METHODS AND COMPOUNDS FOR THE GENETIC TREATMENT OF HYPERLIPIDEMIA

Abstract: The present invention concerns the introduction of specific alterations in the genes that encode three apolipoproteins, Apo A1, Apo B and Apo E. The alternations in Apo A1 introduce a cysteine residue so the disulfide cross-linked Apo A1 homodimers and Apo A1/A2 heterodimers can be formed. The alterations in Apo B introduce stop codons or frame shift mutations that cause the production of a truncated Apo B protein. The alterations in Apo E introduce specific point mutations that have been identified as protective. The production in the liver of a subject of these altered proteins reduces the risk of the subjects developing atherosclerosis. In one embodiment the genetic alterations are introduced by use of chimeric, mixed RNA/DNA, duplex oligonucleotides.

Description: METHODS AND COMPOUNDS FOR THE GENETIC TREATMENT OF HYPERUPIDEMIA This application claims benefit of the priority of application Serial No. 60/074,497, filed February 12, 1998 and application Serial No. 09/108,006 filed June 30, 1998. 1. FIELD OF THE INVENTION The invention concerns methods and compositions for the use of recombinagenic oligonucleobases in vivo for the correction of disease causing genetic defects and the prevention of disease by introducing genetic modifications into the genes that encode Apolipoprotein B (Apo B), Apolipoprotein E (Apo E) and Apolipoprotein A1 (Apo A1). 2. BACKGROUND TO THE INVENTION 2.1 THE USE OF CHIMERIC MUTATIONAL VECTORS TO EFFECT GENETIC CHANGES IN CULTURED CELLS The inclusion of a publication or patent application in this specification is not an admission that the publication or the invention, if any, of the application occurred prior to the present invention or resulted from the conception of a person other than the present inventors. The published examples of recombinagenic oligonucleobases are termed Chimeric Mutational Vectors (CMV) or chimeraplasts because they contain both 2'-0-modified ribonucleotides and deoxyribonucleotides. An oligonucleotide having complementary deoxyribonucleotides and ribonucleotides and containing a sequence homologous to a fragment of the bacteriophage M13mp19, was described in Kmiec, E.B., et al., November 1994, Mol. and Cell. Biol. 14, 7163-7172. The oligonucleotide had a single contiguous segment of ribonucleotides. Kmiec et al. showed that the oligonucleotide was a substrate for the REC2 homologous pairing enzyme from Ustilago maydis. Patent publication WO 95/15972, published June 15, 1995, and counterpart U.S. Patent No. 5,565,350 (the '350 patent) described duplex CMV for the introduction of genetic changes in eukaryotic cells. Examples in a Ustilago maydis gene and in the murine ras gene were reported. The latter example was designed to introduce a transforming mutation into the ras gene so that the successful mutation of the ras gene in NIH 3T3 cells would cause the growth in soft agar of a colony of cells ("transformation"). The '350 patent reported that the maximum rate of transformation of NIH 3T3 was less than 0.1 %, i.e., about 100 transformants per 10 6 cells exposed to the ras duplex CMV. In the Ustilago maydis system, the rate of transformants was about 600 per 10°. A chimeric vector designed to introduce a mutation into a human bcl-2 gene was described in Kmiec, E.B., February 1996, Seminars in Oncology 23, 188. A duplex CMV designed to repair the mutation in codon 12 of K-ras was described in Kmiec, E.B., December 1995, Advanced Drug Delivery Reviews 17, 333-40. The duplex CMV was tested in Capan 2, a cell line derived from a human pancreatic adenocarcinoma, using LIPOFECTIN™ to introduce the duplex CMV into the Capan 2 cells. Twenty four hours after the duplex CMV was introduced, the cells were harvested and genomic DNA was extracted; a fragment containing codon 12 of K-ras was amplified by PCR and the rate of conversion estimated by hybridization with allele specific probes. The rate of repair was reported to be approximately 18%. A duplex CMV designed to repair a mutation in the gene encoding liver/bone/kidney type alkaline phosphatase was reported in Yoon, K., et al., March 1996, Proc. Natl. Acad. Sci. 93, 2071. The alkaline phosphatase gene was transiently introduced into CHO cells by a plasmid. Six hours later the duplex CMV was introduced. The plasmid was recovered at 24 hours after introduction of the duplex CMV and analyzed. The results showed that approximately 30 to 38% of the alkaline phosphatase genes were repaired by the duplex CMV. WO 97/4141 1 and counterpart United States Patent No. 5,760,012 to E.B. Kmiec, A. Cole-Strauss and K. Yoon, and the publication Cole-Strauss, A., et al., September 1996, SCIENCE 273, 1386 disclose duplex CMV that are used in the treatment of genetic diseases of hematopoietic cells, e.g., Sickle Cell Disease, Thalassemia and Gaucher Disease. United States Patent Application Serial No. 08/664,487, filed June 17, 1996, by E.B. Kmiec describes duplex CMV having non-natural nucleotides for use in specific, site-directed mutagenesis. The duplex CMV described in the applications and certain of the publications of Kmiec and his colleagues contain a central segment of DNA:DNA homoduplex and flanking segments of RNA:DNA hybrid-duplex or 2'-OMe- RNA:DNA hybrid-duplex. The work of Kmiec and his colleagues concerned cells that are mitotically active, i.e., proliferating cells, at the time they are exposed to CMV. Kmiec and colleagues used a CMV/liposomal macromolecular carrier complex in which the CMV were mixed with a pre-formed liposome or lipid vesicle. In such a complex the CMV are believed to adhere to the surface of the liposome. Kren et al., June 1997, Hepatology 25, 1462-1468, reported the successful use of a CMV in non-replicating, primary tissue-cultured rat hepatocytes to mutate the coagulation factor IX gene. Kren et al., March 1998, Nature Medicine 4, 285 reported the use of a CMV in vivo to introduce a genetic defect in the same gene. 2.2 THE USE OF A POLYETHYLENIMINE MACROMOLECULAR CARRIER FOR IN VIVO AND IN VITRO TRANSFECTION Branched chain polyethylenimine has been used as a carrier to introduce nucleic acids into eukaryotic cells both in vivo and in vitro. Boussif, O., et al., 1995, Proc. Natl. Acad. Sci. 92, 7297; Abdallah, B. et al., 1996, Human Gene Therapy 7, 1947. Boletta, A., et al., 1997, 8, 1243-1251. The in vitro use of galactosylated polyethylenimine to introduce DNA into cultured HepG2 hepatocarcinoma cell lines is reported by Zanta, et al., October 1 , 1997, Bioconjugate Chemistry 8, 839-844. The coupling of a protein ligand, transferrin, to polyethylenimine and its use to introduce a test gene into cultured cells by use of the transferrin receptor is described in Kircheis, R., et al., 1997, Gene Therapy 4, 409-4-18. Branched chain polyethylenimines contain secondary and tertiary amino groups having a broad range of pK's and, consequently these polyethylenimines have a substantial buffering capacity at a pH where polylysine has little or no capacity, i.e., less than about 8. Tang, M.K., & Szoka, F.C., 1997, Gene Therapy 4, 823-832. The use of branched chain polyalkanylimines, including polyethylenimine as carriers for the introduction of nucleic acids into cells is described in WO 96/02655 to J-P. Behr et al. The successful in vivo and in vitro use of linear polyethylenimine to transfect a gene is reported by Ferrari, S., et al., 1997, Gene Therapy 4, 1 100-1 106. Compositions comprising a linear polyalkanylimine and a nucleic acid as disclosed in patent publication WO 93/20090 to S. Stein et al. 2.3 THE USE OF A LIPOSOMAL CARRIER FOR IN VIVO TRANSFECTION The use of liposomes or lipid vesicles to introduce DNA encoding a foreign protein into cells has been described. The most frequently used techniques adhere the DNA to the surface of a positively charged liposome, rather than encapsulating the DNA, although encapsulated DNA techniques were known. United States Patent Nos. 4,235,871 and 4,394,448 are relevant. The field is reviewed by Smith, J.G., et al., 1993, Biochim. Biophy. Acta 1154, 327-340 and Staubinger, R.M., et al., 1987, Methods in Enzymology 185, 512. The use of DOTAP, a cationic lipid in a liposome to transfect hepatic cells in vivo is described in Fabrega, A.J., et al., 1996, Transplantation 62, 1866- 1871. The use of cationic lipid-containing liposomes to transfect a variety of cells of adult mice is described in Zhu, N., et al., 1993, Science 261, 209. The use of phosphatidylserine containing lipids to form DNA encapsulating liposomes for transfection is described in Fraley, R., et al., 1981 , Biochemistry 20, 6978-87. 2.4 THE USE OF THE ASIALOGLYCOPROTEIN RECEPTOR FOR HEPATOCELLULAR SPECIFIC TRANSFECTION United States Patent Nos. 5,166,320 and 5,635,383 disclose the transfection of hepatocytes by forming a complex of a DNA, a polycationic macromolecular carrier and a ligand for the asialoglycoprotein receptor. In one embodiment, the macromolecular carrier was polylysine. The use of a lactosylcerebroside containing liposome to transfect a hepatocyte in vivo is described by Nandi, P.K., et al., 1986, J. Biol. Chem. 261, 16722- 16722. The use of asialofetuin-labeled liposomes to transfect liver cells with a reporter plasmid is described in Hara et al., 1995, Gene Therapy 2, 764-788. The use of galactosylated poyethyleneimine to transfect cultured hepatocytes is described in Zanta M-A., et al. abst. pub. Oct. 1 , 1997, Bioconjugate Chem., 8, 839-844. 2.5 APO B100, APO B48 AND THE REDUCTION OF SERUM LDL Hepatic and Intestinal Lipoprotein Secretion: Both the liver and the intestines make and export lipoproteins for the transport of lipids. The lipoproteins are termed very low density lipoproteins (VLDL) and chylomicrons, respectively. VLDL and chylomicrons differ in size and in their major protein components. The major protein of VLDL is Apo B100, consisting of 4536 amino acids; the major protein of chylomicrons is Apo B48, which consists of the N-terminal 2152 amino acids of Apo B100. Apo B48 and Apo B100 are encoded by a single gene, the transcript of which is modified at nucleotide 6666 (codon 2179) by a sequence specific cytidine deaminase, termed apolipoprotein B mRNA editing enzyme (APOBE). The action of this enzyme converts a C to U and results in a stop codon. Both VLDL, which contain Apo B100, and chylomicrons, which contain Apo B48 transport triglycerides in the vascular system to a delivery site. However, after triglyceride hydrolysis and delivery VLDL are transformed into LDL, while chylomicrons are not. High levels of circulating LDL per se and a high LDL:HDL ratio increase the risk of arterial atherosclerosis. Hence, it has been suggested that increasing the ratio of Apo B48 to Apo B100 would have a beneficial effect. In many species of mammals, e.g., rats and mice, a high percentage of the lipid secretions of both liver and intestine contain Apo B48. Such species have markedly lower ratios of LDL:HDL. Greve J., et al., 1995, Proc. Zool. Soc, Calcutta, 47, 93-100. In others, such as humans and rabbits, hepatocytes lack APOBE and the hepatocytes consequently produce only VLDL. One strategy to reduce the atherosclerosis in humans has been to introduce the gene for the catalytic component of the apolipoprotein B editing enzyme (APOBEC-1 ) under the control of a constitutive promoter to convert Apo B100 transcripts into Apo B48 transcripts. The transient expression of APOBEC-1 in the hepatocytes of normal and genetically hyperlipidemic Watanabe rabbit does cause a transient reduction in the levels of LDL. Greeve, J., et al., 1996, J. Lipid Res. 37, 2001-17. However, the uncontrolled production of APOBEC-1 is mutagenic and may cause hepatocellular hyperplasia and hepatocellular carcinoma. Yamanaka, S., et al., 1995, Proc. Natl. Acad. Sci. 92, 8483- Individuals who are homozygous or mixed heterozygotes for genes encoding truncated Apo B100 have been observed. Malloy et al., 1981 , J. Clin. Invest. 67, 1441 ; Hardman, D.A., et al., 1991 , j. Clin. Invest. 88, 1 722. These individuals have low or absent LDL. For example, deletion of nucleotides 5391-5394 results in a frame shift mutation and a shortened Apo B (B37). These patients are most often asymptomatic. Steinberg, D., et al., 1979, J. Clin. Invest. 64, 292; Young, S.G., et al., 1988, Science 241, 591 ; Young, S.G., 1987, J. Clin. Invest. 79, 1831. Reviewed Linton, M.F., 1993, J. Lipid. Res. 34, 521 ; Kane, J. P. & Havel, R.J., 1995, Chapt. 57, THE METABOLIC BASIS OF INHERITED DISEASE, ed. Scriver et al. (McGraw Hill, New York). Similarly, as many as 1 in every 3,000 persons has a serum cholesterol level of 100 mg dl or less because the individual is heterozygous for a truncated Apo B gene. Ibid., p. 1866. Truncations that result in an Apo B that are shorter than Apo B 31 do not circulate. Truncated Apo B 86, 87 and 90 have been observed. Apo B 86 and Apo B 87, are not associated with LDL while Apo B 90 is. Each mutation is associated with hypobetalipoproteinemia. Linton, M.L., et al., 1990, Clin. Res. 38, 286A (abstr.); Tennyson, G.E., et al., 1990, Clin. Res. 38, 482A (abstr.); Kruhl, E.S., et al., 1989, Arteriosclerosis 9, 856. 