause skipping of the mutant exon as well as several flanking exons and created a novel in-frame dystrophin transcript with a novel internal deletion. This mutated dystrophin was expressed in 1-2% of antisense treated mdx myotubes. Use of other oligonucleotide modifications such as 2′-0-methoxyethyl phosphodiesters are described (Dunckley et al. (1998) Human Mol. Genetics, 5:1083-90).
Thus, antisense molecules may provide a tool in the treatment of genetic disorders such as Duchenne Muscular Dystrophy (DMD). However, attempts to induce exon skipping using antisense molecules have had mixed success.
Studies on dystrophin exon 19, where successful skipping of that exon from the dystrophin pre-mRNA was achieved using a variety of antisense molecules directed at the flanking splice sites or motifs within the exon involved in exon definition as described by Errington et al. (2003) J Gen Med 5: 518-527).
In contrast to the apparent ease of exon 19 skipping, the first report of exon 23 skipping in the mdx mouse by Dunckley et al., (1998) is now considered to be reporting only a naturally occurring revertant transcript or artefact rather than any true antisense activity. In addition to not consistently generating transcripts missing exon 23, Dunckley et al, (1998) did not show any time course of induced exon skipping, or even titration of antisense oligonucleotides, to demonstrate dose dependent effects where the levels of exon skipping corresponded with increasing or decreasing amounts of antisense oligonucleotide. Furthermore, this work could not be replicated by other researchers.
The first example of specific and reproducible exon skipping in the mdx mouse model was reported by Wilton et al., (1999) Neuromuscular Disorders 9, 330-338. By directing an antisense molecule to the donor splice site, consistent and efficient exon 23 skipping was induced in the dystrophin mRNA within 6 hours of treatment of the cultured cells. Wilton et al., (1999), also describe targeting the acceptor region of the mouse dystrophin pre-mRNA with longer antisense oligonucleotides and being unable to repeat the published results of Dunckley et al. (1998). No exon skipping, either 23 alone or multiple removal of several flanking exons, could be reproducibly detected using a selection of antisense oligonucleotides directed at the acceptor splice site of intron 22.
While the first antisense oligonucleotide directed at the intron 23 donor splice site induced consistent exon skipping in primary cultured myoblasts, this compound was found to be much less efficient in immortalized cell cultures expressing higher levels of dystrophin. However, with refined targeting and antisense oligonucleotide design, the efficiency of specific exon removal was increased by almost an order of magnitude (see Mann C J et al., (2002) J Gen Med 4, 644-654).
Thus, there remains a need to provide antisense oligonucleotides capable of binding to and modifying the splicing of a target nucleotide sequence. Simply directing the antisense oligonucleotides to motifs presumed to be crucial for splicing is no guarantee of the efficacy of that compound in a therapeutic setting.
The preceding discussion of the background to the invention is intended only to facilitate an understanding of the present invention. It should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to was part of the common general knowledge as at the priority date of the application.
SUMMARY OF THE INVENTION
The present invention provides antisense molecule compounds and compositions suitable for binding to RNA motifs involved in the splicing of pre-mRNA that are able to induce specific and efficient exon skipping and a method for their use thereof.
The choice of target selection plays a crucial role in the efficiency of exon skipping and hence its subsequent application of a potential therapy. Simply designing antisense molecules to target regions of pre-mRNA presumed to be involved in splicing is no guarantee of inducing efficient and specific exon skipping. The most obvious or readily defined targets for splicing intervention are the donor and acceptor splice sites although there are less defined or conserved motifs including exonic splicing enhancers, silencing elements and branch points. The acceptor and donor splice sites have consensus sequences of about 16 and 8 bases respectively (see FIG. 1 for schematic representation of motifs and domains involved in exon recognition, intron removal and the splicing process).
According to a first aspect, the invention provides antisense molecules capable of binding to a selected target to induce exon skipping.
For example, to induce exon skipping in exons 5, 12, 17, 21, 22, 24, 43-47, 49, 50, 54-64, 66, 67, 70 and 72 in the Dystrophin gene transcript the antisense molecules are preferably selected from the group listed in Table 1A.
In a further example, it is possible to combine two or more antisense oligonucleotides of the present invention together to induce more efficient exon skipping in exons 3, 4, 8, 10, 26, 36, 48, 60, 66 and 68. A combination or “cocktail” of antisense oligonucleotides are directed at exons to induce efficient exon skipping.
According to a second aspect, the present invention provides antisense molecules selected and or adapted to aid in the prophylactic or therapeutic treatment of a genetic disorder comprising at least an antisense molecule in a form suitable for delivery to a patient.
According to a third aspect, the invention provides a method for treating a patient suffering from a genetic disease wherein there is a mutation in a gene encoding a particular protein and the affect of the mutation can be abrogated by exon skipping, comprising the steps of: (a) selecting an antisense molecule in accordance with the methods described herein; and (b) administering the molecule to a patient in need of such treatment.
The invention also addresses the use of purified and isolated antisense oligonucleotides of the invention, for the manufacture of a medicament for treatment of a genetic disease.
The invention further provides a method of treating a condition characterised by Duchenne muscular dystrophy, which method comprises administering to a patient in need of treatment an effective amount of an appropriately designed antisense oligonucleotide of the invention, relevant to the particular genetic lesion in that patient. Further, the invention provides a method for prophylactically treating a patient to prevent or at least minimise Duchene muscular dystrophy, comprising the step of: administering to the patient an effective amount of an antisense oligonucleotide or a pharmaceutical composition comprising one or more of these biological molecules.
The invention also provides kits for treating a genetic disease, which kits comprise at least a antisense oligonucleotide of the present invention, packaged in a suitable container and instructions for its use.
Other aspects and advantages of the invention will become apparent to those skilled in the art from a review of the ensuing description, which proceeds with reference to the following figures.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1. Schematic representation of motifs and domains involved in exon recognition, intron removal and the splicing process.
FIG. 2. Diagrammatic representation of the concept of antisense oligonucleotide induced exon skipping to by-pass disease-causing mutations (not drawn to scale). The hatched box represents an exon carrying a mutation that prevents the translation of the rest of the mRNA into a protein. The solid black bar represents an antisense oligonucleotide that prevents inclusion of that exon in the mature mRNA.
FIG. 3. Gel electrophoresis showing a “cocktail” of antisense molecules directed at exon 3 which induce strong and consistent exon skipping at a transfection concentration of 10 nanomolar in cultured normal human muscle cells.
FIG. 4. Gel electrophoresis showing a “cocktail” of antisense molecules directed at exon 4 which induce strong and consistent exon skipping at a transfection concentration of 25 nanomolar in cultured normal human muscle cells.
FIG. 5 Gel electrophoresis showing strong and efficient human exon 5 skipping using an antisense molecules [H5A(+35+65)] directed at an exon 5 internal domain, presumably an exon splicing enhancer. This preferred compound induces consistent exon skipping at a transfection concentration of 25 nanomolar in cultured human muscle cells.
FIG. 6. Gel electrophoresis showing a “cocktail” of antisense molecules directed at exon 8 which induce strong and consistent exon skipping of both exon 8 and exon8/9 at a transfection concentration of 10 nanomolar in cultured normal human muscle cells.
FIG. 7. Gel electrophoresis showing various cocktails and single antisense molecules which induce skipping of exon 10 and surrounding exons. A combination of [H10A(−05+16)] and [H10A(+98+119)] or [H10A(−05+16)] and [H10A(+130+149)] induces skipping of exon 10 and exons 9-12, whilst [H10A(−05+16)] alone induces skipping of exons 9-14.
FIG. 8. Gel electrophoresis showing exon 14 skipping using antisense molecule H14A(+31+61) directed at exon 14.
FIG. 9. Gel electrophoresis showing exon 17 skipping using antisense molecule H17A(+10+35) directed at exon 17.
FIG. 10. Gel electrophoresis showing two cocktails of antisense molecules directed at exon 26. The double cocktail of [H26A(−07+19)] and [H26A(+24+50)] induces good skipping of exon 26, and the addition of a further antisense molecule to the cocktail does not affect the efficiency of skipping.
FIG. 11. Gel electrophoresis showing a “cocktail” of antisense molecules directed at exon 36 which induce strong and consistent exon skipping at a transfection concentration of 25 nanomolar in cultured normal human muscle cells.
FIG. 12. Gel electrophoresis showing strong and consistent exon 43 skipping to 25 nanomolar in cultured normal human muscle cells using antisense molecule H43A(+92+117).
FIG. 13. Gel electrophoresis showing dose dependant exon 55 skipping using antisense molecule H44A(+65+90).
FIG. 14. Gel electrophoresis showing strong and consistent exon 45 skipping using antisense molecule H45A(−09+25).
FIG. 15. Gel electrophoresis showing strong and consistent exon 46 skipping using antisense molecule H46A(+81+109).
FIG. 16. Gel electrophoresis showing strong and consistent exon 47 skipping using antisense molecule H47A(+01+29).
FIG. 17. Gel electrophoresis showing a “cocktail” of antisense molecules directed at exon 48 which induce strong and consistent exon skipping.
FIG. 18. Gel electrophoresis showing strong and consistent exon 49 skipping using antisense molecule H49A(+45+70).
FIG. 19. Gel electrophoresis showing strong and consistent exon 50 skipping using antisense molecule H50A(+48+74).
FIG. 20. Gel electrophoresis showing strong and consistent exon 51 skipping using antisense molecule H51A(+66+95).
FIG. 21. Gel electrophoresis showing strong and consistent exon 54 skipping using antisense molecule H54A(+67+97).
FIG. 22. Gel electrophoresis showing antisense molecule H55A(−10+20) induced dose dependant exon 55 skipping.
FIG. 23. Gel electrophoresis showing strong and consistent exon 56 skipping using antisense molecule H56A(+92+121).
FIG. 24. Gel electrophoresis showing antisense molecule H57A(−10+20) induced dose dependant exon 57 skipping.
FIG. 25. Gel electrophoresis showing exon 59 and exon 58/59 skipping using antisense molecule H59A(+96+120) directed at exon 59.
FIG. 26. Gel electrophoresis showing two different cocktails which induce exon skipping of exon 60.
FIG. 27. Gel electrophoresis showing exon 63 skipping using antisense molecule H63A(+20+49).
FIG. 28. Gel electrophoresis showing exon 64 skipping using antisense molecule H64A(+34+62).
FIG. 29. Gel electrophoresis showing a “cocktail” of antisense molecules directed at exon 66 which induce dose dependant exon skipping.
FIG. 30. Gel electrophoresis showing exon 67 skipping using antisense molecule H67A(+17+47).
FIG. 31. Gel electrophoresis showing a “cocktail” of antisense molecules directed at exon 68 which induce dose dependant exon skipping.
FIG. 32. Gel electrophoresis showing a “cocktail” of antisense molecules which induce strong and consistent exon skipping of exons 69/70 at a transfection concentration of 25 nanomolar.
FIG. 33. Gel electrophoresis showing various “cocktails” of antisense molecules which induce various levels of skipping in exon 50.
FIG. 34. Gel electrophoresis showing a cocktail of three antisense molecules which induce efficient skipping of exons 50/51.
FIG. 35. Graph of densitometry results showing various efficiencies of exon skipping. The antisense molecules tested were Exon 3 [H3A(+30+60) & H3A(+61+85)]; Exon 4 [H4D(+14−11) & H4A(+11+40)]; Exon 14 [H14A(+32+61)]; Exon 17 [H17A(+10+35)]; Exon 26 [H26A(−07+19), H26A(+24+50) & H26A(+68+92)]; Exon 36 [H36A(−16+09) & H36A(+22+51)].
FIG. 36. Graph of densitometry results showing various efficiencies of exon skipping. The antisense molecules tested were Exon 46 [H46A(+81+109)]; Exon 47 [H47A(+01+29)]; Exon 48 [H48A(+01+28) & H48A(+40+67)]; Exon 49 [H49A(+45+70)].
FIG. 37. Gel electrophoresis showing exon 11 skipping using antisense molecule H11A(+50+79).
FIG. 38. Gel electrophoresis showing exon 12 skipping using antisense molecule H12A(+30+57).
FIG. 39. Gel electrophoresis showing exon 44 skipping using antisense molecule H44A(+59+85).
FIG. 40. Gel electrophoresis showing exon 45 skipping using antisense molecule H45A(−03+25).
FIG. 41. Gel electrophoresis showing exon 51 skipping using antisense molecule H51A(+71+100).
FIG. 42. Gel electrophoresis showing exon 52 skipping using antisense molecule H52A(+09+38).
FIG. 43. Gel electrophoresis showing exon 53 skipping using antisense molecule H53A(+33+65).
FIG. 44. Gel electrophoresis showing exon 46 skipping using antisense molecule H46A(+93+122).
FIG. 45. Gel electrophoresis showing exon 46 skipping using antisense molecule (H46A(+93+2).
FIG. 46A. Sequences of antisense molecules.
FIG. 46B. Sequences of antisense molecules.



DETAILED DESCRIPTION
Brief Description of the Sequence Listings







TABLE 1A







Single antisense molecules









SEQ ID
Exon
Sequence













Exon 5



1
H5A(+35+65)
AAA CCA AGA GUC AGU UUA UGA UUU CCA UCU A


 



Exon 11



52
H11A(+50+79)
CUG UUC CAA UCA GCU UAC UUC CCA AUU GUA


 



Exon 12



2
H12A(+52+75)
UCU UCU GUU UUU GUU AGC CAG UCA


 


53
H12A(+30+57)
CAG UCA UUC AAC UCU UUC AGU UUC UGA U


 



Exon 17



3
H17A(−07+23)
GUG GUG GUG ACA GCC UGU GAA AUC UGU GAG


 


4
H17A(+61+86)
UGU UCC CUU GUG GUC ACC GUA GUU AC


 



Exon 21



5
H21A(+86+114)
CAC AAA GUC UGC AUC CAG GAA CAU GGG UC


 


6
H21A(+90+119)
AAG GCC ACA AAG UCU GCA UCC AGG AAC AUG


 



Exon 22



7
H22A(+125+146)
CUG CAA UUC CCC GAG UCU CUG C


 



Exon 24



8
H24A(+51+73)
CAA GGG CAG GCC AUU CCU CCU UC


 



Exon 43



9
H43A(+92+117)
GAG AGC UUC CUG UAG CUU CAC CCU UU


 



Exon 44



10
H44A(+65+90)
UGU UCA GCU UCU GUU AGC CAC UGA


 


54
H44A(+59+85)
CUG UUC AGC UUC UGU UAG CCA CUG AUU


 



Exon 45



11
H45A (−09+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA U


 


55
H45A(−03+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU G


 


61
H45A(−06+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA A


 


62
H45A(−12+19)
CAA UGC CAU CCU GGA GUU CCU GUA AGA UAC C


 



Exon 46



12
H46A(+81+109)
UCC AGG UUC AAG UGG GAU ACU AGC AAU GU


 


56
H46A(+93+122)
GUU GCU GCU CUU UUC CAG GUU CAA GUG GGA


 



Exon 47



13
H47A(+01+29)
UGG CGC AGG GGC AAC UCU UCC ACC AGU AA


 



Exon 49



14
H49A(+45+70)
ACA AAU GCU GCC CUU UAG ACA AAA UC


 



Exon 50



15
H50A(+48+74)
GGC UGC UUU GCC CUC AGC UCU UGA AGU


 



Exon 51



57
H51A(+71+100)
GGU ACC UCC AAC AUC AAG GAA GAU GGC AUU


 



Exon 52



58
H52A(+09+38)
UCC AAC UGG GGA CGC CUC UGU UCC AAA UCC UGC


 



Exon 53



59
H53A(+33+65)
UUC AAC UGU UGC CUC CGG UUC UGA AGG UGU UCU


 



Exon 54



16
H54A(+67+97)
UGG UCU CAU CUG CAG AAU AAU CCC GGA GAA G


 



Exon 55



17
H55A(−10+20)
CAG CCU CUC GCU CAC UCA CCC UGC AAA GGA


 



Exon 56



18
H56A(+92+121)
CCA AAC GUC UUU GUA ACA GGA CUG CAU


 


19
H56A(+112+141)
CCA CUU GAA GUU CAU GUU AUC CAA ACG UCU


 



Exon 57



20
H57A(−10+20)
AAC UGG CUU CCA AAU GGG ACC UGA AAA AGA


 



Exon 58



21
H58A(+34+64)
UUC GUA CAG UCU CAA GAG UAC UCA UGA UUA C


 


22
H58D(+17−07)
CAA UUA CCU CUG GGC UCC UGG UAG


 



Exon 59



23
H59A(+96+120)
CUA UUU UUC UCU GCC AGU CAG CGG A


 



Exon 60



24
H60A(+33+62)
CGA GCA AGG UCA UUG ACG UGG CUC ACG UUC


 



Exon 61



25
H61A(+10+40)
GGG CUU CAU GCA GCU GCC UGA CUC GGU CCU C


 



Exon 62



26
H62A(23+52)
UAG GGC ACU UUG UUU GGC GAG AUG GCU CUC


 



Exon 63



27
H63A(+20+49)
GAG CUC UGU CAU UUU GGG AUG GUC CCA GCA


 



Exon 64



28
H64A(+34+62)
CUG CAG UCU UCG GAG UUU CAU GGC AGU CC


 



Exon 66



29
H66A(−8+19)
GAU CCU CCC UGU UCG UCC CCU AUU AUG


 



Exon 67



30
H67A(+17+47)
GCG CUG GUC ACA AAA UCC UGU UGA ACU UGC


 



Exon 73



60
H73A(+02+26)
CAU UGC UGU UUU CCA UUU CUG GUA G
















TABLE 1B







Cocktails of antisense molecules









SEQ ID
Exon
Sequence






Exon 3 cocktails



31
H3A(+30+60)
UAG GAG GCG CCU CCC AUC CUG UAG GUC ACU G


 


32
H3A(+61+85)
G CCC UGU CAG GCC UUC GAG GAG GUC


 



Exon 4 cocktails



33
H4A(+11+40)
UGU UCA GGG CAU GAA CUC UUG UGG AUC CUU


 


34
H4D(+14−11)
GUA CUA CUU ACA UUA UUG UUC UGC A


 



Exon 8 cocktails



35
H8A(−06+24)
UAU CUG GAU AGG UGG UAU CAA CAU CUG UAA


 


36
H8A(+134+158)
AUG UAA CUG AAA AUG UUC UUC UUU A


 



Exon 10 cocktails



37
H10A(−05+16)
CAG GAG CUU CCA AAU GCU GCA


 


38
H10A(+98+119)
UCC UCA GCA GAA AGA AGC CAC G


 



Exon 26 cocktails



39
H26A(−07+19)
CCU CCU UUC UGG CAU AGA CCU UCC AC


 


40
H26A(+24+50)
CUU ACA GUU UUC UCC AAA CCU CCC UUC


 


41
H26A(+68+92)
UGU GUC AUC CAU UCG UGC AUC UCU G


 



Exon 36 cocktails



42
H36A(−16+09)
CUG GUA UUC CUU AAU UGU ACA GAG A


 


43
H36A(+22+51)
UGU GAU GUG GUC CAC AUU CUG GUC AAA AGU


 



Exon 48 cocktails



44
H48A(+01+28)
CUU GUU UCU CAG GUA AAG CUC UGG AAA C


 


45
H48A(+40+67)
CAA GCU GCC CAA GGU CUU UUA UUU GAG C


 



Exon 60 cocktails



46
H60A(+87+116)
UCC AGA GUG CUG AGG UUA UAC GGU GAG AGC


 


47
H60A(+37+66)
CUG GCG AGC AAG GUC CUU GAC GUG GCU CAC


 



Exon 66 cocktails



48
H66A(−02+28)
CAG GAC ACG GAU CCU CCC UGU UCG UCC CCU


 


49
H66D(+13−17)
UAA UAU ACA CGA CUU ACA UCU GUA CUU GUC


 



Exon 68 cocktails



50
H68A(+48+72)
CAC CAU GGA CUG GGG UUC CAG UCU C


 


51
H68D(+23−03)
UAC CUG AAU CCA AUG AUU GGA CAC UC









General

Those skilled in the art will appreciate that the invention described herein is susceptible to variations and modifications other than those specifically described. It is to be understood that the invention includes all such variations and modifications. The invention also includes all of the steps, features, compositions and compounds referred to or indicated in the specification, individually or collectively and any and all combinations or any two or more of the steps or features.
The present invention is not to be limited in scope by the specific embodiments described herein, which are intended for the purpose of exemplification only. Functionally equivalent products, compositions and methods are clearly within the scope of the invention as described herein.
Sequence identity numbers (SEQ ID NO:) containing nucleotide and amino acid sequence information included in this specification are collected at the end of the description and have been prepared using the programme PatentIn Version 3.0. Each nucleotide or amino acid sequence is identified in the sequence listing by the numeric indicator <210> followed by the sequence identifier (e.g. <210>1, <210>2, etc.). The length, type of sequence and source organism for each nucleotide or amino acid sequence are indicated by information provided in the numeric indicator fields <211>, <212> and <213>, respectively. Nucleotide and amino acid sequences referred to in the specification are defined by the information provided in numeric indicator field <400> followed by the sequence identifier (e.g. <400>1, <400>2, etc.).
An antisense molecule nomenclature system was proposed and published to distinguish between the different antisense molecules (see Mann et al., (2002) J Gen Med 4, 644-654). This nomenclature became especially relevant when testing several slightly different antisense molecules, all directed at the same target region, as shown below:

H#A/D(x:y).

