# Patent

## Title
Modulation of transthyretin expression

## Abstract

Provided herein are methods, compounds, and compositions for reducing expression of transthyretin mRNA and protein in an animal. Such methods, compounds, and compositions are useful to treat, prevent, delay, or ameliorate transthyretin amyloidosis, or a symptom thereof.

## Background
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 BIOL0123USD2SEQ_ST25.txt created May 18, 2015 which is 64 Kb in size. The information in the electronic format of the sequence listing is incorporated herein by reference in its entirety.
FIELD OF THE INVENTION
Provided herein are methods, compounds, and compositions for reducing expression of transthyretin mRNA and protein in an animal. Such methods, compounds, and compositions are useful, for example, to treat, prevent, or ameliorate transthyretin amyloidosis.
BACKGROUND OF THE INVENTION
Transthyretin (TTR), (also known as prealbumin, hyperthytoxinemia, dysprealbuminemic, thyroxine; senile systemic amyloidosis, amyloid polyneuropathy, amyloidosis I, PALB; dystransthyretinemic, HST2651; TBPA; dysprealbuminemic euthyroidal hyperthyroxinemia) is a serum/plasma and cerebrospinal fluid protein responsible for the transport of thyroxine and retinol (Sakaki et al, Mol Biol Med. 1989, 6:161-8). Structurally, TTR is a homotetramer; point mutations and misfolding of the protein leads to deposition of amyloid fibrils and is associated with disorders, such as senile systemic amyloidosis (SSA), familial amyloid polyneuropathy (FAP), and familial amyloid cardiopathy (FAC).
TTR is synthesized primarily by the liver and the choroid plexus of the brain and, to a lesser degree, by the retina in humans (Palha, Clin Chem Lab Med, 2002, 40, 1292-1300). Transthyretin that is synthesized in the liver is secreted into the blood, whereas transthyretin originating in the choroid plexus is destined for the CSF. In the choroid plexus, transthyretin synthesis represents about 20% of total local protein synthesis and as much as 25% of the total CSF protein (Dickson et al., J Biol Chem, 1986, 261, 3475-3478).
With the availability of genetic and immunohistochemical diagnostic tests, patients with TTR amyloidosis have been found in many nations worldwide. Recent studies indicate that TTR amyloidosis is not a rare endemic disease as previously thought, and may affect as much as 25% of the elderly population (Tanskanen et al, Ann Med. 2008; 40(3):232-9).
At the biochemical level, TTR was identified as the major protein component in the amyloid deposits of FAP patients (Costa et al, Proc. Natl. Acad. Sci. USA 1978, 75:4499-4503) and later, a substitution of methionine for valine at position 30 of the protein was found to be the most common molecular defect causing the disease (Saraiva et al, J. Clin. Invest. 1984, 74: 104-119). In FAP, widespread systemic extracellular deposition of TTR aggregates and amyloid fibrils occurs throughout the connective tissue, particularly in the peripheral nervous system (Sousa and Saraiva, Prog. Neurobiol. 2003, 71: 385-400). Following TTR deposition, axonal degeneration occurs, starting in the unmyelinated and myelinated fibers of low diameter, and ultimately leading to neuronal loss at ganglionic sites.
The compounds and treatment methods described herein provide significant advantages over the treatments options currently available for TTR related disorders. TTR amyloidosis typically lead to death within ten years, and until recently, was considered incurable. Liver transplantation is an effective means of replacing the disease-associated allele by a wild type (WT) allele in familial cases because the liver is typically the source of amyloidogenic TTR. While liver transplantation is effective as a form of gene therapy it is not without its problems. Transplantation is complicated by the need for invasive surgery for the recipient and the donor, long-term post-transplantation immunosuppressive therapy, a shortage of donors, its high cost, and the large number of TTR amyloidosis patients that are not good candidates because of their disease progression. Unfortunately, cardiac amyloidosis progresses in some familial patients even after liver transplantation because WT TTR often continues to deposit. Central nervous system (CNS) deposition of TTR is also not relieved by transplantation owing to its synthesis by the choroid plexus. Transplantation is not a viable option for the most prevalent TTR disease, senile systemic amyloidosis (SSA), affecting approximately 25% of those over 80 due to the deposition of WT TTR.
Antisense technology is emerging as an effective means for reducing the expression of specific gene products and may therefore prove to be uniquely useful in a number of therapeutic, diagnostic, and research applications for the modulation of TTR expression (See U.S. Patent Publication Nos. 2008/0039418 and 2007/0299027.
The present invention provides compositions and methods for modulating transthyretin expression. Antisense compounds for modulating expression of transthyretin are disclosed in the aforementioned published patent applications. However, there remains a need for additional such compounds.
SUMMARY OF THE INVENTION
Provided herein are methods, compounds, and compositions for modulating expression of transthyretin (TTR) mRNA and protein. In certain embodiments, compounds useful for modulating expression of TTR mRNA and protein are antisense compounds. In certain embodiments, the antisense compounds are antisense oligonucleotides.
In certain embodiments, modulation can occur in a cell or tissue. In certain embodiments, the cell or tissue is in an animal. In certain embodiments, the animal is a human. In certain embodiments, TTR mRNA levels are reduced. In certain embodiments, TTR protein levels are reduced. Such reduction can occur in a time-dependent manner or in a dose-dependent manner.
Provided herein are methods, compounds, and compositions for modulating expression of transthyretin and treating, preventing, delaying or ameliorating transthyretin amyloidosis and or a symptom thereof. In certain embodiments are methods, compounds, and compositions for modulating expression of transthyretin and treating, preventing, delaying or ameliorating transthyretin amyloid disease or transthyretin amyloidosis or transthyretin related amyloidosis (e.g., hereditary TTR amyloidosis, leptomeningeal amyloidosis, transthyretin amyloid polyneuropathy, familial amyloid polyneuropathy, familial amyloid cardiomyopathy, or senile systemic amyloidosis).
In certain embodiments, an animal at risk for transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal at risk for transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal at risk for transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal at risk for transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal at risk for transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal at risk for transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 to 30 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2, or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2, or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2, or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, or 124.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, or 87.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, or 87.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, or 87.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, or 87.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, or 87.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 to 30 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of a nucleobase sequence selected from any one of nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, or 87.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 to 30 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, an animal at risk for transthyretin amyloidosis or having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 linked nucleosides, wherein the modified oligonucleotide is complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 linked nucleosides and having a nucleobase sequence comprising at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, an animal having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 linked nucleosides, wherein the modified oligonucleotide is 100% complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1 or SEQ ID NO: 2; or a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 linked nucleosides and having the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, an animal having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 linked nucleosides, wherein the modified oligonucleotide is 100% complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1; and wherein the compound comprises a modified oligonucleotide consisting of 20 linked nucleosides having the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, an animal having transthyretin amyloidosis is treated by administering to the animal a therapeutically effective amount of a compound comprising a modified oligonucleotide consisting of 20 linked nucleosides, wherein the modified oligonucleotide is 100% complementary to a transthyretin nucleic acid as shown in SEQ ID NO: 1; wherein the compound comprises a modified oligonucleotide consisting of 20 linked nucleosides having the nucleobase sequence recited in SEQ ID NO: 80; and wherein the modified oligonucleotides has a gap segment of 10 linked deoxynucleosides between two wing segments that independently have 5 linked modified nucleosides. In certain embodiments, one or more modified nucleosides in the wing segment have a modified sugar. In certain embodiments, the modified nucleoside is a 2′-substituted nucleoside. In certain embodiments, the modified nucleoside is a 2′-MOE nucleoside.
In certain embodiments, modulation can occur in a cell, tissue, organ or organism. In certain embodiments, the cell, tissue or organ is in an animal. In certain embodiments, the animal is a human. In certain embodiments, transthyretin mRNA levels are reduced. In certain embodiments, transthyretin protein levels are reduced. Such reduction can occur in a time-dependent manner or in a dose-dependent manner.
Also provided are methods, compounds, and compositions useful for preventing, treating, and ameliorating diseases, disorders, and conditions related to transthyretin amyloidosis. In certain embodiments, such diseases, disorders, and conditions are transthyretin amyloidosis related diseases disorders or conditions.
In certain embodiments, methods of treatment include administering a TTR antisense compound to an individual in need thereof. In certain embodiments, methods of treatment include administering a TTR antisense oligonucleotide to an individual in need thereof.
In certain embodiments, methods of treatment include administering a transthyretin antisense oligonucleotide and an additional therapy to an individual in need thereof.


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. Also, terms such as “element” or “component” encompass both elements and components comprising one unit and elements and components that comprise more than one subunit, unless specifically stated otherwise.
The section headings used herein are for organizational purposes only and are not to be construed as limiting the subject matter described. All documents, or portions of documents, cited in this application, including, but not limited to, patents, patent applications, articles, books, and treatises, are hereby expressly incorporated by reference for the portions of the document discussed herein, as well as in their entirety.
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 for the portions of the document discussed herein, as well as 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 nucleotide” means a nucleotide 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.
“Active pharmaceutical agent” means the substance or substances in a pharmaceutical composition that provide a therapeutic benefit when administered to an individual. For example, in certain embodiments an antisense oligonucleotide targeted to transthyretin is an active pharmaceutical agent.
“Active target region” or “target region” means a region to which one or more active antisense compounds is targeted. “Active antisense compounds” means antisense compounds that reduce target nucleic acid levels or protein levels.
“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. The effects of both agents need not manifest themselves at the same time. The effects need only be overlapping for a period of time and need not be coextensive.
“Administering” means providing a pharmaceutical agent to an individual, and includes, but is not limited to administering by a medical professional and self-administering.
“Amelioration” refers to a lessening of at least one indicator, sign, or symptom of an associated disease, disorder, or condition. The severity of indicators may be determined by subjective or objective measures, which are known to those skilled in the art.
“Amyloidosis” is a group of diseases or disorders resulting from abnormal protein (amyloid or amyloid fibril) deposits in various body tissues. The amyloid proteins may either be deposited in one particular area of the body (localized amyloidosis) or they may be deposited throughout the body (systemic amyloidosis). There are three types of systemic amyloidosis: primary (AL), secondary (AA), and familial (ATTR). Primary amyloidosis is not associated with any other diseases and is considered a disease entity of its own. Secondary amyloidosis occurs as a result of another illness. Familial Mediterranean Fever is a form of familial (inherited) amyloidosis.
“Animal” refers to a human or non-human animal, including, but not limited to, mice, rats, rabbits, dogs, cats, pigs, and non-human primates, including, but not limited to, monkeys and chimpanzees.
“Antisense activity” means any detectable or measurable activity attributable to the hybridization of an antisense compound to its target nucleic acid. In certain embodiments, antisense activity is a decrease in the amount or expression of a target nucleic acid or protein encoded by such target nucleic acid.
“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 or target protein levels in the presence of an antisense compound complementary to a target nucleic acid compared to target nucleic acid levels or target protein levels in the absence of the antisense compound.
“Antisense oligonucleotide” means a single-stranded oligonucleotide having a nucleobase sequence that permits hybridization to a corresponding region or segment of a target nucleic acid.
“Bicyclic sugar” means a furosyl ring modified by the bridging of two non-geminal ring atoms. A bicyclic sugar is a modified sugar.
“Bicyclic nucleic acid” or “BNA” refers to a nucleoside or nucleotide wherein the furanose portion of the nucleoside or nucleotide includes a bridge connecting two carbon atoms on the furanose ring, thereby forming a bicyclic ring system.
“Cap structure” or “terminal cap moiety” means chemical modifications, which have been incorporated at either terminus of an antisense compound.
“Central nervous system (CNS)” refers to the vertebrate nervous system which is enclosed in meninges. It contains the majority of the nervous system, and consists of the brain (in vertebrates which have brains), and the spinal cord. The CNS is contained within the dorsal cavity, with the brain within the cranial cavity, and the spinal cord in the spinal cavity. The brain is also protected by the skull, and the spinal cord is, in vertebrates, also protected by the vertebrae.
“Chemically distinct region” refers to a region of an antisense compound that is in some way chemically different than another region of the same antisense compound. For example, a region having 2′-O-methoxyethyl nucleotides is chemically distinct from a region having nucleotides without 2′-O-methoxyethyl modifications.
“Chimeric antisense compound” means an antisense compound that has at least two chemically distinct regions.
“Choroid plexus” is the area on the ventricles of the brain where cerebrospinal fluid (CSF) is produced.
“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 parallel or sequential administration.
“Complementarity” means the capacity for pairing between nucleobases of a first nucleic acid and a second nucleic acid.
“Contiguous nucleobases” means nucleobases immediately adjacent to each other.
“Diluent” means an ingredient in a composition that lacks pharmacological activity, but is pharmaceutically necessary or desirable. For example, the diluent in an injected composition 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 one, 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, therefore, two or more injections may be used to achieve the desired dose. In certain 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.
“Effective amount” means the amount of active pharmaceutical agent sufficient to effectuate a desired physiological outcome in an individual in need of the agent. The effective amount may vary among individuals depending on the health and physical condition of the individual to be treated, the taxonomic group of the individuals to be treated, the formulation of the composition, assessment of the individual's medical condition, and other relevant factors.
“Familial amyloidosis” or “hereditary amyloidosis” is a form of inherited amyloidosis.
“Familial amyloid polyneuropathy” or “FAP” is a neurodegenerative genetically transmitted disorder, characterized by systemic depositions of amyloid variants of transthyretin proteins, causing progressive sensory and motorial polyneuropathy.
“Fully complementary” or “100% complementary” means each nucleobase of a nucleobase sequence of a first nucleic acid has a complementary nucleobase in a second nucleobase sequence of 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.
“Gapmer” means a chimeric antisense compound in which an internal region having a plurality of nucleosides that support RNase H cleavage is positioned between external regions having one or more nucleosides, wherein the nucleosides comprising the internal region are chemically distinct from the nucleoside or nucleosides comprising the external regions. The internal region may be referred to as a “gap segment” and the external regions may be referred to as “wing segments.”
“Gap-widened” means a chimeric antisense compound having a gap segment of 12 or more contiguous 2′-deoxyribonucleosides positioned between and immediately adjacent to 5′ and 3′ wing segments having from one to six nucleosides.
“Hereditary transthyretin (TTR) amyloidosis” is a systemic disease caused by mutations in transthyretin, a plasma transport protein for thyroxine and vitamin A It is most frequently associated with peripheral neuropathy and restrictive cardiomyopathy, but amyloid deposits in blood vessel walls and connective tissue structures throughout the body often cause dysfunction of other organ systems. Gastrointestinal motility abnormalities are common in this disease with constipation, diarrhea and early satiety from delayed gastric-emptying. Connective tissue deposits of amyloid in the wrist may cause carpal tunnel syndrome. Amyloid deposits in spinal blood vessels and surrounding structures cause spinal stenosis with symptoms of claudication.
“Hybridization” means the annealing of complementary nucleic acid molecules. In certain embodiments, complementary nucleic acid molecules include an antisense compound and a target nucleic acid.
“Immediately adjacent” means there are no intervening elements between the immediately adjacent elements.
“Individual” means a human or non-human animal selected for treatment or therapy.
“Intracerebroventricular administration” or “cerebral intraventricular administration” or “cerebral ventricular administration” means administration through injection or infusion into the ventricular system of the brain.
“Intraperitoneal administration” means administration to the peritoneal cavity.
“Intrathecal administration” means administration through injection or infusion into the cerebrospinal fluid bathing the spinal cord and brain.
“Intravenous administration” means administration into a vein.
“Intraventricular administration” means administration into the ventricles of either the brain or heart.
“Internucleoside linkage” refers to the chemical bond between nucleosides.
“Leptomeningeal” means having to do with the leptomeninges, the two innermost layers of tissues that cover the brain and spinal cord. “Leptomeningeal amyloidosis” refers to amyloidosis of the leptomeninges resulting from transthyretin amyloid deposition within the leptomeninges.
“Linked nucleosides” means adjacent nucleosides which are bonded together.
“Mismatch” or “non-complementary nucleobase” refers to the case when a nucleobase of a first nucleic acid is not capable of pairing with the corresponding nucleobase of a second or target nucleic acid.
“Modified internucleoside linkage” refers to a substitution or any change from a naturally occurring internucleoside bond (i.e. a phosphodiester internucleoside bond).
“Modified nucleobase” refers to 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 nucleotide” means a nucleotide having, independently, a modified sugar moiety, modified internucleoside linkage, or modified nucleobase. A “modified nucleoside” means a nucleoside having, independently, a modified sugar moiety or modified nucleobase.
“Modified oligonucleotide” means an oligonucleotide comprising at least one modified nucleotide.
“Modified sugar” refers to a substitution or change from a natural sugar.
“Motif” means the pattern of chemically distinct regions in an antisense compound.
“Naturally occurring internucleoside linkage” means a 3′ to 5′ phosphodiester linkage.
“Natural sugar moiety” means a sugar found in DNA (2′-H) or RNA (2′-OH).
“Nucleic acid” refers to molecules composed of monomeric nucleotides. A nucleic acid includes ribonucleic acids (RNA), deoxyribonucleic acids (DNA), single-stranded nucleic acids, double-stranded nucleic acids, small interfering ribonucleic acids (siRNA), and microRNAs (miRNA). A nucleic acid may also comprise a combination of these elements in a single molecule.
“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, 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.
“Oligomeric compound” or “oligomer” 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 subcutaneous administration, intravenous administration, intramuscular administration, intraarterial administration, intraperitoneal administration, or intracranial administration, e.g. intracerebral administration, intrathecal administration, intraventricular administration, ventricular administration, intracerebroventricular administration, cerebral intraventricular administration or cerebral ventricular administration. Administration can be continuous, or chronic, or short or intermittent.
“Peptide” means a molecule formed by linking at least two amino acids by amide bonds. Peptide refers to polypeptides and proteins.
“Pharmaceutical composition” means a mixture of substances suitable for administering to an individual. For example, a pharmaceutical composition may comprise one or more active pharmaceutical agents and 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.
“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.
“Prevent” refers to delaying or forestalling the onset or development of a disease, disorder, or condition for a period of time from minutes to indefinitely. Prevent also means reducing risk of developing a disease, disorder, or condition.
“Prodrug” means a therapeutic agent that is prepared in an inactive form that is converted to an active form within the body or cells thereof by the action of endogenous enzymes or other chemicals or conditions.
“Side effects” means physiological responses attributable to a treatment other than the desired effects. In certain embodiments, side effects include injection site reactions, liver function test abnormalities, renal function abnormalities, liver toxicity, renal toxicity, central nervous system abnormalities, myopathies, and malaise. For example, increased aminotransferase levels in serum may indicate liver toxicity or liver function abnormality. For example, increased bilirubin may indicate liver toxicity or liver function abnormality.
“Single-stranded oligonucleotide” means an oligonucleotide which is not hybridized to a complementary strand.
“Specifically hybridizable” refers to an antisense compound having a sufficient degree of complementarity between an antisense oligonucleotide and a target nucleic acid to induce a desired effect, while exhibiting minimal or no effects on non-target nucleic acids under conditions in which specific binding is desired, i.e. under physiological conditions in the case of in vivo assays and therapeutic treatments.
“Subcutaneous administration” means administration just below the skin.
“Targeting” or “targeted” means the process of design and selection of an antisense compound that will specifically hybridize to a target nucleic acid and induce a desired effect.
“Target nucleic acid,” “target RNA,” and “target RNA transcript” all refer to a nucleic acid capable of being targeted by antisense compounds.
“Target segment” means the sequence of nucleotides of a target nucleic acid to which an antisense compound is targeted. “5′ target site” refers to the 5′-most nucleotide of a target segment. “3′ target site” refers to the 3′-most nucleotide of a target segment.
“Therapeutically effective amount” means an amount of a pharmaceutical agent that provides a therapeutic benefit to an individual.
“Transthyretin-specific inhibitor” or “Transthyretin inhibitor” means any compound capable of decreasing transthyretin mRNA or protein expression. Examples of such compounds include a nucleic acid, a peptide, an antibody, or a histone deacetylase inhibitor.
“Transthyretin specific modulator” or “transthyretin modulator” means any compound capable of increasing or decreasing transthyretin mRNA or protein expression.
“Transthyretin-related amyloidosis” or “transthyretin amyloidosis” or “Transthyretin amyloid disease”, as used herein, is any pathology or disease associated with dysfunction or dysregulation of transthyretin that result in formation of transthyretin-containing amyloid fibrils. Transthyretin amyloidosis includes, but is not limited to, hereditary TTR amyloidosis, leptomeningeal amyloidosis, familial amyloid polyneuropathy (FAP), familial amyloid cardiomyopathy, familial oculoleptomeningeal amyloidosis, senile cardiac amyloidosis, or senile systemic amyloidosis.
“Treat” refers to administering a pharmaceutical composition to effect an alteration or improvement of a disease, disorder, or condition.
“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).
Certain Embodiments
Certain embodiments provide methods, compounds, and compositions for inhibiting transthyretin expression.
Certain embodiments provide antisense compounds targeted to a transthyretin nucleic acid. In certain embodiments, the transthyretin nucleic acid is any of the sequences set forth in GENBANK Accession No. NM_000371.2 (incorporated herein as SEQ ID NO: 1), GENBANK Accession No. NT_010966.10 truncated from nucleotides 2009236 to U.S. Pat. No. 2,017,289 (incorporated herein as SEQ ID NO: 2); exons 1-4 extracted from the rhesus monkey genomic sequence GENBANK Accession No. NW_001105671.1, based on similarity to human exons; and GENBANK Accession No. NW_001105671.1 truncated from nucleotides 628000 to 638000 (incorporated herein as SEQ ID NO: 4).
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides wherein the linked nucleosides comprise at least 8, at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19 or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, and 87.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 8 to 80 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 80.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 12 to 50 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 80.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 80.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 80.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, or at least 20 contiguous nucleobases of a sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 80.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 to 30 linked nucleosides wherein the linked nucleosides comprise at least 8 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80. In certain embodiments, the modified oligonucleotide comprises at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, or at least 19 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, the compound comprises a modified oligonucleotide consisting of 20 linked nucleosides recited in SEQ ID NO: 80.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides wherein the linked nucleosides comprise at least an 8 contiguous nucleobase portion that is complementary to an equal length nucleobase portion within the region selected from nucleotides 120-139, 212-236, 226-245, 293-468, 293-326, 347-381, 425-468, 425-467, 452-478, 452-474, 459-478, 461-519, 462-500, 500-519, 501-535, 502-531, 505-524, 507-526, 508-527, 514-540, 514-539, 515-534, 516-535, 523-542, 544-606, 544-564, 564-583, 578-601, 580-608, 580-599, 584-606, 585-604, 587-606, or 597-617 of SEQ ID NO: 1. In certain embodiments the region is selected from 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1. In certain embodiments the region is selected from 501-535 or 580-608 of SEQ ID NO: 1. In certain embodiments, the modified oligonucleotide has at least a 9, at least a 10, at least an 11, at least an 12, at least an 13, at least an 14, at least an 15, at least an 16, at least an 17, at least an 18, at least an 19 or at least a 20 contiguous nucleobase portion of which is complementary within a region described herein.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides wherein the linked nucleosides comprise at least an 8 contiguous nucleobase portion that is complementary to an equal length nucleobase portion within the region selected from nucleotides 501-535 or 580-608 of SEQ ID NO: 1. In certain embodiments, the modified oligonucleotide has at least a 9, at least a 10, at least an 11, at least an 12, at least an 13, at least an 14, at least an 15, at least an 16, at least an 17, at least an 18, at least an 19 or at least a 20 contiguous nucleobase portion of which is complementary within a region described herein.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides wherein the linked nucleosides comprise at least an 8 contiguous nucleobase portion that is complementary to an equal length nucleobase portion within the region selected from nucleotides 508-527 of SEQ ID NO: 1. In certain embodiments, the modified oligonucleotide has at least a 9, at least a 10, at least an 11, at least an 12, at least an 13, at least an 14, at least an 15, at least an 16, at least an 17, at least an 18, at least an 19 or at least a 20 contiguous nucleobase portion of which is complementary within a region described herein.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 15 to 25 linked nucleosides wherein the linked nucleosides comprise at least an 8 contiguous nucleobase portion that is complementary to an equal length nucleobase portion within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1. In certain embodiments, the modified oligonucleotide has at least a 9, at least a 10, at least an 11, at least an 12, at least an 13, at least an 14, at least an 15, at least an 16, at least an 17, at least an 18, at least an 19 or at least a 20 contiguous nucleobase portion of which is complementary within a region described herein.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 18 to 21 linked nucleosides wherein the linked nucleosides comprise at least an 8 contiguous nucleobase portion that is complementary to an equal length nucleobase portion within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1. In certain embodiments, the modified oligonucleotide has at least a 9, at least a 10, at least an 11, at least an 12, at least an 13, at least an 14, at least an 15, at least an 16, at least an 17, at least an 18, at least an 19 or at least a 20 contiguous nucleobase portion of which is complementary within a region described herein.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides wherein the linked nucleosides comprise at least an 8 contiguous nucleobase portion that is complementary to an equal length nucleobase portion within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1. In certain embodiments, the modified oligonucleotide has at least a 9, at least a 10, at least an 11, at least a 12, at least a 13, at least a 14, at least a 15, at least a 16, at least a 17, at least an 18, at least 19 or at least a 20 contiguous nucleobase portion of which is complementary within a region described herein. In certain embodiments, the modified oligonucleotide is 90%, 95%, 99%, or 100% complementary to a nucleic acid encoding human transthyretin (TTR), eg. SEQ ID No: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides wherein the linked nucleosides comprise at least an 8 contiguous nucleobase portion that is complementary to an equal length nucleobase portion within the region selected from nucleotides 508-527 of SEQ ID NO: 1. In certain embodiments, the modified oligonucleotide has at least a 9, at least a 10, at least an 11, at least a 12, at least a 13, at least a 14, at least a 15, at least a 16, at least a 17, at least an 18, at least 19 or at least a 20 contiguous nucleobase portion of which is complementary to an equal length portion within the region selected from nucleotides 508-527 of SEQ ID NO: 1. In certain embodiments, the modified oligonucleotide is 90%, 95%, 99%, or 100% complementary to a nucleic acid encoding human transthyretin (TTR), e.g. SEQ ID No: 1
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 60% complementary within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 70% complementary within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 80% complementary within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 90% complementary within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 95% complementary within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 99% complementary within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 100% complementary within the region selected from nucleotides 507-526, 508-527, 515-534, 516-535, 580-599, 585-604, 587-606 and 589-608 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 60% complementary within nucleotides 508-527 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 70% complementary within nucleotides 508-527 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 80% complementary within nucleotides 508-527 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 90% complementary within nucleotides 508-527 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 95% complementary within nucleotides 508-527 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 99% complementary within nucleotides 508-527 of SEQ ID NO: 1.
Certain embodiments provide compounds comprising a modified oligonucleotide consisting of 20 linked nucleosides 100% complementary within nucleotides 508-527 of SEQ ID NO: 1.
In certain embodiments, an antisense compound or modified oligonucleotide targeted to a transthyretin nucleic acid targets the following nucleotide regions of SEQ ID NO: 1: 120-139, 212-236, 226-245, 293-468, 293-326, 347-381, 425-468, 425-467, 452-478, 452-474, 459-478, 461-519, 462-500, 500-519, 502-531, 507-526, 505-524, 508-527, 514-540, 514-539, 515-534, 516-535, 523-542, 544-606, 544-564, 564-583, 578-601, 580-599, 584-606, 585-604, 587-606, or 597-617.
In certain embodiments, antisense compounds or modified oligonucleotides targets a region of a transthyretin nucleic acid. In certain embodiments, such compounds or oligonucleotides targeted to a region of a transthyretin nucleic acid have a contiguous nucleobase portion that is complementary to an equal length nucleobase portion of the region. For example, the portion can be at least an 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20 contiguous nucleobases portion complementary to an equal length portion of a region recited herein. In certain embodiments, such compounds or oligonucleotide target the following nucleotide regions of SEQ ID NO: 1: 120-139, 212-236, 226-245, 293-381, 293-366, 353-381, 293-468, 425-468, 425-467, 452-476, 461-481, 461-500, 500-519, 461-519, 502-531, 502-539, 504-536, 505-525, 506-530, 507-527, 508-527, 508-536, 514-540, 523-542, 544-606, 544-564, 544-583, or 597-617.
In certain embodiments, such compounds or oligonucleotides targeted to a region of a transthyretin nucleic acid have a contiguous nucleobase portion that is complementary to an equal length nucleobase portion of the region 501-535 or 580-608 of SEQ ID NO: 1.
In certain embodiments, the following nucleotide regions of SEQ ID NO: 1, when targeted by antisense compounds or oligonucleotides, displays at least 60% inhibition: 226-245, 293-366, 357-467, 452-474, 457-476, 459-478, 462-500, 500-519, 502-531, 504-536, 505-525, 506-530, 507-527, 508-527, 508-536, 514-539, 544-564, 564-583, 578-601, 584-606, or 597-617.
In certain embodiments, the following nucleotide regions of SEQ ID NO: 1, when targeted by antisense compounds or oligonucleotides, displays at least 65% inhibition: 293-366, 357-376, 425-449, 432-467, 452-474, 459-478, 462-500, 500-519, 502-531, 504-536, 505-525, 506-530, 507-527, 508-527, 508-536, 514-539, 544-563, 564-583, 578-601, 585-606, or 597-617.
In certain embodiments, the following nucleotide regions of SEQ ID NO: 1, when targeted by antisense compounds or oligonucleotides, displays at least 70% inhibition: 293-366, 425-449, 432-467, 452-474, 459-478, 462-500, 500-519, 502-531, 504-536, 505-525, 506-530, 507-527, 508-527, 508-536, 514-539, 564-583, 578-598, 581-600, or 597-617.
In certain embodiments, the following nucleotide regions of SEQ ID NO: 1, when targeted by antisense compounds or oligonucleotides, displays at least 75% inhibition: 293-322, 347-366, 425-449, 432-467, 452-474, 459-478, 462-500, 500-519, 503-531, 504-536, 505-525, 506-530, 507-527, 508-527, 508-536, 514-539, 578-598, 581-600, or 597-616.
In certain embodiments, the following nucleotide regions of SEQ ID NO: 1, when targeted by antisense compounds or oligonucleotides, displays at least 80% inhibition: 303-322, 425-449, 432-460, 443-467, 452-473, 481-500, 500-519, 503-531, 504-536, 505-525, 506-530, 507-527, 508-527, 508-536, 514-536, 519-539, 579-598, 581-600, or 597-616.
In certain embodiments, the following nucleotide regions of SEQ ID NO: 1, when targeted by antisense compounds or oligonucleotides, displays at least 85% inhibition: 427-449, 432-458, 441-460, 443-467, 452-473, 504-531, 504-536, 505-525, 506-530, 507-527, 508-527, 508-536, 514-536, 519-539, or 581-600.
In certain embodiments, the following nucleotide regions of SEQ ID NO: 1, when targeted by antisense compounds or oligonucleotides, displays at least 90% inhibition: 428-449, 432-456, 439-458, 441-460, 445-466, 452-473, 504-525, 508-527, or 515-536.
In certain embodiments, the following nucleotide regions of SEQ ID NO: 1, when targeted by antisense compounds or oligonucleotides, displays at least 95% inhibition: 434-453, 436-456, 441-460, 445-465, 505-524, or 516-535.
In certain embodiments, the following antisense compounds target a region of a SEQ ID NO: 1, a nucleic acid encoding human transthyretin, and demonstrate at least 60% inhibition of a transthyretin mRNA: ISIS NOs: 420954, 420904, 304286, 420874, 420948, 420883, 420955, 420952, 420956, 420957, 420882, 420947, 420950, 304312, 304307, 420879, 420910, 420902, 420908, 420924, 420877, 420880, 304309, 304289, 420906, 304311, 420878, 420911, 304284, 304288, 420909, 304296, 420949, 304290, 304299, 420898, 420920, 420925, 420951, 304287, 420894, 420916, 420918, 420926, 304285, 420919, 420923, 420886, 420900, 420912, 420915, 420917, 420921, 420884, 420885, 420887, 420889, 420892, 420901, 420914, 420897, 420899, 420888, 420895, 420896, 420913, 420922, 420893, 420890, or 420891.
In certain embodiments, the following antisense compounds target a region of a SEQ ID NO: 1, a nucleic acid encoding human transthyretin and demonstrate at least 65% inhibition of a transthyretin mRNA: ISIS NOs: 420955, 420952, 420956, 420957, 420882, 420947, 420950, 304312, 304307, 420879, 420910, 420902, 420908, 420924, 420877, 420880, 304309, 304289, 420906, 304311, 420878, 420911, 304284, 304288, 420909, 304296, 420949, 304290, 304299, 420898, 420920, 420925, 420951, 304287, 420894, 420916, 420918, 420926, 304285, 420919, 420923, 420886, 420900, 420912, 420915, 420917, 420921, 420884, 420885, 420887, 420889, 420892, 420901, 420914, 420897, 420899, 420888, 420895, 420896, 420913, 420922, 420893, 420890, or 420891.
In certain embodiments, the following antisense compounds target a region of a SEQ ID NO: 1, a nucleic acid encoding human transthyretin and demonstrate at least 70% inhibition of a transthyretin mRNA: ISIS NOs: 304312, 304307, 420879, 420910, 420902, 420908, 420924, 420877, 420880, 304309, 304289, 420906, 304311, 420878, 420911, 304284, 304288, 420909, 304296, 420949, 304290, 304299, 420898, 420920, 420925, 420951, 304287, 420894, 420916, 420918, 420926, 304285, 420919, 420923, 420886, 420900, 420912, 420915, 420917, 420921, 420884, 420885, 420887, 420889, 420892, 420901, 420914, 420897, 420899, 420888, 420895, 420896, 420913, 420922, 420893, 420890, or 420891.
In certain embodiments, the following antisense compounds target a region of a SEQ ID NO: 1, a nucleic acid encoding human transthyretin and demonstrate at least 75% inhibition of a transthyretin mRNA: ISIS NOs: 420877, 420878, 420880, 304284, 304285, 420884, 420885, 420886, 420887, 420888, 420889, 420890, 420891, 304287, 420892, 304288, 420893, 304289, 304290, 420894, 420895, 420896, 420897, 420898, 420899, 420900, 420901, 420902, 420906, 420908, 304296, 420909, 420911, 420912, 420913, 420914, 304299, 420915, 420916, 420917, 420918, 420919, 420920, 420921, 420922, 420923, 420924, 420925, 420926, 304309, 420949, 420951, or 304311.
In certain embodiments, the following antisense compounds target a region of a SEQ ID NO: 1, a nucleic acid encoding human transthyretin and demonstrate at least 80% inhibition of a transthyretin mRNA: ISIS NOs: 304311, 420878, 420911, 304284, 304288, 420909, 304296, 420949, 304290, 304299, 420898, 420920, 420925, 420951, 304287, 420894, 420916, 420918, 420926, 304285, 420919, 420923, 420886, 420900, 420912, 420915, 420917, 420921, 420884, 420885, 420887, 420889, 420892, 420901, 420914, 420897, 420899, 420888, 420895, 420896, 420913, 420922, 420893, 420890, or 42089.
In certain embodiments, the following antisense compounds target a region of a SEQ ID NO: 1, a nucleic acid encoding human transthyretin and demonstrate at least 85% inhibition of a transthyretin mRNA: ISIS NOs: 304290, 304299, 420898, 420920, 420925, 420951, 304287, 420894, 420916, 420918, 420926, 304285, 420919, 420923, 420886, 420900, 420912, 420915, 420917, 420921, 420884, 420885, 420887, 420889, 420892, 420901, 420914, 420897, 420899, 420888, 420895, 420896, 420913, 420922, 420893, 420890, or 420891.
In certain embodiments, the following antisense compounds target a region of a SEQ ID NO: 1, a nucleic acid encoding human transthyretin and demonstrate at least 90% inhibition of a transthyretin mRNA: ISIS NOs: 420923, 420886, 420900, 420912, 420915, 420917, 420921, 420884, 420885, 420887, 420889, 420892, 420901, 420914, 420897, 420899, 420888, 420895, 420896, 420913, 420922, 420893, 420890, or 420891.
In certain embodiments, the following antisense compounds target a region of a SEQ ID NO: 1, a nucleic acid encoding human transthyretin and demonstrate at least 95% inhibition of a transthyretin mRNA: ISIS NOs: 420888, 420895, 420896, 420913, 420922, 420893, 420890, or 420891.
In certain embodiments, a target region is nucleotides 120-139 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 120-139 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NO: 37. In certain such embodiments, an antisense compound targeted to nucleotides 120-139 of SEQ ID NO: 1 is selected from ISIS NO: 420872.
In certain embodiments, a target region is nucleotides 212-236 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 212-236 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 8 and 38. In certain such embodiments, an antisense compound targeted to nucleotides 212-236 of SEQ ID NO: 1 is selected from ISIS NOs: 420873 or 304267.
In certain embodiments, a target region is nucleotides 226-245 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 226-245 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NO: 39. In certain such embodiments, an antisense compound targeted to nucleotides 226-245 of SEQ ID NO: 1 is selected from ISIS NO: 420874.
In certain embodiments, a target region is nucleotides 293-381 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 293-381 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 10, 42-48. In certain such embodiments, an antisense compound targeted to nucleotides 293-381 of SEQ ID NO: 1 is selected from ISIS NOs: 420877, 420878, 420879, 420880, 304280, 420881, 420882, or 420883.
In certain embodiments, a target region is nucleotides 293-366 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 293-366 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 42-45. In certain such embodiments, an antisense compound targeted to nucleotides 293-366 of SEQ ID NO: 1 is selected from ISIS NOs: 420877, 420878, 420879, or 420880.
In certain embodiments, a target region is nucleotides 353-381 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 353-381 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 10, 46-48. In certain such embodiments, an antisense compound targeted to nucleotides 353-381 of SEQ ID NO: 1 is selected from ISIS NOs: 304280, 420881, 420882, or 420883.
In certain embodiments, a target region is nucleotides 293-468 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 293-468 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 10-18, 42-63. In certain such embodiments, an antisense compound targeted to nucleotides 293-468 of SEQ ID NO: 1 is selected from ISIS NOs: 420877, 420878, 420879, 420880, 304280, 420881, 420882, 420883, 304284, 304285, 420884, 420885, 304286, 420886, 420887, 420888, 420889, 420890, 420891, 304287, 420892, 304288, 420893, 304289, 304290, 420894, 420895, 420896, 420897, 420898, or 304291.
In certain embodiments, a target region is nucleotides 425-468 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 425-468 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 11-18, 49-63. In certain such embodiments, an antisense compound targeted to nucleotides 425-468 of SEQ ID NO: 1 is selected from ISIS NOs: 304284, 304285, 420884, 420885, 304286, 420886, 420887, 420888, 420889, 420890, 420891, 304287, 420892, 304288, 420893, 304289, 304290, 420894, 420895, 420896, 420897, 420898, or 304291.
In certain embodiments, a target region is nucleotides 425-467 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 425-468 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 11-17, 49-63. In certain such embodiments, an antisense compound targeted to nucleotides 425-468 of SEQ ID NO: 1 is selected from ISIS NOs: 304284, 304285, 420884, 420885, 304286, 420886, 420887, 420888, 420889, 420890, 420891, 304287, 420892, 304288, 420893, 304289, 304290, 420894, 420895, 420896, 420897, or 420898.
In certain embodiments, a target region is nucleotides 452-476 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 452-476 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 64-69. In certain such embodiments, an antisense compound targeted to nucleotides 452-476 of SEQ ID NO: 1 is selected from ISIS NOs: 420889, 420890, 420891, 304287, 420892, 304288, 420893, 304289, 304290, 420894, 420895, 420896, 420897, 420898, 304291, 304292, 304293, 420899, 420900, 420901, 420902, 420903, or 420904.
In certain embodiments, a target region is nucleotides 461-481 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 461-481 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 72-73. In certain such embodiments, an antisense compound targeted to nucleotides 461-481 of SEQ ID NO: 1 is selected from ISIS NOs: 420907 or 420908.
In certain embodiments, a target region is nucleotides 461-500 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 461-500 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 22, 72 and 73. In certain such embodiments, an antisense compound targeted to nucleotides 461-500 of SEQ ID NO: 1 is selected from ISIS NOs: 420907, 420908 or 304296.
In certain embodiments, a target region is nucleotides 500-519 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 500-519 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NO: 74. In certain such embodiments, an antisense compound targeted to nucleotides 500-519 of SEQ ID NO: 1 is selected from ISIS NO: 420909.
In certain embodiments, a target region is nucleotides 461-519 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 461-519 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 22, 23, 72-74. In certain such embodiments, an antisense compound targeted to nucleotides 461-519 of SEQ ID NO: 1 is selected from ISIS NOs: 420907, 420908, 304296, or 420909.
In certain embodiments, a target region is nucleotides 502-531 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 502-531 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 25, 75-84. In certain such embodiments, an antisense compound targeted to nucleotides 502-531 of SEQ ID NO: 1 is selected from ISIS NOs: 420910, 420911, 420912, 420913, 420914, 304299, 420915, 420916, 420917, 420918, or 420919.
In certain embodiments, a target region is nucleotides 502-539 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 502-539 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 25, 26, 75-91. In certain such embodiments, an antisense compound targeted to nucleotides 502-539 of SEQ ID NO: 1 is selected from ISIS NOs: 420910, 420911, 420912, 420913, 420914, 304299, 420915, 420916, 420917, 420918, 420919, 304300, 420920, 420921, 420922, 420923, 420924, 420925, or 420926.
In certain embodiments, a target region is nucleotides 504-536 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 504-536 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 25, 26, 77-88. In certain such embodiments, an antisense compound targeted to nucleotides 504-536 of SEQ ID NO: 1 is selected from ISIS NOs: 420912, 420913, 420914, 304299, 420915, 420916, 420917, 420918, 420919, 304300, 420920, 420921, 420922, or 420923.
In certain embodiments, a target region is nucleotides 505-535 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 505-535 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 25, 26, 78-87. In certain such embodiments, an antisense compound targeted to nucleotides 505-535 of SEQ ID NO: 1 is selected from ISIS NOs: 420913, 420914, 304299, 420915, 420916, 420917, 420918, 420919, 304300, 420920, 420921, or 420922.
In certain embodiments, a target region is nucleotides 506-530 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 506-530 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 25, 79-83. In certain such embodiments, an antisense compound targeted to nucleotides 506-530 of SEQ ID NO: 1 is selected from ISIS NOs: 420913, 420914, 304299, 420915, 420916, 420917, 420918, or 420919.
In certain embodiments, a target region is nucleotides 507-527 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 507-527 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 25 or 80. In certain such embodiments, an antisense compound targeted to nucleotides 507-527 of SEQ ID NO: 1 is selected from ISIS NO: 304299 or 420915.
In certain embodiments, a target region is nucleotides 508-527 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 508-527 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NO: 80. In certain such embodiments, an antisense compound targeted to nucleotides 508-527 of SEQ ID NO: 1 is selected from ISIS NO: 420915.
In certain embodiments, a target region is nucleotides 514-540 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 514-540 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 85-92. In certain such embodiments, an antisense compound targeted to nucleotides 514-540 of SEQ ID NO: 1 is selected from ISIS NOs: 420920, 420921, 420922, 420923, 420924, 420925, 420926, or 420927.
In certain embodiments, a target region is nucleotides 523-542 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 523-542 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NO: 94. In certain such embodiments, an antisense compound targeted to nucleotides 523-542 of SEQ ID NO: 1 is selected from ISIS NO: 420929.
In certain embodiments, a target region is nucleotides 544-606 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 544-606 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 30-33, 112-122. In certain such embodiments, an antisense compound targeted to nucleotides 544-606 of SEQ ID NO: 1 is selected from ISIS NOs: 420947, 420948, 304304, 304307, 304308, 304309, 420949, 420950, 420951, 420952, 420953, 420954, 420955, 420956, or 420957.
In certain embodiments, a target region is nucleotides 544-564 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 544-564 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 112-113. In certain such embodiments, an antisense compound targeted to nucleotides 544-564 of SEQ ID NO: 1 is selected from ISIS NOs: 420947 or 420948.
In certain embodiments, a target region is nucleotides 544-583 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 544-583 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 30, 31, 112, and 113. In certain such embodiments, an antisense compound targeted to nucleotides 544-583 of SEQ ID NO: 1 is selected from ISIS NOs: 420947, 420948, 304304, or 304307.
In certain embodiments, a target region is nucleotides 597-617 of SEQ ID NO: 1. In certain embodiments, an antisense compound is targeted to nucleotides 597-617 of SEQ ID NO: 1. In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid comprises a nucleobase sequence selected from SEQ ID NOs: 34-35. In certain such embodiments, an antisense compound targeted to nucleotides 597-617 of SEQ ID NO: 1 is selected from ISIS NOs: 304311 or 304312.
In certain embodiments, the modified oligonucleotide consists of a single-stranded modified oligonucleotide.
In certain embodiments, the modified oligonucleotide consists of 20 linked nucleosides.
In certain embodiments, the nucleobase sequence of the modified oligonucleotide is at least 90% complementary over its entire length to a nucleobase sequence of SEQ ID NO: 1, 2, or 4. In certain embodiments, the nucleobase sequence of the modified oligonucleotide is at least 95% complementary over its entire length to a nucleobase sequence of SEQ ID NO: 1, 2, or 4. In certain embodiments, the modified oligonucleotide is at least 99% complementary over its entire length to SEQ ID NO: 1, 2, or 4. In certain embodiments, the nucleobase sequence of the modified oligonucleotide is 100% complementary over its entire length to a nucleobase sequence of SEQ ID NO: 1, 2, or 4.
In certain embodiments, the compound has at least one modified internucleoside linkage. In certain embodiments, the internucleoside linkage is a phosphorothioate internucleoside linkage.
In certain embodiments, the compound has at least one nucleoside comprising a modified sugar. In certain embodiments, the at least one modified sugar is a bicyclic sugar. In certain embodiments, the at least one bicyclic sugar comprises a 4′-CH(CH3)—O-2′ bridge. In certain embodiments, the at least one modified sugar comprises a 2′-O-methoxyethyl.
In certain embodiments, the compound comprises at least one at least one tetrahydropyran modified nucleoside wherein a tetrahydropyran ring replaces the furanose ring. In certain embodiments, the at least one tetrahydropyran modified nucleoside has the structure:




wherein Bx is an optionally protected heterocyclic base moiety.

In certain embodiments, the compound has at least one nucleoside comprising a modified nucleobase. In certain embodiments, the modified nucleobase is a 5-methylcytosine.
In certain embodiments, the modified oligonucleotide of the compound comprises:
(i) a gap segment consisting of linked deoxynucleosides;
(ii) a 5′ wing segment consisting of linked nucleosides;
(iii) 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.
In certain embodiments, the modified oligonucleotide of the compound comprises:
(i) a gap segment consisting of ten linked deoxynucleosides;
(ii) a 5′ wing segment consisting of five linked nucleosides;
(iii) a 3′ wing segment consisting of five linked nucleosides, wherein the gap segment is positioned immediately adjacent to and between the 5′ wing segment and the 3′ wing segment, wherein each nucleoside of each wing segment comprises a 2′-O-methoxyethyl sugar; and wherein each internucleoside linkage is a phosphorothioate linkage.
In certain embodiments, the modified oligonucleotide of the compound comprises:
(i) a gap segment consisting of eight linked deoxynucleosides;
(ii) a 5′ wing segment consisting of six linked nucleosides;
(iii) a 3′ wing segment consisting of six linked nucleosides, wherein the gap segment is positioned immediately adjacent to and between the 5′ wing segment and the 3′ wing segment, wherein each nucleoside of each wing segment comprises a 2′-O-methoxyethyl sugar; and wherein each internucleoside linkage is a phosphorothioate linkage.
In certain embodiments, the modified oligonucleotide of the compound comprises:
(i) a gap segment consisting of eight linked deoxynucleosides;
(ii) a 5′ wing segment consisting of five linked nucleosides;
(iii) a 3′ wing segment consisting of five linked nucleosides, wherein the gap segment is positioned immediately adjacent to and between the 5′ wing segment and the 3′ wing segment, wherein each nucleoside of each wing segment comprises a 2′-O-methoxyethyl sugar; and wherein each internucleoside linkage is a phosphorothioate linkage.
In certain embodiments, the modified oligonucleotide of the compound comprises:
(i) a gap segment consisting of ten linked deoxynucleosides;
(ii) a 5′ wing segment consisting of five linked nucleosides;
(iii) a 3′ wing segment consisting of five linked nucleosides, wherein the gap segment is positioned immediately adjacent to and between the 5′ wing segment and the 3′ wing segment, wherein each nucleoside of each wing segment comprises a 2′-O-methoxyethyl sugar; and wherein each internucleoside linkage is a phosphorothioate linkage; and wherein the nucleobase sequence comprises at least 8 contiguous nucleobases of the nucleobase sequence recited in SEQ ID NO: 80.
In certain embodiments, the modified oligonucleotide of the compound comprises:
(i) a gap segment consisting of ten linked deoxynucleosides;
(ii) a 5′ wing segment consisting of five linked nucleosides;
(iii) a 3′ wing segment consisting of five linked nucleosides, wherein the gap segment is positioned immediately adjacent to and between the 5′ wing segment and the 3′ wing segment, wherein each nucleoside of each wing segment comprises a 2′-O-methoxyethyl sugar; and wherein each internucleoside linkage is a phosphorothioate linkage; and wherein the nucleobase sequence is recited in SEQ ID NO: 80.
Certain embodiments provide a composition comprising a compound as described herein, or a salt thereof, and a pharmaceutically acceptable carrier or diluent. In certain embodiments, the composition comprises a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 12 contiguous nucleobases of a nucleobase sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124 or a salt thereof and a pharmaceutically acceptable carrier or diluent.
Certain embodiments provide a composition comprising a compound as described herein, or a salt thereof, and a pharmaceutically acceptable carrier or diluent. In certain embodiments, the composition comprises a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 12 contiguous nucleobases of the nucleobase sequences recited in SEQ ID NO: 80 or a salt thereof and a pharmaceutically acceptable carrier or diluent.
Certain embodiments provide a composition comprising a compound as described herein, wherein the viscosity level is less than 40 cP. In certain embodiments, the composition has a viscosity level less than 15 cP. In certain embodiments, the composition has a viscosity level less than 12 cP. In certain embodiments, the composition has a viscosity level less than 10 cP.
Certain embodiments provide methods of treating, preventing, or ameliorating transthyretin amyloidosis.
Certain embodiments provide methods comprising administering to an animal a compound as described herein to an animal. In certain embodiments, the method comprises administering to an animal a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8 contiguous nucleobases of a nucleobase sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124.
Certain embodiments provide methods comprising administering to an animal a compound as described herein to an animal. In certain embodiments, the method comprises administering to an animal a compound or modified oligonucleotide consisting 12 to 30 linked nucleosides, wherein the linked nucleosides comprise at least an 8 contiguous nucleobase portion complementary to an equal length portion within the region selected from nucleotides 501-535 or 580-608 of SEQ ID NO: 1.
Certain embodiments provide methods comprising administering to an animal a compound as described herein to an animal. In certain embodiments, the method comprises administering to an animal a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8 contiguous nucleobases of a nucleobase sequence recited in SEQ ID NO: 80.
Certain embodiments provide methods comprising administering to an animal a compound as described herein to an animal. In certain embodiments, the method comprises administering to an animal a compound or modified oligonucleotide consisting 12 to 30 linked nucleosides, wherein the linked nucleosides comprise at least an 8 contiguous nucleobase portion complementary to an equal length portion within the region selected from nucleotides 508-527 of SEQ ID NO: 1.
In certain embodiments, the animal is a human.
In certain embodiments, the administering prevents, treats, ameliorates, or slows progression of transthyretin amyloidosis as described herein.
In certain embodiments, the compound is co-administered with a second agent.
In certain embodiments, the compound and the second agent are administered concomitantly.
In certain embodiments, the administering is parenteral administration. In certain embodiments, the parenteral administration is subcutaneous administration. In certain embodiments, the formulation for administering is the compound in saline. In certain embodiments, the compound comprises a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 12 contiguous nucleobases of a nucleobase sequence selected from among the nucleobase sequences recited in SEQ ID NOs: 25, 80, 86, 87, 115, 120, 122, and 124 or a salt thereof and saline. In certain embodiments, the formulation does not include any stabilizing agents or additional stabilizing agents including lipid agents.
In certain embodiments, the administering is parenteral administration. In certain embodiments, the parenteral administration is intracranial administration. In certain embodiments, the intracranial administration is intracerebral, intrathecal, intraventricular, ventricular, intracerebroventricular, cerebral intraventricular or cerebral ventricular administration.
Certain embodiments further provide a method to reduce transthyretin mRNA or protein expression in an animal comprising administering to the animal a compound or composition as described herein to reduce transthyretin mRNA or protein expression in the animal. In certain embodiments, the animal is a human. In certain embodiments, reducing transthyretin mRNA or protein expression prevents, treats, ameliorates, or slows progression of transthyretin amyloidosis.
Certain embodiments provide a method for treating a human with a transthyretin related disease comprising identifying the human with the disease and administering to the human a therapeutically effective amount of a compound or composition as described herein. In certain embodiments, the treatment reduces a symptom selected from the group consisting of restlessness, lack of coordination, nystagmus, spastic paraparesis, lack of muscle coordination, impaired vision, insomnia, unusual sensations, myoclonus, blindness, loss of speech, Carpal tunnel syndrome, seizures, subarachnoid hemorrhages, stroke and bleeding in the brain, hydrocephalus, ataxia, and spastic paralysis, coma, sensory neuropathy, parathesia, hypesthesia, motor neuropathy, autonomic neuropathy, orthostatic hypotension, cyclic constipation, cyclic diarrhea, nausea, vomiting, reduced sweating, impotence, delayed gastric emptying, urinary retention, urinary incontinence, progressive cardiopathy, fatigue, shortness of breath, weight loss, lack of appetite, numbness, tingling, weakness, enlarged tongue, nephrotic syndrome, congestive heart failure, dyspnea on exertion, peripheral edema, arrhythmias, palpitations, light-headedness, syncope, postural hypotension, peripheral nerve problems, sensory motor impairment, lower limb neuropathy, upper limb neuropathy, hyperalgesia, altered temperature sensation, lower extremity weakness, cachexia, peripheral edema, hepatomegaly, purpura, diastolic dysfunction, premature ventricular contractions, cranial neuropathy, diminished deep tendon reflexes, amyloid deposits in the corpus vitreum, vitreous opacity, dry eyes, glaucoma, scalloped appearance in the pupils, swelling of the feet due to water retention. In certain embodiments, the symptom is a cognitive symptom selected from the group consisting of impaired memory, impaired judgment, and thinking, impaired planning, impaired flexibility, impaired abstract thinking, impaired rule acquisition, impaired initiation of appropriate actions, impaired inhibition of inappropriate actions, impaired short-term memory, impaired long-term memory, paranoia, disorientation, confusion, hallucination and dementia. In certain embodiments, the symptom is a psychiatric symptom selected from the group consisting of dementia; anxiety, depression, blunted affect, egocentrisms, aggression, compulsive behavior, irritability, personality changes, including, impaired memory, judgment, and thinking and suicidal ideation.
Further embodiments provide a method of treating a human with transthyretin amyloidosis leading to cardiac amyloidosis and administering to the human a therapeutically effective amount of a compound or composition as described herein. In certain embodiments, the treatment reduces a symptom selected from the group consisting of congestive heart failure, cardiomegaly, dyspnea on exertion, peripheral edema, arrhythmias, palpitations, lightheadedness, syncope, deposition in the subendothelium of the peripheral vasculature can lead to severe postural hypotension, diastolic dysfunction, heart block, premature ventricular contractions, and various tachyarrhythmias.
Further embodiments provide a method of treating a human with transthyretin amyloidosis leading to peripheral neuropathic disorders and administering to the human a therapeutically effective amount of a compound or composition as described herein. In certain embodiments, the treatment reduces a symptom selected from the group consisting of peripheral nerve problems, sensorimotor impairment, lower-limb neuropathy, upper-limb neuropathy, hyperalgesia, altered temperature sensation, lower extremity weakness, pain, autonomic dysfunction, often manifested as sexual or urinary dysfunction, symmetric sensory impairment and weakness, orthostatic hypotension, diarrhea, and/or impotence.
Further embodiments provide a method of treating a human with transthyretin amyloidosis leading to gastrointestinal disorders and administering to the human a therapeutically effective amount of a compound or composition a described herein. In certain embodiments, the treatment reduces a symptom selected from the group consisting of diarrhea, constipation, nausea, vomiting, and related kidney and liver disorders.
Further provided is a method for reducing or preventing transthyretin amyloidosis comprising administering to a human a therapeutically effective amount compound or composition as described herein, thereby reducing or preventing transthyretin amyloidosis.
Further provided is a method for reducing or preventing a cardiac disease comprising administering to a human a therapeutically effective amount compound or composition as described herein, thereby reducing or preventing a cardiac disease. Further provided is a method for reducing or preventing a neuropathic disease comprising administering to a human a therapeutically effective amount compound or composition as described herein, thereby reducing or preventing a neuropathic disease. Further provided is a method for reducing or preventing a gastrointestinal disease comprising administering to a human a therapeutically effective amount compound or composition as described herein, thereby reducing or preventing a gastrointestinal disease.
Further provided is a method for ameliorating a symptom of transthyretin amyloidosis, comprising administering to a human in need thereof a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides, wherein said modified oligonucleotide specifically hybridizes to SEQ ID NO: 1, 2, or 4, thereby ameliorating a symptom of transthyretin amyloidosis in the human.
Further provided is a method for reducing the rate of progression of a symptom associated with transthyretin amyloidosis, comprising administering to a human in need thereof a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides, wherein said modified oligonucleotide specifically hybridizes to SEQ ID NO: 1, 2, or 4, thereby reducing the rate of progression a symptom of transthyretin amyloidosis in the human.
Further provided is a method for reversing degeneration indicated by a symptom associated with a transthyretin amyloidosis, administering to a human in need thereof a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides, wherein said modified oligonucleotide specifically hybridizes to SEQ ID NO: 1, 2, or 4, thereby reversing degeneration indicated by a symptom of transthyretin amyloid disease in the human.
Further provided is a method for ameliorating a symptom of transthyretin amyloidosis, comprising administering to a human in need thereof a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8 contiguous nucleobases of a nucleobase sequence recited in SEQ ID NO: 80, thereby ameliorating a symptom of transthyretin amyloidosis in the human.
Further embodiments provide a method of treating a human with transthyretin amyloidosis, administering to a human in need thereof a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8 contiguous nucleobases of a nucleobase sequence recited in SEQ ID NO: 80, thereby treating transthyretin amyloidosis in a human.
In certain embodiments, the symptom is a physical, cognitive, psychiatric, or peripheral symptom. In certain embodiments, the symptom is a physical symptom selected from the group consisting of restlessness, lack of coordination, nystagmus, spastic paraparesis, lack of muscle coordination, impaired vision, insomnia, unusual sensations, myoclonus, blindness, loss of speech, Carpal tunnel syndrome, seizures, subarachnoid hemorrhages, stroke and bleeding in the brain, hydrocephalus, ataxia, and spastic paralysis, coma, sensory neuropathy, parathesia, hypesthesia, motor neuropathy, autonomic neuropathy, orthostatic hypotension, cyclic constipation, cyclic diarrhea, nausea, vomiting, reduced sweating, impotence, delayed gastric emptying, urinary retention, urinary incontinence, progressive cardiopathy, fatigue, shortness of breath, weight loss, lack of appetite, numbness, tingling, weakness, enlarged tongue, nephrotic syndrome, congestive heart failure, dyspnea on exertion, peripheral edema, arrhythmias, palpitations, light-headedness, syncope, postural hypotension, peripheral nerve problems, sensory motor impairment, lower limb neuropathy, upper limb neuropathy, hyperalgesia, altered temperature sensation, lower extremity weakness, cachexia, peripheral edema, hepatomegaly, purpura, diastolic dysfunction, premature ventricular contractions, cranial neuropathy, diminished deep tendon reflexes, amyloid deposits in the corpus vitreum, vitreous opacity, dry eyes, glaucoma, scalloped appearance in the pupils, swelling of the feet due to water retention. In certain embodiments, the symptom is a cognitive symptom selected from the group consisting of impaired memory, impaired judgment, and thinking, impaired planning, impaired flexibility, impaired abstract thinking, impaired rule acquisition, impaired initiation of appropriate actions, impaired inhibition of inappropriate actions, impaired short-term memory, impaired long-term memory, paranoia, disorientation, confusion, hallucination and dementia. In certain embodiments, the symptom is a psychiatric symptom selected from the group consisting of dementia; anxiety, depression, blunted affect, egocentrisms, aggression, compulsive behavior, irritability, personality changes, including, impaired memory, judgment, and thinking and suicidal ideation.
In certain embodiments the symptom is at least one of at least one physical symptom, at least one cognitive symptom, at least one psychiatric symptom, and at least one peripheral symptom.
In certain embodiments the physical symptom is selected from the group consisting of restlessness, lack of coordination, unintentionally initiated motions, unintentionally uncompleted motions, unsteady gait, chorea, rigidity, writhing motions, abnormal posturing, instability, abnormal facial expressions, difficulty chewing, difficulty swallowing, difficulty speaking, seizure, and sleep disturbances.
In certain embodiments the cognitive symptom is selected from the group consisting of impaired memory, impaired judgment, and thinking, impaired planning, impaired flexibility, impaired abstract thinking, impaired rule acquisition, impaired initiation of appropriate actions, impaired inhibition of inappropriate actions, impaired short-term memory, impaired long-term memory, paranoia, disorientation, confusion, hallucination and dementia.
In certain embodiments the psychiatric symptom is selected from the group consisting of dementia; anxiety, depression, blunted affect, egocentrisms, aggression, compulsive behavior, irritability, personality changes, including, impaired memory, judgment, and thinking and suicidal ideation.
In certain embodiments the peripheral symptom is selected from the group consisting of reduced brain mass, muscle atrophy, cardiac failure, impaired glucose tolerance, weight loss, osteoporosis, and testicular atrophy.
Also provided are methods and compounds for the preparation of a medicament for the treatment, prevention, or amelioration of a central nervous system related disease.
Certain embodiments provide the use of a compound as described herein in the manufacture of a medicament for treating, ameliorating, or preventing a transthyretin amyloidosis.
Certain embodiments provide a compound as described herein for use in treating, preventing, or ameliorating transthyretin amyloidosis as described herein by combination therapy with an additional agent or therapy as described herein. Agents or therapies can be co-administered or administered concomitantly.
Certain embodiments provide the use of a compound as described herein in the manufacture of a medicament for treating, preventing, or ameliorating transthyretin amyloidosis as described herein by combination therapy with an additional agent or therapy as described herein. Agents or therapies can be co-administered or administered concomitantly.
Certain embodiments provide the use of a compound as described herein in the manufacture of a medicament for treating, preventing, or ameliorating transthyretin amyloidosis as described herein in a patient who is subsequently administered an additional agent or therapy as described herein.
Certain embodiments provide a kit for treating, preventing, or ameliorating transthyretin amyloidosis as described herein wherein the kit comprises:
(i) a compound as described herein; and alternatively
(ii) an additional agent or therapy as described herein.
A kit as described herein may further include instructions for using the kit to treat, prevent, or ameliorate transthyretin amyloidosis as described herein by combination therapy as described herein.
Antisense Compounds
Oligomeric compounds include, but are not limited to, oligonucleotides, oligonucleosides, oligonucleotide analogs, oligonucleotide mimetics, antisense compounds, antisense oligonucleotides, and siRNAs. An oligomeric compound may be “antisense” to a target nucleic acid, meaning that is capable of undergoing hybridization to a target nucleic acid through hydrogen bonding.
In certain embodiments, an antisense compound has 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 such embodiments, an antisense oligonucleotide has 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, an antisense compound targeted to a transthyretin nucleic acid is 12 to 30 nucleotides in length. In other words, antisense compounds are from 12 to 30 linked nucleobases. In other embodiments, the antisense compound comprises a modified oligonucleotide consisting of 8 to 80, 12 to 50, 12 to 30, 15 to 30, 18 to 24, 18 to 21, 19 to 22, or 20 linked nucleobases. In certain such embodiments, the antisense compound comprises a modified oligonucleotide consisting of 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 nucleobases in length, or a range defined by any two of the above values.
In certain embodiments, the antisense compound comprises a shortened or truncated modified oligonucleotide. The shortened or truncated modified oligonucleotide can have a single nucleoside deleted from the 5′ end (5′ truncation), or alternatively from the 3′ end (3′ truncation). A shortened or truncated oligonucleotide may have two nucleosides deleted from the 5′ end, or alternatively may have two subunits deleted from the 3′ end. Alternatively, the deleted nucleosides may be dispersed throughout the modified oligonucleotide, for example, in an antisense compound having one nucleoside deleted from the 5′ end and one nucleoside deleted from the 3′ end.
When a single additional nucleoside is present in a lengthened oligonucleotide, the additional nucleoside may be located at the 5′ or 3′ end of the oligonucleotide. When two or more additional nucleosides are present, the added nucleosides may be adjacent to each other, for example, in an oligonucleotide having two nucleosides added to the 5′ end (5′ addition), or alternatively to the 3′ end (3′ addition), of the oligonucleotide. Alternatively, the added nucleoside may be dispersed throughout the antisense compound, for example, in an oligonucleotide having one nucleoside added to the 5′ end and one subunit added to the 3′ end.
It is possible to increase or decrease the length of an antisense compound, such as an antisense 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.
Antisense Compound Motifs
In certain embodiments, antisense compounds targeted to a transthyretin nucleic acid have chemically modified subunits arranged in patterns, or motifs, to confer to the antisense compounds properties such as enhanced the inhibitory activity, increased binding affinity for a target nucleic acid, or resistance to degradation by in vivo nucleases.
Chimeric antisense compounds 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 antisense compound may optionally serve as a substrate for the cellular endonuclease RNase H, which cleaves the RNA strand of an RNA:DNA duplex.
Antisense compounds having a gapmer motif are considered chimeric antisense compounds. In a gapmer an internal region having a plurality of nucleotides or linked nucleosides that supports RNaseH cleavage is positioned between external regions having a plurality of nucleotides or linked nucleosides that are chemically distinct from the nucleotides or linked nucleosides of the internal region. In the case of an antisense oligonucleotide having a gapmer motif, the gap segment generally serves as the substrate for endonuclease cleavage, while the wing segments comprise 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 antisense compounds described herein can have 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 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, 2-8-2, 6-8-6 or 5-8-5.
In certain embodiments, the antisense compound as 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 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 a transthyretin nucleic acid possess a 5-10-5 gapmer motif.
In certain embodiments, antisense compounds targeted to a transthyretin nucleic acid possess a 6-8-6 gapmer motif.
In certain embodiments, antisense compounds targeted to a transthyretin nucleic acid possess a 5-8-5 gapmer motif.
In certain embodiments, an antisense compound targeted to a transthyretin nucleic acid has a gap-widened motif.
In certain embodiments, a gap-widened antisense oligonucleotide targeted to a transthyretin nucleic acid has a gap segment of ten 2′-deoxyribonucleotides positioned immediately adjacent to and between wing segments of five chemically modified nucleosides. In certain embodiments, the chemical modification comprises a 2′-sugar modification. In another embodiment, the chemical modification comprises a 2′-MOE sugar modification.
In certain embodiments, a gap-widened antisense oligonucleotide targeted to a transthyretin nucleic acid has a gap segment of eight 2′-deoxyribonucleotides positioned immediately adjacent to and between wing segments of five chemically modified nucleosides. In certain embodiments, the chemical modification comprises a 2′-sugar modification. In another embodiment, the chemical modification comprises a 2′-MOE sugar modification.
In certain embodiments, a gap-widened antisense oligonucleotide targeted to a transthyretin nucleic acid has a gap segment of eight 2′-deoxyribonucleotides positioned immediately adjacent to and between wing segments of six chemically modified nucleosides. In certain embodiments, the chemical modification comprises a 2′-sugar modification. In another embodiment, the chemical modification comprises a 2′-MOE sugar modification.
Target Nucleic Acids, Target Regions and Nucleotide Sequences
In certain embodiments, the transthyretin nucleic acid is any of the sequences set forth in GENBANK Accession No. NM_000371.2, first deposited with GENBANK® on Feb. 13, 2008 (incorporated herein as SEQ ID NO: 1), GENBANK Accession No. NT_010966.10 truncated from nucleotides 2009236 to 2017289, first deposited with GENBANK® on Aug. 1, 2002 (incorporated herein as SEQ ID NO: 2); exons 1-4 extracted from the rhesus monkey genomic sequence GENBANK Accession No. NW_001105671.1, based on similarity to human exons; and GENBANK Accession No. NW_001105671.1 truncated from nucleotides 628000 to 638000 (incorporated herein as SEQ ID NO: 4), first deposited with GENBANK® on Mar. 28, 2006.
It is understood that the sequence set forth in each SEQ ID NO in the Examples contained herein is independent of any 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) or ISIS NO indicate a combination of nucleobase sequence and motif.
In certain embodiments, a target region is a structurally defined region of the target nucleic acid. For example, a target region may encompass a 3′ UTR, a 5′ UTR, an exon, an intron, an exon/intron junction, a coding region, a translation initiation region, translation termination region, or other defined nucleic acid region. The structurally defined regions for transthyretin can be obtained by accession number from sequence databases such as NCBI and such information is incorporated herein by reference. In certain embodiments, a target region may encompass the sequence from a 5′ target site of one target segment within the target region to a 3′ target site of another target segment within the target region.
Targeting includes determination of at least one target segment to which an antisense compound hybridizes, such that a desired effect occurs. In certain embodiments, the desired effect is a reduction in mRNA target nucleic acid levels. In certain embodiments, the desired effect is reduction of levels of protein encoded by the target nucleic acid or a phenotypic change associated with the target nucleic acid.
A target region may contain one or more target segments. Multiple target segments within a target region may be overlapping. Alternatively, they may be non-overlapping. In certain embodiments, target segments within a target region are separated by no more than about 300 nucleotides. In certain embodiments, target segments within a target region are separated by a number of nucleotides that is, is about, is no more than, is no more than about, 250, 200, 150, 100, 90, 80, 70, 60, 50, 40, 30, 20, or 10 nucleotides on the target nucleic acid, or is a range defined by any two of the preceding values. In certain embodiments, target segments within a target region are separated by no more than, or no more than about, 5 nucleotides on the target nucleic acid. In certain embodiments, target segments are contiguous. Contemplated are target regions defined by a range having a starting nucleic acid that is any of the 5′ target sites or 3′ target sites listed herein.
Suitable target segments may be found within a 5′ UTR, a coding region, a 3′ UTR, an intron, an exon, or an exon/intron junction. Target segments containing a start codon or a stop codon are also suitable target segments. A suitable target segment may specifically exclude a certain structurally defined region such as the start codon or stop codon.
The determination of suitable target segments may include a comparison of the sequence of a target nucleic acid to other sequences throughout the genome. For example, the BLAST algorithm may be used to identify regions of similarity amongst different nucleic acids. This comparison can prevent the selection of antisense compound sequences that may hybridize in a non-specific manner to sequences other than a selected target nucleic acid (i.e., non-target or off-target sequences).
There may be variation in activity (e.g., as defined by percent reduction of target nucleic acid levels) of the antisense compounds within an active target region. In certain embodiments, reductions in transthyretin mRNA levels are indicative of inhibition of transthyretin expression. Reductions in levels of a transthyretin protein are also indicative of inhibition of target mRNA expression. Further, phenotypic changes are indicative of inhibition of transthyretin expression. For example, increase in brain size to normal, improvement in motor coordination, decrease in continual muscular spasms (dystonia), decrease in irritability and/or anxiety, improvement of memory, or an increase in energy, among other phenotypic changes that may be assayed. Other phenotypic indications, e.g., symptoms associated with transthyretin amyloidosis, may also be assessed as described below.
Hybridization
In some embodiments, hybridization occurs between an antisense compound disclosed herein and a transthyretin 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 a transthyretin 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 a transthyretin nucleic acid).
An antisense compound may hybridize over one or more segments of a transthyretin 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 a transthyretin 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 complementarity 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 a transthyretin 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 a transthyretin 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 a transthyretin 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.
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 a transthyretin 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 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)(R2) (R, R1 and R2 are each independently 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, 2′-OCH2CH3, 2′-OCH2CH2F 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, OCH2F, O(CH2)2SCH3, O(CH2)2—O—N(Rm)(Rn), O—CH2—C(═O)—N(Rm)(Rn), and O—CH2—C(═O)—N(Rl)—(CH2)2—N(Rm)(Rn), where each Rl, Rm and Rn is, independently, H or substituted or unsubstituted C1-C10 alkyl.
As used herein, “bicyclic nucleosides” refer to modified nucleosides comprising a bicyclic sugar moiety. Examples of bicyclic nucleosides 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 bicyclic nucleosides comprising a 4′ to 2′ bridge. Examples of such 4′ to 2′ bridged bicyclic nucleosides, include but are not limited to one of the formulae: 4′-(CH2)—O-2′ (LNA); 4′-(CH2)—S-2; 4′-(CH2)2—O-2′ (ENA); 4′-CH(CH3)—O-2′ and 4′-CH(CH2OCH3)—O-2′ (and analogs thereof see U.S. Pat. No. 7,399,845, issued on Jul. 15, 2008); 4′-C(CH3)(CH3)—O-2′ (and analogs thereof see published International Application WO/2009/006478, published Jan. 8, 2009); 4′-CH2—N(OCH3)-2′ (and analogs thereof see published International Application WO/2008/150729, published Dec. 11, 2008); 4′-CH2—O—N(CH3)-2′ (see published U.S. Patent Application US2004-0171570, published Sep. 2, 2004); 4′-CH2—N(R)—O-2′, wherein R is H, C1-C12 alkyl, or a protecting group (see U.S. Pat. No. 7,427,672, issued on Sep. 23, 2008); 4′-CH2—C(H)(CH3)-2′ (see Chattopadhyaya et al., J. Org. Chem., 2009, 74, 118-134); and 4′-CH2—C—(═CH2)-2′ (and analogs thereof see published International Application WO 2008/154401, published on Dec. 8, 2008).
Further reports related to bicyclic nucleosides can also be found in published literature (see for example: Singh et al., Chem. Commun., 1998, 4, 455-456; Koshkin et al., Tetrahedron, 1998, 54, 3607-3630; Wahlestedt et al., Proc. Natl. Acad. Sci. U.S.A., 2000, 97, 5633-5638; Kumar et al., Bioorg. Med. Chem. Lett., 1998, 8, 2219-2222; Singh et al., J. Org. Chem., 1998, 63, 10035-10039; Srivastava et al., J. Am. Chem. Soc., 2007, 129(26) 8362-8379; Elayadi et al., Curr. Opinion Invest. Drugs, 2001, 2, 558-561; Braasch et al., Chem. Biol., 2001, 8, 1-7; and Orum et al., Curr. Opinion Mol. Ther., 2001, 3, 239-243; U.S. Pat. Nos. 6,268,490; 6,525,191; 6,670,461; 6,770,748; 6,794,499; 7,034,133; 7,053,207; 7,399,845; 7,547,684; and 7,696,345; U.S. Patent Publication No. US2008-0039618; US2009-0012281; U.S. Patent Ser. Nos. 60/989,574; 61/026,995; 61/026,998; 61/056,564; 61/086,231; 61/097,787; and 61/099,844; Published PCT International applications WO 1994/014226; WO 2004/106356; WO 2005/021570; WO 2007/134181; WO 2008/150729; WO 2008/154401; and WO 2009/006478. Each of the foregoing bicyclic nucleosides can be prepared having one or more 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, bicyclic sugar moieties of BNA nucleosides include, but are not limited to, compounds having at least one bridge between the 4′ and the 2′ position of the pentofuranosyl sugar moiety wherein such bridges independently comprises 1 or from 2 to 4 linked groups independently selected from —[C(Ra)(Rb)]n—, —C(Ra)═C(Rb)—, —C(Ra)═N—, —C(═O)—, —C(═NRa)—, —C(═S)—, —O—, —Si(Ra)2—, —S(═O)x—, and —N(Ra)—;
wherein:
x is 0, 1, or 2;
n is 1, 2, 3, or 4;
each Ra and Rb is, independently, H, a protecting group, hydroxyl, C1-C12 alkyl, substituted C1-C12 alkyl, C2-C12 alkenyl, substituted C2-C12 alkenyl, C2-C12 alkynyl, substituted C2-C12 alkynyl, C5-C20 aryl, substituted C5-C20 aryl, heterocycle radical, substituted heterocycle radical, heteroaryl, substituted heteroaryl, C5-C7 alicyclic radical, substituted C5-C7 alicyclic radical, halogen, OJ1, NJ1J2, SJ1, N3, COOJ1, acyl (C(═O)—H), substituted acyl, CN, sulfonyl (S(═O)2-J1), or sulfoxyl (S(═O)-J1); and
each J1 and J2 is, independently, H, C1-C12 alkyl, substituted C1-C12 alkyl, C2-C12 alkenyl, substituted C2-C12 alkenyl, C2-C12 alkynyl, substituted C2-C12 alkynyl, C5-C20 aryl, substituted C5-C20 aryl, acyl (C(═O)—H), substituted acyl, a heterocycle radical, a substituted heterocycle radical, C1-C12 aminoalkyl, substituted C1-C12 aminoalkyl or a protecting group.
In certain embodiments, the bridge of a bicyclic sugar moiety is —[C(Ra)(Rb)]n—, —[C(Ra)(Rb)]n—O—, —C(RaRb)—N(R)—O— or —C(RaRb)—O—N(R)—. In certain embodiments, the bridge is 4′-CH2-2′, 4′-(CH2)2-2′, 4′-(CH2)3-2′, 4′-CH2—O-2′, 4′-(CH2)2—O-2′, 4′-CH2—O—N(R)-2′ and 4′-CH2—N(R)—O-2′- wherein each R is, independently, H, a protecting group or C1-C12 alkyl.
In certain embodiments, bicyclic nucleosides are further defined by isomeric configuration. For example, a nucleoside comprising a 4′-2′ methylene-oxy bridge, may be in the α-L configuration or in the β-D configuration. Previously, α-L-methyleneoxy (4′-CH2—O-2′) BNA's have been incorporated into antisense oligonucleotides that showed antisense activity (Frieden et al., Nucleic Acids Research, 2003, 21, 6365-6372).
In certain embodiments, bicyclic nucleosides include, but are not limited to, (A) α-L-methyleneoxy (4′-CH2—O-2′) BNA, (B) β-D-methyleneoxy (4′-CH2—O-2′) BNA, (C) ethyleneoxy (4′-(CH2)2—O-2′) BNA, (D) aminooxy (4′-CH2—O—N(R)-2′) BNA, (E) oxyamino (4′-CH2—N(R)—O-2′) BNA, and (F) methyl(methyleneoxy) (4′-CH(CH3)—O-2′) BNA, (G) methylene-thio (4′-CH2—S-2′) BNA, (H) methylene-amino (4′-CH2—N(R)-2′) BNA, (I) methyl carbocyclic (4′-CH2—CH(CH3)-2′) BNA, and (J) propylene carbocyclic (4′-(CH2)3-2′) BNA as depicted below.







wherein Bx is the base moiety and R is independently H, a protecting group or C1-C12 alkyl.

