# Patent

## Title
Compositions and methods of targeting apolipoprotein B for the reduction of apolipoprotein C-III

## Abstract

Disclosed herein are compositions and methods for lowering Apolipoprotein C-III (ApoC-III) in a subject in need thereof. Subjects in need of ApoC-III reduction include subjects with elevated ApoC-III levels, subjects with a condition associated with ApoC-III, subjects with diabetes, obese subjects and subjects with cardiovascular disease. Compositions to lower ApoC-III include compounds targeting Apolipoprotein B (ApoB) such as Mipomersen and other antisense compound targeting ApoB.

## Background
CROSS REFERENCED TO RELATED APPLICATIONS
This application is a U.S. National Phase filing under 35 U.S.C. §371 claiming priority to International Serial No. PCT/US2010/027541 filed Mar. 16, 2010, which claims priority to U.S. Provisional Application 61/160,671, filed Mar. 16, 2009, each of which is incorporated herein by reference in its entirety.


FIELD OF THE INVENTION
The present invention provides compositions and methods for lowering plasma Apolipoprotein C-III (ApoC-III) and ApoC-III in lipoproteins. More specifically, the invention relates to compositions and methods of targeting Apolipoprotein B (ApoB) for reducing ApoC-III.
SEQUENCE LISTING
The present application is being filed along with a Sequence Listing in electronic format. The Sequence Listing is provided as a file entitled BIOL0110USASEQ.TXT, created Sep. 12, 2011, which is 124 Kb in size. The information in the electronic format of the sequence listing is incorporated herein by reference in its entirety.
BACKGROUND OF THE INVENTION
Coronary heart disease (CHD) has been the leading cause of death in the United States for over a century, and complications from atherosclerosis are the most common causes of death in Western societies (Knopp, New Engl. J. Medicine, 1999, 341, 498-511; Davis and Hui, Arterioscler. Thromb. Vasc. Biol., 2001, 21, 887-898; Bonow, Circulation, 2002, 106, 3140-3141). Elevated low density lipoprotein-cholesterol (LDL-C) is widely recognized as a risk factor for CHD and lowering of LDL-C is highly recommended. However, despite pharmacologic intervention, many individuals are unable to lower LDL-C levels.
Low density lipoproteins (LDL) are one of five broad classes of lipoproteins, which include the following: chylomicrons, responsible for the transport dietary lipids from intestine to tissues; very low density lipoproteins (VLDL); intermediate density lipoproteins (IDL); low density lipoproteins (LDL); all of which transport triacylglycerols and cholesterol from the liver to tissues; and high density lipoproteins (HDL), which transport endogenous cholesterol from tissues to the liver. Lipoprotein particles undergo continuous metabolic processing and have variable properties and compositions. The protein components of lipoproteins are known as apolipoproteins. At least nine apolipoproteins, such as Apolipoprotein B (also known as ApoB, apolipoprotein B-100, ApoB-100, apolipoprotein B-48, ApoB-48 and Ag(x) antigen) and Apolipoprotein C-III (ApoC-III), are distributed in significant amounts among the various human lipoproteins.
ApoB performs a variety of functions, including the absorption and processing of dietary lipids, as well as the regulation of circulating lipoprotein levels (Davidson and Shelness, Annu. Rev. Nutr., 2000, 20, 169-193). Two forms of apolipoprotein B exist in mammals: ApoB-100 and ApoB-48.
ApoC-III is thought to delay catabolism and clearance of triglyceride-rich particles such as VLDL and LDL. Increased ApoC-III levels can induce development of hypertriglyceridemia and ApoC-III concentrations in VLDL and LDL are associated with coronary heart disease (Campos et al., Distinct patterns of lipoproteins with apoB defined by presence of apoE or apoC-III in hypercholesterolemia and hypertriglyceridemia. J. Lipid Res. 2001, 42:1239-1249).
Mipomersen (ISIS 301012), and other second-generation antisense oligonucleotides targeting ApoB-100, have been shown to reduce hepatic production of ApoB. Mipomersen is currently undergoing clinical studies to determine whether it is effective in decreasing LDL-C and triglycerides in specific populations. Although the effect of Mipomersen on ApoB has been studied in detail, its effect, if any, on ApoC-III was unknown.
SUMMARY OF THE INVENTION
Provided herein are compounds useful for modulating gene expression and associated pathways via antisense mechanisms of action such as RNaseH, RNAi and dsRNA enzymes, as well as other mechanisms based on target degradation or target occupancy.
Provided herein are methods, compounds, and compositions for inhibiting or reducing expression of ApoC-III levels in a human subject.
Provided herein are methods of lowering plasma ApoC-III levels in a human subject, comprising: a) selecting a human subject with elevated ApoC-III levels or a condition associated with ApoC-III; and b) administering to the human subject a therapeutically effective amount of a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, or a salt thereof, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human ApoB. The administration of the modified oligonucleotide targeting ApoB reduces plasma ApoC-III levels in the human subject.
A method for treating, reducing the incidence of, or ameliorating a symptom of coronary heart disease in a diabetic subject, comprising: a) selecting a human subject with diabetes having or at risk of having coronary heart disease; and b) administering to the human subject a therapeutically effective amount of a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, or a salt thereof, wherein the modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B. The administration of the modified oligonucleotide targeting ApoB reduces plasma ApoC-III levels in the diabetic human subject.
Provided herein are methods for treating, reducing the incidence of, or ameliorating a symptom of coronary heart disease in an obese subject, comprising: a) selecting an obese human subject having or at risk of having coronary heart disease; and b) administering to the obese human subject a therapeutically effective amount of a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, or a salt thereof, wherein the modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B. The administration of the modified oligonucleotide targeting ApoB reduces plasma ApoC-III levels in the obese human subject.