The first letter designates the species (e.g. H: human, M: murine, C: canine)
“#” designates target dystrophin exon number.
“A/D” indicates acceptor or donor splice site at the beginning and end of the exon, respectively.
(x y) represents the annealing coordinates where “−” or “+” indicate intronic or exonic sequences respectively. As an example, A(−6+18) would indicate the last 6 bases of the intron preceding the target exon and the first 18 bases of the target exon. The closest splice site would be the acceptor so these coordinates would be preceded with an “A”. Describing annealing coordinates at the donor splice site could be D(+2−18) where the last 2 exonic bases and the first 18 intronic bases correspond to the annealing site of the antisense molecule. Entirely exonic annealing coordinates that would be represented by A(+65+85), that is the site between the 65th and 85th nucleotide from the start of that exon.
The entire disclosures of all publications (including patents, patent applications, journal articles, laboratory manuals, books, or other documents) cited herein are hereby incorporated by reference. No admission is made that any of the references constitute prior art or are part of the common general knowledge of those working in the field to which this invention relates.
As used herein the term “derived” and “derived from” shall be taken to indicate that a specific integer may be obtained from a particular source albeit not necessarily directly from that source.
Throughout this specification, unless the context requires otherwise, the word “comprise”, or variations such as “comprises” or “comprising”, will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integers.
Other definitions for selected terms used herein may be found within the detailed description of the invention and apply throughout. Unless otherwise defined, all other scientific and technical terms used herein have the same meaning as commonly understood to one of ordinary skill in the art to which the invention belongs.
DESCRIPTION OF THE PREFERRED EMBODIMENT
When antisense molecule(s) are targeted to nucleotide sequences involved in splicing in exons within pre-mRNA sequences, normal splicing of the exon may be inhibited, causing the splicing machinery to by-pass the entire mutated exon from the mature mRNA. The concept of antisense oligonucleotide induced exon skipping is shown in FIG. 2.
In many genes, deletion of an entire exon would lead to the production of a non-functional protein through the loss of important functional domains or the disruption of the reading frame. However, in some proteins it is possible to shorten the protein by deleting one or more exons from within the protein, without disrupting the reading frame and without seriously altering the biological activity of the protein. Typically, such proteins have a structural role and or possess functional domains at their ends. The present invention describes antisense molecules capable of binding to specified dystrophin pre-mRNA targets and re-directing processing of that gene.
A preferred aim of a therapy based on antisense molecules is to get maximum exon skipping by providing the lowest possible concentration of the antisense molecule. Generally, an antisense molecule may cause strong, robust exon skipping; weak, sporadic exon skipping or no exon skipping at all. It is preferable to develop antisense molecules (alone or in combination) which can deliver strong, robust consistent exon skipping at a low therapeutic dose.
Antisense Molecules
According to a first aspect of the invention, there is provided antisense molecules capable of binding to a selected target to induce exon skipping. To induce exon skipping in exons of the Dystrophin gene transcript, the antisense molecules are preferably selected from the group of compounds shown in Table 1A.
There is also provided a combination or “cocktail” of two or more antisense oligonucleotides capable of binding to a selected target to induce exon skipping. To induce exon skipping in exons of the Dystrophin gene transcript, the antisense molecules in a “cocktail” are preferably selected from the group of compounds shown in Table 1B.
Designing antisense molecules to completely mask consensus splice sites may not necessarily generate any skipping of the targeted exon. Furthermore, the inventors have discovered that size or length of the antisense oligonucleotide itself is not always a primary factor when designing antisense molecules. With some targets such as exon 19, antisense oligonucleotides as short as 12 bases were able to induce exon skipping, albeit not as efficiently as longer (20-31 bases) oligonucleotides. In some other targets, such as murine dystrophin exon 23, antisense oligonucleotides only 17 residues long were able to induce more efficient skipping than another overlapping compound of 25 nucleotides. However, in the present invention it has been generally found that longer antisense molecules are often more effective at inducing exon skipping than shorter molecules. Thus preferably, the antisense molecules of the present invention are between 24 and 30 nucleic acids in length, preferably about 28 nucleotides in length. For example, it has previously been found that an antisense oligonucleotide of 20 bases (H16A(−07+13)) was ineffective at inducing exon skipping of exon 16, but an oligonucleotide of 31 bases (H16A(−06+25)), which completely encompassed the shorter oligonucleotide, was effective at inducing skipping (Harding et al (2007) Mol Ther 15:157-166).
The inventors have also discovered that there does not appear to be any standard motif that can be blocked or masked by antisense molecules to redirect splicing. In some exons, such as mouse dystrophin exon 23, the donor splice site was the most amenable to target to re-direct skipping of that exon. It should be noted that designing and testing a series of exon 23 specific antisense molecules to anneal to overlapping regions of the donor splice site showed considerable variation in the efficacy of induced exon skipping. As reported in Mann et al., (2002) there was a significant variation in the efficiency of bypassing the nonsense mutation depending upon antisense oligonucleotide annealing (“Improved antisense oligonucleotide induced exon skipping in the mdx mouse model of muscular dystrophy”. J Gen Med 4: 644-654). Targeting the acceptor site of exon 23 or several internal domains was not found to induce any consistent exon 23 skipping.
In other exons targeted for removal, masking the donor splice site did not induce any exon skipping. However, by directing antisense molecules to the acceptor splice site (human exon 8 as discussed below), strong and sustained exon skipping was induced. It should be noted that removal of human exon 8 was tightly linked with the co-removal of exon 9. There is no strong sequence homology between the exon 8 antisense oligonucleotides and corresponding regions of exon 9 so it does not appear to be a matter of cross reaction. Rather, the splicing of these two exons is generally linked. This is not an isolated instance, as the same effect is observed in canine cells where targeting exon 8 for removal also resulted in the skipping of exon 9. Targeting exon 23 for removal in the mouse dystrophin pre-mRNA also results in the frequent removal of exon 22 as well. This effect occurs in a dose dependent manner and also indicates close coordinated processing of 2 adjacent exons.
In other targeted exons, antisense molecules directed at the donor or acceptor splice sites did not induce exon skipping or induce poor skipping, while annealing antisense molecules to intra-exonic regions (i.e. exon splicing enhancers within human dystrophin exon 4) was most efficient at inducing exon skipping. Some exons, both mouse and human exon 19 for example, are readily skipped by targeting antisense molecules to a variety of motifs. That is, targeted exon skipping is induced after using antisense oligonucleotides to mask donor and acceptor splice sites or exon splicing enhancers.
It is also not possible to predict which cocktails of antisense molecules will induce exon skipping. For example, the combination of two antisense molecules which, on their own, are very good at inducing skipping of a given exon may not cause skipping of an exon when combined in a cocktail. For example, each of H50A(+02+30) and H50A(+66+95) on their own induce good skipping of exon 50 and 51. However, in combination as a cocktail, they only induced poor skipping of the two exons. Likewise, the combination of H50A(+02+30) and H51A(+66+90) or H50A(+02+30) and H51A(+61+90) did not cause efficient skipping of exons 50 and 51, even though the individual antisense molecules were effective. Yet the introduction of a third antisense molecule ([H51 D(+16−07)] which by itself did not cause skipping), created a three element cocktail ([H50A(+02+30)], H51A(+66+90) and [H51 D(+16−07)]) that was able to cause skipping of exons 50 and 51 down to 1 nM.
Alternatively, the combination of two or three antisense molecules which are ineffective or only moderately effective on their own may cause excellent skipping when combined. For example, individually H26A(−07+19) [SEQ ID NO: 39], H26A(+24+50) [SEQ ID NO: 40] and H26A(+68+92) [SEQ ID NO: 41] cause inefficient skipping of exon 26, and also induce multiple exon skipping (26-29 or 27-30). However, when the three exons are combined as a cocktail, highly efficient skipping of exon 26 occurs.
From the above examples and discussion, it is clear that there is no way to accurately predict whether a combination will work or not.
Antisense molecules may cause skipping of exons in a ‘dose dependant’ or ‘non-dose dependant’ manner. By dose dependant, it is meant that a larger amount of the antisense molecule induces better skipping of the exon, whereas non-dose dependant antisense molecules are able to induce skipping even at very low doses. For example, from FIG. 15 it can be seen that H46A(+81+109) [SEQ ID NO: 12] gives equally good skipping of exon 46 regardless of the amount of antisense molecule present (from 600 nM to 25 nM). In contrast, H57A(−10+20) [SEQ ID NO: 20] (FIG. 24) induces strong skipping of exon 57 at 100 nM, but reduced skipping at 50 nM and an even greater reduction in skipping at 25 nM.
It is preferable to select antisense molecules that induce skipping in a dose independent manner, as these molecules may be administered at very low concentrations and still give a therapeutic effect. However, it is also acceptable to select as preferred molecules those antisense molecules that induce skipping in a dose dependant manner, particularly if those molecules induce good or excellent skipping at low concentrations. Preferably, the antisense molecules of the present invention are able to induce good or excellent exon skipping at concentrations of less than 500 nM, preferably less than 200 nM and more preferably as low as 100 nM, 50 nM or even 25 nM. Most preferably, the oligonucleotide molecules of the present invention are able to induce skipping at levels of greater that 30% at a concentration of 100 nM.
To identify and select antisense oligonucleotides suitable for use in the modulation of exon skipping, a nucleic acid sequence whose function is to be modulated must first be identified. This may be, for example, a gene (or mRNA transcribed form the gene) whose expression is associated with a particular disorder or disease state, or a nucleic acid molecule from an infectious agent. Within the context of the present invention, preferred target site(s) are those involved in mRNA splicing (i.e. splice donor sites, splice acceptor sites, or exonic splicing enhancer elements). Splicing branch points and exon recognition sequences or splice enhancers are also potential target sites for modulation of mRNA splicing.
Preferably, the present invention aims to provide antisense molecules capable of binding to a selected target in the dystrophin pre-mRNA to induce efficient and consistent exon skipping. Duchenne muscular dystrophy arises from mutations that preclude the synthesis of a functional dystrophin gene product. These Duchenne muscular dystrophy gene defects are typically nonsense mutations or genomic rearrangements such as deletions, duplications or micro-deletions or insertions that disrupt the reading frame. As the human dystrophin gene is a large and complex gene (with 79 exons being spliced together to generate a mature mRNA with an open reading frame of approximately 11,000 bases), there are many positions where these mutations can occur. Consequently, a comprehensive antisense oligonucleotide based therapy to address many of the different disease-causing mutations in the dystrophin gene will require that many exons can be targeted for removal during the splicing process.
Within the context of the present invention, preferred target site(s) are those involved in mRNA splicing (i.e. splice donor sites, splice acceptor sites or exonic splicing enhancer elements). Splicing branch points and exon recognition sequences or splice enhancers are also potential target sites for modulation of mRNA splicing.
The oligonucleotide and the DNA or RNA are complementary to each other when a sufficient number of corresponding positions in each molecule are occupied by nucleotides which can hydrogen bond with each other. Thus, “specifically hybridisable” and “complementary” are terms which are used to indicate a sufficient degree of complementarity or precise pairing such that stable and specific binding occurs between the oligonucleotide and the DNA or RNA target. It is understood in the art that the sequence of an antisense molecule need not be 100% complementary to that of its target sequence to be specifically hybridisable. An antisense molecule is specifically hybridisable when binding of the compound to the target DNA or RNA molecule interferes with the normal function of the target DNA or RNA to cause a loss of utility, and there is a sufficient degree of complementarity to avoid non-specific binding of the antisense compound to non-target sequences under conditions in which specific binding is desired, i.e., under physiological conditions in the case of in vivo assays or therapeutic treatment, and in the case of in vitro assays, under conditions in which the assays are performed.
While the above method may be used to select antisense molecules capable of deleting any exon from within a protein that is capable of being shortened without affecting its biological function, the exon deletion should not lead to a reading frame shift in the shortened transcribed mRNA. Thus, if in a linear sequence of three exons the end of the first exon encodes two of three nucleotides in a codon and the next exon is deleted then the third exon in the linear sequence must start with a single nucleotide that is capable of completing the nucleotide triplet for a codon. If the third exon does not commence with a single nucleotide there will be a reading frame shift that would lead to the generation of a truncated or a non-functional protein.
It will be appreciated that the codon arrangements at the end of exons in structural proteins may not always break at the end of a codon. Consequently, there may be a need to delete more than one exon from the pre-mRNA to ensure in-frame reading of the mRNA. In such circumstances, a plurality of antisense oligonucleotides may need to be selected by the method of the invention, wherein each is directed to a different region responsible for inducing splicing in the exons that are to be deleted.
The length of an antisense molecule may vary so long as it is capable of binding selectively to the intended location within the pre-mRNA molecule. The length of such sequences can be determined in accordance with selection procedures described herein. Generally, the antisense molecule will be from about 10 nucleotides in length up to about 50 nucleotides in length. However, it will be appreciated that any length of nucleotides within this range may be used in the method. Preferably, the length of the antisense molecule is between 17 to 30 nucleotides in length. Surprisingly, it has been found that longer antisense molecules are often more effective at inducing exon skipping. Thus, most preferably the antisense molecule is between 24 and 30 nucleotides in length.
In order to determine which exons can be connected in a dystrophin gene, reference should be made to an exon boundary map. Connection of one exon with another is based on the exons possessing the same number at the 3′ border as is present at the 5′ border of the exon to which it is being connected. Therefore, if exon 7 were deleted, exon 6 must connect to either exons 12 or 18 to maintain the reading frame. Thus, antisense oligonucleotides would need to be selected which redirected splicing for exons 7 to 11 in the first instance or exons 7 to 17 in the second instance. Another and somewhat simpler approach to restore the reading frame around an exon 7 deletion would be to remove the two flanking exons. Induction of exons 6 and 8 skipping should result in an in-frame transcript with the splicing of exons 5 to 9. In practise however, targeting exon 8 for removal from the pre-mRNA results in the co-removal of exon 9 so the resultant transcript would have exon 5 joined to exon 10. The inclusion or exclusion of exon 9 does not alter the reading frame.
Once the antisense molecules to be tested have been identified, they are prepared according to standard techniques known in the art. The most common method for producing antisense molecules is the methylation of the 2′ hydroxyribose position and the incorporation of a phosphorothioate backbone. This produces molecules that superficially resemble RNA but that are much more resistant to nuclease degradation.
To avoid degradation of pre-mRNA during duplex formation with the antisense molecules, the antisense molecules used in the method may be adapted to minimise or prevent cleavage by endogenous RNase H. This property is highly preferred, as the presence of unmethylated RNA oligonucleotides in an intracellularly environment or in contact with crude extracts that contain RNase H will lead to degradation of the pre-mRNA: antisense oligonucleotide duplexes. Any form of modified antisense molecules that are capable of by-passing or not inducing such degradation may be used in the present method. The nuclease resistance may be achieved by modifying the antisense molecules of the invention so that it comprises partially unsaturated aliphatic hydrocarbon chain and one or more polar or charged groups including carboxylic acid groups, ester groups, and alcohol groups.
An example of antisense molecules which, when duplexed with RNA, are not cleaved by cellular RNase H are 2′-O-methyl derivatives. 2′-O-methyl-oligoribonucleotides are very stable in a cellular environment and in animal tissues, and their duplexes with RNA have higher Tm values than their ribo- or deoxyribo-counterparts. Alternatively, the nuclease resistant antisense molecules of the invention may have at least one of the last 3′-terminus nucleotides fluoridated. Still alternatively, the nuclease resistant antisense molecules of the invention have phosphorothioate bonds linking between at least two of the last 3-terminus nucleotide bases, preferably having phosphorothioate bonds linking between the last four 3′-terminal nucleotide bases.
Antisense molecules that do not activate RNase H can be made in accordance with known techniques (see, e.g., U.S. Pat. No. 5,149,797). Such antisense molecules, which may be deoxyribonucleotide or ribonucleotide sequences, simply contain any structural modification which sterically hinders or prevents binding of RNase H to a duplex molecule containing the oligonucleotide as one member thereof, which structural modification does not substantially hinder or disrupt duplex formation. Because the portions of the oligonucleotide involved in duplex formation are substantially different from those portions involved in RNase H binding thereto, numerous antisense molecules that do not activate RNase H are available. For example, such antisense molecules may be oligonucleotides wherein at least one, or all, of the inter-nucleotide bridging phosphate residues are modified phosphates, such as methyl phosphonates, methyl phosphorothioates, phosphoromorpholidates, phosphoropiperazidates and phosphoramidates. For example, every other one of the internucleotide bridging phosphate residues may be modified as described. In another non-limiting example, such antisense molecules are molecules wherein at least one, or all, of the nucleotides contain a 2′ lower alkyl moiety (e.g., C1-C4, linear or branched, saturated or unsaturated alkyl, such as methyl, ethyl, ethenyl, propyl, 1-propenyl, 2-propenyl, and isopropyl). For example, every other one of the nucleotides may be modified as described.
While antisense oligonucleotides are a preferred form of the antisense molecules, the present invention comprehends other oligomeric antisense molecules, including but not limited to oligonucleotide mimetics such as are described below.
Specific examples of preferred antisense compounds useful in this invention include oligonucleotides containing modified backbones or non-natural inter-nucleoside linkages. As defined in this specification, oligonucleotides having modified backbones include those that retain a phosphorus atom in the backbone and 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 oligonucleotides that do not have a phosphorus atom in their inter-nucleoside backbone can also be considered to be oligonucleosides.
In other preferred oligonucleotide mimetics, both the sugar and the inter-nucleoside 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 oligonucleotide 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 oligonucleotide is replaced with an amide containing backbone, in particular an aminoethylglycine backbone. The nucleo-bases are retained and are bound directly or indirectly to aza nitrogen atoms of the amide portion of the backbone.
