# Patent

## Title
Antisense oligonucleotides rescue aberrant splicing of ABCA4

## Abstract

The present invention relates to the field of medicine. In particular, it relates to novel antisense oligonucleotides that may be used in the treatment, prevention and/or delay of Stargardt disease

## Background
FIELD OF THE INVENTION
The invention relates to the fields of medicine and immunology. In particular, it relates to novel antisense oligonucleotides that may be used in the treatment, prevention and/or delay of an ABCA4-associated condition.
BACKGROUND OF THE INVENTION
Autosomal recessive mutations in ABCA4 cause Stargardt disease, a progressive disorder characterized by central vision loss and often leading to complete blindness. A typical hallmark of Stargardt disease is the presence of many yellow spots (flecks) distributed throughout the fundus of the patients. The ABCA4 gene is comprised of 50 exons and encodes a protein consisting of 2273 amino acids. This protein is expressed in the outer segments of cone and rod photoreceptor cells and plays an important role in the removal of waste products following phototransduction.
Besides STGD1, variants in ABCA4 can also lead to other subtypes of retinal disease ranging from bull's eye maculopathy to autosomal recessive cone-rod dystrophy (arCRD; Cremers et al, 1998; Maugeri et al, 2000) and pan-retinal dystrophies (Cremers et al, 1998; Martinez-Mir et al, 1998), depending on the severity of the alleles.
Biallelic ABCA4 variants can be identified in approximately 80% of the cases with STGD1 (Allikmets et al, 1997; Fujinami et al, 2013; Lewis et al, 1999; Maugeri et al, 1999; Rivera et al, 2000; Schulz et al, 2017; Webster et al, 2001; Zernant et al, 2011; Zernant et al, 2017), and 30% of cases with arCRD (Maugeri et al, 2000), after sequencing coding regions and flanking splice sites. In general, individuals with arCRD or pan-retinal dystrophy carry two severe ABCA4 alleles, whereas individuals with STGD1 carry two moderately severe variants or a combination of a mild and a severe variant (Maugeri et al, 1999; van Driel et al, 1998). It has been hypothesized that the majority of the missing ABCA4 variants in STGD1 patients reside in intronic regions of the gene, and indeed, over the last few years, several groups have demonstrated the existence of such deep-intronic variants (Bauwens et al, 2015; Bax et al, 2015; Braun et al, 2013; Lee et al, 2016; Schulz et al, 2017; Zernant et al, 2014). Recently, we discovered a recurrent variant in ABCA4, c.4253+43G>A that affects ABCA4 pre-mRNA splicing by skipping the adjacent exon 28 from a proportion of ABCA4 transcripts, a process that can be accompanied by co-skipping of adjacent exons such as exon 27 or exon 29.
The fact that a considerable amount of the mutations in ABCA4 affect pre-mRNA splicing of ABCA4, renders it an attractive target for antisense oligonucleotide (AON)-based splice modulation therapy. Accordingly, there is an urge to develop AONs for splice modulation of the ABCA4 gene to enable expression of a functional ABCA4 protein in subjects suffering from Stargardt disease.
SUMMARY OF THE INVENTION
In a first aspect, the invention provides for an ABCA4 exon 28 retention molecule that binds to and/or is complementary to a polynucleotide with the nucleotide sequence as shown in SEQ ID NO:4, preferably the molecule is complementary to a polynucleotide with SEQ ID NO:5, more preferably the molecule is complementary to a polynucleotide with SEQ ID NO:6.
In a second aspect, the invention provides for an antisense oligonucleotide ABCA4 exon 28 retention molecule wherein the antisense oligonucleotide comprises or consists of a sequence selected from the group consisting of SEQ ID NO: 17, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 20, and SEQ ID NO: 21, preferably the antisense oligonucleotide comprises or consist of SEQ ID NO:19.
In a third aspect, the invention provide for a set of ABCA4 exon 28 retention molecules comprising at least two antisense oligonucleotide according to the invention, wherein preferably the set comprises or consists of at least two antisense oligonucleotides selected from the group consisting of SEQ ID NO: 17, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 20, and SEQ ID NO: 21.
In a fourth aspect, the invention provides for a viral vector expressing an ABCA4 exon 28 retention molecule as defined herein.
In a fifth aspect, the invention provides for a pharmaceutical composition comprising an ABCA4 exon 28 retention molecule as defined herein.
In a sixth aspect, the invention provides for a ABCA4 exon 28 retention molecule as defined herein use as a medicament, preferably for use as a medicament for treating an ABCA4 related disease or a condition requiring modulating splicing of ABCA4 or for use in a method of treating an ABCA4 related disease or a condition requiring modulating splicing of ABCA4.
DETAILED DESCRIPTION OF THE INVENTION
By definition, antisense oligonucleotides (AONs) are substantially complementary (antisense) to their target, allowing them to bind to the corresponding pre-mRNA molecule, thereby, without being bound by theory, preventing the binding of proteins essential for splicing. Usually, this lack of binding results in the skipping of the targeted exon, as the present inventors have previously shown for the c.4539+1100A>G, c.4539+1106C>T, c.4539+2001G>A and c.4539+2028C>T mutations in ABCA4 (WO2018/109011). However, by fusing the sequence of the AON to elements that recruit splice enhancers, AONs can also be employed to force the inclusion of exons that due to mutations are absent in the mutant transcripts of the corresponding gene.
The present inventors have identified one ABCA4 variant, c.4253+43G>A, that is very common in the population, present in  ̃0.4% of all individuals worldwide. Although this mutation is not fully penetrant (not all individuals with this mutation will get STGD1), it is one of the most common mutations in patients with STGD1, in particularly those with a relatively late-onset. The inventors have demonstrated that, in patients with this mutation, the amount of ABCA4 transcripts that contain exon 28 is lower compared to control individuals, indicating that this mutation results in a partial skipping of exon 28 from the ABCA4 mRNA. Occasionally, this process is accompanied by co-skipping of adjacent exons such as exon 27 or exon 29.
Surprisingly, it has now been demonstrated that specific AONs are able to redirect the aberrant splicing of ABCA4 that is caused by the intronic c.4253+43G>A mutation leading to the inclusion of exon 28.
Accordingly, in a first aspect the invention provides an ABCA4 exon 28 retention molecule that binds to and/or is complementary to a polynucleotide with the nucleotide sequence as shown in SEQ ID NO:4, preferably the molecule is complementary to a polynucleotide with SEQ ID NO:5, more preferably the molecule is complementary to a polynucleotide with SEQ ID NO:6 or a part thereof.
The term “exon retention” is herein defined as inducing, producing or increasing production within a cell of a mature mRNA that does retain a particular exon that should be present in the mature mRNA without (aberrant) exon skipping. Exon retention is achieved by providing a cell expressing the pre-mRNA of said mature mRNA with an AON molecule capable of interfering with sequences such as, for example, alternative splice sites upstream or downstream of the regular splice sites.
An AON according to the invention is said to induce exon retention if the retention percentage as measured, preferably by real-time quantitative RT-PCR analysis, is at least 30%, or at least 35%, or at least 40%, or at least 45%, or at least 50%, or at least 55%, or at least 60%, or at least 65%, or at least 70%, or at least 75%, or at least 80%, or at least 85%, or at least 90%, or at least 95%, or 100% of mature mRNA.