DETAILED DESCRIPTION OF THE INVENTION
It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed. Herein, the use of the singular includes the plural unless specifically stated otherwise. As used herein, the use of “or” means “and/or” unless stated otherwise. Furthermore, the use of the term “including” as well as other forms, such as “includes” and “included”, is not limiting.
The section headings used herein are for organizational purposes only and are not to be construed as limiting the subject matter described.
DEFINITIONS
Unless specific definitions are provided, the nomenclature utilized in connection with, and the procedures and techniques of, analytical chemistry, synthetic organic chemistry, and medicinal and pharmaceutical chemistry described herein are those well known and commonly used in the art. Standard techniques may be used for chemical synthesis, and chemical analysis. Where permitted, all patents, applications, published applications and other publications, GENBANK Accession Numbers and associated sequence information obtainable through databases such as National Center for Biotechnology Information (NCBI) and other data referred to throughout in the disclosure herein are incorporated by reference in their entirety.
Unless otherwise indicated, the following terms have the following meanings:
“2′-O-methoxyethyl” (also 2′-MOE and 2′-O(CH2)2-OCH3) refers to an O-methoxy-ethyl modification of the 2′ position of a furosyl ring. A 2′-O-methoxyethyl modified sugar is a modified sugar.
“2′-O-methoxyethyl nucleoside” means a nucleoside comprising a 2′-O-methoxyethyl modified sugar moiety.
“5-methylcytosine” means a cytosine modified with a methyl group attached to the 5′ position. A 5-methylcytosine is a modified nucleobase.
A subject is “at risk” of developing a particular condition or disorder when that subject exhibits one or more signs or symptoms recognized by one skilled in the art as associated with the condition or disorder. For example, a subject is “at risk” for developing coronary heart disease when the subject exhibits, e.g., elevated LDL cholesterol.
“Administered concomitantly” refers to the co-administration of two agents in any manner in which the pharmacological effects of both are manifest in the patient at the same time. Concomitant administration does not require that both agents be administered in a single pharmaceutical composition, in the same dosage form, or by the same route of administration.
“Administering” means providing a pharmaceutical agent to an individual, and includes, but is not limited to administering by a medical professional and self-administering.
“Antisense compound” means an oligomeric compound that is capable of undergoing hybridization to a target nucleic acid through hydrogen bonding.
“Antisense inhibition” means reduction of target nucleic acid levels in the presence of an antisense compound complementary to a target nucleic acid compared to target nucleic acid levels in the absence of the antisense compound.
“Bicyclic sugar” means a furosyl ring modified by the bridging of two non-geminal ring atoms. A bicyclic sugar is a modified sugar moiety.
“Cardiovascular disease” or “cardiovascular disorder” refers to a group of conditions related to the heart, blood vessels, or the circulation. Examples of cardiovascular diseases include, but are not limited to, aneurysm, angina, arrhythmia, atherosclerosis, cerebrovascular disease (stroke), coronary heart disease, and hypertension.
“Chimeric antisense compounds” means antisense compounds that have at least 2 chemically distinct regions, each region having a plurality of subunits, for example, nucleosides.
“Cholesterol” is a sterol molecule found in the cell membranes of all animal tissues. Cholesterol must be transported in an animal's blood plasma by lipoproteins including very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL), low density lipoprotein (LDL), and high density lipoprotein (HDL). “Plasma cholesterol” refers to the sum of all lipoproteins (VDL, IDL, LDL, HDL) esterified and/or non-esterified cholesterol present in the plasma or serum.
“Co-administration” means administration of two or more pharmaceutical agents to an individual. The two or more pharmaceutical agents may be in a single pharmaceutical composition, or may be in separate pharmaceutical compositions. Each of the two or more pharmaceutical agents may be administered through the same or different routes of administration. Co-administration encompasses administration in parallel or sequentially.
“Complementarity” means the capacity for pairing between nucleobases of a first nucleic acid and a second nucleic acid.
“Comprise,” “comprises” and “comprising” will be understood to imply the inclusion of a stated step or element or group of steps or elements but not the exclusion of any other step or element or group of steps or elements.
A “condition associated with elevated apolipoprotein C-III” refers to a disorder or condition afflicting a human subject that results from or manifests as elevated plasma apolipoprotein C-III concentrations. In certain embodiments, such apolipoprotein C-III concentrations are measured in particular lipoprotein, e.g., VLDL-C, LDL-C, IDL-C, and/or HDL-C.
“Contiguous nucleobases” means nucleobases immediately adjacent to each other.
“Deoxyribonucleotide” means a nucleotide having a hydrogen at the 2′ position of the sugar portion of the nucleotide. Deoxyribonucleotides may be modified with any of a variety of substituents.
“Diabetes mellitus” or “diabetes” is a syndrome characterized by disordered metabolism and abnormally high blood sugar (hyperglycemia) resulting from insufficient levels of insulin or reduced insulin sensitivity. The characteristic symptoms are excessive glucose in the urine (glycosuria), excessive urine production (polyuria) due to high blood glucose levels, excessive thirst and increased fluid intake (polydipsia) attempting to compensate for increased urination, blurred vision due to high blood glucose effects on the eye's optics, unexplained weight loss, and lethargy. “Type 2 diabetes,” (also known as “type 2 diabetes mellitus” or “diabetes mellitus, type 2”, and formerly called “diabetes mellitus type II”, “non-insulin-dependent diabetes (NIDDM)”, “obesity related diabetes”, or “adult-onset diabetes”) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia.
“Diabetic dyslipidemia” or “Type II diabetes with dyslipidemia” means a condition characterized by Type II diabetes, reduced HDL, elevated serum triglycerides, and elevated small, dense LDL particles.
“Diluent” means an ingredient in a composition that lacks pharmacological activity, but is pharmaceutically necessary or desirable. For example, in drugs that are injected, the diluent may be a liquid, e.g. saline solution.
“Dose” means a specified quantity of a pharmaceutical agent provided in a single administration, or in a specified time period. In certain embodiments, a dose may be administered in two or more boluses, tablets, or injections. For example, in certain embodiments, where subcutaneous administration is desired, the desired dose requires a volume not easily accommodated by a single injection. In such embodiments, two or more injections may be used to achieve the desired dose. In certain embodiments, a dose may be administered in two or more injections to minimize injection site reaction in an individual. In other embodiments, the pharmaceutical agent is administered by infusion over an extended period of time or continuously. Doses may be stated as the amount of pharmaceutical agent per hour, day, week or month.
“Dosage unit” means a form in which a pharmaceutical agent is provided, e.g. pill, tablet, or other dosage unit known in the art. In certain embodiments, a dosage unit is a vial containing lyophilized antisense oligonucleotide. In certain embodiments, a dosage unit is a vial containing reconstituted antisense oligonucleotide.
“Dyslipidemia” refers to a disorder of lipid and/or lipoprotein metabolism, including lipid and/or lipoprotein overproduction or deficiency. Dyslipidemia may be manifested by elevation of lipids such as cholesterol and triglycerides as well as lipoproteins such as low-density lipoprotein (LDL) cholesterol.
“Elevated apolipoprotein C-III” means a concentration of apolipoprotein C-III in a subject at which apolipoprotein C-III-lowering therapy is recommended. In certain embodiments, apolipoprotein C-III can be measured in particular lipoprotein, e.g., LDL-C, VLDL-C, IDL-C and/or HDL-C.
“Elevated total cholesterol” means total cholesterol at a concentration in an individual at which lipid-lowering therapy is recommended, and includes, without limitation, “elevated LDL-C”, “elevated VLDL-C,” “elevated IDL-C” and “elevated non-HDL-C.” In certain embodiments, total cholesterol concentrations of less than 200 mg/dL, 200-239 mg/dL, and greater than 240 mg/dL are considered desirable, borderline high, and high, respectively. In certain embodiments, LDL-C concentrations of 100 mg/dL, 100-129 mg/dL, 130-159 mg/dL, 160-189 mg/dL, and greater than 190 mg/dL are considered optimal, near optimal/above optimal, borderline high, high, and very high, respectively.
“Elevated lipoprotein” means a concentration of lipoprotein in a subject at which lipid-lowering therapy is recommended.
“Elevated triglyceride” means a concentration of triglyceride in the serum or liver at which lipid-lowering therapy is recommended, and includes “elevated serum triglyceride” and “elevated liver triglyceride.” In certain embodiments, triglyceride concentration of 150-199 mg/dL, 200-499 mg/dL, and greater than or equal to 500 mg/dL is considered borderline high, high, and very high, respectively.
“Fully complementary” or “100% complementary” means each nucleobase of a first nucleic acid has a complementary nucleobase in a second nucleic acid. In certain embodiments, a first nucleic acid is an antisense compound and a target nucleic acid is a second nucleic acid. In certain such embodiments, an antisense oligonucleotide is a first nucleic acid and a target nucleic acid is a second nucleic acid.
“Gapmer” means an antisense compound in which an internal region having a plurality of nucleotides that supports RNaseH cleavage is positioned between external regions having one or more nucleotides that are chemically distinct from the nucleosides of the internal region. A “gap segment” means the plurality of nucleotides that make up the internal region of a gapmer. A “wing segment” means the external region of a gapmer.
“Gap-widened” means an antisense compound which has a gap segment of 12 or more contiguous 2′-deoxyribonucleotides positioned between and immediately adjacent to 5′ and 3′ wing segments having from one to six nucleotides having modified sugar moieties.
“High density lipoprotein-C (HDL-C)” means cholesterol associated with high density lipoprotein particles. Concentration of HDL-C in serum (or plasma) is typically quantified in mg/dL or nmol/L. “Serum HDL-C” and “plasma HDL-C” mean HDL-C in the serum and plasma, respectively.
“Hybridization” means the annealing of complementary nucleic acid molecules. In certain embodiments, complementary nucleic acid molecules include, but are not limited to, an antisense compound and a nucleic acid target. In certain embodiments, complementary nucleic acid molecules include, but are not limited to, an antisense oligonucleotide and a nucleic acid target.
“Hypercholesterolemia” means a condition characterized by elevated cholesterol or circulating (plasma) cholesterol, LDL-cholesterol and VLDL-cholesterol, as per the guidelines of the Expert Panel Report of the National Cholesterol Educational Program (NCEP) of Detection, Evaluation of Treatment of high cholesterol in adults (see, Arch. Int. Med. (1988) 148, 36-39).
“Hyperlipidemia” or “hyperlipemia” is a condition characterized by elevated serum lipids or circulating (plasma) lipids. This condition manifests an abnormally high concentration of fats. The lipid fractions in the circulating blood are cholesterol, low density lipoproteins, very low density lipoproteins and triglycerides.
“Hypertriglyceridemia” means a condition characterized by elevated triglyceride levels.
“Improved cardiovascular outcome” means a reduction in the occurrence of adverse cardiovascular events, or the risk thereof. Examples of adverse cardiovascular events include, without limitation, death, reinfarction, stroke, cardiogenic shock, pulmonary edema, cardiac arrest, and atrial dysrhythmia.
“Internucleoside linkage” refers to the chemical bond between nucleosides.
“Intravenous administration” means administration into a vein.
“Linked nucleosides” means adjacent nucleosides which are bonded together.
“Lipoprotein”, such as VLDL, LDL and HDL, refers to a group of proteins found in the serum, plasma and lymph and are important for lipid transport. The chemical composition of each lipoprotein differs, for example, in that the HDL has a higher proportion of protein versus lipid, whereas the VLDL has a lower proportion of protein versus lipid.
“Low density lipoprotein-cholesterol (LDL-C)” means cholesterol carried in low density lipoprotein particles. Concentration of LDL-C in serum (or plasma) is typically quantified in mg/dL or nmol/L. “Serum LDL-C” and “plasma LDL-C” mean LDL-C in the serum and plasma, respectively.
“Mixed dyslipidemia” means a condition characterized by elevated serum cholesterol and elevated serum triglycerides. “Modified internucleoside linkage” refers to a substitution and/or any change from a naturally occurring internucleoside bond (i.e. a phosphodiester internucleoside bond).
“Modified nucleobase” means any nucleobase other than adenine, cytosine, guanine, thymidine, or uracil. An “unmodified nucleobase” means the purine bases adenine (A) and guanine (G), and the pyrimidine bases thymine (T), cytosine (C) and uracil (U).
“Modified oligonucleotide” means an oligonucleotide comprising a modified internucleoside linkage, a modified sugar, and/or a modified nucleobase. A modified oligonucleotide can also have a nucleoside mimetic or nucleotide mimetic.
“Modified sugar” refers to a substitution and/or any change from a natural sugar.
“Motif” means the pattern of unmodified and modified nucleosides in an antisense compound.
“Naturally occurring internucleoside linkage” means a 3′ to 5′ phosphodiester linkage.
“Natural sugar” means a sugar found in DNA (2′-H) or RNA (2′-OH).
“Nucleobase” means a heterocyclic moiety capable of pairing with a base of another nucleic acid.
“Nucleobase sequence” means the order of contiguous nucleobases independent of any sugar, linkage, and/or nucleobase modification.
“Nucleoside” means a nucleobase linked to a sugar.
“Nucleotide” means a nucleoside having a phosphate group covalently linked to the sugar portion of the nucleoside.
“Nucleoside mimetic” includes those structures used to replace the sugar or the sugar and the base and not necessarily the linkage at one or more positions of an oligomeric compound such as for example nucleoside mimetics having morpholino, cyclohexenyl, cyclohexyl, tetrahydropyranyl, bicyclo or tricyclo sugar mimetics e.g. non furanose sugar units.
“Nucleotide mimetic” includes those structures used to replace the nucleoside and the linkage at one or more positions of an oligomeric compound such as for example peptide nucleic acids or morpholinos (morpholinos linked by —N(H)—C(═O)—O— or other non-phosphodiester linkage).
“Obese” and “obesity” refers to a condition affecting a subject or conditions having a body mass index (BMI) of 30 kg/m2 or higher. In one embodiment, an obese subject includes those having a BMI of between about 25 kg/m2 and about 30 kg/m2.
“Oligomeric compound” means a polymer of linked monomeric subunits which is capable of hybridizing to at least a region of a nucleic acid molecule.
“Oligonucleotide” means a polymer of linked nucleosides each of which can be modified or unmodified, independent one from another.
“Parenteral administration,” means administration through injection or infusion. Parenteral administration includes, but is not limited to, subcutaneous administration, intravenous administration, or intramuscular administration.
“Pharmaceutically acceptable carrier” means a medium or diluent that does not interfere with the structure or the function of the oligonucleotide. Certain of such carriers enable pharmaceutical compositions to be formulated as, for example, tablets, pills, dragees, capsules, liquids, gels, syrups, slurries, suspension and lozenges for the oral ingestion by a subject. For example, a pharmaceutically acceptable carrier can be a sterile aqueous solution.
“Pharmaceutically acceptable salts” means physiologically and pharmaceutically acceptable salts of antisense compounds, i.e., salts that retain the desired biological activity of the parent oligonucleotide and do not impart undesired toxicological effects thereto.
“Pharmaceutical composition” or “composition” means a mixture of substances suitable for administering to an individual. For example, a composition may comprise one or more antisense oligonucleotides and a sterile aqueous solution.
“Phosphorothioate internucleoside linkage” or “phosphorothioate linkage” means a linkage between nucleosides where the phosphodiester bond is modified by replacing one of the non-bridging oxygen atoms with a sulfur atom. A phosphorothioate linkage is a modified internucleoside linkage.
“Portion” means a defined number of contiguous (i.e. linked) nucleobases of a nucleic acid. In certain embodiments, a portion is a defined number of contiguous nucleobases of a target nucleic acid. In certain embodiments, a portion is a defined number of contiguous nucleobases of an antisense compound.
“Prodrug” means a therapeutic agent that is prepared in an inactive form that is converted to an active form (i.e., drug) within the body or cells thereof by the action of endogenous enzymes or other chemicals and/or conditions.
“Subcutaneous administration” means administration just below the skin.
The term “sugar surrogate” overlaps with the slightly broader term “nucleoside mimetic” but is intended to indicate replacement of the sugar unit (furanose ring) only. The tetrahydropyranyl rings provided herein are illustrative of an example of a sugar surrogate wherein the furanose sugar group has been replaced with a tetrahydropyranyl ring system.
“Targeted” or “targeted to” means having a nucleobase sequence that will allow specific hybridization of an antisense compound to a target nucleic acid to induce a desired effect.
“Target nucleic acid,” “target RNA,” “target RNA transcript” and “nucleic acid target” all mean a nucleic acid capable of being targeted by antisense compounds.
“Therapeutically effective amount” or “effective amount” means an amount of a pharmaceutical agent that provides a therapeutic benefit to an individual. “Effective amount” in the context of modulating an activity or of treating or preventing a condition means the administration of that amount of active ingredient to a subject in need of such inhibition, treatment or prophylaxis, either in a single dose or as part of a series, that is effective for inhibition of that effect, or for treatment or prophylaxis or improvement of that condition. The effective amount will vary depending upon the health and physical condition of the subject to be treated, the taxonomic group of subjects to be treated, the formulation of the composition, the assessment of the medical situation, and other relevant factors.
“Total cholesterol” means all types of cholesterol, including, but not limited to, LDL-C, HDL-C, IDL-C and VLDL-C. Concentration of total cholesterol in serum (or plasma) is typically quantified in mg/dL or nmol/L.
“Treat” refers to administering a pharmaceutical composition to effect an alteration or improvement of a disease, disorder, or condition.
“Triglycerides” means lipids that are the triesters of glycerol. “Serum triglycerides” or “plasma triglycerides” means triglycerides present in serum or plasma, respectively. “Liver triglycerides” mean triglycerides present in liver tissue.
“Unmodified nucleotide” means a nucleotide composed of naturally occurring nucleobases, sugar moieties and internucleoside linkages. In certain embodiments, an unmodified nucleotide is an RNA nucleotide (i.e., β-D-ribonucleosides) or a DNA nucleotide (i.e., β-D-deoxyribonucleoside).
“Very low density lipoprotein-cholesterol (VLDL-C)” means cholesterol associated with very low density lipoprotein particles. Concentration of VLDL-C in serum (or plasma) is typically quantified in mg/dL or nmol/L. “Serum VLDL-C” and “plasma VLDL-C” mean VLDL-C in the serum or plasma, respectively.
Certain Embodiments
In certain aspects, provided herein are compositions and methods for reduction of apolipoprotein C-III concentrations in human subjects. In certain embodiments, provided herein are compounds for use in treatment of conditions associated with apolipoprotein C-III. Thus, in certain embodiments provided herein is a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, for treatment of a condition associated with apolipoprotein C-III. In certain embodiments, said treatment is of a human subject with elevated apolipoprotein C-III concentrations. In certain embodiments, treatment of said human subject results in a decrease in plasma apolipoprotein C-III concentrations in said human subject.
In certain embodiments, the condition associated with apolipoprotein C-III is hyperlipidemia, hypertriglyceridemia, hypercholesterolemia, elevated total cholesterol, elevated LDL-C, elevated VLDL-C, elevated IDL-C, elevated lipoprotein concentrations (including apolipoprotein A-I, apolipoprotein A-II, apolipoprotein A-IV, apolipoprotein A-V, apolipoprotein B, apolipoprotein B100, apolipoprotein C-I, apolipoprotein C-II, apolipoprotein C-III, apolipoprotein C-IV, apolipoprotein D, apolipoprotein E, and/or apolipoprotein H; in certain embodiments the condition is not associated with any one or more of elevated apolipoprotein A-I, apolipoprotein A-II, apolipoprotein A-IV, apolipoprotein A-V, apolipoprotein B, apolipoprotein B100, apolipoprotein C-I, apolipoprotein C-II, apolipoprotein C-III, apolipoprotein C-IV, apolipoprotein D, apolipoprotein E, and/or apolipoprotein H), elevated plasma glucose concentrations, elevated plasma triglyceride concentrations, elevated liver triglyceride concentrations, or hepatic steatosis.
In certain embodiments, provided herein is a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, for use in the reduction of apolipoprotein C-III concentrations in a human subject in need of such reduction. In certain embodiments, said human subject is a human subject with elevated apolipoprotein C-III concentrations. In certain embodiments, the human subject does not have elevated plasma apolipoprotein B concentrations.
In a particular embodiment, provided is a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, for treatment of hepatic steatosis. In another particular embodiment, provided is a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, for reduction of liver triglyceride concentrations.
In another aspect, provided herein are compositions and methods for the manufacture of a medicament for reduction of apolipoprotein C-III concentrations in human subjects. In certain embodiments, provided herein are compounds for the manufacture of a medicament for treatment of conditions associated with apolipoprotein C-III. Thus, in certain embodiments provided herein is a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, for the manufacture of a medicament for treatment of a condition associated with apolipoprotein C-III. In certain embodiments, said treatment is of a human subject with elevated apolipoprotein C-III concentrations. In certain embodiments, treatment of said human subject results in a decrease in plasma apolipoprotein C-III concentrations in said human subject.
In certain embodiments, the condition associated with apolipoprotein C-III is hyperlipidemia, hypertriglyceridemia, hypercholesteremia, elevated total cholesterol, elevated lipoprotein concentrations (including apolipoprotein A-I, apolipoprotein A-II, apolipoprotein A-IV, apolipoprotein A-V, apolipoprotein B, apolipoprotein B100, apolipoprotein C-I, apolipoprotein C-II, apolipoprotein C-III, apolipoprotein C-IV, apolipoprotein D, apolipoprotein E, and/or apolipoprotein H; in certain embodiments the condition is not associated with any one or more of elevated apolipoprotein A-I, apolipoprotein A-II, apolipoprotein A-IV, apolipoprotein A-V, apolipoprotein B, apolipoprotein B100, apolipoprotein C-I, apolipoprotein C-II, apolipoprotein C-III, apolipoprotein C-IV, apolipoprotein D, apolipoprotein E, and/or apolipoprotein H), elevated plasma glucose concentrations, elevated plasma triglycerides, elevated liver triglycerides, or hepatic steatosis.
In a particular embodiment, provided is a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, for the manufacture of a medicament for treatment of hepatic steatosis. In another particular embodiment, provided is a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, for the manufacture of a medicament for reduction of liver triglyceride concentrations.
In certain embodiments, provided herein is a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, for the manufacture of a medicament for the reduction of apolipoprotein C-III concentrations in a human subject in need of such reduction. In certain embodiments, said human subject is a human subject with elevated apolipoprotein C-III concentrations. In certain embodiments, the human subject does not have elevated plasma apolipoprotein B concentrations.
In certain embodiments, the modified oligonucleotide has a nucleobase sequence comprising at least an 8 nucleobase portion of SEQ ID NO:10. In certain embodiments, the modified oligonucleotide has a nucleobase sequence comprising at least a 12 nucleobase portion of SEQ ID NO:10. In certain embodiments, the modified oligonucleotide has a nucleobase sequence comprising SEQ ID NO:10. In certain embodiments, the modified oligonucleotide has a nucleobase sequence consisting of SEQ ID NO:10.
In certain embodiments, the antisense oligonucleotide comprises at least one modified internucleoside linkage. In certain embodiments, the modified internucleoside linkage is a phosphorothioate internucleoside linkage.
In certain embodiments, the modified oligonucleotide comprises at least one modified sugar moiety. In certain embodiments, the modified sugar moiety is a 2′-O-methoxyethyl sugar moiety. In certain embodiments, the modified sugar moiety is a bicyclic sugar moiety. In certain embodiments, the bicyclic sugar moiety comprises a 4′-CH2—O-2′ bridge. In certain embodiments, the modified sugar moiety comprises a 2′-O-methoxyethyl group.
In certain embodiments, the modified oligonucleotide comprises at least one nucleoside mimetic. In certain embodiments, the nucleoside mimetic is a tetrahydropyran nucleoside wherein a tetrahydropyran ring replaces the furanose ring.
In certain embodiments, the modified oligonucleotides comprises at least one modified nucleobase. In certain embodiments, the modified nucleobase is a 5-methylcytosine.
In certain embodiments, the modified oligonucleotide is a chimeric oligonucleotide having a plurality of 2′-deoxyribonucleosides flanked on each side by at least one modified nucleoside. In certain embodiments, the modified oligonucleotide consists of 20 linked nucleosides and, wherein nucleosides 1-5 and 16-20 are 2′-O-methoxyethyl nucleosides, nucleosides 6-15 are 2′-deoxyribonucleosides and each internucleoside linkage is a phosphorothioate internucleoside linkage.
In certain embodiments, the compound comprises the salt of the modified oligonucleotide. In certain embodiments, the compound comprises the sodium salt of the modified oligonucleotide.
In certain embodiments, the compound is formulated as a composition comprising a pharmaceutically acceptable excipient, vehicle, carrier or diluent.
In certain embodiments, a therapeutically effective amount is delivered in one or a plurality of doses of the compound.
In certain embodiments, the plurality of doses results in a plasma trough concentration of the compound from about 12 ng/mL to about 40 ng/mL or 18 ng/mL to about 40 ng/mL in the plasma of the human subject. In certain embodiments, the plurality of doses results in a plasma trough AUC of the compound from about 12 μg·hr/mL to about 20 μg·hr/mL or 12 μg·hr/mL to about 60 μg·hr/mL in the plasma of the human subject.
In certain embodiments, the compound is mipomersen.
In certain embodiments, each of the plurality of doses is at least about 100 mg or 200 mg of mipomersen. In certain embodiments, each of the plurality of doses is about 200 mg to about 400 mg of mipomersen. In certain embodiments, each of the plurality of doses is about 100 mg, 200 mg, about 300 mg, or about 400 mg of mipomersen
In certain embodiments, at least one dose of said plurality of doses is administered about twice a week. In certain embodiments, at least one dose of said plurality of doses is administered about once a week. In certain embodiments, at least one dose of said plurality of doses is administered about once every other week. In certain embodiments, at least one dose of said plurality of doses is administered about once a month.
In certain embodiments, the reduction of plasma apolipoprotein C-III levels depends on the dose of the compound administered to the subject. In certain embodiments, the plasma apolipoprotein C-III levels are reduced at least about 10% relative to the amount of plasma apolipoprotein C-III observed in the subject prior to administration of the compound. In certain embodiments, the plasma apolipoprotein C-III levels are reduced at least about 20% relative to the amount of plasma apolipoprotein C-III observed in the subject prior to administration of the compound. In certain embodiments, the plasma apolipoprotein C-III levels are reduced at least about 30% relative to the amount of plasma apolipoprotein C-III observed in the subject prior to administration of the compound. In certain embodiments, the plasma apolipoprotein C-III levels are reduced at least about 40% relative to the amount of plasma apolipoprotein C-III observed in the subject prior to administration of the compound. In certain embodiments, the plasma apolipoprotein C-III levels are reduced at least about 50% relative to the amount of plasma apolipoprotein C-III observed in the subject prior to administration of the compound. In certain embodiments, the plasma apolipoprotein C-III levels are reduced at least about 54% relative to the amount of plasma apolipoprotein C-III observed in the subject prior to administration of the compound. In certain embodiments, the plasma apolipoprotein C-III levels are reduced at least about 60% relative to the amount of plasma apolipoprotein C-III observed in the subject prior to administration of the compound. In certain embodiments, the plasma apolipoprotein C-III levels are reduced at least about 62% relative to the amount of plasma apolipoprotein C-III observed in the subject prior to administration of the compound.
Certain Indications
Surprisingly, antisense inhibition of ApoB is shown herein to reduce plasma concentrations of ApoC-III and ApoC-III-containing lipoproteins in a dose-dependent manner. More specifically, a reduction is achieved in apoC-III concentration in total plasma, VLDL and suggestively in HDL. The new finding that antisense reduction of ApoB decreases ApoC-III is relevant to certain treatment indications.
Patients with non-insulin-dependent diabetes (NIDDM) have 2 to 3 times higher the risk of coronary heart disease (CHD) than nondiabetic patients. Plasma cholesterol, LDL cholesterol, and HDL cholesterol (HDL-C) are strong risk factors for CHD in NIDDM. Diabetic patients also have higher plasma triglyceride concentrations than nondiabetic patients. The metabolism of triglyceride-rich lipoproteins, chylomicrons, and some types of VLDL and LDL is also abnormal in NIDDM. The production of triglyceride and VLDL by the liver is elevated, and the activity of lipoprotein lipase, which metabolizes triglyceride in VLDL, is decreased (Lee et al. Arteriosclerosis, Thrombosis, and Vascular Biology. 2003; 23:853-858).
Triglyceride-rich lipoproteins that contain ApoC-III are also prominent in diabetic dyslipidemia. It is theorized that these lipoproteins increase coronary disease risk in diabetic patients beyond that caused by standard lipid risk factors. Specifically, LDL with ApoC-III has been found to be a predictor of coronary events in diabetic patients independently of other lipids and is thought to be an atherogenic remnant of triglyceride-rich VLDL metabolism (Lee et al. Arteriosclerosis, Thrombosis, and Vascular Biology. 2003; 23:853-858).
Additionally, studies have found that ApoC-III in HDL (or the cholesterol concentration of HDL that has ApoC-III) is associated with risk of CHD. Also, ApoC-III has a direct pro-atherogenic, pro-inflammatory effect on monocytes and vascular endothelial cells. ApoC-III in HDL does not have a protective action against monocyte adhesion to vascular endothelial cells.
ApoC-III is a small protein on the surface of ApoB lipoproteins which strongly effects their metabolism. VLDL and LDL (apoB lipoproteins) contain subpopulations that have ApoCIII and ApoCIII is increased in ApoB lipoproteins in patients with diabetes. ApoCIII is an inhibitor of the activity of lipoprotein lipase, which metabolizes triglyceride in VLDL and facilitates their clearance from plasma. ApoCIII also obstructs the clearance from plasma of VLDL and LDL by interfering with their interaction with hepatic lipoprotein (Lee et al. Arteriosclerosis, Thrombosis, and Vascular Biology. 2003; 23:853-858).
Antisense reduction of ApoC-III coincides with a reduction in serum cholesterol and triglycerides, liver triglycerides, glucose and fat in hyperlipidemic models (U.S. application Ser. No. 10/553,722.
The lowering ApoC-III by antisense inhibition of ApoB therefore renders such ApoB targeting compounds useful for diabetic and/or obese subjects or subjects suffering from diabetic dyslipidemia, mixed dyslipidemia or steatosis.
Accordingly, in a first aspect, provided is a method for treating, reducing the incidence of, or ameliorating a symptom of coronary heart disease in a diabetic subject, comprising selecting a human subject with diabetes having or at risk of having coronary heart disease; and administering to said human subject a therapeutically effective amount of a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, or a salt thereof, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, and wherein plasma apolipoprotein C-III levels in said human subject are lowered.
In certain embodiments, said subject has one or more of elevated plasma total cholesterol concentrations, elevated plasma LDL cholesterol, elevated plasma triglyceride concentrations, elevated plasma HDL cholesterol concentrations or elevated liver triglycerides concentrations. In certain embodiments, said subject has elevated plasma total cholesterol concentrations, elevated plasma LDL cholesterol, elevated plasma triglyceride concentrations, and elevated plasma HDL cholesterol concentrations. In certain embodiments, said subject has or is at risk of having diabetic dyslipidemia or mixed dyslipidemia. In certain embodiments, said subject has elevated Apo C-III concentrations in one or more lipoprotein subfractions. In certain embodiments, said subject has elevated apolipoprotein C-III concentrations in HDL cholesterol particles relative to a non-diabetic subject. In certain embodiments, said subject has elevated apolipoprotein C-III concentrations in VLDL cholesterol particles relative to a non-diabetic subject. In certain embodiments, said subject has elevated apolipoprotein C-III concentrations in cholesterol particles comprising apolipoprotein B relative to a non-diabetic subject. In certain embodiments, said subject has elevated apolipoprotein C-III concentrations in one or more of apolipoprotein B containing VLDL, HDL and LDL.
In another aspect, provided is a method for treating, reducing the incidence of, or ameliorating a symptom of coronary heart disease in an obese subject, comprising selecting an obese human subject having or at risk of having coronary heart disease; and administering to said obese human subject a therapeutically effective amount of a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, or a salt thereof, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, and wherein plasma apolipoprotein C-III levels in said obese human subject are lowered.