Modified oligonucleotides may also contain one or more substituted sugar moieties. Oligonucleotides may also include nucleobase (often referred to in the art simply as “base”) modifications or substitutions. Certain nucleobases are particularly useful for increasing the binding affinity of the oligomeric compounds of the invention. These include 5-substituted pyrimidines, 6-azapyrimidines and N-2, N-6 and O-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° C. and are presently preferred base substitutions, even more particularly when combined with 2′-O-methoxyethyl sugar modifications.
Another modification of the oligonucleotides of the invention involves chemically linking to the oligonucleotide one or more moieties or conjugates that enhance the activity, cellular distribution or cellular uptake of the oligonucleotide. Such moieties include but are not limited to lipid moieties such as a cholesterol moiety, cholic acid, a thioether, e.g., hexyl-S-tritylthiol, a thiocholesterol, an aliphatic chain, e.g., dodecandiol or undecyl residues, a phospholipid, e.g., di-hexadecyl-rac-glycerol or triethylammonium 1,2-di-O-hexadecyl-rac-glycero-3-H-phosphonate, a polyamine or a polyethylene glycol chain, or adamantane acetic acid, a palmityl moiety, or an octadecylamine or hexylamino-carbonyl-oxycholesterol moiety.
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 may be incorporated in a single compound or even at a single nucleoside within an oligonucleotide. The present invention also includes antisense compounds that are chimeric compounds. “Chimeric” antisense compounds or “chimeras,” in the context of this invention, are antisense molecules, particularly oligonucleotides, 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 an oligonucleotide compound. These oligonucleotides typically contain at least one region wherein the oligonucleotide is modified so as to confer upon the increased resistance to nuclease degradation, increased cellular uptake, and an additional region for increased binding affinity for the target nucleic acid.
Methods of Manufacturing Antisense Molecules
The antisense molecules used in accordance with this 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.). One method for synthesising oligonucleotides on a modified solid support is described in U.S. Pat. No. 4,458,066.
Any other means for such synthesis known in the art may additionally or alternatively be employed. It is well known to use similar techniques to prepare oligonucleotides such as the phosphorothioates and alkylated derivatives. In one such automated embodiment, diethyl-phosphoramidites are used as starting materials and may be synthesized as described by Beaucage, et al., (1981) Tetrahedron Letters, 22:1859-1862.
The antisense molecules of the invention are synthesised in vitro and do not include antisense compositions of biological origin, or genetic vector constructs designed to direct the in vivo synthesis of antisense molecules. The molecules of the invention may also be mixed, encapsulated, conjugated or otherwise associated with other molecules, molecule structures or mixtures of compounds, as for example, liposomes, receptor targeted molecules, oral, rectal, topical or other formulations, for assisting in uptake, distribution and/or absorption.
Therapeutic Agents
The present invention also can be used as a prophylactic or therapeutic, which may be utilised for the purpose of treatment of a genetic disease.
Accordingly, in one embodiment the present invention provides antisense molecules that bind to a selected target in the dystrophin pre-mRNA to induce efficient and consistent exon skipping described herein in a therapeutically effective amount admixed with a pharmaceutically acceptable carrier, diluent, or excipient.
The phrase “pharmaceutically acceptable” refers to molecular entities and compositions that are physiologically tolerable and do not typically produce an allergic or similarly untoward reaction, such as gastric upset and the like, when administered to a patient. The term “carrier” refers to a diluent, adjuvant, excipient, or vehicle with which the compound is administered. Such pharmaceutical carriers can be sterile liquids, such as water and oils, including those of petroleum, animal, vegetable or synthetic origin, such as peanut oil, soybean oil, mineral oil, sesame oil and the like. Water or saline solutions and aqueous dextrose and glycerol solutions are preferably employed as carriers, particularly for injectable solutions. Suitable pharmaceutical carriers are described in Martin, Remington's Pharmaceutical Sciences, 18th Ed., Mack Publishing Co., Easton, Pa., (1990).
In a more specific form of the invention there are provided pharmaceutical compositions comprising therapeutically effective amounts of an antisense molecule together with pharmaceutically acceptable diluents, preservatives, solubilizers, emulsifiers, adjuvants and/or carriers. Such compositions include diluents of various buffer content (e.g., Tris-HCl, acetate, phosphate), pH and ionic strength and additives such as detergents and solubilizing agents (e.g., Tween 80, Polysorbate 80), anti-oxidants (e.g., ascorbic acid, sodium metabisulfite), preservatives (e.g., Thimersol, benzyl alcohol) and bulking substances (e.g., lactose, mannitol). The material may be incorporated into particulate preparations of polymeric compounds such as polylactic acid, polyglycolic acid, etc. or into liposomes. Hylauronic acid may also be used. Such compositions may influence the physical state, stability, rate of in vivo release, and rate of in vivo clearance of the present proteins and derivatives. See, e.g., Martin, Remington's Pharmaceutical Sciences, 18th Ed. (1990, Mack Publishing Co., Easton, Pa. 18042) pages 1435-1712 that are herein incorporated by reference. The compositions may be prepared in liquid form, or may be in dried powder, such as lyophilised form.
It will be appreciated that pharmaceutical compositions provided according to the present invention may be administered by any means known in the art. Preferably, the pharmaceutical compositions for administration are administered by injection, orally, or by the pulmonary, or nasal route. The antisense molecules are more preferably delivered by intravenous, intra-arterial, intraperitoneal, intramuscular, or subcutaneous routes of administration.
Antisense Molecule Based Therapy
Also addressed by the present invention is the use of antisense molecules of the present invention, for manufacture of a medicament for modulation of a genetic disease.
The delivery of a therapeutically useful amount of antisense molecules may be achieved by methods previously published. For example, intracellular delivery of the antisense molecule may be via a composition comprising an admixture of the antisense molecule and an effective amount of a block copolymer. An example of this method is described in US patent application US 20040248833.
Other methods of delivery of antisense molecules to the nucleus are described in Mann C J et al., (2001) [“Antisense-induced exon skipping and the synthesis of dystrophin in the mdx mouse”. Proc., Natl. Acad. Science, 98(1) 42-47] and in Gebski et al., (2003). Human Molecular Genetics, 12(15): 1801-1811.
A method for introducing a nucleic acid molecule into a cell by way of an expression vector either as naked DNA or complexed to lipid carriers, is described in U.S. Pat. No. 6,806,084.
It may be desirable to deliver the antisense molecule in a colloidal dispersion system. Colloidal dispersion systems include macromolecule complexes, nanocapsules, microspheres, beads, and lipid-based systems including oil-in-water emulsions, micelles, mixed micelles, and liposomes or liposome formulations.
Liposomes are artificial membrane vesicles which are useful as delivery vehicles in vitro and in vivo. These formulations may have net cationic, anionic or neutral charge characteristics and are useful characteristics with in vitro, in vivo and ex vivo delivery methods. It has been shown that large unilamellar vesicles (LUV), which range in size from 0.2-4.0 .PHI.m can encapsulate a substantial percentage of an aqueous buffer containing large macromolecules. RNA and DNA can be encapsulated within the aqueous interior and be delivered to cells in a biologically active form (Fraley, et al., Trends Biochem. Sci., 6:77, 1981).
In order for a liposome to be an efficient gene transfer vehicle, the following characteristics should be present: (1) encapsulation of the antisense molecule of interest at high efficiency while not compromising their biological activity; (2) preferential and substantial binding to a target cell in comparison to non-target cells; (3) delivery of the aqueous contents of the vesicle to the target cell cytoplasm at high efficiency; and (4) accurate and effective expression of genetic information (Mannino, et al., Biotechniques, 6:682, 1988).
The composition of the liposome is usually a combination of phospholipids, particularly high-phase-transition-temperature phospholipids, usually in combination with steroids, especially cholesterol. Other phospholipids or other lipids may also be used. The physical characteristics of liposomes depend on pH, ionic strength, and the presence of divalent cations.
Alternatively, the antisense construct may be combined with other pharmaceutically acceptable carriers or diluents to produce a pharmaceutical composition. Suitable carriers and diluents include isotonic saline solutions, for example phosphate-buffered saline. The composition may be formulated for parenteral, intramuscular, intravenous, subcutaneous, intraocular, oral or transdermal administration.
The routes of administration described are intended only as a guide since a skilled practitioner will be able to determine readily the optimum route of administration and any dosage for any particular animal and condition.
The antisense molecules of the invention encompass any pharmaceutically acceptable salts, esters, or salts of such esters, or any other compound which, upon administration to an animal including a human, is capable of providing (directly or indirectly) the biologically active metabolite or residue thereof. Accordingly, for example, the disclosure is also drawn to prodrugs and pharmaceutically acceptable salts of the compounds of the invention, pharmaceutically acceptable salts of such pro-drugs, and other bioequivalents.
The term “pharmaceutically acceptable salts” refers to physiologically and pharmaceutically acceptable salts of the compounds of the invention: i.e., salts that retain the desired biological activity of the parent compound and do not impart undesired toxicological effects thereto.
For oligonucleotides, preferred examples of pharmaceutically acceptable salts include but are not limited to (a) salts formed with cations such as sodium, potassium, ammonium, magnesium, calcium, polyamines such as spermine and spermidine, etc.; (b) acid addition salts formed with inorganic acids, for example hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, nitric acid and the like; (c) salts formed with organic acids such as, for example, acetic acid, oxalic acid, tartaric acid, succinic acid, maleic acid, fumaric acid, gluconic acid, citric acid, malic acid, ascorbic acid, benzoic acid, tannic acid, palmitic acid, alginic acid, polyglutamic acid, naphthalenesulfonic acid, methanesulfonic acid, p-toluenesulfonic acid, naphthalenedisulfonic acid, polygalacturonic acid, and the like; and (d) salts formed from elemental anions such as chlorine, bromine, and iodine. The pharmaceutical compositions of the present invention may be administered in a number of ways depending upon whether local or systemic treatment is desired and upon the area to be treated. Administration may be topical (including ophthalmic and to mucous membranes including rectal delivery), 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, intra-arterial, subcutaneous, intraperitoneal or intramuscular injection or infusion; or intracranial, e.g., intrathecal or intraventricular, administration. Oligonucleotides with at least one 2′-O-methoxyethyl modification are believed to be particularly useful for oral administration.
The pharmaceutical formulations of the present invention, which may conveniently be presented in unit dosage form, may 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.
Kits of the Invention
The invention also provides kits for treatment of a patient with a genetic disease which kit comprises at least an antisense molecule, packaged in a suitable container, together with instructions for its use.
In a preferred embodiment, the kits will contain at least one antisense molecule as shown in Table 1A, or a cocktail of antisense molecules as shown in Table 1B. The kits may also contain peripheral reagents such as buffers, stabilizers, etc.
The contents of the kit can be lyophilized and the kit can additionally contain a suitable solvent for reconstitution of the lyophilized components. Individual components of the kit would be packaged in separate containers and, associated with such containers, can be a notice in the form prescribed by a governmental agency regulating the manufacture, use or sale of pharmaceuticals or biological products, which notice reflects approval by the agency of manufacture, use or sale for human administration.
When the components of the kit are provided in one or more liquid solutions, the liquid solution can be an aqueous solution, for example a sterile aqueous solution. For in vivo use, the expression construct may be formulated into a pharmaceutically acceptable syringeable composition. In this case the container means may itself be an inhalant, syringe, pipette, eye dropper, or other such like apparatus, from which the formulation may be applied to an affected area of the animal, such as the lungs, injected into an animal, or even applied to and mixed with the other components of the kit.
The components of the kit may also be provided in dried or lyophilized forms. When reagents or components are provided as a dried form, reconstitution generally is by the addition of a suitable solvent. It is envisioned that the solvent also may be provided in another container means. Irrespective of the number or type of containers, the kits of the invention also may comprise, or be packaged with, an instrument for assisting with the injection/administration or placement of the ultimate complex composition within the body of an animal. Such an instrument may be an inhalant, syringe, pipette, forceps, measured spoon, eye dropper or any such medically approved delivery vehicle.
Those of ordinary skill in the field should appreciate that applications of the above method has wide application for identifying antisense molecules suitable for use in the treatment of many other diseases.
EXAMPLES
The following Examples serve to more fully describe the manner of using the above-described invention, as well as to set forth the best modes contemplated for carrying out various aspects of the invention. It is understood that these Examples in no way serve to limit the true scope of this invention, but rather are presented for illustrative purposes. The references cited herein are expressly incorporated by reference.
Methods of molecular cloning, immunology and protein chemistry, which are not explicitly described in the following examples, are reported in the literature and are known by those skilled in the art. General texts that described conventional molecular biology, microbiology, and recombinant DNA techniques within the skill of the art, included, for example: Sambrook et al., Molecular Cloning: A Laboratory Manual, Second Edition, Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y. (1989); Glover ed., DNA Cloning: A Practical Approach, Volumes I and II, MRL Press, Ltd., Oxford, U.K. (1985); and Ausubel, F., Brent, R., Kingston, R. E., Moore, D. D., Seidman, J. G., Smith, J. A., Struhl, K. Current Protocols in Molecular Biology. Greene Publishing Associates/Wiley Intersciences, New York (2002).
Determining Induced Exon Skipping in Human Muscle Cells
Attempts by the inventors to develop a rational approach in antisense molecules design were not completely successful as there did not appear to be a consistent trend that could be applied to all exons. As such, the identification of the most effective and therefore most therapeutic antisense molecules compounds has been the result of empirical studies.
These empirical studies involved the use of computer programs to identify motifs potentially involved in the splicing process. Other computer programs were also used to identify regions of the pre-mRNA which may not have had extensive secondary structure and therefore potential sites for annealing of antisense molecules. Neither of these approaches proved completely reliable in designing antisense oligonucleotides for reliable and efficient induction of exon skipping.
Annealing sites on the human dystrophin pre-mRNA were selected for examination, initially based upon known or predicted motifs or regions involved in splicing. 2OMe antisense oligonucleotides were designed to be complementary to the target sequences under investigation and were synthesised on an Expedite 8909 Nucleic Acid Synthesiser. Upon completion of synthesis, the oligonucleotides were cleaved from the support column and de-protected in ammonium hydroxide before being desalted. The quality of the oligonucleotide synthesis was monitored by the intensity of the trityl signals upon each deprotection step during the synthesis as detected in the synthesis log. The concentration of the antisense oligonucleotide was estimated by measuring the absorbance of a diluted aliquot at 260 nm.
Specified amounts of the antisense molecules were then tested for their ability to induce exon skipping in an in vitro assay, as described below.
Briefly, normal primary myoblast cultures were prepared from human muscle biopsies obtained after informed consent. The cells were propagated and allowed to differentiate into myotubes using standard culturing techniques. The cells were then transfected with the antisense oligonucleotides by delivery of the oligonucleotides to the cells as cationic lipoplexes, mixtures of antisense molecules or cationic liposome preparations.
The cells were then allowed to grow for another 24 hours, after which total RNA was extracted and molecular analysis commenced. Reverse transcriptase amplification (RT-PCR) was undertaken to study the targeted regions of the dystrophin pre-mRNA or induced exonic re-arrangements.
For example, in the testing of an antisense molecule for inducing exon 19 skipping the RT-PCR test scanned several exons to detect involvement of any adjacent exons. For example, when inducing skipping of exon 19, RT-PCR was carried out with primers that amplified across exons 17 and 21. Amplifications of even larger products in this area (i.e. exons 13-26) were also carried out to ensure that there was minimal amplification bias for the shorter induced skipped transcript. Shorter or exon skipped products tend to be amplified more efficiently and may bias the estimated of the normal and induced transcript.
The sizes of the amplification reaction products were estimated on an agarose gel and compared against appropriate size standards. The final confirmation of identity of these products was carried out by direct DNA sequencing to establish that the correct or expected exon junctions have been maintained.
Once efficient exon skipping had been induced with one antisense molecule, subsequent overlapping antisense molecules may be synthesized and then evaluated in the assay as described above. Our definition of an efficient antisense molecule is one that induces strong and sustained exon skipping at transfection concentrations in the order of 300 nM or less. Most preferably, the oligonucleotide molecules of the present invention are able to induce skipping at levels of greater that 30% at a concentration of 100 nM.
Densitometry Methods
Densitometry analysis of the results of the exon skipping procedures was carried out, in order to determine which antisense molecules achieved the desired efficiency. Amplification products were fractionated on 2% agarose gels, stained with ethidium bromide and the images captured by a Chemi-Smart 3000 gel documentation system (Vilber Lourmat, Marne La Vallee). The bands were then analyzed using gel documentation system (Bio-Profil, Bio-1 D version 11.9, Vilber Lourmat, Marne La Vallee), according to the manufacturer's instructions.
Densitometry was carried out on the following antisense molecules:
FIG. 35
Exon 3 H3A(+30+60) & H3A(+61+85)
Exon 4 H4D(+14−11) & H4A(+11+40)
Exon 14 H14A(+32+61)
Exon 17 H17A(+10+35)
Exon 26 H26A(−07+19), H26A(+24+50) & H26A(+68+92)
Exon 36 H36A(−16+09) & H36A(+22+51)
FIG. 36
Exon 46 H46A(+81+109)
Exon 47 H47A(+01+29)
Exon 48 H48A(+01+28) & H48A(+40+67)
Exon 49 H49A(+45+70)
Antisense Oligonucleotides Directed at Exon 17
Antisense oligonucleotides directed at exon 17 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.
From Table 2 below, it can be seen that the effect of antisense molecules directed at the same site (the exon 17 acceptor splice site) can be very different, even though the binding location of the two antisense molecules are overlapping. H17A(−07+23) [SEQ ID NO:3], which anneals to the last 7 bases of intron 16 and the first 23 bases of exon 17, induces exon 17 skipping when delivered into the cell at a concentration of 25 nM. In contrast, the antisense molecule H17A(−12+18), which anneals to the last 12 bases of intron 16 and the first 18 bases of exon 17, and thus overlaps the location of binding of H17A(−07+23), was not able to induce exon skipping at all. Furthermore, H17A(−07+16), which anneals to the last 7 bases of intron 16 and the first 16 bases of exon 17 caused skipping of both exon 17 and 18 at 200 nM. Antisense molecule H17A(+61+86) [SEQ ID NO:4], which binds in an intra-exonic splicing enhancer motif of exon 17, is also able to induce good skipping. It can be seen that the ability of antisense molecules to induce exon skipping cannot be predicted simply from their binding location and must be determined through rigorous testing.