The term “antisense oligonucleotide” or “AON” is understood to refer to an oligonucleotide molecule comprising a nucleotide sequence which is substantially complementary to a target nucleotide sequence in a pre-mRNA molecule, hnRNA (heterogenous nuclear RNA) or mRNA molecule. The degree of complementarity (or substantial complementarity) of the antisense sequence is preferably such that a molecule comprising the antisense sequence can form a stable hybrid with the target nucleotide sequence in the RNA molecule under physiological conditions.
The term “substantially complementary” used in the context of the invention indicates that some mismatches in the antisense sequence are allowed as long as the functionality, i.e. inducing exon retention is maintained. Preferably, the complementarity is 90% to 100%. In general, this allows for 1 or 2 mismatches in an AON of 20 nucleotides or 1, 2, 3 or 4 mismatches in an AON of 40 nucleotides, or 1, 2, 3, 4, 5 or 6 mismatches in an AON of 60 nucleotides, etc. Optionally, said AON may further be tested by transfection into retina cells of patients. Retention of an exon may be assessed by RT-PCR (such as e.g. described in EP1619249). The complementary regions are preferably designed such that, when combined, they are specific for the exon in the pre-mRNA. Such specificity may be created with various lengths of complementary regions, as this depends on the actual sequences in other (pre-)mRNA molecules in the system. The risk that the AON will also be able to hybridize to one or more other pre-mRNA molecules decreases with increasing size of the AON. It is clear that AONs comprising mismatches in the region of complementarity but that retain the capacity to hybridize and/or bind to the targeted region(s) in the pre-mRNA, can be used in the invention. However, preferably at least the complementary parts do not comprise such mismatches as AONs lacking mismatches in the complementary part typically have a higher efficiency and a higher specificity than AONs having such mismatches in one or more complementary regions. It is thought, that higher hybridization strengths, (i.e. increasing number of interactions with the opposing strand) are favorable in increasing the efficiency of the process of interfering with the splicing machinery of the system.
An AON according to the invention preferably does not contain a stretch of CpG, more preferably does not contain any CpG. The presence of a CpG or a stretch of CpG in an oligonucleotide is usually associated with an increased immunogenicity of said oligonucleotide (Dorn and Kippenberger, 2008). This increased immunogenicity is undesired since it may induce damage of the tissue to be treated, i.e. the eye. Immunogenicity may be assessed in an animal model by assessing the presence of CD4+ and/or CD8+ cells and/or inflammatory mononucleocyte infiltration. Immunogenicity may also be assessed in blood of an animal or of a human being treated with an AON according to the invention by detecting the presence of a neutralizing antibody and/or an antibody recognizing said AON using a standard immunoassay known to the skilled person. An inflammatory reaction, type I-like interferon production, IL-12 production and/or an increase in immunogenicity may be assessed by detecting the presence or an increasing amount of a neutralizing antibody or an antibody recognizing said AON using a standard immunoassay. The AON according to the invention furthermore preferably has acceptable RNA binding kinetics and/or thermodynamic properties. The RNA binding kinetics and/or thermodynamic properties are at least in part determined by the melting temperature of an oligonucleotide (Tm; calculated with the oligonucleotide properties calculator (www.unc.edu/-cail/biotool/oligo/index) for single stranded RNA using the basic Tm and the nearest neighbor model), and/or the free energy of the AON-target exon complex (using RNA structure version 4.5). If a Tm is too high, an AON is expected to be less specific. An acceptable Tm and free energy depend on the sequence of the AON. Therefore, it is difficult to give preferred ranges for each of these parameters. An acceptable Tm may be ranged between 35 and 70° C. and an acceptable free energy may be ranged between 15 and 45 kcal/mol. The skilled person may therefore first choose an AON as a potential therapeutic compound as binding and/or being complementary to SEQ ID NO: 4, or a part thereof as defined later herein. The skilled person may check that said AON is able to bind to said sequences as earlier defined herein. Optionally in a second step, he may use the invention to further optimize said AON by checking for the absence of CpG and/or by optimizing its Tm and/or free energy of the AON-target complex. He may try to design an AON wherein few, preferably, no CpG and/or wherein a more acceptable Tm and/or free energy are obtained by choosing a distinct sequence of ABCA4 (including SEQ ID NO: 4 or a part thereof) to which the AON is complementary. Alternatively, if an AON complementary to a given stretch within SEQ ID NO: 4, comprises a CpG, and/or does not have an acceptable Tm and/or free energy, the skilled person may improve any of these parameters by decreasing the length of the AON, and/or by choosing a distinct stretch within any of SEQ ID NO: 4 to which the AON is complementary and/or by altering the chemistry of the AON.
An AON for redirecting splicing according to the invention may comprise one of more RNA residue (ribonucleotide), or one or more DNA residue (deoxyribonucleotide), and/or one or more nucleotide analogues or equivalents, as will be further detailed herein below.
For the purpose of the invention, the terms “aberrant ABCA4 exon 28” of “aberrant exon 28” are considered to be synonymous, and considered to mean the presence of a mutation in exon 28 (SEQ ID NO:4) of the ABCA4 gene, resulting in an ABC4A mRNA with at least one substitution, deletion or insertion in exon 28 of ABCA4 (SEQ ID NO:4).
In all embodiments of the invention, an exon retention molecule is preferably a nucleic acid molecule, preferably an oligonucleotide. Preferably, an exon retention molecule according to the invention is a nucleic acid molecule, preferably an oligonucleotide, which is complementary or substantially complementary to a nucleotide sequence as shown in in SEQ ID NO:4, preferably the molecule is complementary to a polynucleotide with SEQ ID NO:5, more preferably the molecule is complementary to a polynucleotide with SEQ ID NO:6 or a part thereof of ABCA4.
A preferred ABCA4 exon 28 retention molecule according to the invention is a nucleic acid molecule that comprises or consists of an antisense oligonucleotide that is complementary to the polynucleotide wherein the antisense oligonucleotide has a length from about 8 to about 100 nucleotides, more preferred 10 to about 40 nucleotides, more preferred from about 12 to about 30 nucleotides, more preferred from about 14 to about 28 nucleotides, nucleotides, most preferred about 20 to 24 nucleotides, such as 20 nucleotides, 21 nucleotides, 22 nucleotides, 23 nucleotides, 24 nucleotides or 25 nucleotides.
In certain embodiments, the invention provides a ABCA4 exon 28 retention molecule, wherein the antisense oligonucleotide comprises or consists of a sequence selected from the group consisting of SEQ ID NO: 17, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 20, and SEQ ID NO: 21, preferably the antisense oligonucleotide comprises or consist of SEQ ID NO:19.
In certain embodiments, wherein the antisense oligonucleotide comprises or consists of a sequence selected from the group consisting of SEQ ID NO: 17, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 20, and SEQ ID NO: 21, preferably the antisense oligonucleotide comprises or consist of SEQ ID NO:19, the antisense oligonucleotide has a length of 8 to 100 nucleotides, preferably a length of 10 to 40 nucleotides, more preferably a length of 12 to 30 nucleotides, most preferably the retention molecule has a length of 18 to 24 nucleotides, such as 18, 19, 20, 21, 22, 23 or 24 nucleotides.