In certain embodiments, said subject has one or more of elevated plasma total cholesterol concentrations, elevated plasma LDL cholesterol, elevated plasma triglyceride concentrations, elevated plasma HDL cholesterol concentrations or elevated liver triglycerides concentrations. In certain embodiments, said subject has elevated plasma total cholesterol concentrations, elevated plasma LDL cholesterol, elevated plasma triglyceride concentrations, and elevated plasma HDL cholesterol concentrations. In certain embodiments, said subject has or is at risk of having diabetic dyslipidemia or mixed dyslipidemia. In certain embodiments, said subject has elevated Apo C-III concentrations in one or more lipoprotein subfractions. In certain embodiments, said subject has elevated apolipoprotein C-III concentrations in HDL cholesterol particles relative to a non-obese subject. In certain embodiments, said subject has elevated apolipoprotein C-III concentrations in VLDL cholesterol particles relative to a non-obese subject. In certain embodiments, said subject has elevated apolipoprotein C-III concentrations in cholesterol particles comprising apolipoprotein B relative to a non-obese subject. In certain embodiments, said subject has elevated apolipoprotein C-III concentrations in one or more of apolipoprotein B containing VLDL, HDL and LDL.
Certain Combination Therapies
The invention also provides methods of combination therapy, wherein, one or more compositions or compounds targeting ApoB and one or more other therapeutic/prophylactic agents are administered to treat a condition and/or disease state as described herein. In certain embodiments, a compound targeting ApoB and the therapeutic/prophylactic agent(s) are co-administered as a mixture or administered concomitantly. In certain embodiments, the route of administration is the same for the compound targeting ApoB and the therapeutic/prophylactic agent(s), while in other embodiments, the compound targeting ApoB and the therapeutic/prophylactic agents(s) are administered by different routes. In one embodiment, the dosages of the compound targeting ApoB and the therapeutic/prophylactic agent(s) are amounts that are therapeutically or prophylactically effective for each compound when administered as independent therapy. Alternatively, the combined administration permits use of lower dosages than would be required to achieve a therapeutic or prophylactic effect if administered as independent therapy. In certain embodiments, combination therapy methods are useful in decreasing one or more side effects of either the ApoB targeting compound or other agent.
In certain embodiments, one or more compounds targeting ApoB are co-administered with one or more other therapeutic/prophylactic agents. In certain embodiments, such one or more other therapeutic/prophylactic agent are designed to treat the same disease or condition as the compounds targeting ApoB. In certain embodiments, such one or more other therapeutic/prophylactic agents are designed to treat a different disease or condition. In certain embodiments, one or more compounds targeting ApoB and one or more other therapeutic/prophylactic agents are administered at the same time. In certain embodiments, one or more compounds targeting ApoB and one or more other therapeutic/prophylactic agents are administered at different times. In certain embodiments, one or more compounds targeting ApoB and one or more other therapeutic/prophylactic agents are prepared together in a single formulation. In certain embodiments, one or more compounds targeting ApoB and one or more other therapeutic/prophylactic agents are prepared separately. In certain embodiments, an additive or synergistic effect is achieved by administering one or more compounds and one or more other suitable therapeutic/prophylactic compounds.
Suitable therapeutic/prophylactic compound(s) include, but are not limited to, glucose-lowering agents (also referred to herein, as glucose-lowering drugs or glucose-lowering therapeutics), anti-obesity agents (also referred to herein, as anti-obesity drugs or anti-obesity therapeutics), and lipid lowering agents (also referred to herein, as lipid-lowering drugs or lipid-lowering therapeutics).
Glucose Lowering Agents
Diabetes agents include insulin, other hormones and hormone analogs and mimetics, and other glucose lowering agents, including orally administered glucose lowering drugs. The term “glucose-lowering agent” includes, but is not limited to, the sulfonylureas, biguanides, meglitinides, peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonists (e.g., thiazolidinediones) and alpha-glucosidase inhibitors.
Sulfonylureas work by stimulating beta-cell insulin secretion in the pancreas, and may also improve insulin sensitivity in peripheral tissues. Early sulfonylureas such as acetohexamide (DymelorTM), chlorpropamide (DiabineseTM, GlucamideTM), tolbutamide (OrinaseTM, MobenolTM), and tolazamide (TolamideTM, TolinaseTM) have been generally replaced with newer sulfonureas with better side-effect profiles (specifically lower cardiovascular risk), such as glimepiride (AmarylTM), glipizide (GlucotrolTM), glipizide extended release (Glucotrol XLTM), glyburide (MicronaseTM, EugluconTM, DiabetaTM), gliclazide (DiamicronTM), and micronized glyburide (GlynaseTM) (Luna & Feinglos; AACE et al., 2002). Side effects of sulfonylureas include hypoglycemia and weight gain.
Biguanides such as Metformin (GlucophageTM) work by decreasing hepatic glucose output and enhancing insulin sensitivity in hepatic and peripheral tissues. Metformin is contraindicated in patients with congestive heart failure or severe liver disease.
Meglitinides work by stimulating the beta cells in the pancreas to produce insulin. Nateglinide (StarlixTM) and repaglinide (PrandinTM) are examples of this class.
Peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonists such as the thiazolidinediones enhance insulin sensitivity in muscle and adipose tissue and, to a lesser extent, inhibit hepatic glucose production. Thiazolidinediones include pioglitazone (ActosTM) and rosiglitazone (AvandiaTM; GlaxoSmithKline). The first thiazolidinedione approved for use in the United States, troglitazone (RezulinTM), was withdrawn from the market because of severe liver toxicity. Thiazolidinediones also affect the lipid profiles of patients with type 2 diabetes. Studies have described that rosiglitazone is associated with increases in total, LDL, and HDL cholesterol levels, and either no changes or increases in triglyceride levels. Pioglitazone has been associated with mean decreases in triglyceride levels, mean increases in HDL cholesterol levels, and no consistent mean changes in LDL and total cholesterol levels. Other potential side effects associated with thiazolidinediones include weight gain, slow onset of action, and potential liver toxicity (Luna & Feinglos, 2001).
New PPAR-gamma agonists are being developed; these include isaglitazone (netoglitazone) and the dual-acting PPAR agonists which have affinities for both PPAR-gamma and PPAR-alpha. Examples of dual-acting PPAR agonists are BMS-298585 and tesaglitazar. Agonists of other PPARs (e.g., alpha, delta) or pan-PPAR agonists may also be useful.
Alpha-glucosidase inhibitors inhibit an enzyme found in the lining of the small intestine that is responsible for the breakdown of complex carbohydrates before they are absorbed. Such inhibitors include acarbose (PrecoseTM) and miglitol (GlysetTM)
Oral glucose-lowering drugs are often used in combination to treat Type 2 diabetes. While many combinations of the above are possible, several are already marketed as a combined formulation (for example, AvandametTM (Rosiglitazone+Metformin); GlucovanceTM (glyburide/metformin); and MetaglipTM (glipizide/metformin). These and other combined formulations for treatment of diabetes or obesity may be administered in combination with one or more ApoB targeting compound.
Other classes of glucose-lowering, diabetes drugs are being developed. As alternatives to regular insulin, which is administered by injection, insulin analogs such as insulin lispro (HumalogTM) and insulin glargine (LantusTM) may be used. Both are given by injection as is regular insulin, but result in fewer hypoglycemic events than regular insulin. In addition the onset and duration of action with these is different from regular insulin. A follow-up analog to insulin glargine, insulin glulisine, is being developed by Aventis. Novo Nordisk is developing insulin detemir, a long-acting analog.
Alternative formulations/delivery methods for regular insulin are also being developed. Both liquid and dry powder inhaled insulin formulations are currently in late-stage development or have been recently approved—examples include recently approved ExuberaTM (Nektar/Pfizer/Aventis), which is a powder, and AERxTM (Aradigm/Novo Nordisk), which is an aerosolized liquid. While inhaled insulin is expected to be viewed as more convenient and less invasive than injected insulin, the cost is expected to be much greater for inhaled insulin.
Several companies are developing oral formulations of insulin. OralinTM (Generex Biotechnology) is the farthest along in development but there are others.
Other hormones and hormone mimetics being developed include pramlintide acetate (SymlinTM), and GLP-1. GLP-1 receptor agonists and GLP-1 analogs are being evaluated for clinical use as antidiabetic agents. GLP-1 itself has a short half-life due to N-terminal degradation of the peptide by Dipeptidyl Peptidase (DPP-IV)-mediated cleavage at the position 2 alanine. This limits the clinical usefulness of native GLP-1 or synthetic versions thereof. Longer acting analogs have been developed, including Exendin-4 (ExenatideTM, Exenatide LARTM), a DP IV-resistant GLP-1 analog and LiraglutideTM, an acylated albumin-bound human GLP-1 analog.
DPP-IV inhibitors are also being explored as drugs and one (LAF-237, Novartis) is currently in advanced clinical trials. Glucagon inhibitors may also be useful for diabetes.
Other peptides such as pituitary adenylate cyclase-activating polypeptide (PACAP) and Peptide YY (PYY) (and its subpeptide PYY[3-36]) are also under study for diabetes and/or obesity (Yamamoto et al., 2003, Diabetes 52, 1155-1162; Pittner et al., Int. J. Obes. Relat. Metab. Disord. 2004, 28, 963-71).
ApoB targeting compounds can also be used in combination with other antisense compounds targeting metabolic targets (e.g., PTP-1B and SGLT2 targeting compounds)
Anti-Obesity Agents
In certain embodiments, compounds provided herein are advantageous for reducing fat and may be useful in treatment of obesity. The use of weight loss agents has also been considered useful in diabetes management in general and for delaying or preventing the development or progression of frank Type 2 diabetes in patients with impaired glucose tolerance (Heymsfield S B, 2000, Archives of Internal Medicine, 160, 1321-1326). Thus, anti-obesity drugs are useful in combination with compounds targeting ApoB. Examples of anti-obesity drugs (also called “diet drugs”) include, without limitation, appetite suppressants such as phentermine and MeridiaTM, fat absorption inhibitors such as orlistat (XenicalTM), and AxokineTM, a modified form of ciliary neurotrophic factor, which inhibits hunger signals that stimulate appetite. Other drugs or classes of drugs under evaluation for obesity are CB1 inverse agonists, PYY, MCH4 and MTP inhibitors. ApoB targeting compounds can also be used in combination with other antisense compounds targeting obesity related targets.
Lipid Lowering Agents
Therapeutic/prophylactic compound(s) for the reduction of lipids include, but are not limited to, bile salt sequestering resins (e.g., cholestyramine, colestipol, and colesevelam hydrochloride), cholesterol biosynthesis inhibitors, especially HMG CoA reductase inhibitors (such as atorvastatin, pravastatin, simvastatin, lovastatin, fluvastatin, cerivastatin, rosuvastatin, and pitivastatin (itavastatin/risivastatin)), nicotinic acid, fibric acid derivatives (e.g., clofibrate, gemfibrozil, fenofibrate, bezafibrate, and ciprofibrate), probucol, neomycin, dextrothyroxine, plant-stanol esters, cholesterol absorption inhibitors (e.g., ezetimibe and pamaqueside), CETP inhibitors (e.g. torcetrapib, and JTT-705) MTP inhibitors (e.g., implitapide), squalene synthetase inhibitors, bile acid sequestrants such as cholestyramine, inhibitors of bile acid transporters (apical sodium-dependent bile acid transporters), regulators of hepatic CYP7a, ACAT inhibitors (e.g. Avasimibe), estrogen replacement therapeutics (e.g., tamoxigen), synthetic HDL (e.g. ETC-216), anti-inflammatories (e.g., glucocorticoids) and antisense compounds targeting cardiovascular targets (e.g., ApoC-III targeting compounds).
Dosing
In certain embodiments, pharmaceutical compositions are administered according to a dosing regimen (e.g., dose, dose frequency, and duration) wherein the dosing regimen can be selected to achieve a desired effect.
In certain embodiments, the variables of the dosing regimen are adjusted to result in a desired concentration of pharmaceutical composition in a subject. “Concentration of pharmaceutical composition” as used with regard to dose regimen can refer to the compound, oligonucleotide, or active ingredient of the pharmaceutical composition. For example, in certain embodiments, dose and dose frequency are adjusted to provide plasma concentration of a pharmaceutical composition at an amount sufficient to achieve a desired effect. In certain such embodiments, the pharmaceutical composition includes a modified oligonucleotide. In certain such embodiments, the modified oligonucleotide is ISIS 301012 (SEQ ID NO: 10). In certain of such embodiments the plasma concentration is maintained above the minimal effective concentration (MEC). In certain embodiments, pharmaceutical compositions of the present invention are administered with a dosage regimen designed to maintain a concentration above the MEC for 10-90% of the time, between 30-90% of the time, or between 50-90% of the time.
In certain embodiments, the dosing regimen can be selected to achieve a desired plasma trough concentration of a pharmaceutical composition. In certain such embodiments, the pharmaceutical composition includes a modified oligonucleotide. In certain such embodiments, the modified oligonucleotide is ISIS 301012. In certain such embodiments, the desired plasma trough concentration is from 5-100 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 5-50 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 10-40 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 12-40 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 15-35 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 20-30 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 18-40 ng/mL. In certain such embodiments, the desired plasma trough concentration is about 18 ng/mL or more. In certain embodiments, the plasma trough is achieved from about 3 to about 33 days after administration of at least one dose of the pharmaceutical composition.
In certain embodiments, the dosing regimen can be selected to achieve a desired plasma trough AUC of a pharmaceutical composition. In certain such embodiments, the pharmaceutical composition includes a modified oligonucleotide. In certain such embodiments, the modified oligonucleotide is ISIS 301012. In certain such embodiments, the desired plasma trough AUC is between about 2 to 40 μg·hr/mL, 2 to 30 μg·hr/mL, 2 to 20 μg·hr/mL, 2 to 10 μg·hr/mL, or 2 to 7 μg·hr/mL. In certain embodiments, the oligonucleotide is administered so that the plasma trough AUC is about 2 μg·hr/mL to about 40 μg·hr/mL, about 5 μg·hr/mL to about 30 μg·hr/mL, about μg·hr/mL to about 25 μg·hr/mL, about 12 μg·hr/mL to about 20 μg·hr/mL or about 12 μg·hr/mL to about 60 μg·hr/mL. In certain embodiments, the oligonucleotide is administered so that the plasma trough AUC is about 2 μg·hr/mL, about 3 μg·hr/mL, about 4 μg·hr/mL, about 5 μg·hr/mL, about 6 μg·hr/mL, about 7 μg·hr/mL, about 8 μg·hr/mL, about 9 μg·hr/mL, about 10 μg·hr/mL, about 11 μg·hr/mL, about 12 μg·hr/mL, about 13 μg·hr/mL, about 14 μg·hr/mL, about μg·hr/mL, about 16 μg·hr/mL, about 17 μg·hr/mL, about 18 μg·hr/mL, about 19 μg·hr/mL, about 20 μg·hr/mL, about 21 μg·hr/mL, about 22 μg·hr/mL, about 23 μg·hr/mL, about 24 μg·hr/mL, about 25 μg·hr/mL, about 26 μg·hr/mL, about 27 μg·hr/mL, about 28 μg·hr/mL, about 29 μg·hr/mL, about 30 μg·hr/mL, 31 μg·hr/mL, about 32 μg·hr/mL, about 33 μg·hr/mL, about 34 μg·hr/mL, about 35 μg·hr/mL, about 36 μg·hr/mL, about 37 μg·hr/mL, about 38 μg·hr/mL, about 39 μg·hr/mL or about 40 μg·hr/mL or greater. In certain embodiments, the plasma trough AUC is achieved from about 3 to about 33 days after administration of at least one dose of the pharmaceutical composition.
In certain embodiments, the dosing regimens comprise administering a pharmaceutical composition in certain doses. In certain embodiments, the pharmaceutical composition includes a modified oligonucleotide. In certain such embodiments, the modified oligonucleotide is ISIS 301012. In certain such embodiments, the desired dose is selected from 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg, 100 mg, 105 mg, 110 mg, 115 mg, 120 mg, 125 mg, 130 mg, 135 mg, 140 mg, 145 mg, 150 mg, 155 mg, 160 mg, 165 mg, 170 mg, 175 mg, 180 mg, 185 mg, 190 mg, 195 mg, 200 mg, 205 mg, 210 mg, 215 mg, 220 mg, 225 mg, 230 mg, 235 mg, 240 mg, 245 mg, 250 mg, 255 mg, 260 mg, 265 mg, 270 mg, 270 mg, 280 mg, 285 mg, 290 mg, 295 mg, 300 mg, 305 mg, 310 mg, 315 mg, 320 mg, 325 mg, 330 mg, 335 mg, 340 mg, 345 mg, 350 mg, 355 mg, 360 mg, 365 mg, 370 mg, 375 mg, 380 mg, 385 mg, 390 mg, 395 mg, 400 mg, 405 mg, 410 mg, 415 mg, 420 mg, 425 mg, 430 mg, 435 mg, 440 mg, 445 mg, 450 mg, 455 mg, 460 mg, 465 mg, 470 mg, 475 mg, 480 mg, 485 mg, 490 mg, 495 mg, 500 mg, 505 mg, 510 mg, 515 mg, 520 mg, 525 mg, 530 mg, 535 mg, 540 mg, 545 mg, 550 mg, 555 mg, 560 mg, 565 mg, 570 mg, 575 mg, 580 mg, 585 mg, 590 mg, 595 mg, 600 mg, 605 mg, 610 mg, 615 mg, 620 mg, 625 mg, 630 mg, 635 mg, 640 mg, 645 mg, 650 mg, 655 mg, 660 mg, 665 mg, 670 mg, 675 mg, 680 mg, 685 mg, 690 mg, 695 mg, 700 mg, 705 mg, 710 mg, 715 mg, 720 mg, 725 mg, 730 mg, 735 mg, 740 mg, 745 mg, 750 mg, 755 mg, 760 mg, 765 mg, 770 mg, 775 mg, 780 mg, 785 mg, 790 mg, 795 mg, and 800 mg. In certain such embodiments, the dose is selected from 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 500 mg, 600 mg, 700 mg, and 800 mg. In certain embodiments, the dose is selected from 50 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, and 400 mg. In certain embodiments, the dose is selected from a range defined by any two of the preceding values.
In certain embodiments, the dosing regimen includes administering the pharmaceutical composition in a plurality of doses. In certain embodiments, the pharmaceutical composition includes a modified oligonucleotide. In certain such embodiments, the modified oligonucleotide is ISIS 301012. In certain embodiments, the dose is administered to a subject daily, twice a week, weekly, every two weeks, twice a month, monthly, every other month or on a mixed schedule. In certain embodiments, the pharmaceutical composition is administered at a dose/frequence of 50 mg/month, 100 mg/month, 150 mg/month, 200 mg/month, 250 mg/month, 300 mg/month, 350 mg/month or 400 mg/month. In certain embodiments, pharmaceutical composition is administered at 50 mg twice a month, 100 mg twice a month, 150 mg twice a month, 200 mg twice a month, 250 mg twice a month, 300 twice a month, 350 mg twice a month or 400 mg twice a month. In certain embodiments, pharmaceutical composition is administered at 50 mg/wk, 100 mg/wk, 150 mg/wk, 200 mg/wk, 250 mg/wk, 300 mg/wk, 350 mg/wk or 400 mg/wk. In certain embodiments, pharmaceutical composition is administered at 50 mg twice a week, 100 mg twice a week, 150 mg twice a week, 200 mg twice a week, 250 mg twice a week, 300 twice a week, 350 mg twice a week or 400 mg twice a week. In certain embodiments, pharmaceutical composition is administered at 25 mg/day, 30 mg/day, 35 mg/day, 40 mg/day, 45 mg/day, 50 mg/day, 100 mg/day, 150 mg/day, 200 mg/day, 250 mg/day, 300 mg/day, 350 mg/day or 400 mg/day.
In certain embodiments, a plurality of doses is administered to a subject in a mixed schedule comprising an induction phase (also known as a loading phase) and a maintenance phase.
In certain embodiments, the induction phase includes one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, or more than twenty doses. In certain embodiments where the induction phase includes more than one dose, the doses administered during the induction phase are all the same amount as one another. In certain embodiments, the doses administered during the induction phase are not all the same amount. In certain embodiments, the doses increase over time. In certain embodiments, the doses decrease over time.
In certain embodiments, the dose(s) during the induction phase are selected from 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg, 100 mg, 105 mg, 110 mg, 115 mg, 120 mg, 125 mg, 130 mg, 135 mg, 140 mg, 145 mg, 150 mg, 155 mg, 160 mg, 165 mg, 170 mg, 175 mg, 180 mg, 185 mg, 190 mg, 195 mg, 200 mg, 205 mg, 210 mg, 215 mg, 220 mg, 225 mg, 230 mg, 235 mg, 240 mg, 245 mg, 250 mg, 255 mg, 260 mg, 265 mg, 270 mg, 270 mg, 280 mg, 285 mg, 290 mg, 295 mg, 300 mg, 305 mg, 310 mg, 315 mg, 320 mg, 325 mg, 330 mg, 335 mg, 340 mg, 345 mg, 350 mg, 355 mg, 360 mg, 365 mg, 370 mg, 375 mg, 380 mg, 385 mg, 390 mg, 395 mg, 400 mg, 405 mg, 410 mg, 415 mg, 420 mg, 425 mg, 430 mg, 435 mg, 440 mg, 445 mg, 450 mg, 455 mg, 460 mg, 465 mg, 470 mg, 475 mg, 480 mg, 485 mg, 490 mg, 495 mg, 500 mg, 505 mg, 510 mg, 515 mg, 520 mg, 525 mg, 530 mg, 535 mg, 540 mg, 545 mg, 550 mg, 555 mg, 560 mg, 565 mg, 570 mg, 575 mg, 580 mg, 585 mg, 590 mg, 595 mg, 600 mg, 605 mg, 610 mg, 615 mg, 620 mg, 625 mg, 630 mg, 635 mg, 640 mg, 645 mg, 650 mg, 655 mg, 660 mg, 665 mg, 670 mg, 675 mg, 680 mg, 685 mg, 690 mg, 695 mg, 700 mg, 705 mg, 710 mg, 715 mg, 720 mg, 725 mg, 730 mg, 735 mg, 740 mg, 745 mg, 750 mg, 755 mg, 760 mg, 765 mg, 770 mg, 775 mg, 780 mg, 785 mg, 790 mg, 795 mg, and 800 mg. In certain such embodiments, the dose(s) during the induction phase are selected from 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 500 mg, 600 mg, 700 mg, and 800 mg. In certain such embodiments, the dose(s) during the induction phase are selected from 100 mg, 125 mg, 150 mg, 175 mg, 200 mg, 225 mg, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg, 375 mg, and 400 mg. In certain such embodiments, the dose(s) during the induction phase are selected from 100 mg, 125 mg, 150 mg, 175 mg, 200 mg, 225 mg, 250 mg, and 300 mg.
In certain embodiments, the induction phase lasts from one day to six months. In certain embodiments an induction phase lasts from one week to five months as measured from administration of the first dose of the induction phase to administration of the first dose of the maintenance phase. In certain embodiments an induction phase lasts from one week to five months, from two weeks to five months, from three weeks to four months or from five weeks to three months, as measured from administration of the first dose of the induction phase to administration of the first dose of the maintenance phase. In certain embodiments an induction phase lasts one week, two weeks, three weeks, four weeks, five weeks, six weeks, seven weeks, eight weeks, nine weeks, ten weeks, eleven weeks, twelve weeks, thirteen weeks, fourteen weeks, fifteen weeks, sixteen weeks, seventeen weeks, eighteen weeks, nineteen weeks, twenty weeks, twenty-one weeks, twenty-two weeks, twenty-three weeks, twenty-four weeks or twenty-five weeks, as measured from administration of the first dose of the induction phase to administration of the first dose of the maintenance phase. In certain embodiments an induction phase lasts one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen or fourteen days as measured from administration of the first dose of the induction phase to administration of the first dose of the maintenance phase.
In certain embodiments, dose, dose frequency, and duration of the induction phase can be selected to achieve a desired effect within one to thirteen weeks. In certain such embodiments, the dose can be the same and the dose frequency can varied to achieve the desired effect within one to thirteen weeks. In certain embodiments, the dose increases over time and the dose frequency remains constant. In certain such embodiments, doses and frequency are selected to achieve a desired effect within one week, two weeks, three weeks, four weeks, five weeks, six weeks, seven weeks, eight weeks, nine weeks, ten weeks, eleven weeks, twelve weeks or thirteen weeks.
In certain embodiments, the dose(s) administered during the induction phase are lower than, equal to or higher than the dose(s) administered during the maintenance phase. In certain embodiments, it is desirable to achieve a desired effect as quickly as possible. In such embodiments, an induction phase with a high dose and/or high dose frequency can be desirable. In certain embodiments, one or more doses of the induction phase is greater than one or more doses of the maintenance phase. In certain embodiments, each of the induction doses is greater than each of the maintenance doses. In certain embodiments, it is desirable to mitigate an undesired side effect. In certain embodiments, an induction phase with a low dose and/or low dose frequency and/or long duration can be desirable. For example, a long induction phase, with relatively low doses, can result in better tolerance of the pharmaceutical agent. In certain embodiments, an induction phase results in physiological changes that result in reduced overall side effects. In certain embodiments, such a dose regimen can result in reduced liver toxicity when compared to higher initial doses and/or frequency. Such embodiments can include gradual increases of dose over time.
In certain embodiments, the maintenance phase includes one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, or more than twenty doses.
In certain embodiments, the maintenance phase lasts from one day to the lifetime of the subject. In certain embodiments the maintenance phase lasts from one week to twenty years, from two weeks to fifteen years, three weeks to ten years, four weeks to ten years as measured from administration of the last dose of the induction phase to administration of the last dose of the maintenance phase. In certain embodiments the maintenance phase lasts one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, or more weeks. In certain embodiments the maintenance phase lasts as long as the dose continues to be needed, effective, and tolerated.
In certain embodiments where the maintenance phase includes more than one dose, the doses administered during the maintenance phase are all the same as one another. In certain embodiments, the doses administered during the maintenance phase are not all the same. In certain such embodiments, the doses increase over time. In certain embodiments, the doses decrease over time.
In certain embodiments, the dose(s) during the maintenance phase are selected from 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg, 100 mg, 105 mg, 110 mg, 115 mg, 120 mg, 125 mg, 130 mg, 135 mg, 140 mg, 145 mg, 150 mg, 155 mg, 160 mg, 165 mg, 170 mg, 175 mg, 180 mg, 185 mg, 190 mg, 195 mg, 200 mg, 205 mg, 210 mg, 215 mg, 220 mg, 225 mg, 230 mg, 235 mg, 240 mg, 245 mg, 250 mg, 255 mg, 260 mg, 265 mg, 270 mg, 270 mg, 280 mg, 285 mg, 290 mg, 295 mg, 300 mg, 305 mg, 310 mg, 315 mg, 320 mg, 325 mg, 330 mg, 335 mg, 340 mg, 345 mg, 350 mg, 355 mg, 360 mg, 365 mg, 370 mg, 375 mg, 380 mg, 385 mg, 390 mg, 395 mg, 400 mg, 405 mg, 410 mg, 415 mg, 420 mg, 425 mg, 430 mg, 435 mg, 440 mg, 445 mg, 450 mg, 455 mg, 460 mg, 465 mg, 470 mg, 475 mg, 480 mg, 485 mg, 490 mg, 495 mg, 500 mg, 505 mg, 510 mg, 515 mg, 520 mg, 525 mg, 530 mg, 535 mg, 540 mg, 545 mg, 550 mg, 555 mg, 560 mg, 565 mg, 570 mg, 575 mg, 580 mg, 585 mg, 590 mg, 595 mg, 600 mg, 605 mg, 610 mg, 615 mg, 620 mg, 625 mg, 630 mg, 635 mg, 640 mg, 645 mg, 650 mg, 655 mg, 660 mg, 665 mg, 670 mg, 675 mg, 680 mg, 685 mg, 690 mg, 695 mg, 700 mg, 705 mg, 710 mg, 715 mg, 720 mg, 725 mg, 730 mg, 735 mg, 740 mg, 745 mg, 750 mg, 755 mg, 760 mg, 765 mg, 770 mg, 775 mg, 780 mg, 785 mg, 790 mg, 795 mg, and 800 mg. In certain such embodiments, the dose(s) during the maintenance phase are selected from 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 500 mg, 600 mg, 700 mg, and 800 mg. In certain such embodiments, the dose(s) during the maintenance phase are selected from 100 mg, 125 mg, 150 mg, 175 mg, 200 mg, 225 mg, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg, 375 mg, and 400 mg. In certain such embodiments, the dose(s) during the maintenance phase are selected from 100 mg, 125 mg, 150 mg, 175 mg, 200 mg, 225 mg, and 250 mg.
In certain embodiments, doses, dose frequency, and duration of the maintenance phase can be selected to achieve a desired effect. In certain embodiments, those variables are adjusted to result in a desired concentration of pharmaceutical agent in a subject. For example, in certain embodiments, dose and dose frequency are adjusted to provide plasma concentration of a pharmaceutical agent at an amount sufficient to achieve a desired effect. In certain of such embodiments the plasma concentration is maintained above the minimal effective concentration (MEC). In certain embodiments, pharmaceutical composition is administered with a dosage regimen designed to maintain a concentration above the MEC for 10-90% of the time, between 30-90% of the time, or between 50-90% of the time.
In certain embodiments, doses, dose frequency, and duration of the maintenance phase can be selected to achieve a desired plasma trough concentration of the pharmaceutical composition. In certain such embodiments, the pharmaceutical composition includes a modified oligonucleotide. In certain such embodiments, the modified oligonucleotide is ISIS 301012. In certain such embodiments, the desired plasma trough concentration is from 5-100 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 5-50 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 10-40 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 12-40 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 15-35 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 20-30 ng/mL. In certain such embodiments, the desired plasma trough concentration is from 18-40 ng/mL.
In certain embodiments, doses, dose frequency, and duration of the maintenance phase can be selected to achieve a desired safety profile. For example, in certain embodiments, such variables may be selected to mitigate toxicity of the pharmaceutical composition. In certain such embodiments, such variables are selected to mitigate liver toxicity. In certain such embodiments, such variables are selected to mitigate renal toxicity. In certain such embodiments, doses increase over time.
In certain embodiments, doses, dose frequency, and duration of the maintenance phase can be adjusted from time to time to achieve a desired effect. In certain embodiments, subjects are monitored for effects (therapeutic and/or toxic effects) and doses, dose frequency, and/or duration of the maintenance phase may be adjusted based on the results of such monitoring. Dose, dose frequency, and duration for the induction phase and for the maintenance phase can be manipulated independently to achieve a desired effect.
In certain embodiments, a dose regimen includes administering to a subject a pharmaceutical composition in a plurality of doses. In a certain embodiment, the pharmaceutical composition includes a modified oligonucleotide. In a certain embodiment, the modified oligonucleotide is ISIS 301012. In certain embodiments, the dose regimen includes administering to a subject 200 mg every week for at least 13 weeks or as long as is necessary to sustain the desired effect. In certain embodiments, the dose regimen includes administering to a subject 300 mg every, week for at least 13 weeks or as long as is necessary to sustain the desired effect. In certain embodiments, the dose regimen includes an induction phase, where an induction dose of 200 mg is administered to a subject four times during an eleven day period. The induction phase is followed by a maintenance phase, where a maintenance dose of 200 mg is administered every other week for at least 11 weeks or as long as is necessary to sustain the desired effect.
In certain embodiments, the frequency of administration of the maintenance dose is adjusted to achieved desired efficacy and/or desired safety profile. In certain such embodiments, the frequency of the maintenance dose is adjusted to achieve a desired plasma trough concentration of antisense oligonucleotide ISIS 301012. In certain embodiments, the plasma trough concentration of the administered composition is about 12 ng/mL or more, 15 ng/mL or more, 18 ng/mL or more, 20 ng/mL or more, 25 ng/mL or more, 30 ng/mL or more, 35 ng/mL or more, or 40 ng/mL or more. In certain embodiments, the plasma trough concentration of the administered composition is 12-40 ng/mL, 15-35 ng/mL, 18-30 ng/mL or 20-25 ng/mL. In certain such embodiments, the plasma trough AUC of the administered composition is about 12 μg·hr/mL or more, 15 μg·hr/mL or more, 18 μg·hr/mL or more, 20 μg·hr/mL or more, 25 μg·hr/mL or more, 30 μg·hr/mL or more, 35 μg·hr/mL or more, 40 μg·hr/mL or more, 45 μg·hr/mL or more, 50 μg·hr/mL or more, 55 μg·hr/mL or more, 60 μg·hr/mL or more, 65 μg·hr/mL or more, 70 μg·hr/mL or more, 75 μg·hr/mL or more, 80 μg·hr/mL or more, 85 μg·hr/mL or more, 90 μg·hr/mL or more, 95 μg·hr/mL or more, 100 μg·hr/mL or more, 110 μg·hr/mL or more, 125 μg·hr/mL or more, 150 μg·hr/mL or more. In certain such embodiments, the plasma trough AUC of the administered composition is 12-60 μg·hr/mL, 12-160 μg·hr/mL, 15-125 μg·hr/mL, 18-100 μg·hr/mL, 20-95 μg·hr/mL, 25-90 μg·hr/mL, 30-85 μg·hr/mL, 35-80 μg·hr/mL, 40-75 μg·hr/mL, 45-70 μg·hr/mL, 50-65 μg·hr/mL, 30-40 μg·hr/mL, 30-50 μg·hr/mL, 30-55 μg·hr/mL, 55-60 μg·hr/mL. In certain such embodiments, the desired effect is reduced Apo C-III
Compositions having an oligonucleotide targeting ApoB other than ISIS 301012 may vary in activity (e.g., as defined by percent reduction of target nucleic acid levels) from a composition having ISIS 301012. In certain embodiments, reductions in ApoB mRNA levels are indicative of inhibition of ApoB expression. Reductions in levels of ApoB protein are also indicative of inhibition of target mRNA expression. Further, phenotypic changes are indicative of inhibition of ApoB expression. For example, the lowering of ApoC-III is indicative of inhibition of target mRNA expression. In certain embodiments, the level of activity of a composition is higher or lower than that of a composition containing ISIS 301012. In such embodiment, the dose is adjusted accordingly lower or higher to achieve the desired efficacy.
Administration
In certain embodiments, pharmaceutical compositions can be administered to a subject by various methods. In certain embodiments, the method of administering a pharmaceutical composition to a subject comprises administering the pharmaceutical composition in the form of a dosage unit (e.g., tablet, capsule, bolus, etc.).
In certain embodiments, the pharmaceutical composition is administered by parenteral administration. In certain such embodiments, the parenteral administration is subcutaneous injection. In certain such embodiments, the parenteral administration is intravenous infusion.
In certain embodiments, where subcutaneous administration is desired, a dose of the pharmaceutical composition can be administered in two or more subcutaneous injections. In certain such embodiments, when the desired dose of the pharmaceutical composition requires a volume not easily accommodated by a single injection, two or more subcutaneous injections may be used to achieve the desired dose. In certain such embodiments, two or more subcutaneous injections may be used to administer the desired dose to minimize or eliminate an injection site reaction in a subject.
In certain embodiments in which a pharmaceutical composition is administered locally, the dosage regimen is selected to achieve a desired local concentration of the pharmaceutical agent of the present invention.
Certain Compounds
Modified oligonucleotide ISIS 301012 was designed to target human Apolipoprotein B RNA, using published sequence GenBank accession number NM—000384.1, SEQ ID NO: 1. ISIS 301012 is a chimeric oligonucleotide synthesized using methods as described in WO 2004044181, which is incorporated herein by reference in its entirety. The chimeric ISIS 301012 oligonucleotide is a “gapmer” 20 nucleobases in length (GCCTCAGTCTGCTTCGCACC; SEQ ID NO: 10), composed of a central “gap” region having ten contiguous 2′-deoxyribonucleosides, and flanked on both sides (5′ and 3′ directions) by “wing” regions having five contiguous 2′-O-methoxyethyl (2′-MOE) nucleosides. ISIS 301012 is shown in Table 1. The 2′-deoxyribonucleoside gap (nucleosides 6-15) are indicated by plain type and 2′-MOE nucleosides (nucleosides 1-5 and 16-20) are indicated by emboldened, underlined type. The internucleoside (backbone) linkages are phosphorothioate (P═S) throughout the modified oligonucleotide. All cytidine residues are 5-methylcytidines.