2.6 APO E POLYMORPHISM AND TYPE III HYPERLIPIDEMIA Apolipoprotein E is the major ligand for the LDL receptor for lipoproteins that contain Apo B48. There are three allelic forms of human Apo E that differ from each other by one or two amino acids: Apo E2 (Cys 1 12 Cys 158 ); Apo E3 (Cys 1 12 Arg 158 ); and Apo E4 (Arg 1 12 Arg 158 ). There is considerable geographical variation in the prevalences of the alleles. Excluding Africa, E2 ranges between 4% and 12 %, E3 between 70% and 85% and E4 between 7.5 and 25%. In the Sudan, the prevalences are 8.1 %, 61.9% and 29.1 %, respectively. Mahley, R.W. & Rail, S.C. r., 1995, Chapt. 61 , THE METABOLIC BASIS OF INHERITED DISEASE, ed. Scriver et al. (McGraw Hill, New York). Thus approximately 1 % of the North American and European population are Apo E 2/2 homozygotes. Of these homozygotes approximately between 2% and 10% display type III hyperlipidemia. Paradoxically, however, Apo E 2/2 homozygotes that have not developed overt Type III hyperlipidemia display lower than average LDL associated cholesterol. Davignon, J., 1988, Arteriosclerosis 8, 1. The E4 allele is also associated with increased incidence of a major disease, Alzheimer's Disease, and with increased risk of coronary artery disease. Roses, A.D., 1996, Ann. NY Acad. Sci. 802, 50-57; Okumoto, K., & Fujiki, Y., 1997, Nature Genetics 17, 263; Kuusi, T., et al., 1989, Arteriosclerosis 9, 237. A polymorphism in the region 491 nt 5' to the transcription start site of the Apo E gene is also an independently associated with increased risk of Alzheimer's disease. Individuals homozygous for the - 491-A genotype have an increased risk of Alzheimer's, while individuals homozygous or heterozygous for the -491 T genotype have no increased risk. Bullido, M.J., 1998, et al., Nature Genetics 18, 69-71. The E2 allele in most individuals is associated with the lowest levels of serum cholesterol and LDL. However, about 5% of E2/E2 homozygous persons who are subject to environmental or genetic stress develop type III hyperlipidemia. The most common stressors are hypothyroidism, untreated diabetes mellitus, alcoholism and marked weight gain. Removal of the stressor usually results in control of the hyperlipidemia. Rare patients with type III hyperlipidemia have mutant Apo E genes. Mahley & Rail, ibid. Table 61-5. 2.7 APO A1 AND HDL High density lipoproteins (HDL) transport cholesterol and phospholipids from peripheral extraheptatic locations to the liver. In particular, HDL are believed to remove lipid deposits from vascular endothelial cells and that the observed negative correlation between the levels of HDL-cholesterol (HDL-C) and coronary artery disease is due to this function. Eisenberg, S., 1984, J. Lipid Research 25, 1017; Gordon, D.J., et al., 1986, Circulation 74, 121 7. HDL are secreted by the liver and intestines as nacent HDL particles containing four molecules of apo A1 , which is a 243 amino acid protein. The nascent HDL physically attract free cholesterol from cell membranes and/or other lipoproteins. The resulting particle contains apo A1 , phospholipid, and cholesterol. Such particles are substrates for lecithin:cholesterol acyltransferase (LCAT), which esterifies the free cholesterol to cholesterol esters. The presence of the more hydrophobic cholesterol esters transforms the nascent HDL initially to a more stable mature HDL3 and subsequently HDL3 particle. Cholesterol ester transfer protein removes the esterified cholesterol from the HDL3 and HDL2 particles and transfers them into LDL and thence into hepatocytes through the LDL receptors. Two mutations of apo A1 have been discovered wherein the levels of HDL are depressed. The mutations are missense mutations that replace an arginine with a cysteine amino acid. Weisgraber, K.H., et al., 1983 . Biol. Chem. 258, 2508 (apo A1 milano (Arg-Cys) 173 ); Bruckert, E., et al., 1997, Atherosclerosis 128, 121 (apo A1 R151 C (Arg-Cys) 151 ). The mutation is dominant, i.e., HDL levels are depressed in affected individuals who are heterozygous for the mutation. An explanation for this is that the mutant apo A1 proteins form cystine linked heterodimers with wild apo A2 molecules, which are a minor apolipoprotein found in HDL, as well as homodimers. Surprising even though the lipid profile, i.e., low HDL and elevated triglycerides, is one that ordinarily is associated with accelerated atherosclerosis, the mutations are not associated with atherosclerosis, but, rather, are believed to be protective of atheroscelerosis. The mechanism of protection is not established. A large (N = 33) retrospective epidemologic study of apo A1 milano carriers shows that there is a low incidence of coronary artery disease in these individuals, however, the significance of this fact must be viewed in the context of similar low incidence among non-affected residents of the village Limone sul Garda. Gualandri, V., et al., 1985, Am. J. Hum.Gen. 37, 1083. In vitro studies indicate that the mutant apo A1 is not more effective in recruiting plasma membrane cholesterol. Bielicki, J.K., et al., 1997, Arterioscler Thromb Vase Biol 17, 1637 There is direct evidence that the administration of exogenous apo A1 milano, but not wild type apo A1 , in the form of a complex with phospholipids, is protective in an accepted model system of atherosclerosis. Ameli, S. et al., 1994, Circulation 90, 1935; Shah, P.K., et al., 1998, Circulation 97, 780. 3. SUMMARY OF THE INVENTION The present invention concerns methods of treatment and/or prophylaxis which consists of the introduction of specific genetic alterations in genes of a subject individual. In one embodiment, the specific genetic alteration blocks the synthesis of Apo B100 and thereby reduces the level of LDL cholesterol. In an alternative embodiment, the specific alteration converts an Apo E4 allele to an Apo E3 or Apo E2 allele, which is associated with decreased risk of atherosclerosis and Alzheimer's Disease. In further alternative embodiments, the invention concerns the correction of inherited genetic defects in the genes of hepatocytes of individuals having a disease caused by such defects. The present invention further comprises a method of treating and/or preventing atherosclerosis by causing mutations in the genes encoding apo A1 and compounds that are useful for the introduction of such mutations. The mutations useful for the practice of the invention are mutations that insert a cysteine residue that forms a cystine and results in the formation of homodimers and apo A2-containing heterodimers. The embodiments of the invention can be practiced using any oligonucleotide or analog or derivative thereof, now known or hereafter developed, that can cause specific genetic alterations in the genome of the hepatocytes of the subject individual (hereafter a "recombinagenic oligonucleobase"), for example a chimeric mutational vector (CMV) as, for example, described in United States patent No. 5,565,350, No. 5,731 ,181 , and No. 5,760,012. Alternatively, the recombinagenic oligonucleobase can be a heteroduplex mutational vector or a non-chimeric mutational vector as described in U.S. patent application No. 09/078,063 and No. 09/078,064, filed May 12, 1998, each of which are hereby incorporated by reference. In a preferred embodiment the recombinagenic oligonucleobase is complexed with a macromolecular carrier to which is attached a specific ligand. The ligand is selected to bind to a cell-surface receptor that is internalized into hepatocytes through clathrin-coated pits into endosomes. The cell surface receptors that bind such ligands are termed herein "clathrin-coated pit receptors". Examples of hepatic clathrin-coated pit receptors include the low density lipoprotein (LDL) receptor and the asialoglycoprotein receptor. In specific embodiments the macromolecular carrier can be 1 ) an aqueous-cored lipid vesicle of between 25 nm and 400 nm diameter, wherein the aqueous core contains the CMV; 2) a lipid nanosphere of between 25 nm and 400 nm diameter, having a lipid core, wherein the lipid core contains a lipophilic salt of the CMV; or 3) a polycationic salt of the CMV. Examples of polycations for such salts include polyethylenimine, polylysine and histone H 1. In one embodiment the polycation is a linear polyethylenimine (PEI) salt having a mass average molecular weight greater than 500 daltons and less than 1 .3 Md. Alternatively the polycation can be a branched-chain polyethylenimine. 4. BRIEF DESCRIPTION OF THE FIGURE Figure 1 is a schematic of one embodiment of CMV useful in the invention. Figures 2A-2C show the genomic sequence of human APO E gene with translation of exons. Introns are in lower case and exons are in upper case. Figure 3A-3G shows the sequence of the human APO A1 gene (SEQ ID No. 59) 5. DEFINITIONS The invention is to be understood in accordance with the following definitions. An oligonucleobase is a polymer of nucleobases, which polymer can hybridize by Watson-Crick base pairing to a DNA having the complementary sequence. Nucleobases comprise a base, which is a purine, pyrimidine, or a derivative or analog thereof. Nucleobases include peptide nucleobases. the subunits of peptide nucleic acids, and morpholine nucleobases as well as nucleosides and nucleotides. Nucleosides are nucleobases that contain a pentosefuranosyl moiety, e.g., an optionally substituted riboside or 2'-deoxyriboside. Nucleosides can be linked by one of several linkage moieties, which may or may not contain a phosphorus. Nucleosides that are linked by unsubstituted phosphodiester linkages are termed nucleotides. An oligonucleobase chain has a single 5' and 3' terminus, which are the ultimate nucleobases of the polymer. A particular oligonucleobase chain can contain nucleobases of all types. An oligonucleobase compound is a compound comprising one or more oligonucleobase chains that are complementary and hybridized by Watson-Crick base pairing. Nucleobases are either deoxyribo-type or ribo-type. Ribo-tvpe nucleobases are 10 pentosefuranosyl containing nucleobases wherein the 2' carbon is a methylene substituted with a hydroxyl, alkyloxy or halogen. Deoxyribo-type nucleobases are nucleobases other than ribo-type nucleobases and include all nucleobases that do not contain a pentosefuranosyl moiety. An oligonucleobase strand generically includes both oligonucleobase chains and segments or regions of oligonucleobase chains. An oligonucleobase strand has a 3' end and a 5' end. When a oligonucleobase strand is coextensive with a chain, the 3' and 5' ends of the strand are also 3' and 5 1 termini of the chain. A region is a portion of an oligonucleobase, the sequence of which is derived from some particular source, e.g., a CMV having a region of at least 15 nucleotides having the sequence of a fragment of the human β-globin gene. A segment is a portion of a CMV having some characteristic structural feature. A given segment or a given region can contain both 2'-deoxynucleotides and ribonucleotides. However, a ribo-tvpe segment or a 2'-deoxyribo-type segment contain only ribo-type and 2 '-deoxyribo-type nucleobases, respectively. 