In a preferred embodiment, the invention provides for an ABCA4 retention molecule comprising or preferably consisting of the AON SEQ ID NO: 19. It was found that this molecule was very efficient in redirecting the aberrant splicing of ABCA4 that is caused by the intronic c.4253+43G>A. This preferred exon retention molecule of the invention comprising SEQ ID NO: 19, preferably comprises from about 8 to about 100 nucleotides, more preferred 10 to about 40 nucleotides, more preferred from about 12 to about 30 nucleotides, more preferred from about 14 to about 28 nucleotides, nucleotides, most preferred about 20 to 24 nucleotides, such as 20 nucleotides, 21 nucleotides, 22 nucleotides, 23 nucleotides, 24 nucleotides or 25 nucleotides
It is preferred that an AON for redirecting splicing according to the invention comprises one or more residues that are modified to increase nuclease resistance, and/or to increase the affinity of the antisense oligonucleotide for the target sequence. Therefore, in a preferred embodiment, the AON comprises at least one nucleotide analogue or equivalent, wherein a nucleotide analogue or equivalent is defined as a residue having a modified base, and/or a modified backbone, and/or a non-natural internucleoside linkage, or a combination of these modifications.
In a preferred embodiment, the nucleotide analogue or equivalent comprises a modified backbone. Examples of such backbones are provided by morpholino backbones, carbamate backbones, siloxane backbones, sulfide, sulfoxide and sulfone backbones, formacetyl and thioformacetyl backbones, methyleneformacetyl backbones, riboacetyl backbones, alkene containing backbones, sulfamate, sulfonate and sulfonamide backbones, methyleneimino and methylenehydrazino backbones, and amide backbones. Phosphorodiamidate morpholino oligomers are modified backbone oligonucleotides that have previously been investigated as antisense agents.
Morpholino oligonucleotides have an uncharged backbone in which the deoxyribose sugar of DNA is replaced by a six membered ring and the phosphodiester linkage is replaced by a phosphorodiamidate linkage. Morpholino oligonucleotides are resistant to enzymatic degradation and appear to function as antisense agents by arresting translation or interfering with pre-mRNA splicing rather than by activating RNase H. Morpholino oligonucleotides have been successfully delivered to tissue culture cells by methods that physically disrupt the cell membrane, and one study comparing several of these methods found that scrape loading was the most efficient method of delivery; however, because the morpholino backbone is uncharged, cationic lipids are not effective mediators of morpholino oligonucleotide uptake in cells. A recent report, demonstrated triplex formation by a morpholino oligonucleotide and, because of the non-ionic backbone, these studies showed that the morpholino oligonucleotide was capable of triplex formation in the absence of magnesium.
It is further preferred that the linkage between the residues in a backbone do not include a phosphorus atom, such as a linkage that is formed by short chain alkyl or cycloalkyl internucleoside linkages, mixed heteroatom and alkyl or cycloalkyl internucleoside linkages, or one or more short chain heteroatomic or heterocyclic internucleoside linkages.
A preferred nucleotide analogue or equivalent comprises a Peptide Nucleic Acid (PNA), having a modified polyamide backbone (Nielsen et al., 1991). PNA-based molecules are true mimics of DNA molecules in terms of base-pair recognition. The backbone of the PNA is composed of N-(2-aminoethyl)-glycine units linked by peptide bonds, wherein the nucleobases are linked to the backbone by methylene carbonyl bonds. An alternative backbone comprises a one-carbon extended pyrrolidine PNA monomer (Govindaraju and Kumar, 2005). Since the backbone of a PNA molecule contains no charged phosphate groups, PNA-RNA hybrids are usually more stable than RNA-RNA or RNA-DNA hybrids, respectively (Egholm et al., 1993). A further preferred backbone comprises a morpholino nucleotide analog or equivalent, in which the ribose or deoxyribose sugar is replaced by a 6-membered morpholino ring. A most preferred nucleotide analog or equivalent comprises a phosphorodiamidate morpholino oligomer (PMO), in which the ribose or deoxyribose sugar is replaced by a 6-membered morpholino ring, and the anionic phosphodiester linkage between adjacent morpholino rings is replaced by a non-ionic phosphorodiamidate linkage.
In yet a further embodiment, a nucleotide analogue or equivalent according to the invention comprises a substitution of one of the non-bridging oxygens in the phosphodiester linkage. This modification slightly destabilizes base-pairing but adds significant resistance to nuclease degradation. A preferred nucleotide analogue or equivalent comprises phosphorothioate, chiral phosphorothioate, phosphorodithioate, phosphotriester, aminoalkylphosphotriester, H-phosphonate, methyl and other alkyl phosphonate including 3′-alkylene phosphonate, 5′-alkylene phosphonate and chiral phosphonate, phosphinate, phosphoramidate including 3′-amino phosphoramidate and aminoalkylphosphoramidate, thionophosphoramidate, thionoalkylphosphonate, thionoalkylphosphotriester, selenophosphate or boranophosphate.
A further preferred nucleotide analogue or equivalent according to the invention comprises one or more sugar moieties that are mono- or disubstituted at the 2′, 3′ and/or 5′ position such as a —OH; —F; substituted or unsubstituted, linear or branched lower (CI-C10) alkyl, alkenyl, alkynyl, alkaryl, allyl, or aralkyl, that may be interrupted by one or more heteroatoms; O-, S-, or N-alkyl; O-, S-, or N-alkenyl; O-, S- or N-alkynyl; O-, S-, or N-allyl; O-alkyl-O-alkyl, -methoxy, -aminopropoxy; methoxyethoxy; dimethylaminooxyethoxy; and -dimethylaminoethoxyethoxy. The sugar moiety can be a pyranose or derivative thereof, or a deoxypyranose or derivative thereof, preferably ribose or derivative thereof, or deoxyribose or derivative of. A preferred derivatized sugar moiety comprises a Locked Nucleic Acid (LNA), in which the 2′-carbon atom is linked to the 3′ or 4′ carbon atom of the sugar ring thereby forming a bicyclic sugar moiety. A preferred LNA comprises 2′-O, 4′-C-ethylene-bridged nucleic acid (Morita et al., 2001). These substitutions render the nucleotide analogue or equivalent RNase H and nuclease resistant and increase the affinity for the target RNA. In another embodiment, a nucleotide analogue or equivalent according to the invention comprises one or more base modifications or substitutions. Modified bases comprise synthetic and natural bases such as inosine, xanthine, hypoxanthine and other -aza, deaza, -hydroxy, -halo, -thio, thiol, -alkyl, -alkenyl, -alkynyl, thioalkyl derivatives of pyrimidine and purine bases that are or will be known in the art.
It is understood by a skilled person that it is not necessary for all positions in an AON to be modified uniformly. In addition, more than one of the aforementioned analogues or equivalents may be incorporated in a single AON or even at a single position within an AON. In certain embodiments, an AON according to the invention has at least two different types of analogues or equivalents.
Accordingly, in a preferred embodiment an ABCA4 exon 28 retention molecule according to the invention comprises a 2′-0 alkyl phosphorothioate antisense oligonucleotide, such as 2′-O-methyl modified ribose (RNA), 2′-O-ethyl modified ribose, 2′-O-propyl modified ribose, and/or substituted derivatives of these modifications such as halogenated derivatives. [Claim 6]
It will also be understood by a skilled person that different antisense oligonucleotides can be combined for efficient inclusion of the aberrant exon 28. In a preferred embodiment the invention comprises a set of ABCA4 exon 28 retention molecules comprising at least two ABCA4 exon 28 retention molecules according to the invention. Preferably wherein of ABCA4 exon 28 retention molecules set comprises or consists of at least two, at least three, at least four antisense oligonucleotides selected from the group consisting of SEQ ID NO: 17, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 20, and SEQ ID NO: 21. For example, such set may comprise or consist of:

    
    
        antisense oligonucleotide SEQ ID NO: 17 and antisense oligonucleotide SEQ ID NO: 18,
        antisense oligonucleotide SEQ ID NO: 17 and antisense oligonucleotide SEQ ID NO: 19,
        antisense oligonucleotide SEQ ID NO: 17 and antisense oligonucleotide SEQ ID NO: 20
        antisense oligonucleotide SEQ ID NO: 17 and antisense oligonucleotide SEQ ID NO: 21,
        antisense oligonucleotide SEQ ID NO: 18 and antisense oligonucleotide SEQ ID NO: 19,
        antisense oligonucleotide SEQ ID NO: 18 and antisense oligonucleotide SEQ ID NO: 20,
        antisense oligonucleotide SEQ ID NO: 18 and antisense oligonucleotide SEQ ID NO: 21,
        antisense oligonucleotide SEQ ID NO: 19 and antisense oligonucleotide SEQ ID NO: 20,
        antisense oligonucleotide SEQ ID NO: 19 and antisense oligonucleotide SEQ ID NO: 21, or
        antisense oligonucleotide SEQ ID NO: 20 and antisense oligonucleotide SEQ ID NO: 21.
    
    


Stargardt disease (STGD1) usually has an autosomal recessive inheritance caused by biallelic ABCA4 variants. It is thus entirely plausible that patients can carry several ABCA4 mutations thereby requiring a combination of AONs for the treatment of the disease. Accordingly, the invention provides for a composition comprising one or more of the AONs of the invention and optionally, one or more AONs targeting other mutations in ABCA4. For example, the invention provides for a composition comprising an AON of the present invention and an AON described in WO2018/109011.
An AON for redirecting splicing according to the invention may be indirectly administrated using suitable means known in the art. It may for example be provided to an individual or a cell, tissue or organ of said individual as such, as a so-called ‘naked’ AON. It may also be administered in the form of an expression vector wherein the expression vector encodes an RNA transcript comprising the sequence of said AON according to the invention. The expression vector is preferably introduced into a cell, tissue, organ or individual via a gene delivery vehicle. In a preferred embodiment, there is provided a viral-based expression vector comprising an expression cassette or a transcription cassette that drives expression or transcription of an AON for redirecting splicing according to the invention. Accordingly, the invention provides for a viral vector expressing an antisense oligonucleotide according to the invention when placed under conditions conducive to expression of the molecule.
A cell can be provided with an AON for redirecting splicing according to the invention by plasmid-derived antisense oligonucleotide expression or viral expression provided by adenovirus- or adeno-associated virus-based vectors. Expression may be driven by an RNA polymerase II promoter (Pol II) such as a U7 RNA promoter or an RNA polymerase III (Pol III) promoter, such as a U6 RNA promoter. A preferred delivery vehicle is a viral vector such as an adeno-associated virus vector (AAV), or a retroviral vector such as a lentivirus vector and the like. Also, plasmids, artificial chromosomes, plasmids usable for targeted homologous recombination and integration in the human genome of cells may be suitably applied for delivery of an AON for redirecting splicing according to the invention. Preferred for the invention are those vectors wherein transcription is driven from PolIII promoters, and/or wherein transcripts are in the form fusions with U1 or U7 transcripts, which yield good results for delivering small transcripts. It is within the skill of the artisan to design suitable transcripts. Preferred are PolIII driven transcripts, preferably, in the form of a fusion transcript with an U1 or U7 transcript. Such fusions may be generated as previously described (Gorman et al., 1998).
A preferred expression system for an AON for redirecting splicing according to the invention is an adenovirus associated virus (AAV)-based vector. Single chain and double chain AAV-based vectors have been developed that can be used for prolonged expression of antisense nucleotide sequences for highly efficient redirection of splicing. A preferred AAV-based vector, for instance, comprises an expression cassette that is driven by an RNA polymerase III-promoter (Pol III) or an RNA polymerase II promoter (Pol II). A preferred RNA promoter is, for example, a Pol III U6 RNA promoter, or a Pol II U7 RNA promoter.
The invention accordingly provides for a viral-based vector, comprising a Pol II or a Pol III promoter driven expression cassette for expression of an AON for redirecting splicing according to the invention.
An AAV vector according to the invention is a recombinant AAV vector and refers to an AAV vector comprising part of an AAV genome comprising an encoded AON for redirecting splicing according to the invention encapsidated in a protein shell of capsid protein derived from an AAV serotype as depicted elsewhere herein. Part of an AAV genome may contain the inverted terminal repeats (ITR) derived from an adeno-associated virus serotype, such as AAV1, AAV2, AAV3, AAV4, AAV5, AAV8, AAV9 and others. A protein shell comprised of capsid protein may be derived from an AAV serotype such as AAV1, 2, 3, 4, 5, 8, 9 and others. A protein shell may also be named a capsid protein shell. AAV vector may have one or preferably all wild type AAV genes deleted, but may still comprise functional ITR nucleic acid sequences. Functional ITR sequences are necessary for the replication, rescue and packaging of AAV virions. The ITR sequences may be wild type sequences or may have at least 80%, 85%, 90%, 95, or 100% sequence identity with wild type sequences or may be altered by for example in insertion, mutation, deletion or substitution of nucleotides, as long as they remain functional. In this context, functionality refers to the ability to direct packaging of the genome into the capsid shell and then allow for expression in the host cell to be infected or target cell. In the context of the invention a capsid protein shell may be of a different serotype than the AAV vector genome ITR. An AAV vector according to present the invention may thus be composed of a capsid protein shell, i.e. the icosahedral capsid, which comprises capsid proteins (VP1, VP2, and/or VP3) of one AAV serotype, e.g. AAV serotype 2, whereas the ITRs sequences contained in that AAV5 vector may be any of the AAV serotypes described above, including an AAV2 vector. An “AAV2 vector” thus comprises a capsid protein shell of AAV serotype 2, while e.g. an “AAV5 vector” comprises a capsid protein shell of AAV serotype 5, whereby either may encapsidate any AAV vector genome ITR according to the invention.
Preferably, a recombinant AAV vector according to the invention comprises a capsid protein shell of AAV serotype 2, 5, 8 or AAV serotype 9 wherein the AAV genome or ITRs present in said AAV vector are derived from AAV serotype 2, 5, 8 or AAV serotype 9; such AAV vector is referred to as an AAV2/2, AAV 2/5, AAV2/8, AAV2/9, AAV5/2, AAV5/5, AAV5/8, AAV 5/9, AAV8/2, AAV 8/5, AAV8/8, AAV8/9, AAV9/2, AAV9/5, AAV9/8, or an AAV9/9 vector.
More preferably, a recombinant AAV vector according to the invention comprises a capsid protein shell of AAV serotype 2 and the AAV genome or ITRs present in said vector are derived from AAV serotype 5; such vector is referred to as an AAV 2/5 vector.
More preferably, a recombinant AAV vector according to the invention comprises a capsid protein shell of AAV serotype 2 and the AAV genome or ITRs present in said vector are derived from AAV serotype 8; such vector is referred to as an AAV 2/8 vector.
More preferably, a recombinant AAV vector according to the invention comprises a capsid protein shell of AAV serotype 2 and the AAV genome or ITRs present in said vector are derived from AAV serotype 9; such vector is referred to as an AAV 2/9 vector.
More preferably, a recombinant AAV vector according to the invention comprises a capsid protein shell of AAV serotype 2 and the AAV genome or ITRs present in said vector are derived from AAV serotype 2; such vector is referred to as an AAV 2/2 vector.
A nucleic acid molecule encoding an AON for redirecting splicing according to the invention represented by a nucleic acid sequence of choice is preferably inserted between the AAV genome or ITR sequences as identified above, for example an expression construct comprising an expression regulatory element operably linked to a coding sequence and a 3′ termination sequence. “AAV helper functions” generally refers to the corresponding AAV functions required for AAV replication and packaging supplied to the AAV vector in trans. AAV helper functions complement the AAV functions which are missing in the AAV vector, but they lack AAV ITRs (which are provided by the AAV vector genome). AAV helper functions include the two major ORFs of AAV, namely the rep coding region and the cap coding region or functional substantially identical sequences thereof. Rep and Cap regions are well known in the art, see e.g. (Chiorini et al., 1999) or U.S. Pat. No. 5,139,941, incorporated herein by reference. The AAV helper functions can be supplied on an AAV helper construct, which may be a plasmid. Introduction of the helper construct into the host cell can occur e.g. by transformation, transfection, or transduction prior to or concurrently with the introduction of the AAV genome present in the AAV vector as identified herein. The AAV helper constructs according to the invention may thus be chosen such that they produce the desired combination of serotypes for the AAV vector's capsid protein shell on the one hand and for the AAV genome present in said AAV vector replication and packaging on the other hand.
“AAV helper virus” provides additional functions required for AAV replication and packaging. Suitable AAV helper viruses include adenoviruses, herpes simplex viruses (such as HSV types 1 and 2) and vaccinia viruses. The additional functions provided by the helper virus can also be introduced into the host cell via vectors, as described in U.S. Pat. No. 6,531,456 incorporated herein by reference.
Preferably, an AAV genome as present in a recombinant AAV vector according to the invention does not comprise any nucleotide sequences encoding viral proteins, such as the rep (replication) or cap (capsid) genes of AAV. An AAV genome may further comprise a marker or reporter gene, such as a gene for example encoding an antibiotic resistance gene, a fluorescent protein (e.g. gfp) or a gene encoding a chemically, enzymatically or otherwise detectable and/or selectable product (e.g. lacZ, aph, etc.) known in the art.
Preferably, an AAV vector according to the invention is constructed and produced according to the method according to Garanto et al., 2016 which is herein incorporated by reference.
A preferred AAV vector according to the invention is an AAV vector, preferably an AAV2/5, AAV2/8, AAV2/9 or AAV2/2 vector, expressing an AON for redirecting splicing according to the invention that is an AON that comprises, or preferably consists of, a sequence that is:
complementary or substantially complementary to a nucleotide sequence consisting of SEQ ID NO:4, preferably the molecule is complementary to a polynucleotide with SEQ ID NO:5, more preferably the molecule is complementary to a polynucleotide with SEQ ID NO:6;