Modified oligonucleotides have been designed to target the human Apolipoprotein B RNA or DNA, using published sequences such as GenBank accession number NM—000384.1, incorporated herein as SEQ ID NO: 1; GenBank accession number NM—000384.2, incorporated herein as SEQ ID NO: 2; GenBank accession number M19734.1, incorporated herein as SEQ ID NO: 3; GenBank accession number M18471.1, incorporated herein as SEQ ID NO: 4; GenBank accession number M17779.1, incorporated herein as SEQ ID NO: 5; GenBank accession number X04714.1, incorporated herein as SEQ ID NO: 6; GenBank accession number M14162.1, incorporated herein as SEQ ID NO: 7; nucleotides 39835 to 83279 of GenBank accession number NT—022227.9, incorporated herein as SEQ ID NO: 8; and, GenBank accession number AI249040.1, incorporated herein as SEQ ID NO: 9.
Examples of oligonucleotides designed to target human Apolipoprotein B RNA can be found in U.S. application Ser. Nos. 11/123,656, 11/573,537 and 10/712,795, herein incorporated by reference.
Length
Compounds include, but are not limited to, those having an oligomeric sequence including oligonucleotides, oligonucleosides, oligonucleotide analogs, oligonucleotide mimetics, antisense compounds, antisense oligonucleotides, and siRNAs. A compound may have a nucleobase portion that is “antisense” to a target nucleic acid, meaning that is capable of undergoing hybridization to a target nucleic acid through hydrogen bonding. In such embodiment, the compound is targeted to the nucleic acid.
In certain embodiments, a compound has a nucleobase portion that, when written in the 5′ to 3′ direction, comprises the reverse complement of the target segment of a target nucleic acid to which it is targeted. In certain such embodiments, the compound has a modified oligonucleotide with a nucleobase sequence that, when written in the 5′ to 3′ direction, comprises the reverse complement of the target segment of a target nucleic acid to which it is targeted.
In certain embodiments, a compound targeted to an Apo B nucleic acid has an oligomeric sequence that is 12 to 30 subunits in length. In other words, the oligomeric sequence is from 12 to 30 linked subunits. In other embodiments, the compound has a an oligomeric sequence that is 8 to 80, 12 to 50, 15 to 30, 18 to 24, 19 to 22, or 20 linked subunits. In certain such embodiments, the compound has an oligomeric sequence that is 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, or 80 linked subunits, or a range defined by any two of the above values. In certain embodiments the compound has a modified oligonucleotide sequence, and the linked subunits are nucleosides.
In certain embodiments, a compound has a shortened or truncated sequence targeted to an Apo B nucleic acid. In certain embodiments the trucated sequence has a single subunit deleted from the 5′ end (5′ truncation), or alternatively from the 3′ end (3′ truncation). A compound with a shortened or truncated sequence targeted to an Apo B nucleic acid may have two subunits deleted from the 5′ end, or alternatively may have two subunits deleted from the 3′ end, of the sequence. Alternatively, the deleted subunits may be dispersed throughout the sequence, for example, in a sequence having one subunit deleted from the 5′ end and one subunit deleted from the 3′ end. In certain embodiments the sequence is a modified oligonucleotide sequence, and the subunits are nucleosides.
When a single additional subunit is present in a lengthened sequence targeted to an Apo B nucleic acid, the additional subunit may be located at the 5′ or 3′ end of the sequence. When two or more additional subunits are present, the added subunits may be adjacent to each other, for example, two subunits can be added to the 5′ end (5′ addition), or alternatively to the 3′ end (3′ addition), of the sequence. Alternatively, the added subunits may be dispersed throughout the sequence, for example, one subunit can added to the 5′ end and one subunit added to the 3′ end. In certain embodiments the sequence is a modified oligonucleotide sequence, and the subunits are nucleosides.
It is possible to increase or decrease the length of a sequence targeted to an Apo B nucleic acid, such as modified oligonucleotide, and/or introduce mismatch bases without eliminating activity. For example, in Woolf et al. (Proc. Natl. Acad. Sci. USA 89:7305-7309, 1992), a series of antisense oligonucleotides 13-25 nucleobases in length were tested for their ability to induce cleavage of a target RNA in an oocyte injection model. Antisense oligonucleotides 25 nucleobases in length with 8 or 11 mismatch bases near the ends of the antisense oligonucleotides were able to direct specific cleavage of the target mRNA, albeit to a lesser extent than the antisense oligonucleotides that contained no mismatches. Similarly, target specific cleavage was achieved using 13 nucleobase antisense oligonucleotides, including those with 1 or 3 mismatches.
Gautschi et al (J. Natl. Cancer Inst. 93:463-471, March 2001) demonstrated the ability of an oligonucleotide having 100% complementarity to the bcl-2 mRNA and having 3 mismatches to the bcl-xL mRNA to reduce the expression of both bcl-2 and bcl-xL in vitro and in vivo. Furthermore, this oligonucleotide demonstrated potent anti-tumor activity in vivo.
Maher and Dolnick (Nuc. Acid. Res. 16:3341-3358, 1988) tested a series of tandem 14 nucleobase antisense oligonucleotides, and a 28 and 42 nucleobase antisense oligonucleotides comprised of the sequence of two or three of the tandem antisense oligonucleotides, respectively, for their ability to arrest translation of human DHFR in a rabbit reticulocyte assay. Each of the three 14 nucleobase antisense oligonucleotides alone was able to inhibit translation, albeit at a more modest level than the 28 or 42 nucleobase antisense oligonucleotides.
Motifs
In certain embodiments, compounds having oligomeric sequences targeted to an Apo B nucleic acid have chemically modified subunits arranged in patterns, or motifs, to confer to the certain properties such as enhanced inhibitory activity, increased binding affinity for a target nucleic acid, or resistance to degradation by in vivo nucleases.
Chimeric sequences typically contain at least one region modified so as to confer increased resistance to nuclease degradation, increased cellular uptake, increased binding affinity for the target nucleic acid, and/or increased inhibitory activity. A second region of a chimeric sequence may optionally serve as a substrate for the cellular endonuclease RNase H, which cleaves the RNA strand of an RNA:DNA duplex. In certain embodiments the chimeric sequence is a chimeric oligonucleotide.
Oligomeric sequence with a gapmer motif are considered chimeric. In a gapmer, an internal region or “gap” having a plurality of subunits that support RNaseH cleavage is positioned between external regions or “wings” having a plurality of subunits that are chemically distinct from the subunits of the internal region. In the case of an antisense oligonucleotide having a gapmer motif, the gap segment has consecutive linked 2′ deoxyribonucleosides and generally serves as the substrate for endonuclease cleavage, while the wing segments comprise 1 or more consecutive modified nucleosides. In certain embodiments, the regions of a gapmer are differentiated by the types of sugar moieties comprising each distinct region. The types of sugar moieties that are used to differentiate the regions of a gapmer may in some embodiments include β-D-ribonucleosides, β-D-deoxyribonucleosides, 2′-modified nucleosides (such 2′-modified nucleosides may include 2′-MOE, and 2′-O—CH3, among others), and bicyclic sugar modified nucleosides (such bicyclic sugar modified nucleosides may include those having a 4′-(CH2)n-O-2′ bridge, where n=1 or n=2). Preferably, each distinct region comprises uniform sugar moieties. The wing-gap-wing motif is frequently described as “X-Y-Z”, where “X” represents the length of the 5′ wing region, “Y” represents the length of the gap region, and “Z” represents the length of the 3′ wing region. As used herein, a gapmer described as “X-Y-Z” has a configuration such that the gap segment is positioned immediately adjacent each of the 5′ wing segment and the 3′ wing segment. Thus, no intervening nucleotides exist between the 5′ wing segment and gap segment, or the gap segment and the 3′ wing segment. Any of the compounds described herein can have a sequence with a gapmer motif. In some embodiments, X and Z are the same, in other embodiments they are different. In a preferred embodiment, Y is between 8 and 15 nucleotides. X, Y or Z can be any of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30 or more nucleotides. Thus, gapmers of the present invention include, but are not limited to, for example 5-10-5, 4-8-4, 4-12-3, 4-12-4, 3-14-3, 2-13-5, 2-16-2, 1-18-1, 3-10-3, 2-10-2, 1-10-1 or 2-8-2.
In certain embodiments, the compound has a sequence with a “wingmer” motif, having a wing-gap or gap-wing configuration, i.e. an X-Y or Y-Z configuration as described above for the gapmer configuration. Thus, wingmer configurations of the present invention include, but are not limited to, for example 5-10, 8-4, 4-12, 12-4, 3-14, 16-2, 18-1, 10-3, 2-10, 1-10, 8-2, 2-13, or 5-13.
In certain embodiments, antisense compounds targeted to an Apo B nucleic acid possess a 5-10-5 gapmer motif.
Modifications
A nucleoside is a base-sugar combination. The nucleobase (also known as base) portion of the nucleoside is normally a heterocyclic base moiety. Nucleotides are nucleosides that further include a phosphate group covalently linked to the sugar portion of the nucleoside. For those nucleosides that include a pentofuranosyl sugar, the phosphate group can be linked to the 2′, 3′ or 5′ hydroxyl moiety of the sugar. Oligonucleotides are formed through the covalent linkage of adjacent nucleosides to one another, to form a linear polymeric oligonucleotide. Within the oligonucleotide structure, the phosphate groups are commonly referred to as forming the internucleoside linkages of the oligonucleotide.
Modifications to antisense compounds encompass substitutions or changes to internucleoside linkages, sugar moieties, or nucleobases. Modified antisense compounds are often preferred over native forms because of desirable properties such as, for example, enhanced cellular uptake, enhanced affinity for nucleic acid target, increased stability in the presence of nucleases, or increased inhibitory activity.
Chemically modified nucleosides may also be employed to increase the binding affinity of a shortened or truncated antisense oligonucleotide for its target nucleic acid. Consequently, comparable results can often be obtained with shorter antisense compounds that have such chemically modified nucleosides.
Modified Internucleoside Linkages
The naturally occurring internucleoside linkage of RNA and DNA is a 3′ to 5′ phosphodiester linkage. Antisense compounds having one or more modified, i.e. non-naturally occurring, internucleoside linkages are often selected over antisense compounds having naturally occurring internucleoside linkages because of desirable properties such as, for example, enhanced cellular uptake, enhanced affinity for target nucleic acids, and increased stability in the presence of nucleases.
Oligonucleotides having modified internucleoside linkages include internucleoside linkages that retain a phosphorus atom as well as internucleoside linkages that do not have a phosphorus atom. Representative phosphorus containing internucleoside linkages include, but are not limited to, phosphodiesters, phosphotriesters, methylphosphonates, phosphoramidate, and phosphorothioates. Methods of preparation of phosphorous-containing and non-phosphorous-containing linkages are well known.
In certain embodiments, antisense compounds targeted to an Apo B nucleic acid comprise one or more modified internucleoside linkages. In certain embodiments, the modified internucleoside linkages are phosphorothioate linkages. In certain embodiments, each internucleoside linkage of an antisense compound is a phosphorothioate internucleoside linkage.
Modified Sugar Moieties
Antisense compounds of the invention can optionally contain one or more nucleosides wherein the sugar group has been modified. Such sugar modified nucleosides may impart enhanced nuclease stability, increased binding affinity or some other beneficial biological property to the antisense compounds. In certain embodiments, nucleosides comprise a chemically modified ribofuranose ring moieties. Examples of chemically modified ribofuranose rings include without limitation, addition of substitutent groups (including 5′ and 2′ substituent groups, bridging of non-geminal ring atoms to form bicyclic nucleic acids (BNA), replacement of the ribosyl ring oxygen atom with S, N(R), or C(R1)(R)2 (R═H, C1-C12 alkyl or a protecting group) and combinations thereof. Examples of chemically modified sugars include 2′-F-5′-methyl substituted nucleoside (see PCT International Application WO 2008/101157 Published on Aug. 21, 2008 for other disclosed 5′,2′-bis substituted nucleosides) or replacement of the ribosyl ring oxygen atom with S with further substitution at the 2′-position (see published U.S. Patent Application US2005-0130923, published on Jun. 16, 2005) or alternatively 5′-substitution of a BNA (see PCT International Application WO 2007/134181 Published on Nov. 22, 2007 wherein LNA is substituted with for example a 5′-methyl or a 5′-vinyl group).
Examples of nucleosides having modified sugar moieties include without limitation nucleosides comprising 5′-vinyl, 5′-methyl (R or S), 4′-S, 2′-F, 2′-OCH3 and 2′-O(CH2)2OCH3 substituent groups. The substituent at the 2′ position can also be selected from allyl, amino, azido, thio, O-allyl, O—C1-C10 alkyl, OCF3, O(CH2)2SCH3, O(CH2)2-O—N(Rm)(Rn), and O—CH2-C(═O)—N(Rm)(Rn), where each Rm and Rn is, independently, H or substituted or unsubstituted C1-C10 alkyl.
Examples of bicyclic nucleic acids (BNAs) include without limitation nucleosides comprising a bridge between the 4′ and the 2′ ribosyl ring atoms. In certain embodiments, antisense compounds provided herein include one or more BNA nucleosides wherein the bridge comprises one of the formulas: 4′-(CH2)-O-2′ (LNA); 4′-(CH2)-S-2′; 4′-(CH2)-O-2′ (LNA); 4′-(CH2)2-O-2′ (ENA); Each of the foregoing BNAs include various stereochemical sugar configurations including for example α-L-ribofuranose and β-D-ribofuranose (see PCT international application PCT/DK98/00393, published on Mar. 25, 1999 as WO 99/14226).
In certain embodiments, nucleosides are modified by replacement of the ribosyl ring with a sugar surrogate. Such modification includes without limitation, replacement of the ribosyl ring with a surrogate ring system (sometimes referred to as DNA analogs) such as a morpholino ring, a cyclohexenyl ring, a cyclohexyl ring or a tetrahydropyranyl ring.
Many other bicyclo and tricyclo sugar surrogate ring systems are also know in the art that can be used to modify nucleosides for incorporation into antisense compounds Such ring systems can undergo various additional substitutions to enhance activity.
In nucleotides having modified sugar moieties, the nucleobase moieties (natural, modified or a combination thereof) are maintained for hybridization with an appropriate nucleic acid target.
In certain embodiments, antisense compounds targeted to an Apo B nucleic acid comprise one or more nucleotides having modified sugar moieties. In certain embodiments, the modified sugar moiety is 2′-MOE. In certain embodiments, the 2′-MOE modified nucleotides are arranged in a gapmer motif.
Modified Nucleobases
Nucleobase (or base) modifications or substitutions are structurally distinguishable from, yet functionally interchangeable with, naturally occurring or synthetic unmodified nucleobases. Both natural and modified nucleobases are capable of participating in hydrogen bonding. Such nucleobase modifications may impart nuclease stability, binding affinity or some other beneficial biological property to antisense compounds. Modified nucleobases include synthetic and natural nucleobases such as, for example, 5-methylcytosine (5-me-C). Certain nucleobase substitutions, including 5-methylcytosine substitutions, are particularly useful for increasing the binding affinity of an antisense compound for a target nucleic acid. For example, 5-methylcytosine substitutions have been shown to increase nucleic acid duplex stability by 0.6-1.2° C. (Sanghvi, Y. S., Crooke, S. T. and Lebleu, B., eds., Antisense Research and Applications, CRC Press, Boca Raton, 1993, pp. 276-278).
Additional modified nucleobases include 5-hydroxymethyl cytosine, xanthine, hypoxanthine, 2-aminoadenine, 6-methyl and other alkyl derivatives of adenine and guanine, 2-propyl and other alkyl derivatives of adenine and guanine, 2-thiouracil, 2-thiothymine and 2-thiocytosine, 5-halouracil and cytosine, 5-propynyl (—C≡C—CH3) uracil and cytosine and other alkynyl derivatives of pyrimidine bases, 6-azo uracil, cytosine and thymine, 5-uracil (pseudouracil), 4-thiouracil, 8-halo, 8-amino, 8-thiol, 8-thioalkyl, 8-hydroxyl and other 8-substituted adenines and guanines, 5-halo particularly 5-bromo, 5-trifluoromethyl and other 5-substituted uracils and cytosines, 7-methylguanine and 7-methyladenine, 2-F-adenine, 2-amino-adenine, 8-azaguanine and 8-azaadenine, 7-deazaguanine and 7-deazaadenine and 3-deazaguanine and 3-deazaadenine.
Heterocyclic base moieties may also include those in which the purine or pyrimidine base is replaced with other heterocycles, for example 7-deaza-adenine, 7-deazaguanosine, 2-aminopyridine and 2-pyridone. Nucleobases that are particularly useful for increasing the binding affinity of antisense compounds include 5-substituted pyrimidines, 6-azapyrimidines and N-2, N-6 and O-6 substituted purines, including 2 aminopropyladenine, 5-propynyluracil and 5-propynylcytosine.
In certain embodiments, antisense compounds targeted to an Apo B nucleic acid comprise one or more modified nucleobases. In certain embodiments, antisense oligonucleotides targeted to an Apo B nucleic acid comprise one or more modified nucleobases. In certain embodiments, the modified nucleobase is 5-methylcytosine. In certain embodiments, each cytosine is a 5-methylcytosine.
Hybridization
In some embodiments, hybridization occurs between an antisense compound disclosed herein and an Apo B nucleic acid. The most common mechanism of hybridization involves hydrogen bonding (e.g., Watson-Crick, Hoogsteen or reversed Hoogsteen hydrogen bonding) between complementary nucleobases of the nucleic acid molecules.
Hybridization can occur under varying conditions. Stringent conditions are sequence-dependent and are determined by the nature and composition of the nucleic acid molecules to be hybridized.
Methods of determining whether a sequence is specifically hybridizable to a target nucleic acid are well known in the art. In certain embodiments, the antisense compounds provided herein are specifically hybridizable with an Apo B nucleic acid.
Complementarity
An antisense compound and a target nucleic acid are complementary to each other when a sufficient number of nucleobases of the antisense compound can hydrogen bond with the corresponding nucleobases of the target nucleic acid, such that a desired effect will occur (e.g., antisense inhibition of a target nucleic acid, such as an Apo B nucleic acid).
Non-complementary nucleobases between an antisense compound and an Apo B nucleic acid may be tolerated provided that the antisense compound remains able to specifically hybridize to a target nucleic acid. Moreover, an antisense compound may hybridize over one or more segments of an Apo B nucleic acid such that intervening or adjacent segments are not involved in the hybridization event (e.g., a loop structure, mismatch or hairpin structure).
In certain embodiments, the antisense compounds provided herein, or a specified portion thereof, are, or are at least, 70%, 80%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% complementary to an Apo B nucleic acid, a target region, target segment, or specified portion thereof. Percent complementarity of an antisense compound with a target nucleic acid can be determined using routine methods. For example, an antisense compound in which 18 of 20 nucleobases of the antisense compound are complementary to a target region, and would therefore specifically hybridize, would represent 90 percent complementarity. In this example, the remaining noncomplementary nucleobases may be clustered or interspersed with complementary nucleobases and need not be contiguous to each other or to complementary nucleobases. As such, an antisense compound which is 18 nucleobases in length having 4 (four) noncomplementary nucleobases which are flanked by two regions of complete complementarity with the target nucleic acid would have 77.8% overall complementarity with the target nucleic acid and would thus fall within the scope of the present invention. Percent complementarily of an antisense compound with a region of a target nucleic acid can be determined routinely using BLAST programs (basic local alignment search tools) and PowerBLAST programs known in the art (Altschul et al., J. Mol. Biol., 1990, 215, 403 410; Zhang and Madden, Genome Res., 1997, 7, 649 656). Percent homology, sequence identity or complementarity, can be determined by, for example, the Gap program (Wisconsin Sequence Analysis Package, Version 8 for Unix, Genetics Computer Group, University Research Park, Madison Wis.), using default settings, which uses the algorithm of Smith and Waterman (Adv. Appl. Math., 1981, 2, 482 489).
In certain embodiments, the antisense compounds provided herein, or specified portions thereof, are fully complementary (i.e. 100% complementary) to a target nucleic acid, or specified portion thereof. For example, antisense compound may be fully complementary to an Apo B nucleic acid, or a target region, or a target segment or target sequence thereof. As used herein, “fully complementary” means each nucleobase of an antisense compound is capable of precise base pairing with the corresponding nucleobases of a target nucleic acid. For example, a 20 nucleobase antisense compound is fully complementary to a target sequence that is 400 nucleobases long, so long as there is a corresponding 20 nucleobase portion of the target nucleic acid that is fully complementary to the antisense compound. Fully complementary can also be used in reference to a specified portion of the first and/or the second nucleic acid. For example, a 20 nucleobase portion of a 30 nucleobase antisense compound can be “fully complementary” to a target sequence that is 400 nucleobases long. The 20 nucleobase portion of the 30 nucleobase oligonucleotide is fully complementary to the target sequence if the target sequence has a corresponding 20 nucleobase portion wherein each nucleobase is complementary to the 20 nucleobase portion of the antisense compound. At the same time, the entire 30 nucleobase antisense compound may or may not be fully complementary to the target sequence, depending on whether the remaining 10 nucleobases of the antisense compound are also complementary to the target sequence.
The location of a non-complementary nucleobase may be at the 5′ end or 3′ end of the antisense compound. Alternatively, the non-complementary nucleobase or nucleobases may be at an internal position of the antisense compound. When two or more non-complementary nucleobases are present, they may be contiguous (i.e. linked) or non-contiguous. In one embodiment, a non-complementary nucleobase is located in the wing segment of a gapmer antisense oligonucleotide.
In certain embodiments, antisense compounds that are, or are up to 12, 13, 14, 15, 16, 17, 18, 19, or 20 nucleobases in length comprise no more than 4, no more than 3, no more than 2, or no more than 1 non-complementary nucleobase(s) relative to a target nucleic acid, such as an Apo B nucleic acid, or specified portion thereof.
In certain embodiments, antisense compounds that are, or are up to 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, or 30 nucleobases in length comprise no more than 6, no more than 5, no more than 4, no more than 3, no more than 2, or no more than 1 non-complementary nucleobase(s) relative to a target nucleic acid, such as an Apo B nucleic acid, or specified portion thereof.
The antisense compounds provided herein also include those which are complementary to a portion of a target nucleic acid. As used herein, “portion” refers to a defined number of contiguous (i.e. linked) nucleobases within a region or segment of a target nucleic acid. A “portion” can also refer to a defined number of contiguous nucleobases of an antisense compound. In certain embodiments, the antisense compounds, are complementary to at least an 8 nucleobase portion of a target segment. In certain embodiments, the antisense compounds are complementary to at least a 12 nucleobase portion of a target segment. In certain embodiments, the antisense compounds are complementary to at least a 15 nucleobase portion of a target segment. Also contemplated are antisense compounds that are complementary to at least a 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, or more nucleobase portion of a target segment, or a range defined by any two of these values.
Identity
The antisense compounds provided herein may also have a defined percent identity to a particular nucleotide sequence, SEQ ID NO, or compound represented by a specific Isis number, or portion thereof. As used herein, an antisense compound is identical to the sequence disclosed herein if it has the same nucleobase pairing ability. For example, a RNA which contains uracil in place of thymidine in a disclosed DNA sequence would be considered identical to the DNA sequence since both uracil and thymidine pair with adenine. Shortened and lengthened versions of the antisense compounds described herein as well as compounds having non-identical bases relative to the antisense compounds provided herein also are contemplated. The non-identical bases may be adjacent to each other or dispersed throughout the antisense compound. Percent identity of an antisense compound is calculated according to the number of bases that have identical base pairing relative to the sequence to which it is being compared.
In certain embodiments, the antisense compounds, or portions thereof, are at least 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99% or 100% identical to one or more of the antisense compounds or SEQ ID NOs, or a portion thereof, disclosed herein.
Compositions and Methods for Formulating Pharmaceutical Compositions
The compounds provided herein may be admixed with pharmaceutically acceptable active or inert substance for the preparation of pharmaceutical compositions or formulations. Compositions and methods for the formulation of compositions are dependent upon a number of criteria, including, but not limited to, route of administration, extent of disease, or dose to be administered.
The Compounds provided herein can be utilized in pharmaceutical compositions by combining the compound with a suitable pharmaceutically acceptable excipient, vehicle, carrier or diluent. Such pharmaceutically acceptable excipient, vehicle, carrier or diluent can include phosphate-buffered saline (PBS). In certain embodiments PBS is used in compositions to be delivered parenterally. Accordingly, in one embodiment, employed in the methods described herein is a composition comprising a compound targeted to an Apo B nucleic acid and a pharmaceutically acceptable excipient, vehicle, carrier or diluent. In certain embodiments, the pharmaceutically acceptable excipient, vehicle, carrier or diluent is PBS. In certain embodiments, the compound includes a modified oligonucleotide.
Pharmaceutical compositions comprising compounds targeting Apo B nucleic acid encompass any pharmaceutically acceptable salts, esters, or salts of such esters, or any other oligonucleotide 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 pharmaceutically acceptable salts compounds, oligonucleotides, prodrugs, and other bioequivalents. Suitable pharmaceutically acceptable salts include, but are not limited to, sodium and potassium salts.
A prodrug can include the incorporation of additional nucleosides at one or both ends of an antisense compound which are cleaved by endogenous nucleases within the body, to form the active antisense compound.
Conjugated Antisense Compounds
The oligomeric sequences provided herein may be covalently linked to one or more moieties or conjugates which enhance the activity, cellular distribution or cellular uptake of the resulting oligomeric sequence. In certain embodiments, the oligomeric sequence is a modified oligonucleotide. In certain embodiments, the modified oligonucleotide is a single stranded oligonucleotide. Typical conjugate groups include cholesterol moieties and lipid moieties. Additional conjugate groups include carbohydrates, phospholipids, biotin, phenazine, folate, phenanthridine, anthraquinone, acridine, fluoresceins, rhodamines, coumarins, and dyes.
Oligomeric sequences can also be modified to have one or more stabilizing groups that are generally attached to one or both termini of the sequence to enhance properties such as, for example, nuclease stability. In certain embodiments, the oligomeric sequence is a modified oligonucleotide. In certain embodiments, the modified oligonucleotide is a single stranded oligonucleotide. Included in stabilizing groups are cap structures. These terminal modifications protect the compounds having terminal nucleotides from exonuclease degradation, and can help in delivery and/or localization within a cell. The cap can be present at the 5′-terminus (5′-cap), or at the 3′-terminus (3′-cap), or can be present on both termini. Cap structures are well known in the art and include, for example, inverted deoxy abasic caps. Further 3′ and 5′-stabilizing groups that can be used to cap one or both ends of an antisense compound to impart nuclease stability include those disclosed in WO 03/004602 published on Jan. 16, 2003, herein incorporated by reference.
Analysis of Inhibition of Target Levels or Expression
Inhibition of levels or expression of an ApoB nucleic acid can be assayed in a variety of ways known in the art (Sambrooke and Russell, Molecular Cloning: A Laboratory Manual, 3rd Ed., 2001). For example, target nucleic acid levels can be quantitated by, e.g., Northern blot analysis, competitive polymerase chain reaction (PCR), or quantitative real-time PCR. RNA analysis can be performed on total cellular RNA or poly(A)+ mRNA. Methods of RNA isolation are well known in the art. Northern blot analysis is also routine in the art. Quantitative real-time PCR can be conveniently accomplished using the commercially available ABI PRISM® 7600, 7700, or 7900 Sequence Detection System, available from PE-Applied Biosystems, Foster City, Calif. and used according to manufacturer's instructions.
Quantitative Real-Time PCR Analysis of Target RNA Levels
Quantitation of target RNA levels may be accomplished by quantitative real-time PCR using the ABI PRISM® 7600, 7700, or 7900 Sequence Detection System (PE-Applied Biosystems, Foster City, Calif.) according to manufacturer's instructions. Methods of quantitative real-time PCR are well known in the art.
Prior to real-time PCR, the isolated RNA is subjected to a reverse transcriptase (RT) reaction, which produces complementary DNA (cDNA) that is then used as the substrate for the real-time PCR amplification. The RT and real-time PCR reactions are performed sequentially in the same sample well. RT and real-time PCR reagents are obtained from Invitrogen (Carlsbad, Calif.). RT, real-time-PCR reactions are carried out by methods well known to those skilled in the art.
Gene (or RNA) target quantities obtained by real time PCR are normalized using either the expression level of a gene whose expression is constant, such as cyclophilin A, or by quantifying total RNA using RIBOGREEN® (Invitrogen, Inc. Carlsbad, Calif.). Cyclophilin A expression is quantified by real time PCR, by being run simultaneously with the target, multiplexing, or separately. Total RNA is quantified using RIBOGREEN® RNA quantification reagent (Invitrogen, Inc. Carlsbad, Calif.). Methods of RNA quantification by RIBOGREEN® are taught in Jones, L. J., et al, (Analytical Biochemistry, 1998, 265, 368-374). A CYTOFLUOR® 4000 instrument (PE Applied Biosystems) is used to measure RIBOGREEN® fluorescence.
Probes and primers are designed to hybridize to an ApoB nucleic acid. Methods for designing real-time PCR probes and primers are well known in the art, and may include the use of software such as PRIMER EXPRESS® Software (Applied Biosystems, Foster City, Calif.).
Analysis of Protein Levels
Antisense inhibition of Apo B nucleic acids can be assessed by measuring ApoB protein levels. Protein levels of Apo B can be evaluated or quantitated in a variety of ways well known in the art, such as immunoprecipitation, Western blot analysis (immunoblotting), enzyme-linked immunosorbent assay (ELISA), quantitative protein assays, protein activity assays (for example, caspase activity assays), immunohistochemistry, immunocytochemistry or fluorescence-activated cell sorting (FACS) (Sambrooke and Russell, Molecular Cloning: A Laboratory Manual, 3rd Ed., 2001). Antibodies directed to a target can be identified and obtained from a variety of sources, such as the MSRS catalog of antibodies (Aerie Corporation, Birmingham, Mich.), or can be prepared via conventional monoclonal or polyclonal antibody generation methods well known in the art. Antibodies useful for the detection of human and rat Apo B are commercially available.
It is understood that the sequence set forth in each SEQ ID NO in the Examples contained herein is independent of any nucleotide modification including modification to a sugar moiety, an internucleoside linkage, or a nucleobase. As such, antisense compounds defined by a SEQ ID NO may comprise, independently, one or more modifications to a sugar moiety, an internucleoside linkage, or a nucleobase. Antisense compounds described by Isis Number (Isis No) indicate a combination of nucleobase sequence and motif.
EXAMPLES
Non-Limiting Disclosure and Incorporation by Reference
While certain compounds, compositions and methods described herein have been described with specificity in accordance with certain embodiments, the following examples serve only to illustrate the compounds described herein and are not intended to limit the same. Each of the references recited in the present application is incorporated herein by reference in its entirety.
Example 1
Mipomersen (ISIS 301012)
Modified oligonucleotides have been designed to target the human Apolipoprotein B RNA or DNA, using published sequences such as GenBank accession number NM—000384.1, incorporated herein as SEQ ID NO: 1; GenBank accession number NM—000384.2, incorporated herein as SEQ ID NO: 2; GenBank accession number M19734.1, incorporated herein as SEQ ID NO: 3; GenBank accession number M18471.1, incorporated herein as SEQ ID NO: 4; GenBank accession number M17779.1, incorporated herein as SEQ ID NO: 5; GenBank accession number X04714.1, incorporated herein as SEQ ID NO: 6; GenBank accession number M14162.1, incorporated herein as SEQ ID NO: 7; nucleotides 39835 to 83279 of GenBank accession number NT—022227.9, incorporated herein as SEQ ID NO: 8; and, GenBank accession number AI249040.1, incorporated herein as SEQ ID NO: 9.
Examples of oligonucleotides designed to target human Apolipoprotein B RNA can be found in U.S. application Ser. Nos. 11/123,656, 11/573,537 and 10/712,795, herein incorporated by reference.
Modified oligonucleotide ISIS 301012 was designed to target human Apolipoprotein B RNA, using published sequence GenBank accession number NM—000384.1, SEQ ID NO: 1. ISIS 301012 is a chimeric oligonucleotide synthesized using methods as described in WO 2004044181, which is incorporated herein by reference in its entirety. The chimeric ISIS 301012 oligonucleotide is a “gapmer” 20 nucleobases in length (GCCTCAGTCTGCTTCGCACC; SEQ ID NO: 10), composed of a central “gap” region having ten contiguous 2′-deoxyribonucleosides, and flanked on both sides (5′ and 3′ directions) by “wing” regions having five contiguous 2′-O-methoxyethyl (2′-MOE) nucleosides. ISIS 301012 is shown in Table 1. The 2′-deoxyribonucleoside gap (nucleosides 6-15) are indicated by plain type and 2′-MOE nucleosides (nucleosides 1-5 and 16-20) are indicated by emboldened, underlined type. The internucleoside (backbone) linkages are phosphorothioate (P═S) throughout the modified oligonucleotide. All cytidine residues are 5-methylcytidines.
In Table 1, “Target site” indicates the first (5′-most) nucleotide number on the particular target sequence to which the oligonucleotide binds.