In certain embodiments, bicyclic nucleosides are provided having Formula I:




wherein:

Bx is a heterocyclic base moiety;
-Qa-Qb-Qc- is —CH2—N(Rc)—CH2—, —C(═O)—N(Rc)—CH2—, —CH2—O—N(Rc)—, —CH2—N(Rc)—O— or —N(Rc)—O—CH2;
Rc is C1-C12 alkyl or an amino protecting group; and
Ta and Tb are each, independently H, a hydroxyl protecting group, a conjugate group, a reactive phosphorus group, a phosphorus moiety or a covalent attachment to a support medium.
In certain embodiments, bicyclic nucleosides are provided having Formula II:




wherein:

Bx is a heterocyclic base moiety;
Ta and Tb are each, independently H, a hydroxyl protecting group, a conjugate group, a reactive phosphorus group, a phosphorus moiety or a covalent attachment to a support medium;
Za is C1-C6 alkyl, C2-C6 alkenyl, C2-C6 alkynyl, substituted C1-C6 alkyl, substituted C2-C6 alkenyl, substituted C2-C6 alkynyl, acyl, substituted acyl, substituted amide, thiol or substituted thio.
In one embodiment, each of the substituted groups is, independently, mono or poly substituted with substituent groups independently selected from halogen, oxo, hydroxyl, OJc, NJcJd, SJc, N3, OC(═X)Jc, and NJeC(═X)NJcJd, wherein each Jc, Jd and Je is, independently, H, C1-C6 alkyl, or substituted C1-C6 alkyl and X is O or NJc.
In certain embodiments, bicyclic nucleosides are provided having Formula III:




wherein:

Bx is a heterocyclic base moiety;
Ta and Tb are each, independently H, a hydroxyl protecting group, a conjugate group, a reactive phosphorus group, a phosphorus moiety or a covalent attachment to a support medium;
Zb is C1-C6 alkyl, C2-C6 alkenyl, C2-C6 alkynyl, substituted C1-C6 alkyl, substituted C2-C6 alkenyl, substituted C2-C6 alkynyl or substituted acyl (C(═O)—).
In certain embodiments, bicyclic nucleosides are provided having Formula IV:




wherein:

Bx is a heterocyclic base moiety;
Ta and Tb are each, independently H, a hydroxyl protecting group, a conjugate group, a reactive phosphorus group, a phosphorus moiety or a covalent attachment to a support medium;
Rd is C1-C6 alkyl, substituted C1-C6 alkyl, C2-C6 alkenyl, substituted C2-C6 alkenyl, C2-C6 alkynyl or substituted C2-C6 alkynyl;
each qa, qb, qc and qd is, independently, H, halogen, C1-C6 alkyl, substituted C1-C6 alkyl, C2-C6 alkenyl, substituted C2-C6 alkenyl, C2-C6 alkynyl or substituted C2-C6 alkynyl, C1-C6 alkoxyl, substituted C1-C6 alkoxyl, acyl, substituted acyl, C1-C6 aminoalkyl or substituted C1-C6 aminoalkyl;
In certain embodiments, bicyclic nucleosides are provided having Formula V:




wherein:

Bx is a heterocyclic base moiety;
Ta and Tb are each, independently H, a hydroxyl protecting group, a conjugate group, a reactive phosphorus group, a phosphorus moiety or a covalent attachment to a support medium;
qa, qb, qe and qf are each, independently, hydrogen, halogen, C1-C12 alkyl, substituted C1-C12 alkyl, C2-C12 alkenyl, substituted C2-C12 alkenyl, C2-C12 alkynyl, substituted C2-C12 alkynyl, C1-C12 alkoxy, substituted C1-C12 alkoxy, OJj, SJj, SOJj, SO2Jj, NJjJk, N3, CN, C(═O)OJj, C(═O)NJjJk, C(═O)Jj, O—C(═O)NJjJk, N(H)C(═NH)NJjJk, N(H)C(═O)NJjJk or N(H)C(═S)NJjJk;
or qe and qf together are ═C(qg)(qh);
qg and qh are each, independently, H, halogen, C1-C12 alkyl or substituted C1-C12 alkyl.
The synthesis and preparation of the methyleneoxy (4′-CH2—O-2′) BNA monomers adenine, cytosine, guanine, 5-methyl-cytosine, thymine and uracil, along with their oligomerization, and nucleic acid recognition properties have been described (Koshkin et al., Tetrahedron, 1998, 54, 3607-3630). BNAs and preparation thereof are also described in WO 98/39352 and WO 99/14226.
Analogs of methyleneoxy (4′-CH2—O-2′) BNA and 2′-thio-BNAs, have also been prepared (Kumar et al., Bioorg. Med. Chem. Lett., 1998, 8, 2219-2222). Preparation of locked nucleoside analogs comprising oligodeoxyribonucleotide duplexes as substrates for nucleic acid polymerases has also been described (Wengel et al., WO 99/14226). Furthermore, synthesis of 2′-amino-BNA, a novel comformationally restricted high-affinity oligonucleotide analog has been described in the art (Singh et al., J. Org. Chem., 1998, 63, 10035-10039). In addition, 2′-amino- and 2′-methylamino-BNA's have been prepared and the thermal stability of their duplexes with complementary RNA and DNA strands has been previously reported.
In certain embodiments, bicyclic nucleosides are provided having Formula VI:




wherein:

Bx is a heterocyclic base moiety;
Ta and Tb are each, independently H, a hydroxyl protecting group, a conjugate group, a reactive phosphorus group, a phosphorus moiety or a covalent attachment to a support medium;
each qi, qj, qk and ql is, independently, H, halogen, C1-C12 alkyl, substituted C1-C12 alkyl, C2-C12 alkenyl, substituted C2-C12 alkenyl, C2-C12 alkynyl, substituted C2-C12 alkynyl, C1-C12 alkoxyl, substituted C1-C12 alkoxyl, OJj, SJj, SOJj, SO2Jj, NJkJk, N3, CN, C(═O)OJj, C(═O)NJjJk, C(═O)Jj, O—C(═O)NJjJk, N(H)C(═NH)NJjJk, N(H)C(═O)NJjJk or N(H)C(═S)NJjJk; and
qi and qj or ql and qk together are ═C(qg)(qh), wherein qg and qh are each, independently, H, halogen, C1-C12 alkyl or substituted C1-C12 alkyl.
One carbocyclic bicyclic nucleoside having a 4′-(CH2)3-2′ bridge and the alkenyl analog bridge 4′-CH═CH—CH2-2′ have been described (Freier et al., Nucleic Acids Research, 1997, 25(22), 4429-4443 and Albaek et al., J. Org. Chem., 2006, 71, 7731-7740). The synthesis and preparation of carbocyclic bicyclic nucleosides along with their oligomerization and biochemical studies have also been described (Srivastava et al., J. Am. Chem. Soc., 2007, 129(26), 8362-8379).
As used herein, “4′-2′ bicyclic nucleoside” or “4′ to 2′ bicyclic nucleoside” refers to a bicyclic nucleoside comprising a furanose ring comprising a bridge connecting two carbon atoms of the furanose ring connects the 2′ carbon atom and the 4′ carbon atom of the sugar ring.
As used herein, “monocylic nucleosides” refer to nucleosides comprising modified sugar moieties that are not bicyclic sugar moieties. In certain embodiments, the sugar moiety, or sugar moiety analogue, of a nucleoside may be modified or substituted at any position.
As used herein, “2′-modified sugar” means a furanosyl sugar modified at the 2′ position. In certain embodiments, such modifications include substituents selected from: a halide, including, but not limited to substituted and unsubstituted alkoxy, substituted and unsubstituted thioalkyl, substituted and unsubstituted amino alkyl, substituted and unsubstituted alkyl, substituted and unsubstituted allyl, and substituted and unsubstituted alkynyl. In certain embodiments, 2′ modifications are selected from substituents including, but not limited to: O[(CH2)nO]mCH3, O(CH2)nNH2, O(CH2)nCH3, O(CH2)nF, O(CH2)nONH2, OCH2C(═O)N(H)CH3, and O(CH2)nON[(CH2)nCH3]2, where n and m are from 1 to about 10. Other 2′-substituent groups can also be selected from: C1-C12 alkyl, substituted alkyl, alkenyl, alkynyl, alkaryl, aralkyl, O-alkaryl or O-aralkyl, SH, SCH3, OCN, Cl, Br, CN, F, CF3, OCF3, SOCH3, SO2CH3, ONO2, NO2, N3, NH2, heterocycloalkyl, heterocycloalkaryl, aminoalkylamino, polyalkylamino, substituted silyl, an RNA cleaving group, a reporter group, an intercalator, a group for improving pharmacokinetic properties, or a group for improving the pharmacodynamic properties of an antisense compound, and other substituents having similar properties. In certain embodiments, modified nucleosides comprise a 2′-MOE side chain (Baker et al., J. Biol. Chem., 1997, 272, 11944-12000). Such 2′-MOE substitution have been described as having improved binding affinity compared to unmodified nucleosides and to other modified nucleosides, such as 2′-O-methyl, O-propyl, and O-aminopropyl. Oligonucleotides having the 2′-MOE substituent also have been shown to be antisense inhibitors of gene expression with promising features for in vivo use (Martin, Helv. Chim. Acta, 1995, 78, 486-504; Altmann et al., Chimia, 1996, 50, 168-176; Altmann et al., Biochem. Soc. Trans., 1996, 24, 630-637; and Altmann et al., Nucleosides Nucleotides, 1997, 16, 917-926).
As used herein, a “modified tetrahydropyran nucleoside” or “modified THP nucleoside” means a nucleoside having a six-membered tetrahydropyran “sugar” substituted in for the pentofuranosyl residue in normal nucleosides (a sugar surrogate). Modified THP nucleosides include, but are not limited to, what is referred to in the art as hexitol nucleic acid (HNA), anitol nucleic acid (ANA), manitol nucleic acid (MNA) (see Leumann, Bioorg. Med. Chem., 2002, 10, 841-854), fluoro HNA (F-HNA) or those compounds having Formula VII:




wherein independently for each of said at least one tetrahydropyran nucleoside analog of Formula VII:

Bx is a heterocyclic base moiety;
Ta and Tb are each, independently, an internucleoside linking group linking the tetrahydropyran nucleoside analog to the antisense compound or one of Ta and Tb is an internucleoside linking group linking the tetrahydropyran nucleoside analog to the antisense compound and the other of Ta and Tb is H, a hydroxyl protecting group, a linked conjugate group or a 5′ or 3′-terminal group;
q1, q2, q3, q4, q5, q6 and q7 are each independently, H, C1-C6 alkyl, substituted C1-C6 alkyl, C2-C6 alkenyl, substituted C2-C6 alkenyl, C2-C6 alkynyl or substituted C2-C6 alkynyl; and each of R1 and R2 is selected from hydrogen, hydroxyl, halogen, substituted or unsubstituted alkoxy, NJ1J2, SJ1, N3, OC(═X)J1, OC(═X)NJ1J2, NJ3C(═X)NJ1J2 and CN, wherein X is O, S or NJ1 and each J1, J2 and J3 is, independently, H or C1-C6 alkyl.
In certain embodiments, the modified THP nucleosides of Formula VII are provided wherein q1, q2, q3, q4, q5, q6 and q7 are each H. In certain embodiments, at least one of q1, q2, q3, q4, q5, q6 and q7 is other than H. In certain embodiments, at least one of q1, q2, q3, q4, q5, q6 and q7 is methyl. In certain embodiments, THP nucleosides of Formula VII are provided wherein one of R1 and R2 is fluoro. In certain embodiments, R1 is fluoro and R2 is H; R1 is methoxy and R2 is H, and R1 is H and R2 is methoxyethoxy.
As used herein, “2′-modified” or “2′-substituted” refers to a nucleoside comprising a sugar comprising a substituent at the 2′ position other than H or OH. 2′-modified nucleosides, include, but are not limited to, bicyclic nucleosides wherein the bridge connecting two carbon atoms of the sugar ring connects the 2′ carbon and another carbon of the sugar ring; and nucleosides with non-bridging 2′ substituents, such as allyl, amino, azido, thio, O-allyl, O—C1-C10 alkyl, —OCF3, O—(CH2)2—O—CH3, 2′-O(CH2)2SCH3, O—(CH2)2—O—N(Rm)(Rn), or O—CH2—C(═O)—N(Rm)(Rn), where each Rm and Rn is, independently, H or substituted or unsubstituted C1-C10 alkyl. 2′-modified nucleosides may further comprise other modifications, for example at other positions of the sugar and/or at the nucleobase.
As used herein, “2′-F” refers to a nucleoside comprising a sugar comprising a fluoro group at the 2′ position.
As used herein, “2′-OMe” or “2′-OCH3” or “2′-O-methyl” each refers to a nucleoside comprising a sugar comprising an —OCH3 group at the 2′ position of the sugar ring.
As used herein, “MOE” or “2′-MOE” or “2′-OCH2CH2OCH3” or “2′-O-methoxyethyl” each refers to a nucleoside comprising a sugar comprising a —OCH2CH2OCH3 group at the 2′ position of the sugar ring.
As used herein, “oligonucleotide” refers to a compound comprising a plurality of linked nucleosides. In certain embodiments, one or more of the plurality of nucleosides is modified. In certain embodiments, an oligonucleotide comprises one or more ribonucleosides (RNA) and/or deoxyribonucleosides (DNA).
Many other bicyclo and tricyclo sugar surrogate ring systems are also known in the art that can be used to modify nucleosides for incorporation into antisense compounds (see for example review article: Leumann, Bioorg. Med. Chem., 2002, 10, 841-854).
Such ring systems can undergo various additional substitutions to enhance activity.
Methods for the preparations of modified sugars are well known to those skilled in the art.
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 comprise one or more nucleosides having modified sugar moieties. In certain embodiments, the modified sugar moiety is 2′-MOE. In certain embodiments, the 2′-MOE modified nucleosides are arranged in a gapmer motif. In certain embodiments, the modified sugar moiety is a bicyclic nucleoside having a (4′-CH(CH3)—O-2′) bridging group. In certain embodiments, the (4′-CH(CH3)—O-2′) modified nucleosides are arranged throughout the wings of 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 unmodified 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 a transthyretin nucleic acid comprise one or more modified nucleobases. In certain embodiments, gap-widened antisense oligonucleotides targeted to a transthyretin 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.
Compositions and Methods for Formulating Pharmaceutical Compositions
Antisense oligonucleotides 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 pharmaceutical compositions are dependent upon a number of criteria, including, but not limited to, route of administration, extent of disease, or dose to be administered.
Antisense compound targeted to a transthyretin nucleic acid can be utilized in pharmaceutical compositions by combining the antisense compound with a suitable pharmaceutically acceptable diluent or carrier. A pharmaceutically acceptable diluent includes phosphate-buffered saline (PBS). PBS is a diluent suitable for use in compositions to be delivered parenterally. Accordingly, in one embodiment, employed in the methods described herein is a pharmaceutical composition comprising an antisense compound targeted to a transthyretin nucleic acid and a pharmaceutically acceptable diluent. In certain embodiments, the pharmaceutically acceptable diluent is PBS. In certain embodiments, the antisense compound is an antisense oligonucleotide.
Pharmaceutical compositions comprising antisense compounds 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 of antisense compounds, prodrugs, pharmaceutically acceptable salts of such 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
Antisense compounds may be covalently linked to one or more moieties or conjugates which enhance the activity, cellular distribution or cellular uptake of the resulting antisense oligonucleotides. 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.
Antisense compounds can also be modified to have one or more stabilizing groups that are generally attached to one or both termini of antisense compounds to enhance properties such as, for example, nuclease stability. Included in stabilizing groups are cap structures. These terminal modifications protect the antisense compound having terminal nucleic acid 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.
Cell Culture and Antisense Compounds Treatment
The effects of antisense compounds on the level, activity or expression of transthyretin nucleic acids can be tested in vitro in a variety of cell types. Cell types used for such analyses are available from commercial vendors (e.g. American Type Culture Collection, Manassas, Va.; Zen-Bio, Inc., Research Triangle Park, NC; Clonetics Corporation, Walkersville, Md.) and cells are cultured according to the vendor's instructions using commercially available reagents (e.g. Invitrogen Life Technologies, Carlsbad, Calif.). Illustrative cell types include, but are not limited to, HepG2 cells, Hep3B cells, primary hepatocytes, A549 cells, GM04281 fibroblasts and LLC-MK2 cells.
In Vitro Testing of Antisense Oligonucleotides
Described herein are methods for treatment of cells with antisense oligonucleotides, which can be modified appropriately for treatment with other antisense compounds.
In general, cells are treated with antisense oligonucleotides when the cells reach approximately 60-80% confluence in culture.
One reagent commonly used to introduce antisense oligonucleotides into cultured cells includes the cationic lipid transfection reagent LIPOFECTIN® (Invitrogen, Carlsbad, Calif.). Antisense oligonucleotides are mixed with LIPOFECTIN® in OPTI-MEM® 1 (Invitrogen, Carlsbad, Calif.) to achieve the desired final concentration of antisense oligonucleotide and a LIPOFECTIN® concentration that typically ranges 2 to 12 ug/mL per 100 nM antisense oligonucleotide.
Another reagent used to introduce antisense oligonucleotides into cultured cells includes LIPOFECTAMINE 2000® (Invitrogen, Carlsbad, Calif.). Antisense oligonucleotide is mixed with LIPOFECTAMINE 2000® in OPTI-MEM® 1 reduced serum medium (Invitrogen, Carlsbad, Calif.) to achieve the desired concentration of antisense oligonucleotide and a LIPOFECTAMINE® concentration that typically ranges 2 to 12 ug/mL per 100 nM antisense oligonucleotide.
Another reagent used to introduce antisense oligonucleotides into cultured cells includes Cytofectin® (Invitrogen, Carlsbad, Calif.). Antisense oligonucleotide is mixed with Cytofectin® in OPTI-MEM® 1 reduced serum medium (Invitrogen, Carlsbad, Calif.) to achieve the desired concentration of antisense oligonucleotide and a Cytofectin® concentration that typically ranges 2 to 12 ug/mL per 100 nM antisense oligonucleotide.
Another technique used to introduce antisense oligonucleotides into cultured cells includes electroporation.
Cells are treated with antisense oligonucleotides by routine methods. Cells are typically harvested 16-24 hours after antisense oligonucleotide treatment, at which time RNA or protein levels of target nucleic acids are measured by methods known in the art and described herein. In general, when treatments are performed in multiple replicates, the data are presented as the average of the replicate treatments.
The concentration of antisense oligonucleotide used varies from cell line to cell line. Methods to determine the optimal antisense oligonucleotide concentration for a particular cell line are well known in the art. Antisense oligonucleotides are typically used at concentrations ranging from 1 nM to 300 nM when transfected with LIPOFECTAMINE2000®, Lipofectin or Cytofectin. Antisense oligonucleotides are used at higher concentrations ranging from 625 to 20,000 nM when transfected using electroporation.
RNA Isolation
RNA analysis can be performed on total cellular RNA or poly(A)+mRNA. Methods of RNA isolation are well known in the art. RNA is prepared using methods well known in the art, for example, using the TRIZOL® Reagent (Invitrogen, Carlsbad, Calif.) according to the manufacturer's recommended protocols.
Analysis of Inhibition of Target Levels or Expression
Inhibition of levels or expression of a transthyretin nucleic acid can be assayed in a variety of ways known in the art. For example, target nucleic acid levels can be quantitated by, e.g., Northern blot analysis, competitive polymerase chain reaction (PCR), or quantitaive 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. Eugene, Oreg.). 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 a transthyretin 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 transthyretin nucleic acids can be assessed by measuring transthyretin protein levels. Protein levels of transthyretin 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). 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 transthyretin are commercially available.
In Vivo Testing of Antisense Compounds
Antisense compounds, for example, antisense oligonucleotides, are tested in animals to assess their ability to inhibit expression of transthyretin and produce phenotypic changes. Testing may be performed in normal animals, or in experimental disease models. For administration to animals, antisense oligonucleotides are formulated in a pharmaceutically acceptable diluent, such as phosphate-buffered saline. Administration includes parenteral routes of administration. Following a period of treatment with antisense oligonucleotides, RNA is isolated from tissue and changes in transthyretin nucleic acid expression are measured. Changes in transthyretin protein levels are also measured.
Certain Compounds
About two hundred and forty six newly designed antisense compounds of various lengths, motifs and backbone composition were tested for their effect on human transthyretin mRNA in vitro in several cell types. The new compounds were compared with about seventy nine previously designed compounds including ISIS NOs. 304267, 304268, 304280, 304284, 304285, 304286, 304287, 304288, 304289, 304290, 304291, 304292, 304293, 304294, 304296, 304297, 304298, 304299, 304300, 304301, 304302, 304303, 304304, 304307, 304308, 304309, 304311, and 304312 which have previously been determined to be some of the most potent antisense compounds in vitro (see e.g., U.S. Patent Publication Nos. US2005/0244869 and US2009/0082300). Of the about three hundred and twenty five newly designed and previously designed antisense compounds, about fifteen compounds were selected for further study based on in vitro potency. The selected compounds were tested for in vivo potency and tolerability in a transgenic mouse model (see Example 10). Of the fifteen compounds tested, eleven were selected and tested for systemic tolerability (see Example 11) and half-life measurement in liver (see Example 12) in CD1 mice, and also for systemic tolerability (see Example 13) and pharmacokinetic studies of oligonucleotide concentration in liver (see Example 14) in Sprague-Dawley rats. From these studies, seven compounds were tested for dose dependent inhibition and tolerability in transgenic mice (see Example 15). Furthermore, fifteen additional compounds were selected from Table 1 and six additional compounds with various motifs were designed with overlapping sequences to ISIS 420951, which displayed high potency and tolerability in the above-mentioned assays. These additional compounds were compared with ISIS 420951 for potency and tolerability in transgenic mice (see Example 16). Based on all these studies (Examples 10-16), twenty two compounds were selected and tested for systemic tolerability in CD1 mice (see Example 17). Seven compounds were considered tolerable in the mouse model and further tested for systemic tolerability in Sprague-Dawley rats (see Example 18) and for pharmacokinetic studies of oligonucleotide concentration in the liver and kidney (see Example 19). The seven compounds were also tested for dose-dependent potency in transgenic mice (see Example 20).
Final evaluation of these studies (Examples 16-20), led to the selection of nine compounds having a nucleobase sequence of a sequence recited in SEQ ID NO: 25, 78, 80, 86, 87, 115, 120, 122 and 124. By virtue of their complementary sequence, the compounds are complementary to the regions 505-524, 507-526, 508-527, 513-532, 515-534, 516-535, 580-599, 585-604, 587-606, or 589-608 of SEQ ID NO: 1. In certain embodiments, the compounds targeting the listed regions, as further described herein, comprise a modified oligonucleotide having some nucleobase portion of the sequence recited in the SEQ ID NOs, as further described herein. In certain embodiments, the compounds targeting the listed regions or having a nucleobase portion of a sequence recited in the listed SEQ ID NOs can be of various length, as further described herein, and can have one of various motifs, as further described herein. In certain embodiments, a compound targeting a region or having a nucleobase portion of a sequence recited in the listed SEQ ID NOs has the specific length and motif as indicated by the ISIS NOs: ISIS 304299, ISIS 420913, ISIS 420915, ISIS 420921, ISIS 420922, ISIS 420950, ISIS 420955, ISIS 420957, or ISIS 420959.
The nine compounds having a nucleobase sequence of a sequence recited in SEQ ID NO: 25, 78, 80, 86, 87, 115, 120, 122 and 124, were further tested for dose dependent inhibition in primary hepatocytes of cynomolgus monkey (See Example 21). These compounds were also tested for optimal viscosity (Example 22). The half life in the liver of CD1 mice of seven of the compounds having a nucleobase sequence of a sequence recited in SEQ ID NOs: 78, 86, 87, 115, 120 and 124 was also evaluated (Example 23).
Final evaluation of these studies (Examples 1-23), led to the selection of eight compounds having a nucleobase sequence of a sequence recited in SEQ ID NO: 25, 80, 86, 87, 115, 120, 122 and 124. By virtue of their complementary sequence, the compounds are complementary to the regions 504-523, 505-524, 512-531, 513-532, 577-596, 582-601, 584-603, and 586-605 of SEQ ID NO: 1. In certain embodiments, the compounds targeting the listed regions, as further described herein, comprise a modified oligonucleotide having some nucleobase portion of the sequence recited in the SEQ ID NOs, as further described herein, In certain embodiments, the compounds targeting the listed regions or having a nucleobase portion of a sequence recited in the listed SEQ ID NOs can be of various length, as further described herein, and can have one of various motifs, as further described herein. In certain embodiments, a compound targeting a region or having a nucleobase portion of a sequence recited in the listed SEQ ID NOs has the specific length and motif as indicated by the ISIS NOs: ISIS 304299, ISIS 420915, ISIS 420921, ISIS 420922, ISIS 420950, ISIS 420955, ISIS 420957, or ISIS 420959.
These eight compounds were tested for efficacy, pharmacokinetic profile and tolerability in cynomolgus monkeys (Example 24). The inhibition studies in these monkeys indicated that treatment with some of these compounds caused high inhibition of TTR mRNA in the liver. Specifically, treatment with ISIS 420950, ISIS 420955 and ISIS 420915 caused 91%, 79% and 78% inhibition, respectively compared to the PBS control. It was noted that ISIS 420915 caused greater inhibition of TTR (78%) mRNA compared to ISIS 304299 (59%), even though the two oligonucleotides differ from each other by a single base-pair shift of their target region on SEQ ID NO: 1. Protein analysis also complemented the RNA analysis data with treatment with ISIS 420915 causing 76% inhibition and treatment with ISIS 304299 causing 47% inhibition of TTR protein compared to the control. RBP4 protein levels, as a protein associated with transthyretin, was also expected to decrease after treatment with the antisense compounds. RBP4 protein levels decreased by 63% after treatment with ISIS 420915. Treatment with ISIS 304299 decreased RBP4 protein levels by 19%. Additionally, ISIS 420915 was more tolerable than ISIS 304299, as indicated in the monkey study (Example 24) Transaminase levels of monkeys treated with ISIS 304299 (ALT 81 IU/L and AST 101 IU/L) were higher than those treated with ISIS 420915 (ALT 68 IU/L and AST 62 IU/L). The complement C3 levels of monkeys treated with ISIS 304299 (96 mg/dL) were lower than that of monkeys treated with ISIS 420915 (104 mg/dL).
Accordingly, provided herein are antisense compounds with any one or more of the improved characteristics. In a certain embodiments, provided herein are compounds comprising a modified oligonucleotide as further described herein targeted to or specifically hybridizable with the region of nucleotides of SEQ ID NO: 1.
Accordingly, provided herein are antisense compounds with any one or more of the improved characteristics. In a certain embodiments, provided herein are compounds comprising a modified oligonucleotide as further described herein targeted to or specifically hybridizable with the region of nucleotides of SEQ ID NO: 2.
Accordingly, provided herein are antisense compounds with any one or more of the improved characteristics. In a certain embodiments, provided herein are compounds comprising a modified oligonucleotide as further described herein targeted to or specifically hybridizable with the region of nucleotides of SEQ ID NO: 4.
In certain embodiments, the compounds as described herein are efficacious by virtue of having at least one of an in vitro IC50 of less than 2.9 uM, less than 2.2 uM, less than 2.0 uM, less than 1.5 uM, less than 1.4 uM, less than 1.3 uM, less than 1.0 uM, less than 0.7 uM, less than 0.6 uM, when delivered to a cynomolgous monkey hepatocyte cell line using electroporation as described in Example 67. In certain embodiments, the compounds as described herein are highly tolerable as demonstrated by having at least one of an increase in ALT or AST value of no more than 4 fold, 3 fold, or 2 fold over saline treated animals; or an increase in liver, spleen or kidney weight of no more than 30%, 20%, 15%, 12%, 10%, 5% or 2%.
Certain Indications
In certain embodiments, provided herein are methods of treating an individual comprising administering one or more pharmaceutical compositions as described herein. In certain embodiments, the individual has central nervous system related disease.
As shown in the examples below, compounds targeted to transthyretin as described herein have been shown to reduce the severity of physiological symptoms of central nervous system related diseases. In certain of the experiments, the compounds reduced rate of amyloid plaque formation, e.g., the animals continued to experience symptoms, but the symptoms were less severe compared to untreated animals. In other of the experiments, however, the compounds appear to result in regeneration of function over time; e.g., animals treated for a longer period of time experienced less severe symptoms than those administered the compounds for a shorter period of time. The ability of the compounds exemplified below to restore function therefore demonstrates that symptoms of the disease may be reversed by treatment with a compound as described herein.
Accordingly, provided herein are methods for ameliorating a symptom associated with central nervous system related, cardiac, neuropathologic or gastrointestinal disease in a subject in need thereof. In certain embodiments, provided is a method for reducing the rate of onset of a symptom associated with central nervous system related, cardiac, neuropathologic or gastrointestinal disease. In certain embodiments, provided is a method for reducing the severity of a symptom associated with central nervous system related, cardiac, neuropathologic or gastrointestinal. In such embodiments, the methods comprise administering to an individual in need thereof a therapeutically effective amount of a compound targeted to a Transthyretin nucleic acid.
Transthyretin amyloidosis is characterized by numerous physical, neurological, psychiatric, and/or peripheral symptoms. Any symptom known to one of skill in the art to be associated with transthyretin amyloidosis can be ameliorated or otherwise modulated as set forth above in the methods described above. In certain embodiments, the symptom is a physical, cognitive, psychiatric, or peripheral symptom. In certain embodiments, the symptom is a physical symptom selected from the group consisting of restlessness, lack of coordination, nystagmus, spastic paraparesis, lack of muscle coordination, impaired vision, insomnia, unusual sensations, myoclonus, blindness, loss of speech, Carpal tunnel syndrome, seizures, subarachnoid hemorrhages, stroke and bleeding in the brain, hydrocephalus, ataxia, and spastic paralysis, coma, sensory neuropathy, parathesia, hypesthesia, motor neuropathy, autonomic neuropathy, orthostatic hypotension, cyclic constipation, cyclic diarrhea, nausea, vomiting, reduced sweating, impotence, delayed gastric emptying, urinary retention, urinary incontinence, progressive cardiopathy, fatigue, shortness of breath, weight loss, lack of appetite, numbness, tingling, weakness, enlarged tongue, nephrotic syndrome, congestive heart failure, dyspnea on exertion, peripheral edema, arrhythmias, palpitations, light-headedness, syncope, postural hypotension, peripheral nerve problems, sensory motor impairment, lower limb neuropathy, upper limb neuropathy, hyperalgesia, altered temperature sensation, lower extremity weakness, cachexia, peripheral edema, hepatomegaly, purpura, diastolic dysfunction, premature ventricular contractions, cranial neuropathy, diminished deep tendon reflexes, amyloid deposits in the corpus vitreum, vitreous opacity, dry eyes, glaucoma, scalloped appearance in the pupils, swelling of the feet due to water retention. In certain embodiments, the symptom is a cognitive symptom selected from the group consisting of impaired memory, impaired judgment, and thinking, impaired planning, impaired flexibility, impaired abstract thinking, impaired rule acquisition, impaired initiation of appropriate actions, impaired inhibition of inappropriate actions, impaired short-term memory, impaired long-term memory, paranoia, disorientation, confusion, hallucination and dementia. In certain embodiments, the symptom is a psychiatric symptom selected from the group consisting of dementia; anxiety, depression, blunted affect, egocentrisms, aggression, compulsive behavior, irritability, personality changes, including, impaired memory, judgment, and thinking and suicidal ideation.
In certain embodiments, the symptom is restlessness. In certain embodiments, the symptom is lack of coordination. In certain embodiments, the symptom is nystagmus. In certain embodiments, the symptom is spastic paraparesis. In certain embodiments, the symptom is lack of muscle coordination. In certain embodiments, the symptom is impaired vision. In certain embodiments, the symptom is insomnia. In certain embodiments, the symptom is unusual sensations. In certain embodiments, the symptom is myoclonus. In certain embodiments, the symptom is blindness. In certain embodiments, the symptom is loss of speech. In certain embodiments, the symptom is Carpal tunnel syndrome. In certain embodiments, the symptom is seizures. In certain embodiments, the symptom is subarachnoid hemorrhages. In certain embodiments, the symptom is stroke. In certain embodiments, the symptom is bleeding in the brain. In certain embodiments, the symptom is hydrocephalus. In certain embodiments, the symptom is ataxia. In certain embodiments, the symptom is spastic paralysis. In certain embodiments, the symptom is coma. In certain embodiments, the symptom is sensory neuropathy. In certain embodiments, the symptom is parathesia. In certain embodiments, the symptom is hypesthesia. In certain embodiments, the symptom is motor neuropathy. In certain embodiments, the symptom is autonomic neuropathy. In certain embodiments, the symptom is orthostatic hypotension. In certain embodiments, the symptom is cyclic constipation. In certain embodiments, the symptom is cyclic diarrhea. In certain embodiments, the symptom is nausea. In certain embodiments, the symptom is vomiting. In certain embodiments, the symptom is reduced sweating. In certain embodiments, the symptom is impotence. In certain embodiments, the symptom is delayed gastric emptying. In certain embodiments, the symptom is urinary retention. In certain embodiments, the symptom is urinary incontinence. In certain embodiments, the symptom is progressive cardiopathy. In certain embodiments, the symptom is fatigue. In certain embodiments, the symptom is shortness of breath. In certain embodiments, the symptom is weight loss. In certain embodiments, the symptom is numbness. In certain embodiments, the symptom is tingling. In certain embodiments, the symptom is weakness. In certain embodiments, the symptom is enlarged tongue. In certain embodiments, the symptom is nephrotic syndrome. In certain embodiments, the symptom is congestive heart failure. In certain embodiments, the symptom is dyspnea on exertion. In certain embodiments, the symptom is peripheral edema. In certain embodiments, the symptom is arrhythmias. In certain embodiments, the symptom is palpitations. In certain embodiments, the symptom is light-headedness. In certain embodiments, the symptom is syncope. In certain embodiments, the symptom is postural hypotension. In certain embodiments, the symptom is peripheral nerve problems. In certain embodiments, the symptom is sensory motor impairment. In certain embodiments, the symptom is lower limb neuropathy. In certain embodiments, the symptom is upper limb neuropathy. In certain embodiments, the symptom is hyperalgesia. In certain embodiments, the symptom is altered temperature sensation. In certain embodiments, the symptom is lower extremity weakness. In certain embodiments, the symptom is cachexia. In certain embodiments, the symptom is edema. In certain embodiments, the symptom is hepatomegaly. In certain embodiments, the symptom is purpura. In certain embodiments, the symptom is diastolic dysfunction. In certain embodiments, the symptom is premature ventricular contractions. In certain embodiments, the symptom is cranial neuropathy. In certain embodiments, the symptom is diminished deep tendon reflexes. In certain embodiments, the symptom is amyloid deposits in the corpus vitreum. In certain embodiments, the symptom is vitreous opacity. In certain embodiments, the symptom is dry eyes. In certain embodiments, the symptom is glaucoma. In certain embodiments, the symptom is scalloped appearance in the pupils. In certain embodiments, the symptom is swelling of the feet due to water retention.
In certain embodiments, the symptom is impaired memory. In certain embodiments, the symptom is impaired judgment, and thinking. In certain embodiments, the symptom is impaired planning. In certain embodiments, the symptom is impaired flexibility. In certain embodiments, the symptom is impaired abstract thinking. In certain embodiments, the symptom is impaired rule acquisition. In certain embodiments, the symptom is impaired initiation of appropriate actions. In certain embodiments, the symptom is impaired inhibition of inappropriate actions. In certain embodiments, the symptom is impaired short-term memory. In certain embodiments, the symptom is impaired long-term memory. In certain embodiments, the symptom is paranoia. In certain embodiments, the symptom is disorientation. In certain embodiments, the symptom is confusion. In certain embodiments, the symptom is hallucination. In certain embodiments, the symptom is dementia.
In certain embodiments, the symptom is dementia. In certain embodiments, the symptom is anxiety. In certain embodiments, the symptom is depression. In certain embodiments, the symptom is blunted affect. In certain embodiments, the symptom is egocentrisms. In certain embodiments, the symptom is aggression. In certain embodiments, the symptom is compulsive behavior. In certain embodiments, the symptom is irritability. In certain embodiments, the symptom is personality changes. In certain embodiments, the symptom is suicidal ideation.
In certain embodiments, provided are methods of treating an individual comprising administering one or more pharmaceutical compositions as described herein. In certain embodiments, the individual has central nervous system related disease.
In certain embodiments, administration of an antisense compound targeted to a transthyretin nucleic acid results in reduction of transthyretin expression by at least about 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95 or 99%, or a range defined by any two of these values.
In certain embodiments, pharmaceutical compositions comprising an antisense compound targeted to transthyretin are used for the preparation of a medicament for treating a patient suffering or susceptible to central nervous system related disease.
In certain embodiments, the methods described herein include administering a compound comprising a modified oligonucleotide having a contiguous nucleobases portion as described herein of a sequence recited in SEQ ID NO: 25, 78, 80, 86, 87, 115, 120, 122 and 124.
Administration
In certain embodiments, the compounds and compositions as described herein may be administered in a number of ways depending upon whether local or systemic treatment is desired and upon the area to be treated. Administration may be topical, pulmonary, e.g., by inhalation or insufflation of powders or aerosols, including by nebulizer; intratracheal, intranasal, epidermal and transdermal, oral or parenteral. The compounds and compositions as described herein can be delivered in a manner to target a particular tissue, such as the liver or brain.
In certain embodiments, the compounds and compositions as described herein are administered parenterally. “Parenteral administration” means administration through injection or infusion. Parenteral administration includes subcutaneous administration, intravenous administration, intramuscular administration, intraarterial administration, intraperitoneal administration, or intracranial administration, e.g. intracerebral administration, intrathecal administration, intraventricular administration, ventricular administration, intracerebroventricular administration, cerebral intraventricular administration or cerebral ventricular administration. Administration can be continuous, or chronic, or short or intermittent.
In certain embodiments, parenteral administration is by infusion. Infusion can be chronic or continuous or short or intermittent. In certain embodiments, infused pharmaceutical agents are delivered with a pump. In certain embodiments, parenteral administration is by injection.
In certain embodiments, parenteral administration is subcutaneous.
In further embodiments, the formulation for administration is the compounds described herein and saline.
In certain embodiments, compounds and compositions are delivered to the CNS. In certain embodiments, compounds and compositions are delivered to the cerebrospinal fluid. In certain embodiments, compounds and compositions are administered to the brain parenchyma. In certain embodiments, compounds and compositions are delivered to an animal into multiple regions of the central nervous system (e.g., into multiple regions of the brain, and/or into the spinal cord) by intrathecal administration, or intracerebroventricular administration. Broad distribution of compounds and compositions, described herein, within the central nervous system may be achieved with intraparenchymal administration, intrathecal administration, or intracerebroventricular administration.
In certain embodiments, the present invention includes pharmaceutical compositions that can be delivered by injection directly into the brain. The injection can be by stereotactic injection into a particular region of the brain (e.g., the substantia nigra, choroid plexus, cortex, hippocampus, striatum, choroid plexus or globus pallidus). The compound can also be delivered into diffuse regions of the brain (e.g., diffuse delivery to the cortex of the brain).
In certain embodiments, parenteral administration is by injection. The injection may be delivered with a syringe or a pump. In certain embodiments, the injection is a bolus injection. In certain embodiments, the injection is administered directly to a tissue, such as striatum, caudate, cortex, hippocampus and cerebellum.
In certain embodiments, delivery of a compound or composition described herein can affect the pharmacokinetic profile of the compound or composition. In certain embodiments, injection of a compound or composition described herein, to a targeted tissue improves the pharmacokinetic profile of the compound or composition as compared to infusion of the compound or composition. In a certain embodiment, the injection of a compound or composition improves potency compared to broad diffusion, requiring less of the compound or composition to achieve similar pharmacology. In certain embodiments, similar pharmacology refers to the amount of time that a target mRNA and/or target protein is down-regulated (e.g. duration of action). In certain embodiments, methods of specifically localizing a pharmaceutical agent, such as by bolus injection, decreases median effective concentration (EC50) by a factor of about 50 (e.g. 50 fold less concentration in tissue is required to achieve the same or similar pharmacodynamic effect). In certain embodiments, methods of specifically localizing a pharmaceutical agent, such as by bolus injection, decreases median effective concentration (EC50) by a factor of 20, 25, 30, 35, 40, 45 or 50. In certain embodiments the pharmaceutical agent in an antisense compound as further described herein. In certain embodiments, the targeted tissue is brain tissue. In certain embodiments the targeted tissue is striatal tissue. In certain embodiments, decreasing EC50 is desirable because it reduces the dose required to achieve a pharmacological result in a patient in need thereof.
The half-life of MOE gapmer oligonucleotides in CD1 mice liver tissue is about 21 days (see Examples 12).
In certain embodiments, an antisense oligonucleotide is delivered by injection or infusion once every month, every two months, every 90 days, every 3 months, every 6 months, twice a year or once a year.
Certain Combination Therapies
In certain embodiments, one or more pharmaceutical compositions of the present invention are co-administered with one or more other pharmaceutical agents. In certain embodiments, such one or more other pharmaceutical agents are designed to treat the same disease, disorder, or condition as the one or more pharmaceutical compositions described herein. In certain embodiments, such one or more other pharmaceutical agents are designed to treat a different disease, disorder, or condition as the one or more pharmaceutical compositions described herein. In certain embodiments, such one or more other pharmaceutical agents are designed to treat an undesired side effect of one or more pharmaceutical compositions as described herein. In certain embodiments, one or more pharmaceutical compositions are co-administered with another pharmaceutical agent to treat an undesired effect of that other pharmaceutical agent. In certain embodiments, one or more pharmaceutical compositions are co-administered with another pharmaceutical agent to produce a combinational effect. In certain embodiments, one or more pharmaceutical compositions are co-administered with another pharmaceutical agent to produce a synergistic effect.
In certain embodiments, one or more pharmaceutical compositions and one or more other pharmaceutical agents are administered at the same time. In certain embodiments, one or more pharmaceutical compositions and one or more other pharmaceutical agents are administered at different times. In certain embodiments, one or more pharmaceutical compositions and one or more other pharmaceutical agents are prepared together in a single formulation. In certain embodiments, one or more pharmaceutical compositions and one or more other pharmaceutical agents are prepared separately.
In certain embodiments, the second compound is administered prior to administration of a pharmaceutical composition of the present invention. In certain embodiments, the second compound is administered following administration of a pharmaceutical composition of the present invention. In certain embodiments, the second compound is administered at the same time as a pharmaceutical composition of the present invention. In certain embodiments, the dose of a co-administered second compound is the same as the dose that would be administered if the second compound was administered alone. In certain embodiments, the dose of a co-administered second compound is lower than the dose that would be administered if the second compound was administered alone. In certain embodiments, the dose of a co-administered second compound is greater than the dose that would be administered if the second compound was administered alone.
In certain embodiments, the co-administration of a second compound enhances the effect of a first compound, such that co-administration of the compounds results in an effect that is greater than the effect of administering the first compound alone. In certain embodiments, the co-administration results in effects that are additive of the effects of the compounds when administered alone. In certain embodiments, the co-administration results in effects that are supra-additive of the effects of the compounds when administered alone. In certain embodiments, the first compound is an antisense compound. In certain embodiments, the second compound is an antisense compound.
In certain embodiments, pharmaceutical agents that may be co-administered with a pharmaceutical composition of the present invention include antipsychotic agents, such as, e.g., haloperidol, chlorpromazine, clozapine, quetapine, and olanzapine; antidepressant agents, such as, e.g., fluoxetine, sertraline hydrochloride, venlafaxine and nortriptyline; tranquilizing agents such as, e.g., benzodiazepines, clonazepam, paroxetine, venlafaxin, and beta-blockers; mood-stabilizing agents such as, e.g., lithium, valproate, lamotrigine, and carbamazepine; paralytic agents such as, e.g., Botulinum toxin; and/or other experimental agents including, but not limited to, tetrabenazine (Xenazine), creatine, conezyme Q10, trehalose, docosahexanoic acids, ACR16, ethyl-EPA, atomoxetine, citalopram, dimebon, memantine, sodium phenylbutyrate, ramelteon, ursodiol, zyprexa, xenasine, tiapride, riluzole, amantadine, [123I]MNI-420, atomoxetine, tetrabenazine, digoxin, detromethorphan, warfarin, alprozam, ketoconazole, omeprazole, and minocycline.
In certain embodiments, pharmaceutical agents that may be co-administered with a pharmaceutical composition of the present invention include analgesics, such as, paracetamol (acetaminophen); non-steroidal anti-inflammatory drugs (NSAIDs), such as, salicylates; narcotic drugs, such as, morphine, and synthetic drugs with narcotic properties such as tramadol.
In certain embodiments, pharmaceutical agents that may be co-administered with a pharmaceutical composition of the present invention include muscle relaxants, such as, benzodiapines and methocarbamol.
Formulations
The compounds of the invention may also be admixed, conjugated or otherwise associated with other molecules, molecule structures or mixtures of compounds, as for example, liposomes, receptor-targeted molecules, or other formulations, for assisting in uptake, distribution and/or absorption. Representative United States patents that teach the preparation of such uptake, distribution and/or absorption-assisting formulations include, but are not limited to, U.S. Pat. Nos. 5,108,921; 5,354,844; 5,416,016; 5,459,127; 5,521,291; 5,543,158; 5,547,932; 5,583,020; 5,591,721; 4,426,330; 4,534,899; 5,013,556; 5,108,921; 5,213,804; 5,227,170; 5,264,221; 5,356,633; 5,395,619; 5,416,016; 5,417,978; 5,462,854; 5,469,854; 5,512,295; 5,527,528; 5,534,259; 5,543,152; 5,556,948; 5,580,575; and 5,595,756, each of which is herein incorporated by reference.
The antisense compounds of the invention encompass any pharmaceutically acceptable salts, esters, or salts of such esters, or any other compound which, upon administration to an animal, including a human, is capable of providing (directly or indirectly) the biologically active metabolite or residue thereof.
The term “pharmaceutically acceptable salts” refers to physiologically and pharmaceutically acceptable salts of the compounds of the invention: i.e., salts that retain the desired biological activity of the parent compound and do not impart undesired toxicological effects thereto. For oligonucleotides, preferred examples of pharmaceutically acceptable salts and their uses are further described in U.S. Pat. No. 6,287,860, which is incorporated herein in its entirety. Sodium salts have been shown to be suitable forms of oligonucleotide drugs.
The present invention also includes pharmaceutical compositions and formulations which include the antisense compounds of the invention. The pharmaceutical compositions of the present invention may be administered in a number of ways depending upon whether local or systemic treatment is desired and upon the area to be treated. Administration may be parenteral. Parenteral administration includes intravenous, intraarterial, subcutaneous, intraperitoneal or intramuscular injection or infusion; or intracranial, e.g., intracerebral administration, intrathecal administration, intraventricular administration, ventricular administration, intracerebroventricular administration, cerebral intraventricular administration or cerebral ventricular administration.
Administration intraventricularly, is preferred to target transthyretin expression in the choroid plexus. Oligonucleotides with at least one 2′-O-methoxyethyl modification are believed to be particularly useful for oral administration. Pharmaceutical compositions and formulations for topical administration may include transdermal patches, ointments, lotions, creams, gels, drops, suppositories, sprays, liquids and powders. Conventional pharmaceutical carriers, aqueous, powder or oily bases, thickeners and the like may be necessary or desirable. Coated condoms, gloves and the like may also be useful.
The pharmaceutical formulations of the present invention, which may conveniently be presented in unit dosage form, may be prepared according to conventional techniques well known in the pharmaceutical industry. Such techniques include the step of bringing into association the active ingredients with the pharmaceutical carrier(s) or excipient(s). In general, the formulations are prepared by uniformly and intimately bringing into association the active ingredients with liquid carriers or finely divided solid carriers or both, and then, if necessary, shaping the product.
The compositions of the present invention may be formulated into any of many possible dosage forms such as, but not limited to, tablets, capsules, gel capsules, liquid syrups, soft gels, suppositories, and enemas. The compositions of the present invention may also be formulated as suspensions in aqueous, non-aqueous or mixed media. Aqueous suspensions may further contain substances which increase the viscosity of the suspension including, for example, sodium carboxymethylcellulose, sorbitol and/or dextran. The suspension may also contain stabilizers.
Pharmaceutical compositions of the present invention include, but are not limited to, solutions, emulsions, foams and liposome-containing formulations. The pharmaceutical compositions and formulations of the present invention may comprise one or more penetration enhancers, carriers, excipients or other active or inactive ingredients.
Emulsions are typically heterogenous systems of one liquid dispersed in another in the form of droplets usually exceeding 0.1 μm in diameter. Emulsions may contain additional components in addition to the dispersed phases, and the active drug which may be present as a solution in the aqueous phase, oily phase or itself as a separate phase. Microemulsions are included as an embodiment of the present invention. Emulsions and their uses are well known in the art and are further described in U.S. Pat. No. 6,287,860, which is incorporated herein in its entirety.
Formulations of the present invention include liposomal formulations. As used in the present invention, the term “liposome” means a vesicle composed of amphiphilic lipids arranged in a spherical bilayer or bilayers. Liposomes are unilamellar or multilamellar vesicles which have a membrane formed from a lipophilic material and an aqueous interior that contains the composition to be delivered. Cationic liposomes are positively charged liposomes which are believed to interact with negatively charged DNA molecules to form a stable complex. Liposomes that are pH-sensitive or negatively-charged are believed to entrap DNA rather than complex with it. Both cationic and noncationic liposomes have been used to deliver DNA to cells.
Liposomes also include “sterically stabilized” liposomes, a term which, as used herein, refers to liposomes comprising one or more specialized lipids that, when incorporated into liposomes, result in enhanced circulation lifetimes relative to liposomes lacking such specialized lipids. Liposomes and their uses are further described in U.S. Pat. No. 6,287,860, which is incorporated herein in its entirety.
In another embodiment of the invention, formulations of the present invention include saline formulations. In certain embodiment of the invention, a formulation consists of the compounds described herein and saline. In certain embodiments, a formulation consists essentially of the compounds described herein and saline. In certain embodiments, the saline is pharmaceutically acceptable grade saline. In certain embodiments, the saline is buffered saline. In certain embodiments, the saline is phosphate buffered saline (PBS).
In certain embodiments, a formulation excludes liposomes. In certain embodiments, the formulation excludes sterically stabilized liposomes. In certain embodiments, a formulation excludes phospholipids. In certain embodiments, the formulation consists essentially of the compounds described herein and saline and excludes liposomes.
The pharmaceutical formulations and compositions of the present invention may also include surfactants. Surfactants and their uses are further described in U.S. Pat. No. 6,287,860, which is incorporated herein in its entirety.
In one embodiment, the present invention employs various penetration enhancers to affect the efficient delivery of nucleic acids, particularly oligonucleotides. Penetration enhancers and their uses are further described in U.S. Pat. No. 6,287,860, which is incorporated herein in its entirety.
One of skill in the art will recognize that formulations are routinely designed according to their intended use, i.e. route of administration.
Preferred formulations for topical administration include those in which the oligonucleotides of the invention are in admixture with a topical delivery agent such as lipids, liposomes, fatty acids, fatty acid esters, steroids, chelating agents and surfactants. Preferred lipids and liposomes include neutral (e.g. dioleoylphosphatidyl DOPE ethanolamine, dimyristoylphosphatidyl choline DMPC, distearolyphosphatidyl choline) negative (e.g. dimyristoylphosphatidyl glycerol DMPG) and cationic (e.g. dioleoyltetramethylaminopropyl DOTAP and dioleoylphosphatidyl ethanolamine DOTMA).
Compositions and formulations for parenteral administration, including intravenous, intraarterial, subcutaneous, intraperitoneal, intramuscular injection or infusion, or intracranial may include sterile aqueous solutions which may also contain buffers, diluents and other suitable additives such as, but not limited to, penetration enhancers, carrier compounds and other pharmaceutically acceptable carriers or excipients.
Certain embodiments of the invention provide pharmaceutical compositions containing one or more oligomeric compounds and one or more other chemotherapeutic agents which function by a non-antisense mechanism. Examples of such chemotherapeutic agents include but are not limited to cancer chemotherapeutic drugs such as daunorubicin, daunomycin, dactinomycin, doxorubicin, epirubicin, idarubicin, esorubicin, bleomycin, mafosfamide, ifosfamide, cytosine arabinoside, bis-chloroethylnitrosurea, busulfan, mitomycin C, actinomycin D, mithramycin, prednisone, hydroxyprogesterone, testosterone, tamoxifen, dacarbazine, procarbazine, hexamethylmelamine, pentamethylmelamine, mitoxantrone, amsacrine, chlorambucil, methylcyclohexylnitrosurea, nitrogen mustards, melphalan, cyclophosphamide, 6-mercaptopurine, 6-thioguanine, cytarabine, 5-azacytidine, hydroxyurea, deoxycoformycin, 4-hydroxyperoxycyclophosphoramide, 5-fluorouracil (5-FU), 5-fluorodeoxyuridine (5-FUdR), methotrexate (MTX), colchicine, taxol, vincristine, vinblastine, etoposide (VP-16), trimetrexate, irinotecan, topotecan, gemcitabine, teniposide, cisplatin and diethylstilbestrol (DES). When used with the compounds of the invention, such chemotherapeutic agents may be used individually (e.g., 5-FU and oligonucleotide), sequentially (e.g., 5-FU and oligonucleotide for a period of time followed by MTX and oligonucleotide), or in combination with one or more other such chemotherapeutic agents (e.g., 5-FU, MTX and oligonucleotide, or 5-FU, radiotherapy and oligonucleotide). Anti-inflammatory drugs, including but not limited to nonsteroidal anti-inflammatory drugs and corticosteroids, and antiviral drugs, including but not limited to ribivirin, vidarabine, acyclovir and ganciclovir, may also be combined in compositions of the invention. Combinations of antisense compounds and other non-antisense drugs are also within the scope of this invention. Two or more combined compounds may be used together or sequentially.
In another related embodiment, compositions of the invention may contain one or more antisense compounds, particularly oligonucleotides, targeted to a first nucleic acid and one or more additional antisense compounds targeted to a second nucleic acid target. Alternatively, compositions of the invention may contain two or more antisense compounds targeted to different regions of the same nucleic acid target. Numerous examples of antisense compounds are known in the art. Two or more combined compounds may be used together or sequentially.
Dosing
The formulation of therapeutic compositions and their subsequent administration (dosing) is believed to be within the skill of those in the art. Dosing is dependent on severity and responsiveness of the disease state to be treated, with the course of treatment lasting from several days to several months, or until a cure is effected or a diminution of the disease state is achieved. Optimal dosing schedules can be calculated from measurements of drug accumulation in the body of the patient. Optimum dosages may vary depending on the relative potency of individual oligonucleotides, and can generally be estimated based on EC50s found to be effective in in vitro and in vivo animal models. In general, dosage is from 0.01 μg to 100 g per kg of body weight, and may be given once or more daily, weekly, monthly or yearly, or at desired intervals. Following successful treatment, it may be desirable to have the patient undergo maintenance therapy to prevent the recurrence of the disease state, wherein the oligonucleotide is administered in maintenance doses, ranging from 0.01 μg to 100 g per kg of body weight, once or more daily.
While the present invention has been described with specificity in accordance with certain of its preferred embodiments, the following examples serve only to illustrate the invention and are not intended to limit the same. Each of the references, GenBank accession numbers, and the like recited in the present application is incorporated herein by reference in its entirety.
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
Antisense Inhibition of Human Transthyretin in HepG2 Cells
Antisense oligonucleotides were designed targeting a transthyretin nucleic acid and were tested for their effects on transthyretin mRNA in vitro. Cultured HepG2 cells at a density of 10,000 cells per well were transfected using lipofectin reagent with 50 nM antisense oligonucleotide. After a treatment period of approximately 24 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human primer probe set RTS1396 (forward sequence CCCTGCTGAGCCCCTACTC, designated herein as SEQ ID NO: 5; reverse sequence TCCCTCATTCCTTGGGATTG, designated herein as SEQ ID NO: 6; probe sequence ATTCCACCACGGCTGTCGTCAX, designated herein as SEQ ID NO: 7). Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells.
The chimeric antisense oligonucleotides in Tables 1 and 2 were designed as 5-10-5 MOE gapmers. The gapmers are 20 nucleotides in length, wherein the central gap segment is comprised of ten 2′-deoxynucleotides and is flanked on both sides (in the 5′ and 3′ directions) by wings comprising five nucleotides each. Each nucleotide in the 5′ wing segment and each nucleotide in the 3′ wing segment has a 2′-MOE modification. The internucleoside linkages throughout each gapmer are phosphorothioate (P═S) linkages. All cytidine residues throughout each gapmer are 5-methylcytidines. “Human Target start site” indicates the 5′-most nucleotide to which the gapmer is targeted in the human gene sequence. “Human Target stop site” indicates the 3′-most nucleotide to which the gapmer is targeted human gene sequence. Each gapmer listed in Table 1 is targeted to human transthyretin mRNA, designated herein as SEQ ID NO: 1 (GENBANK Accession No. NM_000371.2). Certain gapmers were also designed which targeted intronic sequences or intron-exon junctions of the human transthyretin genomic sequence, designated herein as SEQ ID NO: 2 (GENBANK Accession No. NT_010966.10 truncated from nucleotides 2009236 to 2017289) and are listed in Table 2.
The human oligonucleotides of Tables 1 and 2 are also cross-reactive with rhesus monkey gene sequences. ‘Mismatches’ indicate the number of nucleobases by which the human oligonucleotide is mismatched with a rhesus monkey gene sequence. The greater the complementarity between the human oligonucleotide and the rhesus monkey sequence, the more likely the human oligonucleotide can cross-react with the rhesus monkey sequence. The human oligonucleotides in Table 1 were compared to exons 1-4 extracted from the rhesus monkey genomic sequence GENBANK Accession No. NW_001105671.1, based on similarity to human exons. The human oligonucleotides in Table 2 were compared to the rhesus monkey genomic sequence, designated herein as SEQ ID NO: 4 (GENBANK Accession No. NW_001105671.1 truncated from nucleotides 628000 to 638000). “Rhesus monkey Target start site” indicates the 5′-most nucleotide to which the gapmer is targeted in the rhesus monkey gene sequence. “Rhesus monkey Target stop site” indicates the 3′-most nucleotide to which the gapmer is targeted rhesus monkey gene sequence.







TABLE 1







Inhibition of human transthyretin mRNA levels by chimeric antisense


oligonucleotides having 5-10-5 MOE wings and deoxy gap targeted to


SEQ ID NO: 1 and SEQ ID NO: 4






















Rhesus
Rhesus





Human
Human



monkey
monkey

SEQ


ISIS
Start
Stop


%
start
stop
Mis-
ID


NO
Site
Site
Region
Sequence
inhibition
site
site
matches
NO





304267
217
236
coding
ACTGGTTTTCC
53
217
236
0
  8






CAGAGGCAA







 


304268
222
241
coding
GACTCACTGGT
16
222
241
0
  9






TTTCCCAGA







 


304280
353
372
coding
TGAATACCAC
51
353
372
0
 10






CTCTGCATGC







 


304284
425
444
coding
CCGTGGTGGA
82
425
444
0
 11






ATAGGAGTAG







 


304285
427
446
coding
AGCCGTGGTG
89
427
446
0
 12






GAATAGGAGT







 


304286
431
450
coding
CGACAGCCGT
63
431
450
0
 13






GGTGGAATAG







 


304287
438
457
coding
TTGGTGACGA
88
438
457
0
 14






CAGCCGTGGT







 


304288
440
459
coding
GATTGGTGAC
82
440
459
0
 15






GACAGCCGTG







 


304289
442
461
coding
GGGATTGGTG
78
442
461
0
 16






ACGACAGCCG







 


304290
443
462
coding
TGGGATTGGT
85
443
462
0
 17






GACGACAGCC







 


304291
449
468
coding-
ATTCCTTGGGA
52
449
468
0
 18





stop
TTGGTGACG










codon








 


304292
450
469
coding-
CATTCCTTGGG
34
450
469
0
 19





stop
ATTGGTGAC










codon








 


304293
451
470
coding-
TCATTCCTTGG
29
451
470
0
 20





stop
GATTGGTGA










codon








 


304294
460
479
coding-
AGAAGTCCCT
32
460
479
0
 21





stop
CATTCCTTGG










codon-











3′ UTR








 


304296
481
500
3′-
GTCCTTCAGGT
84
478
497
2
 22





UTR
CCACTGGAG







 


304297
489
508
3′-
CATCCCTCGTC
0
486
505
1
 23





UTR
CTTCAGGTC







 


304298
501
520
3′-
TACATGAAAT
26
498
517
0
 24





UTR
CCCATCCCTC







 


304299
507
526
3′
CTTGGTTACAT
85
504
523
0
 25





UTR
GAAATCCCA







 


304300
513
532
3′-
AATACTCTTGG
49
510
529
0
 26





UTR
TTACATGAA







 


304301
526
545
3′UTR
TTAGTAAAAA
 0
523
542
0
 27






TGGAATACTC







 


304302
532
551
3′UTR
ACTGCTTTAGT
42
529
548
0
 28






AAAAATGGA







 


304303
539
558
3′UTR
TGAAAACACT
41
536
555
0
 29






GCTTTAGTAA







 


304304
546
565
3′UTR
TATGAGGTGA
49
543
562
0
 30






AAACACTGCT







 


304307
564
583
3′UTR
TGGACTTCTAA
73
561
580
2
 31






CATAGCATA







 


304308
572
591
3′UTR
TCTCTGCCTGG
55
569
588
1
 32






ACTTCTAAC







 


304309
578
597
3′
TTATTGTCTCT
77
575
594
0
 33





UTR
GCCTGGACT







 


304311
597
616
3′-
TGCCTTTCACA
80
594
613
0
 34





UTR
GGAATGTTT







 


304312
598
617
3′-
GTGCCTTTCAC
71
595
614
0
 35





UTR
AGGAATGTT







 


420871
 36
 55
coding
CAGAGGAGGA
48
 36
 55
0
 36






GCAGACGATG







 


420872
120
139
coding
TCTAGAACTTT
55
120
139
0
 37






GACCATCAG







 


420873
212
231
coding
TTTTCCCAGAG
54
212
231
0
 38






GCAAATGGC







 


420874
226
245
coding
TCCAGACTCAC
63
226
245
0
 39






TGGTTTTCC







 


420875
271
290
coding
TATCCCTTCTA
40
271
290
0
 40






CAAATTCCT







 


420876
285
304
coding
ATTTCCACTTT
42
285
304
0
 41






GTATATCCC







 


420877
293
312
coding
TGGTGTCTATT
76
293
312
0
 42






TCCACTTTG







 


420878
303
322
coding
CAGTAAGATTT
80
303
322
0
 43






GGTGTCTAT







 


420879
307
326
coding
CTTCCAGTAAG
73
307
326
0
 44






ATTTGGTGT







 


420880
347
366
coding
CCACCTCTGCA
76
347
366
0
 45






TGCTCATGG







 


420881
355
374
coding
TGTGAATACC
58
355
374
0
 46






ACCTCTGCAT







 


420882
357
376
coding
GCTGTGAATA
69
357
376
0
 47






CCACCTCTGC







 


420883
362
381
coding
CGTTGGCTGTG
64
362
381
0
 48






AATACCACC







 


420884
428
447
coding
CAGCCGTGGT
93
428
447
0
 49






GGAATAGGAG







 


420885
430
449
coding
GACAGCCGTG
93
430
449
0
 50






GTGGAATAGG







 


420886
432
451
coding
ACGACAGCCG
92
432
451
0
 51






TGGTGGAATA







 


420887
433
452
coding
GACGACAGCC
93
433
452
0
 52






GTGGTGGAAT







 


420888
434
453
coding
TGACGACAGC
95
434
453
0
 53






CGTGGTGGAA







 


420889
435
454
coding
GTGACGACAG
93
435
454
0
 54






CCGTGGTGGA







 


420890
436
455
coding
GGTGACGACA
97
436
455
0
 55






GCCGTGGTGG







 


420891
437
456
coding
TGGTGACGAC
97
437
456
0
 56






AGCCGTGGTG







 


420892
439
458
coding
ATTGGTGACG
93
439
458
0
 57






ACAGCCGTGG







 


420893
441
460
coding
GGATTGGTGA
96
441
460
0
 58






CGACAGCCGT







 


420894
444
463
coding
TTGGGATTGGT
88
444
463
0
 59






GACGACAGC







 


420895
445
464
coding
CTTGGGATTGG
95
445
464
0
 60






TGACGACAG







 


420896
446
465
coding
CCTTGGGATTG
95
446
465
0
 61






GTGACGACA







 


420897
447
466
coding
TCCTTGGGATT
94
447
466
0
 62






GGTGACGAC







 


420898
448
467
coding-
TTCCTTGGGAT
86
448
467
0
 63





stop
TGGTGACGA










codon








 


420899
452
471
coding-
CTCATTCCTTG
94
452
471
0
 64





stop
GGATTGGTG










codon-











3′UTR








 


420900
453
472
coding-
CCTCATTCCTT
92
453
472
0
 65





stop
GGGATTGGT










codon-











3′UTR








 


420901
454
473
coding-
CCCTCATTCCT
93
454
473
0
 66





stop
TGGGATTGG










codon-











3′UTR








 


420902
455
474
coding-
TCCCTCATTCC
75
455
474
0
 67





stop
TTGGGATTG










codon-











3′UTR








 


420903
456
475
coding-
GTCCCTCATTC
57
456
475
0
 68





stop
CTTGGGATT










codon-











3′UTR








 


420904
457
476
coding-
AGTCCCTCATT
62
457
476
0
 69





stop
CCTTGGGAT










codon-











3′UTR








 


420905
458
477
coding-
AAGTCCCTCAT
58
458
477
0
 70





stop
TCCTTGGGA










codon-











3′UTR








 


420906
459
478
coding-
GAAGTCCCTC
79
459
478
0
 71





stop
ATTCCTTGGG










codon-











3′UTR








 


420907
461
480
coding-
GAGAAGTCCC
59
461
480
0
 72





stop
TCATTCCTTG










codon-











3′UTR








 


420908
462
481
coding-
GGAGAAGTCC
75
462
481
0
 73





stop
CTCATTCCTT










codon-











3′UTR








 


420909
500
519
3′UTR
ACATGAAATC
82
497
516
0
 74






CCATCCCTCG







 


420910
502
521
3′UTR
TTACATGAAAT
74
499
518
0
 75






CCCATCCCT







 


420911
503
522
3′UTR
GTTACATGAA
81
500
519
0
 76






ATCCCATCCC







 


420912
504
523
3′UTR
GGTTACATGA
92
501
520
0
 77






AATCCCATCC







 


420913
505
524
3′UTR
TGGTTACATGA
95
502
521
0
 78






AATCCCATC







 


420914
506
525
3′UTR
TTGGTTACATG
93
503
522
0
 79






AAATCCCAT







 


420915
508
527
3′UTR
TCTTGGTTACA
92
505
524
0
 80






TGAAATCCC







 


420916
509
528
3′UTR
CTCTTGGTTAC
88
506
525
0
 81






ATGAAATCC







 


420917
510
529
3′UTR
ACTCTTGGTTA
92
507
526
0
 82






CATGAAATC







 


420918
511
530
3′UTR
TACTCTTGGTT
88
508
527
0
 83






ACATGAAAT







 


420919
512
531
3′UTR
ATACTCTTGGT
89
509
528
0
 84






TACATGAAA







 


420920
514
533
3′UTR
GAATACTCTTG
87
511
530
0
 85






GTTACATGA







 


420921
515
534
3′UTR
GGAATACTCTT
92
512
531
0
 86






GGTTACATG







 


420922
516
535
3′UTR
TGGAATACTCT
95
513
532
0
 87






TGGTTACAT







 


420923
517
536
3′UTR
ATGGAATACT
90
514
533
0
 88






CTTGGTTACA







 


420924
518
537
3′UTR
AATGGAATAC
75
515
534
0
 89






TCTTGGTTAC







 


420925
519
538
3′UTR
AAATGGAATA
87
516
535
0
 90






CTCTTGGTTA







 


420926
520
539
3′UTR
AAAATGGAAT
88
517
536
0
 91






ACTCTTGGTT







 


420927
521
540
3′UTR
AAAAATGGAA
50
518
537
0
 92






TACTCTTGGT







 


420928
522
541
3′UTR
TAAAAATGGA
26
519
538
0
 93






ATACTCTTGG







 


420929
523
542
3′UTR
GTAAAAATGG
56
520
539
0
 94






AATACTCTTG







 


420930
524
543
3′UTR
AGTAAAAATG
18
521
540
0
 95






GAATACTCTT







 


420931
525
544
3′UTR
TAGTAAAAAT
12
522
541
0
 96






GGAATACTCT







 


420932
527
546
3′UTR
TTTAGTAAAA
 1
524
543
0
 97






ATGGAATACT







 


420933
528
547
3′UTR
CTTTAGTAAAA
 0
525
544
0
 98






ATGGAATAC







 


420934
529
548
3′UTR
GCTTTAGTAAA
 6
526
545
0
 99






AATGGAATA







 


420935
530
549
3′UTR
TGCTTTAGTAA
 0
527
546
0
100






AAATGGAAT







 


420936
531
550
3′UTR
CTGCTTTAGTA
40
528
547
0
101






AAAATGGAA







 


420937
533
552
3′UTR
CACTGCTTTAG
47
530
549
0
102






TAAAAATGG







 


420938
534
553
3′UTR
ACACTGCTTTA
30
531
550
0
103






GTAAAAATG







 