more preferably complementary or substantially complementary to a polynucleotide with a nucleotide sequence selected from the group consisting of SEQ ID NO: 17, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 20, and SEQ ID NO: 21.

Improvements in means for providing an individual or a cell, tissue, organ of said individual with an AON for redirecting splicing according to the invention, are anticipated considering the progress that has already thus far been achieved. Such future improvements may of course be incorporated to achieve the mentioned effect on restructuring of mRNA using a method according to the invention. An AON for redirecting splicing according to the invention can be delivered as such as a ‘naked’ AON to an individual, a cell, tissue or organ of said individual. When administering an AON for redirecting splicing according to the invention, it is preferred that the molecule is dissolved in a solution that is compatible with the delivery method. Retina cells can be provided with a plasmid for antisense oligonucleotide expression by providing the plasmid in an aqueous solution.
Alternatively, a preferred delivery method for an AON for redirecting splicing or a plasmid for expression of such AON is a viral vector or are nanoparticles. Preferably, viral vectors or nanoparticles are delivered to retina or other relevant cells. Such delivery to retina cells or other relevant cells may be in vivo, in vitro or ex vivo; see e.g. Garanto et al, 2016, which is herein incorporated by reference.
Alternatively, a plasmid can be provided by transfection using known transfection agents. For intravenous, subcutaneous, intramuscular, intrathecal and/or intraventricular administration it is preferred that the solution is a physiological salt solution. Particularly preferred in the invention is the use of an excipient or transfection agents that will aid in delivery of each of the constituents as defined herein to a cell and/or into a cell, preferably a retina cell. Preferred are excipients or transfection agents capable of forming complexes, nanoparticles, micelles, vesicles and/or liposomes that deliver each constituent as defined herein, complexed or trapped in a vesicle or liposome through a cell membrane. Many of these excipients are known in the art. Suitable excipients or transfection agentia comprise polyethylenimine (PEI; ExGen500 (MBI Fermentas)), LipofectAMINETM 2000 (Invitrogen) or derivatives thereof, or similar cationic polymers, including polypropyleneimine or polyethylenimine copolymers (PECs) and derivatives, synthetic amphiphils (SAINT-18), LipofectinTM, DOTAP and/or viral capsid proteins that are capable of self-assembly into particles that can deliver each constitutent as defined herein to a cell, preferably a retina cell. Such excipients have been shown to efficiently deliver an oligonucleotide such as AONs to a wide variety of cultured cells, including retina cells. Their high transfection potential is combined with an excepted low to moderate toxicity in terms of overall cell survival. The ease of structural modification can be used to allow further modifications and the analysis of their further (in vivo) nucleic acid transfer characteristics and toxicity.
Lipofectin represents an example of a liposomal transfection agent. It consists of two lipid components, a cationic lipid N-[1-(2,3 dioleoyloxy)propyl]-N, N, N-trimethylammonium chloride (DOTMA) (cp. DOTAP which is the methylsulfate salt) and a neutral lipid dioleoylphosphatidylethanolamine (DOPE). The neutral component mediates the intracellular release. Another group of delivery systems are polymeric nanoparticles.
Polycations such as diethylaminoethylaminoethyl (DEAE)-dextran, which are well known as DNA transfection reagent can be combined with butylcyanoacrylate (PBCA) and hexylcyanoacrylate (PHCA) to formulate cationic nanoparticles that can deliver each constituent as defined herein, preferably an AON according to the invention, across cell membranes into cells.
In addition to these common nanoparticle materials, the cationic peptide protamine offers an alternative approach to formulate an oligonucleotide with colloids. This colloidal nanoparticle system can form so called proticles, which can be prepared by a simple self-assembly process to package and mediate intracellular release of an oligonucleotide. The skilled person may select and adapt any of the above or other commercially available alternative excipients and delivery systems to package and deliver an exon retention molecule for use in the current invention to deliver it for the prevention, treatment or delay of ABCA4-related disease or condition. “Prevention, treatment or delay of an ABCA4-related disease or condition” is herein preferably defined as preventing, halting, ceasing the progression of, or reversing partial or complete visual impairment or blindness that is caused by a genetic defect in the ABCA4 gene.
In addition, an AON for redirecting splicing according to the invention could be covalently or non-covalently linked to a targeting ligand specifically designed to facilitate the uptake into the cell, cytoplasm and/or its nucleus. Such ligand could comprise (i) a compound (including but not limited to peptide(-like) structures) recognizing cell, tissue or organ specific elements facilitating cellular uptake and/or (ii) a chemical compound able to facilitate the uptake in to cells and/or the intracellular release of an oligonucleotide from vesicles, e.g. endosomes or lysosomes.
Therefore, in a preferred embodiment, an AON for redirecting splicing according to the invention is formulated in a composition or a medicament or a composition, which is provided with at least an excipient and/or a targeting ligand for delivery and/or a delivery device thereof to a cell and/or enhancing its intracellular delivery.
It is to be understood that if a composition comprises an additional constituent such as an adjunct compound as later defined herein, each constituent of the composition may not be suitably formulated in one single combination or composition or preparation. Depending on their identity and specific features, the skilled person will know which type of formulation is the most appropriate for each constituent as defined herein. In a preferred embodiment, the invention provides a composition or a preparation which is in the form of a kit of parts comprising an AON for redirecting splicing according to the invention and a further adjunct compound as later defined herein.
If required and/or if desired, an AON for redirecting splicing according to the invention or a vector, preferably a viral vector, according to the invention, expressing an AON for redirecting splicing according to the invention can be incorporated into a pharmaceutically active mixture by adding a pharmaceutically acceptable carrier.
Accordingly, the invention also provides for a composition, preferably a pharmaceutical composition, comprising an AON for redirecting splicing according to the invention, or a viral vector according to the invention and a pharmaceutically acceptable excipient. Such composition may comprise a single AON for redirecting splicing or viral vector according to the invention, but may also comprise multiple, distinct AONs for redirecting splicing or viral vectors according to the invention. Such a pharmaceutical composition may comprise any pharmaceutically acceptable excipient, including a carrier, filler, preservative, adjuvant, solubilizer and/or diluent. Such pharmaceutically acceptable carrier, filler, preservative, adjuvant, solubilizer and/or diluent may for instance be found in Remington, 2000. Each feature of said composition has earlier been defined herein.
A preferred route of administration is through intra-vitreal injection of an aqueous solution or specially adapted formulation for intraocular administration. [claim 10] EP2425 814 discloses an oil in water emulsion especially adapted for intraocular (intravitreal) administration of peptide or nucleic acid drugs. This emulsion is less dense than the vitreous fluid, so that the emulsion floats on top of the vitreous, avoiding that the injected drug impairs vision.
If multiple distinct AONs for redirecting splicing according to the invention are used, the concentration or dose defined herein may refer to the total concentration or dose of all oligonucleotides used or the concentration or dose of each exon rentention molecule used or added. Therefore, in an embodiment, there is provided a composition wherein each or the total amount of AONs for redirecting splicing according to the invention used is dosed in an amount ranged from 0.01 and 20 mg/kg, preferably from 0.05 and 20 mg/kg per eye. A suitable intravitreal dose is provided and comprises between 0.05 mg and 5 mg, preferably between 0.1 and 1 mg of total exon 28 retention molecule per eye, such as about per eye: 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9 or 1.0 mg.
A preferred AON for redirecting splicing according to the invention, is for the treatment of an ABCA4-related disease or condition of an individual. In all embodiments of the invention, the term “treatment” is understood to include the prevention and/or delay of the ABCA4-related disease or condition. An individual, which may be treated using an AON for redirecting splicing according to the invention may already have been diagnosed as having an ABCA4-related disease or condition. Alternatively, an individual which may be treated using an AON for redirecting splicing according to the invention may not have yet been diagnosed as having a ABCA4-related disease or condition but may be an individual having an increased risk of developing a ABCA4-related disease or condition in the future given his or her genetic background. A preferred individual is a human being. In all embodiments of the invention, the ABCA4-related disease or condition preferably is Stargardt disease.