6. DETAILED DESCRIPTION OF THE INVENTION 6.1 THE STRUCTURE OF THE CHIMERIC MUTATIONAL VECTOR The Chimeric Mutational Vectors (CMV) are comprised of oligonucleobases, i.e., polymers of nucleobases, which polymers form Watson-Crick base pairs of purines and pyrimidines (hybridize), to DNA having the appropriate sequence. Each CMV is divided into a first and a second strand of at least 15 nucleobases each that are complementary to each other. The strands can be, but need not be, covalently linked. Nucleobases contain a base, which is either a purine or a pyrimidine or analog or derivative thereof. There are two types of nucleobases. Ribo-type nucleobases are ribonucleosides having a 2'- hydroxyl, substituted 2'-hydroxyl or 2'-halo-substituted ribose. All nucleobases other than ribo-type nucleobases are deoxyribo-type nucleobases. Thus, deoxy-type nucleobases include peptide nucleobases. As used herein, only a recombinagenic oligonucleobase that contains at least three contiguous ribo-type nucleobases that are hybridized to deoxyribo-type nucleobases are considered CMV. 1 1 The sequence of the first and second strands consists of at least two regions that are homologous to the target gene, i.e., have the same sequence as fragments of the target gene, and one or more regions (the "mutator regions") that differ from the target gene and introduce the genetic change into the target gene. The mutator region is located between homologous regions. In certain embodiments of the invention, each of the flanking homologous regions contains a ribo-type segment of at least three ribo-type nucleobases, that form a hybrid duplex, preferably at least six ribo-type nucleobases and more preferably at least ten ribo-type nucleobases in length, but not more than 25 and preferably not more than 20, more preferably not more than 15 ribo-type nucleobases. The hybrid-duplex-forming ribo-type oligonucleobase segments need not be adjacent to the mutator region. In certain embodiments of the invention the ribo-type oligonucleobase segments are separated from the mutator region by a portion of the homologous region comprising deoxyribo-type nucleobases. In these embodiments the mutator region is also composed of deoxyribo-type nucleobases. Accordingly, the mutator region and a portion of one or both homologous regions form an intervening segment of homo-duplex, which separates the two segments of hybrid-duplex. The total length of all homologous regions is preferably at least 16 nucleobases and is more preferably from about 20 nucleobases to about 60 nucleobases in length. Preferably, the mutator region consists of 20 or fewer bases, more preferably 6 or fewer bases and most preferably 3 or fewer bases. The mutator region can be of a length different than the length of the sequence that separates the regions of the target gene homology with the homologous regions of the CMV so that an insertion or deletion of the target gene results. When the CMV is used to introduce a deletion in the target gene there is no base identifiable as within the mutator region. Rather, the mutation is effected by the juxtaposition of the two homologous regions that are separated in the target gene. For the purposes of the invention, the length of the mutator region of a CMV that introduces a deletion in the target gene is deemed to be the length of the deletion. In one embodiment the mutator region is a deletion of from 6 to 1 bases or more preferably from 3 to 1 bases. Multiple separated mutations can be introduced by a single CMV, in which case there are multiple mutator regions in the same CMV. Alternatively multiple CMV can be used simultaneously to introduce multiple genetic changes in a single gene 12 or, alternatively to introduce genetic changes in multiple genes of the same cell. Herein the mutator region is also termed the heterologous region. In one embodiment the CMV is a single oligonucleobase chain of between 40 and 100 nucleobases. In an alternative embodiment, the CMV comprises a first and a second oligonucleobase chain, each of between 20 and 100 bases; wherein the first chain comprises the first strand and the second chain comprises the second strand. The first and second chains can be linked covalently by other than nucleobases or, alternatively, can be associated only by Watson-Crick base pairings. In an alternative embodiment the CMV is a first strand which is a single oligonucleobase chain and a second strand, complementary to the first which consists of two oligonucleobase chains, which are linked to the first strand chain by linkers. The combined length of the two chains of the second strand is the length of the first strand. Linkers: Covalent linkage of the first and second strands can be made by oligo- alkanediols such as polyethyleneglycol, poly-1 ,3-propanediol or poly-1 ,4-butanediol. The length of various linkers suitable for connecting two hybridized nucleic acid strands is understood by those skilled in the art. A polyethylene glycol linker having from six to three ethylene units and terminal phosphoryl moieties is suitable. Durand, M. et al., 1990, Nucleic Acid Research 18, 6353; Ma, M. Y-X., et al., 1993, Nucleic Acids Res. 21, 2585-2589. A preferred alternative linker is bis-phosphorylpropyl-trans-4,4'- stilbenedicarboxamide. Letsinger, R.L., et alia, 1994, J. Am. Chem. Soc. 116, 81 1-812; Letsinger, R.L. et alia, 1995 . Am. Chem. Soc. 117, 7323-7328, which are hereby incorporated by reference. Such linkers can be inserted into the CMV using conventional solid phase synthesis. Alternatively, the strands of the CMV can be separately synthesized and then hybridized and the interstrand linkage formed using a thiophoryl-containing stilbenedicarboxamide as described in patent publication WO 97/05284, February 13, 1997, to Letsinger R.L. et alia. In a further alternative embodiment the linker can be a single strand oligonucleobase comprised of nuclease resistant nucleobases, e.g., a 2'-0-methyl, 2'-0- allyl or 2'-F-ribonucleotides. The tetranucleotide sequences I I I I , UUUU and UUCG and the trinucleotide sequences I I I , UUU, or UCG are particularly preferred nucleotide linkers. 13 Nucleotides: In an alternative embodiment the invention can be practiced using CMV comprising deoxynucleotides or deoxynucleosides and 2'-0 substituted ribonucleotides or ribonucleosides. Suitable substituents include the substituents taught by the Kmiec Application, Cx. 6 alkane. Alternative substituents include the substituents taught by U.S. Patent No. 5,334,71 1 (Sproat) and the substituents taught by patent publications EP 629 387 and EP 679657 (collectively, the Martin Applications), which are hereby incorporated by reference. As used herein a 2' fluoro, chloro or bromo derivative of a ribonucleotide or a ribonucleotide having a substituted 2'-0 as described in the Martin Applications or Sproat is termed a "2 '-Substituted Ribonucleotide." Particular preferred embodiments of 2 '-Substituted Ribonucleotides are 2'-fluoro, 2'-methoxy, 2'-propyloxy, 2'-allyloxy, 2 '-hydroxy lethyloxy, 2'-methoxyethyloxy, 2'-fluoropropyloxy and 2'- trifluoropropyloxy substituted ribonucleotides. In more preferred embodiments the 2'- Substituted Ribonucleotides are 2'-fluoro, 2'-methoxy, 2'-methoxyethyloxy, and 2'- allyloxy substituted nucleotides. 2'-Substituted Ribonucleosides are defined analogously. Particular preferred embodiments of 2'-Substituted Ribonucleosides are 2'-fluoro, 2'-methoxy, 2'-propyloxy, 2'-allyloxy, 2 '-hydroxy lethyloxy, 2'-methoxyethyloxy, 2'-fluoropropyloxy and 2'- trifluoropropyloxy substituted ribonucleotides. In more preferred embodiment on the 2'- Substituted Ribonucleosides are 2'-fluoro, 2'-methoxy, 2'-methoxyethyloxy, and 2'- allyloxy substituted nucleotides. The term "nuclease resistant ribonucleoside" encompasses 2'-Substituted Ribonucleosides, including 2 '-Substituted Ribonucleotides and also all 2'-hydroxyl ribonucleosides other than ribonucleotides. In a preferred embodiment , the CMV preferably includes at least three and more preferably six nuclease resistant ribonucleosides. In one preferred embodiment the CMV contains no nuclease sensitive ribonucleosides. In an alternative preferred embodiment, every other ribonucleoside is nuclease resistant. Certain 2'-blocking groups can be more readily synthesized for purines or pyrimidines. In one embodiment of the CMV only the ribonucleoside purines or only the ribonucleoside pyrimdines are nuclease resistant. Recombinagenic oligonucleobases, including non-chimeric mutational oligonucleobases and improved CMV and their use in eukaryotic cells and cell-free 14 systems are described in U.S. patent applications Serial No. 09/078,063, filed May 12, 1998, and Serial No. 09/078,064, filed May 12, 1998, which are each hereby incorporated in their entirety. These mutational oligonucleobases can be used in the same manner as the CMV described in this application. 6.2 THE GENE-SPECIFIC STRUCTURE OF THE CHIMERIC MUTATIONAL VECTOR Figure 1 shows a diagram of a CMV according to one embodiment of the invention. In the Figure segments "a" and "c-e" are target gene specific segments of the CMV. The sequence of segment "a" and "c-e" are complements of each other. The sequence of segments "f" and "h" are also complements of each other but are unrelated to the specific target gene and are selected merely to ensure the stability of hybridization in order to protect the 3' and 5' ends. Additional protection of the 3' and 5' ends can be accomplished by making the 5' and 3' most internucleotide bonds a phosphorothioate, phosphonate or any other nuclease resistant bond. The sequence of segments "f" and "h" can be 5'-GCGCG-3' or permutations thereof. Segments "g" and "b" can be any linker that covalently connects the two strands, e.g., four unpaired nucleotides or an alkoxy oligomer such as polyethylene glycol. When segments "g" and "b" are composed of other than nucleobases, then segments "a", "c-f" and "h" are each an oligonucleobase chain. The ribo-type nucleobase segments are segments "c" and "e," which form hybrid- duplexes by Watson-Crick base pairing to the complementary portions of segment "a." The segment "a" can have the sequence of either the coding or non-coding strand of the gene. Table I contains SEQ ID No. 4 - No. 21 and Table III contains SEQ ID No. 22-25 and 54-58, which are examples of the sequences that can be used to practice the invention. The mutator region in each case is underlined and in bold. CMV having a segment "a" with a sequence selected from the sequences of Table I can be used to practice the invention. Alternatively, segment "a" may have the sequence of the complement of a sequence of Table I. As used herein, a CMV or other type of recombinagenic oligonucleobase comprises a sequence if either strand of the CMV or recombinagenic oligonucleobase comprises the sequence or comprises a sequence containing ribo-type nucleobases with uracil bases replacing thymine bases. Thus, for 1 5 example, a CMV having the sequence 5'-agucuggaugGGTAAgccgcccuca-3' (SEQ ID No. 26) is considered to have the sequence of SEQ ID No: 4, wherein the lower case letters denote ribo-type nucleobases and the UPPER CASE letters denote deoxyribo-type nucleobases. Subjects can be treated with a recombinagenic oligonucleobase specific for Apo B or Apo E according to the guidance of the Factor IX example below. More particularly the recombinagenic oligonucleobase can be given in divided doses at intervals that permit determining of the phenotypic effect of the dose, i.e., evaluation of the extent of the decline in LDL cholesterol and observation for adverse reactions. A reduction of the subject's fasting LDL serum cholesterol to below the level of the 5th percentile of the age- matched population (80-90 mg/dl) can be used as a therapeutic end point; alternatively reduction of fasting LDL serum cholesterol to below the average age-matched normal value (100-140) can be used. The number and size of the dose(s) can be modified to control the extent of the phenotypic effects. In the event that reversal of the specific genetic changes appear desirable, a recombinagenic oligonucleobase having a sequence appropriate to reverse the specific changes can be administered so that the fraction of unmodified Apo B or Apo E genes can be increased. Modification of the dose size and number and the administration of a reversing recombinagenic oligonucleobase permits the adjustment of the number of altered genes in the subject so that a predetermined amount of the phenotypic change can be effected. 6.2.1 Specific Alterations of the Apo B Gene SEQ ID No. 1 contains the Apo B amino acid sequence and SEQ ID No. 2 contains the Apo B cDNA sequence. The level of serum cholesterol and particularly of LDL-associated cholesterol can be reduced in a subject by introducing mutations into the subject's hepatic Apo B genes. The mutation can be any mutation that causes termination of the Apo B translation product between amino acid 1433 (Apo B 31 ) and amino acid 3974 (Apo B 87). (The amino acid numbering for Apo B in this specification refers to the 4553 amino acid primary translation product, i.e., mature Apo B100 plus the 27 amino acid leader sequence. Mature Apo B 100 consists of 4536 amino acids and mature Apo B 48 consists 16 of 2152 amino acids.) Preferably the translation product is terminated between amino acids 1841 (Apo B 40) and 2975 (Apo 65). The translation product can be terminated by introducing a frameshift mutation, i.e., by adding or deleting one or two nucleotides from the gene, or by introducing a stop codon (a TAA, TAG or TGA). The preferred stop codon is TAA. To monitor the introduction of the mutation it is preferred to have the mutation introduce or remove a palindromic sequence, which is the substrate of a restriction enzyme. The sequence of the CMV is selected to have two homologous regions of at least 10 nucleobases and preferably at least 12 nucleobases each with a fragment of the Apo B gene located between nucleotides encoding amino acid 1433 (nt 4425) and 3974 (nt 12,048) and preferably located between the nucleotides encoding amino acids 1841 (nt 5649) and 2975 (nt 9051 ). In this specification, nt 6666 is the first nucleotide of codon 2180, the nucleotide that is converted by APOBE. In a preferred embodiment, the two homologous regions are separated by a single nucleobase in the sequence of the Apo B gene, where the CMV introduces a base substitution in the Apo B gene. Alternatively, the two homology regions can be adjacent in the Apo B gene and separated by a single or double nucleobase in the CMV, such that a one or two base insertion results from the action of the CMV on the Apo B gene. Alternatively, the homologous regions can be separated in the Apo B gene by one or two nucleotides that are deleted from the sequence of the CMV, such that the action of the CMV results in a one or two base deletion in the gene. Nucleotides 4425-12,048 of the Apo B cDNA are encoded by exon 26 (nt 4342- 1 1913), exon 27 (nt 1 1914 - 12028) and exon 28 (nt 12029-12212); see Table I, and GENBANK Accession No. 19828, which is hereby incorporated by reference. When an alteration is to be made at a position 3' of nt 1 1913, attention must be paid to the exon/intron boundary. Mutations that are located within 10-15 nucleotides of the exon/intron boundary must be identified so that the homology region of the CMV continues with the sequence of the intron and not the exon. The homologous regions can be each from 10 to about 15 nucleobases in length; the two regions need not be of the same length. The fraction of nucleobases that contain a guanine or cytosine base is a design consideration (the GC fraction). It is preferred that 17 when the homologous region contains 12 or fewer nucleobases, the GC fraction be at least 33% and preferably at least 50%. When the GC fraction is less than 337o the length of the homologous regions is preferably 13, 14 or 15 nucleobases. Table I contains 18 exemplary embodiments, SEQ ID No. 4-21 and Table III contains 9 exemplary embodiments, SEQ ID No. 22-25 and 54-58, of CMV sufficient for the practice of the embodiments of the invention described in this section. Suitable CMV can be made using nt 3-23 of SEQ ID No. 4-10, 12, and 16-20. SEQ ID NO. 1 1 and 13-15 have a lower GC fraction; CMV sufficient for the practice of the invention can be made containing residues 3-25 of SEQ ID NO. 1 1 and 13-15. 