420939
535
554
3′UTR
AACACTGCTTT
 0
532
551
0
104






AGTAAAAAT







 


420940
536
555
3′UTR
AAACACTGCTT
 0
533
552
0
105






TAGTAAAAA







 


420941
537
556
3′UTR
AAAACACTGC
 0
534
553
0
106






TTTAGTAAAA







 


420942
538
557
3′UTR
GAAAACACTG
 0
535
554
0
107






CTTTAGTAAA







 


420943
540
559
3′UTR
GTGAAAACAC
14
537
556
0
108






TGCTTTAGTA







 


420944
541
560
3′UTR
GGTGAAAACA
43
538
557
0
109






CTGCTTTAGT







 


420945
542
561
3′UTR
AGGTGAAAAC
41
539
558
0
110






ACTGCTTTAG







 


420946
543
562
3′UTR
GAGGTGAAAA
20
540
559
0
111






CACTGCTTTA







 


420947
544
563
3′UTR
TGAGGTGAAA
69
541
560
0
112






ACACTGCTTT







 


420948
545
564
3′UTR
ATGAGGTGAA
63
542
561
0
113






AACACTGCTT







 


420949
579
598
3′UTR
TTTATTGTCTC
84
576
595
0
114






TGCCTGGAC







 


420950
580
599
3′UTR
TTTTATTGTCT
69
577
596
0
115






CTGCCTGGA







 


420951
581
600
3′UTR
GTTTTATTGTC
87
578
597
0
116






TCTGCCTGG







 


420952
582
601
3′UTR
TGTTTTATTGT
67
579
598
0
117






CTCTGCCTG







 


420953
583
602
3′UTR
ATGTTTTATTG
51
580
599
0
118






TCTCTGCCT







 


420954
584
603
3′UTR
AATGTTTTATT
60
581
600
0
119






GTCTCTGCC







 


420955
585
604
3′UTR
GAATGTTTTAT
65
582
601
0
120






TGTCTCTGC







 


420956
586
605
3′UTR
GGAATGTTTTA
67
583
602
0
121






TTGTCTCTG







 


420957
587
606
3′UTR
AGGAATGTTTT
68
584
603
0
122






ATTGTCTCT







 


420958
588
607
3′UTR
CAGGAATGTTT
45
585
604
0
123






TATTGTCTC







 


420959
589
608
3′UTR
ACAGGAATGT
28
586
605
0
124






TTTATTGTCT
















TABLE 2







Inhibition of human transthyretin mRNA levels by chimeric antisense


oligonucleotides having 5-10-5 MOE wings and deoxy gap targeted to


SEQ ID NO: 2 and SEQ ID NO: 4






















Rhesus
Rhesus





Human
Human



monkey
monkey

SEQ


ISIS
Start
Stop


%
start
stop
Mis-
ID


NO
Site
Site
Region
Sequence
inhibition
site
site
matches
NO





420960
 606
 625
exon1-
GATGTCACAG
13
1755
1774
0
125





intron1
AAACACTCAC







 


420961
 665
 684
intron
GCAAAGCTGG
 7
1814
1833
0
126





1
AAGGAGTCAC







 


420962
 748
 767
intron
GAACTTCATTC
 0
1897
1916
0
127





1
TTTTTGAAG







 


420963
 882
 901
intron
AGCTTCCTTAA
 0
2031
2050
0
128





1
TATCATATC







 


420964
 966
 985
intron
TATAGGGCCA
10
2115
2134
0
129





1
GAATATAATC







 


420965
1010
1029
intron
ACTAAGCCTTT
17
2159
2178
0
130





1
TAAAGATTA







 


420966
1208
1227
intron
TGGAATTACT
35
2356
2375
0
131





1
GAAAAGATGT







 


420967
1289
1308
intron
ACCAGGGATG
43
2437
2456
0
132





1
TGTATAATGA







 


420968
1364
1383
intron
TCCCTACTCAG
 0
2512
2531
0
133





1
TATAACACA







 


420969
1472
1491
intron
GATCAGAGTG
 0
2620
2639
0
134





1
AAAGGATTTA







 


420970
1687
1706
intron
GGGAAGATAA
46
2826
2845
0
135





2
AACCAAGTCC







 


420971
1739
1758
intron
TAAATTCTTTA
 0
2878
2897
0
136





2
GCAGATGAT







 


420972
1842
1861
intron
AATGATGCTC
23
2980
2999
0
137





2
AGGTTCCTGG







 


420973
2051
2070
intron
TTGGTGTTACC
 0
3187
3206
0
138





2
CAGGGACAC







 


420974
2207
2226
intron
AAAGTGTTCA
29
3344
3363
0
139





2
TTAGGCAAAA







 


420975
2655
2674
intron
GGCATTTTATA
 0
3798
3817
0
140





2
TAAACATAA







 


420976
2733
2752
intron
AAGAACATTG
 0
3876
3895
0
141





2
GAATATTTTT







 


420977
2874
2893
intron
GTTGGAAATT
 9
4017
4036
0
142





2
GCTTCCCATT







 


420978
3015
3034
intron
AGTGGAAAAC
 0
4156
4175
0
143





2
CTAAAGTAGG







 


420979
3618
3637
intron
TTCCCCTCAAC
 0
4795
4814
0
144





2
TAAGTCAGA







 


420980
3735
3754
intron2-
CCTATAAGGT
 0
4930
4949
0
145





exon 3
GTGAAAGTCT







 


420981
4096
4115
intron
TGTAAGTTCA
 0
5291
5310
0
146





3
AGTCATGTTA







 


420982
4306
4325
intron
GTGTTGCCAA
 0
5502
5521
0
147





3
GAATCACTTG







 


420983
4404
4423
intron
AAAACACTTA
 0
5600
5619
0
148





3
TAATTGTGTC







 


420984
4518
4537
intron
CTTTGACAAGT
 0
5714
5733
0
149





3
TATTTGACT







 


420985
4880
4899
intron
ATCCATGACT
 0
6073
6092
0
150





3
AAGCCAGAGA







 


420986
5185
5204
intron
ATGGTTCCCAT
 0
6379
6398
0
151





3
CAGGCTGAG







 


420987
5542
5561
intron
GCATTTATCAG
 0
6732
6751
0
152





3
AAGAAGCTG







 


420988
6030
6049
intron
TTGACCTTCAG
 0
7226
7245
0
153





3
CCCACTTGA







 


420989
6133
6152
intron
AGGAAGTGAG
 0
7641
7660
0
154





3
AATCACCTAA







 


420990
6320
6339
intron
AGAAGACAGT
 0
7828
7847
0
155





3
AAAGATGTGT







 


420991
6457
6476
intron
AAATTGTGGA
 0
7966
7985
0
156





3
TCAAAATGCT







 


420992
6736
6755
intron
AACCAGACTT
 0
8246
8265
0
157





3
GAATTATTGT







 


420993
6811
6830
intron
AGTGGCTGCC
 0
8321
8340
0
158





3
AACCACAGAC







 


420994
7106
7125
intron
GGAAGTCCAG
 0
8615
8634
0
159





3
TGCCAACTTA







 


420995
7162
7181
intron
ATCCATTTCCA
 0
8670
8689
0
160





3
CCAGAGCCC









Due to the short length of the human transthyretin mRNA, a second primer probe set was designed away from the first primer probe set, RTS 1396, to avoid amplicon oligonucleotides. The antisense oligonucleotides were also tested for their effects on transthyretin mRNA in vitro using new human primer probe set RTS3029 (forward sequence CTTGCTGGACTGGTATTTGTGTCT, designated herein as SEQ ID NO: 161, reverse sequence AGAACTTTGACCATCAGAGGACACT, designated herein as SEQ ID NO: 162; probe sequence CCCTACGGGCACCGGTGAATCCX, designated herein as SEQ ID NO: 163). Cultured HepG2 cells at a density of 10,000 cells per well were transfected using lipofectin reagent with 50 nM antisense oligonucleotide. After a treatment period of approximately 24 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. The results are presented in Table 3 as percent inhibition of the PBS control cell set.







TABLE 3







Inhibition of human transthyretin mRNA 


levels by chimeric antisense oligonucleotides 


having 5-10-5 MOE wings and deoxy 


gap with primer probe set RTS3029









ISIS 

% 


NO
Region
inhibition












304267
coding
13


304268
coding
10


304280
coding
23


304284
coding
10


304285
coding
34


304286
coding
0


304287
coding
34


304288
coding
45


304289
coding
3


304290
coding
16


304291
coding-stop codon
4


304292
coding-stop codon
10


304293
coding-stop codon
14


304294
stop codon-3’ UTR
30


304296
exon 4
78


304297
exon 4
29


304298
exon 4
19


304299
exon 4
85


304300
exon 4
52


304301
exon 4
15


304302
exon 4
45


304303
exon 4
51


304304
exon 4
62


304307
exon 4
76


304308
exon 4
63


304309
exon 4
75


304311
exon 4
81


304312
exon 4
68


420871
coding
0


420872
coding
5


420873
coding
19


420874
coding
0


420875
coding
6


420876
coding
20


420877
coding
28


420878
coding
37


420879
coding
34


420880
coding
36


420881
coding
10


420882
coding
27


420883
coding
13


420884
coding
28


420885
coding
4


420886
coding
21


420887
coding
39


420888
coding
37


420889
coding
9


420890
coding
27


420891
coding
39


420892
coding
43


420893
coding
39


420894
coding
0


420895
coding
0


420896
coding
24


420897
coding
31


420898
coding-
0


420899
stop codon-3’UTR
41


420900
stop codon-3’UTR
26


420901
stop codon-3’UTR
28


420902
stop codon-3’UTR
20


420903
stop codon-3’UTR
20


420904
stop codon-3’UTR
22


420905
stop codon-3’UTR
32


420906
stop codon-3’UTR
13


420907
-stop codon-3’UTR
0


420908
stop codon-3’UTR
45


420909
3’UTR
41


420910
3’UTR
14


420911
3’UTR
45


420912
3’UTR
62


420913
3’UTR
81


420914
3’UTR
68


420915
3’UTR
71


420916
3’UTR
54


420917
3’UTR
50


420918
3’UTR
43


420919
3’UTR
65


420920
3’UTR
61


420921
3’UTR 
65


420922
3’UTR 
68


420923
3’UTR 
62


420924
3’UTR 
9


420925
3’UTR 
17


420926
3’UTR 
47


420927
3’UTR 
57


420928
3’UTR 
51


420929
3’UTR 
46


420930
3’UTR 
39


420931
3’UTR 
14


420932
3’UTR 
6


420933
3’UTR 
1


420934
3’UTR 
48


420935
3’UTR 
13


420936
3’UTR 
62


420937
3’UTR 
65


420938
3’UTR 
48


420939
3’UTR 
7


420940
3’UTR 
3


420941
3’UTR
31


420942
3’UTR 
0


420943
3’UTR 
40


420944
3’UTR 
78


420945
3’UTR 
58


420946
3’UTR 
52


420947
3’UTR 
71


420948
3’UTR 
73


420949
3’UTR 
88


420950
3’UTR 
82


420951
3’UTR 
90


420952
3’UTR
82


420953
3’UTR 
71


420954
3’UTR 
67


420955
3’UTR 
73


420956
3’UTR 
65


420957
3’UTR 
74


420958
3’UTR 
69


420959
3’UTR
63


420960
exon1-intron1
14


420961
intron 1
16


420962
intron 1
0


420963
intron 1
0


420964
intron 1
14


420965
intron 1
23


420966
intron 1
25


420967
intron 1
12


420968
intron 1
0


420969
intron 1
0


420970
intron 2
25


420971
intron 2
0


420972
intron 2
25


420973
intron 2
7


420974
intron 2
28


420975
intron 2
9


420976
intron 2
21


420977
intron 2
14


420978
intron 2
37


420979
intron 2
37


420980
intron2-exon 3
16


420981
intron 3
0


420982
intron 3
28


420983
intron 3
0


420984
intron 3
0


420985
intron 3
0


420986
intron 3
7


420987
intron 3
0


420988
intron 3
0


420989
intron 3
0


420990
intron 3
6


420991
intron 3
15


420992
intron 3
0


420993
intron 3
0


420994
intron 3
0


420995
intron 3
10









Based on the inhibition results using the new primer probe set RTS3029, antisense oligonucleotides exhibiting 50% or more inhibition of transthyretin mRNA were selected for further studies.
Example 2
Antisense Inhibition of Human Transthyretin in HepG2 Cells by Oligonucleotides Designed by Microwalk
Additional gapmers were designed based on the gapmers presented in Table 3 that demonstrated an inhibition of at least 50%. These gapmers were designed by creating gapmers shifted slightly upstream and downstream (i.e. “microwalk”) of the original gapmers from Table 3. Gapmers were also created with various motifs, e.g. 5-10-5 MOE, 3-14-3 MOE, 2-13-5 MOE, and 4-11-5 MOE motifs. These gapmers were tested in vitro. Cultured HepG2 cells at a density of 10,000 cells per well were transfected using lipofectin reagent with 50 nM antisense oligonucleotide. After a treatment period of approximately 24 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. The human primer probe set RTS3029 was used to measure transthyretin mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. The results are presented in Table 4.
The chimeric antisense oligonucleotides in Table 4 were designed as 5-10-5 MOE, 3-14-3 MOE, 2-13-5 MOE or 4-11-5 MOE gapmers. The gapmers designated with an asterisk (*) in Table 4 are the original gapmers from which gapmers, ISIS 425650-425763, were designed via microwalk. The 5-10-5 gapmers are 20 nucleotides in length, wherein the central gap segment is comprised of ten 2′-deoxynucleotides and is flanked on both sides (in the 5′ and 3′ directions) by wings comprising five nucleotides each. The 3-14-3 gapmers are 20 nucleotides in length, wherein the central gap segment is comprised of fourteen 2′-deoxynucleotides and is flanked on both sides (in the 5′ and 3′ directions) by wings comprising three nucleotides each. The 2-13-5 gapmers are 20 nucleotides in length, wherein the central gap segment is comprised of thirteen 2′-deoxynucleotides and is flanked on the 5′ and the 3′ directions with wings comprising two and five nucleotides respectively. The 4-11-5 gapmers are 20 nucleotides in length, wherein the central gap segment is comprised of eleven 2′-deoxynucleotides and is flanked on the 5′ and the 3′ directions with wings comprising four and five nucleotides respectively. For each of the motifs (5-10-5, 3-14-3, 2-113-5, and 4-11-5), each nucleotide in the 5′ wing segment and each nucleotide in the 3′ wing segment has a 2′-MOE modification. The internucleoside linkages throughout each gapmer are phosphorothioate (P═S) linkages. All cytidine residues throughout each gapmer are 5-methylcytidines. “Target start site” indicates the 5′-most nucleotide to which the gapmer is targeted. “Target stop site” indicates the 3′-most nucleotide to which the gapmer is targeted. Each gapmer listed in Table 4 is targeted to the target region spanning nucleobases 481-619 of SEQ ID NO: 1 (GENBANK Accession No. NM_000371.2).
As shown in Table 4, several of the gapmers exhibited at least 50% inhibition, including ISIS numbers: 304296, 425655, 425695, 425735, 425649, 425656, 425696, 425736, 420912, 425657, 425697, 425737, 420913, 425658, 425698, 425738, 420914, 425659, 425699, 425739, 304299, 425660, 425700, 425740, 420915, 420916, 425662, 425702, 420919, 425703, 420920, 425664, 425704, 425742, 420921, 425665, 425705, 425743, 420922, 425666, 425706, 420923, 420937, 420944, 425669, 425709, 425746, 425710, 425711, 425747, 420948, 425712, 425748, 425673, 425713, 425749, 425651, 425675, 425715, 425751, 304309, 425676, 425716, 425752, 420949, 425677, 425717, 425753, 420950, 425678, 425718, 425754, 420951, 425679, 425719, 425755, 420952, 425680, 425720, 425756, 420953, 425681, 425721, 425757, 420954, 425722, 425758, 420955, 425759, 425724, 425760, 425762, 304310, 425729, 425764, 425653, 425690, 425730, 425765, 304311, 425691, 425731, 425766, 304312, 425692, 425732, 425767, 425654, 425693, 425733, 425768, 304313, 425734, and 425769.
Several of the gapmers exhibited at least 60% inhibition, including ISIS numbers: 304296, 425655, 425695, 425735, 425649, 425656, 425696, 425736, 420912, 425657, 425697, 425737, 420913, 425658, 425698, 425738, 420914, 425659, 425739, 304299, 425740, 420915, 425702, 420919, 420920, 425742, 420921, 425665, 425705, 425706, 420923, 425746, 425711, 425747, 420948, 425712, 425748, 425651, 425715, 425751, 304309, 425716, 425752, 425677, 425717, 425753, 420950, 425718, 425754, 420951, 425679, 425719, 425755, 420952, 425680, 425720, 420953, 425681, 425721, 425757, 420954, 425722, 425758, 420955, 425724, 425760, 425764, 425653, 425690, 425730, 425765, 304311, 425691, 425731, 425766, 304312, 425692, 425732, 425767, 425654, 425693, 425733, 304313, and 425769.
Several of the gapmers exhibited at least 70% inhibition, including ISIS numbers: 304296, 425655, 425695, 425735, 425649, 425656, 425696, 425736, 420912, 425657, 425737, 420913, 425738, 420914, 425659, 304299, 420915, 420920, 425742, 425712, 425748, 425716, 425754, 420951, 425679, 425719, 425755, 425680, 425721, 425757, 425760, 425653, 425690, 425730, 425765, 304311, 425691, 425731, 425766, 304312, 425767, 425693, and 304313.
Several of the gapmers exhibited at least 80% inhibition, including ISIS numbers: 304296, 425655, 425695, 425736, 420913, 425659, 304299, 420915, 425716, 425754, 425719, 425757, 425765, and 425767.
Several of the gapmers exhibited at least 85% inhibition, including ISIS numbers: 420913, 425716, 425754, and 425719.
One gapmer, ISIS 425719, exhibited 90% inhibition.







TABLE 4







Inhibition of human transthyretin mRNA levels by chimeric


antisense oligonucleotides targeted to SEQ ID NO: 1


(GENBANK Accession No. NM_000371.2)



















SEQ



Start
Stop


%
ID


OligoID
Site
Site
Sequence
Motif
inhibition
NO





*304296
481
500
GTCCTTCAGGTCCACTGGAG
5-10-5
83
 22


 


 425655
481
500
GTCCTTCAGGTCCACTGGAG
3-14-3
80
 22


 


 425695
481
500
GTCCTTCAGGTCCACTGGAG
2-13-5
80
 22


 


 425735
481
500
GTCCTTCAGGTCCACTGGAG
4-11-5
72
 22


 


 425649
482
501
CGTCCTTCAGGTCCACTGGA
5-10-5
75
170


 


 425656
482
501
CGTCCTTCAGGTCCACTGGA
3-14-3
78
170


 


 425696
482
501
CGTCCTTCAGGTCCACTGGA
2-13-5
74
170


 


 425736
482
501
CGTCCTTCAGGTCCACTGGA
4-11-5
83
170


 


*420912
504
523
GGTTACATGAAATCCCATCC
5-10-5
73
 77


 


 425657
504
523
GGTTACATGAAATCCCATCC
3-14-3
76
 77


 


 425697
504
523
GGTTACATGAAATCCCATCC
2-13-5
69
 77


 


 425737
504
523
GGTTACATGAAATCCCATCC
4-11-5
78
 77


 


*420913
505
524
TGGTTACATGAAATCCCATC
5-10-5
89
 78


 


 425658
505
524
TGGTTACATGAAATCCCATC
3-14-3
69
 78


 


 425698
505
524
TGGTTACATGAAATCCCATC
2-13-5
61
 78


 


 425738
505
524
TGGTTACATGAAATCCCATC
4-11-5
78
 78


 


*420914
506
525
TTGGTTACATGAAATCCCAT
5-10-5
70
 79


 


 425659
506
525
TTGGTTACATGAAATCCCAT
3-14-3
83
 79


 


 425699
506
525
TTGGTTACATGAAATCCCAT
2-13-5
56
 79


 


 425739
506
525
TTGGTTACATGAAATCCCAT
4-11-5
69
 79


 


*304299
507
526
CTTGGTTACATGAAATCCCA
5-10-5
83
 25


 


 425660
507
526
CTTGGTTACATGAAATCCCA
3-14-3
59
 25


 


 425700
507
526
CTTGGTTACATGAAATCCCA
2-13-5
52
 25


 


 425740
507
526
CTTGGTTACATGAAATCCCA
4-11-5
69
 25


 


*420915
508
527
TCTTGGTTACATGAAATCCC
5-10-5
81
 80


 


 425661
508
527
TCTTGGTTACATGAAATCCC
3-14-3
48
 80


 


 425701
508
527
TCTTGGTTACATGAAATCCC
2-13-5
41
 80


 


 425741
508
527
TCTTGGTTACATGAAATCCC
4-11-5
37
 80


 


*420916
509
528
CTCTTGGTTACATGAAATCC
5-10-5
52
 81


 


 425662
509
528
CTCTTGGTTACATGAAATCC
3-14-3
57
 81


 


 425702
509
528
CTCTTGGTTACATGAAATCC
2-13-5
63
 81


 


*420919
512
531
ATACTCTTGGTTACATGAAA
5-10-5
69
 84


 


 425663
512
531
ATACTCTTGGTTACATGAAA
3-14-3
46
 84


 


 425703
512
531
ATACTCTTGGTTACATGAAA
2-13-5
52
 84


 


*420920
514
533
GAATACTCTTGGTTACATGA
5-10-5
71
 85


 


 425664
514
533
GAATACTCTTGGTTACATGA
3-14-3
57
 85


 


 425704
514
533
GAATACTCTTGGTTACATGA
2-13-5
58
 85


 


 425742
514
533
GAATACTCTTGGTTACATGA
4-11-5
71
 85


 


*420921
515
534
GGAATACTCTTGGTTACATG
5-10-5
68
 86


 


 425665
515
534
GGAATACTCTTGGTTACATG
3-14-3
65
 86


 


 425705
515
534
GGAATACTCTTGGTTACATG
2-13-5
60
 86


 


 425743
515
534
GGAATACTCTTGGTTACATG
4-11-5
56
 86


 


*420922
516
535
TGGAATACTCTTGGTTACAT
5-10-5
54
 87


 


 425666
516
535
TGGAATACTCTTGGTTACAT
3-14-3
56
 87


 


 425706
516
535
TGGAATACTCTTGGTTACAT
2-13-5
64
 87


 


 425744
516
535
TGGAATACTCTTGGTTACAT
4-11-5
39
 87


 


*420923
517
536
ATGGAATACTCTTGGTTACA
5-10-5
62
 88


 


 425667
517
536
ATGGAATACTCTTGGTTACA
3-14-3
44
 88


 


 425707
517
536
ATGGAATACTCTTGGTTACA
2-13-5
30
 88


 


*420937
533
552
CACTGCTTTAGTAAAAATGG
5-10-5
59
102


 


 425668
533
552
CACTGCTTTAGTAAAAATGG
3-14-3
37
102


 


 425708
533
552
CACTGCTTTAGTAAAAATGG
2-13-5
32
102


 


 425745
533
552
CACTGCTTTAGTAAAAATGG
4-11-5
43
102


 


*420944
541
560
GGTGAAAACACTGCTTTAGT
5-10-5
52
109


 


 425669
541
560
GGTGAAAACACTGCTTTAGT
3-14-3
54
109


 


 425709
541
560
GGTGAAAACACTGCTTTAGT
2-13-5
54
109


 


 425746
541
560
GGTGAAAACACTGCTTTAGT
4-11-5
60
109


 


*420945
542
561
AGGTGAAAACACTGCTTTAG
5-10-5
38
110


 


 425670
542
561
AGGTGAAAACACTGCTTTAG
3-14-3
38
110


 


 425710
542
561
AGGTGAAAACACTGCTTTAG
2-13-5
52
110


 


*420947
544
563
TGAGGTGAAAACACTGCTTT
5-10-5
34
112


 


 425671
544
563
TGAGGTGAAAACACTGCTTT
3-14-3
27
112


 


 425711
544
563
TGAGGTGAAAACACTGCTTT
2-13-5
68
112


 


 425747
544
563
TGAGGTGAAAACACTGCTTT
4-11-5
61
112


 


*420948
545
564
ATGAGGTGAAAACACTGCTT
5-10-5
66
113


 


 425672
545
564
ATGAGGTGAAAACACTGCTT
3-14-3
47
113


 


 425712
545
564
ATGAGGTGAAAACACTGCTT
2-13-5
70
113


 


 425748
545
564
ATGAGGTGAAAACACTGCTT
4-11-5
71
113


 


*304304
546
565
TATGAGGTGAAAACACTGCT
5-10-5
46
 30


 


 425673
546
565
TATGAGGTGAAAACACTGCT
3-14-3
51
 30


 


 425713
546
565
TATGAGGTGAAAACACTGCT
2-13-5
50
 30


 


 425749
546
565
TATGAGGTGAAAACACTGCT
4-11-5
58
 30


 


 425650
547
566
ATATGAGGTGAAAACACTGC
5-10-5
28
171


 


 425674
547
566
ATATGAGGTGAAAACACTGC
3-14-3
40
171


 


 425714
547
566
ATATGAGGTGAAAACACTGC
2-13-5
44
171


 


 425750
547
566
ATATGAGGTGAAAACACTGC
4-11-5
47
171


 


 425651
577
596
TATTGTCTCTGCCTGGACTT
5-10-5
65
172


 


 425675
577
596
TATTGTCTCTGCCTGGACTT
3-14-3
55
172


 


 425715
577
596
TATTGTCTCTGCCTGGACTT
2-13-5
65
172


 


 425751
577
596
TATTGTCTCTGCCTGGACTT
4-11-5
62
172


 


*304309
578
597
TTATTGTCTCTGCCTGGACT
5-10-5
66
 33


 


 425676
578
597
TTATTGTCTCTGCCTGGACT
3-14-3
59
 33


 


 425716
578
597
TTATTGTCTCTGCCTGGACT
2-13-5
87
 33


 


 425752
578
597
TTATTGTCTCTGCCTGGACT
4-11-5
67
 33


 


*420949
579
598
TTTATTGTCTCTGCCTGGAC
5-10-5
57
114


 


 425677
579
598
TTTATTGTCTCTGCCTGGAC
3-14-3
67
114


 


 425717
579
598
TTTATTGTCTCTGCCTGGAC
2-13-5
68
114


 


 425753
579
598
TTTATTGTCTCTGCCTGGAC
4-11-5
69
114


 


*420950
580
599
TTTTATTGTCTCTGCCTGGA
5-10-5
61
115


 


 425678
580
599
TTTTATTGTCTCTGCCTGGA
3-14-3
59
115


 


 425718
580
599
TTTTATTGTCTCTGCCTGGA
2-13-5
69
115


 


 425754
580
599
TTTTATTGTCTCTGCCTGGA
4-11-5
86
115


 


*420951
581
600
GTTTTATTGTCTCTGCCTGG
5-10-5
78
116


 


 425679
581
600
GTTTTATTGTCTCTGCCTGG
3-14-3
73
116


 


 425719
581
600
GTTTTATTGTCTCTGCCTGG
2-13-5
90
116


 


 425755
581
600
GTTTTATTGTCTCTGCCTGG
4-11-5
73
116


 


*420952
582
601
TGTTTTATTGTCTCTGCCTG
5-10-5
61
117


 


 425680
582
601
TGTTTTATTGTCTCTGCCTG
3-14-3
77
117


 


 425720
582
601
TGTTTTATTGTCTCTGCCTG
2-13-5
67
117


 


 425756
582
601
TGTTTTATTGTCTCTGCCTG
4-11-5
57
117


 


*420953
583
602
ATGTTTTATTGTCTCTGCCT
5-10-5
65
118


 


 425681
583
602
ATGTTTTATTGTCTCTGCCT
3-14-3
61
118


 


 425721
583
602
ATGTTTTATTGTCTCTGCCT
2-13-5
77
118


 


 425757
583
602
ATGTTTTATTGTCTCTGCCT
4-11-5
83
118


 


*420954
584
603
AATGTTTTATTGTCTCTGCC
5-10-5
63
119


 


 425682
584
603
AATGTTTTATTGTCTCTGCC
3-14-3
42
119


 


 425722
584
603
AATGTTTTATTGTCTCTGCC
2-13-5
69
119


 


 425758
584
603
AATGTTTTATTGTCTCTGCC
4-11-5
61
119


 


*420955
585
604
GAATGTTTTATTGTCTCTGC
5-10-5
65
120


 


 425683
585
604
GAATGTTTTATTGTCTCTGC
3-14-3
30
120


 


 425723
585
604
GAATGTTTTATTGTCTCTGC
2-13-5
44
120


 


 425759
585
604
GAATGTTTTATTGTCTCTGC
4-11-5
50
120


 


*420956
586
605
GGAATGTTTTATTGTCTCTG
5-10-5
47
121


 


 425684
586
605
GGAATGTTTTATTGTCTCTG
3-14-3
44
121


 


 425724
586
605
GGAATGTTTTATTGTCTCTG
2-13-5
65
121


 


*420957
587
606
AGGAATGTTTTATTGTCTCT
5-10-5
37
122


 


 425685
587
606
AGGAATGTTTTATTGTCTCT
3-14-3
46
122


 


 425725
587
606
AGGAATGTTTTATTGTCTCT
2-13-5
43
122


 


 425760
587
606
AGGAATGTTTTATTGTCTCT
4-11-5
78
122


 


*420958
588
607
CAGGAATGTTTTATTGTCTC
5-10-5
41
123


 


 425686
588
607
CAGGAATGTTTTATTGTCTC
3-14-3
 6
123


 


 425726
588
607
CAGGAATGTTTTATTGTCTC
2-13-5
41
123


 


 425761
588
607
CAGGAATGTTTTATTGTCTC
4-11-5
39
123


 


*420959
589
608
ACAGGAATGTTTTATTGTCT
5-10-5
43
124


 


 425687
589
608
ACAGGAATGTTTTATTGTCT
3-14-3
22
124


 


 425727
589
608
ACAGGAATGTTTTATTGTCT
2-13-5
25
124


 


 425762
589
608
ACAGGAATGTTTTATTGTCT
4-11-5
57
124


 


 425652
590
609
CACAGGAATGTTTTATTGTC
5-10-5
23
173


 


 425688
590
609
CACAGGAATGTTTTATTGTC
3-14-3
11
173


 


 425728
590
609
CACAGGAATGTTTTATTGTC
2-13-5
37
173


 


 425763
590
609
CACAGGAATGTTTTATTGTC
4-11-5
38
173


 


 304310
595
614
CCTTTCACAGGAATGTTTTA
5-10-5
57
174


 


 425689
595
614
CCTTTCACAGGAATGTTTTA
3-14-3
38
174


 


 425729
595
614
CCTTTCACAGGAATGTTTTA
2-13-5
58
174


 


 425764
595
614
CCTTTCACAGGAATGTTTTA
4-11-5
60
174


 


 425653
596
615
GCCTTTCACAGGAATGTTTT
5-10-5
79
175


 


 425690
596
615
GCCTTTCACAGGAATGTTTT
3-14-3
73
175


 


 425730
596
615
GCCTTTCACAGGAATGTTTT
2-13-5
76
175


 


 425765
596
615
GCCTTTCACAGGAATGTTTT
4-11-5
83
175


 


*304311
597
616
TGCCTTTCACAGGAATGTTT
5-10-5
71
 34


 


 425691
597
616
TGCCTTTCACAGGAATGTTT
3-14-3
74
 34


 


 425731
597
616
TGCCTTTCACAGGAATGTTT
2-13-5
73
 34


 


 425766
597
616
TGCCTTTCACAGGAATGTTT
4-11-5
79
 34


 


*304312
598
617
GTGCCTTTCACAGGAATGTT
5-10-5
71
 35


 


 425692
598
617
GTGCCTTTCACAGGAATGTT
3-14-3
69
 35


 


 425732
598
617
GTGCCTTTCACAGGAATGTT
2-13-5
67
 35


 


 425767
598
617
GTGCCTTTCACAGGAATGTT
4-11-5
83
 35


 


 425654
599
618
AGTGCCTTTCACAGGAATGT
5-10-5
64
176


 


 425693
599
618
AGTGCCTTTCACAGGAATGT
3-14-3
79
176


 


 425733
599
618
AGTGCCTTTCACAGGAATGT
2-13-5
68
176


 


 425768
599
618
AGTGCCTTTCACAGGAATGT
4-11-5
50
176


 


 304313
600
619
AAGTGCCTTTCACAGGAATG
5-10-5
73
177


 


 425694
600
619
AAGTGCCTTTCACAGGAATG
3-14-3
45
177


 


 425734
600
619
AAGTGCCTTTCACAGGAATG
2-13-5
55
177


 


 425769
600
619
AAGTGCCTTTCACAGGAATG
4-11-5
62
177









Example 3
Dose-Dependent Antisense Inhibition of Human Transthyretin in HepG2 Cells
Gapmers from Example 2 exhibiting significant in vitro inhibition of human transthyretin were tested at various doses in HepG2 cells. Cells were plated at a density of 20,000 cells per well and transfected using electroporation with 625 nM, 1250 nM, 2500 nM, 5000 nM and 10000 nM concentrations of antisense oligonucleotide, as specified in Table 5. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS3029 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells.
The half maximal inhibitory concentration (IC50) of each oligonucleotide is also presented in Table 5 and was calculated by plotting the concentrations of oligonucleotides used versus the percent inhibition of transthyretin mRNA expression achieved at each concentration, and noting the concentration of oligonucleotide at which 50% inhibition of transthyretin mRNA expression was achieved compared to the control. As illustrated in Table 5, transthyretin mRNA levels were significantly reduced in a dose-dependent manner in antisense oligonucleotide treated cells.







TABLE 5







Dose-dependent antisense inhibition of human transthyretin


in HepG2 cells using electroporation













ISIS




10000
IC50


NO
625 nM
1250 nM
2500 nM
5000 nM
nM
(μM)
















304296
57
74
83
91
96
<0.625


304299
43
76
82
95
94
0.627


420913
59
75
90
88
98
<0.625


420915
60
85
91
95
99
<0.625


420951
64
77
90
97
99
<0.625


425653
70
86
86
88
82
<0.625


425655
48
80
85
97
96
<0.625


425656
70
89
92
92
96
<0.625


425659
46
56
68
82
93
0.8


425679
63
77
72
94
97
<0.625


425680
28
79
85
93
98
0.8


425693
2
64
74
76
81
1.7


425695
74
87
91
97
98
<0.625


425716
69
84
95
97
98
<0.625


425719
58
84
92
96
98
<0.625


425721
40
75
89
95
98
0.7


425736
64
71
86
93
93
<0.625


425737
78
93
95
97
98
<0.625


425738
40
77
88
94
95
0.7


425754
56
75
87
96
99
<0.625


425755
58
84
88
94
97
<0.625


425757
62
82
94
97
99
<0.625


425760
58
42
74
85
93
<0.625


425765
81
86
87
83
88
<0.625


425766
83
89
81
75
74
<0.625


425767
56
75
83
81
80
<0.625









Gapmers from Example 2 were also tested at various doses in HepG2 cells using the transfection reagent, lipofectin. Cells were plated at a density of 10,000 cells per well and transfected using electroporation with 6.25 nM, 12.5 nM, 25 nM, 50 nM and 100 nM concentrations of antisense oligonucleotide, as specified in Table 6. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS3029 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. As illustrated in Table 6, transthyretin mRNA levels were significantly reduced in a dose-dependent manner in antisense oligonucleotide treated cells.







TABLE 6







Dose-dependent antisense inhibition of human transthyretin


in HepG2 cells using lipofectin reagent













ISIS





IC50


NO
6.25 nM
12.5 nM
25 nM
50 nM
100 nM
(nM)
















304296
26
41
43
52
65
39


304299
22
70
43
74
83
20


420913
4
60
60
68
82
30


420915
36
31
46
64
67
28


420951
10
37
56
85
84
19


425653
25
38
60
74
77
18


425655
27
15
62
79
81
16


425656
37
62
47
69
82
15


425659
17
35
33
79
73
30


425679
32
6
63
79
77
14


425680
16
48
41
84
84
28


425693
10
19
51
66
61
26


425695
36
23
54
76
84
28


425716
57
52
36
85
81
38


425719
25
39
28
60
76
45


425721
0
22
38
73
75
32


425736
25
60
30
77
80
22


425737
36
52
50
60
76
14


425738
13
15
19
65
70
27


425754
8
18
38
75
71
42


425755
26
46
54
77
86
20


425757
0
37
81
83
71
19


425760
28
46
72
70
80
18


425765
0
52
48
66
69
29


425766
24
19
48
69
71
29


425767
41
49
48
65
75
14









Example 4
Dose-Dependent Antisense Inhibition of Human Transthyretin in HepG2 Cells
Gapmers selected from Example 3 were tested at various doses in HepG2 cells. Cells were plated at a density of 20,000 cells per well and transfected using electroporation with 0.0617 μM, 0.1852 μM, 0.5556 μM, 1.6667 μM and 5 μM concentrations of antisense oligonucleotide, as specified in Table 7. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS3029 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. As illustrated in Table 7, transthyretin mRNA levels were reduced in a dose-dependent manner in antisense oligonucleotide treated cells.