Accordingly, the invention further provides for an AON for redirecting splicing according to the invention, or a viral vector according to the invention, or a (pharmaceutical) composition according to the invention for use as a medicament, preferably as a medicament for the treatment of an ABCA4-related disease or condition requiring modulating splicing of ABCA4 and for use as a medicament for the prevention, treatment or delay of an ABCA4-related disease or condition. Each feature of all medical use embodiment herein has earlier been defined herein and is preferably such feature as earlier defined herein.
The invention further provides for the use of an AON for redirecting splicing according to the invention, a vector according to the invention or a (pharmaceutical) composition according to the invention for treating an ABCA4-related disease or condition requiring modulating splicing of ABCA4. Each feature of all medical use embodiment herein has earlier been defined herein and is preferably such feature as earlier defined herein.
The invention further provides for, a method of treatment of an ABCA4-related disease or condition requiring modulating splicing of ABCA4, comprising said method comprising contacting a cell of said individual with an AON for redirecting splicing according to the invention, a vector according to the invention or a (pharmaceutical) composition according to the invention. Each feature of all medical use embodiment herein has earlier been defined herein and is preferably such feature as earlier defined herein.
The invention further provides for the use of an AON for redirecting splicing according to the invention, a vector according to the invention or a (pharmaceutical) composition according to the invention for the preparation of a medicament for the treatment of an ABCA4-related disease or condition requiring modulating splicing of ABCA4. Each feature of all medical use embodiment herein has earlier been defined herein and is preferably such feature as earlier defined herein.
The invention further provides for the use of an AON for redirecting splicing according to the invention, a vector according to the invention or a (pharmaceutical) composition according to the invention for the preparation of a medicament. Each feature of all medical use embodiment herein has earlier been defined herein and is preferably such feature as earlier defined herein.
The invention further provides for the use of an AON for redirecting splicing according to the invention, a vector according to the invention or a (pharmaceutical) composition according to the invention or a method of treatment according to the invention wherein the ABCA4-related disease or condition is Stargardt disease.
Treatment in a use or in a method according to the invention is preferably at least once, and preferably lasts at least one week, one month, several months, one year, 2, 3, 4, 5, 6 years or longer, such as life-long. Each AON for redirecting splicing according to the invention or equivalent thereof as defined herein for use according to the invention may be suitable for direct administration to a cell, tissue and/or an organ in vivo of individuals already affected or at risk of developing an ABCA4-related disease or condition, and may be administered directly in vivo, ex vivo or in vitro. The frequency of administration of an AON, composition, compound or adjunct compound according to the invention may depend on several parameters such as the severity of the disease, the age of the patient, the mutation of the patient, the number of AON for redirecting splicing according to the invention (i.e. dose), the formulation of the AON, composition, compound or adjunct compound according to the invention, the route of administration and so forth. The frequency of administration may vary between daily, weekly, at least once in two weeks, or three weeks or four weeks or five weeks or a longer time period.
Dose ranges of an AON, composition, compound or adjunct compound according to the invention are preferably designed on the basis of rising dose studies in clinical trials (in vivo use) for which rigorous protocol requirements exist. An AON according to the invention may be used at a dose which is ranged from 0.01 and 20 mg/kg, preferably from 0.05 and 20 mg/kg. A suitable intravitreal dose would be between 0.05 mg and 5 mg, preferably between 0.1 and 1 mg per eye, such as about per eye: 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9 or 1.0 mg.
In a preferred embodiment, a concentration of an oligonucleotide as defined herein, which is ranged from 0.1 nM and 1 μM is used. Preferably, this range is for in vitro use in a cellular model such as retina cells or retinal tissue. More preferably, the concentration used is ranged from 1 to 400 nM, even more preferably from 10 to 200 nM, even more preferably from 50 to 100 nM. If multiple distinct AONs are used, this concentration or dose may refer to the total concentration or dose of the AONs or the concentration or the dose of each AON added.
In a preferred embodiment, a viral vector, preferably an AAV vector as described earlier herein, as delivery vehicle for a molecule according to the invention, is administered in a dose ranging from 1×109-1×1017 virus particles per injection, more preferably from 1×1010-1×1012 virus particles per injection.
The ranges of concentration or dose of AONs as depicted above are preferred concentrations or doses for in vivo, in vitro or ex vivo uses. The skilled person will understand that depending on the AONs used, the target cell to be treated, the gene target and its expression levels, the medium used and the transfection and incubation conditions, the concentration or dose of AONs used may further vary and may need to be optimized any further.
An AON for redirecting splicing according to the invention, or a viral vector according to the invention, or a composition according to the invention for use according to the invention may be administered to a cell, tissue and/or an organ in vivo of individuals already affected or at risk of developing a ABCA4-related disease or condition, and may be administered in vivo, ex vivo or in vitro. An AON for redirecting splicing according to the invention, or a viral vector according to the invention, or a composition according to the invention may be directly or indirectly administered to a cell, tissue and/or an organ in vivo of an individual already affected by or at risk of developing a ABCA4-related disease or condition, and may be administered directly or indirectly in vivo, ex vivo or in vitro. As Stargardt disease has a pronounced phenotype in retina cells, it is preferred that said targeted cells are retina cells, it is further preferred that said tissue is the retina and it is further preferred that said organ comprises or consists of the eye.
The invention further provides for a method for modulating splicing of ABCA4 in a cell comprising contacting the cell, preferably a retina cell, with an AON for redirecting splicing according to the invention, or a viral vector according to the invention, or a (pharmaceutical) composition according to the invention. The features of this aspect are preferably those defined earlier herein. Contacting the cell with an AON for redirecting splicing according to the invention, or a viral vector according to the invention, or a composition according to the invention may be performed by any method known by the person skilled in the art. Use of the methods for delivery of AONs for redirecting splicing, viral vectors and compositions as described earlier herein is included. Contacting may be directly or indirectly and may be in vivo, ex vivo or in vitro.
Unless otherwise indicated each embodiment as described herein may be combined with another embodiment as described herein.
Definitions
In this document and in its claims, the verb “to comprise” and its conjugations is used in its non-limiting sense to mean that items following the word are included, but items not specifically mentioned are not excluded. In addition, reference to an element by the indefinite article “a” or “an” does not exclude the possibility that more than one of the element is present, unless the context clearly requires that there be one and only one of the elements. The indefinite article “a” or “an” thus usually means “at least one”.
The word “about” or “approximately” when used in association with a numerical value (e.g. about 10) preferably means that the value may be the given value (of 10) more or less 5% of the value. The sequence information as provided herein should not be so narrowly construed as to require inclusion of erroneously identified bases. The skilled person is capable of identifying such erroneously identified bases and knows how to correct for such errors. In case of sequence errors, the sequence of the polypeptide obtainable by expression of the gene present in SEQ ID NO: 1 containing the nucleic acid sequence coding for the polypeptide should prevail.
All patent and literature references cited in the present specification are hereby incorporated by reference in their entirety.