TABLE 2







Antisense molecule sequences tested to determine if they induce exon 17 skipping











Antisense




SEQ
Oligonucleotide




ID
name
Sequence
Ability to induce skipping













459
H17A(−12 +18)
GGU GAC AGC CUG UGA AAU CUG UGA GAA GUA
No Skipping


 


3
H17A(−07+23)
GUG GUG GUG ACA GCC UGU GAA AUC UGU GAG
Skipping at 25 nM


 


460
H17A(−07+16)
UGA CAG CCU GUG AAA UCU GUG AG
Skipping ex 17 + 18 at





200 nM


461
H17A(+10 +35)
AGU GAU GGC UGA GUG GUG GUG ACA GC
Skipping at 50 nM


 


462
H17A(+31+50)
ACA GUU GUC UGU GUU AGU GA
inconsistent skipping


 


4
H17A(+61 +86)
UGU UCC CUU GUG GUC ACC GUA GUU AC
Skipping at 50 nM


 


463
H17A(+144+163)
CAG AAU CCA CAG UAA UCU GC
skipping at 300 nM









This data shows that some particular antisense molecules induce efficient exon skipping while another antisense molecule, which targets a near-by or overlapping region, can be much less efficient. Titration studies show one molecule is able to induce targeted exon skipping at 20-25 nM while a less efficient antisense molecule might only induced exon skipping at concentrations of 300 nM and above. Therefore, we have shown that targeting of the antisense molecules to motifs involved in the splicing process plays a crucial role in the overall efficacy of that compound.
Efficacy refers to the ability to induce consistent skipping of a target exon. However, sometimes skipping of the target exons is consistently associated with a flanking exon. That is, we have found that the splicing of some exons is tightly linked. For example, in targeting exon 23 in the mouse model of muscular dystrophy with antisense molecules directed at the donor site of that exon, dystrophin transcripts missing exons 22 and 23 are frequently detected. As another example, when using an antisense molecule directed to exon 8 of the human dystrophin gene, many induced transcripts are missing both exons 8 and 9.
Antisense Oligonucleotides Directed at Exon 2
Antisense oligonucleotides directed at exon 2 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 3







Antisense molecule sequences tested to determine


if they induce exon 2 skipping











Antisense

Ability to


SEQ
Oligonucleotide

induce


ID
name
Sequence
skipping





75
H2A(−14+10)
UCU CUU UCA UCU AAA AUG CAA AAU
No Skipping


 


76
H2A(−1+23)
CUU UUG AAC AUC UUC UCU UUC AUC
No Skipping


 


77
H2A(+7+38)
UUU UGU GAA UGU UUU CUU UUG AAC AUC UUC UC
No Skipping


 


78
H2A(+16+39)
AUU UUG UGA AUG UUU UCU UUU GAA
No Skipping


 


79
H2A(+30+60)
UAG AAA AUU GUG CAU UUA CCC AUU UUG UGA A
No Skipping


 


80
H2D(+19−11)
ACC AUU CUU ACC UUA GAA AAU UGU GCA UUU
No Skipping


 


81
H2D(+03−21)
AAA GUA ACA AAC CAU UCU UAC CUU
No Skipping









Antisense Oligonucleotides Directed at Exon 3

Antisense oligonucleotides directed at exon 3 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.
Each used alone, antisense molecules H3A(+30+60) [SEQ ID NO: 31] and H3A(+61+85) [SEQ ID NO: 32] induce exon 3 skipping. However, in combination, the two molecules are even more effective at inducing skipping (FIG. 3), and are also able to induce skipping of exons 4 and 5 at 300 nM and 600 nM, a result not seen or predicted by the results of the use of each antisense molecule alone. Additional products above the induced transcript missing exon 3 arise from amplification from carry-over outer primers from the RT-PCR as well as heteroduplex formation.







TABLE 4







Antisense molecule sequences tested to determine if they induce exon 3 skipping











Antisense




SEQ
Oligonucleotide

Ability to induce


ID
name
Sequence
skipping





82
H3A(+14+38)
AGG UCA CUG AAG AGG UUC UCA AUA U
Moderate skipping to





10 nM


 


83
H3A(+20+40)
GUA GGU CAC UGA AGA GGU UCU
Strong skipping to





50 nM


 


84
H3A(+25+60)
AGG AGG CGU CUC CCA UCC UGU AGG UCA CUG AAG
weak skipping




AG



 


85
H3A(+45+65)
AGG UCU AGG AGG CGC CUC CCA
No skipping


 


86
H3A(+48+73)
CUU CGA GGA GGU CUA GGA GGC GCC UC
No Skipping


 


32
H3A(+61+85)
GCC CUG UCA GGC CUU CGA GGA GGU C
Skipping to 300 nM


 


87
H3D(+17−08)
uca cau acA GUU UUU GCC CUG UCA G
No skipping


 


88
H3D(+19−02)
UAC AGU UUU UGC CCU GUC AGG
No skipping


 


89
H3D(+14−10)
AAG UCA CAU ACA GUU UUU GCC CUG
No skipping


 


90
H3D(+12−07)
UCA CAU ACA GUU UUU GCC C
No skipping


 



Cocktails for exon 3




31 &
H3A(+30+60)
UAG GAG GCG CCU CCC AUC CUG UAG GUC ACU G
Excellent skipping to


32
H3A(+61+85)
G CCC UGU CAG GCC UUC GAG GAG GUC
100 nM, skipping to





10 nM.





Also taking out 4&5 to





300 nM


 


32 &
H3A(+61+85)
G CCC UGU CAG GCC UUC GAG GAG GUC
Very strong skipping to


464
H3A(+30+54)
GCG CCU CCC AUC CUG UAG GUC ACU G
50 nM


 


32 &
H3A(+61+85)
G CCC UGU CAG GCC UUC GAG GAG GUC
Very strong skipping to


84
H3A(+25+60)
AGG AGG CGU CUC CCA UCC UGU AGG UCA CUG AAG
50 nM




AG









Antisense Oligonucleotides Directed at Exon 4

Antisense oligonucleotides directed at exon 4 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. FIG. 4 shows skipping of exon 4 using a cocktail of H4A(+11+40) [SEQ ID NO: 33] and H4D(+14−11) [SEQ ID NO: 34].







TABLE 5







Antisense molecule sequences tested to determine if they induce exon 4 skipping











Antisense




SEQ
Oligonucleotide




ID
name
Sequence
Ability to induce skipping





91
H4A(−08+17)
GAU CCU UUU UCU UUU GGC UGA GAA C
Weak skipping down to 10 nM


 


92
H4A(+36+60)
CCG CAG UGC CUU GUU GAC AUU GUU C
Good skipping to 10 nM


 


93
H4D(+14−11)
GUA CUA CUU ACA UUA UUG UUC UGC A
Very poor skipping to 10 nM


 



Exon 4 Cocktails




33 &
H4A(+11+40)
UGU UCA GGG CAU GAA CUC UUG UGG AUC CUU
Excellent skipping (100% to


34
H4D(+14−11)
GUA CUA CUU ACA UUA UUG UUC UGC A
100 nM) and good skipping down





to 5 nM









Antisense Oligonucleotides Directed at Exon 5

Antisense oligonucleotides direct at exon 5 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. H5D(+26−05) would be regarded as a non-preferred antisense molecule as it failed to induce even low level skipping of exon 5. However, H5A(+35+65) [SEQ ID NO: 1], which presumably targets an exonic splicing enhancer was evaluated, found to be highly efficient at inducing skipping of that target exon, as shown in FIG. 5 and is regarded as the preferred compound for induced exon 5 skipping.







TABLE 6







Antisense molecule sequences tested to


determine if they induce exon 5 skipping











Antisense

Ability to


SEQ
Oligonucleotide

induce


ID
name
Sequence
skipping













1
H5A(+35+65)
AAA CCA AGA GUC AGU
Great




UUA UGA UUU CCA
skipping




UCU A
to 10 nM


 


94
H5D(+26−05)
CUU ACC UGC CAG
No skipping




UGG AGG AUU AUA UUC





CAA A









Antisense Oligonucleotides Directed at Exon 6

Antisense oligonucleotides directed at exon 6 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 7







Antisense molecule sequences tested to determine if they induce exon 6


skipping










SEQ
Antisense

Ability to induce


ID
Oligonucleotide name
Sequence
skipping













95
H6A(−09+17)
UUC AUU ACA UUU UUG ACC UAC AUG UG
faint to 600 nM


 


96
H6A(+32+57)
CUU UUC ACU GUU GGU UUG UUG CAA UC
skipping at 25 nM


 


97
KH9 6A(+66+94)
AAU UAC GAG UUG AUU GUC GGA CCC AGC UC
skipping at 25 nM


 


98
H6A(+69+96)
AUA AUU ACG AGU UGA UUG UCG GAC CCA G
skipping to 100 nM


 


99
H6A(+98+123)
GGU GAA GUU GAU UAC AUU AAC CUG UG
No skipping


 


100
H6D(+18−06)
UCU UAC CUA UGA CUA UGG AUG AGA
No skipping


 


101
H6D(+07−15)
CAG UAA UCU UCU UAC CUA UGA C
No skipping


 


102
H6D(+07−16)
UCA GUA AUC UUC UUA CCU AUG AC
No skipping


 


103
H6D(+04−20)
UGU CUC AGU AAU CUU CUU ACC UAU
No skipping









Antisense Oligonucleotides Directed at Exon 7

Antisense oligonucleotides directed at exon 7 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 8







Antisense molecule sequences tested to determine if they induce exon 7


skipping










SEQ
Antisense

Ability to induce


ID
Oligonucleotide name
Sequence
skipping













104
H7A(−07+15)
UCA AAU AGG UCU GGC CUA AAA C
no skipping


 


105
H7A(−03+18)
CCA GUC AAA UAG GUC UGG CCU A
no skipping


 


106
H7A(+41+63)
UGU UCC AGU CGU UGU GUG GCU GA
skipping 50 nM


 


73
H7A(+41+67)
UGC AUG UUC CAG UCG UUG UGU GGC UGA
skipping 25 nM


 


107
H7A(+47+74)
UGU UGA AUG CAU GUU CCA GUC GUU GUG U
skippking 25 nM but weak


 


72
H7A(+49+71)
UGA AUG CAU GUU CCA GUC GUU GU
good skipping to 25 nM









Antisense Oligonucleotides Directed at Exon 8

Antisense oligonucleotides directed at exon 8 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 6.







TABLE 9







Antisense molecule sequences tested to determine if they induce exon 8


skipping











Antisense




SEQ
Oligonucleotide




ID
name
Sequence
Ability to induce skipping













108
H8A(−10+20)
UGG AUA GGU GGU AUC AAC AUC UGU AAG CAC
Very weak skipping of 8 + 9 to





10 nM


 


109
H8A(−07+15)
GAU AGG UGG UAU CAA CAU CUG U
Very, very weak skipping of 8 + 9





to 10 nM


 


35
H8A(−06+24)
UAU CUG GAU AGG UGG UAU CAA CAU CUG UAA
Weak skipping of 8 + 9 to 10 nM


 


110
H8A(−04+18)
GAU AGG UGG UAU CAA CAU CUG U
works strongly to 40 nM


 


71
H8A(+42+66)
AAA CUU GGA AGA GUG AUG UGA UGU A
good skipping of 8 + 9 to 10 nM


 


70
H8A(+57+83)
GCU CAC UUG UUG AGG CAA AAC UUG GAA
good skipping of 8 + 9 at high





conc, down to 10 nM


 


111
H8A(+96+120)
GCC UUG GCA ACA UUU CCA CUU CCU G
Weak skipping of 8 + 9 to 300 nM


 


36
H8A(+134+158)
AUG UAA CUG AAA AUG UUC UUC UUU A
Weak skipping of 8 + 9 to 100 nM


 


112
H8D(+13−12)
UAC ACA CUU UAC CUG UUG AGA AUA G
Weak skipping of 8 + 9 to 50 nM


 



Exon 8





Cocktails




35 &
H8A(−06+24)
UAU CUG GAU AGG UGG UAU CAA CAU CUG UAA
Good skipping to 10 nM (8 + 9) but


36
H8A(+134+158)
AUG UAA CUG AAA AUG UUC UUC UUU A
also 8 on its own


 


35 &
H8A(−06+24)
UAU CUG GAU AGG UGG UAU CAA CAU CUG UAA
Good skipping to 10 nM (8 + 9) but


112
H8D(+13−12)
UAC ACA CUU UAC CUG UUG AGA AUA G
also 8 on its own


 


35 &
H8A(−06+24)
UAU CUG GAU AGG UGG UAU CAA CAU CUG UAA
Good skipping to 10 nM (8 + 9) but


70
H8A(+57+83)
GCU CAC UUG UUG AGG CAA AAC UUG GAA
also 8 on its own


 


35 &
H8A(−06+24)
UAU CUG GAU AGG UGG UAU CAA CAU CUG UAA
Good skipping to 10 nM (8 + 9) but


111
H8A(+96+120)
GCC UUG GCA ACA UUU CCA CUU CCU G
also 8 on its own









Antisense Oligonucleotides Directed at Exon 9

Antisense oligonucleotides directed at exon 9 were prepared and test for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 10







Antisense molecule sequences tested to


determine if they induce exon 9 skipping











Antisense

Ability to


SEQ
Oligonucleotide

induce


ID
name
Sequence
skipping





113
H9A(+154+184)
AGC AGC CUG UGU GUA
working




GGC AUA GCU CUU GAA
strongly to




U
100 nM


 


114
H9D(+26−04)
AGA CCU GUG AAG GAA
working




AUG GGC UCC GUG UAG
strongly to





200 nM









Antisense Oligonucleotides Directed at Exon 10

Antisense oligonucleotides directed at exon 10 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 7 for examples of a single antisense oligonucleotide molecule and cocktails which induce skipping of exon 10 and surrounding exons. Single antisense oligonucleotide molecule H10A(−05+16) [SEQ ID NO: 37] was able to induce skipping of exons 9-14, whilst the combination with H10A(+98+119) [SEQ ID NO: 38] was able to induce skipping of exon 10 alone and exons 9-12 (and some skipping of exons 10-12). The combination of H10A(−05+16) and H10A(+130+149) was able to induce skipping of exon 10 and exons 9-12.







TABLE 11







Antisense molecule sequences tested to determine if they induce exon


10 skipping










SEQ
Antisense




ID
Oligonucleotide name
Sequence
Ability to induce skipping





115
H10A(−09+16)
CAG GAG CUU CCA AAU GCU GCA CAA U
no skipping


 


116
H10A(+08+27)
UGA CUU GUC UUC AGG AGC UU
no skipping


 


117
H10A(+21 +42)
CAA UGA ACU GCC AAA UGA CUU G
Skipping at 100 nM


 


118
H10A(+27+51)
ACU CUC CAU CAA UGA ACU GCC AAA U
No Skipping


 


119
H10A(+55+79)
CUG UUU GAU AAC GGU CCA GGU UUA C
No Skipping


 


120
H10A(+80+103)
GCC ACG AUA AUA CUU CUU CUA AAG
No Skipping


 


121
H10D(+16−09)
UUA GUU UAC CUC AUG AGU AUG AAA C
No Skipping


 



Cocktails Exon 10




37 &
H10A(−05+16)
CAG GAG CUU CCA AAU GCU GCA
Strong skipping at 200 nM


38 
H10A(+98+119)
UCC UCA GCA GAA AGA AGC CAC G



 


37 &
H10A(−05+16)
CAG GAG CUU CCA AAU GCU GCA
Skipping at 200 nM


122
H10A(+130+149)
UUA GAA AUC UCU CCU UGU GC









Antisense Oligonucleotides Directed at Exon 11

Antisense oligonucleotides directed at exon 11 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 37.







TABLE 12







Antisense molecule sequences tested to determine if they induce exon


11 skipping











Antisense




SEQ
Oligonucleotide




ID
name
Sequence
Ability to induce skipping













123
H11A(−07+13)
CCA UCA UGU ACC CCU GAC AA
Skipping at 300 nM


 


124
H11A+(+134+157)
CCC UGA GGC AUU CCC AUC UUG AAU
Skipping at 100 nM


 


125
H11A(+20+45)
AUU ACC AAC CCG GCC CUG AUG GGC UG
skipping to 25 nM


 


126
H11A(+46+75)
UCC AAU CAG CUU ACU UCC CAA UUG UAG AAU
Strong skipping to 25 nM





hint at 2.5 nM


 


127
H11A(+50+75)
UCC AAU CAG CUU ACU UCC CAA UUG UA
Strong skipping to 10 nM





faint at 2.5 nM


 


52
H11A(+50+79)
CUG UUC CAA UCA GCU UAC UUC CCA AUU GUA
Strong skipping to 5 nM





faint at 2.5 nM


 


128
H11A(+80+105)
AGU UUC UUC AUC UUC UGA UAA UUU UC
Faint skipping to 25 nM


 


129
H11A(+106+135)
AUU UAG GAG AUU CAU CUG CUC UUG UAC UUC
Strong skipping to 25 nM





(20%)


 


130
H11A(+110+135)
AUU UAG GAG AUU CAU CUG CUC UUG UA
Strong skipping to 25 nM





(20%)


 


131
H11A(+110+139)
UUG AAU UUA GGA GAU UCA UCU GCU CUU GUA
Strong skipping to 25 nM





(20%)









Antisense Oligonucleotides Directed at Exon 12

Antisense oligonucleotides directed at exon 12 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 38.







TABLE 13







Antisense molecule sequences tested to determine if they induce exon


12 skipping










SEQ
Antisense




ID
Oligonucleotide name
Sequence
Ability to induce skipping













132
H12D(+06−16)
CAU AAG AUA CAC CUA CCU UAU G
No Skipping


 


2
H12A(+52+75)
UCU UCU GUU UUU GUU AGC CAG UCA
Strong skipping


 


53
H12A(+30+57)
CAG UCA UUC AAC UCU UUC AGU UUC UGA U
Strong skipping to 10 nM





faint at 2.5 nM


 


133
H12A(+60+87)
UUC CUU GUU CUU UCU UCU GUU UUU GUU A
Strong skipping to 25 nM





faint at 5 nM


 


134
H12A(+90+117)
AGA UCA GGU CCA AGA GGC UCU UCC UCC A
Strong skipping to 25 nM





(30%)


 


135
H12A(+120+147)
UGU UGU UGU ACU UGG CGU UUU AGG UCU U
Strong skipping to 25 nM





(30%)









Antisense Oligonucleotides Directed at Exon 13

Antisense oligonucleotides directed at exon 13 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 14







Antisense molecule sequences tested to determine


if they induce exon 13 skipping











Antisense

Ability to


SEQ
Oligonucleotide

induce


ID
name
Sequence
skipping





136
H13A(−12+12)
UUC UUG AAG CAC
No Skipping




CUG AAA GAU AAA









Antisense Oligonucleotides Directed at Exon 14

Antisense oligonucleotides directed at exon 14 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 8.