TABLE 1







ISIS 301012 Target Site and Sequence















SEQ


ISIS

TARGET

ID


#
REGION
SITE
SEQUENCE
NO





301012
Coding Region
3249
GCCTCAGTCTGCTTCGCACC
10





ISIS 301012 has been shown to reduce human


Apolipoprotein B in vitro and in vivo


(U.S. application Ser. Nos. 11/123,656 and


11/200,710, incorporated herein by reference in


their entirety).






Example 2
Effects of Apolipoprotein B Antisense Inhibition in Cynomolgus Monkeys
Cynomolgus monkeys (male or female) were used to evaluate antisense oligonucleotides for their potential to lower Apolipoprotein B mRNA or protein levels in vivo, as well as to evaluate phenotypic endpoints associated with Apolipoprotein B expression. As part of this example, LDL-cholesterol and total cholesterol levels of the treated monkeys were determined.
ISIS 301012 in Lean Cynomolgus Monkeys
The oligonucleotide ISIS 301012 was investigated in a long-term study for its effects on Apolipoprotein B expression and serum lipid levels in Cynomolgus monkeys.
Male and female Cynomolgus monkeys were treated with 2, 4 or 12 mg/kg of ISIS 301012 intravenously, or 2 or 20 mg/kg subcutaneously, at a frequency of every two days for the first week, and every 4 days thereafter, for 1 and 3 month treatment periods. Saline-treated animals served as negative controls. Each treatment group included 2 to 3 animals of each sex.
At a one month interval and at the 3 month study termination, the animals were sacrificed and evaluated for Apolipoprotein B expression in liver, lipid levels in serum and indicators of toxicity. RNA was isolated from liver tissue and Apolipoprotein B mRNA expression was measured by real-time PCR as described in U.S. application Ser. No. 10/712,795, which is herein incorporated by reference in its entirety. Serum lipids, including total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, were evaluated by routine clinical analysis, e.g., using an Olympus Clinical Analyzer (Olympus America Inc., Melville, N.Y.). Ratios of LDL-cholesterol to HDL-cholesterol and total cholesterol to HDL-cholesterol were also calculated. Analyses of serum alanine aminotransferase (ALT) and serum asparate aminotransferase (AST), inflammatory infiltrates in tissue and basophilic granules in tissue provided an assessment of toxicities related to the treatment. Hepatic steatosis, or accumulation of lipids in the liver, was assessed by routine histological analysis with oil red O stain and measurement of liver tissue triglycerides using a Triglyceride GPO Assay (Sigma-Aldrich, St. Louis, Mo.).
The results from the one month interval of the long term treatment are shown in Table 2 and were normalized to saline-treated animals for mRNA and to untreated baseline values for lipid levels. Total cholesterol, LDL-cholesterol, HDL-cholesterol, LDL particle concentration and triglyceride levels in serum were measured by nuclear magnetic resonance spectroscopy by Liposcience (Raleigh, N.C.). Additionally, the concentration of intact oligonucleotide in liver was measured by capillary gel electrophoresis and is presented as micrograms of oligonucleotide per gram of liver tissue. Each result represents the average of data from 4 animals (2 males and 2 females). Where present, “N.D.” indicates “not determined.”







TABLE 2







Effects of ISIS 301012 in lean Cynomolgus monkeys after 4 weeks of treatment










Intravenous delivery
Subcutaneous injection















2
4
12
3.5
20



Saline
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg

















apolipoprotein B expression

−45
−76
−96
N.D.
−94


(% change normalized to saline)


antisense oligonucleotide

92
179
550
N.D.
855


concentration in liver (μg/g)


Lipid Parameters


(% change normalized to untreated


baseline value)


Total cholesterol
+1
−6
−2
−2
+5
−5


LDL-cholesterol
+17
+15
+9
+3
−4
−16


HDL-cholesterol
−11
−23
−15
−8
+13
+5


LDL/HDL
+62
+94
+38
+44
−15
−19


Total cholesterol/HDL
+30
+44
+22
+21
−7
−10


Triglyceride
+37
+26
+32
+15
+1
−3


LDL Particle concentration
+15
+8
+8
−11
−14
−21









These data show that ISIS 301012 inhibited Apolipoprotein B expression in a dose-dependent manner in a primate species and concomitantly lowered lipid levels at higher doses of ISIS 301012. Furthermore, these results demonstrate that ISIS 301012 accumulated in the liver in a dose-dependent manner.
Following 13 weeks of treatment with a 2 mg/kg intravenous dose of ISIS 301012 or a 20 mg/kg subcutaneous dose of ISIS 301012, total cholesterol, LDL-cholesterol, HDL-cholesterol, LDL particle concentration and triglyceride levels in serum were measured by nuclear magnetic resonance spectroscopy by LipoScience, Inc. (Raleigh, N.C.). These data are shown in Table 3 and are normalized to untreated baseline values. Each result represents the average of data from 4 animals (2 males and 2 females).