6.2.2 Specific Alterations of the Apo E Gene In a further embodiment, the invention consists of introducing specific alterations to the Apo E gene. E4 homozygous individuals are at increased risk for atherosclerosis, particularly coronary artery disease, and Alzheimer's disease. Therefore, one embodiment of the present invention is the introduction of the substitution Arg→Cys at residues 1 12, to convert an E4 allele to an E3 allele, and optionally at residue 158 to convert an E3 or E4 allele into an E2 allele of an Apo E gene of an hepatocyte of a subject. The substitutions can be introduced using an oligonucleobase containing the sequence of nt 3-23 of SEQ ID No. 22 and No. 23 or complement thereof and more preferably of an oligonucleobase containing SEQ ID No. 22 and No. 23 or complement thereof. In addition, in individuals lacking genetic or environment stressors, the E2 allele results in a lowered LDL level and a decreased risk of atherosclerosis and coronary artery disease. Thus, these risks in an E3/E3 individual can be reduced by introduction of the (Arg→Cys) 158 substitution to convert the individual Apo E genes to E2 alleles. Apo E2/E2 homozygous individuals who are suffering from Type III hyperlipidemia can be treated by converting E2 alleles to E3 alleles by making a Cys→Arg 158 substitution. Such a substitution can be made using an oligonucleobase containing the sequence of nt 3-23 of SEQ ID No. 24 or complement thereof and more preferably of an oligonucleobase containing SEQ ID No. 24 or complement thereof. Independent of the Apo E allele, individuals who are homozygous for -491-A are at increased risk to develop Alzheimer's Disease. Bullido, M.J., 1998, et al., Nature 18 Genetics 18, 69-71. These individuals can be advantageously treated with an oligonucleobase containing the sequence of nt 3-23 of SEQ ID No. 25. 6.2.3 Repair of Mutations of the Apo B and Apo E Gene SEQ ID No. 3 contains the Apo E genomic DNA sequence. A further embodiment of the invention concerns the use of CMV to repair mutations in the Apo B and Apo E genes that cause hypobetalipoproteinemia and dysbetaiiproteinemia, respectively. Mutations that are located within 10-15 nucleotides of the exon/intron boundary must be identified so that the homology region of the CMV continues with the sequence of the intron and not the exon. The genomic sequence of Apo E4 indicating the exon and intron boundaries is given in Paik et al., 1985, Proc. Natl. Acad. Sci. 82, 3445, which is hereby incorporated by reference. The exon/intron boundaries of the Apo B gene are given in Table II along with the GENBANK accession numbers for the genomic sequence of Apo B. 6.2.4 Specific Alterations of the Apo A1 Gene Apo A1 is a 243 amino acid protein. Amino acids 99-230 are encoded by six tandem duplications of a 66 base pair prototype sequence. The duplications are between 80 7o and 64 % homologous to the consensus sequence. Without limitation as to theory the conformation of amino acids 120 to 230 is believed to be helical. The sequence of the amino acids is such that the helix is amphipathic, i.e., the helix has a hydrophobic face and a hydrophilic face, which contains polar amino acids. The mutations most suitable for the practice of the invention are substitutions of polar amino acids by cysteine. Particularly suitable mutations are at arginine residues that are located next to other polar amino acids because the arginine codon used in apo A1 (CGC) can be converted into a TGC cysteine codon by a single base change. Thus, particularly suitable sites for mutations according to the present invention are arginine 149, 151 , 153, 171 and 173. 19 6.3 FORMULATIONS SUITABLE FOR IN VIVO USE The prior art formulations of CMV and a macromolecular carrier are of limited utility for in vivo use because of their low capacity for CMV and because the CMV is not protected from extracellular enzymes. The invention provides three alternative macromolecular carriers that overcome the limitations of the prior art. The carriers are polyethylenimine (PEI), aqueous-cored lipid vesicles, which are also termed unilamellar liposomes and lipid nanospheres. Each of the carriers can be further provided with a ligand that is complementary to a cell-surface protein of the target cell. Such ligands are useful to increase both the amount and specificity of the uptake of CMV into the targeted cell. In one embodiment of the invention the target cell is a hepatocyte and the ligand is a galactose saccharide or lactose disaccharide that binds to the asialoglycoprotein receptor. 6.3.1 Polycationic Carriers The invention can be practiced using any polycation that is non-toxic when administered to cells in vitro or to subjects in vivo. Suitable examples include polybasic amino acids such as polylysine, polyarginine, basic proteins such as histone H1 , and synthetic polymers such as the branched-chain polyethylenimine: (-NHCH 2 CH 2 -) X [-N(CH 2 CH 2 NH 2 )CH 2 CH 2 -] Y . The invention can be practiced with any branched chain polyethylenimine (PEI) having an average molecular weight of greater than about 500 daltons, preferably greater than between about 10 Kd and more preferably about 25 Kd (mass average molecular weight determined by light scattering) The upper limit of suitability is determined by the toxicity and solubility of the PEI. Toxicity and insolubility of molecular weights greater than about 1.3 Md makes such PEI material less suitable. The use of high molecular weight PEI as a carrier to transfect a cell with DNA is described in Boussif, O. et al., 1995, Proc. Natl. Acad. Sci. 92, 7297, which is hereby incorporated by reference. PEI solutions can be prepared according to the procedure of Boussif et al. The CMV carrier complex is formed by mixing an aqueous solution of CMV and a neutral aqueous solution of PEI at a ratio of between 9 and 4 PEI nitrogens per CMV phosphate. In a preferred embodiment the ratio is 6. The complex can be formed, for 20 example, by mixing a 10 mM solution of PEI, at pH 7.0 in 0.15 M NaCl with CMV to form a final CMV concentration of between 100 and 500 nM. In addition a ligand for a clathrin-coated pit receptor can be attached to the polycation or to a fraction of the polycations. In one embodiment the ligand is a saccharide or disaccharide that binds to the asialoglycoprotein receptor, such as lactose, galactose, or N-acetylgalactosamine. Any technique can be used to attach the ligands. The optimal ratio of ligand to polyethylene subunit can be determined by fluorescently labeling the CMV and injecting fluorescent CMV/molecular carrier/I igand complexes directly into the tissue of interest and determining the extent of fluorescent uptake according to the method of Kren et al., 1997, Hepatology 25, 1462-1468. Good results can be obtained using a 1 :1 mixture of lactosylated PEI having a ratio of 0.4-0.8 lactosyl moieties per nitrogen and unmodified PEI. The mixture is used in a ratio of between 4 and 9 PEI nitrogens per CMV phosphate. A preferred ratio of oligonucleotide phosphate to nitrogen is 1 :6. Good results can be obtained with PEIs having a mass average molecular weight of 25 Kd and 800 Kd which are commercially available from Aldrich Chemical Co., Catalog No. 40,872-7 and 18,197-8, respectively. Linear PEI such as that described in Ferrarri, S., et al., 1997, Gene Therapy 4, 1 100-1 106 and sold under the trademark EXGEN 500™ is particularly suitable for the practice of the invention because of its lower toxicity compared to branched-chain PEI. In an alternative embodiment the polycationic carrier can be a basic protein such as histone H 1 , which can be substituted with a ligand for a clathrin-coated pit receptor. A 1 : 1 (w/w) mixture of histone and CMV can be used to practice the invention. 6.3.2 l ipids that Are Useful in Carriers The selection of lipids for incorporation into the lipid vesicle and lipid nanosphere carriers of the invention is not critical. Lipid nanospheres can be constructed using semi- purified lipid biological preparations, e.g., soybean oil (Sigma Chem. Co.) and egg phosphatidyl choline (EPC) (Avanti Polar Lipids). Other lipids that are useful in the preparation of lipid nanospheres and/or lipid vesicles include neutral lipids, e.g., dioleoyi phosphatidylcholine (DOPC), and dioleoyi phosphatidyl ethanolamine (DOPE), anionic lipids, e.g., dioleoyi phosphatidyl serine (DOPS) and cationic lipids, e.g., dioleoyi 21 trimethyl ammonium propane (DOTAP), dioctadecyldiamidoglycyl spermine (DOGS), dioleoyi trimethyl ammonium (DOTMA) and DOSPER (1 ,3-di-oleoyloxy-2-(6-carboxy- spermyD-propyl-amide tetraacetate, commercially available from Boehringer-Mannheim). Additional examples of lipids that can be used in the invention can be found in Gao, X. and Huany, L., 1995, Gene Therapy 2, 710. Saccharide ligands can be added in the form of saccharide cerebrosides, e.g., lactosylcerebroside or galactocerebroside (Avanti Polar Lipids). The particular choice of lipid is not critical. Hydrogenated EPC or lysolecithin can be used in place of EPC. DPPC (dipalmitoyl phosphatidylcholine), can be incorporated to improve the efficacy and/or stability of the delivery system. 6.3.3 The Construction of Lipid Nanosphere Carriers Lipid nanospheres can be constructed by the following process. A methanol or chloroform methanol solution of phospholipids is added to a small test tube and the solvent removed by a nitrogen stream to leave a lipid film. A lipophilic salt of CMV is formed by mixing an aqueous saline solution of CMV with an ethanolic solution of a cationic lipid. Good results can be obtained when the cationic species are in about a 4 fold molar excess relative to the CMV anions (phosphates). The lipophilic CMV salt solution is added to the lipid film, vortexed gently followed by the addition of an amount of neutral lipid equal in weight to the phospholipids. The concentration of CMV can be up to about 37o (w/w) of the total amount of lipid. After addition of the neutral lipid, the emulsion is sonicated at 4°C for about 1 hour until the formation of a milky suspension with no obvious signs of separation. The suspension is extruded through polycarbonate filters until a final diameter of about 50 nm is achieved. When the target cell is a reticuloendothelial cell the preferred diameter of the lipid nanospheres is about 100-200 nm. The CMV-carrying lipid nanospheres can then be washed and placed into a pharmaceutically acceptable carrier or tissue culture medium. The capacity of lipid nanospheres is about 2.5 mg CMV/ 500 μl of a nanosphere suspension. 