TABLE 15







Antisense molecule sequences tested to determine


if they induce exon 14 skipping











Antisense

Ability to


SEQ
Oligonucleotide

induce


ID
name
Sequence
skipping





137
H14A(+45 +73)
GAA GGA UGU CUU
Skipping




GUA AAA GAA CCC AGC
at 25 nM




GG









Antisense Oligionucleotides Directed at Exon 16

Antisense oligonucleotides directed at exon 16 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 16







Antisense molecule sequences tested to


determine if they induce exon 16 skipping











Antisense

Ability


SEQ
Oligonucleotide

to induce


ID
name
Sequence
skipping





138
H16A(−07+19)
CUA GAU CCG CUU
No skipping




UUA AAA CCU GUU AA



 


139
H16A(+09+31)
GCU UUU UCU UUU
No skipping




CUA GAU CCG CU



 


140
H16D(+18−07)
CAC UAA CCU GUG
No skipping




CUG UAC UCU UUU C









Antisense Oligionucleotides Directed at Exon 17

Antisense oligonucleotides directed at exon 17 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 64







Antisense molecule sequences tested to


determine if they induce exon 17 skipping











Antisense

Ability


SEQ
Oligonucleotide 

to induce


ID
name
Sequence
skipping





141
H17A(+48+78)
UGU GGU CAC CGU AGU
No




UAC UGU UUC CAU UCA A
skipping


 


142
H17A(+55+85)
GUU CCC UUG UGG UCA
Skipping




CCG UAG UUA CUG UUU C
to 100 nM









Antisense Oligionucleotides Directed at Exon 18

Antisense oligonucleotides directed at exon 18 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 9.







TABLE 17







Antisense molecule sequences tested to determine if they induce exon


18 skipping










SEQ
Antisense Oligonucleotide




ID
name
Sequence
Ability to induce skipping





143
H18A(−09+11)
CAA CAU CCU UCC UAA GAC UG
No skipping


 


144
H18A(+24+43)
GCG AGU AAU CCA GCU GUG AA
Inconsistent skipping of both





exon 17 + 18


 


145
H18A(+41 +70)
UUC AGG ACU CUG CAA CAG AGC UUC UGA
Skipping exons 17 + 18




GCG
300 nM


 


146
H18A(+83+108)
UUG UCU GUG AAG UUG CCU UCC UUC CG
Skipping exons 17 + 18





300 nM


 


147
H18D(+04−16)
UUA AUG CAU AAC CUA CAU UG
No skipping









Antisense Oligonucleotides Directed at Exon 19

Antisense oligonucleotides directed at exon 19 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 18







Antisense molecule sequences tested to


determine if they induce exon 19 skipping











Antisense

Ability


SEQ
Oligonucleotide 

to induce


ID
name
Sequence
skipping





148
H19A(+19+48)
GGC AUC UUG CAG
skipping




UUU UCU GAA CUU CUC
to 25 nM




AGC



 


149
H19A(+27+54)
UCU GCU GGC AUC
skipping




UUG CAG UUU UCU GAA C
to 25 nM


 


150
H19D(+3−17)
UCA ACU CGU
skipping




GUA AUU ACC GU









Antisense Oligonucleotides Directed at Exon 20

Antisense oligonucleotides directed at exon 20 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 19







Antisense molecule sequences tested to determine


if they induce exon 20 skipping











Antisense

Ability


SEQ
Oligonucleotide

to induce


ID
name
Sequence
skipping





151
H20A(+23+47)
GUU CAG UUG UUC
faint shadow




UGA GGC UUG UUU G
at 600 nM


 


152
H20A(+140+164)
AGU AGU UGU CAU
no skipping




CUG CUC CAA UUG U









Antisense Oligonucleotides Directed at Exon 23

Antisense oligonucleotides directed at exon 23 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. Antisense oligonucleotides directed at exon 23 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. H23(+69+98)-SNP contains a single nucleotide polymorphism (SNP) that has been previously documented.







TABLE 65







Antisense molecule sequences tested to


determine if they induce exon 23 skipping











Antisense

Ability to


SEQ
Oligonucleotide 

induce


ID
name
Sequence
skipping





153
H23(+69+98)-SNP
CGG CUA AUU UCA GAG
skipping




GGC GCU UUC UUU GAC
to 25 nM









Antisense Oligonucleotides Directed at Exon 24

Antisense oligonucleotides directed at exon 24 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 20







Antisense molecule sequences tested to


determine if they induce exon 24 skipping.











Antisense

Ability to


SEQ
Oligonucleotide

induce


ID
name
Sequence
skipping





8
H24A(+51+73)
CAA GGG CAG GCC
Strong




AUU CCU CCU UC
skipping





to 25 nM









Antisense Oligonucleotides Directed at Exon 25

Antisense oligonucleotides directed at exon 25 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. Oligonucleotide H25A(+95+119)-DupA is a patient specific antisense molecule.







TABLE 21







Antisense molecule sequences tested to determine if they induce exon


25 skipping.










SEQ
Antisense




ID
Oligonucleotide name
Sequence
Ability to induce skipping





154
H25A(+10+33)
UGG GCU GAA UUG UCU GAA UAU CAC
strong at 25 nM but did not





reduce the full length





product


 


155
H25D(+06−14)
GAG AUU GUC UAU ACC UGU UG
very strong at 25 nM


 


156
H25A(+10+38)
AGA CUG GGC UGA AUU GUC UGA AUA UCA
Strong skipping at 5 nM faint




CU
2.5 nM


 


157
H25A(+95+119)-DupA*
UUG AGU UCU GUU CUC AAG UCU CGA AG
Strong skipping at 25 nM





faint 5 nM (patient specific)


 


158
H25D(+13−14)
GAG AUU GUC UAU ACC UGU UGG CAC AUG
Strong skipping at 10 nM









Antisense Oligonucleotides Directed at Exon 26

Antisense oligonucleotides directed at exon 26 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 10.







TABLE 22







Antisense molecule sequences tested to determine if they induce exon


26 skipping.











Antisense

Ability to induce


SEQ
Oligonucleotide name
Sequence
skipping













159
H26A(−16+09)
GGC AUA GAC CUU CCA CAA AAC AAA C
Faint skipping 600 nM





&300 nM


 


160
H26A(−7+23)
AAG GCC UCC UUU CUG GCA UAG ACC UUC
Faint at 600, 300 nM,




CAC
multiple exons 26-29 or





27-30


 


161
H26A(−03+27)
CUU CAA GGC CUC CUU UCU GGC AUA GAC
Faint at 600, 300 nM,




CUU
multiple exons 26-29 or





27-30


 


162
H26A(+5+35)
AAC CUC CCU UCA AGG CCU CCU UUC UGG
No skipping




CAU


 


40
H26A(+24+50)
CUU ACA GUU UUC UCC AAA CCU CCC UUC
Faint at 600, 300 nM,





multiple exons 26-29 or





27-30


 


163
H26D(+06−19)
UUU CUU UUU UUU UUU UUA CCU UCA U
Faint at 600, multiple





exons 26-29 or 27-30


 


164
H26D(+21−04)
UUA CCU UCA UCU CUU CAA CUG CUU U
multiple exons 26-29 or





27-30


 


165
H26D(+10−10)
UUU UUU UUA CCU UCA UCU CU
Not skipping 26 other





bands



Exon 26 cocktails


39,
H26A(−07+19)
CCU CCU UUC UGG CAU AGA CCU UCC AC
strong skipping down to


40 &
H26A(+24+50)
CUU ACA GUU UUC UCC AAA CCU CCC UUC
25 nM


41
H26A(+68+92)
UGU GUC AUC CAU UCG UGC AUC UCU G









Antisense Oligonucleotides Directed at Exon 31

Antisense oligonucleotides directed at exon 31 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 23







Antisense molecule sequences tested to determine if they induce exon


31 skipping










SEQ
Antisense

Ability to induce


ID
Oligonucleotide name
Sequence
skipping













166
H31D(+12−18)
UUC UGA AAU UUC AUA UAC CUG UGC AAC AUC
skipping to 100 nM


 


167
H31D(+08−22)
UAG UUU CUG AAA UAA CAU AUA CCU GUG CAA
skipping to 100 nM


 


168
H31D(+06−24)
CUU AGU UUC UGA AAU AAC AUA UAC CUG UGC
skipping to 100 nM


 


169
H31D(+02−22)
UAG UUU CUG AAA UAA CAU AUA CCU
skipping to 100 nM


 


170
H31D(+01−25)
CCU UAG UUU CUG AAA UAA CAU AUA CC
strong skipping at





300 nM









Antisense Oligonucleotides Directed at Exon 32

Antisense oligonucleotides directed at exon 32 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 24







Antisense molecule sequences tested to


determine if they induce exon 32 skipping











Antisense

Ability to


SEQ
Oligonucleotide

induce


ID
name
Sequence
skipping





171
H32A(+49+78)
ACU UUC UUG UAG ACG
skipping




CUG CUC AAA AUU GGC
to 100 nM









Antisense Oligonucleotides Directed at Exon 34

Antisense oligonucleotides directed at exon 34 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 25







Antisense molecule sequences tested to determine if they induce exon


34 skipping











Antisense

Ability to induce


SEQ ID
Oligonucleotide name
Sequence
skipping













172
H34A(+36+59)
UUU CGC AUC UUA CGG GAC AAU UUC
skipping to 200 nM


 


173
H34A(+41+70)
CAU UCA UUU CCU UUC GCA UCU UAC GGG ACA
skipping to 200 nM


 


174
H34A(+43+72)
GAC AUU CAU UUC CUU UCG CAU CUU ACG GGA
skipping to 100 nM


 


175
H34A(+51+83)
UCU GUC AAG ACA UUC AUU UCC UUU CGC AUC
skipping to 200 nM


 


176
H34A(+91+120)
UGA UCU CUU UGU CAA UUC CAU AUC UGU AGC
skipping to 100 nM


 


177
H34A(+92+121)
CUG AUC UCU UUG UCA AUU CCA UAU CUG UGG
skipping to 100 nM


 


178
H34A(+95+120)
UGA UCU CUU UGU CAA UUC CAU AUC UG
Faint to 25 nM


 


179
H34A(+95+124)
CUG CUG AUC UCU UUG UCA AUU CCA UAU CUG
skipping to 100 nM









Antisense Oligonucleotides Directed at Exon 35

Antisense oligonucleotides directed at exon 35 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 26







Antisense molecule sequences tested to


determine if they induce exon 35 skipping











Antisense

Ability to


SEQ
Oligonucleotide

induce


ID
name
Sequence
skipping





180
H35A(+14+43)
UCU UCA GGU GCA CCU
skipping




UCU GUU UCU CAA UCU
to 100 nM


 


181
H35A(+24+53)
UCU GUG AUA CUC UUC
skipping




AGG UGC ACC UUC UGU
to 100 nM









Antisense Oligonucleotides Directed at Exon 36

Antisense oligonucleotides directed at exon 36 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 11.







TABLE 27







Antisense molecule sequences tested to determine if they induce exon


36 skipping










SEQ
Antisense

Ability to induce


ID
Oligonucleotide name
Sequence
skipping













42
H36A(−16+09)
CUG GUA UUC CUU AAU UGU ACA GAG A
no skipping


 


182
H36A(−01+19)
CCA UGU GUU UCU GGU AUU CC
very faint skipping 300 nM


 


183
H36A(+10+39)
CAC AUU CUG GUC AAA AGU UUC CAU GUG UUU
Skipping to 25 nM


 


43
H36A(+22+51)
UGU GAU GUG GUC CAC AUU CUG GUC AAA AGU
Skipping at 100 nM


 


184
H36A(+27+51)
UGU GAU GUG GUC CAC AUU CUG GUC A
Skipping at 100 nM


 


185
H36A(+27+56)
CAC UUU GUG AUG UGG UCC ACA UUC UGG UCA
Skipping at 300 nM


 


186
H36A(+32+61)
UGA UCC ACU UUG UGA UGU GGU CCA CAU UCU
Skipping to 25 nM


 


187
H36A(+59+78)
AAG UGU GUC AGC CUG AAU GA
very weak skipping


 


188
H36A(+65+94)
UCU CUG AUU CAU CCA AAA GUG UGU CAG CCU
100% skipping at 600 nM,





skipoping to 25 nM


 


189
H36A(+80+109)
GCU GGG GUU UCU UUU UCU CUG AUU CAU CCA
100% skipping at 600 nM,





skipoping to 25 nM


 


190
H36D(+15−10)
UAU UUG CUA CCU UAA GCA CGU CUU C
very weak skipping



Exon 36 cocktails


42 &
H36A(−16+09)
CUG GUA UUC CUU AAU UGU ACA GAG A
good skipping down to


43
H36A(+22+51)
UGU GAU GUG GUC CAC AUU CUG GUC AAA AGU
25 nM









Antisense Oligonucleotides Directed at Exon 38

Antisense oligonucleotides directed at exon 38 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 28







Antisense molecule sequences tested to determine if they induce exon


38 skipping











Antisense Oligonucleotide

Ability to induce


SEQ ID
name
Sequence
skipping





191
H38A(−21−01)
CUA AAA AAA AAG AUA GUG CUA
skipping to 25 nM


 


192
H38A(−12+14)
AAA GGA AUG GAG GCC UAA AAA AAA AG
skipping to 25 nM


 


193
H38D(+14−11)
AAC CAA UUU ACC AUA UCU UUA UUG A
skipping to 25 nM









Antisense Oligonucleotides Directed at Exon 39

Antisense oligonucleotides directed at exon 39 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 29







Antisense molecule sequences tested to determine if they induce exon


39 skipping










SEQ
Antisense

Ability to induce


ID
Oligonucleotide name
Sequence
skipping













194
H39A(−07+23)
ACA GUA CCA UCA UUG UCU UCA UUC UGA UC
skipping to 600 nM


 


195
H39A(−07+23)
ACA GUA CCC UCA UUG UCU UCA UUC UGA UC
skipping to 600 nM


 


196
H39A(+58+87)
CUC UCG CUU UCU CUC AUC UGU GAU UCU UUG
skipping to 100 nM


 


197
H39A(+60+89)
UCC UCU CGC UUU CUC UCA UCU GUG AUU CUU
skipping to 100 nM


 


198
H39A(+102+126)
UAU GUU UUG UCU GUA ACA GCU GCU G
skipping to 600 nM









Antisense Oligonucleotides Directed at Exon 41

Antisense oligonucleotides directed at exon 41 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 30







Antisense molecule sequences tested to determine if they induce exon


41 skipping










SEQ
Antisense

Ability to induce


ID
Oligonucleotide name
Sequence
skipping













199
H41A(−15+5)
AUU UCC UAU UGA GCA AAA CC
Skipping down to 200 nM


 


200
H41A(+66+90)
CAU UGC GGC CCC AUC CUC AGA CAA G
Skipping down to 100 nM


 


201
H41A(+92+120)
GCU GAG CUG GAU CUG AGU UGG CUC CAC
Skipping down to 10 nM




UG


 


202
H41A(+143+171)
GUU GAG UCU UCG AAA CUG AGC AAA UUU GC
No visible skipping


 


203
H41D(+5−15)
CCA GUA ACA ACU CAC AAU UU
Skipping down to 200 nM









Antisense Oligonucleotides Directed at Exon 42

Antisense oligonucleotides directed at exon 42 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 31







Antisense molecule sequences tested to


determine if they induce exon 20 skipping











Antisense





Oligonucleotide

Ability to


SEQ
name

induce


ID
Exon 42
Sequence
skipping





204
H42D(+18−02)
ACC UUC AGA GAC
strong




UCC UCU UGC
skipping









Antisense Oligonucleotides Directed at Exon 43

Antisense oligonucleotides directed at exon 43 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 12.







TABLE 32







Antisense molecule sequences tested to determine if they induce exon


20 skipping











Antisense




SEQ
Oligonucleotide name

Ability to induce


ID
Exon 43
Sequence
skipping













205
H43A(+83+110)
UCC UGU AGC UUC ACC CUU UCC ACA GGC G
No skipping


 


9
H43A(+92+117)
GAG AGC UUC CUG UAG CUU CAC CCU UU
Skipping at 10 nM


 


206
H43A(+101+130)
AAU CA GCU GGG AGA GAG CUU CCU GUA GCU
No skipping


 


207
H43D(+08−12)
UGU GUU ACC UAC CCU UGU CG
Skipping down to 200 nM


 


208
H43A(−09+18)
UAG ACU AUC UUU UAU AUU CUG UAA UAU
Faint skipping to 25 nM


 


209
H43A(+89+117)
GAG AGC UUC CUG UAG CUU CAC CCU UUC CA
Strong skipping at 25 nM





faint 2.5 nM


 


210
H43A(+81+111)
UUC CUG UAG CUU CAC CCU UUC CAC AGG CGU U
Strong skipping at 50 nM





faint 2.5 nM


 


211
H43A(+92+114)
AGC UUC CUG UAG CUU CAC CCU UU
Faint skipping to 2.5 nM


 


74
H43A(+92+120)
GGA GAG AGC UUC CUG UAG CUU CAC CCU UU
Strong skipping at 10 nM





faint 5 nM


 


212
H43A(+95+117)
GAG AGC UUC CUG UAG CUU CAC CC
Strong skipping at 25 nM





faint 10 nM









Antisense Oligonucleotides Directed at Exon 44

Antisense oligonucleotides directed at exon 44 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 13 and FIG. 39.







TABLE 33







Antisense molecule sequences tested to determine if they induce exon


44 skipping











Antisense





Oligonucleotide name

Ability to induce


SEQ
Exon 44
Sequence
skipping













213
H44A(−13+13)
UCU GUC AAA UCG CCU GCA GGU AAA AG



 


214
H44A(−06+24)
UUC UCA ACA GAU CUG UCA AAU CGC CUG CAG
No skipping


 


215
H44A(+44+68)
GCC ACU GAU UAA AUA UCU UUA UAU C
Skipping at 100 nM


 


216
H44A(+46+75)
UCU GUU AGC CAC UGA UUA AAU AUC UUU AUA
Skipping at 50 nM


 


217
H44A(+61+84)
UGU UCA GCU UCU GUU AGC CAC UGA
Skipping at 100 nM


 


218
H44A(+61+91)
GAG AAA CUG UUC AGC UUC UGU UAG CCA CUG A
Skipping at 25 nM


 


10
H44A(+65+90)
UGU UCA GCU UCU GUU AGC CAC UGA
Skipping at 10 nM


 


219
H44A(+68+98)
UCU UUC UGA GAA ACU GUU CAG CUU CUG UUA G
weak at 50 nM


 


220
H44A(−09+17)
CAG AUC UGU CAA AUC GCC UGC AGG UA
Faint skipping to 10 nM


 


68
H44A(−06+20)
CAA CAG AUC UGU CAA AUC GCC UGC AG
Faint skipping to 2.5 nM


 


221
H44A(+56+88)
AAA CUG UUC AGC UUC UGU UAG CCA CUG AUU
Strong skipping at 5 nM




AAA
faint 2.5 nM


 


54
H44A(+59+85)
CUG UUC AGC UUC UGU UAG CCA CUG AUU
Strong skipping at 5 nM


 


222
H44A(+59+89)
GAA ACU GUU CAG CUU CUG UUA GCC ACU GAU U
Faint skipping to 10 nM


 


223
H44A(+61+88)
AAA CUG UUC AGC UUC UGU UAG CCA CUG A
Faint skipping to 25 nM


 


224
H44A(+65+92)
UGA GAA ACU GUU CAG CUU CUG UUA GCC A
Faint skipping to 25 nM


 


225
H44A(+64+95)
UUC UGA GAA ACU GUU CAG CUU CUG UUA GCCA C
Faint skipping to 25 nM


 


226
H44A(+70+95)
UUC UGA GAA ACU GUU CAG CUU CUG UU
Faint skipping to 50 nM









Antisense Oligonucleotides Directed at Exon 45

Antisense oligonucleotides directed at exon 45 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 14 and FIG. 40.