TABLE 7







Dose-dependent antisense inhibition of human transthyretin


in HepG2 cells using electroporation



















IC50


ISIS NO
0.0617 μM
0.1852 μM
0.5556 μM
1.6667 μM
5 μM
(μM)
















304296
0
6
44
58
83
1.2


304299
38
10
57
83
92
0.6


420913
51
51
54
73
93
0.2


420915
33
35
62
65
93
0.2


420951
40
33
36
82
96
0.4


425653
55
58
74
72
84
<0.06


425655
8
35
54
57
90
0.5


425656
12
43
43
78
94
0.4


425659
14
35
19
46
82
0.6


425679
30
13
23
69
91
0.8


425680
0
35
45
74
84
0.7


425693
0
6
14
32
59
3.4


425695
15
47
61
81
91
0.3


425716
20
17
53
77
91
0.6


425719
0
14
45
78
94
0.8


425721
0
0
22
74
84
0.9


425736
42
43
56
76
91
0.3


425737
21
29
61
81
97
0.3


425738
14
39
57
74
93
0.4


425754
29
34
45
78
94
0.4


425755
8
21
57
78
95
0.5


425757
29
28
62
83
95
0.4


425760
3
6
9
56
77
1.4


425765
24
51
75
77
88
0.3


425766
7
41
59
73
77
0.3


425767
1
18
49
66
79
1.0









Example 5
Dose Response Confirmation of Antisense Oligonucleotides Targeting Human Transthyretin in Hep3B Cells
Gapmers from Example 4 exhibiting significant in vitro inhibition of human transthyretin were tested at various doses in Hep3B cells. Cells were plated at a density of 20,000 cells per well and transfected using electroporation with 0.0206 μM, 0.062 μM, 0.185 μM, 0.556 μM, 1.667 μM and 5 μM concentrations of antisense oligonucleotide, as specified in Table 8. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS1396 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. As illustrated in Table 8, transthyretin mRNA levels were reduced in a dose-dependent manner in antisense oligonucleotide treated cells. The IC50 of each oligonucleotide is also presented in Table 8.







TABLE 8







Dose-dependent antisense inhibition of human transthyretin


in Hep3B cells using electroporation





















IC50


ISIS NO
0.0206 μM
0.062 μM
0.185 μM
0.556 μM
1.667 μM
5 μM
(μM)

















304299
27
2
25
52
76
96
0.5


420915
0
12
27
30
69
93
0.8


425653
23
13
55
86
88
91
0.1


425655
3
30
32
62
84
94
0.3


425656
0
0
29
66
82
95
0.5


425679
0
21
36
71
92
97
0.3


425695
37
23
63
79
94
98
0.1


425736
31
43
40
64
82
95
0.1


425737
0
13
62
82
95
98
0.2


425755
17
8
18
69
86
98
0.4


425757
22
47
53
79
96
98
0.2









Example 6
Dose Response Confirmation of Antisense Oligonucleotides Targeting Human Transthyretin in Human Transthyretin-Transgenic Mouse Primary Hepatocytes
Gapmers from Example 5 were also tested at various doses in primary hepatocytes of human transthyretin-transgenic mice. ISIS 304309, ISIS 304311, ISIS 304312 and ISIS 420951 (see Example 2) were also retested along with these gapmers under the same culture conditions. Cells were plated at a density of 10,000 cells per well and transfected using cytofectin with 18.75 nM, 37.5 nM, 75 nM, 150 nM and 300 nM concentrations of antisense oligonucleotide, as specified in Table 9. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS1396 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. As illustrated in Table 9, transthyretin mRNA levels were reduced in a dose-dependent manner in antisense oligonucleotide treated cells.







TABLE 9







Dose-dependent antisense inhibition of human transthyretin in


mouse primary hepatocytes using cytofectin













ISIS








NO
18.75 nM
37.5 nM
75 nM
150 nM
300 nM
Motif





304299
54
79
97
98
99
5-10-5


304309
48
77
94
99
99
5-10-5


304311
45
79
92
96
98
5-10-5


304312
33
71
89
96
98
5-10-5


420915
40
70
92
98
99
5-10-5


420951
41
86
96
98
99
5-10-5


425653
44
81
93
96
99
5-10-5


425655
61
88
96
99
99
3-14-3


425656
61
84
94
98
99
3-14-3


425679
74
78
97
98
99
3-14-3


425695
66
84
96
98
99
2-13-5


425736
58
84
95
98
99
4-11-5


425737
57
77
95
98
99
4-11-5


425755
61
82
96
99
99
4-11-5


425757
37
77
93
98
98
4-11-5









Example 7
Dose Response Confirmation of Antisense Oligonucleotides Targeting Human Transthyretin in HepG2 Cells
Gapmers from Example 6 were tested at various doses in HepG2 cells. Cells were plated at a density of 10,000 cells per well and transfected using electroporation with 0.062 μM, 0.185 μM, 0.556 μM, 1.66 μM and 5000 μM concentrations of antisense oligonucleotide, as specified in Table 10. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS1396 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. As illustrated in Table 10, transthyretin mRNA levels were reduced in a dose-dependent manner in antisense oligonucleotide treated cells.







TABLE 10







Dose-dependent antisense inhibition of human transthyretin


in HepG2 cells using electroporation




















IC50



ISIS NO
0.062 μM
0.185 μM
0.556 μM
1.667 μM
5.000 μM
(μM)
Motif





304299
55
66
72
87
96
0.037
5-10-5


304309
41
65
72
91
96
0.087
5-10-5


304311
57
83
88
89
83
0.001
5-10-5


304312
46
69
74
84
81
0.038
5-10-5


420915
38
62
80
90
98
0.096
5-10-5


420951
45
71
84
93
97
0.049
5-10-5


425653
48
73
87
88
82
0.017
5-10-5


425655
40
57
77
85
95
0.105
3-14-3


425656
28
54
70
94
97
0.177
3-14-3


425679
43
51
81
95
99
0.106
3-14-3


425695
49
67
90
96
99
0.043
2-13-5


425736
32
63
85
95
98
0.108
4-11-5


425737
42
71
90
98
99
0.053
4-11-5


425755
24
63
85
95
99
0.137
4-11-5


425757
21
62
86
96
99
0.148
4-11-5









Example 8
Dose Response Confirmation of Antisense Oligonucleotides Targeting Human Transthyretin in Human Transthyretin-Transgenic Mouse Primary Hepatocytes
Gapmers from Example 6 were also tested at various doses in primary hepatocytes of human transthyretin-transgenic mice. Cells were plated at a density of 10,000 cells per well and transfected using cytofectin with 5 nM, 10 nM, 20 nM, 40 nM and 80 nM concentrations of antisense oligonucleotide, as specified in Table 11. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS3029 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. As illustrated in Table 11, transthyretin mRNA levels were reduced in a dose-dependent manner in antisense oligonucleotide treated cells.







TABLE 11







Dose-dependent antisense inhibition of human transthyretin


in mouse primary hepatocytes using cytofectin













ISIS NO
5 nM
10 nM
20 nM
40 nM
80 nM
Motif
















304299
0
8
37
69
90
5-10-5


304309
0
9
39
75
93
5-10-5


304311
1
13
43
70
81
5-10-5


304312
0
3
32
64
76
5-10-5


420915
0
0
34
59
87
5-10-5


420951
0
12
57
84
92
5-10-5


425653
0
9
44
72
84
5-10-5


425655
0
19
45
80
91
3-14-3


425656
0
2
33
70
93
3-14-3


425679
0
13
42
72
90
3-14-3


425695
3
12
33
70
90
2-13-5


425736
2
7
37
70
89
4-11-5


425737
0
4
36
65
89
4-11-5


425755
0
25
50
75
94
4-11-5


425757
0
5
43
72
92
4-11-5









Gapmers were also tested using electroporation as the transfection agent. Cells were plated at a density of 35,000 cells per well and transfected using electroporation with 148.148 nM, 444.444 nM, 1,333.333 nM, 4,000 nM and 12,000 nM concentrations of antisense oligonucleotide, as specified in Table 12. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS3029 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells.







TABLE 12







Dose-dependent antisense inhibition of human transthyretin


in mouse primary hepatocytes using electroporation













ISIS








NO
148.148 nM
444.444 nM
1333.333 nM
4000 nM
12000 nM
Motif





304299
75
96
98
98
99
5-10-5


304309
72
96
98
98
98
5-10-5


304311
68
92
93
94
97
5-10-5


304312
50
84
92
93
97
5-10-5


420915
55
89
96
96
97
5-10-5


420951
65
92
95
96
98
5-10-5


425653
68
89
91
93
95
5-10-5


425655
63
94
96
96
96
3-14-3


425656
69
93
98
98
98
3-14-3


425679
63
92
97
98
98
3-14-3


425695
69
92
96
96
95
2-13-5


425736
75
93
96
96
96
4-11-5


425737
71
94
96
96
95
4-11-5


425755
70
93
95
95
95
4-11-5


425757
61
91
95
95
95
4-11-5









Example 9
Dose Response Confirmation of Antisense Oligonucleotides Targeting Human Transthyretin in Cynomolgus Monkey Primary Hepatocytes
Gapmers from Example 6 were also tested at various doses in primary hepatocytes of cynomolgus monkeys. Cells were plated at a density of 35,000 cells per well and transfected using electroporation with 1,250 nM, 2,500 nM, 5,000 nM, 10,000 nM and 20,000 nM concentrations of antisense oligonucleotide, as specified in Table 13. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS1396 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. As illustrated in Table 13, transthyretin mRNA levels were reduced in a dose-dependent manner in hepatocytes treated with ISIS oligonucleotides.
In absence of a complete cynomolgus monkey gene sequence in the NCBI database, the oligonucleotides were tested for cross-reactivity against the rhesus monkey gene sequence, since the two species are from the same genus, ‘Macaca’. The human oligonucleotides are cross-reactive with rhesus monkey transthyretin gene, designated herein as SEQ ID NO: 4 (exons 1-4 extracted from GENBANK Accession No. NW_001105671.1). ‘Mismatches’ indicates the number of mismatches between the human oligonucleotide and the rhesus monkey transthyretin gene. ‘n/a.’ indicates that the human oligonucleotide has more than 3 mismatches with the rhesus monkey transthyretin gene and therefore does not cross-react with it.







TABLE 13







Dose-dependent antisense inhibition of human transthyretin in Rhesus monkey primary hepatocytes using


electroporation























Rhesus
Rhesus










monkey
monkey









IC50
Target start
Target stop
Mis


ISIS NO
1,250 nM
2,500 nM
5,000 nM
10,000 nM
2,0000 nM
(μM)
site
site
matches



















304299
21
45
69
80
95
3.1
504
523
0


304309
53
66
79
85
93
<1.25
575
594
0


304311
75
78
82
86
90
<1.25
594
613
0


304312
37
53
65
75
80
2.3
595
614
0


420915
59
54
77
87
94
<1.25
505
524
0


420951
67
77
91
93
96
<1.25
578
597
0


425653
56
72
84
83
85
<1.25
593
612
0


425655
0
7
0
21
45
>20
478
497
2


425656
41
20
38
53
51
8.7
479
498
2


425679
68
74
88
94
98
<1.25
578
597
0


425695
42
29
41
49
65
25.8
478
497
2


425736
36
27
37
49
74
8.2
479
498
2


425737
76
78
89
95
97
<1.25
501
520
0


425755
79
80
92
94
97
<1.25
578
597
0


425757
68
74
88
95
96
<1.25
580
599
0









Example 10
In Vivo Inhibition of Human Transthyretin in Human Transthyretin-Transgenic Mice
Gapmers from Example 6, demonstrating significant inhibition of transthyretin mRNA, were tested in transgenic mice containing the human transthyretin gene and the efficacy of the gapmers was evaluated.
Treatment
Fifteen groups of four hTTR transgenic female mice each were administered subcutaneously twice a week for four weeks with 25 mg/kg of ISIS 304299, ISIS 304309, ISIS 304311, ISIS 304312, ISIS 420915, ISIS 420951, ISIS 425653, ISIS 425655, ISIS 425656, ISIS 425679, ISIS 425695, ISIS 425736, ISIS 425737, ISIS 425755, or ISIS 425757. Another group of four female hTTR transgenic mice was injected with 25 mg/kg of control oligonucleotide ISIS 141923 (CCTTCCCTGAAGGTTCCTCC, designated herein as SEQ ID NO: 165) twice a week for four weeks. Another group of four hTTR transgenic female mice were injected subcutaneously with PBS twice a week for four weeks. The mice injected with PBS served as a control group. Blood samples were collected from all groups on weeks 0, 1, 2, 3, and 4 for plasma transthyretin level analysis. The mice were sacrificed two days after the last dose and livers were harvested for target mRNA analysis.
RNA Analysis
RNA was extracted from liver tissue for real-time PCR analysis of transthyretin using primer probe set RTS3029. Results are presented as percent inhibition of human transthyretin, relative to PBS control. As shown in Table 14, treatment with ISIS antisense oligonucleotides resulted in significant reduction of human transthyretin mRNA in comparison to the PBS control. Treatment with the control oligonucleotide, ISIS 141923 did not result in significant reduction of transthyretin, as expected.







TABLE 14







Inhibition of human transthyretin


mRNA in the hTTR transgenic mice


liver relative to the PBS control










ISIS
%



NO
inhibition






304299
79



304309
83



304311
63



304312
64



420915
82



420951
92



425653
66



425655
76



425656
76



425679
93



425695
82



425736
63



425737
76



425755
91



425757
91



141923
28









Protein Analysis

Human transthyretin protein levels were measured in transgenic mice plasma by ELISA using an anti-transthyretin polyclonal antibody (Abcam Ab37774) and a sheep anti-TTR horse radish peroxidase detection antibody (Abcam cat. no. 35217). The color reaction was developed by the ImmunoPure® TMB Substrate Kit and absorbance measured at 450 nm using a microtiter plate spectrophotometer. Plasma samples were taken predose and on days 7, 14 and 28. The results are presented in Table 15 expressed as percentage inhibition compared to the predose levels and demonstrate a time-dependent reduction in protein levels with treatment with ISIS oligonucleotides.







TABLE 15







Inhibition of human transthyretin protein in the


hTTR transgenic mice plasma relative to predose levels


















ISIS
ISIS
ISIS
ISIS
ISIS
ISIS
ISIS
ISIS



PBS
304299
304309
420915
420951
425679
425695
425755
141923



















Day 7
0
50
63
71
92
99
69
57
3


Day 14
3
76
78
90
98
100
80
72
3


Day 21
20
88
81
95
100
99
88
78
13


Day 28
13
89
83
98
100
100
91
79
8









Body Weight and Organ Weight

The body weights of the mice were measured predose and at the end of the treatment period. The body weights are presented in Table 16 and are expressed as percent increase over the PBS control weight taken before the start of treatment. Liver, spleen and kidney weights were measured at the end of the study, and are also presented in Table 16 as a percent change over the respective organ weights of the PBS control. As shown in Table 16, there was no significant change in body or organ weights as a result of antisense oligonucleotide treatment.







TABLE 16







Percent change in body and organ weights of transgenic


mice after antisense oligonucleotide treatment











Body














weight
Liver
Spleen
Kidney





PBS
1.1
1.0
1.0
1.0


ISIS 304299
1.1
1.1
1.0
0.8


ISIS 304309
1.1
1.1
1.0
1.0


ISIS 304311
1.1
1.2
1.0
1.2


ISIS 304312
1.1
1.3
1.0
0.8


ISIS 420915
1.1
1.1
1.0
1.1


ISIS 420951
1.1
1.2
1.0
1.5


ISIS 425653
1.1
1.1
0.9
1.0


ISIS 425655
1.1
1.3
1.0
1.2


ISIS 425656
1.2
1.3
1.0
1.3


ISIS 425679
1.2
1.2
1.0
1.6


ISIS 425695
1.1
1.3
1.0
1.0


ISIS 425736
1.2
1.2
1.0
1.0


ISIS 425737
1.1
1.2
1.1
1.2


ISIS 425755
1.2
1.3
1.1
1.3


ISIS 425757
1.1
1.9
1.0
1.5


ISIS 141923
1.1
1.1
1.0
0.8









Liver Function

To evaluate the effect of ISIS oligonucleotides on hepatic function, plasma concentrations of transaminases were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Plasma concentrations of ALT (alanine transaminase) and AST (aspartate transaminase) were measured and the results are presented in Table 17, expressed in IU/L. Plasma levels of bilirubin were also measured using the same clinical chemistry analyzer; results are also presented in Table 17 and expressed in mg/dL.







TABLE 17







Effect of antisense oligonucleotide treatment


on metabolic markers in theliver of transgenic mice













ALT
AST
Bilirubin




(IU/L)
(IU/L)
(mg/dL)















PBS
31
78
0.23



ISIS 304299
40
121
0.19



ISIS 304309
38
119
0.20



ISIS 304311
34
60
0.16



ISIS 304312
43
67
0.17



ISIS 420915
34
75
0.26



ISIS 420951
75
124
0.17



ISIS 425653
35
78
0.20



ISIS 425655
131
109
0.16



ISIS 425656
68
110
0.19



ISIS 425679
119
180
0.20



ISIS 425695
43
69
0.15



ISIS 425736
23
58
0.16



ISIS 425737
35
64
0.19



ISIS 425755
109
162
0.16



ISIS 425757
1904
937
0.24



ISIS 141923
31
76
0.19









Kidney Function

To evaluate the effect of ISIS oligonucleotides on kidney function, plasma concentrations of blood urea nitrogen (BUN) were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Results are presented in Table 18, expressed in mg/dL. The data indicates that antisense inhibition of transthyretin has no effect on BUN levels in these transgenic mice.







TABLE 18







Effect of antisense oligonucleotide


treatment on BUN (mg/dL) in the 


kidney of transgenic mice









BUN



(mg/dL)





PBS
26


ISIS 304299
24


ISIS 304309
29


ISIS 304311
28


ISIS 304312
26


ISIS 420915
25


ISIS 420951
25


ISIS 425653
24


ISIS 425655
28


ISIS 425656
25


ISIS 425679
26


ISIS 425695
28


ISIS 425736
25


ISIS 425737
23


ISIS 425755
24


ISIS 425757
25


ISIS 141923
23









Example 11
Tolerability of Antisense Oligonucleotides Targeting Human Transthyretin in CD1 Mice
CD1® mice (Charles River, Mass.) are a multipurpose model of mice, frequently utilized for safety and efficacy testing. The mice were treated with ISIS antisense oligonucleotides selected from studies described in Example 10 and evaluated for changes in the levels of various metabolic markers.
Treatment
Groups of eight CD1 mice each were injected subcutaneously twice a week with 50 mg/kg of ISIS 304299, ISIS 304309, ISIS 420915, ISIS 420951, ISIS 425655, ISIS 425656, ISIS 425679, ISIS 425695, ISIS 425736, ISIS 425737, and ISIS 425755. Four mice from each group were evaluated at week 2 and week 6 of the treatment period. Three days after the last dose at each time point, body weights were taken, mice were euthanized and organs and plasma were harvested for further analysis.
Body and Organ Weights
The body weights of the mice were measured pre-dose and at the end of each treatment period (two weeks and six weeks). The body weights are presented in Tables 19 and 20, and are expressed as percent increase over the PBS control weight taken before the start of treatment. Liver, spleen and kidney weights were measured at the end of the study, and are also presented in Tables 19 and 20 as a percentage change over the respective organ weights of the PBS control.







TABLE 19







Change in body and organ weights of


CD1 mice after antisense oligonucleotide


treatment (%) at week 2












Body






weight
Liver
Spleen
Kidney





PBS
1.1
1.0
1.0
1.0


ISIS 304299
1.1
1.1
1.1
1.1


ISIS 304309
1.1
1.1
1.1
1.0


ISIS 420915
1.1
1.1
1.1
1.0


ISIS 420951
1.1
1.3
1.7
1.2


ISIS 425655
1.1
1.2
1.2
0.9


ISIS 425656
1.1
1.1
1.1
1.0


ISIS 425679
1.1
1.1
1.4
1.1


ISIS 425695
1.1
1.1
0.9
1.1


ISIS 425736
1.1
1.1
1.0
1.1


ISIS 425737
1.2
1.1
1.1
1.1


ISIS 425755
1.2
1.2
1.3
1.2
















TABLE 20







Change in body and organ weights


of CD1 mice after antisense


oligonucleotide treatment (%) at week 6











Body














weight
Liver
Spleen
Kidney





PBS
1.2
1.0
1.0
1.0


ISIS 304299
1.3
1.2
1.4
1.0


ISIS 304309
1.3
1.3
2.0
1.0


ISIS 420915
1.3
1.1
1.5
0.9


ISIS 420951
1.3
1.3
2.0
1.1


ISIS 425655
1.4
1.3
1.7
0.9


ISIS 425656
1.3
1.3
1.1
1.0


ISIS 425679
1.3
1.4
2.3
1.2


ISIS 425695
1.3
1.4
1.5
1.0


ISIS 425736
1.3
1.1
1.2
0.9


ISIS 425737
1.2
1.1
1.3
1.0


ISIS 425755
1.3
1.3
2.1
1.0









Liver Function

To evaluate the effect of ISIS oligonucleotides on hepatic function, plasma concentrations of transaminases were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Plasma concentrations of ALT (alanine transaminase) and AST (aspartate transaminase) were measured and the results are presented in Tables 21 and 22 expressed in IU/L. Plasma levels of bilirubin and albumin were also measured using the same clinical chemistry analyzer and the results are also presented in Tables 21 and 22.







TABLE 21







Effect of antisense oligonucleotide


treatment on metabolic markers in the


liver of CD1 mice at week 2












ALT
AST
Bilirubin
Albumin



(IU/L)
(IU/L)
(mg/dL)
(g/dL)














PBS
38
66
0.19
5.0


ISIS 304299
42
79
0.33
3.8


ISIS 304309
52
77
0.22
3.2


ISIS 420915
32
61
0.28
3.5


ISIS 420951
1184
804
0.17
3.7


ISIS 425655
60
70
0.20
3.9


ISIS 425656
37
53
0.31
3.5


ISIS 425679
88
147
0.23
3.7


ISIS 425695
25
50
0.23
3.6


ISIS 425736
31
79
0.23
3.2


ISIS 425737
39
43
0.23
3.1


ISIS 425755
104
85
0.29
3.6
















TABLE 22







Effect of antisense oligonucleotide


treatment on metabolic markers in


the liver of CD1 mice at week 6












ALT
AST
Bilirubin
Albumin



(IU/L)
(IU/L)
(mg/dL)
(g/dL)














PBS
31
67
0.20
5.6


ISIS 304299
54
71
0.20
5.2


ISIS 304309
1211
504
0.30
5.2


ISIS 420915
89
91
0.17
5.0


ISIS 420951
872
319
0.20
3.6


ISIS 425655
730
247
0.13
4.3


ISIS 425656
502
261
0.17
4.3


ISIS 425679
935
475
0.29
4.5


ISIS 425695
1627
563
0.16
4.0


ISIS 425736
41
47
0.15
4.1


ISIS 425737
32
55
0.16
4.1


ISIS 425755
233
176
0.16
4.3









Kidney Function

To evaluate the effect of ISIS oligonucleotides on kidney function, plasma concentrations of blood urea nitrogen (BUN) and creatinine were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Results are presented in Tables 23 and 24, expressed in mg/dL.







TABLE 23







Effect of antisense oligonucleotide treatment on metabolic


markers (mg/dL) in the kidney of CD1 mice at week 2










BUN
Creatinine












PBS
32
0.23


ISIS 304299
26
0.21


ISIS 304309
30
0.19


ISIS 420915
30
0.22


ISIS 420951
24
0.17


ISIS 425655
29
0.22


ISIS 425656
25
0.19


ISIS 425679
28
0.19


ISIS 425695
29
0.19


ISIS 425736
24
0.19


ISIS 425737
24
0.16


ISIS 425755
27
0.17
















TABLE 24







Effect of antisense oligonucleotide treatment on metabolic 


markers (mg/dL) in the kidney of CD1 mice at week 6










BUN
Creatinine












PBS
24
0.15


ISIS 304299
19
0.11


ISIS 304309
20
0.14


ISIS 420915
24
0.18


ISIS 420951
19
0.08


ISIS 425655
22
0.11


ISIS 425656
21
0.10


ISIS 425679
20
0.06


ISIS 425695
21
0.08


ISIS 425736
22
0.07


ISIS 425737
18
0.07


ISIS 425755
22
0.09









Hematology Assays

Blood obtained from all mice groups were sent to Antech Diagnostics for hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) measurements and analyses, as well as measurements of the differential blood cell counts, such as that of WBC (neutrophils, lymphocytes, and monocytes), RBC, and platelets, and total hemoglobin content. The results are presented in Tables 25-28. Percentages given in the tables indicate the percent change in total blood cell count compared to the PBS control. Those antisense oligonucleotides which did not affect a decrease in platelet count less than 70% of the PBS control or an increase in monocyte count more than two-fold were selected for further studies.







TABLE 25







Effect of antisense oligonucleotide treatment on complete blood cell


count (%) compared to the PBS control in CD1 mice at week 2














ISIS









NO.
WBC
RBC
Hemoglobin
HCT
MCV
MCH
MCHC

















304299
−15
−3
−2
0
+3
+1
−1


304309
−13
−4
−7
−6
−2
−4
−2


420915
+7
−7
−7
−5
+2
+1
−2


420951
+79
−6
−5
−5
+1
+1
0


425655
+56
−3
−5
−4
−1
−2
−1


425656
+69
−5
−6
−5
0
−1
−2


425679
+30
−6
−7
−7
−1
−1
0


425695
+49
−3
−4
−4
0
0
+1


425736
+15
−6
−6
−4
+1
0
−2


425737
+19
−5
−7
−5
−1
−3
−2


425755
+85
−3
−6
−6
−4
−3
0
















TABLE 26







Effect of antisense oligonucleotide treatment on complete blood cell


count (%) compared to the PBS control in CD1 mice at week 6














ISIS









NO.
WBC
RBC
Hemoglobin
HCT
MCV
MCH
MCHC

















304299
−7
−9
−10
−13
−5
0
+4


304309
+10
−12
−11
−15
−5
+1
+6


420915
+11
−7
−8
−10
−4
−2
+2


420951
+81
−12
−20
−19
−9
−9
−1


425655
+29
−3
−11
−10
−8
−9
−2


425656
+72
−1
−5
−6
−4
−5
−1


425679
+154
−11
−20
−21
−10
−9
+2


425695
+118
+3
−9
−9
−2
−12
+3


425736
+51
+4
−5
−7
0
−10
+1


425737
+30
+8
−1
−2
0
−8
+1


425755
+54
−1
−11
−12
−8
−10
0
















TABLE 27







Effect of antisense oligonucleotide treatment on differential blood


cell count (%) compared to the PBS control in CD1 mice at week 2











ISIS






NO.
Neutrophils
Monocytes
Lymphocytes
Platelets














304299
11
−3
20
17


304309
−11
5
8
14


420915
1
4
−24
41


420951
18
−7
32
−9


425655
18
−5
20
18


425656
31
−7
−4
24


425679
2
−1
24
−19


425695
−50
15
20
29


425736
8
−1
0
10


425737
−29
10
−8
24


425755
−13
7
−4
9
















TABLE 28







Effect of antisense oligonucleotide treatment on differential blood 


cell count (%) compared to the PBS control in CD1 mice at week 6











ISIS






NO.
Neutrophils
Lymphocytes
Monocytes
Platelets














304299
−60
+26
+10
−16


304309
−28
+12
+30 
+2


420915
−29
+6
+50
−30


420951
−26
+11
0
−40


425655
−16
+8
−10
−19


425656
−22
+16
−50
−25


425679
−36
+19
−20
−27


425695
−25
+9
−15
−49


425736
−41
+16
−5
−46


425737
−53
+23
−20
−65


425755
−20
+4
+25
−41









Example 12
Measurement of Half-Life of Antisense Oligonucleotide in CD1 Mouse Liver
CD1 mice were treated with ISIS antisense oligonucleotides from studies described in Example 11 and the oligonucleotide half-life as well as the elapsed time for oligonucleotide degradation and elimination from the liver was evaluated.
Treatment
Groups of twelve CD1 mice each were injected subcutaneously twice per week for 2 weeks with 50 mg/kg of ISIS 304299, ISIS 304309, ISIS 420915, ISIS 420951, ISIS 425655, ISIS 425656, ISIS 425679, ISIS 425695, ISIS 425736, ISIS 425737, and ISIS 425755. Four mice from each group were sacrificed 3 days, 28 days and 56 days following the final dose. Livers were harvested for analysis.
Measurement of Oligonucleotide Concentration
The concentration of the full-length oligonucleotide as well as the total oligonucleotide concentration (including the degraded form) was measured. The method used is a modification of previously published methods (Leeds et al., 1996; Geary et al., 1999) which consist of a phenol-chloroform (liquid-liquid) extraction followed by a solid phase extraction. An internal standard (ISIS 355868, a 27-mer 2′O-methoxyethyl modified phosphorothioate oligonucleotide, GCGTTTGCTCTTCTTCTTGCGTTTTTT, designated herein as SEQ ID NO: 166) was added prior to extraction. Tissue sample concentrations were calculated using calibration curves, with a lower limit of quantitation (LLOQ) of approximately 1.14 μg/g. Half-lives were then calculated using WinNonlin software (PHARSIGHT).
The results are presented in Tables 29 and 30, expressed as mg/g liver tissue. The half-life of each oligonucleotide is presented in Table 31. Antisense oligonucleotides with half-lives within 11-34 days were chosen for further studies.







TABLE 29







Full-length oligonucleotide concentration (μg/g) in the liver of CD1 mice










ISIS NO.
3 days
28 days
56 days













304299
180
56
8


304309
317
254
106


420915
248
126
34


420951
173
109
49


425655
191
113
33


425656
256
73
29


425679
201
73
27


425695
315
194
65


425736
219
110
47


425737
190
40
9


425755
211
120
47
















TABLE 30







Total oligonucleotide concentration (μg/g) in the liver of CD1 mice










ISIS





NO.
3 days
28 days
56 days













304299
268
168
38


304309
389
354
152


420915
314
229
83


420951
262
196
131


425655
298
217
87


425656
328
135
85


425679
333
161
103


425695
364
263
143


425736
298
211
140


425737
266
117
31


425755
337
227
140
















TABLE 31







Half-life of oligonucleotide (days) in the liver of CD1 mice










ISIS
Half-life



NO.
(days)













304299
12



304309
33



420915
19



420951
29



425655
21



425656
17



425679
18



425695
23



425736
24



425737
12



425755
24









Example 13
Tolerability of Antisense Oligonucleotides Targeting Human Transthyretin in Sprague-Dawley Rats
Sprague-Dawley rats were treated with ISIS antisense oligonucleotides selected from studies described in Examples 11 and 12 and evaluated for changes in the levels of various metabolic markers.
Treatment
The body weights, complete blood count and different blood count, as well as the urine protein/creatinine ratio of the rats were evaluated pre-dose. Groups of four Sprague-Dawley rats each were injected subcutaneously twice a week with 50 mg/kg of ISIS 304299, ISIS 304309, ISIS 420915, ISIS 420951, ISIS 425655, ISIS 425656, ISIS 425679, ISIS 425695, ISIS 425736, ISIS 425737, and ISIS 425755. Three days after the last dose at each time point, body weights were taken, mice were euthanized and organs and plasma were harvested for further analysis.
Body and Organ Weights
The body weights of the rats were measured pre-dose and at the end of the treatment period. The body weights are presented in Table 32, and are expressed as percent increase over the PBS control weight taken before the start of treatment. Liver, spleen and kidney weights were measured at the end of the study, and are also presented in Table 32 as a percentage change over the respective organ weights of the PBS control.







TABLE 32







Change in body and organ weights of Sprague-


Dawley rats after antisense oligonucleotide treatment (%)












Body






weight
Liver
Spleen
Kidney





PBS
1.6
1.0
1.0
1.0


ISIS 304299
1.2
1.7
4.9
1.6


ISIS 304309
1.1
1.6
4.3
1.4


ISIS 420915
1.4
1.4
3.3
1.3


ISIS 420951
1.1
1.4
5.0
1.5


ISIS 425655
1.2
1.5
3.4
1.3


ISIS 425656
1.2
1.5
2.9
1.2


ISIS 425679
1.0
1.9
6.4
1.7


ISIS 425695
1.2
1.6
3.3
1.3


ISIS 425736
1.3
1.5
2.9
1.2


ISIS 425737
1.2
1.7
4.0
1.5


ISIS 425755
1.0
1.5
5.4
1.5









As shown in Tables 32, certain compounds showed a less than a 4-fold increase in spleen weight.
Liver Function
To evaluate the effect of ISIS oligonucleotides on hepatic function, plasma concentrations of transaminases were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Plasma concentrations of ALT (alanine transaminase) and AST (aspartate transaminase) were measured and the results are presented in Table 33 expressed in IU/L. Plasma levels of bilirubin and albumin were also measured using the same clinical chemistry analyzer and the results are also presented in Table 33.







TABLE 33







Effect of antisense oligonucleotide treatment on metabolic


markers in the liver of Sprague-Dawley rats












ALT
AST
Bilirubin
Albumin



(IU/L)
(IU/L)
(mg/dL)
(g/dL)














PBS
55
138
0.15
3.3


ISIS 304299
69
154
0.15
2.7


ISIS 304309
80
138
0.11
2.9


ISIS 420915
43
95
0.11
3.0


ISIS 420951
353
511
0.32
2.6


ISIS 425655
312
497
0.47
2.6


ISIS 425656
277
335
0.20
3.0


ISIS 425679
537
659
0.38
2.7


ISIS 425695
228
445
0.23
2.3


ISIS 425736
362
553
0.32
2.9


ISIS 425737
55
79
0.09
1.9


ISIS 425755
271
303
0.41
2.8









Kidney Function

To evaluate the effect of ISIS oligonucleotides on kidney function, plasma concentrations of blood urea nitrogen (BUN) and creatinine were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Results are presented in Table 34, expressed in mg/dL. The ratio of total urine protein to creatinine was also evaluated and presented in Table 35.







TABLE 34







Effect of antisense oligonucleotide treatment on metabolic


markers (mg/dL) in the kidney of Sprague-Dawley rats










BUN
Creatinine












PBS
20
0.26


ISIS 304299
30
0.40


ISIS 304309
24
0.33


ISIS 420915
20
0.26


ISIS 420951
37
0.47


ISIS 425655
28
0.40


ISIS 425656
25
0.34


ISIS 425679
46
0.42


ISIS 425695
30
0.37


ISIS 425736
26
0.37


ISIS 425737
30
0.36


ISIS 425755
29
0.36
















TABLE 35







Effect of antisense oligonucleotide treatment on total 


urine protein/creatinine in the kidney of Sprague-Dawley rats










Pre-




dose
Week 6












PBS
0.82
0.95


ISIS 304299
0.95
7.57


ISIS 304309
1.10
5.20


ISIS 420915
0.91
5.30


ISIS 420951
0.90
5.02


ISIS 425655
0.78
6.03


ISIS 425656
0.86
9.37


ISIS 425679
0.91
7.80


ISIS 425695
0.89
5.71


ISIS 425736
1.00
5.85


ISIS 425737
0.86
43.76


ISIS 425755
0.78
3.70









As shown in Tables 34 and 35, certain compounds demonstrated a less than 7-fold increase in the total urine protein/creatinine in the kidney of these rats. Furthermore, certain compounds demonstrated a less than 6-fold increase in the total urine protein/creatinine in the kidney of these rats.
Hematology Assays
Blood obtained from all rat groups were sent to Antech Diagnostics for hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) measurements and analyses, as well as measurements of the differential blood cell counts, such as that of WBC (neutrophils, lymphocytes, and monocytes), RBC, and platelets, and total hemoglobin content. The results are presented in Tables 36 and 37. Percentages given in the tables indicate the percent change in total blood cell count compared to the PBS control.







TABLE 36







Effect of antisense oligonucleotide treatment on complete blood cell


count (%) compared to the PBS control in Sprague-Dawley rats














ISIS









NO.
WBC
RBC
Hemoglobin
HCT
MCV
MCH
MCHC

















304299
+4
−5
−3
+2
+11
+5
−5


304309
−10
−8
−11
−12
−4
−3
+1


420915
−9
−16
−20
−17
+1
−3
−3


420951
+5
−5
−8
−5
+1
−2
−3


425655
+22
−17
−18
−19
−2
0
+2


425656
−1
−13
−19
−16
−3
−6
−2


425679
+49
−42
−32
−28
+26
+19
−5


425695
−2
−25
−31
−29
−4
−8
−3


425736
+18
+1
−3
+2
0
−4
−4


425737
−15
−20
−18
−20
+2
+3
+1


425755
+35
−31
−27
−23
+14
+8
−4
















TABLE 37







Effect of antisense oligonucleotide treatment on complete blood 


cell count (%) compared to the PBS control in Sprague-Dawley rats











ISIS NO.
Neutrophils
Lymphocytes
Monocytes
Platelet














304299
−61
+15
−10
−41


304309
−35
+8
+10
−37


420915
−23
+6
0
−29


420951
−62
+15
+10
−67


425655
+23
−8
+80
−13


425656
−14
0
+70
−15


425679
−4
−1
+60
−75


425695
+68
−20
+80
−5


425736
0
−2
+70
−1


425737
−6
+1
+20
−21


425755
−18
+3
+70
−58









Example 14
Pharmacokinetic Studies of Antisense Oligonucleotide Concentration in Sprague-Dawley Rat Liver and Kidney
Sprague Dawley rats were treated with ISIS antisense oligonucleotides from studies described in Example 13 and the oligonucleotide half-life as well as the elapsed time for oligonucleotide degradation and elimination from the liver and kidney was evaluated.
Treatment
Groups of four Sprague Dawley rats each were injected subcutaneously twice a week for 2 weeks with 20 mg/kg of ISIS 304299, ISIS 304309, ISIS 420915, ISIS 420951, ISIS 425655, ISIS 425656, ISIS 425679, ISIS 425695, ISIS 425736, ISIS 425737, and ISIS 425755. Three days after the last dose, the rats were sacrificed and livers and kidneys were collected for analysis.
Measurement of Oligonucleotide Concentration
The concentration of the full-length oligonucleotide as well as the total oligonucleotide concentration (including the degraded form) was measured. The method used is a modification of previously published methods (Leeds et al., 1996; Geary et al., 1999) which consist of a phenol-chloroform (liquid-liquid) extraction followed by a solid phase extraction. An internal standard (ISIS 355868, a 27-mer 2′-O-methoxyethyl modified phosphorothioate oligonucleotide, GCGTTTGCTCTTCTTCTTGCGTTTTTT, designated herein as SEQ ID NO: 166) was added prior to extraction. Tissue sample concentrations were calculated using calibration curves, with a lower limit of quantitation (LLOQ) of approximately 1.14 μg/g. The results are presented in Tables 38 and 39, expressed as mg/g liver or kidney tissue. The kidney to liver ratio of full length oligonucleotide was also calculated and presented in Table 38.