22 6.3.4 The Construction of Lipid Vesicles A lipid film is formed by placing a chloroform methanol solution of lipid in a tube and removing the solvent by a nitrogen stream. An aqueous saline solution of CMV is added such that the amount of CMV is between 20% and 507o (w/w) of the amount of lipid, and the amount of aqueous solvent is about 807o (w/w) of the amount of lipid in the final mixture. After gentle vortexing the liposome-containing liquid is forced through successively finer polycarbonate filter membranes until a final diameter of about 50 nm is achieved. The passage through the successively finer polycarbonate filter results in the conversion of polylamellar liposomes into unilamellar liposomes, i.e., vesicles. When the target cell is a reticuloendothelial cell the preferred diameter of the lipid nanospheres is about 100-200 nm. The CMV-carrying lipid nanospheres can then be washed and placed into a pharmaceutically acceptable carrier or tissue culture medium. The CMV are entrapped in the aqueous core of the vesicles. About 507o of the added CMV is entrapped. A variation of the basic procedure comprises the formation of an aqueous solution containing a PEI/CMV condensate at a ratio of about 4 PEI imines per CMV phosphate. The condensate can be particularly useful when the liposomes are positively charged, i.e., the lipid vesicle contains a concentration of cations of cationic lipids such as DOTAP, DOTMA or DOSPER, greater than the concentration of anions of anionic lipids such as DOPS. The capacity of lipid vesicles is about 150 μg CMV per 500 μl of a lipid vesicle suspension. In a preferred embodiment the lipid vesicles contain a mixture of the anionic phospholipid, DOPS, and a neutral lipid such as DOPE or DOPC. Other negatively charged phospholipids that can be used to make lipid vesicles include dioleoyi phosphatidic acid (DOPA) and dioleoyi phosphatidyl glycerol (DOPG). In a more preferred embodiment the neutral lipid is DOPC and the ratio of DOPS:DOPC is between 2:1 and 1 :2 and is preferably about 1 :1. The ratio of negatively charged to neutral lipid should be greater than 1 :9 because the presence of less than 107o charged lipid results in instability of the lipid vesicles because of vesicle fusion. A particular lipid vesicle formulation can be tested by using the formulation to transfect a target cell population with a plasmid of about 5.0 kb in length that expresses 23 some readily detectable product in the transfected target cell. Lipid vesicles can be used to transfect a cell with the plasmid if the plasmid is condensed with PEI at an imine:phosphate ratio of about 9-4: 1. The capacity of the lipid vesicle formulation to transfect a cell with a plasmid is indicative of the formulation's capacity to introduce a CMV into a cell and effect a transmutation. Certain lipids, particularly the polycationic lipids, can be toxic to certain cell lines and primary cell cultures. The formulation of the lipid vesicles should be adjusted to avoid such toxic lipids. Ligands for clathrin-coated pit receptors can be introduced into the lipid vesicles by a variety of means. Cerebrosides, such as lactocerebroside or galactocerebroside can be introduced into the lipid mixture and are incorporated into the vesicle to produce a ligand for the asialoglycoprotein receptor. In an alternative embodiment the lipid vesicle further comprises an integral membrane protein that inserts itself into the lipid bilayer of the vesicle. In a specific embodiment the protein is a fusigenic (F-protein) from the virus alternatively termed Sendai Virus or Hemagglutinating Virus of Japan (HVJ). The preparation and use of F- protein containing lipid vesicles to introduce DNA into liver, myocardial and endothelial cells have been reported. See, e.g., U.S. Patent No. 5,683,866, International Application PCT JP97/ 00612 (published as WO 97/31656). See also, Ramani, K., et al., 1996, FEBS Letters 404, 164-168; Kaneda, Y., et al., 1989 . Biol. Chem. 264, 121 126-12129; Kaneda, Y., et al., 1989, Science 243, 375; Dzau, V.J., et al., Proc. Natl. Acad. Sci. 93, 1 1421-1 1425; Aoki, M., et al., 1997, J.Mol.Cardiol. 29, 949-959. 6.4 THE USE OF THE FORMULATIONS IN Vivo The CMV of the invention can be parenterally administered directly to the target organ at a dose of between 50 and 250 μg/gm. When the target organ is the liver muscle or kidney, the CMV/macromolecular carrier complex can be injected directly into the organ. When the target organ is the liver, intravenous injection into the hepatic or portal veins of a liver, having temporarily obstructed circulation can be used. Alternatively the CMV/macromolecular complex can further comprise a hepatic targeting ligand, such as a 24 lactosyl or galactosyl saccharide, which allows for administration of the CMV/macromolecular complex intravenously into the general circulation. When the target organ is the lung or a tissue thereof, e.g., the bronchiolar epithelium CMV/macromolecular complex can be administered by aerosol. Small particle aerosol delivery of liposomal/DNA complexes is described in Schwarz L.A., et al., 1996, Human Gene Therapy 7, 731-741. When the target organ is the vascular endothelium, as for example in von Willebrand's Disease, the CMV/macromolecular complex can be delivered directly into the systemic circulation. Other organs can be targeted by use of liposomes that are provided with ligands that enable the liposome to be extravasated through the endothelial cells of the circulatory system. For enzymatic defects, therapeutic effects can be obtained by correcting the genes of about 1 7o of the cells of the affected tissue. In a tissue in which the parenchyma! cells have an extended life, such as the liver, treatments with CMV can be repeatedly performed to obtain an increased therapeutic effect. 25 7. EXAMPLES 7.1 CMV/MACROMOLECULAR CARRIER COMPLEXES 7.1.1 Lipid Nanospheres Materials Egg phosphatidylcholine (EPC), DOTAP and galactocerebroside (Gc) (Avanti Polar Lipids); soybean oil (Sigma Chemical Co.); dioctadecyldiamidoglycyl spermine (DOGS ® ) (Promega). Methods EPC, DOTAP and Gc were previously dissolved at defined concentrations in chloroform or anhydrous methanol and stored in small glass vials in desiccated containers at -20°C until use. EPC (40-45 mg), DOTAP (200 μg) and Gc (43 μg) solutions were aliquoted into a small 10 x 75 mm borosilicate tube and solvents removed under a stream of nitrogen. CMV were diluted in 0.15 M NaCl (-80-125 μg/250-300μl); DOGS (as a 10 mg/ml solution in ethanol) was diluted into 250-300 μl 0.15 M NaCl at 3-5 times the weight of added CMV. The two solutions were mildly vortexed to mix contents and then CMV solution was added slowly to the DOGS solution. The contents were mixed by gentle tapping and inverting the tube a few times. The DOGS-complex solution was added to the dried lipids followed by soybean oil (40-45 mg), the mixture was vortexed on high for a few seconds and bath sonicated in a FS-15 (Fisher Scientific) bath sonicator for ~ 1 hr in a 4°C temperature controlled room. Occasionally, the tube was removed from the bath and vortexed. When a uniform looking, milky suspension was formed (with no obvious separation of oil droplets), it was extruded through a series of polycarbonate membranes down to a pore size of 50 nm. Preparations were stored at 4°C until use and vortexed before use. 7.1.2 Negatively Charged Targeted Lipid Vesicles Materials Dioleoyi phosphatidylcholine (DOPC), dioleoyi phosphatidylserine (DOPS), galactocerebroside (Gc) or lactosylcerebroside, (Avanti Polar Lipids). 26 Methods DOPS, DOPC and Gc at a molar ratio of 1 :1 :0.16 (500 μg total lipid) were dissolved in chloroform:methanol (1 : 1 v/v) and then dried under a stream of nitrogen to obtain a uniform lipid film. The CMV were diluted in 500 μl of 0.15 M NaCl (approximately 100- 250 μg 500μl). The solution was added to the lipid film at room temperature. Lipids were dispersed entirely by alternate mild vortexing and warming (in a water bath at 37- 42°C). After a uniform milky suspension was formed, it was extruded through a series of polycarbonate membranes (pore sizes 0.8, 0.4, 0.2, 0.1 and 0.05μm) using a Liposofast ® mini-extruder. Extrusion was done 5 to 7 times through each pore size. After preparation, lipid vesicles were stored at 4°C until use. Under these conditions the lipid vesicles were stable for at least one month. The final product can be lyophilized. 7.1.3 Neutral Targeted Lipid Vesicles Materials Dioleoyi phosphatidylcholine (DOPC), dioleoyi phosphatidylethanolamine (DOPE), galactocerebroside (Gc) or lactosylcerebroside, (Avanti Polar Lipids). Methods DOPC, DOPE and Gc (1 : 1 :0.16 molar ratio) or DOPCGc (1 :0.08) were dissolved in chloroform:methanol (1 : 1 v/v) and then dried under a stream of nitrogen to obtain a uniform lipid film. The oligonucleotides (or chimeric molecules) were diluted in 500 μl of 0.15 M NaCl (approximately 100-250 μg/500 μl). The solution was added to the lipid film at room temperature. Lipids were dispersed entirely by alternate mild vortexing and warming (in a water bath at 37-42°C). After a uniform milky suspension was formed, it was extruded through a series of polycarbonate membranes (pore sizes 0.8, 0.4, 0.2, 0.1 and 0.05 μm) using a Liposofast ® mini-extruder. Extrusion was done 5 to 7 times through each pore size. After preparation, lipid vesicles were stored at 4°C until use. The size of the lipid vesicles of the preparation was stable for about 5 days. 27 7.1.4 Positively Charged Targeted Lipid Vesicles Materials Dioleoyi phosphatidylcholine (DOPC), dioleoyi trimethylammonium propane (DOTAP), galactocerebroside (Gc) or lactosylcerebroside, (Avanti Polar Lipids). Polyethylenimine (PEI) (M.W. 800 Kd), Fluka Chemicals. Methods DOPC, DOTAP and Gc (6: 1 :0.56 molar ratio) (500 μg total lipid) were dissolved in chloroform: methanol (1 : 1 v/v) and then dried under a stream of nitrogen to obtain a uniform lipid film. PEI was diluted to a concentration of 45 mg/100 ml using water. pH of the solution was adjusted to -7.6 using HCI. This PEI stock solution was prepared fresh each time and was equivalent to approximately 50 nmol amine/μl. CMV were diluted into 0.15 M NaCl at a concentration of - 125 μg in 250 μl. PEI was further diluted into 250 μl 0.15 M NaCl so that approximately 4 moles of PEI amine were present per mole of oligonucleotide/chimeric phosphate. PEI solution was added dropwise to the CMV solution (both at room temperature) and vortexed for 5-10 minutes. The PEI-complex solution was then added to the lipid film and the lipids dispersed as described above. After a uniform milky suspension was formed, it was extruded through a series of polycarbonate membranes (pore sizes 0.8, 0.4, 0.2, 0.1 and 0.05 μm) using a Liposofast ® mini-extruder. Extrusion was done 5 to 7 times through each pore size. After preparation lipid vesicles were stored at 4°C until use. Under these conditions the lipid vesicles were stable for at least one month. For longer and improved stability the final product can be lyophilized. 7.1.5 I actosvlated-PEI/PEI Complexes PEI (25 kDa) was purchased from Aldrich Chemical (Milwaukee, WI). PEI (800 kDa) was purchased from Fluka chemicals (Ronkonkoma, NY, USA) . Lactosylation of the PEI was carried out by modification of a previously described method for the conjugation of oligosaccharides to proteins. Briefly, 3 to 5 ml of PEI (0.1 to 1.2 M monome r ) m ammonium acetate (0.2 M) or Tris buffer (0.2 M) (pH 7.6) solution was incubated with 7 to 8 mg of sodium cyanoborohydride (Sigma Chemical Co., St. Louis, MO) and 28 approximately 30 mg of lactose monohydrate (Sigma Chemical Co., St. Louis, MO). Reaction was carried out in polypropylene tubes, tightly capped in a 37°C shaking water bath. After 10 days the reaction mixture was dialyzed against distilled water (500 ml) for 48 h with 1 to 2 changes of water. The purified complex was sterile filtered through 0.2 μm filter and stored at 4°C. The amount of sugar (as galactose) associated with PEI was determined by the phenol-sulphuric acid method. The number of moles of free amine (primary + secondary) in the lactosylated PEI was determined as follows: a standard curve was set up using a 0.02M stock solution of PEI; several aliquots of the stock were diluted to 1 ml using deionized water in glass tubes, then 50 μl of Ninhydrin reagent (Sigma Chemical Co., St. Louis, Mo) was added to each tube and vortexed vigorously for 10 sec. Color development was allowed to proceed at room temperature for 10 to 12 min. and then O.D. was read (within 4 minutes) at 485 nm on a Beckman DU-64 spectrophotometer. 