TABLE 3







Effects of ISIS 301012 in lean Cynomolgus monkeys after 13 weeks


of treatment












Lipid parameters,






% change normalized to



untreated baseline value
Saline
2 mg/kg
20 mg/kg
















Total cholesterol
+11
+7
+11



LDL-cholesterol
+36
+4
−3



HDL-cholesterol
−8
+18
+5



LDL/HDL
+64
−6
−20



Total cholesterol/HDL
+30
+5
−11



Triglyceride
+36
+5
+10



LDL Particle concentration
+31
−3
−7










These data illustrate significantly decreased LDL-cholesterol and total cholesterol/HDL and LDL/HDL ratios following 13 weeks of treatment with ISIS 301012. Furthermore, HDL-cholesterol levels were significantly increased.
Hepatic steatosis, or accumulation of lipids in the liver, was not observed following 4 weeks of treatment with the doses indicated. Expected dose-related toxicities were observed at the higher doses of 12 and 20 mg/kg, including a transient 1.2-1.3 fold increase in activated partial thromboplastin time (APTT) during the first 4 hours and basophilic granules in the liver and kidney (as assessed by routine histological examination of tissue samples). No functional changes in kidney were observed.
In a similar experiment, male and female Cynomolgus monkeys received an intravenous dose of ISIS 301012 at 4 mg/kg, every two days for the first week and every 4 days thereafter. Groups of animals were sacrificed after the first dose and the fourth dose, as well as 11, 15 and 23 days following the fourth and final dose. Liver RNA was isolated and Apolipoprotein B mRNA levels were evaluated by real-time PCR as described in U.S. application Ser. No. 10/712,795, which is herein incorporated by reference in its entirety. The results of this experiment demonstrated a 40% reduction in Apolipoprotein B mRNA expression after a single intravenous dose of 4 mg/kg ISIS 301012. Furthermore, after 4 doses of ISIS 301012 at 4 mg/kg, Apolipoprotein B mRNA was reduced by approximately 85% and a 50% reduction in Apolipoprotein B mRNA was sustained for up to 16 days following the cessation of ISIS 301012 treatment.
Example 3
Evaluation of Mipomersen (ISIS 301012) in a Phase I Clinical Study
As described below, ISIS 301012 was tested in a double blind, placebo-controlled, Phase I, dose-escalation study for the purpose of evaluating the safety and tolerability of single and multiple doses of ISIS 301012 administered to humans intravenously and subcutaneously. In addition, these studies evaluated the pharmacokinetic profile of single and multiple doses of ISIS 301012 administered intravenously and subcutaneously; and also evaluated the pharmacodynamics of ISIS 301012 administered intravenously and subcutaneously.
For this Example, a solution of ISIS 301012 (250 mg/mL, 0.5 mL) in sterile, unpreserved, buffered saline contained in 2-mL stoppered glass vials was provided. The study drug was stored securely at 2° C. to 8° C. and protected from light. The placebo was 0.9% sterile saline.
Study Design
Subjects, 18 to 65 years of age with total cholesterol between 200 and 300 mg/dL after an overnight fast and a body mass index (BMI) of less than 30 kg/m2, were randomized into Cohorts to receive ISIS 301012 or placebo in a 3:1 ratio. The dosing cohorts were as follows: Cohort A, 50 mg ISIS 301012 or placebo; Cohort B, 100 mg ISIS 301012 or placebo; Cohort C, 200 mg ISIS 301012 or placebo; Cohort D, 400 mg ISIS 301012 or placebo.
The study consisted of a single dose component (SD) followed by a multiple dose component (MD). In the single dose component, each subject received one subcutaneous dose of study drug, which was followed by a 4 week observation period. Subjects who completed the single dose component and the observation period of the study were continued in the multiple dose component of the study. Additional subjects were recruited for the multiple dose component of the study only. The multiple dose period was following by a post-treatment evaluation period (PD).
During the multiple dose component, subjects from the single dose component of the study continued to receive the study drug (ISIS 301012 or placebo) to which they had previously been randomized. During the first week of the multiple dose treatment period, subjects received three intravenous doses at their respective cohort dose levels on alternate days followed by a single weekly subcutaneous dose for three weeks. This dosing regimen resulted in estimated tissue concentrations that were approximately 70 to 80% of steady state levels.
On Day SD1 (day 1 of single dose period), blood for a lipid panel (total cholesterol, LDL-cholesterol, HDL-cholesterol, VLDL-cholesterol, Apolipoprotein B, triglyceride, lipoprotein(a) and high-sensitivity CRP) was collected following an overnight fast (at least 12 hours). These measurements represent baseline measurements. Study drug was administered via a subcutaneous injection (s.c.) with the end of the injection designated as Time 0 (t=zero). Blood samples for pharmacokinetic (PK) analysis were collected at the following timepoints: 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 12 hrs after study drug administration. Urine samples for PK analysis were collected over a 24 hour period, beginning at Time 0 (t=zero) on Day SD1 and ending on Day SD2. On SD4, blood samples were collected for PK analysis and lipid panel analysis.
Individual cohort treatments for the single dose administration period are summarized in Table 4. The subjects in the placebo group receive the same injection volume as in the Cohort to which they were assigned.







TABLE 4







Single Dose Treatment Period











Total

All SQ injections at 250 mg/mL



Dose
# Subjects
SD1







Placebo
7
According to cohort



 50 mg
8
1 injection, 0.2 mL



100 mg
8
1 injection, 0.4 mL



200 mg
9
1 injection, 0.8 mL



400 mg
4
2 injections, 0.8 mL










During the multiple dose component, study drug was administered intravenously as a 2-hour infusion on Days MD1, MD3 and MD5 of Week 1 and as a subcutaneous injection(s) of no more than 200 mg per injection on Days MD8, MD15 and MD22. All subjects were required to fast for at least 12 hours before the blood sampling for the lipid panel on MD1, MD8, MD15, MD22, MD25, PD14, PD30, and, if applicable, on Days PD44, PD58, PD72, and PD86.
On Day MD1 (day 1 of multiple dose period), study drug was administered via a 2-hour intravenous (i.v.) infusion with the start of the infusion designated Time 0 (t=zero). Blood samples for pharmacokinetic (PK) analysis were collected 0.5, 1, 2, 2.25, 2.5, 3, 4, 6, and 8 hrs after start of study drug infusion. The 2 hour PK sampling was collected just prior to the end of study drug infusion. In addition, a 24-hour urine collection was performed beginning at Time 0 (t=zero) for PK analysis.
On Days MD3 and Day MD5, study drug was administered via intravenous infusion and blood samples for PK analysis were collected 5 minutes prior to the start of study drug infusion and 2 hours after the start of study drug infusion.
On Days MD2, MD4, MD6, blood samples for PK were collected 24 hours after the start of study drug infusion.
On Days MD8, MD15, study drug was administered via subcutaneous injection. Blood samples for PK analysis and urine samples for urinalysis were collected.
On Day MD22, study drug was administered via subcutaneous injection. Blood samples for PK analysis were collected prior to and 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 12 hours after study drug administration. A urine sample for urinalysis was collected over a 24 hour period, beginning at time of dosing on Day MD22 and ending on Day MD23.
On Day MD23, blood samples for PK were collected 24 hours after dosing of the study drug on Day MD22.
On Day MD25, 3 days after the final dose on Day MD22, blood samples were collected for PK analysis.
Shown in Table 5 is a summary of the dosing schedule for the multiple dose period. The 50 mg and 200 mg groups each had one less subject than during the single dose period. The subjects in the placebo group receive the same injection volume as in the Cohort to which they were assigned.







TABLE 5







Multiple Dose Treatment Period










Loading Week—All 2
Once a Week Dosing—SQ



hour I.V. infusions
Injections at 250 mg/mL














Dose
# Subjects
MD1
MD3
MD5
MD8
MD15
MD22















Placebo
7
N/A
N/A
N/A
According to cohort














 50 mg
7
 50
 50
 50
1 inj,
1 inj,
1 inj,




mg
mg
mg
0.2 mL
0.2 mL
0.2 mL


100 mg
8
100
100
100
1 inj,
1 inj,
1 inj,




mg
mg
mg
0.4 mL
0.4 mL
0.4 mL


200 mg
8
200
200
200
1 inj,
1 inj,
1 inj,




mg
mg
mg
0.8 mL
0.8 mL
0.8 mL


400 mg
2
400
400
400
2 inj,
2 inj,
2 inj,




mg
mg
mg
0.8 mL
0.8 mL
0.8 mL









During the post-treatment evaluation period, on Days PD14 (or PD39, 39 days since MD1), and PD30 (or PD55, 55 days since MD1) blood samples were collected for lipid panel and PK analysis. All subjects who had fasting total serum cholesterol levels less than or equal to 90% of their baseline values on PD30 continued in an extended follow-up period. Fasting lipid panel measurements were made every 2 weeks until PD86 (or PD111, 111 days past MD1) or until total serum cholesterol levels returned to greater than 90% of baseline. On Days PD44, PD58, PD72, and PD 86 (or PD69, PD83, PD97 and PD111, respectively), blood samples were collected for lipid panel and PK analysis.
Pharmacodynamic Analysis
The pharmacodynamic effects of ISIS 301012 were assessed by comparing parameter levels at the start of treatment to those following multiple doses of ISIS 301012; these data are shown in the following tables. Data are presented as mean percent change from baseline, where the baseline is either the respective parameter measurement made on the first day of the first dose of study drug administered, which was either the first day of the single dose treatment period (SD1) or the first day of the multiple dose treatment period (MD1).
The baseline value to which the data were normalized is indicated for each Table. The baseline values were set at 100%, and values above or below 100% indicate an increase or decrease, respectively, in the parameter measured. Data are presented for parameter measurements made during the multiple dose periods, for example, MD8 indicates a measurement made 8 days following administration of the first dose during the multiple dose periods. Also shown are data from parameter measurements made during the post-treatment evaluation period, for example, a measurement on day PD39 was made on the 14th day of the post-treatment evaluation period, which is equivalent to 39 days following the first administration of the first dose during the multiple dose period. Where present, “ND” indicates that the particular measurement is “not determined”. Analyses of other serum biomarkers revealed no clinical adverse event trends, including no changes in white blood cell count, platelet count or renal function. Furthermore, no toxicities were observed following administration of ISIS 301012.
Non-compartmental pharmacokinetic analysis of ISIS 301012 was carried out on each individual subject data set. Plasma concentrations of ISIS 301012 were measured by hybridization-based ELISA at PPD Development (Richmond, Va.). The maximum observed drug concentration (Cmax) and the time taken to reach Cmax (Tmax) were obtained directly from the concentration-time data. The plasma disposition half-life (t1/2λz) associated with the apparent terminal elimination phase was calculated from the equation, t1/2λz=0.693/λz, where λz is the terminal rate constant associated with the apparent terminal elimination phase. The terminal elimination rate constant is calculated using log-linear regression of the last 3 or more concentration time points. The apparent distribution half-life was calculated from a similar equation, using the apparent distribution rate constant in place of the terminal elimination rate constant. The apparent distribution rate constant is calculated using log-linear regression of distribution phase time points. Following single dosing, an area under the plasma concentration-time curve from zero time (pre-dose) to infinite time (AUC∞) was calculated using the linear trapezoidal rule and extrapolation to infinity by dividing the final measurable concentration (Clast) by λz. Following multiple dosing, the area under the plasma concentration-time curve during the time of each dosing interval (tau, τc) at steady-state (AUCτ) was calculated using the linear trapezoidal rule. Further, partial areas under the plasma concentration-time curve from zero time (pre-dose) to selected times (t) after the start of the intravenous infusion or subcutaneous administration (AUCτ) was calculated using the linear trapezoidal rule. Plasma clearance (CL) was calculated from CL=Actual Dose/AUCiv. Steady-state volume of distribution [Vss=(AUMCiv*Actual Dose)/(AUCiv)2; where AUMCiv is the area under the first moment curve following intravenous infusion] was also calculated. Mean absorption time following subcutaneous injection was calculated by subtracting the plasma AUMCsc (first moment curve for subcutaneous injection) from AUMCiv (first moment curve for intravenous infusion) estimated for each subject, and refers to the extent to which ISIS 301012 was distributed throughout the body at steady state concentrations. In addition, ratios of subcutaneous over intravenous plasma AUC were used to estimate subcutaneous plasma bioavailability (F) for each subject.
The amount of ISIS 301012 and total oligonucleotide excreted in the urine was determined from the following expression:

Aet=Curine×Vurine 

where Aet is the amount excreted up to some fixed time t (i.e., 24 hours), Curine is the urine concentration of the analyte, and Vurine is the total urine volume. The percentage of the administered dose excreted in urine (intact or as total oligonucleotide) was then calculated from the following expression:

% Dose Excreted=(Aet/Administered dose)×100%

Pharmacokinetic Summary

The plasma pharmacokinetic profile of ISIS 301012 was determined from blood sampling following the first 2-hr intravenous infusion (MD1), and is summarized in Table 6. Data are presented as mean±standard deviation for each dose group. Cmax=maximal plasma concentration; Tmax=time to reach Cmax; AUC0-48hr=area under the plasma concentration-time curve from time 0 to 48 hours after the start of dose administration; CL=plasma clearance; Vss=steady-state volume of distribution. Bioavailability following an intravenous administration is assumed to be 100%.







TABLE 6







ISIS 301012 Dosed Intravenously: Plasma Pharmacokinetics









Dose Group












50 mg
100 mg
200 mg
400 mg















Dose, mg/kg for 70 kg
0.7 ± 0.1
  1 ± 0.1
2.7 ± 0.5
5.9 ± 1.2


N
8
8
8
3


Cmax (ug/ml)
5 ± 1
9 ± 1
22 ± 4 
38 ± 5 


Tmax (hr)
  2 ± 0.1
  2 ± 0.1
  2 ± 0.2
  2 ± 0.2


AUC0-48 hr (ug * hr/mL)
11 ± 3 
24 ± 3 
68 ± 14
148 ± 14 


CL (L/hr)
5 ± 1
  4 ± 0.6
  3 ± 0.7
  3 ± 0.3


Vss (L)
6 ± 3
7 ± 1
7 ± 1
  8 ± 0.8


Apparent
0.7 ± 0.1
0.8 ± 0.1
  1 ± 0.2
1.7 ± 0.4


Distribution t1/2 (hr)









Dose-dependent maximum plasma concentrations (Cmax) following 2-hour intravenous infusions were seen at the end of infusion followed by a biphasic decline. An initial, relatively fast distribution phase (mean apparent distribution half-life ranged 0.7 to 1.7 hours) dominated the plasma clearance and was followed by a slower apparent elimination phase.
Plasma pharmacokinetics determined from blood sampling following the final subcutaneous injection (MD22) are summarized in Table 7. Data are presented as mean±standard deviation. Cmax=maximal plasma concentration; Tmax=time to reach Cmax; AUC0-48hr=area under the plasma concentration-time curve from time 0 to 48 hours after the start of dose administration; AUC0-∞ at ss=area under the plasma concentration-time curve from time 0 to infinity at steady-state; % BAV=plasma bioavailability (%) following subcutaneous administration.







TABLE 7







ISIS 301012 Dosed Subcutaneously: Plasma Pharmacokinetics









Dose Group












50 mg
100 mg
200 mg
400 mg















Dose, mg/kg for 70 kg
0.7 ± 0.1
1.3 ± 0.1
2.7 ± 0.5
5.9 ± 1.2


N
7
8
8
2


Cmax (μg/ml)
  1 ± 0.3
2 ± 1
3 ± 1
7


Tmax (hr)
4 ± 2
4 ± 2
3 ± 2
7


AUC0-48 hr (ug * hr/mL)
8 ± 2
18 ± 4 
35 ± 7 
109


AUC0-∞ at ss
19 ± 9 
28 ± 5 
63 ± 13
160


(ug * hr/mL)


Apparent
4 ± 1
5 ± 3
7 ± 3
8


Distribution t1/2 (hr)


Elimination t1/2 (hr)
23 ± 1 
27 ± 12
31 ± 11
47


% BAV
69 ± 9 
76 ± 18
54 ± 11
78









The mean time to maximum plasma concentrations (Tmax) following the final subcutaneous injection (MD22) of ISIS 301012 was approximately 4 hours following administration of the 50 and 100 mg doses, and approximately 3 hours following administration of the 200 mg dose. Plasma concentrations decreased more slowly from the maximum plasma concentration (Cmax) following subcutaneous injection, when compared to intravenous infusion, indicating continued absorption of ISIS 301012 after achievement of Cmax. Maximum plasma concentrations (Cmax) ranged from approximately 1 to 3 ug/mL (50 mg to 200 mg) and were dose-dependent over the studied subcutaneous dose range, but were much lower in comparison to equivalent intravenous infusion doses. Cmax, Tmax, plasma AUC following the first subcutaneous dose of ISIS 301012 were similar to those shown in Table 7, following the final subcutaneous dose. Plasma drug concentration was decreased by at least 10 fold by 24 hours. The terminal elimination phase observed in plasma provided a measure of tissue elimination rate, thus the elimination half-life represents the time at which approximately 50% of ISIS 301012 was cleared from tissues. Characterization of the terminal elimination phase yielded an elimination half-life of approximately 23 (±1) to 31 (±11) days (see Table 7). This result is consistent with the slow elimination of ISIS 301012 observed from monkey tissues, and thus appears to reflect an equilibrium of oligonucleotide between plasma and tissue. Absolute plasma bioavailability (BAV) of ISIS 301012 following subcutaneous administration ranged from 54% to 78%, in comparison to intravenous infusion, and was independent of dose. Plasma BAV may underestimate the ultimate complete absorption of ISIS 301012, as nonhuman primate studies have shown that the entire dose is ultimately distributed to tissues such that there is no difference between intravenous and subcutaneous administration with regard to end organ drug concentrations.
Mean urinary excretion of total oligonucleotide was less than 8% within the first 24 hours. Excretion of chain shortened metabolites was evident. Urine excretion data indicate that ISIS 301012 is primarily distributed to tissues. Ultimate elimination is a combination of nuclease metabolism and excretion in urine.
Exposure-Response Relationships
The correlation between ISIS 301012 plasma concentrations, serum Apolipoprotein B protein and LDL-cholesterol is shown in Table 8. Serum Apolipoprotein B, LDL-cholesterol and total cholesterol are presented as percentage of baseline. The numbers in parentheses following Apolipoprotein B percent baseline indicates the number of samples used to calculate the mean; all other means were calculated using the number of samples in the “N” column.







TABLE 8







Exposure-Response Relationship: ISIS 301012 Plasma Level,


Apolipoprotein B protein and LDL-cholesterol in 200 mg treatment group














ISIS

LDL-
Total




301012
Apolipoprotein B
Cholesterol
Cholesterol


Study Day
N
ng/mL
% Baseline
% Baseline
% Baseline















MD1
9
0.5
96
93
99


MD8
8
18
92
86
90


MD15
8
16
68
71
77


MD22
8
21
66
68
76


MD25
8
30
50
69
76


PD39
8
15
61
65
74


PD55
8
8.7
58
66
76


PD69
6
6.1
64
73
76


PD83
7
5.2
70
79
83


PD97
5
4.7
76 (7)
82
87


PD111
4
5.1
77 (6)
80
81









As shown in Table 8, total tissue exposure, represented by ISIS 301012 plasma concentrations (measured at least 72 hr after dosing during and following the multiple dose treatment period) was highly correlated with serum Apolipoprotein B protein levels and LDL-cholesterol levels, both of which responded in similar dose-response manners. Increases in plasma AUC were slightly greater than dose-proportional. Significant reduction in Apolipoprotein B protein (p<0.02) from baseline for the 200 mg treatment group was achieved from Day 15 (MD 15) to Day 97 (PD 72, or 75 days after last dose), consistent with the slow elimination of ISIS 301012 in plasma (terminal elimination t1/2 of approximately 31 days).
A comparison of serum reductions versus plasma trough AUC for 26 ISIS 301012-treated subjects at the end of the multiple dosing period (MD25) revealed a direct correlation between trough AUC and the observed reductions in serum Apolipoprotein B protein levels, LDL-cholesterol and total cholesterol (r≧0.67, p≦0.0002). Such a correlation is consistent with the fact that trough AUC is a representation of liver concentrations, as result of the equilibrium reached between drug concentration in plasma and in liver. A correlation was also observed between plasma trough concentrations and serum reductions, when plasma trough concentrations (Ctrough; mean trough concentration determined from plasma levels just prior to dosing on days MD15 and MD22) were compared to reductions in serum Apolipoprotein B, serum LDL-cholesterol, and serum total cholesterol. Ctrough and trough AUC correlate with reductions in lipid parameters, demonstrating that as exposure to ISIS 301012 increased, serum Apolipoprotein B, LDL-cholesterol and total cholesterol decreased.
The relationship between serum Apolipoprotein B protein levels and plasma trough concentrations of ISIS 301012 is described with a sigmoidal inhibitory effect Emax model using the data collected 3 days post dosing. The estimated plasma EC50 and predicted liver concentrations based on prior nonhuman primate studies were 18 (±2) ng/mL and 60 ug/g, respectively. Plasma trough concentration increases following multiple doses of ISIS 301012, reflecting accumulation of ISIS 301012 in the liver; were 2-fold following the loading dose of ISIS 301012, and 5-fold following the final dose of ISIS 301012. Monkey and human plasma pharmacokinetics for ISIS 301012 are essentially superimposable at mg/kg equivalent doses. Utilizing these known PK similarities, measurement of drug concentrations in the terminal elimination phase in human clinical studies can be used to assess accumulation in liver. Such estimates are shown in Table 9. ISIS 301012 liver concentrations are estimated based on monkey data. Monkey average plasma concentrations represent an average from 6 animals and were measured 48 to 72 hours after the last dose in a 13 week repeat dose toxicology study (e.g. the study described in Example 2, above). Human plasma trough concentration data was obtained 72 hours after the last intravenous loading dose; the number of study subjects is indicated in parentheses. Monkey liver concentrations represent an average of 4-6 animals and were measured in tissues collected 48 hours after the last dose in a 13 week repeat dose toxicology study.







TABLE 9





ISIS 301012: Monkey and Human Plasma Pharmacokinetics

















Dose/Route




Monkey
Plasma Ctrough (ng/mL)
Actual Liver Conc. (μg/g)





3.5 mg/kg/week/i.v.
28
100 ± 59 


  7 mg/kg/week/i.v.
107
293 ± 105


 21 mg/kg/week/i.v.
292
584 ± 129


 35 mg/kg/week/s.c.
570
1129 ± 242 














Estimated Liver Conc.


Human
Plasma Ctrough (ng/mL)
(μg/g)





 50 mg/week/i.v./s.c.
24 (n = 5)
10


100 mg/week/i.v./s.c.
 8 (n = 3)
28


200 mg/week/i.v./s.c.
18 (n = 6)
60


400 mg/week/i.v./s.c.
40 (n = 2)
150





Plasma trough AUC for the 50 mg, 100 mg, 200 mg and 400 mg dose groups was found to be 3, 5, 12 and 18 μg · hr/mL, respectively, on MD25 (three days following the final dose during the multiple dosing period).






Example 4
Antisense Inhibition of ApoB Reduces Plasma ApoC-III and Apo-CIII-Containing Lipoproteins
A randomized, double-blind, placebo controlled, parallel group clinical trial was performed to evaluate the effect of ISIS 301012 (Mipomersen) on hypercholesterolemic subjects.
Subjects were chosen to comply with the following eligibility criteria: age between 18-65 years; fasting levels of LDL-C≧130 mg/dl; fasting levels of TG<400 mg/dl; Body Mass Index (BMI) between 25-32.
ISIS 301012 or control placebo was administered to subjects as shown in Table 10.







TABLE 10







Summary of Cohorts










N (No. of



Cohort
Subjects)
ISIS 301012 Doses





A
8
200 mg × 4 load during 11 days, followed by




200 mg every other week × 11 weeks


B
8
200 mg × 4 load during 11 days, followed by




100 mg every other week × 11 weeks


C
8
200 mg every week × 13 weeks


D
8
300 mg every week × 13 weeks


Placebo
8
Placebo was administered to 2 subjects from each of




Cohorts A-D





Group A received a slow loading phase, during which 4 doses of 200 mg ISIS 301012 are administered over 11 days. This slow loading phase is followed by an 11 week maintenance phase, during which a 200 mg dose of ISIS 301012 is administered every other week.


Group B received a slow loading phase, during which 4 doses of 200 mg ISIS 301012 are administered over 11 days. This slow loading phase is followed by an 11 week maintenance phase, during which a 100 mg dose of ISIS 301012 is administered every other week.


Group C receives a maintenance phase only, during which a 200 mg dose of ISIS 301012 is administered once weekly for 13 weeks.