TABLE 34







Antisense molecule sequences tested to determine if they induce exon


45 skipping











Antisense




SEQ
Oligonucleotide name

Ability to induce


ID
Exon 45
Sequence
skipping













227
H45A(−14+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA
Generates multiple bands




AG


 


228
H45A(−10+20)
CCA AUG CCA UCC UGG AGU UCC UGU AAG AUA
Skipping at 10 nM


 


229
H45A(−09+30)
UUG CCG CUG CCC AAU GCC AUC CUG GAG UUC
No Skipping




CUG UAA GAU


 


11
H45A (−09+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA
Skipping at 10 nM (100%




AGA U
skipping at 25 nM)


 


230
H45A(−08+19)
CAA UGC CAU CCU GGA GUU CCU GUA AGA
Skipping at 50 nM


 


231
HM45A(−07+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA
Skipping at 25 nM




AG


 


232
H45A(+09+34)
CAG UUU GCC GCU GCC CAA UGC CAU CC
No Skipping


 


233
H45A(+41+64)
CUU CCC CAG UUG CAU UCA AUG UUC
No Skipping


 


234
H45A(+76+98)
CUG GCA UCU GUU UUU GAG GAU UG
No Skipping


 


235
H45D(+02−18)
UUA GAU CUG UCG CCC UAC CU
No Skipping


 


236
H45A(−14+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA




AGA UAC CAA


 


237
H45A(−12+22)
GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA
Strong skipping at 5 nM




UAC C
faint 2.5 nM


 


238
H45A(−12+13)
CAU CCU GGA GUU CCU GUA AGA UAC C
No skipping


 


66
H45A(−12+16)
UGC CAU CCU GGA GUU CCU GUA AGA UAC C
Strong skipping at 25 nM





faint 5 nM


 


65
H45A(−09+16)
UGC CAU CCU GGA GUU CCU GUA AGA U
skipping to 10 nM


 


64
H45A(−09+19)
CAA UGC CAU CCU GGA GUU CCU GUA AGA U
Strong skipping at 25 nM





faint 2.5 nM


 


239
H45A(−09+22)
GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA U
Strong skipping at 10 nM





faint 5 nM


 


240
H45A(−09+30)
UUG CCG CUG CCC AAU GCC AUC CUG GAG UUC
Strong skipping at 5 nM




CUG UAA GAU
faint 2.5 nM


 


241
HM45A(−07+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA
Strong skipping at 2.5 nM




AG


 


242
H45A(−06+22)
GCC CAA UGC CAU CCU GGA GUU CCU GUA A
Strong skipping at 5 nM





faint 2.5 nM


 


243
H45A(−06+28)
GCC GCU GCC CAA UGC CAU CCU GGA GUU CCU
Strong skipping at 2.5 nM




GUA A


 


63
H45A(−03+19)
CAA UGC CAU CCU GGA GUU CCU G
Strong skipping at 5 nM





faint 2.5 nM


 


244
H45A(−03+22)
GCC CAA UGC CAU CCU GGA GUU CCU G
Strong skipping at 10 nM





faint 2.5 nM


 


55
H45A(−03+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU G
Strong skipping at 2.5 nM


 


245
H45A(−03+28)
GCC GCU GCC CAA UGC CAU CCU GGA GUU CCU G
Strong skipping at 10 nM





faint 2.5 nM


 


246
H45D(+10−19)
AUU AGA UCU GUC GCC CUA CCU CUU UUU UC
No skipping


 


247
H45D(+16−11)
UGU CGC CCU ACC UCU UUU UUC UGU CUG
No skipping


 


61
H45A(−06+25)
GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA A
strong skipping at 2.5 nM


 


62
H45A(−12+19)
CAA UGC CAU CCU GGA GUU CCU GUA AGA UAC C
strong skipping at 25 nM









Antisense Oligonucleotides Directed at Exon 46

Antisense oligonucleotides directed at exon 46 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 15 and FIG. 44.







TABLE 35







Antisense molecule sequences tested to determine if they induce exon 46 skipping











Antisense





Oligonucleotide



name

Ability to induce


SEQ
Exon 46
Sequence
skipping













248
H46A(−05+19)
AUU CUU UUG UUC UUC UAG CCU GGA
No skipping


 


249
H46A(+16+42)
UCU CUU UGA AAU UCU GAC AAG AUA UUC
skipping to 25 nM, other





bands


 


250
H46A(+27+44)
UUA AAU CUC UUU GAA AUU CU
No skipping


 


251
H46A(+35+60)
AAA ACA AAU UCA UUU AAA UCU CUU UG
very faint skipping to 50 nM


 


252
H46A(+56+77)
CUG CUU CCU CCA ACC AUA AAA C
No skipping


 


253
H46A(+63+87)
GCA AUG UUA UCU GCU UCC UCC AAC C
No skipping


 


12
H46A(+81+109)
UCC AGG UUC AAG UGG GAU ACU AGC AAU GU
strong skipping at 25 nM


 


254
H46A(+83+103)
UUC AAG UGG GAU ACU AGC AAU
skipping at 25 nM


 


255
H46A(+90+109)
UCC AGG UUC AAG UGG GAU AC
no skipping


 


256
H46A(+91+118)
CUG CUC UUU UCC AGG UUC AAG UGG GAU A
strong skipping at 25 nM


 


257
H46A(+95+122)
GUU GCU GCU CUU UUC CAG GUU CAA GUG G
strong skipping at 25 nM


 


258
H46A(+101+128)
CUU UUA GUU GCU GCU CUU UUC CAG GUU C
strong skipping at 25 nM


 


259
H46A(+113+136)
AAG CUU UUC UUU UAG UUG CUG CUC
skipping at 100 nM


 


260
H46A(+115+134)
GCU UUU CUU UUA GUU GCU GC
skipping at 100 nM


 


261
H46A(+116+145)
GAC UUG CUC AAG CUU UUC UUU UAG UUG CUG
strong skipping at 25 nM


 


262
H46D(+02−18)
UUC AGA AAA UAA AAU UAC CU
no skipping


 


56
H46A(+93+122)
GUU GCU GCU CUU UUC CAG GUU CAA GUG GGA
100% skipping at 25 nM





strong at 5 nM


 


263
H46A(+95+124)
UAG UUG CUG CUC UUU UCC AGG UUC AAG UGG
100% skipping at 25 nM









Antisense Oligonucleotide Cocktails Directed at Exons 44 to 46

Antisense oligonucleotide cocktails directed at exons 44 to 46 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 36







Antisense molecule sequence cocktails that induce exon 44 to 45 skipping










SEQ
Antisense Oligonucleotide

Ability to


ID
name
Sequence
induce skipping






Cocktails for skipping 44 +





45


10 &
H44A(+65 +90)
AGA AAC UGU UCA GCU UCU GUU AGC CA
Skipping at 25 nM


228
H45A(−10 +20)
CCA AUG CCA UCC UGG AGU UCC UGU AAG AUA


 



Cocktails for skipping exons



45 and 46


228 &
H45A(−10 +20)
CCA AUG CCA UCC UGG AGU UCC UGU AAG AUA
Skipping at 25 nM


256
H46A(+91 +118)
CUG CUC UUU UCC AGG UUC AGG UGG GAU A


 


228 &
H45A(−10 +20)
CCA AUG CCA UCC UGG AGU UCC UGU AAG AUA
Skipping at 25 nM


264
H46A(+107 +137)
CAA GCU UUU CUU UUA GUU GCU GCU CUU UUC C


 



Cocktail for skipping exon



44/45/46


228,
H45A(−10 +20)
CCA AUG CCA UCC UGG AGU UCC UGU AAG AUA
Skipping at 25 nM


10 &
H44A(+65 +90)
AGA AAC UGU UCA GCU UCU GUU AGC CA


256
H46A(+91 +118)
CUG CUC UUU UCC AGG UUC AGG UGG GAU A









Antisense Oligonucleotides Directed at Exon 47

Antisense oligonucleotides directed at exon 47 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 16.







TABLE 37







Antisense molecule sequences tested to determine if they induce exon 47 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 47
Sequence
skipping













265
H47A(−07+19)
GCA ACU CUU CCA CCA GUA ACU GAA AC
Skipping at 100 nM


 


13
H47A(+01+29)
UGG CGC AGG GGC AAC UCU UCC ACC AGU AA
strong skipping at 25 nM


 


266
H47A(+44+70)
GCA CGG GUC CUC CAG UUU CAU UUA AUU
Skipping at 600 nM


 


267
H47A(+68+92)
GGG CUU AUG GGA GCA CUU ACA AGC A
No skipping


 


268
H47A(+73+103)
CUU GCU CUU CUG GGC UUA UGG GAG CAC UUA C
No skipping


 


269
H47A(+76+103)
CUU GCU CUU CUG GGC UUA UGG GAG CAC U
Faint skipping at 200 nM,





full length product not





reduced


 


270
H47D(+17−10)
AAU GUC UAA CCU UUA UCC ACU GGA GAU
No skipping









Antisense Oligonucleotides Directed at Exon 48

Antisense oligonucleotides directed at exon 48 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 17.







TABLE 38







Antisense molecule sequences tested to determine if they induce exon 48 skipping











Antisense




SEQ
Oligonucleotide

Ability to induce


ID
name
Sequence
skipping














Exon 48




271
H48A(−09+21)
CUC AGG UAA AGC UCU GGA AAC CUG AAA GGA
No skipping


 


272
H48A(−08+19)
CAG GUA AAG CUC UGG AAA CCU GAA AGG
No skipping


 


273
H48A(−07+23)
UUC UCA GGU AAA GCU CUG GAA ACC UGA AAG
Skipping at 600, 300 nM


 


274
H48A(−05+25)
GUU UCU CAG GUA AAG CUC UGG AAA CCU GAA
No skipping


 


44
H48A(+01+28)
CUU GUU UCU CAG GUA AAG CUC UGG AAA C
faint to 50 nM


 


275
H48A(+07+33)
UUC UCC UUG UUU CUC AGG UAA AGC UCU
faint to 50 nM


 


45
H48A(+40+67)
CAA GCU GCC CAA GGU CUU UUA UUU GAG C
No skipping (sporadic)


 


276
H48A(+75+100)
UUA ACU GCU CUU CAA GGU CUU CAA GC
faint to 1000 nM


 


277
H48A(+96+122)
GAU AAC CAC AGC AGC AGA UGA UUU AAC
No skipping


 


278
H48D(+17−10)
AGU UCC CUA CCU GAA CGU CAA AUG GUC
No skipping


 


279
H48D(+16−09)
GUU CCC UAC CUG AAC GUC AAA UGG U
No skipping


 



Cocktail 48


44 &
H48A(+01+28)
CUU GUU UCU CAG GUA AAG CUC UGG AAA C
Strong skipping at 25 nM


45
H48A(+40+67)
CAA GCU GCC CAA GGU CUU UUA UUU GAG C









Antisense Oligonucleotides Directed at Exon 49

Antisense oligonucleotides directed at exon 49 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 18.







TABLE 39







Antisense molecule sequences tested to determine if they induce exon


49 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 49
Sequence
skipping













280
H49A(−07+19)
GAA CUG CUA UUU CAG UUU CCU GGG GA
Skipping to 100 nM


 


281
H49A(+22+47)
AUC UCU UCC ACA UCC GGU UGU UUA GC
Skipping to 25 nM


 


14
H49A(+45+70)
ACA AAU GCU GCC CUU UAG ACA AAA UC
Skipping to 25 nM


 


282
H49D(+18−08)
UUC AUU ACC UUC ACU GGC UGA GUG GC
Skipping to 100 nM









Antisense Oligonucleotides Directed at Exon 50

Antisense oligonucleotides directed at exon 50 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIGS. 19 and 33.







TABLE 40







Antisense molecule sequences tested to determine if they induce exon 50 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 50
Sequence
skipping













283
H50A(−07+20)
CUC AGA UCU UCU AAC UUC CUC UUU AAC
Faint skipping 25 nM


 


284
H50A(−02+27)
CUC AGA GCU CAG AUC UUC UAA CUU CCU CU
faint skipping 100 nM


 


285
H50A(+10+36)
CGC CUU CCA CUC AGA GCU CAG AUC UUC
skipping faintly to 25


 


286
H50A(+35+61)
UCA GCU CUU GAA GUA AAC GGU UUA CCG
strong skipping to 25 nM


 


287
H50A(+42+68)
UUU GCC CUC AGC UCU UGA AGU AAA CGG
reasonable skipping to 25 nM


 


15
H50A(+48+74)
GGC UGC UUU GCC CUC AGC UCU UGA AGU
strong skipping at 25 nM


 


288
H50A(+63+88)
CAG GAG CUA GGU CAG GCU GCU UUG CC
strong skipping to 25 nM


 


289
H50A(+81+105)
UCC AAU AGU GGU CAG UCC AGG AGC U


 


290
H50D(−01−27)
AAA GAG AAU GGG AUC CAG UAU ACU UAC
faint skipping 100 nM


 


291
H50D(−15−41)
AAA UAG CUA GAG CCA AAG AGA AUG GGA
No skipping


 


292
H50A(+42+74)
GGC UGC UUU GCC CUC AGC UCU UGA AGU AAA
Strong skipping to 10 nM




CGG
faint at 5 nM


 


293
H50A(+46+75)
AGG CUG CUU UGC CCU CAG CUC UUG AAG UAA
Strong skipping to 25 nM





faint at 10 nM


 


294
H50A(+48+78)
GUC AGG CUG CUU UGC CCU CAG CUC UUG AAG U
Strong skipping to 10 nM





faint at 2.5 nM


 


295
H50A(+51+80)
AGG UCA GGC UGC UUU GCC CUC AGC UCU UGA
Strong skipping to 25 nM





faint at 2.5 nM


 


296
Hint49(−72−46)
AAG AUA AUU CAU GAA CAU CUU AAU CCA
No skipping









Antisense Oligonucleotides Directed at Exon 51

Antisense oligonucleotides directed at exon 51 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 20 and FIG. 41.







TABLE 41







Antisense molecule sequences tested to determine if they induce exon 51 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 51
Sequence
skipping













297
H51A(−29−10)
UUU GGG UUU UUG CAA AAA GG
No skipping


 


298
H51A(−22−01)
CUA AAA UAU UUU GGG UUU UUG C
No skipping


 


299
H51A(−14+10)
UGA GUA GGA GCU AAA AUA UUU UGG
No skipping


 


300
H51(+26+52)
GUU UCC UUA GUA ACC ACA GGU UGU GUC
very faint skipping to





25 nM


 


301
H51A(+40+67)
AGU UUG GAG AUG GCA GUU UCC UUA GUA A
skipping to 25 nM





also skips 50 or 52 a





well


 


302
H51A(+66+77)
UGG CAU UUC UAG
No skipping


 


303
H51A(+66+80)
AGA UGG CAU UUC UAG
No skipping


 


304
H51A(+66+83)
GGA AGA UGG CAU UUC UAG
No skipping


 


305
H51A(+78+95)
CUC CAA CAU CAA GGA AGA
No skipping


 


306
H51A(+81+95)
CUC CAA CAU CAA GGA
No skipping


 


307
H51A(+84+95)
CUC CAA CAU CAA
No skipping


 


308
H51A(+90+116)
GAA AUC UGC CAG AGC AGG UAC CUC CAA
No skipping


 


309
H51A(+53+79)
GAU GGC AUU UCU AGU UUG GAG AUG GCA
Strong skipping to 25 nM


 


310
H51A(+57+85)
AAG GAA GAU GGC AUU UCU AGU UUG GAG AU
Strong skipping to 25 nM





faint at 2.5 nM


 


69
H51A(+71+100)
GGU ACC UCC AAC AUC AAG GAA GAU GGC AUU
Strong skipping to 5 nM


 


311
H51A(+76+104)
AGC AGG UAC CUC CAA CAU CAA GGA AGA UG
Strong skipping to 25 nM









Antisense Oligonucleotides Directed at Exon 52

Antisense oligonucleotides directed at exon 52 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 42.







TABLE 42







Antisense molecule sequences tested to determine if they induce exon 52 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 52
Sequence
skipping













312
H52A(−12+13)
CCU GCA UUG UUG CCU GUA AGA ACA A
No skipping


 


313
H52A(−10+10)
GCA UUG UUG CCU GUA AGA AC
No skipping


 


314
H52A(+07+33)
GGG ACG CCU CUG UUC CAA AUC CUG CAU
skippping 50 nM


 


315
H52A(+17+46)
GUU CUU CCA ACU GGG GAC GCC UCU GUU CCA
skippping 25 nM


 


316
H52A(+17+37)
ACU GGG GAC GCC UCU GUU CCA
skippping 25 nM


 


317
H52A(+67+94)
CCU CUU GAU UGC UGG UCU UGU UUU UCA A
vey very faint skipping to





25 nM


 


318
Hint51(−40−14)
UAC CCC UUA GUA UCA GGG UUC UUC AGC
No skipping (SNP C or T)


 


58
H52A(+09+38)
AAC UGG GGA CGC CUC UGU UCC AAA UCC UGC
Strong skipping to 2.5 nM


 


319
H52A(+09+41)
UCC AAC UGG GGA CGC CUC UGU UCC AAA UCC
Strong skipping to 5 nM




UGC
faint at 5 nM


 


320
H52A(+15+44)
UCU UCC AAC UGG GGA CGC CUC UGU UCC AAA
Strong skipping to 10 nM





faint at 5 nM









Antisense Oligonucleotides Directed at Exon 53

Antisense oligonucleotides directed at exon 53 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 43.