20 to 50 μl aliquots of the L-PEI samples were treated as above and the number of moles of free amine was determined from the standard curve. Lactosylated-PEI (L-PEI) complexes were prepared as follows: an equivalent of 3 mmol of amine as L-PEI and 3 mmol of amine as PEI, per mmol of RNA/DNA phosphate, were mixed together and diluted in 0.15M NaCl as required; the mixture was added dropwise to a solution of the chimeric and vortexed for 5 min. To verify complete association of the chimeric oligonucleotides with PEI or L-PEI, gel analysis (47o LMP agarose) of the uncomplexed and complexed chimerics was performed. To determine the degree of protection against nuclease degradation provided by complexation of the chimerics, samples were treated with RNAse and DNAse. After a chloroform phenol extraction, the complexes were dissociated using heparin (50 units/μg nucleic acid) and the products analyzed on a 47o LMP agarose gel. 7.2 DEMONSTRATION OF PEI/CMV MEDIATED ALTERATION OF RAT AND HUMAN FACTOR IX Materials. Fetal bovine serum was obtained from Atlanta Biologicals, Inc. (Atlanta, GA). The terminal transferase, fluorescein-12-dUTP, Expand™ high fidelity PCR system, dNTPs and high pure PCR template preparation kit were obtained from Boehringer Mannheim Corp. (Indianapolis, IN). Reflection™ NEF-496 autoradiography 29 film and Reflection™ NEF-491 intensifying screens were from DuPont NEN ® Research Products (Boston, MA). Polyethylenimine (PEI) 800 kDa was obtained from Fluka Chemical Corp. (Ronkonkoma, NY). The [γ- 32 P]ATP was obtained from ICN Biochemicals, Inc. (Costa Mesa, CA). pCR™2.1 was obtained from Invitrogen (San Diego, CA). OPTIMEM™, Dulbecco's modified Eagle's medium, William's E medium and oligonucleotides 365-A and 365-C were from Life Technologies, Inc. (Gaithersburg, MD). Spin filters of 30,000 mol wt cutoff were purchased from Millipore Corp. (Bedford, MA). Dil and SlowFade™ antifade mounting medium were obtained from Molecular Probes, Inc. (Eugene, OR). T4 polynucleotide kinase was purchased from New England Biolabs, Inc. (Beverly, MA). MSI MagnaGraph membrane was purchased from Micron Separations, Inc. (Westboro, MA). The primers used for PCR amplification were obtained from Oligos Etc., Inc. (Wilsonville, OR). Tetramethylammonium chloride was purchased from Sigma Chemical Company (St. Louis, MO). All other chemicals were molecular biology or reagent grade and purchased from Aldrich Chemical Company (Milwaukee, WI), Curtin Matheson Scientific, Inc. (Eden Prairie, MN), and Fisher Scientific (Itasca, IL). Oligonucleotide synthesis. Chimeric RNA/DNA oligonucleotides HIXF, RIXF and RIXR were synthesized. The CMV were prepared with DNA and 2'-0-methyl RNA phosphoramidite nucleoside monomers on an ABI 394 synthesizer. The DNA phosphoramidite exocyclic amine groups were protected with benzoyl (adenosine and cytidine) and isobutyryl (guanosine). The protective groups on the 2'-0-methyl RNA phosphoramidites were phenoxyacetyl for adenosine, isobutyryl for cytidine, and dimethylformamide for guanosine. The base protecting groups were removed following synthesis by heating in ethanol/concentrated ammonium hydroxide for 20 h at 55°C. The crude oligonucleotides were electrophoresed on 157o polyacrylamide gels containing 7 M urea, and the DNA visualized using UV shadowing. The chimeric molecules were eluted from the gel slices, concentrated by precipitation and desalted using G-25 spin columns. Greater than 957o of the purified oligonucleotides were full length. 30 The sequence of the wild type and "mutant" rat Factor IX are (SEQ ID No.27) 365 wt AAA GAT TCA TGT GAA GGA GAT AGT GGG GGA CCC CAT GTT Lys Asp Ser Cys Glu Gly Asp Ser Gly Gly Pro His Val (SEQ ID No.28) (SEQ ID No.29) mt AAA GAT TCA TGT GAA GGA GAT CGT GGG GGA CCC CAT GTT Arg The structure of the RIXR, RIXF and HIXR CMV is as follows Chimeric Oligonucleotides RIXR ( SEQ ID No . 30 ) TGCGCG- ccccagggggTGCTAgaggaaguguT T T T T TCGCGC GGGGTCCCCCACfiATCTCCTTCACAT 3 ' 5 ' RIXR C ( SEQ ID No . 31 ) TGCGCG-acacuuccucTAQCAcccccuggggT T T T T TCGCGC TGTGAAGGAGATC.GTGGGGGACCCCT 3' 5' RIXF (SEQ ID No. 32) TGCGCG-acacuuccucTASCAcccccuggggT T T T T TCGCGC TGTGAAGGAGAT£GTGGGGGACCCCT 3' 5' 31 HIXF (SEQ ID No. 33) TGCGCG-acaguuccucTAG÷CAcccccuggggT T T T T TCGCGC TGTCAAGGAGATC.GTGGGGGACCCCT Uppercase letters are deoxyribonucleotides, lower case letters are 2'OMe- ribonucleotides. The nucleotide of the heterologous region is underlined. Cell Culture, transfections and hepatocyte isolation. HuH-7 cells were maintained in Dulbecco's modified Eagle's medium containing 10% (vol/vol) heat inactivated fetal bovine serum in a humidified C0 2 atmosphere at 37°C. Twenty four hours prior to transfection 1 x 10 5 cells were plated per 35 mm culture dish. At the time of transfection, the cells were rinsed twice with OPTIMEM™ media and transfections were performed in 1 ml of the same media. Eighteen hours after transfection, 2 ml of Dulbecco's modified Eagle's medium containing 207o (vol/vol) heat inactivated fetal bovine serum was added to each 35 mm dish and the cells maintained for an additional 30 h prior to harvesting for DNA isolation. A PEI (800 kDa) 10 mM stock solution, pH 7.0, was prepared. Briefly, the chimeric oligonucleotides were transfected with 10 mM PEI at 9 equivalents of PEI nitrogen per chimeric phosphate in 100 μl of 0.15 M NaCl at final concentrations of either 150 nM (4 μg), 300 nM (8 μg) and 450 nM (12 μg). After 18 h, an additional 2 ml of medium was added and reduced the chimeric concentrations to 50 nM, 100 nM, and 150 nM, respectively, for the remaining 30 h of culture. HuH-7 vehicle control transfections utilized the same amount of PEI as was used in the HulXF transfections, but substituted an equal volume of 10 mM Tris-HCl pH 7.6 for the oligonucleotides. Primary rat hepatocytes were isolated from 250 g male Sprague-Dawley rats (Harlan Sprague-Dawley, Inc., Indianapolis, IN) by a two step collagenase perfusion as previously described (Fan et al., Oncogene 12:1909-1919, 1996, which is hereby incorporated by reference) and plated on Primaria™ plates at a density of 4 x 10 5 cells per 35 mm dish. The cultures were maintained in William's E medium supplemented with 107o heat inactivated FBS, 26 mM sodium bicarbonate, 23 mM HEPES, 0.01 U/ml 32 insulin, 2 mM L-glutamine, 10 nM dexamethasone, 5.5 mM glucose, 100 U/ml penicillin and 100 U/ml streptomycin. Twenty four hours after plating, the hepatocytes were washed twice with the same medium and 1 ml of fresh medium added and the cells transfected using PEI/chimeric oligonucleotide complexes at the identical concentrations as for the HuH-7 cells. After 18 h, an additional 2 ml of the medium was added and the cells harvested 6 or 30 h later. Direct injection of chimeric oligonucleotides into liver. Male Sprague-Dawley rats ( " 175 g) were maintained on a standard 12 h light-dark cycle and fed ad libitum standard laboratory chow. The rats were anesthetized, a midline incision made the liver exposed. A clamp was placed on the hepatic and portal veins as they enter the caudate lobe, and 75 μg of the 1 :9 chimeric/PEI complex was injected in a final volume of 250 - 300 μl directly into the caudate lobe. The lobe remained ligated for 15 min and then blood flow was restored by removing the clamp. After suturing the incision the animals were allowed to recover from the anesthesia and given food and water ad libitum. Vehicle controls were done substituting an equal volume of Tris-HCl pH 7.6 for the chimeric oligonucleotides. Twenty-four and 48 h post-injection the animals were sacrificed, the caudate lobe removed and the tissue around the injection site dissected for DNA isolation. DNA was isolated and the terminal exon of the rat factor IX gene was amplified by PCR. Nuclear uptake of the chimeric molecules. Chimeric duplexes were 3' end- labeled using terminal transferase and fluorescein-12-dUTP according to the manufacturer's recommendation, and were then mixed with unlabeled oligonucleotides at a 2:3 ratio. Transfections were performed as described above and after 24 h the cells were fixed in phosphate buffered saline, pH 7.4, containing 47o paraformaldehyde (wt/vol) for 10 min at room temperature. Following fixation, the cells were counterstained using a 5 μM solution of Dil in 0.32 M sucrose for 10 min according to the manufacturer's recommendation. After washing with 0.32 M sucrose and then phosphate buffered saline, pH 7.4, the cells were coversliped using SlowFade™ antifade mounting medium in phosphate buffered saline and examined using a MRC1000 confocal microscope (BioRad, Inc., Hercules, CA). The caudate lobes of liver in situ were injected with fluorescently-labeled chimerics as described above and harvested 24 h post- 33 injection. The lobes were bisected longitudinally, embedded using OCT and frozen. Cryosections were cut - 10 μm thick, fixed for 10 min at room temperature using phosphate buffered saline, pH 7.4, containing 4% paraformaldehyde (wt/vol). Following fixation, the cells were counterstained using a 5 μM solution of Dil in 0.32 M sucrose for 10 min according to the manufacturer's recommendation. After washing with 0.32 M sucrose and then phosphate buffered saline, pH 7.4, the sections were coversliped using SlowFade™ antifade mounting medium and examined using a MRC1000 confocal microscope (BioRad, Inc.). The collection series for the fixed cells and sectioned tissue were made at 1 μm steps to establish the presence of the chimeric in the nucleus. DNA isolation and cloning. The cells were harvested by scrapping 24 and 48 h after transfection. Genomic DNA larger than 100-150 base pairs was isolated using the high pure PCR template preparation kit according to the manufacturer's recommendation. PCR amplification of a 31 7-nt fragment of the eighth exon in the human liver factor IX gene was performed with 500 ng of the isolated DNA. The primers used were 5'-CATTGCTGACAAGGAATACACGAAC-3' (SEQ ID No. 34) and 5'-ATTTGCCTTTCATTGCACACTCTTC-3' (SEQ ID No. 35) corresponding to nucleotides 1008-1032 and 1300-1324, respectively, of the human factor IX cDNA. Primers were annealed at 58°C for 20 sec, elongation was for 45 sec at 72°C and denaturation proceeded for 45 sec at 94°C. The sample was amplified for 30 cycles using Expand Hi- fidelity™ polymerase. PCR amplification of a 374-nt fragment of the rat factor IX gene was performed with 500 ng of the isolated DNA from either the primary hepatocytes or liver caudate lobe. The primers used were 5'-ATTGCCTTGCTGGAACTGGATAAC-3' (SEQ ID No. 36) and 5'-TTGCCTTTCATTGCACATTCTTCAC-3' (SEQ ID No. 37) corresponding to nucleotides 433-457 and 782-806, respectively, of the rat factor IX cDNA. Primers were annealed at 59°C for 20 sec, elongation was for 45 sec at 72°C and denaturation proceeded for 45 sec at 94°C. The sample was amplified for 30 cycles using Expand Hi-fidelity™ polymerase. The PCR amplification products from both the human and rat factor IX genes were subcloned into the TA cloning vector pCR™2.1 according to the manufacturer's recommendations, and the ligated material used to transform frozen competent Escherichia coli. 34 Colony hybridization and sequencing. Eighteen to 20 h after plating, the colonies were lifted onto MSI MagnaGraph nylon filters, replicated and processed for hybridization according to the manufacturer's recommendation. The filters were hybridized for 24 h with 1 7 mer oligonucleotide probes 365-A (5'- AAGGAGATAGTGGGGGA-3') (SEQ ID No. 38) or 365-C (5ΑAGGAGATCGTGGGGGA-3') (SEQ ID No. 39), where the underlined nucleotide is the target of the mutagenesis. The probes were 32 P-end-labeled using [γ- 32 ]ATP (> 7,000 Ci/mmol) and T4 polynucleotide kinase according to the manufacturer's recommendations. Hybridizations were preformed at 37°C in 2X sodium chloride sodium citrate containing 1 % SDS, 5X Denhardt's and 200 μg/ml denatured sonicated fish sperm DNA. After hybridization, the filters were rinsed in 1 X sodium chloride phosphate EDTA, 0.5 % SDS and then washed at 54°C for 1 h in 50 mM Tris-HCl, pH 8.0 containing 3 M tetramethylammonium chloride, 2 mM EDTA, pH 8.0, 0.1 7o SDS. Autoradiography was performed with NEN ® Reflection film at -70°C using an intensifying screen. Plasmid DNA was prepared from colonies identified as hybridizing with 365-A or 365-C using Qiagen minprep kit (Chatsworth, CA) and subjected to automatic sequencing using the mp13 reverse primer on an ABI 370A sequencer (Perkin-Elmer, Corp., Foster City, CA). Results In Vivo Chimeric oligonucleotides were fluorescein-labeled and used to determine whether direct injection into the caudate lobe of the liver was feasible. The results indicated that the hepatocytes adjacent to the injection site within the caudate lobe showed uptake of the fluorescently-labeled chimeric molecules similar to that observed in isolated primary hepatocytes and HuH-7 cells. Although some punctate material was present in the cytoplasm, the labeled material was detected primarily in the nucleus. In fact, only nuclear labeling was observed in hepatocytes farthest from the injection site. The unlabeled PEI/RIXF chimeric complexes and vehicle controls were injected directly into the caudate lobe using the same protocol and the animals sacrificed 24 and 48 h post- injection. Liver DNA was isolated as described in Methods, subjected to PCR amplification of a 374 nt sequence spanning the targeted nt exchange site. Following 35 subcloning and transformation of Escherichia coli with the PCR amplified material, duplicate filter lifts of the transformed colonies were performed. The filters were hybridized with 32 -labeled 17-mer oligonucleotides specific for either 365-A (wild-type) or 365-C (factor IX mutation) and processed post-hybridization as described in Methods. Rats which received direct hepatic injection of the RIXF chimeric molecules exhibited a A-*C conversion frequency of -1 % at both 24 and 48 h. In contrast, the vehicle controls showed no hybridization with the 365-C probe. Colonies that hybridized with the 365-C probe from the RIXF treated animals were cultured, the plasmid DNA isolated and subjected to sequencing to confirm the A-C conversion. The ends of the amplified 374- nt fragment correspond exactly with the primers and the only nucleotide change observed was an A-C at the targeted exchange site. 7.3 DEMONSTRATION OF LACTOSYLATED-PEI/CMV MEDIATED ALTERATION OF RAT FACTOR IX 7.3.1 Results CMV complexed to a mixture of lactosylated-PEI and PEI was prepared using the RIXR oligonucleotide