Group D receives a maintenance phase only, during which a 300 mg dose of ISIS 301012 is administered once weekly for 13 weeks.






After administration of ISIS 301012 to the subjects, plasma samples from the subjects in Cohorts A, C and D were tested (samples from Cohort B were not tested). ApoB, ApoC-III, ApoE, TG, and cholesterol levels were measured in plasma and plasma-derived lipoproteins from the subjects.
Pharmacokinetic Parameters
After administration of ISIS 301012 to the subjects, plasma levels and pharmacokinetic (PK) parameters of ISIS 301012 were determined in the subjects in Cohorts A, C and D as shown in Tables 11-15.
Pharmacokinetic parameters were obtained from plasma drug concentration-time profiles. Serial blood samples were collected prior to, during and following the last s.c. dose on Day 85 to determine PK parameters. Subjects also had blood drawn for the determination of ISIS 301012 concentrations at various time points during the 13-week treatment period. Two subjects stopped treatment early (Subject 104 in Cohort A and Subject 403 in Cohort D), and plasma concentration-time profiling samples on Day 85 were not collected for these two subjects.
Blood was collected in tubes containing EDTA as the anticoagulant for plasma drug concentration analysis. Plasma samples were stored frozen at −70° C. until plasma samples shipped to PPD (Richmond, Va.) via overnight freight on dry ice. Samples were stored frozen at −60 to −90° C. at the bioanalytical lab until analysis for oligonucleotide concentration using a validated hybridization ELISA. Analysis was performed based on the principles and requirements described in 21 CFR part 58 of United States Food and Drug Administration Good Laboratory Practice guidelines (PPD Project KMP; Isis Study No. 301012-CS3BA01, herein incorporated by reference).
Briefly, the hybridization ELISA/cutting procedure is a non-competitive immunoassay. In this assay, hybridization of the complementary sequence to ISIS 301012 containing biotin at the 5′ end and digoxigenin at the 3′ end (i.e., the detection probe) to ISIS 301012 in plasma occurs, with the hybridized complex subsequently immobilized onto a neutravidin coated plate. This detection probe contained five LNA nucleotides on the 5′-end of the sequence to improve hybridization with ISIS 301012. S1 nuclease is then added to the plate and incubated at 37° C. for 1 hour to cleave any remaining unhybridized detection probe. The measurement of hybridized complex (which is digoxigenin-labeled) attached to the plate is then performed following the addition of anti-digoxigenin conjugated to alkaline phosphatase, which catalyzes the formation of fluorescent AttoPhos®. The reaction is stopped by adding EDTA sodium (20%) and the fluorescence intensity is measured using a fluorescent plate reader.
The calibration range of the assay was 0.228 to 30.4 ng/mL for ISIS 301012 in plasma, with the low end of this range defining the lower limit of quantitation (LLOQ). The precision at the lower limit of quantification was within 25%, and the accuracy at lower limit of quantification was within 25% of the nominal concentration. The precision at the low, mid, high, and upper limit of quantification levels was within 20%, and the accuracy at low, mid, high, and upper limit of quantification levels was within 20% of the nominal concentration. Samples with concentrations previously observed or expected to be above the upper level of quantitation (ULOQ) were diluted within the range using a suitable volume of blank human plasma prior to analysis. All study samples were analyzed within the established stability timeframe, which was established by analyzing stability samples stored under the same conditions as study samples of approximately 365 days at −80° C.
Plasma pharmacokinetics for ISIS 301012 were analyzed using non-compartment methods with WinNonLin Professional Version 5.2 software (Pharsight Corp., Mountain View, Calif.). Cmax was the maximum concentration observed in plasma. Tmax was the time at which Cmax occurred. Area under the plasma concentration-time curve (AUC) was calculated using the linear trapezoidal rule from 0 to 48 hours and from 0 to 168 hours (weekly dosing interval, t) following dose administration (partial area, AUC0-48hr and AUC0-τ). When calculating partial areas, linear interpolation was done to estimate the corresponding concentration if the ending times did not coincide with an observed data point. Plasma elimination half-life for ISIS 301012 was calculated from the equation, t1/2λz=0.693/λz, where λz is the rate constant associated with the terminal elimination phase. A minimum of three data points were used to define λz and the correlation of determination values (rsq) had to be at or greater than 0.8 for the estimate to be accepted.
Trough plasma concentrations (Ctrough) at 168 hr from previous dose were determined throughout the 13-week treatment period.
BLQ values (below the limit of quantitation) (a total of 2 observations) were treated as “missing” in the pharmacokinetic analyses.
Ideal body weight (IBW) was calculated based on the following equations:

Males: IBW(kg)=1.1×(HT−152)+48

Females: IBW(kg)=0.9×(HT−152)+45

Where, HT is subject height in centimeters.

Body mass index (BMI) was calculated based on the following equation:

BMI(kg/m2)=10000×(WT/HT2)

Where, HT is subject height in centimeters, WT is subject weight in kilograms.

Plasma concentrations and pharmacokinetic parameters were summarized using descriptive statistics (WinNonlin Professional, Version 5.2). Nominal time was used when summarizing plasma concentration-time profiles by descriptive statistics. BLQ values (below the limit of quantitation) (a total of 2 observations) were treated as “missing” in the calculation of descriptive statistics.







TABLE 11







Summary of ISIS 301012 Concentrations (μg/mL) in Plasma


during and following Weekly Doses of 100 mg Administered


Subcutaneously in Hypercholesterolemic Subjects












Co-
Weekly
Study
Time

ISIS 301012 Conc. (μg/mL)













hort
Dose
Day
Point (hr)
N
(Mean ± SD)
(SE)
















A
100 mg*
4
72
7
0.00353 ± 0.00120
0.00045




8
96
7
0.00659 ± 0.00182
0.00069




14
72
7
0.0122 ± 0.0049
0.0018




15
96
7
0.0112 ± 0.0041
0.0015




22
168
7
0.0106 ± 0.0027
0.0010




36
168
7
0.0107 ± 0.0036
0.0014




50
168
7
0.0102 ± 0.0046
0.0017




64
168
7
0.0105 ± 0.0036
0.0014




78
168
7
0.0108 ± 0.0036
0.0013




85
0
7
0.00795 ± 0.00296
0.00112




85
0.5
7
0.823 ± 0.388
0.147




85
1
7
1.41 ± 0.45
0.17




85
1.5
7
1.55 ± 0.44
0.17




85
2
7
1.81 ± 0.54
0.20




85
3
7
2.22 ± 0.55
0.21




85
4
7
2.16 ± 0.43
0.16




85
6
7
1.55 ± 0.29
0.11




85
8
7
1.28 ± 0.31
0.12




85
12
7
0.919 ± 0.244
0.092




86
24
7
0.0731 ± 0.0445
0.0168




87
48
7
0.0147 ± 0.0033
0.0012




88
72
7
0.0132 ± 0.0023
0.0009




92
168
7
0.0116 ± 0.0041
0.0015




99
336
7
0.0127 ± 0.0080
0.0030




115
720
7
0.0107 ± 0.0071
0.0027




145
1440
7
0.00910 ± 0.01034
0.00391




175
2160
7
0.00803 ± 0.01048
0.00396




205
2880
7
0.00489 ± 0.00689
0.00261




235
3600
7
0.00314 ± 0.00338
0.00128




265
4320
6
0.00264 ± 0.00262
0.00107





*200 mg administered every other week.













TABLE 12







Summary of ISIS 301012 Concentrations (μg/mL) in Plasma


during and following Weekly Doses of 200 mg Administered


Subcutaneously in Hypercholesterolemic Subjects












Co-
Weekly
Study
Time

ISIS 301012 Conc. (μg/mL)













hort
Dose
Day
Point (hr)
N
(Mean ± SD)
(SE)
















C
200 mg
8
168
8
0.00330 ± 0.00105
0.00037




15
168
8
0.00573 ± 0.00205
0.00072




22
168
8
0.00815 ± 0.00287
0.00101




36
168
8
0.0125 ± 0.0060
0.0021




50
168
8
0.0178 ± 0.0086
0.0030




64
168
8
0.0240 ± 0.0138
0.0049




78
168
8
0.0325 ± 0.0223
0.0079




85
0
8
0.0365 ± 0.0257
0.0091




85
0.5
8
0.806 ± 0.316
0.112




85
1
8
1.56 ± 0.44
0.15




85
1.5
8
1.87 ± 0.55
0.19




85
2
8
2.32 ± 0.77
0.27




85
3
8
2.64 ± 0.95
0.33




85
4
8
2.68 ± 0.96
0.34




85
6
8
2.09 ± 0.67
0.24




85
8
8
1.90 ± 0.56
0.20




85
12
8
1.07 ± 0.13
0.05




86
24
8
0.138 ± 0.063
0.022




87
48
8
0.0498 ± 0.0333
0.0118




88
72
8
0.0474 ± 0.0358
0.0127




92
168
8
0.0468 ± 0.0374
0.0132




99
336
7
0.0284 ± 0.0210
0.0079




115
720
8
0.0407 ± 0.0386
0.0136




145
1440
8
0.0244 ± 0.0255
0.0090




175
2160
8
0.0222 ± 0.0258
0.0091




205
2880
8
0.0121 ± 0.0106
0.0038




235
3600
8
0.00699 ± 0.00522
0.00184




265
4320
8
0.00395 ± 0.00276
0.00098
















TABLE 13







Summary of ISIS 301012 Concentrations (μg/mL) in Plasma


during and following Weekly Doses of 300 mg Administered


Subcutaneously in Hypercholesterolemic Subjects












Co-
Weekly
Study
Time

ISIS 301012 Conc. (μg/mL)













hort
Dose
Day
Point (hr)
N
(Mean ± SD)
(SE)
















D
300 mg
8
168
7
0.00475 ± 0.00099
0.00037




15
168
7
0.00711 ± 0.00176
0.00067




22
168
7
0.0112 ± 0.0026
0.0010




36
168
7
0.0154 ± 0.0029
0.0011




50
168
7
0.0208 ± 0.0028
0.0011




64
168
7
0.0233 ± 0.0079
0.0030




78
168
7
0.0260 ± 0.0078
0.0029




85
0
7
0.0261 ± 0.0048
0.0018




85
0.5
7
1.44 ± 0.44
0.17




85
1
7
2.82 ± 1.64
0.62




85
1.5
7
3.16 ± 1.95
0.74




85
2
7
3.31 ± 1.51
0.57




85
3
7
4.21 ± 2.51
0.95




85
4
7
3.96 ± 1.99
0.75




85
6
7
3.03 ± 1.25
0.47




85
8
7
2.93 ± 0.94
0.35




85
12
7
1.97 ± 0.45
0.17




86
24
7
0.193 ± 0.126
0.048




87
48
7
0.0449 ± 0.0171
0.0065




88
72
7
0.0348 ± 0.0094
0.0036




92
168
7
0.0338 ± 0.0077
0.0029




99
336
7
0.0230 ± 0.0077
0.0029




115
720
7
0.0176 ± 0.0087
0.0033




145
1440
6
0.0112 ± 0.0060
0.0025




175
2160
6
0.00873 ± 0.00522
0.00213




205
2880
6
0.00647 ± 0.00359
0.00146




235
3600
6
0.00296 ± 0.00168
0.00069




265
4320
7
0.00367 ± 0.00418
0.00158





N Number of observations


SD Standard deviation of the mean


SE Standard error of the mean


Note:


Subject 104 (Cohort A) and 403 (Cohort D) were not included in the descriptive summary due to their early termination.













TABLE 14







Descriptive Statistical Summary of Pharmacokinetic Parameter Estimates for ISIS


301012 in Hypercholesterolemic Subjects following the last Subcutaneous Injection
















Dose

Weekly Dose
Cmax
Tmax
AUC0-48 hr
AUC0-τ
t1/2λz


Cohort
(mg/dose)
N
(mg/week)
(μg/ml)
(hr)
(μg*hr/mL)
(μg*hr/mL)
(day)


















A
200
7
100
2.27 ± 0.50
3.43 ± 0.54
24.6 ± 2.2
26.1 ± 2.3 
45.7 ± 10.9







3 (3 to 4)


C
200
8
200
2.81 ± 0.95
3.50 ± 0.53
32.1 ± 6.5
37.7 ± 10.2
46.2 ± 11.2







4 (3 to 4)


D
300
7
300
4.32 ± 2.46
4.00 ± 1.82
 51.0 ± 15.1
55.2 ± 15.0
47.0 ± 11.7







3 (3 to 8)





Data are presented as Mean ± Standard Deviation (median (range) is also included for Tmax)).


N Number of subjects


Cmax Maximum plasma concentration


Tmax Time Cmax observed


AUC0-48 hr Partial area under the plasma concentration-time curve from time 0 to 48 hours after dose administration


AUC0-τ Partial area under the plasma concentration-time curve from time 0 to 168 hours (weekly dosing interval) after dose administration


AUC0-∞ Area under the plasma concentration-time curve from time 0 to infinity


ND Not determined due to PK profiling samples were not collected.


Note:


The PK parameters for Subject 104 (Cohort A) and 403 (Cohort D) were not included in the descriptive summary due to their early termination.













TABLE 15







Descriptive Statistical Summary of Plasma Trough Concentrations


(ng/mL) During Treatment









Ctrough at 168 hr



from Previous Dose



(ng/mL)












Cohort
Weekly Dose
Study Day
N
Mean ± SD
SE















A
100 mg
22
7
10.6 ± 2.7
1.0




36
7
10.7 ± 3.6
1.4




50
7
10.2 ± 4.6
1.7




64
7
10.5 ± 3.6
1.4




78
7
10.8 ± 3.6
1.3




92
7
11.6 ± 4.1
1.5


C
200 mg
8
8
 3.30 ± 1.05
0.37




15
8
 5.73 ± 2.05
0.72




22
8
 8.15 ± 2.87
1.01




36
8
12.5 ± 6.0
2.1




50
8
17.8 ± 8.6
3.0




64
8
 24.0 ± 13.8
4.9




78
8
 32.5 ± 22.3
7.9




85
8
 36.5 ± 25.7
9.1




92
8
 46.8 ± 37.4
13.2


D
300 mg
8
7
 4.75 ± 0.99
0.37




15
7
 7.11 ± 1.76
0.67




22
7
11.2 ± 2.6
1.0




36
7
15.4 ± 2.9
1.1




50
7
20.8 ± 2.8
1.1




64
7
23.3 ± 7.9
3.0




78
7
26.0 ± 7.8
2.9




85
7
26.1 ± 4.8
1.8




92
7
33.8 ± 7.7
2.9





N Number of subjects


SD Standard deviation of the mean


SE Standard error of the mean


Note:


Subject 104 (Cohort A) and 403 (Cohort D) were not included in the descriptive summary due to their early termination.






ApoC-III Analysis

ApoC-III-containing lipoproteins were separated from plasma by immunoaffinity chromatography (IAC) followed by ultracentrifugation. Immunoaffinity chromatography separation was performed as described by Campos et al. (Distinct patterns of lipoproteins with ApoB defined by presence of ApoE or ApoC-III in hypercholesterolemia and hypertriglyceridemia. J. Lipid Res., 2001, 42:1239-1249, herein incorporated by reference). Blood was drawn from the subjects after a 12-h fast and immediately centrifuged at 4° C. to isolate plasma. A mixture containing 2 μM benzamidine, aprotinin (0.01 mg/ml), PMSF (17.5 μg/ml), and gentamicin (0.05 mg/ml) was added to the plasma and the samples were immediately sealed under N2 and frozen at 80° C. until they were analyzed.
Separation of lipoproteins by ApoE and ApoC-III content was carried out with affinity-purified polyclonal antibodies anti-ApoE (kindly provided by Genzyme, Cambridge, Mass.) and anti-ApoC-III (DMA, Arlington, Tex.), coupled to cyanogen bromide-activated Sephacryl S-1000 resins as previously described by Khoo et al. (Effects of estrogenic oral contraceptives on the lipoprotein B particle system defined by apolipoproteins E and C-III content. J. Lipid Res. 1999 40:202-212, herein incorporated by reference). For each subject 3 ml of plasma was first incubated with 1 ml of anti-ApoE resin for 1 h at room temperature with constant mixing. All incubations and rinses were carried out with disposable Econopac columns (Bio-Rad, Hercules, Calif.). The unbound fractions (E) were collected by gravity flow from the Econopac columns and the resin was washed with PBS. The bound fraction (E+) was eluted by incubation with 3 M NaSCN, passed through a gel-filtration column using PBS, and then immediately dialyzed against PBS in microconcentrators (Amicon, Beverly, Mass.). The E− fractions and the dialyzed E+ fractions were further incubated with 1.0 ml of anti-ApoC-III resin for 4 h at 4° C. The same elution protocol used for the anti-ApoE resin was carried out to yield four immunofractions, two with ApoE (E+C-III+, E+C-III−) and two without ApoE (E−C-III+, and E−C-III−).
Each of the four immunofractions was then separated into four density fractions by using a modification of the Lindgren, Jensen, and Hatch method (Lindgren, F. T., L. C. Jensen, and F. T. Hatch. 1972. The isolation and quantitative analysis of serum lipoproteins. In Blood Lipids and Lipoproteins: Quantitation, Composition, and Metabolism, G. J. Nelson, editor. John Wiley-Interscience, New York. 181-274, herein incorporated by reference). The IAC separation procedure was carried out before ultracentrifugation, so that any loss of ApoC-III and ApoE during ultracentrifugation could not affect the separation of particle types by IAC. To separate VLDL subfractions with Svedberg units of flotation (Sf°) 60-400 (light VLDL) and Sf° 20-60 (dense VLDL), samples were spun in the outer row of a Beckman (Palo Alto, Calif.) type 25 rotor at 25,000 rpm in an L8-70M instrument (Beckman) for 1 h at 10° C. to collect light VLDL and for 6 h to collect dense VLDL. To separate IDL (d=1.006-1.025 g/ml) and LDL (d=1.025-1.050 g/ml), the density was raised with KBr, and centrifugation was carried out at 25,000 rpm for 24 h each at 10° C. For each subject, a sample was ultracentrifuged after IAC to separate light and dense VLDL, IDL, and LDL. Cholesterol, triglyceride, and ApoB were also measured in samples ultracentrifuged after IAC.
Results
Three dose cohorts, Cohort A, Cohort C, and Cohort D, were analyzed (n=8 each). The doses of ISIS 301012 administered to the subjects in Cohorts C and D, but not Cohort A, reduced plasma total ApoC-III from 14 mg/dL to 6.5 mg/dL (−54%) and 5.3 mg/dL (−62%), respectively (both p<0.01 vs placebo). These doses decreased ApoC-III significantly in VLDL (p<0.01) and trended toward promoting reductions in HDL ApoC-III. All ApoB lipoprotein types studied were reduced relative to placebo. The dose administered to Cohort C produced statistically significant reductions in VLDL and LDL without ApoC-III (p<0.05) and dose administered to Cohort D reduced LDL both with and without ApoC-III. ApoE was decreased slightly in whole plasma (12-14%) both Cohorts C and D, with decreases mainly in HDL, while the ApoE to ApoB ratio in VLDL and LDL (p<0.03) were increased. The doses of ISIS 301012 administered to subject in Cohorts C and D also reduced plasma TG by about 60% (p<0.04) and LDL-C by 66-87% (p<0.01).
Surprisingly, antisense inhibition of ApoB is shown to reduce plasma concentrations of ApoC-III and ApoC-III-containing lipoproteins in a dose-dependent manner. Without being bound to a particular theory, it is hypothesized that either reduced ApoB in hepatocytes limits the amount of VLDL to which ApoC-III can attach before secretion into the circulation or that ApoB inhibition directly reduces ApoC-III synthesis.
The new finding that antisense reduction of ApoB decreases ApoC-III concentration in total plasma, VLDL and suggestively in HDL is relevant to treatment because ApoC-III in VLDL has been associated with coronary heart disease (CHD). Additionally, studies have found that ApoC-III in HDL (or the cholesterol concentration of HDL that has apoC-III) is associated with risk of CHD. Also, ApoC-III has a direct pro-atherogenic, pro-inflammatory effect on monocytes and vascular endothelial cells. ApoC-III in HDL does not have a protective action against monocyte adhesion to vascular endothelial cells. Thus, the findings in the present study suggest an anti-atherogenic action of mipomersen, mediated through reduction in ApoC-III in ApoB lipoproteins and in HDL. Also, the ApoB concentration in LDL containing ApoC-III strongly predicts recurrent cardiovascular disease in type 2 diabetics. As shown in the example below, antisense reduction of ApoC-III results in reduced fat and plasma glucose along with a reduction in lipids.
In conclusion, lowering ApoC-III by antisense inhibition of ApoB renders such ApoB targeting compounds useful for diabetic and/or obese subjects or subjects suffering from diabetic dyslipidemia, mixed dyslipidemia or steatosis.
Example 5
Effects of Apolipoprotein C-III Antisense Inhibition
As provided in U.S. application Ser. No. 10/553,722, modified oligonucleotides were designed to target different regions of the mouse Apolipoprotein C-III RNA, using published sequences (GenBank accession number L04150.1, incorporated herein as SEQ ID NO: 11). Examples of modified oligonucleotides are shown in Table 16. “Target site” indicates the first (5′-most) nucleotide number on the particular target nucleic acid to which the compound binds. All compounds in the table are chimeric oligonucleotides (“gapmers”) 20 nucleotides in length, composed of a central “gap” region consisting of ten 2′-deoxynucleotides, which is flanked on both sides (5′ and 3′ directions) by five-nucleotide “wings”. The wings are composed of 2′-methoxyethyl (2′-MOE) nucleotides. The internucleoside (backbone) linkages are phosphorothioate (P═S) throughout the oligonucleotide. All cytidine residues are 5-methylcytidines.