TABLE 43







Antisense molecule sequences tested to determine if they induce exon 53 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 53
Sequence
skipping













321
H53A(−49−26)
AUA GUA GUA AAU GCU AGU CUG GAG
No skipping


 


322
H53A(−38−13)
GAA AAA UAA AUA UAU AGU AGU AAA UG
No skipping


 


323
H53A(−32−06)
AUA AAA GGA AAA AUA AAU AUA UAG UAG
No skipping


 


324
H53A(−15+15)
UCU GAA UUC UUU CAA CUA GAA UAA AAG GAA
No skipping


 


325
H53A(+39+65)
CAA CUG UUG CCU CCG GUU CUG AAG GUG
skippping 50 nM


 


326
H53A(+39+67)
UUC AAC UGU UGC CUC CGG UUC UGA AGG UG
skippping 100 nM


 


327
H39A(+39+69)SNP
CGU UCA ACU GUU GCC UCC GGU UCU GAA GGU G
skipping to 25 nM


 


328
H53A(+40+70)
UCA UUC AAC UGU UGC CUC CGG UUC UGA AGG U
skippping 50 nM


 


329
H53A(+41+69)
CAU UCA ACU GUU GCC UCC GGU UCU GAA GG
skippping 50 nM


 


330
H53A(+43+69)
CAU UCA ACU GUU GCC UCC GGU UCU GAA
skippping 50 nM


 


331
H53A(+69+98)
CAG CCA UUG UGU UGA AUC CUU UAA CAU UUC
Skipping at 50 nM


 


332
Hint52(−47−23)
UAU AUA GUA GUA AAU GCU AGU CUG G
No skipping


 


67
H53A(+27+56)
CCU CCG GUU CUG AAG GUG UUC UUG UAC UUC
strong skipping to 25 nM





faint at 5 nM


 


333
H53A(+27+59)
UUG CCU CCG GUU CUG AAG GUG UUC UUG UAC
strong skipping to 10 nM




UUC
faint at 5 nM


 


334
H53A(+30+59)
UUG CCU CCG GUU CUG AAG GUG UUC UUG UAC


 


335
H53A(+30+64)
AAC UGU UGC CUC CGG UUC UGA AGG UGU UCU
strong skipping to 25 nM




UGU AC
faint at 10 nM


 


336
H53A(+30+69)
CAU UCA ACU GUU GCC UCC GGU UCU GAA GGU
strong skipping to 25 nM




GUU CUU GUA C
faint at 5 nM


 


337
H53A(+33+63)
ACU GUU GCC UCC GGU UCU GAA GGU GUU CUU G
strong skipping to 25 nM





faint at 5 nM


 


338
H53A(+33+67)
UUC AAC UGU UGC CUC CGG UUC UGA AGG UGU
strong skipping to 50 nM




UCU UG
faint at 5 nM


 


59
H53A(+33+65)
CAA CUG UUG CCU CCG GUU CUG AAG GUG UUC
strong skipping to 25 nM




UUG
faint at 2.5 nM


 


339
H53A(+35+67)
UUC AAC UGU UGC CUC CGG UUC UGA AGG UGU
strong skipping to 25 nM




UCU


 


340
H53A(+37+67)
UUC AAC UGU UGC CUC CGG UUC UGA AGG UGU U
strong skipping to 25 nM


 


341
H53A(+36+70)
UCA UUC AAC UGU UGC CUC CGG UUC UGA AGG
reasonable sipping to 5 nM




UGU UC


 


342
H53A(+39+71)
UUC AUU CAA CUG UUG CCU CCG GUU CUG AAG
strong skipping to 25 nM




GUG


 


343
H53A(+42+71)
UUC AUU CAA CUG UUG CCU CCG GUU CUG AAG
strong skipping to 100 nM





faint at 5 nM









Antisense Oligonucleotides Directed at Exon 54

Antisense oligonucleotides directed at exon 54 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 21.







TABLE 44







Antisense molecule sequences tested to determine if they induce exon 54 skipping











Antisense




SEQ
Oligonucleotide

Ability to induce


ID
name
Sequence
skipping














Exon 54




344
H54A(+13+34)
UUG UCU GCC ACU GGC GGA GGU C
Skipping at 300 nM





brings out 55 + 54


 


345
H54A(+60+90)
AUC UGC AGA AUA AUC CCG GAG AAG UUU CAG
Skipping at 25 nM


 


346
H54A (+67+89)
UCU GCA GAA UAA UCC CGG AGA AG
Weak skipping to 40 nM-





both 54 + 55


 


16
H54A(+67+97)
UGG UCU CAU CUG CAG AAU AAU CCC GGA GAA G
Skipping at 10 nM


 


347
H54A(+77+106)
GGA CUU UUC UGG UAU CAU CUG CAG AAU AAU
Skipping 50 nM


 



Cocktail for Exons



54 + 55


16 &
H54A(+67+97)
UGG UCU CAU CUG CAG AAU AAU CCC GGA GAA G
Specific for 54&55


348
H55A(−10+14)
CUC GCU CAC UCA CCC UGC AAA GGA
Skipping at 10 nM





No additional bands









Antisense Oligonucleotides Directed at Exon 55

Antisense oligonucleotides directed at exon 55 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 22.







TABLE 45







Antisense molecule sequences tested to determine if they induce exon 55 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 55
Sequence
skipping













348
H55A(−10+14)
CUC GCU CAC UCA CCC UGC AAA GGA
No Skipping


 


17
H55A(−10 +20)
CAG CCU CUC GCU CAC UCA CCC UGC AAA GGA
Skipping at 10 nM


 


349
H55A(+39 +61)
CAG GGG GAA CUG UUG CAG UAA UC
No Skipping


 


350
H55A(+41+71)
UCU UUU ACU CCC UUG GAG UCU UCU AGG AGC C
No Skipping


 


351
H55A(+73+93)
UCU GUA AGC CAG GCA AGA AAC
No Skipping


 


352
H55A(+107+137)
CCU UAC GGG UAG CAU CCU GAU GGA CAU UGG C
No Skipping


 


353
H55A(+112 +136)
CUU ACG GGU AGC AUC CUG UAG GAC A
very weak skipping at 100 nM


 


354
H55A(+132 +161)
CCU UGG AGU CUU CUA GGA GCC UUU CCU UAC
Skipping at 200 nM


 


355
H55A(+141 +160)
CUU GGA GUC UUC UAG GAG CC
Skipping at 100 nM


 


356
H55A(+143 +171)
CUC UUU UAC UCC CUU GGA GUC UUC UAG GAG
No skipping


 


357
H55D(+11 −09)
CCU GAC UUA CUU GCC AUU GU
No skipping









Antisense Oligonucleotides Directed at Exon 56

Antisense oligonucleotides directed at exon 56 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 23.







TABLE 46







Antisense molecule sequences tested to determine if they induce exon


56 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 56
Sequence
skipping













358
H56A(−06+23)
GCU UCA AUU UCA CCU UGG AGG UCC UAC AG
Skipping at 25 nM


 


359
H56A(−06+15)
UUC ACC UUG GAG GUC CUA CAG
No Skipping


 


360
H56A(+23 +44)
GUU GUG AUA AAC AUC UGU GUG A
No skipping


 


361
H56A(+56 +81)
CCA GGG AUC UCA GGA UUU UUU GGC UG
No skipping


 


362
H56A(+67+91)
CGG AAC CUU CCA GGG AUC UCA GGA U
Skipping at 200 nM


 


18
H56A(+92+121)
CCA AAC GUC UUU GUA ACA GGA CUG CAU
skipping at 25 nM


 


363
H56A(+102+126)
GUU AUC CAA ACG UCU UUG UAA CAG G
skipping at 100 nM


 


364
H56A(+102+131)
UUC AUG UUA UCC AAA CGU CUU UGU AAC AGG
skipping at 25 nM


 


19
H56A(+112+141)
CCA CUU GAA GUU CAU GUU AUC CAA ACG UCU
skipping at 25 nM


365
H56A(+117+146)
UCA CUC CAC UUG AAG UUC AUG UUA UCC AAA
skipping weakly at 25 nM


 


366
H56A(+121+143)
CUC CAC UUG AAG UUC AUG UUA UC
No Skipping


 


367
H56D(+11−10)
CUU UUC CUA CCA AAU GUU GAG
Skipping at 600 nM









Antisense Oligonucleotides Directed at Exon 57

Antisense oligonucleotides directed at exon 57 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 24.







TABLE 47







Antisense molecule sequences tested to determine if they induce exon


57 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 57
Sequence
skipping













368
H57A(−15+18)
CUG GCU UCC AAA UGG GAC CUG AAA AAG AAC AGC
No Skipping


 


369
H57A (−12 +18)
CUG GCU UCC AAA UGG GAC CUG AAA AAG AAC
Skipping at 50 nM


 


20
H57A(−10+20)
AAC UGG CUU CCA AAU GGG ACC UGA AAA AGA
Skipping at 300 nM


 


370
H57A(−06 +24)
UCA GAA CUG GCU UCC AAA UGG GAC CUG AAA
Skipping at 300 nM


 


371
H57A(+21+44)
GGU GCA GAC GCU UCC ACU GGU CAG
No Skipping


 


372
H57A(+47 +77)
GCU GUA GCC ACA CCA GAA GUU CCU GCA GAG A
No Skipping


 


373
H57A(+79+103)
CUG CCG GCU UAA UUC AUC AUC UUU C
No Skipping


 


374
H57A(+105+131)
CUG CUG GAA AGU CGC CUC CAA UAG GUG
No Skipping









Antisense Oligonucleotides Directed at Exon 59

Antisense oligonucleotides directed at exon 59 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 25.







TABLE 48







Antisense molecule sequences tested to determine if they induce exon


59 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 59
Sequence
skipping













375
H59A (−06 +16)
UCC UCA GGA GGC AGC UCU AAA U
No skipping


 


376
H59A(+31 +61)
UCC UC GCC UGC UUU CGU AGA AGC CGA GUG A
No skipping


 


377
H59A(+66+91)
AGG UUC AAU UUU UCC CAC UCA GUA UU
No Skipping


 


23
H59A(+96 +120)
CUA UUU UUC UCU GCC AGU CAG CGG A
Skipping at 100 nM


 


378
H59A(+96+125)
CUC AUC UAU UUU UCU CUG CCA GUC AGC GGA
No skipping


 


379
H59A(+101 +132)
CA GGG UCU CAU CUA UUU UUC UCU GCC AGU CA
No skipping


 


380
H59A(+141 +165)
CAU CCG UGG CCU CUU GAA GUU CCU G
Skipping exon





58& 59 at 200 nM


 


381
H59A(+151 +175)
AGG UCC AGC UCA UCC GUG GCC UCU U
Skipping at 300 nM


 


382
H59A(+161 +185)
GCG CAG CUU GAG GUC CAG CUC AUC C
weak skipping at





200 nM


 


383
H59A(+161+190)
GCU UGG CGC AGC UUG AGG UCC AGC UCA UCC
Skipping at 100 nM


 


384
H59A(+171+197)
CAC CUC AGC UUG GCG CAG CUU GAG GUC
No skipping


 


385
H59A(+181+205)
CCC UUG AUC ACC UCA GCU UGG CGC A
No Skipping


 


386
H59A(+200+220)
ACG GGC UGC CAG GAU CCC UUG
No Skipping


 


387
H59A(+221+245)
GAG AGA GUC AAU GAG GAG AUC GCC C
No Skipping


 


388
H59A(+92+125)
CUC AUC UAU UUU UCU CUG CCA GUC AGC GGA GUG C









Antisense Oligonucleotides Directed at Exon 60

Antisense oligonucleotides directed at exon 60 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 26.







TABLE 49







Antisense molecule sequences tested to determine if they induce exon


60 skipping











Antisense




SEQ
Oligonucleotide

Ability to induce


ID
name
Sequence
skipping














Exon 60




389
H60A(−10+20)
GCA AUU UCU CCU CGA AGU GCC UGU GUG CAA
no skipping


 


390
H60A(−8+19)
CAA UUU CUC CUC GAA GUG CCU GUG UGC
no skipping


 


391
H60A(+29+58)
CAA GGU CAU UGA CGU GGC UCA CGU UCU CUU
skipping to 50 nM


 


24
H60A(+33+62)
CGA GCA AGG UCA UUG ACG UGG CUC ACG UUC
strong skipping to 50 nM


 


47
H60A(+37+66)
CUG GCG AGC AAG GUC CUU GAC GUG GCU CAC
good skipping at 100 nM


 


392
H60A(+37+66)
CUG GCG AGC AAG GUC AUU GAC GUG GCU CAC
SNP


 


393
H60A(+39+66)
CUG GCG AGC AAG GUC CUU GAC GUG GCU C
good skipping at 100 nM


 


394
H60A(+43+73)
UGG UAA GCU GGC GAG CAA GGU CCU UGA CGU G
weak skipping at 100 nM


 


395
H60A(+51+75)
AGU GGU AAG CUG GCG UGC AAG GUC A
weak skipping at 100 nM


 


396
H60A(+72+102)
UUA UAC GGU GAG AGC UGA AUG CCC AAA GUG
no skipping


 


397
H60A(+75+105)
GAG GUU AUA CGG UGA GAG CUG AAU GCC CAA A
no skipping


 


398
H60A(+80+109)
UGC UGA GGU UAU ACG GUG AGA GCU GAA
good skipping at 100 nM


 


46
H60A(+87+116)
UCC AGA GUG CUG AGG UUA UAC GGU GAG AGC
weak skipping at 100 nM


 


399
H60D(+25−5)
CUU UCC UGC AGA AGC UUC CAU CUG GUG UUC
weak skipping at 600 nM


 



Exon 60 cocktails


390
H60A(−8+19)
CAA UUU CUC CUC GAA GUG CCU GUG UGC
weak skipping at 10 nM


392
H60A(+37+66)
CUG GCG AGC AAG GUC CUU GAC GUG GCU CAC


 


46 &
H60A(+87+116)
UCC AGA GUG CUG AGG UUA UAC GGU GAG AGC
skipping at 10 nM


47
H60A(+37+66)
CUG GCG AGC AAG GUC CUU GAC GUG GCU CAC


 


389
H60A(−10+20)
GCA AUU UCU CCU CGA AGU GCC UGU GUG CAA
skipping at 10 nM


394
H60A(+43+73)
UGG UAA GCU GGC GAG CAA GGU CCU UGA CGU G


 


393
H60A(+39+66)
CUG GCG AGC AAG GUC CUU GAC GUG GCU C
skipping at 10 nM


389
H60A(−10+20)
GCA AUU UCU CCU CGA AGU GCC UGU GUG CAA









Antisense Oligonucleotides Directed at Exon 61

Antisense oligonucleotides directed at exon 61 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 50







Antisense molecule sequences tested to determine if they induce exon


61 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 61
Sequence
skipping





400
H61A(−7+19)
CUC GGU CCU CGA CGG CCA CCU GGG AG
no skipping


 


401
H61A(+05+34)
CAU GCA GCU GCC UGA CUC GGU CCU CGC CGG
skipping to 50 nM


 


25
H61A(+10+40)
GGG CUU CAU GCA GCU GCC UGA CUC GGU CCU C
Skipping at 100 nM


 


402
H61A(+16+40)
GGG CUU CAU GCA GCU GCC UGA CUC G
no skipping


 


403
H61A(+16+45)
CCU GUG GGC UUC AUG CAG CUG CCU GAC UCG
skipping to 50 nM


 


404
H61A(+42+67)
GCU GAG AUG CUG GAC CAA AGU CCC UG
no skipping


 


405
H61D(+10−16)
GCU GAA AAU GAC UUA CUG GAA AGA AA
no skipping









Antisense Oligonucleotides Directed at Exon 62

Antisense oligonucleotides directed at exon 62 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 51







Antisense molecule sequences tested to determine if they induce exon


62 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 62
Sequence
skipping













406
H62A(−15+15)
GAC CCU GGA CAG ACG CUG AAA AGA AGG GAG
No skipping


 


407
H62A(−10+20)
CCA GGG ACC CUG GAC AGA CGC UGA AAA GAA
No skipping


 


408
H62A(−05+15)
GAC CCU GGA CAG ACG CUG AA
Faint to 25 nM


 


409
H62A(−3+25)
CUC UCC CAG GGA CCC UGG ACA GAC GCU G
No skipping


 


410
H62A(+01+30)
UGG CUC UCU CCC AGG GAC CCU GGA CAG ACG
almost 100%





skipping to 300 nM


 


411
H62A(+8+34)
GAG AUG GCU CUC UCC CAG GGA CCC UGG
Skipping at 300 nM


 


412
H62A(+13+43)
UUG UUU GGU GAG AUG GCU CUC UCC CAG GGA C
Faint to 25 nM


 


26
H62A(23+52)
UAG GGC ACU UUG UUU GGC GAG AUG GCU CUC
Skipping at 100 nM


 


413
H62D(+17−03)
UAC UUG AUA UAG UAG GGC AC
Faint to 100 nM


 


414
H62D(+25−5)
CUU ACU UGA UAU AGU AGG GCA CUU UGU UUG
No skipping









Antisense Oligonucleotides Directed at Exon 63

Antisense oligonucleotides directed at exon 63 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 27.







TABLE 52







Antisense molecule sequences tested to determine if they induce exon


63 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 63
Sequence
skipping













415
H63A(−14+11)
GAG UCU CGU GGC UAA AAC ACA AAA C
No visible skipping


 


416
H63A(+11+35)
UGG GAU GGU CCC AGC AAG UUG UUU G
Possible skipping at 600 nM


 


27
H63A(+20+49)
GAG CUC UGU CAU UUU GGG AUG GUC CCA GCA
Skipping to 100 nM


 


417
H63A(+33+57)
GAC UGG UAG AGC UCU GUC AUU UUG G
No visible skipping


 


418
H63A(+40+62)
CUA AAG ACU GGU AGA GCU CUG UC
No Skipping


 


419
H63D(+8−17)
CAU GGC CAU GUC CUU ACC UAA AGA C
No visible skipping









Antisense Oligonucleotides Directed at Exon 64

Antisense oligonucleotides directed at exon 64 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 28.







TABLE 53







Antisense molecule sequences tested to determine if they induce exon


64 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 64
Sequence
skipping













420
H64A(−3+27)
CUG AGA AUC UGA CAU UAU UCA GGU CAG CUG
No skipping


 


28
H64A(+34+62)
CUG CAG UCU UCG GAG UUU CAU GGC AGU CC
Skipping at 50 nM


 


421
H64A(+43+72)
AAA GGG CCU UCU GCA GUC UUC GGA GUU UCA
Skipping at 50 nM


 


422
H64A(+47+74)
GCA AAG GGC CUU CUG CAG UCU UCG GAG
Skipping at 200 nM


 


423
H64D(+15−10)
CAA UAC UUA CAG CAA AGG GCC UUC U
No skipping









Antisense Oligonucleotides Directed at Exon 65

Antisense oligonucleotides directed at exon 65 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 54







Antisense molecule sequences tested to determine if they induce exon


65 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 65
Sequence
skipping





424
H65A(+123+148)
UUG ACC AAA UUG UUG UGC UCU UGC UC
No skipping









Antisense Oligonucleotides Directed at Exon 66

Antisense oligonucleotides directed at exon 66 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 29.