as described in Section 6.1.5 above. A CMV directed to the complementary strand of the same region of the factor IX was also constructed (RIXR C ). Conversion of the targeted nucleotide at Sei 365 by the chimeric oligonucleotides The nuclear localization of the fluorescently-labeled chimeric molecules indicated efficient transfection in the isolated rat hepatocytes. The cultured hepatocytes were then transfected with the unlabeled chimeric molecules factor RIXR C and RIXR at comparable concentrations using 800 kDa PEI as the carrier. Additionally, vehicle control transfections were performed simultaneously. Forty eight hours after transfection, the cells were harvested and the DNA isolated and processed for hybridization as described in Section 6.1.5. The A→C targeted nucleotide conversion at Ser 365 was determined by hybridization of duplicate colony lifts of the PCR-amplified and cloned 374-nt stretch of exon 8 of the factor IX gene (Sarkar, B., Koeberl, D. D. & Somer, S. S., "Direct Sequencing of the activation peptide and the catalytic domain of the factor IX gene in six species," Cenomics, 6, 133-143, 1990.) The 17 mer oligonucleotide probes used to distinguish between the wild-type 365-A (5'-AAGGAGATAGTGGGGGA-3') (SEQ ID No. 36 40) or converted 365-C (5'-AAGGAGATCGTGGGGGA-3') (SEQ ID No. 41 ) corresponded to nucleotides 710 through 726 of the cDNA sequence. The overall frequency of conversion of the targeted nucleotide was calculated by dividing the number of clones hybridizing with the 365-C oligonucleotide by the total number of clones hybridizing with both oligonucleotide probes. The results are summarized in Table III for RIXR C . A→C conversion at Ser 365 was observed only in primary hepatocytes transfected with the RIXR or RIXR C . Similar conversion frequencies were observed in hepatocytes transfected with RIXR or RIXR C Neither vehicle transfected cells nor those transfected with other chimeric oligonucleotides yielded any clones hybridizing with the 365-C oligonucleotide probe (unpublished observations). Additionally, no hybridization of the 365-C oligonucleotide probe was observed to clones derived from DNA isolated from untreated hepatocytes and PCR-amplified in the presence of 0.5 to 1.5 μg of the oligonucleotides. The A→C conversion rate in the isolated hepatocytes was also dose dependent using lactosylated PEI derivatives as described in Section 6.1.5 and was as high as 19%. RT-PCR and hybridization analysis of RNA isolated from cultured cells transfected in parallel with lactosylated PEIs demonstrated A→C conversion frequencies ranging from 1 1.9 to 22.37o. Site-directed nucleotide exchange by chimeric oligonucleotides in intact liver The fluorescein-labeled oligonucleotides were also used to determine cellular uptake of the chimeric molecules after direct injection into the caudate lobe of the liver. The results indicated that hepatocytes adjacent to the injection site in the caudate lobe showed uptake of the fluorescently-labeled chimerics similar to that observed in the isolated rat hepatocytes. Although some punctate material was present in the cytoplasm of the hepatocytes, the labeled material was primarily present in the nucleus. In fact, only nuclear labeling was observed in those areas farthest from the injection site. The unlabeled RIXR chimeric oligonucleotides and vehicle controls were then administered in vivo by tail vein injection of the 25 kDa PEI and liver tissue harvested 5 days post- injection. Liver DNA Was isolated and subjected to PCR amplification of a 374-nt sequence spanning the targeted nucleotide exchange site, using the same primers as those used with the primary hepatocytes. Following subcloning and transformation of E. coli 37 with the PCR-amplified material, duplicate filter lifts of the transformed colonies were done. The filters were hybridized with the same 32 P-labeled 1 7-mer oligonucleotides specific for either 365-A (wild-type) or 365-C (mutant) and processed post-hybridization. Rats treated with 100 μg of the RIXR chimeric oligonucleotides exhibited an A→C conversion frequency ranging from 13.97o to 18.97o, while those that received a total of 350 μg in two injections showed 407o conversion, in contrast, the vehicle controls showed no hybridization with the 365-C probe. RT-PCR hybridization of isolated RNA indicated A→C conversion frequencies of 26.4% to 28.47o in the high dose livers. The APTT for vehicle-treated rats ranged from 89.77o to 181.9% of control values (131.84% + 32.897o), while the APTT for the oligonucleotide-treated animals ranged from 48.97o to 61.7% (53.8% ± 4.8%). The APTT times for a 1/10 dilution of rat test plasma in Hepes buffer (50 mM Hepes/100 mM NaCI/0.027o NaN 3 pH 7.4) were determined for both normal (n = 9) and the double injected animals (n = 3). The factor IX activity of duplicate samples was determined from a log-log standard curve that was constructed from the APTT results for dilution (1 : 10 to 1 :80) of pooled plasma from 12 normal male rats, 6-8 weeks old. The APTT results for the normal rats ranged from 89.77o to 181.97o of the control values (mean = 131.84% ± 32.897o), while the APTT results for the double injected animals ranged from 49.0% to 61.77o (mean 53.87o ± 5.87o). The APTT clotting time in seconds for the normal rats ranged from 60.9 seconds to 81.6 seconds (mean - 71.3 ± 7.3 seconds) while the APTT times ranged from 92.3 seconds to 98.6 seconds (mean = 96.3 ± 2.9 seconds) for the double-infected rats. Sequence analysis of the mutated factor IX gene in isolated hepatocytes and intact liver Direct sequencing of the wild-type and mutated genes was performed to confirm the results from the filter hybridizations in both the in vitro and in vivo studies. At least 10 independent clones hybridizing to either 365-A or 365-C from the intact liver or isolated hepatocytes were analyzed. The results of the sequencing indicated that colonies hybridizing to 365-A (Fig. 6, top panel) exhibited the wild-type IX sequence, i.e. an A at Ser 365 of the reported cDNA sequence. In contrast, those colonies derived from the factor RIXR C transfected primary hepatocytes hybridizing to the 365-C oligonucleotide probe 38 converted to a C at Ser 365 . The same A→C conversion at Ser 365 was observed in the clones derived from the transfected rat liver that hybridized with the 1 7 mer 365-C oligonucleotide probe. The entire 374-nt PCR amplified region of the factor IX gene was sequenced for all the clones and no alteration other than the indicated changes at Ser 365 was detected. Finally, the start and end points of the 374-nt PCR amplified genomic DNA derived from both the primary hepatocytes and the intact liver corresponded exactly to those of the primers used for the amplification process, indicating that the cloned and sequenced DNA was derived from genomic DNA rather than nondegraded chimeric oligonucleotides. 39 Table III Percent A- C conversion at Ser 365 of rat factor IX genomic DNA by colony lift hybridizations PEI Deliver System 365-C clones Total clones A-C (%) PEI 800 kDa 1 Concentration In vitro 150 nM 24 572 4.2 300 31 367 8.5 450 63 502 12.5 Lac-PEI 800 kDa In vitro 90 18 337 5.3 180 34 300 11.3 270 47 253 18.6 Lac-PEI 25 kDa In vitro 90 28 527 5.3 180 53 417 12.7 270 60 305 19.7 Lac-PEI 25 kDa 2 DOS'? In vivo xl 100 μg 24 166 14.5 71 386 18.4 50 360 13.9 Lac-PEI 25 kDa In vivo x2 350 μg 237 601 39.4 228 563 40.5 271 678 40.0 'The data shown for the primary hepatocyte transfections represents a mean of two experiments. 2 The in vivo chimeric/PEI complexes were administered in a volume of 300 μl of 5% dextrose by tail vein injection. The results of three animals at each dose are shown individually. 40 7.3.2 Materials and Methods In vivo delivery of the chimeric oligonucleotides. Male Sprague-Dawley rats (Harlan Sprague-Dawley, Inc.) (-50 g) were maintained on a standard 12 h light-dark cycle and fed ad libitum standard laboratory chow. Vehicle controls and lactosylated 25 kDa PEI at a ratio of 6 equivalents of PEI nitrogen per chimeric phosphate were administered in 300 μl of 57o dextrose (Abdallah, B. et al., "A powerful nonviral vector for in vivo gene transfer into the adult mammalian brain: polyethylenimine:, Human Cene Therapy, 7, 1947-1954, 1996.). The aliquots were administered by tail vein injection either as a single dose of 100 μg or divided dose of 150 μg and 200 μg on consecutive days. Five days post-injection, liver tissue was removed for DNA and RNA isolation. DNA was isolated as previously described (Kren, B. T., Trembley, J. H. & Steer, C. J., "Alterations in mRNA stability during rat liver regeneration," Am. J. PhysioL, 270, G763-G777, 1996) for PCR amplification of exon 8 of the rat factor IX gene. RNA was isolated for RT-PCR amplification of the same region as the genomic DNA using RNAexol and RNAmate (Intermountian Scientific Corp., Kaysville, UT) according to the manufacturer's protocol. Factor IX activity assay. Blood samples from vehicle (n = 9) and oligonucleotide-treated (n = 3) rats were collected 20 days after the second tail vein injection in 0.1 vol. of 0.105 M sodium citrate/citric acid. After centrifugation at 2,500 x g and then 15,000 x g the resulting plasma was stored at -70 ° C. The factor IX activity was determined from activated partial thromboplastin time (APTT) assays. Briefly, 50 μl of APTT reagent (DADE, Miami, FL), 50 μl of human factor IX-deficient plasma (George King Biomedical, Overland, KS), and 50 μl of 1/10 dilution of rat test plasma in Hepes buffer (50 mM Hepes/100 mM NaCI/0.02% NaN 3 pH 7.4) were incubated at 37°C for 3 min in an ST4 coagulometer (American Bioproducts, Parsippany, NJ). Clotting was initiated by addition of 50 μl of 33 mM CaCI 2 in Hepes buffer. Factor IX activity of duplicate samples was determined from a log-log standard curve constructed from the APTT results for dilution (1 : 10 to 1 :80) of pooled plasma from normal male rats (n = 12). DNA/RNA isolation and cloning. The cells were harvested by scrapping 48 h after transfection. Genomic DNA larger than 100-150 base pairs was isolated using the high 41 pure PCR template preparation kit (Boehringer Mannheim, Corp., Indianapolis, IN). RNA was isolated using RNAzol™ B (Tel-Test, Inc., Friendswood, TX), according to the manufacturer's protocol. PCR amplification of a 374-nt fragment of the rat factor IX gene was performed with 300 ng of the isolated DNA from either the primary hepatocytes or liver tissue. The primers were designed as 5'-ATTGCCTTGCTGGAACTGGATAAAC-3' (SEQ ID No. 42) and 5 TGCCTTTCATTGCACATTCTTCAC-3' (SEQ ID No. 43) (Oligos Etc., Wilsonville, OR) corresponding to nucleotides 433-457 and 782-806, respectively, of the rat factor IX cDNA. Primers were annealed at 59°C for 20 sec, elongation was for 45 sec at 72 ° C and denaturation proceeded for 45 sec at 94°C. The sample was amplified for 30 cycles using Expand Hi-fidelity™ polymerase (Boehringer Mannheim, Corp.). The PCR amplification products from both the hepatocytes and intact liver factor IX genes were subcloned into the TA cloning vector pCR™2.1 (Invitrogen, San Diego, CA), and the ligated material used to transform frozen competent E. coli. To rule out PCR artifacts 300 ng of control DNA was incubated with 0.5, 1.0 and 1.5 μg of the oligonucleotide prior to the PCR-amplification reaction. Additionally, 1.0 μg of the chimeric alone was used as the "template" for the PCR amplification. RT-PCR amplification was done utilizing the Titian ™ one tube RT-PCR system (Boehringer Mannheim, Corp.) According to the manufacturer's protocol using the same primers as those used for the DNA PCR amplification. To rule out DNA contamination, the RNA samples were treated with RQ1 DNase free RNase (Promega Corp., Madison, WI) and RT-PCR negative controls of RNased RNA samples were performed in parallel with the RT-PCR reaction. Each of the PCR reactions were ligated into the same TA cloning vector and transformed into frozen competent E. coli. Colony hybridization and sequencing. Eighteen to 20 h after plating, the colonies were lifted onto MSI MagnaGraph nylon filters, replicated and processed for hybridization according to the manufacturer's recommendation. The filters were hybridized for 24 h with 1 7 mer oligonucleotide probes 365-A (5ΑAGGAGATAGTGGGGGA-3') (SEQ ID No. 44) OR 365-C (5'-AAGGAGATCGTGGGGGA-3') (SEQ ID No. 45) (Life technologies, Inc., Gaithersburg, MD), where the underlined nucleotide is the target for 42 mutagenesis. The probes were 32 P-end-labeled using (γ- 32 P) ATP (> 7,000 Ci/mmol) and T4 polynucleotide kinase (New England Biolabs, Inc., Beverly MA). Hybridizations were performed at 37°C in 2X sodium chloride sodium citrate containing 1 7o SDS, 5X Denhardt's and 200 μg/ml denatured sonicated fish sperm DNA. After hybridization, the filters were rinsed in 1 X sodium chloride sodium phosphate EDTA, 0.57o SDS and then washed at 54°C for 1 h in 50 mM Tris-HCl, pH 8.0 containing 3 M tetramethylammonium chloride, 2 mM EDTA, pH 8.0, 0.1 % SDS (Melchior, W. B. & Von Hippel, P. H. "Alteration of the relative stability of dA.dT and dG.dC base pairs in DNA," Proc. Natl. Acad. Sci. USA, 70, 298-302, 1973.). Autoradiography was performed with NEN s Reflection film at -70°C using an intensifying screen. Plasmid DNA was prepared from colonies identified as hybridizing with 365-A or 365-C using Qiagen miniprep kit (Chatsworth, CA) and subjected to automatic sequencing using the mp13 forward and reverse primers as well as a gene specific primer, 5'GTTGACCGAGCCACATGCCTTAG-3' (SEQ ID No. 46) corresponding to nucleotides 616 to 638 of the rat factor IX cDNA using an ABI 370A sequencer (Perkin-Elmer, Corp., Foster City, CA). 