TABLE 38







Full-length oligonucleotide concentration (μg/g) and ratio in 


the liver and kidney of Sprague-Dawley rats













Kidney/Liver


ISIS NO.
Liver
Kidney
Ratio













304299
165
487
2.9


304309
344
606
1.8


420915
171
680
4.0


420951
214
389
1.8


425655
242
466
1.9


425656
286
595
2.1


425679
290
334
1.2


425695
266
566
2.1


425736
245
571
2.3


425737
167
477
2.9


425755
218
379
1.7
















TABLE 39







Total oligonucleotide concentration (μg/g) in the liver and 


kidney of Sprague-Dawley rats









ISIS NO.
Liver
Kidney












304299
208
653


304309
409
803


420915
196
844


420951
348
879


425655
340
764


425656
329
703


425679
461
710


425695
369
843


425736
282
738


425737
195
587


425755
351
886









Example 15
In Vivo Close-Dependent Inhibition of Human Transthyretin in Transgenic Mice
Transgenic mice containing the human transthyretin gene were dosed in increasing doses of ISIS oligonucleotides selected from studies described in Example 14 to evaluate the effect of dose-dependent inhibition of human transthyretin in these mice.
Treatment
Groups of four mice, two male and two female, each were injected subcutaneously twice a week for 4 weeks with 4 mg/kg, 10 mg/kg or 25 mg/kg of ISIS 304299, ISIS 420915, ISIS 420951, ISIS 425679, ISIS 425736, ISIS 425737, or ISIS 425755. One group of four mice, two male and two female, was injected subcutaneously twice a week for 4 weeks with 25 mg/kg of the control oligonucleotide, ISIS 141923. One control group of four mice, two male and two female, was injected subcutaneously twice a week for 4 weeks with PBS. Plasma samples were taken from each group at days 0, 7, 14, 21 and 28. Two days after the last dose, the mice were euthanized and organs were harvested for further analysis.
RNA Analysis
RNA was extracted from liver tissue for real-time PCR analysis of transthyretin using primer probe set RTS3029. Results are presented as percent inhibition of human transthyretin, relative to PBS control. As shown in Table 40, treatment with ISIS antisense oligonucleotides resulted in significant dose-dependent reduction of human transthyretin mRNA in comparison to the PBS control. Treatment with the control oligonucleotide, ISIS 141923 did not result in significant reduction of transthyretin, as expected.







TABLE 40







Inhibition of human transthyretin mRNA in the hTTR 


transgenic mice liver relative to the PBS control









ISIS
Dose
%


NO.
(mg/kg)
inhibition












304299
25
73



10
60



4
9


420915
25
78



10
57



4
43


420951
25
91



10
85



4
52


425679
25
94



10
88



4
42


425736
25
49



10
54



4
15


425737
25
82



10
59



4
21


425755
25
91



10
79



4
24


141923
25
0









Protein Analysis

Human transthyretin protein levels were measured in transgenic mice plasma by ELISA using an anti-transthyretin polyclonal antibody (Abcam Ab37774) and a sheep anti-TTR horse radish peroxidase detection antibody (Abcam cat. no. 35217). The color reaction was developed by the ImmunoPure® TMB Substrate Kit and absorbance measured at 450 nm using a microtiter plate spectrophotometer. Plasma samples were taken predose and on days 7, 14, 21 and 28. The results are presented in Table 41 expressed as percentage inhibition compared to the predose levels and demonstrate a time-dependent and dose-dependent reduction in protein levels on treatment with ISIS oligonucleotides.







TABLE 41







Inhibition of human transthyretin protein in


transgenic mice plasma relative to pre-dose levels













ISIS








NO.

Day 0
Day 7
Day 14
Day 21
Day 28
















141923
25
0
0
20
77
41


304299
25
0
44
85
100
88



10
0
0
8
93
78



4
0
0
0
57
0


420915
25
0
0
67
86
91



10
0
21
39
70
71



4
0
25
0
0
0


420951
25
0
83
96
100
100



10
0
35
66
91
86



4
0
7
26
0
0


425679
25
0
93
97
96
98



10
0
38
80
96
95



4
0
0
0
0
0


425736
25
0
56
76
82
92



10
0
0
33
37
66



4
0
0
0
0
0


425737
25
0
90
96
99
98



10
0
51
80
88
89



4
0
29
21
37
31


425755
25
0
88
96
98
99



10
0
52
76
90
88



4
0
29
22
36
26









Body Weight and Organ Weight

The body weights of the mice were measured pre-dose and at the end of the treatment period. The body weights are presented in Table 42 and are expressed as percent increase over the PBS control weight taken before the start of treatment. Liver, spleen and kidney weights were measured at the end of the study, and are also presented in Table 42 as a percentage change over the respective organ weights of the PBS control.







TABLE 42







Change in body and organ weights of transgenic mice 


after antisense oligonucleotide treatment (%)













Dose
Body






(mg/kg)
weight
Liver
Spleen
Kidney















PBS

+13
0
0
0


ISIS
25
+17
+16
+3
−2


304299
10
+14
+10
−13
−4



4
+17
+2
+17
−2


ISIS
25
+18
+12
−6
−6


420915
10
+16
+6
−4
−5



4
+15
+4
+8
−2


ISIS
25
+22
+23
+32
−2


420951
10
+16
+11
+10
−3



4
+24
+7
+19
+5


ISIS
25
+24
+33
+40
−1


425679
10
+14
+5
+9
−2



4
+19
+7
+10
0


ISIS
25
+16
+15
0
−5


425736
10
+28
+8
−12
−6



4
+20
+10
−9
−2


ISIS
25
+16
+13
0
−2


425737
10
+19
+6
+18
−3



4
+19
+5
+4
+1


ISIS
25
+21
+25
+34
−5


425755
10
+17
+10
+13
−4



4
+22
+3
+27
+4


ISIS
25
+20
+8
−3
−4


141923









Liver Function

To evaluate the effect of ISIS oligonucleotides on hepatic function, plasma concentrations of transaminases were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Plasma concentrations of ALT (alanine transaminase) and AST (aspartate transaminase) were measured and the results are presented in Table 43 expressed in IU/L. Plasma levels of bilirubin were also measured using the same clinical chemistry analyzer; results are also presented in Table 43 and expressed in mg/dL.







TABLE 43







Effect of antisense oligonucleotide treatment on 


metabolic markers in the liver of transgenic mice












Dose
ALT
AST
TBIL



(mg/kg)
(IU/L)
(IU/L)
(mg/dL)














PBS
—
48
112
0.20


ISIS
25
42
93
0.14


304299
10
37
56
0.18



4
35
71
0.15


ISIS
25
63
181
0.22


420915
10
46
132
0.22



4
35
114
0.22


ISIS
25
63
85
0.17


420951
10
42
107
0.21



4
31
74
0.19


ISIS
25
156
150
0.13


425679
10
93
148
0.23



4
38
119
0.22


ISIS
25
37
78
0.21


425736
10
33
62
0.20



4
46
228
0.23


ISIS
25
55
121
0.20


425737
10
41
94
0.18



4
32
73
0.14


ISIS
25
74
160
0.17


425755
10
31
80
0.16



4
45
122
0.21


ISIS
25
66
141
0.17


141923













Kidney Function

To evaluate the effect of ISIS oligonucleotides on kidney function, plasma concentrations of blood urea nitrogen (BUN) were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Results are presented in Table 44, expressed in mg/dL.







TABLE 44







Effect of antisense oligonucleotide treatment on BUN


(mg/dL) in the kidney of transgenic mice










Dose




(mg/kg)
BUN












PBS

22


ISIS
25
22


304299
10
22



4
22


ISIS
25
24


420915
10
25



4
20


ISIS
25
24


420951
10
25



4
26


ISIS
25
26


425679
10
24



4
22


ISIS
25
20


425736
10
22



4
22


ISIS
25
21


425737
10
19



4
23


ISIS
25
23


425755
10
21



4
20


ISIS
25
21


141923











Example 16
In Vivo Inhibition of Human Transthyretin in Human Transthyretin-Transgenic Mice
Antisense oligonucleotides with 5-10-5 MOE motifs, ISIS 304313, ISIS 420913, ISIS 420919, ISIS 420921, ISIS 420922, ISIS 420937, ISIS 420944, ISIS 420947, ISIS 420949, ISIS 420950, ISIS 420951, ISIS 420952, ISIS 420953, ISIS 420955, ISIS 420957, and ISIS 420959 from Table 4. These antisense oligonucleotides exhibited 65% inhibition or more of transthyretin mRNA were selected and tested in transgenic mice containing the human transthyretin gene. Additional oligonucleotides with overlapping sequences to ISIS 420951 (GTTTTATTGTCTCTGCCTGG (SEQ ID NO: 116)), and with various motifs were also designed to test in the transgenic mice. These additional oligonucleotides were ISIS 450518 (TTTTATTGTCTCTGCCTG (SEQ ID NO: 5-8-5 MOE (SEQ ID NO: 167)), ISIS 450519 (GTTTTATTGTCTCTGCCTGG, 6-8-6 MOE (SEQ ID NO: 116)), ISIS 450520 (GTTTTATTGTCTCTGCCTGG, 3-10-7 MOE (SEQ ID NO: 116)), ISIS 450521 (GTTTTATTGTCTCTGCCTGG, 7-10-3 MOE (SEQ ID NO: 116)), ISIS 450522 (GTTTTATTGTCTCTGCCTGG, 2-10-8 MOE (SEQ ID NO: 116)), and ISIS 450523 (GTTTTATTGTCTCTGCCTGG, 8-10-2 MOE (SEQ ID NO: 116)).
Treatment
Groups of four hTTR transgenic mice each, two male and two female, were administered subcutaneously twice per week for four weeks with 25 mg/kg of ISIS 304313, ISIS 420913, ISIS 420919, ISIS 420921, ISIS 420922, ISIS 420937, ISIS 420944, ISIS 420947, ISIS 420949, ISIS 420950, ISIS 420951, ISIS 420952, ISIS 420953, ISIS 420955, ISIS 420957, ISIS 420959, ISIS 425518, ISIS 425519, ISIS 425520, ISIS 425521, ISIS 425522, or ISIS 425523. A control group four hTTR transgenic mice, two male and two female, were injected subcutaneously with PBS twice per week for four weeks. Blood samples were collected from all groups on days 0, 14 and 28 for plasma transthyretin level analysis. The mice were sacrificed two days after the last dose and livers were harvested for target mRNA analysis.
RNA Analysis
RNA was extracted from liver tissue for real-time PCR analysis of transthyretin using primer probe set RTS3029. Results are presented as percent inhibition of human transthyretin, relative to PBS control. As shown in Table 45, treatment with ISIS antisense oligonucleotides resulted in significant reduction of human transthyretin mRNA in comparison to the PBS control.







TABLE 45







Inhibition of human transthyretin mRNA in the


hTTR transgenic mice liver relative to the PBS control










ISIS
%



NO.
inhibition






304313
68



420913
83



420919
64



420921
70



420922
82



420937
46



420944
58



420947
62



420949
87



420950
94



420952
95



420953
93



420955
93



420957
90



420959
73



450518
80



450519
87



450520
85



450521
94



450522
73



450523
94



420951
94









Protein Analysis

Human transthyretin protein levels were measured in transgenic mice plasma by ELISA using an anti-transthyretin transthyretin polyclonal antibody (Abcam Ab37774) and a sheep anti-TTR horse radish peroxidase detection antibody (Abcam cat. no. 35217). The color reaction was developed by the ImmunoPure® TMB Substrate Kit and absorbance measured at 450 nm using a microtiter plate spectrophotometer. Plasma samples were taken predose and on days 7, 14 and 28. The results are presented in Table 46 expressed as percentage inhibition compared to the pre-dose levels and demonstrate a time-dependent reduction in protein levels on treatment with ISIS oligonucleotides.







TABLE 46







Inhibition of human transthyretin protein in the hTTR 


transgenic mice plasma relative to pre-dose levels











Day 0
Day 14
Day 28













PBS
0
0
0


ISIS 304313
0
62
77


ISIS 420913
0
91
97


ISIS 420919
0
70
82


ISIS 420921
0
83
87


ISIS 420922
0
95
97


ISIS 420937
0
37
59


ISIS 420944
0
57
72


ISIS 420947
0
57
65


ISIS 420949
0
93
99


ISIS 420950
0
97
100


ISIS 420952
0
98
100


ISIS 420953
0
99
100


ISIS 420955
0
89
100


ISIS 420957
0
92
94


ISIS 420959
0
69
87


ISIS 450518
0
80
97


ISIS 450519
0
94
100


ISIS 450520
0
83
100


ISIS 450521
0
100
100


ISIS 450522
0
93
97


ISIS 450523
0
100
100


ISIS 420951
0
99
100









Liver Function

To evaluate the effect of ISIS oligonucleotides on hepatic function, plasma concentrations of transaminases were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Plasma concentrations of ALT (alanine transaminase) and AST (aspartate transaminase) were measured and the results are presented in Table 47 expressed in IU/L. Plasma levels of bilirubin were also measured using the same clinical chemistry analyzer; results are also presented in Table 47 and expressed in mg/dL.







TABLE 47







Effect of antisense oligonucleotide treatment on


metabolic markers in the liver of transgenic mice











ALT
AST
Bilirubin



(IU/L)
(IU/L)
(mg/dL)













PBS
34
88
0.20


ISIS 304313
42
79
0.16


ISIS 420913
35
67
0.17


ISIS 420919
63
177
0.20


ISIS 420921
47
103
0.15


ISIS 420922
42
128
0.16


ISIS 420937
33
160
0.15


ISIS 420944
38
84
0.15


ISIS 420947
42
120
0.17


ISIS 420949
46
125
0.15


ISIS 420950
73
106
0.15


ISIS 420952
151
271
0.19


ISIS 420953
982
452
0.16


ISIS 420955
47
80
0.15


ISIS 420957
53
133
0.18


ISIS 420959
31
89
0.11


ISIS 450518
103
200
0.20


ISIS 450519
64
81
0.12


ISIS 450520
350
270
0.12


ISIS 450521
104
226
0.13


ISIS 450522
109
201
0.14


ISIS 450523
80
170
0.19


ISIS 420951
67
100
0.09









Kidney Function

To evaluate the effect of ISIS oligonucleotides on kidney function, plasma concentrations of blood urea nitrogen (BUN) were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Results are presented in Table 48, expressed in mg/dL.







TABLE 48





Effect of antisense oligonucleotide treatment on BUN


(mg/dL) in the kidney of transgenic mice
















PBS
35


ISIS 304313
29


ISIS 420913
30


ISIS 420919
29


ISIS 420921
29


ISIS 420922
27


ISIS 420937
29


ISIS 420944
27


ISIS 420947
26


ISIS 420949
25


ISIS 420950
34


ISIS 420952
23


ISIS 420953
34


ISIS 420955
24


ISIS 420957
23


ISIS 420959
29


ISIS 450518
28


ISIS 450519
25


ISIS 450520
29


ISIS 450521
24


ISIS 450522
29


ISIS 450523
27


ISIS 420951
25









Example 17
Tolerability of Antisense Oligonucleotides Targeting Human Transthyretin in CD1 Mice
CD1 mice were treated with ISIS antisense oligonucleotides from Example 16 and evaluated for changes in the levels of various metabolic markers.
Treatment
Groups of eight CD1 mice each were injected subcutaneously twice a week with 50 mg/kg of ISIS 304313, ISIS 420913, ISIS 420919, ISIS 420921, ISIS 420922, ISIS 420937, ISIS 420944, ISIS 420947, ISIS 420949, ISIS 420950, ISIS 420951, ISIS 420952, ISIS 420953, ISIS 420955, ISIS 420957, ISIS 420959, ISIS 425518, ISIS 425519, ISIS 425520, ISIS 425521, ISIS 425522, or ISIS 425523. Three days after the last dose at each time point, body weights were taken, mice were euthanized and organs and plasma were harvested for further analysis.
Body and Organ Weights
The body weights of the mice were measured pre-dose and at the end of each treatment period (two weeks and six weeks). The body weights are presented in Table 49 and are expressed as percent increase over the PBS control weight taken before the start of treatment. Liver, spleen and kidney weights were measured at the end of the study, and are also presented in Table 49 as a percentage change over the respective organ weights of the PBS control.







TABLE 49







Change in body and organ weights of CD1 mice after


antisense oligonucleotide treatment (%) at week 6












Body






weight
Liver
Spleen
Kidney














PBS
1.3
1.0
1.0
1.0


ISIS 304313
1.2
1.2
1.4
1.2


ISIS 420913
1.2
1.2
1.3
1.1


ISIS 420919
1.3
1.2
1.9
1.1


ISIS 420921
1.1
1.1
2.2
1.1


ISIS 420922
1.1
1.0
1.6
0.9


ISIS 420937
1.1
1.0
1.2
1.0


ISIS 420944
1.1
1.1
2.0
1.0


ISIS 420947
1.3
1.2
1.7
1.0


ISIS 420949
1.3
1.2
1.8
1.1


ISIS 420950
1.3
1.0
1.7
1.0


ISIS 420952
1.4
1.3
2.1
0.9


ISIS 420953
1.3
1.5
2.2
1.0


ISIS 420955
1.2
1.2
2.2
1.0


ISIS 420957
1.1
1.1
1.8
1.1


ISIS 420959
1.3
1.2
3.2
1.1


ISIS 450518
1.4
1.3
1.8
1.1


ISIS 450519
1.3
1.5
2.4
1.0


ISIS 450520
1.4
1.4
2.2
1.0


ISIS 450521
1.2
1.2
1.9
1.1


ISIS 450522
1.3
1.5
2.3
1.1


ISIS 450523
1.2
1.3
2.4
1.1


ISIS 420951
1.3
1.2
1.9
1.0









Liver Function

To evaluate the effect of ISIS oligonucleotides on hepatic function, plasma concentrations of transaminases were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Plasma concentrations of ALT (alanine transaminase) and AST (aspartate transaminase) were measured and the results are presented in Table 50 expressed in IU/L. Plasma levels of bilirubin and albumin were also measured using the same clinical chemistry analyzer and the results are also presented in Table 50.







TABLE 50







Effect of antisense oligonucleotide treatment on


metabolic markers in the liver of CD1 mice











ALT
AST
TBIL













PBS
34
88
0.20


ISIS 304313
42
79
0.16


ISIS 420913
35
67
0.17


ISIS 420919
63
177
0.20


ISIS 420921
47
103
0.15


ISIS 420922
42
128
0.16


ISIS 420937
33
160
0.15


ISIS 420944
38
84
0.15


ISIS 420947
42
120
0.17


ISIS 420949
46
125
0.15


ISIS 420950
73
106
0.15


ISIS 420952
151
271
0.19


ISIS 420953
982
452
0.16


ISIS 420955
47
80
0.15


ISIS 420957
53
133
0.18


ISIS 420959
31
89
0.11


ISIS 450518
103
200
0.20


ISIS 450519
64
81
0.12


ISIS 450520
350
270
0.12


ISIS 450521
104
226
0.13


ISIS 450522
109
201
0.14


ISIS 450523
80
170
0.19


ISIS 420951
67
100
0.09









Kidney Function

To evaluate the effect of ISIS oligonucleotides on kidney function, plasma concentrations of blood urea nitrogen (BUN) and creatinine were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Results are presented in Table 51, expressed in mg/dL.







TABLE 51







Effect of antisense oligonucleotide treatment on 


BUN (mg/dL) in the kidney of CD1 mice









BUN





PBS
35


ISIS 304313
29


ISIS 420913
30


ISIS 420919
29


ISIS 420921
29


ISIS 420922
27


ISIS 420937
29


ISIS 420944
27


ISIS 420947
26


ISIS 420949
25


ISIS 420950
34


ISIS 420952
23


ISIS 420953
34


ISIS 420955
24


ISIS 420957
23


ISIS 420959
29


ISIS 450518
28


ISIS 450519
25


ISIS 450520
29


ISIS 450521
24


ISIS 450522
29


ISIS 450523
27


ISIS 420951
25









Hematology Assays

Blood obtained from all mice groups were sent to Antech Diagnostics for hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) measurements and analyses, as well as measurements of the differential blood cell counts, such as that of WBC (neutrophils, lymphocytes, and monocytes), RBC, and platelets, and total hemoglobin content. The results are presented in Table 52 and 53. Percentages given in the tables indicate the percent change in total blood cell count compared to the PBS control.







TABLE 52







Effect of antisense oligonucleotide treatment on complete blood cell


count (%) compared to the PBS control in CD1 mice















WBC
RBC
Hemoglobin
HCT
MCV
MCH
MCHC

















ISIS 304313
+80
−5
−7
−9
−4
−2
+4


ISIS 420913
−10
−1
−3
−5
−4
−2
+3


ISIS 420919
+26
−2
−7
−9
−7
−5
+4


ISIS 420921
+60
−9
−12
−15
−6
−3
+5


ISIS 420922
+18
−6
−11
−16
−11
−6
+6


ISIS 420937
+42
−3
−4
−7
−5
−1
+5


ISIS 420944
+49
−5
−9
−13
−8
−4
+6


ISIS 420947
+36
−2
−2
−5
−3
0
+4


ISIS 420949
+61
−4
−6
−9
−7
−3
+5


ISIS 420950
+56
−14
−16
−19
−7
−3
+6


ISIS 420952
+36
−20
−24
−25
−7
−5
+4


ISIS 420953
+105
−21
−24
−26
−6
−4
+4


ISIS 420955
+107
−14
−19
−21
−9
−5
+6


ISIS 420957
+79
−5
−10
−13
−9
−6
+5


ISIS 420959
+92
−8
−14
−18
−11
−7
+6


ISIS 450518
+138
−5
−10
−12
−7
−4
+4


ISIS 450519
+118
−17
−21
−24
−9
−5
+6


ISIS 450520
+151
−18
−21
−23
−7
−4
+4


ISIS 450521
+118
−15
−21
−23
−11
−7
+5


ISIS 450522
+63
−22
−28
−31
−12
−8
+6


ISIS 450523
+116
−22
−27
−29
−11
−7
+6


ISIS 420951
+54
−15
−21
−24
−10
−6
+5
















TABLE 53







Effect of antisense oligonucleotide treatment on differential blood 


cell count (%) compared to the PBS control in CD1 mice












Neutrophils
Lymphocytes
Monocytes
Platelets














ISIS 304313
−54
+49
−45
+36


ISIS 420913
−46
+39
−21
−2


ISIS 420919
−57
+49
−21
+19


ISIS 420921
−55
+47
−24
+25


ISIS 420922
−53
+46
−31
+24


ISIS 420937
−63
+57
−48
+20


ISIS 420944
−40
+37
−28
+18


ISIS 420947
−55
+49
−38
−9


ISIS 420949
−30
+24
+7
+17


ISIS 420950
−50
+40
0
+6


ISIS 420952
−34
+33
−28
+13


ISIS 420953
−37
+35
−34
+11


ISIS 420955
−37
+34
−21
+30


ISIS 420957
−71
+61
−28
+16


ISIS 420959
−52
+45
−24
−1


ISIS 450518
−56
+49
−28
+18


ISIS 450519
−18
+11
+41
+55


ISIS 450520
−41
+34
0
+7


ISIS 450521
−41
+36
−14
+21


ISIS 450522
−41
+31
+17
+58


ISIS 450523
−28
+19
+31
+51


ISIS 420951
−28
+24
0
+26









Example 18
Tolerability of Antisense Oligonucleotides Targeting Human Transthyretin in Sprague-Dawley Rats
ISIS oligonucleotides selected from studies described in Example 17 were also tested in Sprague-Dawley rats and evaluated for changes in the levels of various metabolic markers.
Treatment
The body weights, complete blood count and different blood count, as well as the urine protein/creatinine ratio of the rats were evaluated pre-dose. Groups of four Sprague-Dawley rats each were injected subcutaneously twice a week with 50 mg/kg of ISIS 420913, ISIS 420921, ISIS 420922, ISIS 420950, ISIS 420955, ISIS 420957, and ISIS 420959. Three days after the last dose at each time point, body weights were taken, mice were euthanized and organs and plasma were harvested for further analysis.
Body and Organ Weights
The body weights of the rats were measured pre-dose and at the end of the treatment period. The body weights are presented in Table 54, and are expressed as percent increase over the PBS control weight taken before the start of treatment. Liver, spleen and kidney weights were measured at the end of the study, and are also presented in Table 54 as a percentage change over the respective organ weights of the PBS control.







TABLE 54







Change in body and organ weights of Sprague-Dawley


rats after antisense oligonucleotide treatment (%)












Body






weight
Liver
Spleen
Kidney














PBS
2.1
1.0
1.0
1.0


ISIS 420913
1.5
1.5
4.7
1.1


ISIS 420921
1.6
1.5
4.2
1.3


ISIS 420922
1.3
1.5
4.4
1.4


ISIS 420950
1.4
1.5
6.4
1.7


ISIS 420955
1.5
1.6
5.9
1.4


ISIS 420957
1.4
1.4
6.8
1.3


ISIS 420959
1.5
1.4
5.5
1.4









As shown in Table 54, the compounds demonstrated a less than 10-fold increase in organ weight of these rats. Furthermore, certain compounds demonstrated a less than 7-fold increase in organ weight of these rats. While certain compounds demonstrated a less than 6-fold increase in organ weight of these rats. Certain compounds demonstrated a less than 5-fold increase in organ weight of these rats.
Liver Function
To evaluate the effect of ISIS oligonucleotides on hepatic function, plasma concentrations of transaminases were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Plasma concentrations of ALT (alanine transaminase) and AST (aspartate transaminase) were measured and the results are presented in Table 55 expressed in IU/L. Plasma levels of bilirubin and albumin were also measured using the same clinical chemistry analyzer and the results are also presented in Table 55.







TABLE 55







Effect of antisense oligonucleotide treatment on


metabolic markers in the liver of Sprague-Dawley rats












ALT
AST
TBIL
Albumin



(IU/L
(IU/L)
(mg/dL)
(g/dL)














PBS
26
66
0.09
4.5


ISIS 420913
38
95
0.08
3.3


ISIS 420921
65
151
0.11
3.2


ISIS 420922
40
121
0.11
4.0


ISIS 420950
398
327
0.19
4.0


ISIS 420955
78
241
0.18
4.1


ISIS 420957
84
244
0.14
3.7


ISIS 420959
82
405
0.17
4.6









Kidney Function

To evaluate the effect of ISIS oligonucleotides on kidney function, plasma concentrations of blood urea nitrogen (BUN) and creatinine were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Results are presented in Table 56, expressed in mg/dL. The ratio of total urine protein to creatinine was also evaluated and presented in Table 56.







TABLE 56







Effect of antisense oligonucleotide treatment on metabolic 


markers (mg/dL) in the kidney of Sprague-Dawley rats










BUN
Creatinine












PBS
14
0.05


ISIS 420913
22
0.09


ISIS 420921
23
0.07


ISIS 420922
21
0.08


ISIS 420950
20
0.11


ISIS 420955
22
0.06


ISIS 420957
23
0.18


ISIS 420959
24
0.17
















TABLE 57







Effect of antisense oligonucleotide treatment on total urine 


protein/creatinine in the kidney of Sprague-Dawley rats









Urine



protein/creatinine



ratio





PBS
1.50


ISIS 420913
19.51 


ISIS 420921
5.07


ISIS 420922
4.72


ISIS 420950
5.61


ISIS 420955
5.57


ISIS 420957
5.40


ISIS 420959
4.39









Hematology Assays

Blood obtained from all rat groups were sent to Antech Diagnostics for hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) measurements and analyses, as well as measurements of the differential blood cell counts, such as that of WBC (neutrophils, lymphocytes, and monocytes), RBC, and platelets, and total hemoglobin content. The results are presented in Tables 58 and 59. Percents given in the tables indicate the percent change in total blood cell count compared to the PBS control.







TABLE 58







Effect of antisense oligonucleotide treatment on complete blood cell


count (%) compared to the PBS control in Sprague-Dawley rats















WBC
RBC
Hemoglobin
HCT
MCV
MCH
MCHC





PBS
1.0
1.0
1.0
1.0
1.0
1.0
1.0


ISIS 420913
1.7
0.9
0.9
0.9
0.9
0.9
1.0


ISIS 420921
1.6
0.9
0.9
0.9
1.0
1.0
1.0


ISIS 420922
1.6
0.9
0.9
0.8
1.0
1.0
1.0


ISIS 420950
2.2
0.7
0.7
0.7
1.0
1.0
1.0


ISIS 420955
1.9
0.7
0.8
0.7
1.1
1.2
1.0


ISIS 420957
3.1
0.8
0.8
0.8
1.0
1.0
1.0


ISIS 420959
2.2
0.8
0.8
0.8
1.0
1.0
1.0
















TABLE 59







Effect of antisense oligonucleotide treatment on differential blood cell 


count (%) compared to the PBS control in Sprague-Dawley rats












Neutrophils
Lymphocytes
Monocytes
Platelet





PBS
1.0
1.0
1.0
1.0


ISIS 420913
0.5
1.1
1.7
0.7


ISIS 420921
0.7
1.0
1.6
0.6


ISIS 420922
0.5
1.1
1.3
0.7


ISIS 420950
0.8
1.0
2.3
0.7


ISIS 420955
0.5
1.0
2.4
0.7


ISIS 420957
0.7
1.0
1.6
0.3


ISIS 420959
0.5
1.1
1.3
n.d.









Example 19
Pharmacokinetic Studies of Half-Life of Antisense Oligonucleotide Concentration in Sprague-Dawley Rat Liver and Kidney
Sprague Dawley rats were treated with ISIS antisense oligonucleotides targeting from studies described in Example 18 and the oligonucleotide half-life as well as the elapsed time for oligonucleotide degradation and elimination from the liver and kidney was evaluated.
Treatment
Groups of four Sprague Dawley rats each were injected subcutaneously twice a week for 2 weeks with 20 mg/kg of ISIS 420913, ISIS 420921, ISIS 420922, ISIS 420950, ISIS 420955, ISIS 420957, and ISIS 420959. Three days after the last dose, the rats were sacrificed and livers and kidneys were collected for analysis.
Measurement of Oligonucleotide Concentration
The concentration of the full-length oligonucleotide as well as the total oligonucleotide concentration (including the degraded form) was measured. The method used is a modification of previously published methods (Leeds et al., 1996; Geary et al., 1999) which consist of a phenol-chloroform (liquid-liquid) extraction followed by a solid phase extraction. An internal standard (ISIS 355868, a 27-mer 2′-O-methoxyethyl modified phosphorothioate oligonucleotide, GCGTTTGCTCTTCTTCTTGCGTTTTTT, designated herein as SEQ ID NO: 166) was added prior to extraction. Tissue sample concentrations were calculated using calibration curves, with a lower limit of quantitation (LLOQ) of approximately 1.14 μg/g. The results are presented in Tables 60 and 61, expressed as μg/g liver or kidney tissue. The kidney to liver ratio of oligonucleotide concentration was also calculated and presented in Tables 60 and 61.







TABLE 60







Full-length oligonucleotide concentration (μg/g) and 


ratio in the liver and kidney of Sprague-Dawley rats













Kidney/Liver


ISIS NO.
Liver
Kidney
ratio













420913
154
285
1.9


420921
147
293
2.0


420922
226
497
2.2


420950
161
411
2.6


420955
152
383
2.5


420957
235
453
1.9


420959
187
513
2.7
















TABLE 61







Total oligonucleotide concentration (μg/g) 


in the liver and kidney of Sprague-Dawley rats










ISIS


Kidney/Liver


NO.
Liver
Kidney
ratio





420913
180
310
1.7


420921
159
305
1.9


420922
238
544
2.3


420950
168
466
2.8


420955
156
442
2.8


420957
244
551
2.3


420959
202
534
2.6









Example 20
In Vivo Close-Dependent Inhibition of Human Transthyretin in Transgenic Mice
ISIS 420913, ISIS 420921, ISIS 420922, ISIS 420957 and ISIS 420959, which exhibited good efficacy and tolerability, as demonstrated in Examples 16-19, were chosen for the study of dose-dependent target knockdown in transgenic mice containing the human transthyretin gene. ISIS 420950 and ISIS 420955, which demonstrated 90% or more target knockdown, but which also demonstrated toxicity in CD1 mice (Examples 16-19) were also chosen for this study for comparison.
Treatment
Groups of four mice, two male and two female, each were injected subcutaneously twice a week for 4 weeks with 4 mg/kg, 10 mg/kg or 25 mg/kg of ISIS 420913, ISIS 420921, ISIS 420922, ISIS 420950, ISIS 420955, ISIS 420957, or ISIS 420959. One group of four mice, two male and two female, was injected subcutaneously twice a week for 4 weeks with 25 mg/kg of the control oligonucleotide, ISIS 141923. One control group of four mice, two male and two female, was injected subcutaneously twice a week for 4 weeks with PBS. Plasma samples were taken from each group at days 0, 14 and 28. Two days after the last dose, the mice were euthanized and organs were harvested for further analysis.
RNA Analysis
RNA was extracted from liver tissue for real-time PCR analysis of transthyretin using primer probe set RTS3029. Results are presented as percent inhibition of human transthyretin, relative to PBS control. As shown in Table 62, treatment with ISIS antisense oligonucleotides resulted in significant dose-dependent reduction of human transthyretin mRNA in comparison to the PBS control. Treatment with the control oligonucleotide, ISIS 141923 did not result in significant reduction of transthyretin, as expected.







TABLE 62







Inhibition of human transthyretin mRNA in the hTTR


transgenic mice liver relative to the PBS control











ISIS
Dose
%



NO.
(mg/kg)
inhibition














420913
25
78




10
65




4
32



420921
25
76




10
64




4
13



420922
25
80




10
53




4
21



420950
25
92




10
77




4
57



420955
25
88




10
56




4
23



420957
25
85




10
72




4
32



420959
25
75




10
26




4
11



141923
25
0









Protein Analysis

Human transthyretin protein levels were measured in transgenic mice plasma by ELISA using an anti-transthyretin transthyretin polyclonal antibody (Abcam Ab37774) and a sheep anti-TTR horse radish peroxidase detection antibody (Abcam cat. no. 35217). The color reaction was developed by the ImmunoPure® TMB Substrate Kit and absorbance measured at 450 nm using a microtiter plate spectrophotometer. Plasma samples were taken predose and on days 7, 14, 21 and 28. The results are presented in Table 63 expressed as percentage inhibition compared to the predose levels and demonstrate a time-dependent and dose-dependent reduction in protein levels on treatment with ISIS oligonucleotides.







TABLE 63







Inhibition of human transthyretin protein in the hTTR 


transgenic mice plasma relative to predose levels











ISIS
Dose





NO.
(mg/kg)
d0
d14
d28














420913
25
0
73
93



10
0
27
96



4
0
25
54


420921
25
0
73
90



10
0
63
79



4
0
42
67


420922
25
0
63
96



10
0
57
89



4
0
38
77


420950
25
0
95
97



10
0
71
96



4
0
29
53


420955
25
0
84
96



10
0
53
91



4
0
20
30


420957
25
0
83
93



10
0
51
66



4
0
32
49


420959
25
0
74
80



10
0
31
58



4
0
0
0


141923
25
0
22
0









Body Weight and Organ Weight

The body weights of the mice were measured pre-dose and at the end of the treatment period. The body weights are presented in Table 64 and are expressed as percent increase over the PBS control weight taken before the start of treatment. Liver, spleen and kidney weights were measured at the end of the study, and are also presented in Table 64 as a percentage change over the respective organ weights of the PBS control.