TABLE 55







Antisense molecule sequences tested to determine if they induce exon


66 skipping











Antisense




SEQ
Oligonucleotide

Ability to induce


ID
name
Sequence
skipping






Exon 66




29
H66A(−8+19)
GAU CCU CCC UGU UCG UCC CCU AUU AUG
Skipping at 100 nM


 


48
H66A(−02+28)
CAG GAC ACG GAU CCU CCC UGU UCG UCC CCU
No skipping


 


49
H66D(+13−17)
UAA UAU ACA CGA CUU ACA UCU GUA CUU GUC
No skipping


 



Exon 66 cocktails


48 &
H66A(−02+28)
CAG GAC ACG GAU CCU CCC UGU UCG UCC CCU
skipping at 25 nM


49
H66D(+13−17)
UAA UAU ACA CGA CUU ACA UCU GUA CUU GUC









Antisense Oligonucleotides Directed at Exon 67

Antisense oligonucleotides directed at exon 67 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 30.







TABLE 56







Antisense molecule sequences tested to determine if they induce exon


67 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 67
Sequence
skipping













30
H67A(+17+47)
GCG CUG GUC ACA AAA UCC UGU UGA ACU UGC
strong skipping at 25 nM


 


425
H67A(+120+147)
AGC UCC GGA CAC UUG GCU CAA UGU UAC U
No skipping


 


426
H67A(+125+149)
GCA GCU CCG GAC ACU UGG CUC AAU G
Skipping at 600 nM


 


427
H67D(+22−08)
UAA CUU ACA AAU UGG AAG CAG CUC CGG ACA
No skipping









Antisense Oligonucleotides Directed at Exon 68

Antisense oligonucleotides directed at exon 68 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 31.







TABLE 57







Antisense molecule sequences tested to determine if they induce exon


68 skipping











Antisense




SEQ
Oligonucleotide

Ability to induce


ID
name
Sequence
skipping














Exon 68




428
H68A(−4+21)
GAU CUC UGG CUU AUU AUU AGC CUG C
Skipping at 100 nM


 


429
H68A(+22+48)
CAU CCA GUC UAG GAA GAG GGC CGC UUC
Skipping at 200 nM


 


50
H68A(+48+72)
CAC CAU GGA CUG GGG UUC CAG UCU C
Skipping at 200 nM


 


430
H68A(+74+103)
CAG CAG CCA CUC UGU GCA GGA CGG GCA GCC
No skipping


 


51
H68D(+23−03)
UAC CUG AAU CCA AUG AUU GGA CAC UC
No skipping


 



Exon 68 cocktails


50 &
H68A(+48+72)
CAC CAU GGA CUG GGG UUC CAG UCU C
skipping at 10 nM


51
H68D(+23−03)
UAC CUG AAU CCA AUG AUU GGA CAC UC









Antisense Oligonucleotides Directed at Exon 69

Antisense oligonucleotides directed at exon 69 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above. See FIG. 32 which shows a cocktail of H69A(+32+60) and H70A(−06+18) to remove both exons 69 and 70.







TABLE 58







Antisense molecule sequences tested to determine if they induce exon


69 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 69
Sequence
skipping





431
H69A(−12+19)
GUG CUU UAG ACU CCU GUA CCU GAU AAA GAG C
No skipping


 


432
H69A(+09 +39)
UGG CAG AUG UCA UAA UUA AAG UGC UUU AGAC
Skipping 68-71 at 200 nM


 


433
H69A(+29 +57)
CCA GAA AAA AAG CAG CUU UGG CAG AUG UC
Skipping 68-71 at 200 nM





also 68 + 69 & 69 + 70


 


434
H69A(+51+74)
GGC CUU UUG CAA CUC GAC CAG AAA
Skipping 68-71


 


435
H69A(+51 +80)
UUU UAU GGC CUU UUG CAA CUC GAC CAG AAA
~90% Skipping of 68-71





at 200 nM


 


436
H69 D(+08−16)
CUG GCG UCA AAC UUA CCG GAG UGC
no skipping









Antisense Oligonucleotides Directed at Exon 70

Antisense oligonucleotides directed at exon 70 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 59







Antisense molecule sequences tested to determine if they induce exon


70 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 70
Sequence
skipping





437
H70A(−09+15)
UUC UCC UGA UGU AGU CUA AAA GGG
no skipping


 


438
H70A(−07 +23)
CGA ACA UCU UCU CCU GAU GUA GUC UAA AAG
No skipping


 


439
H70A(+16 +40)
GUA CCU UGG CAA AGU CUC GAA CAU C
No skipping


 


440
H70A(+25 +48)
GUU UUU UAG UAC CUU GGC AAA GUC
No Skipping


 


441
H70A(+32+60)
GGU UCG AAA UUU GUU UUU UAG UAC CUU GG
No skipping


 


442
H70A(+64 +93)
GCC CAU UCG GGG AUG CUU CGC AAA AUA CCU
No skipping









Antisense Oligonucleotides Directed at Exon 71

Antisense oligonucleotides directed at exon 71 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 60







Antisense molecule sequences tested to determine if they induce exon


71 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 71
Sequence
skipping





443
H71A(−08+16)
GAU CAG AGU AAC GGG ACU GCA AAA



 


444
H71A(+07+30)
ACU GGC CAG AAG UUG AUC AGA GUA
weak skipping at 100 nM


 


445
H71A(+16+39)
GCA GAA UCU ACU GGC CAG AAG UUG
skipping at 100 nM


 


446
H71D(+19−05)
CUC ACG CAG AAU CUA CUG GCC AGA









Antisense Oligonucleotides Directed at Exon 72

Antisense oligonucleotides directed at exon 72 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 61







Antisense molecule sequences tested to determine if they induce exon


72 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 72
Sequence
skipping





447
H72A(−8+22)
AAG CUG AGG GGA CGA GGC AGG CCU AUA AGG
faint skipping at 600 nM


 


448
H72A(+02+28)
GUG UGA AAG CUG AGG GGA CGA GGC AGG
no skipping


 


449
H72D(+14−10)
AGU CUC AUA CCU GCU AGC AUA AUG
no skipping









Antisense Oligonucleotides Directed at Exon 73

Antisense oligonucleotides directed at exon 73 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 62







Antisense molecule sequences tested to determine if they induce exon


73 skipping











Antisense





Oligonucleotide


SEQ
name

Ability to induce


ID
Exon 73
Sequence
skipping













450
H73A(+24+49)
AUG CUA UCA UUU AGA UAA GAU CCA U
weak skipping


 


451
H73A(−16+10)
UUC UGC UAG CCU GAU AAA AAA CGU AA
Faint to 25 nM


 


60
H73A(+02+26)
CAU UGC UGU UUU CCA UUU CUG GUA G
Strong to 25 nM


 


452
H73D(+23−02)
ACA UGC UCU CAU UAG GAG AGA UGC U
Skipping to 25 nM


 


453
HM73A(+19+44)
UAU CAU UUA GAU AAG AUC CAU UGC UG
Faint skipping to 25 nM









Antisense Oligonucleotides Directed at Exon 74

Antisense oligonucleotides directed at exon 74 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 66







Antisense molecule sequences tested to determine if they induce exon


74 skipping










SEQ
Antisense

Ability to induce


ID
Oligonucleotide name
Sequence
skipping





454
HM74A(+20+46)
GUU CAA ACU UUG GCA GUA AUG CUG GAU
skipping 25 nM


 


455
HM74A(+50+77)
GAC UAC GAG GCU GGC UCA GGG GGG AGU C
100% skipping at 25 nM


 


456
HM74A(+96+122)
GCU CCC CUC UUU CCU CAC UCU CUA AGG
skipping 25 nM









Antisense Oligonucleotides Directed at Exon 76

Antisense oligonucleotides directed at exon 76 were prepared and tested for their ability to induce exon skipping in human muscle cells using similar methods as described above.







TABLE 63







Antisense molecule sequences tested to determine if they induce exon


76 skipping











Antisense Oligonucleotide




SEQ
name

Ability to induce


ID
Exon 76
Sequence
skipping





457
H76A(−02+25)
CAU UCA CUU UGG CCU CUG CCU GGG GCU
no detectable skipping


 


458
H76A(+80+106)
GAC UGC CAA CCA CUC GGA GCA GCA UAG
no detectable skipping









Modifications of the above-described modes of carrying out the various embodiments of this invention will be apparent to those skilled in the art based on the above teachings related to the disclosed invention. The above embodiments of the invention are merely exemplary and should not be construed to be in any way limiting.

## Claims

1. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient an antisense oligonucleotide selected from the group consisting of:
(i) an antisense oligonucleotide of 34 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−09+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(ii) an antisense oligonucleotide of 28 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−03+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(iii) an antisense oligonucleotide of 31 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−06+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(iv) an antisense oligonucleotide of 31 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−12+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(v) an antisense oligonucleotide of 22 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−03+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(vi) an antisense oligonucleotide of 28 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−09+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(vii) an antisense oligonucleotide of 28 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−12+16), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(viii) an antisense oligonucleotide of 39 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−14+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(ix) an antisense oligonucleotide of 27 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−08+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(x) an antisense oligonucleotide of 32 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−07+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xi) an antisense oligonucleotide of 34 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−12+22), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xii) an antisense oligonucleotide of 31 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−09+22), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xiii) an antisense oligonucleotide of 39 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−09+30), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xiv) an antisense oligonucleotide of 28 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−06+22), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xv) an antisense oligonucleotide of 34 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−06+28), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xvi) an antisense oligonucleotide of 25 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−03+22), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping; and
(xvii) an antisense oligonucleotide of 31 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−03+28), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
or a pharmaceutically acceptable salt thereof,
thereby treating the patient.

2. The method of claim 1, wherein the antisense oligonucleotide is chemically linked to one or more moieties or conjugates that enhance the activity, cellular distribution, or cellular uptake of the antisense oligonucleotide.

3. The method of claim 1, wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain.

4. The method of claim 1, wherein the antisense oligonucleotide is administered intravenously.

5. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient an antisense oligonucleotide selected from the group consisting of:
(i) an antisense oligonucleotide of 34 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA U (SEQ ID NO: 11), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(ii) an antisense oligonucleotide of 28 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 55), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(iii) an antisense oligonucleotide of 31 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA A (SEQ ID NO: 61), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(iv) an antisense oligonucleotide of 31 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU GUA AGA UAC C (SEQ ID NO: 62), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base,
(v) an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(vi) an antisense oligonucleotide of 28 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU GUA AGA U (SEQ ID NO: 64), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(vii) an antisense oligonucleotide of 28 bases comprising the base sequence UGC CAU CCU GGA GUU CCU GUA AGA UAC C (SEQ ID NO: 66), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(viii) an antisense oligonucleotide of 39 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA UAC CAA (SEQ ID NO: 236), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(ix) an antisense oligonucleotide of 27 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU GUA AGA (SEQ ID NO: 230), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(x) an antisense oligonucleotide of 34 bases comprising the base sequence GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA UAC C (SEQ ID NO: 237), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(xi) an antisense oligonucleotide of 31 bases comprising the base sequence GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA U (SEQ ID NO: 239), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(xii) an antisense oligonucleotide of 39 bases comprising the base sequence UUG CCG CUG CCC AAU GCC AUC CUG GAG UUC CUG UAA GAU (SEQ ID NO: 240), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(xiii) an antisense oligonucleotide of 32 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA AG (SEQ ID NO: 241), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(xiv) an antisense oligonucleotide of 28 bases comprising the base sequence GCC CAA UGC CAU CCU GGA GUU CCU GUA A (SEQ ID NO: 242), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(xv) an antisense oligonucleotide of 34 bases comprising the base sequence GCC GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA A (SEQ ID NO: 243), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
(xvi) an antisense oligonucleotide of 25 bases comprising the base sequence GCC CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 244), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base; and
(xvii) an antisense oligonucleotide of 31 bases comprising the base sequence GCC GCU GCC CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 245), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide and is uniformly modified to comprise a 5-substituted pyrimidine base;
or a pharmaceutically acceptable salt thereof,
thereby treating the patient.

6. The method of claim 5, wherein the antisense oligonucleotide is chemically linked to one or more moieties or conjugates that enhance the activity, cellular distribution, or cellular uptake of the antisense oligonucleotide.

7. The method of claim 5, wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain.

8. The method of claim 5, wherein the antisense oligonucleotide is administered intravenously.

9. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutical composition comprising: (i) antisense oligonucleotide selected from the group consisting of:
(i) an antisense oligonucleotide of 34 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA U (SEQ ID NO: 11), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(ii) an antisense oligonucleotide of 28 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 55), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(iii) an antisense oligonucleotide of 31 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA A (SEQ ID NO: 61), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(iv) an antisense oligonucleotide of 31 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU GUA AGA UAC C (SEQ ID NO: 62), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(v) an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(vi) an antisense oligonucleotide of 28 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU GUA AGA U (SEQ ID NO: 64), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(vii) an antisense oligonucleotide of 28 bases comprising the base sequence UGC CAU CCU GGA GUU CCU GUA AGA UAC C (SEQ ID NO: 66), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(viii) an antisense oligonucleotide of 39 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA UAC CAA (SEQ ID NO: 236), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(ix) an antisense oligonucleotide of 27 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU GUA AGA (SEQ ID NO: 230), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(x) an antisense oligonucleotide of 34 bases comprising the base sequence GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA UAC C (SEQ ID NO: 237), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(xi) an antisense oligonucleotide of 31 bases comprising the base sequence GCC CAA UGC CAU CCU GGA GUU CCU GUA AGA U (SEQ ID NO: 239), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(xii) an antisense oligonucleotide of 39 bases comprising the base sequence UUG CCG CUG CCC AAU GCC AUC CUG GAG UUC CUG UAA GAU (SEQ ID NO: 240), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(xiii) an antisense oligonucleotide of 32 bases comprising the base sequence GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA AG (SEQ ID NO: 241), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(xiv) an antisense oligonucleotide of 28 bases comprising the base sequence GCC CAA UGC CAU CCU GGA GUU CCU GUA A (SEQ ID NO: 242), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(xv) an antisense oligonucleotide of 34 bases comprising the base sequence GCC GCU GCC CAA UGC CAU CCU GGA GUU CCU GUA A (SEQ ID NO: 243), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
(xvi) an antisense oligonucleotide of 25 bases comprising the base sequence GCC CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 244), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain; and
(xvii) an antisense oligonucleotide of 31 bases comprising the base sequence GCC GCU GCC CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 245), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain;
or a pharmaceutically acceptable salt thereof;
and (ii) a pharmaceutically acceptable carrier,
thereby treating the patient.

10. The method of claim 9, wherein the antisense oligonucleotide is administered intravenously.

11. A method for restoring an mRNA reading frame to induce dystrophin protein production in a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient an antisense oligonucleotide selected from the group consisting of:
(i) an antisense oligonucleotide of 34 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−09+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(ii) an antisense oligonucleotide of 28 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−03+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(iii) an antisense oligonucleotide of 31 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−06+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(iv) an antisense oligonucleotide of 31 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−12+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(v) an antisense oligonucleotide of 22 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−03+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(vi) an antisense oligonucleotide of 28 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−09+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(vii) an antisense oligonucleotide of 28 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−12+16), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(viii) an antisense oligonucleotide of 39 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−14+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(ix) an antisense oligonucleotide of 27 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−08+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(x) an antisense oligonucleotide of 32 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−07+25), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xi) an antisense oligonucleotide of 34 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−12+22), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xii) an antisense oligonucleotide of 31 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−09+22), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xiii) an antisense oligonucleotide of 39 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−09+30), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xiv) an antisense oligonucleotide of 28 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−06+22), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xv) an antisense oligonucleotide of 34 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−06+28), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
(xvi) an antisense oligonucleotide of 25 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−03+22), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping; and
(xvii) an antisense oligonucleotide of 31 bases in length 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A (−03+28), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping;
or a pharmaceutically acceptable salt thereof,
thereby restoring the mRNA reading frame to induce dystrophin protein production in the patient.

12. The method of claim 11, wherein the antisense oligonucleotide is chemically linked to one or more moieties or conjugates that enhance the activity, cellular distribution, or cellular uptake of the antisense oligonucleotide.

13. The method of claim 11, wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain.

14. The method of claim 11, wherein the antisense oligonucleotide is administered intravenously.

15. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), or a pharmaceutically acceptable salt thereof, wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, thereby treating the patient.

16. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, thereby treating the patient.

17. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutically acceptable salt of an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, thereby treating the patient.

18. A method for restoring an mRNA reading frame to induce dystrophin protein production in a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), or a pharmaceutically acceptable salt thereof, wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, thereby restoring the mRNA reading frame to induce dystrophin protein production in the patient.

19. A method for restoring an mRNA reading frame to induce dystrophin protein production in a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, thereby restoring the mRNA reading frame to induce dystrophin protein production in the patient.

20. A method for restoring an mRNA reading frame to induce dystrophin protein production in a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutically acceptable salt of an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, thereby restoring the mRNA reading frame to induce dystrophin protein production in the patient.

21. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutical composition comprising (i) an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), or a pharmaceutically acceptable salt thereof, wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, and (ii) a pharmaceutically acceptable carrier, thereby treating the patient.

22. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutical composition comprising (i) an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, and (ii) a pharmaceutically acceptable carrier, thereby treating the patient.

23. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutical composition comprising (i) a pharmaceutically acceptable salt of an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, and (ii) a pharmaceutically acceptable carrier, thereby treating the patient.

24. A method for restoring an mRNA reading frame to induce dystrophin protein production in a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutical composition comprising (i) an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), or a pharmaceutically acceptable salt thereof, wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, and (ii) a pharmaceutically acceptable carrier, thereby restoring the mRNA reading frame to induce dystrophin protein production in the patient.

25. A method for restoring an mRNA reading frame to induce dystrophin protein production in a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutical composition comprising (i) an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, and (ii) a pharmaceutically acceptable carrier, thereby restoring the mRNA reading frame to induce dystrophin protein production in the patient.

26. A method for restoring an mRNA reading frame to induce dystrophin protein production in a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutical composition comprising (i) a pharmaceutically acceptable salt of an antisense oligonucleotide of 22 bases comprising the base sequence CAA UGC CAU CCU GGA GUU CCU G (SEQ ID NO: 63), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, wherein the antisense oligonucleotide is uniformly modified to comprise a 5-substituted pyrimidine base, and wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain, and (ii) a pharmaceutically acceptable carrier, thereby restoring the mRNA reading frame to induce dystrophin protein production in the patient.

27. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient an antisense oligonucleotide of 22 bases in length, or a pharmaceutically acceptable salt thereof, wherein the antisense oligonucleotide is 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A(−03+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping, thereby treating the patient.

28. The method of claim 27, wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain.

29. A method for treating a patient with Duchenne muscular dystrophy (DMD) in need thereof who has a mutation of the DMD gene that is amenable to exon 45 skipping, comprising administering to the patient a pharmaceutical composition comprising (i) an antisense oligonucleotide of 22 bases in length, or a pharmaceutically acceptable salt thereof, wherein the antisense oligonucleotide is 100% complementary to a target region of exon 45 of the human dystrophin pre-mRNA, wherein the target region is annealing site H45A(−03+19), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide specifically hybridizes to the annealing site inducing exon 45 skipping, and (ii) a pharmaceutically acceptable carrier, thereby treating the patient.

30. The method of claim 29, wherein the antisense oligonucleotide is chemically linked to a polyethylene glycol chain.