DESCRIPTION OF THE FIGURES
FIG. 1: Schematic representation of the location of the c.4253+43G>A variant and the designed AONs.
FIG. 2: RT-PCR analysis of AONs in WT and MUT midigenes in HEK293T cells transfected with Wild-type (WT) or c.4253+43G>A mutant (MUD constructs. Sense oligonucleotide (SON) was used as a control.
FIG. 3: Semi-quantification of the transcripts identified by RT-PCR. All ABCA4 transcripts detected in the gel were semi-quantified using FIJI software.
FIG. 4: RT-PCR analysis using control and patient-derived photoreceptor progenitor cells (PPCs).



DESCRIPTION OF THE SEQUENCES











SEQ ID NO:
Name
















1
Genomic DNA sequence ABCA4


2
mRNA sequence ABCA4


3
ABCA4 Protein sequence


4
Exon 28 sequence (starting at the last 100 bp of



intron 26 to the first 100 bp of intron 29)


5
Target region in exon 28 (±75 bp)


6
Target region in exon 28


7
AON1 target + 10


8
AON1 target + 5


9
AON2 target + 10


10
AON2 target + 5


11
AON3 target + 10


12
AON3 target + 5


13
AON4 target + 10


14
AON4 target + 5


15
AON5 target + 10


16
AON5 target + 5


17
AON1


18
AON2


19
AON3


20
AON4


21
AON5


22
pCI-Neo-Rho-ABCA4-26-29


23
pCI-Neo-Rho-ABCA4-26-29 c.4243 + 43G > A


24
ABCA4_ex26_Fw PCR primer


25
ABCA4_ex29_Rv PCR primer


26
RHO_Fw PCR primer


27
RHO_Rv PCR primer


28
ACTB_Fw PCR primer


29
ACTB_Rv PCR primer


30
ABCA4_ex31 PCR primer









EXAMPLES
We have assessed the in vitro efficacy of a number of AONs to redirect splicing of ABCA4 in cells. For this we used midigene constructs, i.e. plasmids that harbour the sequence of a part of the ABCA4 gene, usually the region of interest with or without the mutation, and flanked by at least 100 bp of wild-type ABCA4 sequence on each side. In addition to the midigene assays, we also used photoreceptor precursor cells (PPCs) from a patient with compound heterozygous ABCA4 mutations and heterozygously carrying the c.4253+43G>A mutation to assess the nature of the splice defect associated with this mutation.
Example 1
AON Assessment Using Midigene Construct
Generation of Midigene Splice Constructs
A midigene was created including part of the 26 intron, the complete exon 28, and part of exon 29.
This genomic region was cloned into a pCI-Neo-Rhodopsin vector using the Gateway System. The resulting vector (coined pCI-Neo-Rho-ABCA4-26-29 wild-type, SEQ ID NO:22) was used to introduce the c. c.4243+43G>A mutation by site-directed mutagenesis (new vector was coined pCI-Neo-Rho-ABCA4-26-29 c.4243+43G>A SEQ ID NO:23). The control and mutated vectors were validated by Sanger sequencing. The minigenes were then transfected in HEK293T cells, which were harvested 48 h post-transfection and were subjected to RT-PCR analysis in order to detect the splicing defect. Subsequently, these midigene constructs can be transfected in eukaryotic immortalized cells (such as Human Embryonic Kidney cells HEK293T, which were used in this study), and the splice pattern can be studied via RT-PCR analysis. If the mutant construct shows an aberrant splicing pattern, co-transfection of midigenes together with AONs allows to determine the efficacy of the AONs to redirect splicing.
Design Antisense Oligonucleotides
The transfection of midigene pCI-Neo-Rho-ABCA4-26-29 c.4243+43G>A in HEK293T cells showed the skipping of exon 28, which is predicted to result in premature termination of ABCA4 protein synthesis and thus reduced expression of ABCA4 protein levels. Using the sequence of exon 28, several AONs were designed.
AON Assessment
HEK293T cells were transfected with either the wild-type (WT) or c.4253+43G>A mutant (MUD midigene construct. Twenty-four hours later, transfected cells were subdivided in wells to decrease transfection variability. AON was delivered at a final concentration of 0.5 uM. Forty-eight hours post-AON-transfection, cells were harvested and subjected to RNA analysis by RT-PCR. For the RT-PCR, total RNA was isolated by using the NucleoSpin RNA Clean-up Kit (catalog no., 740955-50; Macherey-Nagel, Duren, Germany) according to the manufacturers protocol. RNA was quantified and cDNA was synthesized from 1 μg RNA by using the iScript cDNA synthesis kit (catalog no., 1708891; Bio-Rad, Hercules, Calif.) following the manufacturers instructions.
In the RT-PCR ABCA4 was amplified from exon 26 to 29 using the primers represented by SEQ ID NOs: 24 and 25. RHO was included as transfection control and ACTB as loading control (primers used SEQ ID NOs:26-29). SON (sense oligonucleotide) was used as a control. All tested AONs were capable of redirecting splicing (FIG. 2).
Example 2
Semi-Quantification of the Transcripts Identified by RT-PCR
Following RT-PCR analysis of all replicates, the ratio of the bands was semi-quantified using Fiji software. Briefly, the intensity and area of all the bands in each lane were measured. Each of these bands represents a different transcript, and all transcripts together represent the 100% ABCA4 transcripts present in the sample. Subsequently, the measurement of each band was used to calculate the percentage of each transcript. Percentages are represented in FIG. 3.