TABLE 16







Chimeric phosphorothioate oligonucleotides


having 2′-MOE wings and a deoxy gap











ISIS 

TARGET

SEQ ID


#
REGION
SITE
SEQUENCE
NO





167875
stop codon
334
TCACGACTCAATAGCTGGAG
12


 


167878
3′UTR
441
AGACATGAGAACATACTTTC
13


 


167879
3′UTR
471
CATGTTTAGGTGAGATCTAG
14


 


167880
3′UTR
496
TCTTATCCAGCTTTATTAGG
15









The effects of oligonucleotides targeting Apolipoprotein C-III were tested in vivo. Antisense oligonucleotides were administered to mice to determine the effect of antisence inhibition on various parameters.
Effects of Antisense Inhibition of Apolipoprotein C-III (ISIS 167880) on Serum Cholesterol and Triglyceride Levels
C57BL/6 mice, a strain reported to be susceptible to hyperlipidemia-induced atherosclerotic plaque formation were used in the following studies to evaluate Apolipoprotein C-III antisense oligonucleotides as potential agents to lower cholesterol and triglyceride levels.
Male C57BL/6 mice (n=8) receiving a high fat diet (60% kcal fat) were evaluated over the course of 6 weeks for the effects of ISIS 167880 on serum cholesterol and triglyceride levels. Control animals received saline treatment. Mice were dosed intraperitoneally every three days (twice a week), after fasting overnight, with 50 mg/kg ISIS 167880 or saline for six weeks.
Male C57BL/6 mice fed a normal rodent diet were fasted overnight then dosed intraperitoneally every three days with saline (control), 50 mg/kg ISIS 167880 or 50 mg/kg ISIS 167879 for two weeks.
At study termination, forty eight hours after the final injections, the animals were sacrificed and evaluated for serum cholesterol and triglyceride levels and compared to the saline control. Measurements of serum cholesterol and triglyceride levels were obtained through routine clinical analysis.
High fat fed mice treated with ISIS 167880 showed a reduction in both serum cholesterol (196 mg/dL for control animals and 137 mg/dL for ISIS 167880) and triglycerides (151 mg/dL for control animals and 58 mg/dL for ISIS 167880) by study end.
No effect was seen on serum cholesterol levels for lean mice treated with ISIS 167880 (91 mg/dL for control animals and 91 mg/dL for ISIS 167880), however triglycerides were lowered (91 mg/dL for control animals and 59 mg/dL for ISIS 167880) by study end.
Lean mice treated with ISIS 167879 showed an increase in serum cholesterol (91 mg/dL for control animals and 116 mg/dL for ISIS 167879) but a reduction in triglycerides (91 mg/dL for control animals and 65 mg/dL for ISIS 167879) by study end.
These results indicate that, in mice fed a high fat diet, ISIS 167880 reduces cholesterol and triglyceride to levels that are comparable to lean littermates while having no deleterious effects on the lean animals (see Table 17 for summary of in vivo data).
Effects of Antisense Inhibition of Apolipoprotein C-III (ISIS 167880) on Serum AST and ALT Levels
C57BL/6 mice were used in the following studies to evaluate the liver toxicity of Apolipoprotein C-III antisense oligonucleotides.
Male C57BL/6 mice (n=8) receiving a high fat diet (60% kcal fat) were evaluated over the course of 6 weeks for the effects of ISIS 167880 on liver enzyme (AST and ALT) levels. Control animals received saline treatment. Mice were dosed intraperitoneally every three days (twice a week), after fasting overnight, with 50 mg/kg ISIS 167880 or saline for six weeks.
Male C57BL/6 mice fed a normal rodent diet were fasted overnight then dosed intraperitoneally every three days with saline (control), 50 mg/kg ISIS 167880 or 50 mg/kg ISIS 167879 for two weeks.
At study termination and forty-eight hours after the final injections, animals were sacrificed and evaluated for serum AST and ALT levels, which were measured by routine clinical methods. Increased levels of the liver enzymes ALT and AST can indicate toxicity and liver damage.
High fat fed mice treated with ISIS 167880 showed an increase in AST levels over the duration of the study compared to saline controls (157 IU/L for ISIS 167880, compared to 92 IU/L for saline control).
ALT levels in high fat fed mice were increased by treatments with ISIS 167880 over the duration of the study compared to saline controls (64 IU/L for ISIS 167880, compared to 40 IU/L for saline control).
Lean mice treated with ISIS 167880 showed no significant increase in AST and ALT levels over the duration of the study compared to saline controls (AST levels of 51 IU/L for control compared to 58 IU/L for ISIS 167880; ALT levels of 26 IU/L for control compared to 27 IU/L for ISIS 167880).
Lean mice treated with ISIS 167879 showed no change in AST levels and a decrease in ALT levels over the duration of the study compared to saline controls (AST levels of 51 IU/L for control compared to 51 IU/L for ISIS 167879; ALT levels of 26 IU/L for control compared to 21 IU/L for ISIS 167879).
These results suggest a minor liver toxicity effect from ISIS 167880 in mice fed a high fat diet but no liver toxicity from ISIS 167880 or 167879 in mice fed a normal rodent diet (see Table 17 for summary of in vivo data).
Effects of Antisense Inhibition of Apolipoprotein C-III (ISIS 167880) on Serum Glucose Levels
Male C57BL/6 mice (n=8) receiving a high fat diet (60% kcal fat) were evaluated over the course of 6 weeks for the effects of ISIS 167880 on serum glucose levels. Control animals received saline treatment. Mice were dosed intraperitoneally every three days (twice a week), after fasting overnight, with 50 mg/kg ISIS 167880 or saline for six weeks.
Male C57BL/6 mice fed a normal rodent diet were fasted overnight then dosed intraperitoneally every three days with saline (control), 50 mg/kg ISIS 167880 or 50 mg/kg ISIS 167879 for two weeks.
At study termination and forty-eight hours after the final injections, animals were sacrificed and evaluated for serum glucose levels, which was measured by routine clinical methods.
In the high fat fed mice, ISIS 167880 reduced serum glucose levels to 183 mg/dL, compared to the saline control of 213 mg/dL. In lean mice, ISIS 167880 had no significant effect on serum glucose levels with measurements of 203 mg/dL, compared to the saline control of 204 mg/dL; while ISIS 167879 only slightly increased serum glucose levels to 216 mg/dL.
These results indicate that, in mice fed a high fat diet, ISIS 167880 is able to reduce serum glucose to levels comparable to lean littermates, while having no deleterious effects on the lean animals (see Table 17 for summary of in vivo data).
Effects of Antisense Inhibition of Apolipoprotein C-III (ISIS 167880) on Apolipoprotein C-III mRNA Levels in C57BL/6 Mice
Male C57BL/6 mice received a high fat diet (60% kcal fat) fasted overnight, and dosed intraperitoneally every three days with saline or 50 mg/kg ISIS 167880 for six weeks.
Male C57BL/6 mice fed a normal rodent diet were fasted overnight then dosed intraperitoneally every three days with saline (control) or 50 mg/kg ISIS 167880 or 50 mg/kg ISIS 167879 for two weeks.
At study termination, forty-eight hours after the final injections, animals were sacrificed and evaluated for Apolipoprotein C-III mRNA levels in liver. The high fat fed mice dosed with ISIS 167880 had Apolipoprotein C-III mRNA levels 8% that of the saline treated mice. The lean mice showed decreased Apolipoprotein C-III mRNA after treatment with either ISIS 167880 or ISIS 167879. The lean mice dosed with ISIS 167880 had Apolipoprotein C-III mRNA levels 21% that of the saline treated mice and those dosed with ISIS 167879 had Apolipoprotein C-III mRNA levels 27% that of the saline treated mice.
These results indicate that in both high fat fed mice and lean mice, antisense oligonucleotides directed against Apolipoprotein C-III are able to decrease Apolipoprotein C-III mRNA levels in vivo to a similar extent (see Table 17 for summary of in vivo data).







TABLE 17







Effects of ISIS 167880 or 167879 Treatment on Cholesterol, Triglyceride,


Glucose, Liver Enzyme, and Apolipoprotein C-III mRNA in Liver,


in Lean and High Fat Fed C57BL/6 Mice.









Diet, Experiment



duration












Biological Marker

High Fat,
Lean,



Measured units
ISIS #
6 week
2 week
















Cholesterol
control
196
91



mg/dL
167880
137
91




167879
N.D.
116



Triglycerides
control
151
91



mg/dL
167880
 58
59




167879
N.D.
65



Glucose
control
213
204



mg/dL
167880
183
203




167879
N.D.
216


Liver
AST
control
 92
51


Enzymes
IU/L
167880
157
58




167879
N.D.
51



ALT
control
 40
26



IU/L
167880
 64
27




167879
N.D.
21



Apolipoprotein C-III mRNA
167880
8%
21%



% of control
167879
N.D.
27%









In summary, these results indicate that, in mice fed a high fat diet, ISIS 167880 is able to reduce serum glucose, cholesterol and triglyceride to levels comparable to lean littermates, while having no deleterious effects on the lean animals. Furthermore, antisense oligonucleotides directed against Apolipoprotein C-III are able to decrease Apolipoprotein C-III mRNA levels in vivo to a similar extent in both high fat fed mice and lean mice. These results suggest a minor liver toxicity effect from ISIS 167880 in mice fed a high fat diet but no liver toxicity from ISIS 167880 or 167879 in mice fed a normal rodent diet.
Effects of Antisense Inhibition of Apolipoprotein C-III mRNA In Vivo
C57BL/6 mice, a strain reported to be susceptible to hyperlipidemia-induced atherosclerotic plaque formation, were used in the following studies to evaluate Apolipoprotein C-III antisense oligonucleotides as potential agents to lower cholesterol and triglyceride levels. Accordingly, in a further embodiment, C57BL/6 mice on a high-fat diet were treated with antisense oligonucleotides targeted to Apolipoprotein C-III.
Male C57BL/6 mice (n=8; 7 to 8 weeks of age) receiving a high fat diet (60% kcal fat) were evaluated for Apolipoprotein C-III mRNA expression in liver after 6 weeks of treatment with antisense oligonucleotides targeted to Apolipoprotein C-III. Mice received twice weekly intraperitoneal injections at a dose of 25 mg/kg of ISIS 167880, ISIS 167875, ISIS 167878 or ISIS 167879. Control animals received saline treatment twice weekly for a period of 6 weeks.
At study termination, forty-eight hours after the final injections, the animals were sacrificed and evaluated for Apolipoprotein C-III mRNA expression in liver. RNA was isolated from liver and mRNA was quantitated as described herein. Apolipoprotein C-III mRNA levels from each treatment group (n=8) were averaged. Relative to saline-treated animals, treatment with ISIS 167875, ISIS 167878, ISIS 167879 and ISIS 167880 resulted in a 24%, 56%, 50% and 77% reduction in Apolipoprotein C-III mRNA levels, respectively, demonstrating that these compounds significantly reduced Apolipoprotein C-III mRNA expression in liver.
Effects of Antisense Inhibition of Apolipoprotein C-III on Serum Cholesterol, Triglyceride, Glucose and Serum Transaminases
In a further embodiment, the mice treated with saline or a 25 mg/kg dose of ISIS 167880 ISIS 167875, ISIS 167878 or ISIS 167879 as described above were evaluated for serum cholesterol and triglyceride levels following 6 weeks of treatment.
At study termination, forty-eight hours after the dose of saline or antisense compound, the animals were sacrificed and evaluated for serum cholesterol, triglyceride and glucose levels by routine analysis using an Olympus Clinical Analyzer (Olympus America Inc., Melville, N.Y.). The serum transaminases ALT and AST, increases in which can indicate hepatotoxicity, were also measured using an Olympus Clinical Analyzer (Olympus America Inc., Melville, N.Y.). The levels of serum cholesterol, triglycerides and glucose are presented in Table 18 as the average result from each treatment group (n=8), in mg/dL. ALT and AST, also shown in the table, are also shown as the average result from each treatment group (n=8), in international units/L (IU/L).







TABLE 18







Effects of antisense inhibition of apolipoprotein C-III on serum


cholesterol, triglyceride, glucose and transaminases









Treatment














ISIS
ISIS
ISIS
ISIS


Serum marker
Saline
167875
167878
167879
167880















Total Cholesterol
172
197
180
132
155


mg/dL


HDL Cholesterol
149
162
157
117
137


mg/dL


LDL Cholesterol
25
37
28
24
21


mg/dL


Serum Triglyerides
126
99
75
60
52


mg/dL


ALT
24
555
32
45
66


IU/L


AST
56
489
76
117
132


IU/L


Glucose
273
234
251
189
255


mg/dL









A significant reduction in serum triglyceride levels was observed following treatment with ISIS 167875, ISIS 167878, ISIS 167879 and ISIS 167880, which reduced triglyceride levels 22%, 40%, 52% and 58%, respectively. This reduction in serum triglycerides correlated with the reduction in Apolipoprotein C-III liver mRNA expression. Moreover, reductions in target and serum triglycerides following treatment with ISIS 167878, ISIS 167879 and ISIS 167880 were not accompanied by hepatoxicity, as indicated by the lack of significant increases in ALT and AST levels. Glucose levels were significantly lowered following treatment with ISIS 167879.
Effects of Antisense Inhibition of Apolipoprotein C-III on Body Weight and Organ Weight
In a further embodiment, the animals treated with saline or a 25 mg/kg dose of ISIS 167880, ISIS 167875, ISIS 167878 or ISIS 167879 as described above were evaluated for changes in body weight, fat pad, liver and spleen weights. At study termination, forty-eight hours following the final dose of saline or antisense compound, the animals were sacrificed and body and organ weights were measured. The data shown in Table 19 represent average weights from all animals in each treatment group (n=8). Body weight is presented in grams (g), while spleen, liver and fat pad weights are presented in milligrams (mg).







TABLE 19







Effects of Antisense Inhibition of Apolipoprotein C-III on Body and


Organ Weights









Treatment














ISIS
ISIS
ISIS
ISIS



Saline
167875
167878
167879
167880
















Body weight
33
30
32
28
30


(g)


Liver weight
126
190
141
133
146


(mg)


Fat pad weight
182
125
125
61
62


(mg)


Spleen weight
8
12
12
12
14


(mg)









As is evident in Table 19, treatment with antisense compounds targeted to mouse Apolipoprotein C-III resulted in significant reductions in fat pad weight. ISIS 167875 and ISIS 167878 both led to a 31% reduction in fat pad weight, while ISIS 167879 and ISIS 167880 both resulted in a 66% lowering of fat pad weight. Body weights were not significantly changed and spleen weights were slightly increased following antisense compound treatment. With the exception livers from animals treated with ISIS 167875, liver weights were not significantly changed.
Effects of Antisense Inhibition of Apolipoprotein C-III on Liver Triglyceride Levels
Hepatic steatosis refers to the accumulation of lipids in the liver, or “fatty liver”, which is frequently caused by alcohol consumption, diabetes and hyperlipidemia and can progress to end-stage liver damage. Given the deleterious consequences of a fatty liver condition, it is of use to identify compounds that prevent or ameliorate hepatic steatosis. Hepatic steatosis is evaluated both by measurement of tissue triglyceride content and by histologic examination of liver tissue.
Liver tissue triglyceride content was assessed in the animals treated with saline or a 25 mg/kg dose of ISIS 167880, ISIS 167875, ISIS 167878 or ISIS 167879 as described above. Liver tissue triglyceride content was measured using the Triglyceride GPO assay (Roche Diagnostics, Indianapolis, Ind.). Histological analysis was conducted by routine procedures, whereby liver tissue was fixed in neutral-buffered formalin, embedded in paraffin, sectioned and subsequently stained with hematoxylin and eosin, to visualize nuclei and cytoplasm, respectively. Alternatively, liver tissue was procured then immediately frozen, sectioned, and subsequently stained with oil red O stain to visualize lipid deposits and counterstained with eosin to mark cytoplasm. The prepared samples were evaluated by light microscopy.
Relative to saline treated mice, liver tissue triglyceride levels were significantly lowered, by 25%, 35%, 40% and 64% following treatment with ISIS 167875, ISIS 167878, ISIS 167879 and ISIS 167880, respectively. Histological analysis of stained liver sections similarly revealed a reduction in liver tissue triglycerides. Thus, as demonstrated by measurement of tissue triglycerides and histological analyses of liver tissue sections, treatment with antisense compounds targeted to Apolipoprotein C-III reduced liver triglyceride content. As such, antisense compounds targeted to Apolipoprotein C-III are candidate therapeutic agents for the prevention or amelioration of hepatic steatosis.

## Claims

1. A method of lowering plasma apolipoprotein C-III levels in a human subject, comprising:
selecting a human subject with elevated apolipoprotein C-III levels or a condition associated with apolipoprotein C-III; and
administering to said human subject a therapeutically effective amount of a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, or a salt thereof,
wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, and whereby plasma apolipoprotein C-III levels in said human subject are lowered.

2. A method for treating, reducing the incidence of, or ameliorating a symptom of diabetes in a human subject, comprising administering to said human subject a therapeutically effective amount of a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, or a salt thereof, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, and wherein plasma apolipoprotein C-III levels in said human subject are lowered, whereby the diabetes is treated, the incidence reduced or the symptom ameliorated.

3. The method of claim 2, wherein said subject is selected based on a determination of elevated plasma apolipoprotein C-III concentrations, elevated plasma total cholesterol concentrations, elevated plasma LDL cholesterol, elevated plasma triglyceride concentrations, reduced plasma HDL cholesterol concentrations, elevated liver triglyceride concentrations, elevated apolipoprotein C-III concentrations in HDL cholesterol particles, elevated apolipoprotein C-III concentrations in VLDL cholesterol particles or elevated apolipoprotein C-III concentrations in cholesterol particles comprising apolipoprotein B.

4. The method of claim 3, wherein said subject has or is at risk of having diabetic dyslipidemia or mixed dyslipidemia.

5. A method for treating, reducing the incidence of, or ameliorating a symptom of coronary heart disease in a human subject, comprising administering to said human subject a therapeutically effective amount of a compound comprising a modified oligonucleotide having 12-30 linked nucleosides, or a salt thereof, wherein said modified oligonucleotide is 100% complementary to a nucleic acid encoding human apolipoprotein B, and wherein plasma apolipoprotein C-III levels in said human subject are lowered, whereby the coronary heart disease is treated, the incidence reduced or the symptom ameliorated.

6. The method of claim 5, wherein said subject is selected based on a determination of elevated plasma apolipoprotein C-III concentrations, elevated plasma total cholesterol concentrations, elevated plasma LDL cholesterol, elevated plasma triglyceride concentrations, reduced plasma HDL cholesterol concentrations, elevated liver triglyceride concentrations, elevated apolipoprotein C-III concentrations in HDL cholesterol particles, elevated apolipoprotein C-III concentrations in VLDL cholesterol particles or elevated apolipoprotein C-III concentrations in cholesterol particles comprising apolipoprotein B.

7. The method of claim 6, wherein said subject has or is at risk of having diabetic dislipidemia or mixed dyslipidemia.

8. The method of claim 3, wherein the human subject is obese.

9. The method of claim 6, wherein the human subject is obese.

10. The method of claim 6, wherein the human subject is diabetic.

11. The method of claim 1, wherein selection of the subject is based on a determination of elevated apolipoprotein C-III levels or a condition associated with apolipoprotein C-III.

12. The method of claim 11, wherein the selected subject is determined to have elevated plasma total cholesterol concentrations, elevated plasma LDL cholesterol, elevated plasma triglyceride concentrations, reduced plasma HDL cholesterol concentrations, elevated liver triglyceride concentrations, elevated apolipoprotein C-III concentrations in HDL cholesterol particles, elevated apolipoprotein C-III concentrations in VLDL cholesterol particles or elevated apolipoprotein C-III concentrations in cholesterol particles comprising apolipoprotein B.

13. The method of claim 11, wherein the modified oligonucleotide has a nucleobase sequence comprising at least an 8 nucleobase portion or at least a 12 nucleobase portion of SEQ ID NO:10.

14. The method of claim 11, wherein the modified oligonucleotide has a nucleobase sequence comprising SEQ ID NO:10.

15. The method of claim 11, wherein the modified oligonucleotide has a nucleobase sequence consisting of SEQ ID NO:10.

16. The method of claim 11, wherein the modified oligonucleotide comprises at least one modified internucleoside linkage, at least one modified sugar moiety, and/or at least one modified nucleobase.

17. The method of claim 16, wherein the modified internucleoside linkage is a phosphorothioate internucleoside linkage.

18. The method of claim 16, wherein the modified sugar moiety is a bicyclic sugar moiety or a 2′-substituted sugar moiety.

19. The method of claim 18, wherein the bicyclic sugar moiety comprises a 4′-CH2—O-2′ bridge.

20. The method of claim 18, wherein the 2′-substituted sugar moiety comprises a 2′-O-methoxyethyl.

21. The method of claim 16, wherein the modified nucleobase is a 5-methylcytosine.

22. The method of claim 11, wherein the modified oligonucleotide comprises:
a gap segment consisting of linked deoxynucleosides;
a 5′ wing segment consisting of linked nucleosides; and
a 3′ wing segment consisting of linked nucleosides;
wherein the gap segment is positioned between the 5′ wing segment and the 3′ wing segment and wherein each nucleoside of each wing segment comprises a modified sugar moiety, wherein the modified oligonucleotide comprises at least one modified nucleobase, and wherein at least one internucleoside linkage is a phosphorothioate linkage.

23. The method of claim 22, wherein each modified sugar moiety is a 2′-O-methoxyethyl sugar moiety or a bicyclic sugar moiety.

24. The method of claim 22, wherein the modified nucleobase is a 5-methylcytosine.

25. The method of claim 22, wherein the modified oligonucleotide comprises:
a gap segment consisting of ten deoxynucleosides;
a 5′ wing segment consisting of five linked nucleosides; and
a 3′ wing segment consisting of five linked nucleosides;
wherein the gap segment is positioned between the 5′ wing segment and the 3′ wing segment, wherein each nucleoside of each wing segment comprises a 2′-O-methoxyethyl sugar moiety, wherein each cytosine is a 5′-methylcytosine, and wherein each internucleoside linkage is a phosphorothioate internucleoside linkage.

26. The method of claim 11, wherein the compound comprises a salt of the modified oligonucleotide.

27. The method of claim 11, wherein the compound is formulated as a composition comprising a pharmaceutically acceptable excipient, vehicle, carrier or diluent.

28. The method of claim 11, wherein the therapeutically effective amount is delivered in a plurality of doses of the compound.

29. The method of claim 28, wherein the plurality of doses results in a plasma trough concentration of the compound from about 12 ng/mL to about 40 ng/mL in the plasma of the human subject or a plasma trough AUC of the compound from about 12 μg·hr/mL to about 60 μg·hr/mL in the plasma of the human subject.

30. The method of claim 29, wherein the compound is mipomersen.

31. The method of claim 30, wherein each of the plurality of doses is 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg, at least about 100 mg, at least about 200 mg, about 200 mg to about 400 mg, about 100 mg, about 200 mg, about 300 mg, or about 400 mg of mipomersen.

32. The method of claim 28, wherein at least one dose of said plurality of doses is administered daily, about twice a week, about once a week, about once every other week or about once a month.

33. The method of claim 11, wherein the plasma apolipoprotein C-III levels are reduced at least about 10%, at least about 20%, at least about 30%, at least about 40%, at least about 50%, at least about 54%, at least about 60% or at least about 62% relative to the amount of plasma apolipoprotein C-III observed in the subject prior to administration of the compound.

34. The method of claim 1, wherein the selected subject is determined to have elevated plasma total cholesterol concentrations, elevated plasma LDL cholesterol, elevated plasma triglyceride concentrations, reduced plasma HDL cholesterol concentrations, elevated liver triglyceride concentrations, elevated apolipoprotein C-III concentrations in HDL cholesterol particles, elevated apolipoprotein C-III concentrations in VLDL cholesterol particles or elevated apolipoprotein C-III concentrations in cholesterol particles comprising apolipoprotein B.