TABLE 64







Change in body and organ weights of transgenic


mice after antisense oligonucleotide treatment (%)














Body







weight
Liver
Spleen
Kidney















PBS

6.4
0.0
0.0
0.0


ISIS
25
8.1
0.3
11.4
4.1


420913
10
10.6
−8.6
14.3
13.6



4
7.4
3.7
5.0
12.0


ISIS
25
10.5
8.8
25.6
−0.1


420921
10
9.7
5.7
10.8
4.0



4
8.7
−4.4
16.0
11.0


ISIS
25
8.4
5.6
18.0
1.7


420922
10
9.2
−1.7
27.1
6.3



4
8.1
−2.1
−11.4
5.1


ISIS
25
12.8
14.3
22.8
1.7


420950
10
8.4
4.3
−2.8
0.6



4
9.1
0.4
14.2
1.5


ISIS
25
10.1
14.6
17.7
−4.4


420955
10
11.8
5.6
−0.3
1.4



4
7.9
4.7
−12.3
4.5


ISIS
25
12.8
6.4
33.1
2.8


420957
10
14.5
13.9
−6.3
9.7



4
7.4
−5.4
12.2
6.2


ISIS
25
10.0
2.4
72.7
23.3


420959
10
7.2
−5.4
40.2
9.8



4
4.1
−4.4
27.8
−6.6


ISIS
25
9.2
−1.3
20.4
−5.5


141923














Liver Function

To evaluate the effect of ISIS oligonucleotides on hepatic function, plasma concentrations of transaminases were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Plasma concentrations of ALT (alanine transaminase) and AST (aspartate transaminase) were measured and the results are presented in Table 65 expressed in IU/L. Plasma levels of bilirubin were also measured using the same clinical chemistry analyzer; results are also presented in Table 65 and expressed in mg/dL.







TABLE 65







Effect of antisense oligonucleotide treatment on 


metabolic markers in the liver of transgenic mice












Dose
ALT
AST
TBIL



(mg/kg)
(IU/L)
(IU/L)
(mg/dL)














PBS

47
63
0.16


ISIS
25
42
69
0.13


420913
10
49
90
0.17



4
42
59
0.18


ISIS
25
56
96
0.12


420921
10
51
68
0.22



4
42
75
0.14


ISIS
25
50
76
0.12


420922
10
40
170
0.14



4
37
48
0.13


ISIS
25
74
116
0.14


420950
10
37
67
0.13



4
34
64
0.11


ISIS
25
46
117
0.15


420955
10
54
76
0.16



4
50
153
0.17


ISIS
25
40
73
0.13


420957
10
36
63
0.20



4
37
61
0.12


ISIS
25
51
92
0.19


420959
10
48
69
0.13



4
37
67
0.13


ISIS
25
44
79
0.12


141923













Kidney Function

To evaluate the effect of ISIS oligonucleotides on kidney function, plasma concentrations of blood urea nitrogen (BUN) were measured using an automated clinical chemistry analyzer (Hitachi Olympus AU400e, Melville, N.Y.). Results are presented in Table 66, expressed in mg/dL.







TABLE 66







Effect of antisense oligonucleotide treatment on 


BUN (mg/dL) in the kidney of transgenic mice










Dose




(mg/kg)
BUN












PBS
—
23


ISIS
25
24


420913
10
22



4
20


ISIS
25
24


420921
10
22



4
23


ISIS
25
23


420922
10
22



4
24


ISIS
25
22


420950
10
26



4
23


ISIS
25
23


420955
10
24



4
25


ISIS
25
20


420957
10
22



4
20


ISIS
25
25


420959
10
22



4
22


ISIS
25
19


141923











Example 21
Dose Response Confirmation of Antisense Oligonucleotides Targeting Human Transthyretin in Cynomolgus Monkey Primary Hepatocytes
Gapmers showing tolerability in CD1 mice and Sprague Dawley rats (studies described in Examples 17-19) as well as potency in transgenic mice (studies described in Examples 16 and 20) were selected and tested at various doses in primary hepatocytes of cynomolgus monkeys. Cells were plated at a density of 35,000 cells per well and transfected using electroporation with 156.25 nM, 312.5 nM, 625 nM, 1,250 nM 2,500 nM, 5,000 nM, 10,000 nM and 20,000 nM concentrations of antisense oligonucleotide, as specified in Table 67. After a treatment period of approximately 16 hours, RNA was isolated from the cells and transthyretin mRNA levels were measured by quantitative real-time PCR. Human transthyretin primer probe set RTS1396 was used to measure mRNA levels. Transthyretin mRNA levels were adjusted according to total RNA content, as measured by RIBOGREEN®. Results are presented as percent inhibition of transthyretin, relative to untreated control cells. As illustrated in Table 67, transthyretin mRNA levels were reduced in a dose-dependent manner in hepatocytes treated with all the ISIS oligonucleotides, which are cross-reactive with rhesus monkey transthyretin gene, designated herein as SEQ ID NO: 4 (exons 1-4 extracted from GENBANK Accession No. NW_001105671.1).







TABLE 67







Dose-dependent antisense inhibition of human transthyretin in cynomolgus monkey primary hepatocytes


using electroporation



























Target


ISIS








IC50
Start


No.
156.25 nM
312.5 nM
625 nM
1250 nM
2500 nM
5000 nM
10000 nM
20000 nM
(μM)
Site




















304299
0
0
25
42
89
95
98
99
1.4
504


420913
0
0
42
49
84
96
98
98
1.2
502


420915
0
8
46
58
84
94
97
99
1
505


420921
0
0
26
30
53
74
94
97
2
512


420922
4
0
13
29
38
69
87
97
2.9
513


420950
23
27
60
71
88
94
98
98
0.6
577


420955
19
0
25
50
74
86
93
97
1.4
582


420957
0
0
15
34
65
72
87
94
2.2
584


420959
3
12
10
37
71
88
94
94
1.5
586









Example 22
Measurement of Viscosity of ISIS Antisense Oligonucleotides Targeting Human Transthyretin
The viscosity of antisense oligonucleotides from studies described in Example 21 was measured with the aim of screening out antisense oligonucleotides which have a viscosity more than 40 cP. Oligonucleotides having a viscosity greater than 40 cP would be too viscous to be administered to any subject.
ISIS oligonucleotides (32-35 mg) were weighed into a glass vial, 120 μL of water was added and the antisense oligonucleotide was dissolved into solution by heating the vial at 50° C. Part of (75 μL) the pre-heated sample was pipetted to a micro-viscometer (Cambridge). The temperature of the micro-viscometter was set to 25° C. and the viscosity of the sample was measured. Another part (20 μL) of the pre-heated sample was pipetted into 10 mL of water for UV reading at 260 nM at 85° C. (Cary UV instrument). The results are presented in Table 68 and indicate that all the antisense oligonucleotides solutions are optimal in their viscosity under the criterion stated above.







TABLE 68







Viscosity and concentration of ISIS antisense 


oligonucleotides targeting human transthyretin











ISIS
Viscosity
Concentration



No.
(cP)
(mg/mL)














304299
9.9
169



420913
6.5
178



420915
8.4
227



420921
8.2
234



420922
5.3
191



420950
12.5
297



420955
15.7
259



420957
12.9
233



420959
18.7
276









Example 23
Measurement of Half-Life of Antisense Oligonucleotide in CD1 Mouse Liver
CD1 mice were treated with ISIS antisense oligonucleotides from studies described in Example 22 and the oligonucleotide half-life as well as the elapsed time for oligonucleotide degradation and elimination from the liver was evaluated.
Treatment
Groups of twelve CD1 mice each were injected subcutaneously twice per week for 2 weeks with 50 mg/kg of ISIS 420913, ISIS 420921, ISIS 420922, ISIS 420950, ISIS 420955, ISIS 420957, and ISIS 420959. Four mice from each group were sacrificed 3 days, 28 days and 56 days following the final dose. Livers were harvested for analysis.
Measurement of Oligonucleotide Concentration
The concentration of the full-length oligonucleotide as well as the total oligonucleotide concentration (including the degraded form) was measured. The method used is a modification of previously published methods (Leeds et al., 1996; Geary et al., 1999) which consist of a phenol-chloroform (liquid-liquid) extraction followed by a solid phase extraction. An internal standard (ISIS 355868, a 27-mer 2′-O-methoxyethyl modified phosphorothioate oligonucleotide, GCGTTTGCTCTTCTTCTTGCGTTTTTT, designated herein as SEQ ID NO: 166) was added prior to extraction. Tissue sample concentrations were calculated using calibration curves, with a lower limit of quantitation (LLOQ) of approximately 1.14 μg/g. Half-lives were then calculated using WinNonlin software (PHARSIGHT).
The results are presented in Tables 69, expressed as mg/g liver tissue. The half-life of each oligonucleotide is presented in Table 70.







TABLE 69







Full-length oligonucleotide concentration (μg/g) in the liver of CD1 mice










ISIS No.
3 days
28 days
56 days













420913
243
109
33


420921
225
49
6


420922
310
129
53


420950
254
88
62


420955
308
137
79


420957
325
129
49


420959
258
97
37
















TABLE 70







Half-life of oligonucleotide (days) in the liverof CD1 mice










ISIS
Half-life



No.
(days)






420913
18.5



420921
10.0



420922
20.7



420950
26.4



420955
27.2



420957
19.5



420959
18.9









Example 24
Effect of ISIS Antisense Oligonucleotides Targeting Human Transthyretin in Cynomolgus Monkeys
Cynomolgus monkeys were treated with ISIS antisense oligonucleotides from studies described in Examples 21, 22 and 23. Antisense oligonucleotide efficacy and tolerability, as well as their pharmacokinetic profile in the liver and kidney, were evaluated.
Treatment
Prior to the study, the monkeys were kept in quarantine for a 30-day time period, during which standard panels of serum chemistry and hematology, examination of fecal samples for ova and parasites, and a tuberculosis test, were conducted to screen out abnormal or ailing monkeys. Nine groups of four randomly assigned male cynomolgus monkeys each were injected subcutaneously thrice per week for the first week, and subsequently twice a week for the next 11 weeks, with 25 mg/kg of ISIS 304299, ISIS 420915, ISIS 420921, ISIS 420922, ISIS 420950, ISIS 420955, ISIS 420957, or ISIS 420959. A control group of 4 cynomolgus monkeys was injected with PBS subcutaneously thrice per week for the first week, and subsequently twice a week for the next 11 weeks. Blood samples were collected 5 days before the treatment as well as on various days of the study period and analyzed. The animals were fasted for at least 13 hours (overnight) prior to blood collection. Terminal sacrifices of all groups were conducted on day 86, which was 48 hours after the last dose.
During the study period, the monkeys were observed daily for signs of illness or distress. Any animal showing adverse effects to the treatment was removed and referred to the veterinarian and Study Director. All the animals treated with ISIS 420955 were removed from the study on day 31 due to symptoms of illness displayed by 2 monkeys in the group. Similarly, one monkey each from groups treated with ISIS 420957 and ISIS 420950 was removed from the study on days 44 and 76, respectively, due to signs of illness.
Inhibition Studies
RNA Analysis
On day 86, RNA was extracted from liver tissue for real-time PCR analysis of transthyretin using primer probe set RTS3029. Results are presented as percent inhibition of transthyretin, relative to PBS control, normalized to cyclophilin. Similar results were obtained on normalization with RIBOGREEN®. As shown in Table 71, treatment with ISIS antisense oligonucleotides resulted in significant reduction of transthyretin mRNA in comparison to the PBS control. Specifically, treatment with ISIS 420915 caused greater inhibition of TTR mRNA than treatment with ISIS 304299, even though the two oligonucleotides differ from each other by a single base-pair shift. The data for animals treated with ISIS 420955 was taken at day 31.







TABLE 71







Inhibition of transthyretin mRNA inthe cynomolgus


monkey liver relative to the PBS control











%



ISIS No
inhibition






304299
59



420915
78



420921
54



420922
61



420950
91



420955*
79



420957
64



420959
55





(*Data of day 31)






Protein Analysis

The monkeys were fasted overnight prior to blood collection. Approximately 1 mL of blood was collected from all available animals and placed in tubes containing the potassium salt of EDTA. The tubes were centrifuged (3000 rpm for 10 min at room temperature) to obtain plasma. Transthyretin protein levels were measured in the plasma using a clinical analyzer. Plasma samples were taken predose (on day −5) and on days 1, 9, 16, 23, 30, 44, 58, 72, and 86. The results are presented in Table 72 expressed as percentage inhibition compared to the predose levels and demonstrate a time-dependent reduction in protein levels with treatment with ISIS oligonucleotides. The final plasma TTR levels are presented in Table 73 and demonstrate the strong correlation between TTR protein level reduction and TTR mRNA inhibition (Table 71). Specifically, treatment with ISIS 420915 caused greater inhibition of TTR plasma protein than treatment with ISIS 304299 (76% inhibition vs. 47% inhibition), even though the two oligonucleotides differ from each other by a single base-pair shift.







TABLE 72







Time course of transthyretin protein level reduction in the


cynomolgus monkey plasma relative to predose levels
















ISIS No.
Day 0
Day 9
Day 16
Day 23
Day 30
Day 44
Day 58
Day 72
Day 86



















304299
4
15
21
23
26
27
31
38
47


420915
2
8
23
34
42
54
63
70
76


420921
5
11
21
31
23
27
30
40
50


420922
0
17
37
42
49
49
50
49
54


420950
0
39
63
68
72
79
85
82
87


420955
0
42
63
80
81
n/a
n/a
n/a
n/a


420957
2
18
28
26
26
35
35
41
50


420959
0
25
29
28
32
38
42
43
50





n/a = study was terminated on day 31 for animals treated with ISIS 420955; therefore data for subsequent days is not available.













TABLE 73







Day 86 transthyretin protein level reductionin the cynomolgus


monkey plasma relative to predose levels










ISIS
%



No.
reduction






304299
47



420915
76



420921
50



420922
54



420950
87



420957
50



420959
50









RBP4 protein levels were also measured in the plasma using an ELISA kit. Plasma samples were taken predose (on day −5) and on days 9, 16, 23, 30, 44, 58, 72, and 86. The results are presented in Table 74 expressed as percentage inhibition compared to the predose levels. Some of the ISIS oligonucleotides (ISIS 420915, ISIS 420922, ISIS 420950, ISIS 420955 and ISIS 420959) demonstrate a time-dependent reduction in protein levels, concomitant with TTR reduction. The final plasma RBP4 levels are presented in Table 75 and also demonstrate the strong correlation between RBP4 and TTR protein level reductions (Table 73) on treatment with the above-mentioned oligonucleotides. Specifically, treatment with ISIS 420915 caused greater inhibition of RBP4 plasma protein than treatment with ISIS 304299 (63% inhibition vs. 19% inhibition), even though the two oligonucleotides differ from each other by a single base-pair shift.







TABLE 74







Time course of RBP4 protein level reduction in the


cynomolgus monkey plasma relative to predose levels















ISIS

Day
Day
Day
Day
Day
Day
Day


No.
Day 9
16
23
30
44
58
72
86


















304299
0
6
10
4
1
9
13
19


420915
5
22
22
30
38
47
54
63


420921
0
0
0
0
0
0
6
24


420922
4
19
16
34
33
29
15
32


420950
30
44
46
47
52
54
47
48


420955
6
36
53
65
n/a
n/a
n/a
n/a


420957
0
10
0
0
0
0
3
27


420959
18
22
14
17
19
25
22
34





n/a = study was terminated on day 31 for animals treated with ISIS 420955; therefore data for subsequent days is not available.













TABLE 75







Day 86 RBP4 protein level reduction in the cynomolgus 


monkey plasma relative to predose levels










ISIS
%



No.
reduction






304299
19



420915
63



420921
24



420922
32



420950
48



420957
27



420959
34









Tolerability Studies

Body and Organ Weight Measurements

To evaluate the effect of ISIS oligonucleotides on the overall health of the animals, body and organ weights were measured at day 86. The data for animals treated with ISIS 420955 was taken at day 31. Body weights were measured and compared to that at pre-dose levels. Organ weights were measured and treatment group weights were compared to the corresponding PBS control weights. The data is presented in Table 76.







TABLE 76







Final body and organ weight % changes in the cynomolgus 


monkey relative to predose levels











ISIS
Body
Liver
Kidney
Spleen


No.
weight
weight
weight
weight














304299
+6
+27
+37
+53


420915
+6
+37
+26
+41


420921
+4
+42
+43
+22


420922
+4
+45
+39
+63


420950
0
+204
+166 
+297


 420955*
−3
+36
+81
+70


420957
−6
+55
+184
+109


420959
0
+57
+101
+112





(*Data of day 31)






Liver Function

To evaluate the effect of ISIS oligonucleotides on hepatic function, blood samples were collected from all the study groups. The blood samples were collected in tubes without any anticoagulant for serum separation. The tubes were kept at room temperature for 90 min and then centrifuged (3000 rpm for 10 min at room temperature) to obtain serum. Concentrations of transaminases were measured using a Toshiba 200FR NEO chemistry analyzer (Toshiba Co., Japan). Plasma concentrations of ALT (alanine transaminase) and AST (aspartate transaminase) were measured on day 86 and the results are presented in Table 77, expressed in IU/L. Alkaline phosphatase, which is synthesized in increased amounts by damaged liver cells, is also a marker of liver disease and was similarly measured. C-reactive protein (CRP), which is synthesized in the liver and which serves as a marker of inflammation, was also similarly measured on day 86. Both alkaline phosphatase and CRP data are also presented in Table 77. Bilirubin is also a liver metabolic marker and was similarly measured and is presented in Table 77, expressed in mg/dL.







TABLE 77







Effect of antisense oligonucleotide treatment on liver 


metabolic markers in cynomolgus monkey plasma













AST
ALT
ALP
CRP
Bilirubin



(IU/L)
(IU/L)
(IU/L)
(mg/L)
(mg/dL)















PBS
60
54
955
2.4
0.24


ISIS 304299
81
101
747
3.3
0.17


ISIS 420915
68
62
672
1.6
0.15


ISIS 420921
98
107
832
3.2
0.14


ISIS 420922
94
96
907
2.4
0.15


ISIS 420950
132
94
1032
12.9
0.11


ISIS 420957
100
73
868
23.5
0.15


ISIS 420959
70
63
811
16.0
0.13









Kidney Function

To evaluate the effect of ISIS oligonucleotides on kidney function, blood samples were collected from all the study groups. The blood samples were collected in tubes without any anticoagulant for serum separation. The tubes were kept at room temperature for 90 min and then centrifuged (3000 rpm for 10 min at room temperature) to obtain serum. Concentrations of BUN and creatinine were measured at day 86 using a Toshiba 200FR NEO chemistry analyzer (Toshiba Co., Japan). Results are presented in Table 78, expressed in mg/dL.
Urine samples were collected by drainage from special stainless-steel cage pans on day 5 before the study, and subsequently on days 25 and 84. Urine total protein to creatinine ratio was measured using a Toshiba 200FR NEO chemistry analyzer (Toshiba Co., Japan) and the results are presented in Table 79.







TABLE 78







Effect of antisense oligonucleotide treatment on plasma BUN 


and creatinine levels (mg/dL) in cynomolgus monkeys










BUN
Creatinine





PBS
28
0.86


ISIS 304299
27
0.85


ISIS 420915
25
0.90


ISIS 420921
33
0.99


ISIS 420922
28
0.86


ISIS 420950
36
0.97


ISIS 420957
35
0.86


ISIS 420959
27
0.89
















TABLE 79







Effect of antisense oligonucleotide treatment on urine 


protein to creatine ratio in cynomolgus monkeys











Day −5
Day 25
Day 84





PBS
0.003
0.01
0.00


ISIS 304299
0.000
0.01
0.00


ISIS 420915
0.003
0.00
0.00


ISIS 420921
0.033
0.13
0.09


ISIS 420922
0.010
0.05
0.02


ISIS 420950
0.008
0.29
0.21


ISIS 420955
0.000
0.61
n/a


ISIS 420957
0.000
0.48
0.36


ISIS 420959
0.005
0.08
0.03





n/a = study was terminated on day 31 for animals treated with ISIS 420955; therefore data for subsequent days is not available.






Hematology

To evaluate any inflammatory effect of ISIS oligonucleotides in cynomolgus monkeys, blood samples were approximately 0.5 mL of blood was collected from each of the available study animals in tubes containing the potassium salt of EDTA. Samples were analyzed for red blood cell (RBC) count, white blood cells (WBC) count, individual white blood cell percentages, such as that of monocytes, neutrophils, lymphocytes, as well as for platelet count and hematocrit (%), using an ADVIAl20 hematology analyzer (Bayer, USA). The data is presented in Table 80.







TABLE 80







Effect of antisense oligonucleotide treatment on hematologic parameters in cynomolgus monkeys















WBC
RBC
Platelet
Hematocrit
Lymphocytes
Neutrophil
Monocytes



(×103/μL)
(×106/μL)
(×1000/μL)
(%)
(%)
(%)
(%)

















PBS
9.6
5.3
415
40
62
35
1.8


ISIS
11.6
5.2
395
38
68
26
3.1


304299









ISIS
10.3
5.1
382
36
72
22
3.5


420915









ISIS
9.8
5.2
385
36
60
34
2.5


420921









ISIS
11.6
5.2
396
37
62
29
5.4


420922









ISIS
13.7
4.4
260
33
51
34
7.8


420950









ISIS
18.6
4.7
298
33
52
35
9.1


420957









ISIS
7.7
4.8
306
32
62
29
5.5


420959









Analysis of Factors of Inflammation

To evaluate the effect of ISIS oligonucleotides on factors involved in inflammation, blood was collected on day 86 from all available animals for complement C3 analysis, as well as for measurement of cytokine levels. For complement C3 analysis, the blood samples were collected in tubes without anticoagulant for serum separation. The tubes were kept at room temperature for 90 min and then centrifuged (3000 rpm for 10 min at room temperature) to obtain serum. Complement C3 was measured using an automatic analyzer (Toshiba 200 FR NEO chemistry analyzer, Toshiba co., Japan). The data is presented in Table 81, expressed in mg/dL.
For cytokine level analyses, blood was collected in tubes containing EDTA for plasma separation. The tubes were then centrifuged (3000 rpm for 10 min at room temperature) to obtain plasma. Plasma samples were sent to Aushon Biosystems Inc. (Billerica, Mass.) for measurement of chemokine and cytokine levels. Levels of TNF-α were measured using the respective primate antibodies and levels of MIP-1α, MCP-1, and MIP-1β were measured using the respective cross-reacting human antibodies. Measurements were taken 5 days before the start of treatment and on days 3 and 86. The results are presented in Tables 82-85.







TABLE 81







Effect of antisense oligonucleotide treatment on 


complement C3 (mg/dL) in cynomolgus monkeys









C3











PBS
133


ISIS 304299
96


ISIS 420915
104


ISIS 420921
91


ISIS 420922
102


ISIS 420950
70


ISIS 420957
69


ISIS 420959
95
















TABLE 82







Effect of antisense oligonucleotide treatment 


on MCP-1 (pg/mL) in cynomolgus monkeys











Day −5
Day 3
Day 86













PBS
232
362
206


ISIS 304299
219
292
427


ISIS 420915
204
342
400


ISIS 420921
281
407
2120


ISIS 420922
215
482
838


ISIS 420950
170
370
3355


ISIS 420957
208
308
3485


ISIS 420959
237
715
2035
















TABLE 83







Effect of antisense oligonucleotide treatment


on TNF-α (pg/mL) in cynomolgus monkeys











Day −5
Day 3
Day 86













PBS
60
46
16


ISIS 304299
46
35
24


ISIS 420915
113
83
30


ISIS 420921
57
50
56


ISIS 420922
30
59
46


ISIS 420950
48
54
266


ISIS 420957
29
33
87


ISIS 420959
22
77
74
















TABLE 84







Effect of antisense oligonucleotide treatment


on MIP-1α (pg/mL) in cynomolgus monkeys











Day −5
Day 3
Day 86













PBS
6
7
7


ISIS 304299
6
7
9


ISIS 420915
5
5
10


ISIS 420921
8
11
9


ISIS 420922
9
8
5


ISIS 420950
7
9
5


ISIS 420957
6
6
6


ISIS 420959
9
6
5
















TABLE 85







Effect of antisense oligonucleotide treatment


on MIP-1β (pg/mL) in cynomolgus monkeys











Day −5
Day 3
Day 86













PBS
13
19
42


ISIS 304299
17
23
54


ISIS 420915
15
27
72


ISIS 420921
23
43
112


ISIS 420922
9
41
70


ISIS 420950
8
25
126


ISIS 420957
16
27
182


ISIS 420959
36
46
117









Coagulation Tests

To evaluate the effect of ISIS oligonucleotides on factors involved in the coagulation pathway, the standard tests for coagulation were employed. PT and aPTT were measured using platelet poor plasma (PPP) from the monkeys over a period of 48 hrs. PT and aPTT values are provided in Tables 86 and 87 and expressed in seconds. Fibrinogen levels on the plasma were also quantitated over a period of 48 hrs and the data is presented in Table 88. As shown in Tables 86-88, PT, aPTT and fibrinogen were not significantly altered in monkeys treated with ISIS oligonucleotides compared to the PBS control.







TABLE 86







Effect of antisense oligonucleotide treatment on PT (sec)














0 hr
1 hr
4 hr
8 hr
24 hr
48 hr
















PBS
10.08
10.38
10.10
10.33
9.83
9.40


ISIS 304299
10.38
10.30
10.48
10.20
9.95
9.53


ISIS 420915
10.15
10.13
10.38
9.93
9.75
9.48


ISIS 420921
10.28
10.13
10.43
10.18
9.80
9.55


ISIS 420922
9.95
10.00
10.05
9.70
9.48
9.28


ISIS 420950
10.30
10.47
10.57
10.27
9.63
9.50


ISIS 420957
10.63
10.47
10.60
10.77
10.33
10.27


ISIS 420959
10.08
10.10
10.20
10.15
9.80
9.55
















TABLE 87







Effect of antisense oligonucleotide treatment on aPTT (sec)














0 hr
1 hr
4 hr
8 hr
24 hr
48 hr





PBS
19.40
19.70
20.13
20.20
19.43
17.30


ISIS 304299
21.83
24.35
27.05
25.73
22.40
18.78


ISIS 420915
20.05
22.83
23.83
24.00
21.78
17.90


ISIS 420921
24.15
26.68
31.78
31.90
27.80
22.15


ISIS 420922
25.28
29.48
34.83
33.90
29.13
25.08


ISIS 420950
28.13
31.40
35.40
35.40
31.40
28.37


ISIS 420957
29.13
33.27
39.13
37.40
36.50
29.93


ISIS 420959
22.45
24.73
29.18
28.38
25.50
20.65
















TABLE 88







Effect of antisense oligonucleotide treatment on fibrinogen (mg/dL)














0 hr
1 hr
4 hr
8 hr
24 hr
48 hr





PBS
212
203
240
247
282
272


ISIS 304299
175
172
198
207
227
200


ISIS 420915
213
196
204
258
257
215


ISIS 420921
208
209
230
237
301
249


ISIS 420922
278
277
335
338
400
304


ISIS 420950
293
295
348
376
390
296


ISIS 420957
280
299
344
330
434
328


ISIS 420959
276
277
354
326
414
320









Thyroid Panel Analysis

To evaluate the effect of ISIS oligonucleotides on thyroid hormones, monkeys were fasted overnight and 3.5 mL of blood was drawn from each of the available study animals 5 days prior to the start of treatment and on days 51 and 86. Collected blood samples were kept in tubes without anticoagulant for serum separation. The tubes were kept for 90 min at room temperature, after which they were centrifuged (3000 rpm for 10 min at room temperature) to obtain serum. Serum samples were sent to the Biomarkers Core Laboratory of Emory University (Atlanta, Ga.) for thyroid panel analysis. The results for thyroid stimulating hormone (TSH) are provided in Table 89 and expressed μL/mL. The results for total and free T3 hormone are provided in Tables 90 and 91. The results for total and free T4 hormone are provided in Tables 92 and 93. Overall, the thyroid panel analysis showed that all the animals remained within acceptable hormone levels even though transthyretin expression levels were reduced, demonstrating that the transthyretin antisense oligonucleotides did not affect hormone levels.







TABLE 89







Effect of antisense oligonucleotide treatment on TSH (μL/mL)











Day −5
Day 51
Day 86





PBS
0.8
0.7
1.0


ISIS 304299
1.4
1.0
2.2


ISIS 420915
1.4
1.5
2.5


ISIS 420921
0.7
0.6
1.0


ISIS 420922
1.0
1.2
1.9


ISIS 420950
0.6
2.2
5.4


ISIS 420957
0.6
2.6
4.9


ISIS 420959
0.9
1.6
4.7
















TABLE 90







Effect of antisense oligonucleotide treatment on total T3 (ng/dL)











Day −5
Day 51
Day 86













PBS
177
248
140


ISIS 304299
202
226
176


ISIS 420915
156
206
156


ISIS 420921
217
204
137


ISIS 420922
188
177
131


ISIS 420950
260
208
105


ISIS 420957
266
160
78


ISIS 420959
299
219
137
















TABLE 91







Effect of antisense oligonucleotide treatment on free T3 (pg/mL)











Day −5
Day 51
Day 86













PBS
7.7
5.8
5.2


ISIS 304299
9.2
6.0
4.7


ISIS 420915
8.9
5.6
4.5


ISIS 420921
10.2
4.8
4.0


ISIS 420922
8.9
5.4
3.7


ISIS 420950
7.2
3.8
2.1


ISIS 420957
8.8
4.0
2.4


ISIS 420959
8.3
4.9
3.3
















TABLE 92







Effect of antisense oligonucleotide treatment on total T4 (ng/dL)











Day −5
Day 51
Day 86





PBS
5.8
4.9
4.4


ISIS 304299
8.1
5.5
6.1


ISIS 420915
8.3
5.7
5.5


ISIS 420921
7.6
6.1
5.6


ISIS 420922
7.3
6.1
5.8


ISIS 420950
6.1
6.3
5.7


ISIS 420957
6.3
4.4
5.0


ISIS 420959
7.9
5.9
8.1
















TABLE 93







Effect of antisense oligonucleotide treatment on free T4 (pg/mL)











Day −5
Day 51
Day 86





PBS
3.4
2.4
1.7


ISIS 304299
3.2
2.5
1.7


ISIS 420915
5.0
1.8
1.7


ISIS 420921
2.6
1.5
1.5


ISIS 420922
3.5
1.6
1.5


ISIS 420950
2.5
1.2
1.1


ISIS 420957
2.4
1.2
1.2


ISIS 420959
3.8
1.4
1.5









Pharmacokinetic Studies

Measurement of Oligonucleotide Concentration

The concentration of the full-length oligonucleotide as well as the total oligonucleotide concentration (including the degraded form) was measured. The method used is a modification of previously published methods (Leeds et al., 1996; Geary et al., 1999) which consist of a phenol-chloroform (liquid-liquid) extraction followed by a solid phase extraction. An internal standard (ISIS 355868, a 27-mer 2′-O-methoxyethyl modified phosphorothioate oligonucleotide, GCGTTTGCTCTTCTTCTTGCGTTTTTT, designated herein as SEQ ID NO: 166) was added prior to extraction. Tissue sample concentrations were calculated using calibration curves, with a lower limit of quantitation (LLOQ) of approximately 1.14 μg/g. The ratio of the concentrations in the kidney versus the liver was calculated. The results are presented in Tables 94 and 95, expressed as mg/g tissue.







TABLE 94







Full-length oligonucleotide concentration (μg/g)


in the liver of cynomolgus monkey










ISIS


Kidney/Liver


No.
Kidney
Liver
ratio





304299
2179
 739
2.9


420915
2439
1064
2.3


420921
4617
1521
3.0


420922
3957
1126
3.5


420950
3921
1082
3.6


420955
2444
1111
2.2


420957 
3619
1230
2.9


420959 
3918
1158
3.4
















TABLE 95







Total oligonucleotide concentration (μg/g) 


in the liver of cynomolgus monkey












ISIS


Kidney/Liver



No.
Kidney
Liver
ratio






304299
3098
 992
3.1



420915
3024
1266
2.4



420921
6100
1974
3.1



420922
4861
1411
3.4



420950
6003
1553
3.9



420955
2763
1208
2.3



420957
5420
1582
3.4



420959
5498
1501
3.7

## Claims

1. A method of treating transthyretin amyloidosis in an individual comprising administering to the individual a composition comprising an aqueous solution having a viscosity level less than 40 centipoise (cP), wherein the aqueous solution comprises a compound comprising a single-stranded modified oligonucleotide consisting of 20 linked nucleosides having a nucleobase sequence consisting of SEQ ID NO: 80, wherein the modified oligonucleotide comprises:
a gap segment consisting of ten linked 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, wherein each internucleoside linkage is a phosphorothioate linkage, and wherein each cytosine of the modified oligonucleotide is a 5-methylcytosine.

2. The method of claim 1, wherein the aqueous solution has a temperature of about 25° C.

3. The method of claim 1, wherein the aqueous solution has a viscosity level less than 15 centipoise (cP).

4. The method of claim 3, wherein the aqueous solution has a temperature of about 25° C.

5. The method of claim 1, wherein the aqueous solution has a viscosity level less than 12 centipoise (cP).

6. The method of claim 5, wherein the aqueous solution has a temperature of about 25° C.

7. The method of claim 1, wherein the aqueous solution has a viscosity level less than 10 centipoise (cP).

8. The method of claim 7, wherein the aqueous solution has a temperature of about 25° C.

9. The method of claim 1, wherein the aqueous solution consists of water and the compound, and the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).

10. The method of claim 2, wherein the aqueous solution consists of water and the compound, and the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).

11. The method of claim 3, wherein the aqueous solution consists of water and the compound, and the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).

12. The method of claim 4, wherein the aqueous solution consists of water and the compound, and the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).

13. The method of claim 5, wherein the aqueous solution consists of water and the compound, and the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).

14. The method of claim 6, wherein the aqueous solution consists of water and the compound, and the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).

15. The method of claim 7, wherein the aqueous solution consists of water and the compound, and the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).

16. The method of claim 8, wherein the aqueous solution consists of water and the compound, and the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).

17. A method comprising administering to an individual having transthyretin amyloidosis a tolerable amount of a compound comprising a single-stranded modified oligonucleotide consisting of 20 linked nucleosides having a nucleobase sequence consisting of SEQ ID NO: 80, wherein administering the tolerable amount of the compound increases plasma alanine transaminase (ALT) or aspartate transaminase (AST) levels in the individual by less than 4-fold and the modified oligonucleotide comprises:
a gap segment consisting of ten linked 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, wherein each internucleoside linkage is a phosphorothioate linkage; and wherein each cytosine of the modified oligonucleotide is a 5-methylcytosine.

18. The method of claim 17, wherein the administering the tolerable amount of the compound increases plasma ALT or AST levels in the individual by less than 3-fold in the individual.

19. The method of claim 17, wherein the administering the tolerable amount of the compound increases plasma ALT or AST levels in the individual by less than 2-fold in the individual.

20. The method of claim 17, wherein administering the tolerable amount of the compound increases plasma ALT and AST levels in the individual by less than 4-fold.

21. The method of claim 17, wherein administering the tolerable amount of the compound increases plasma ALT and AST levels in the individual by less than 3-fold.

22. The method of claim 17, wherein administering the tolerable amount of the compound increases plasma ALT and AST levels in the individual by less than 2-fold.

23. The method of claim 17, wherein administering the tolerable amount of the compound increases plasma ALT levels in the individual by less than 4-fold.

24. The method of claim 17, wherein administering the tolerable amount of the compound increases plasma ALT levels in the individual by less than 3-fold.

25. The method of claim 17, wherein administering the tolerable amount of the compound increases plasma ALT levels in the individual by less than 2-fold.

26. The method of claim 17, wherein administering the tolerable amount of the compound increases plasma AST levels in the individual by less than 4-fold.

27. The method of claim 17, wherein administering the tolerable amount of the compound increases plasma AST levels in the individual by less than 3-fold.

28. The method of claim 17, wherein administering the tolerable amount of the compound increases plasma AST levels in the individual by less than 2-fold.

29. The method of claim 17, wherein administering the tolerable amount of the compound increases liver, spleen or kidney weight of the individual less than 30%.

30. The method of claim 17, wherein administering the tolerable amount of the compound treats, ameliorates, or slows progression of transthyretin amyloidosis in the individual.

31. The method of claim 17, wherein administering the tolerable amount of the compound reduces transthyretin mRNA or protein expression in the individual.

32. The method of claim 17, wherein the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP).

33. The method of claim 17, wherein the transthyretin amyloidosis is familial amyloid cardiopathy (FAC).

34. The method of claim 30, wherein administering the tolerable amount of the compound treats, ameliorates, or slows progression of familial amyloid polyneuropathy (FAP) in the individual.

35. The method of claim 30, wherein administering the tolerable amount of the compound treats, ameliorates, or slows progression of familial amyloid cardiopathy (FAC) in the individual.

36. A method of treating transthyretin amyloidosis in an individual comprising administering to the individual a compound consisting of a pharmaceutically acceptable salt of a single-stranded modified oligonucleotide consisting of 20 linked nucleosides having a nucleobase sequence consisting of SEQ ID NO: 80, wherein the modified oligonucleotide comprises:
a gap segment consisting of ten linked 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, wherein each internucleoside linkage is a phosphorothioate linkage, and wherein each cytosine of the modified oligonucleotide is a 5-methylcytosine.

37. The method of claim 36, wherein the pharmaceutically acceptable salt is a sodium salt.

38. The method of claim 37, wherein the pharmaceutically acceptable salt is a potassium salt.

39. The method of claim 36, wherein the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).

40. The method of claim 37, wherein the transthyretin amyloidosis is familial amyloid polyneuropathy (FAP) or familial amyloid cardiopathy (FAC).