Example 3
Generation of Photoreceptor Precursor Cells
Skin biopsies of a patient carrying the c.4253+43G>A in a heterozygous manner in a heterozygous were obtained and fibroblast cell lines were generated. Subsequently, induced pluripotent stem cells (iPSCs) were reprogrammed and differentiated to photoreceptor precursor cells (PPCs), as described previously (Sangermano et al., 2016). Differentiated cells were subjected to RT-PCR analysis.
RT-PCR Analysis Using Control and Patient-Derived PPCs
Total RNA was isolated from iPSC-derived PPCs using the NucleoSpin RNA Clean-up Kit (catalog no., 740955-50; Macherey-Nagel, Duren, Germany) according to the manufacturers protocol. One microgram was employed for cDNA synthesis using the SuperScriptTM VILOTM Master Mix (catalog no., 11755050; ThermoFisher Scientific, Waltham, Mass., USA) following the manufacturer's instructions. In the RT-PCR, ABCA4 was amplified from exon 26 to 31 using the primers represented by SEQ ID NOs: 24 and 30.
RT-PCR using patient-derived differentiated cells to PPCs in the presence (+CHX) or absence (−CHX) of cycloheximide (an inhibitor of the nonsense-mediated decay, NMD), showed an increase on skipping of exon 28 (delta28). In addition, skipping of exon 28 and 29 was found in all samples, including human retina (hRET), suggesting that this is a naturally occurring event. The skipping of exon 28 was especially visible after CHX treatment, indicating that the transcript is subjected to NMD degradation (FIG. 4).
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## Claims

1. An ABCA4 exon 28 retention molecule that binds to and/or is complementary to a polynucleotide with SEQ ID NO:5, wherein the ABCA4 exon 28 retention molecule comprises a 2′-O alkyl phosphorothioate antisense oligonucleotide.

2. The ABCA4 exon 28 retention molecule according to claim 1, wherein the molecule is a nucleic acid molecule.

3. The ABCA4 exon 28 retention molecule according to claim 2, wherein the nucleic acid molecule comprises or consists of an antisense oligonucleotide that is complementary to the polynucleotide, wherein the antisense oligonucleotide has a length of 8 to 100 nucleotides.

4. The ABCA4 exon 28 retention molecule according to claim 3, wherein the antisense oligonucleotide has a length of 10 to 40 nucleotides.

5. The ABCA4 exon 28 retention molecule according to claim 3, wherein the antisense oligonucleotide has a length 12 to 30 nucleotides.

6. The ABCA4 exon 28 retention molecule according to claim 3, wherein the antisense oligonucleotide has a length of 20 to 24 nucleotides.

7. The ABCA4 exon 28 retention molecule according to claim 3, wherein the antisense oligonucleotide comprises or consists of a sequence selected from the group consisting of SEQ ID NO: 17, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 20, and SEQ ID NO: 21.

8. The ABCA4 exon 28 retention molecule according to claim 4 wherein the antisense oligonucleotide comprises or consist of SEQ ID NO:19.

9. A set of ABCA4 exon 28 retention molecules comprising at least two ABCA4 exon 28 retention molecules as defined in claim 1.

10. The set of ABCA4 exon 28 retention molecules according to claim 9, wherein the set comprises or consists of at least two antisense oligonucleotides selected from the group consisting of SEQ ID NO: 17, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 20, and SEQ ID NO: 21.

11. A viral vector expressing an ABCA4 exon 28 retention molecule that binds to and/or is complementary to a polynucleotide with SEQ ID NO:5 when placed under conditions conducive to expression of the molecule.

12. A pharmaceutical composition comprising an ABCA4 exon 28 retention molecule according to claim 1 and a pharmaceutically acceptable excipient.

13. A method for modulating splicing of ABCA4 in a cell, said method comprising contacting said cell with an ABCA4 exon 28 retention molecule as defined claim 1.

14. The method according to claim 13, wherein the method is for treating an ABCA4-related disease or condition.

15. The ABCA4 exon 28 retention molecule according to claim 1, wherein the ABCA4 exon 28 retention molecule is complementary to a polynucleotide with SEQ ID NO:6.

16. The ABCA4 exon 28 retention molecule according to claim 1, wherein the 2′-O alkyl phosphorothioate antisense oligonucleotide is selected from the group consisting of a 2′-O-methyl modified ribose (RNA), 2′-O-ethyl modified ribose, 2′-O-propyl modified ribose, and substituted derivatives of these modifications.

17. The method according to claim 13, wherein the ABCA4-related disease or condition is Stargardt disease.

18. The method according to claim 13, wherein the pharmaceutical composition is administered by intravitreal administration in an amount ranged from 0.05 mg and 5 mg of total exon 28 retention molecule per eye.

19. The method according to claim 13, wherein the pharmaceutical composition is for intravitreal administration and is dosed in an amount ranged from 0.1 and 1 mg of total antisense oligonucleotides for redirecting splicing per eye.