7.4 EXAMPLES OF CMV USEFUL FOR THE REDUCTION OF LDL LEVELS IN HUMANS A CMV suitable for the modification of Apo B having a sequence comprising the sequence of SEQ ID No: 5 is given below. Apo B 41/UR (mut→WT) (SEQ ID No. 47) u GCGCG gac ccg ace gaa J Ϊ UC ggu aac ugu au u u u u u CGCGC CTG GGC TGG CTT AAG CCA TTG ACA Tu 3' 5' 43 A CMV suitable for the modification of Apo B having a sequence comprising the sequence of SEQ ID No: 12 is given below. Apo B 5/U88 (mut→WT) (SEQ ID No. 48) u GCGCG cug uuc aaa gug uaC GGA TCC ucu uug acu gac gau u u u u u CGCGC 3 ' G 5A'C AAG TTT CAC ATG CCT AGG AGA AAC TGA CTG CTu 7.5 CORRECTION OF A CRIGLER-NAJJAR-LIKE MUTATION IN THE GUNN RAT Mutant rats with hyperbilirubinemia, termed Gunn rats, have a single nucleotide deletion in the gene encoding bilirubin-uridinediphosphoglucuronate glucuronosyltransferase (UCT1A 1). Roy Chowdhury, J., et al., 1991 , J. Biol. Chem. 266, 18294. Human patients with Crigler-Najjar syndrome type I also have mutations of the UGT1A 1 gene, resulting in life-long hyperbilirubinemia and consequent brain damage. Bosma, P.J., et al., 1992, FASEB J. 6, 2859; Jansen, P.L.M., et al., Progress In Liver Diseases, XIII, Boyer, J.L., & Ockner, R.K., editors (W.B. Saunders, Phil. 1995), pp 125- 150. The structure of CN3, a CMV designed to correct the Gunn rat mutation is given below. CN3 (mut→WT) ( SEQ ID No . 49 ) T GCGCG gg gac uua caG GAC CTT TAC uga ctt cua T T T T T T CGCGC CC CTG AAT GTC CTG GAA ATG ACT GCC GAT T 3 ' 5 ' Gunn rat primary cultured hepatocytes were treated with 150 nM CN3 according to the above protocol except that the carrier was either the negatively charged glycosylated lipid vesicles of section 6.2.2 or a lactosylated-PEI carrier at a ratio of 44 oligonucleotide phosphate to imine of 1 :4 . The results were 8.5% conversion with the negatively charged liposome and 3.67o conversion with lactosylated-PEI carrier. Gunn rats were injected with 1 mg/Kg of CN3 complexed with either 25 kDa Lac- PEI or complexed with negatively charged Gc lipid vesicles (Gc-NLV) as described above. The rate of gene conversion was determined by cloning and hybridization according to the procedure described for factor IX. The results shown below indicate that between about 157o and 257o of the copies of the UGT1A 1 gene were converted. 45 Frequency of Insertion of G at nucleotide 1239 of the UGT-1 Gene (In Gunn Rats) Vehicle Dosage G Clones/Total Frequency (%) Clones Gc-NLV 1 mg 112/815 15.4 208/761 27.3 185/974 18.9 39/273 14.6 1 78/403 19.3 2 25 kDa PEI 1 mg 188/838 22.4 (Lactosylated) 254/1150 22.1 245/997 24.6 initial conversion frequency determined. Conversion frequency determined 7 days after 70% partial hepatectomy. A Gunn rat was injected on five successive days with 1 mg/Kg of CN3 complexed with 25 kDa Lac-PEI as above. Twenty five days after the final injection the serum bilirubin had declined from 6.2 mg/dl to 3.5 mg/dl and remained at that level for a further 25 days. 7.6 CORRECTION OF A FACTOR IX MUTATION IN DOG , 1477 The Chapel Hill strain of dogs, which has a (G→A) "* / mutation that results in hemophilia in the animals, was used to obtain primary cultured hepatocytes. Four CMV to correct this mutation have been synthesized. DIXl (mut→WT) (SEQ ID No. 50) T gcgcg auu caa aga aTT GAC C.CT AAT AAT cga ccc cT T T T T T CGCGC TAA GTT TCT TAA CTG G.GA TTA TTA GCT GGG GT 3' 5' DIX2 (mut→WT) (SEQ ID No. 51) T gcgcg caa aga auu gAC C.CT AAT aau cga cT T T T T T CGCGC GTT TCT TAA CTG G.GA TTA TTA GCT GT 3' 5' 46 DIX3 (mut→WT) (SEQ ID No. 52) u gcgcg auu caa aga auu gac ecu aau aau cga ccc cu u u u u u CGCGC TAA GTT TCT TAA CTG GGA TTA TTA GCT GGG Gu 3' 5' DIX4 (mut→WT) (SEQ ID No. 53) u gcgcg auu caa aga auu gac ucu aau aau cga ccc cu u u u u u CGCGC TAA GTT TCT TAA CTG GGA TTA TTA GCT GGG Gu 3 ' 5 ' DIX1 differs from DIX3 by the replacement of the intervening DNA segment with 2'-0-methyl RNA and replacement of the tetrathymidine linkers with tetrauracil. DIX 4 differs from DIX3 in that the mutational vector contains a mismatch in the mutator region. In DIX4 the 5' (lower) strand encodes the desired (wild-type) sequence while the 3' (upper) strand has the sequence of the target, i.e., the mutant sequence. The hepatocytes were treated with 360 nM DIX1 complexed in either 25 kDa Lac- PEI or galactocerebroside-containing aqueous-cored, negatively charged lipid vesicles (Gc-NLV). The results are given in the table below. Frequency of conversion of A to G at nucleotide 1477 of the Factor IX Gene (Primary Hepatocytes from the Chapel Hill Strain of Hemophilia B Dogs) Vehicle Number of Concentration G Clones/Total Frequency (%) Times Clones Transfected Gc-NLV Once 360 nM 30/195 15.44 30/218 13.76 Twice 30/118 25.4 Lac-PEI Once* 360 nM 20/141 14.2 25 kDa 48/348 13.3 Twice 21/107 19.6 *RT-PCR on parallel transfected cultures gave an A to G conversion frequency of 11.1% 47 Each of the DIX2-DIX4 were also tested on primary cultured dog hepatocytes as above. The results showed that DIX2 worked poorly, possibly due to the low (257o) GC percentage. The subsequent experiments the results of DIX3 were about 167o conversion, while a parallel experiments DIX1 gave 107o conversion and the results of DIX4 were about as good as DIX1. 48 GenBank Sequence References for the Exons of the Human Apolipoprotein B-100 Gene TABLE II Exon No. cDNA Boundary GenBank Accession No. Sequence Reference 1 126 to 207 M19808 2 208 to 246 M19808 3 247 to 362 M19809 4 363 to 508 M19810 5 509 to 662 19811 6 663 to 818 M19812 7 819 to 943 M19813 8 944 to 1029 M19813 9 1030 to 1249 19815 10 1250 to 1477 M19816 11 1478 to 1595 M19818 12 1596 to 1742 M19818 13 1743 to 1954 M19820 14 1955 to 2192 M19820 15 2193 to 2359 M19821 16 2360 to 2561 19823 17 2562 to 2729 M19824 18 2730 to 2941 M19824 19 2942 to 3124 M19825 20 3125 to 3246 Ml9825 21 3247 to 3457 M19827 22 3458 to 3633 M19828 23 3634 to 3821 M19828 24 3822 to 3967 M19828 25 3968 to 4341 M19828 26 4342 to 11913 M19828 27 11914 to 12028 M19828 28 12029 to 12212 M19828 29 12213 to 13816 Ml9828 49 SEQ ID TABLE I /C# NA Change AA AA %APOB100 Restriction No. Sequence (5* -*3') Change Site 5 4 AGTCTGGATGGGIAAGCCGCCCTCA 15 A=>T K=»Stop 1701 36.9 None o ≥: -4 00 5 CTGGGCTGGCTTAAGCCATTGACAT 13 C-A S-TAA 1876 40.8 + CTT AAG 6 GCTCTCTGGGGAIAACATACTGGGC 14 G=>T E=>Stop 1921 41.8 None 7 GATGCCGTTGAGIAGCCCCAAGAAT 13 A=»T K *** -*Stop 2047 44.5 None 8 GAGAGGAATCGAIAAACCATTATAG 10 c-=>τ Q=»Stop 2085 45.4 + ATCGAT 9 TGTAAGAAAATAAAGAGCAGCCCTG 10 C=>A Y-Stop 21 10 45.9 None 10 GCAGCCCTGGGAIAACTCCCACAGC 16 A=>T K=»Stop 21 16 46.0 None 11 GCAAGCTAATGATTAGCTGAATTCATTCAAT 8 T~G Y-^Stop 2124 46.2 +AGCT © 12 CAAGTTTCACATGCCTAGGAGAAACTGACTG 1 1 A=>T K=~Stop 2138 46.5 + CCTAGG 13 ATATACAAATTGCATGAGATGATGCCAAAAT 9 T=»G L-^Stop 2159 47.0 + CATG 14 AAACTATCTCAACTGIAGACATATATGATAC 8 c=>τ Q=--Stop 2174 47.3 -CTGCAG 15 GCTMTATTATTGATΓAAATCATTGAAATTA 3 G=>T E=>Stop 2204 48.0 +TTAA 16 TGATGAGCACTAGCATATCCGTGTA 1 1 T=->G Y-^Stop 2216 48.3 + CTAG 17 CTGCAGCAGCTTΓAGAGACACATAC 12 A-=>T K=>Stop 2270 49.4 -CTTAAG 18 AACAGTGAGCTGIAGTGGCCCGTTC 14 c=>τ Q=>Stop 2684 58.6 None 19 CAGACTTCCGTTAACCAGAAATCGC 12 T~A L=>Stop 2712 59.2 + GTTAAC 20 AAAGGGTCATGGIAATGGGCCTGCC 14 A=>T K=>Stop 2930 64.0 None "3 n 21 ACATATATGATATAATTTGATCAGT c-τ Q- ^ Stop 2180 47.5 Physiologic 00 --> o ∞ Table III Seq ID No. Sequence (5'-*3') GG//CC## AAAA CChhaannggee NNAA CChhaannggee AAAA GGeennee -f o 22 ATGGAGGACGTGIGCGGCCGCCTGG 1188 RR==>CC CC==>>TT 111122 AAppoo EE 00 SO 23 GACCTGCAGAAGIGCCTGGCAGTGT 15 R-C C=*T 158 Apo E 24 GACCTGCAGAAGCGCCTGGCAGTGT 16 C- » R T=>C 158 Apo E 25 TAAGGTCAGGAGTJTGAGACCAGCC 13 NA A=*T -491 Apo E 54 GGCGAGGACATGIGCGACCGGGCGC 19 R=»C C= » T 149 Apo Al 55 GAGATGCGCGACIGCGCGCGCGCCC 20 R= C C=*T 151 Apo Al 56 CGCGACCGCGCGIGCGCGCATGTGG 20 R= » C C=>T 153 Apo Al n 57 AGCGACCAGCTGIGCCAGCGCTTGG 17 R= C C→T 171 Apo Al 58 GAGCTGCGCCAGIGCTTGGCCGCGC 19 R-C C= T 1 73 Apo Al n H VO 00 * —- -J © 00

Claims: WE CLAIM 1. A method of reducing LDL in the blood of a subject comprising altering an Apo B gene of a hepatocyte of the subject such that the transcript of the altered Apo B gene contains an in-frame stop codon whereby the altered gene encodes a protein having at least 1433 amino acids and not more than 3974 amino acids. 2. The method of claim 1 , which further comprises the steps of determining the effect on the level of LDL of the alteration of the Apo B genes in the subject and subsequently adjusting the number of altered Apo B genes in the subject. 3. The method of claim 1 , wherein the altered gene encodes a protein having at least 1841 amino acids and not more than 2975 amino acids. 4. The method of any one of claims 1-3, wherein the altered gene encodes a protein having a sequence of a fragment of SEQ ID No. 1 , which fragment is at least amino acids 1-1841 and not more than amino acids 1-2975. 5. The method of any one of claims 1-4 which comprises administering a recombinagenic oligonucleobase which comprises a first and a second homologous region each having a sequence of at least 10 nucleobases selected from nt 4342-1 1913 of SEQ ID No: 2, whereby the alteration of the Apo B gene is effected. 6. The method of any one of claims 1-5, wherein the subject's fasting LDL serum cholesterol is reduced to below 140 mg/dl. 7. A composition for the modification of a human Apo B gene comprising an oligonucleobase which oligonucleobase comprises: a. a first and a second homologous region that are each at least 8 nucleobases in length and together at least 20 nucleobases in length, which homologous regions are each homologous with a fragment of the sequence of nt 5649-9051 of SEQ ID No. 2, and 52 b. a heterologous region that is disposed between the first and second homologous region, such that the introduction of the sequence of the heterologous region into the Apo B gene results in the truncation of the protein encoded thereby. 8. The composition of claim 7, in which the first and the second homologous regions each comprises at least 3 contiguous nucleobase-pairs of hybrid-duplex. 9. The composition of claim 7 or 8, in which the sum of the lengths of the first and second homologous regions is not more than 60 nucleobases in length. 10. The composition of any one of claims 7-9, in which the homologous regions together comprise between 9 and 25 nucleobase pairs of hybrid-duplex. 11. The composition of any one of claims 7-10 , in which the GC fraction of each homologous region is at least 337o. 12. The composition of any one of claims 7-10, in which the GC fraction of a homologous region is at least 507o. 13. The composition of any one of claims 7-10, in which the sequence of the oligonucleobase comprises the sequence of at least a 21 nucleobase fragment of any one of SEQ ID No. 4-21 or the complement thereof. 14. The composition of any one of claims 7-10 , in which the sequence of the oligonucleobase comprises the sequence of at least a 25 nucleobase fragment of any one of SEQ ID No. 4-21 or the complement thereof. 15. The composition of any one of claims 7-14 which further comprises: a. an aqueous carrier; and b. a macromolecular carrier selected from the group consisting of 53 i. an aqueous-cored lipid vesicle, wherein the aqueous core contains the oligonucleobase, ii. a lipid nanosphere, which comprises a lipophilic salt of the oligonucleobase, and iii. a polycation having an average molecular weight of between 500 daltons and 1.3 Md wherein the polycation forms a salt with the oligonucleobase. 16. The composition of claiml 5, in which the macromolecular carrier further comprises a ligand for a clathrin-coated pit receptor. 17. The composition of claiml 6, in which the clathrin-coated pit receptor is selected from the group consisting of the receptors for transferrin, nicotinic acid, camitine, insulin and insulin like growth factor-1. 18. The composition of claim 16, in which the clathrin-coated pit receptor is an asialoglycoprotein receptor. 19. The composition of any one of claims 15-18, in which the macromolecular carrier is a negatively charged, aqueous-cored lipid vesicle. 20. The composition of any one of claimsl 6-18, in which the aqueous-cored lipid vesicle further comprises a cerebroside. 21. The composition of any one of claims 15-20, in which the aqueous-cored lipid vesicle comprises dioleoylphosphatidylcholine and dioleoylphosphatidylserine. 22. The composition of any one of claims 16, 18, 19 and 21 wherein the macromolecular carrier is an aqueous-cored lipid vesicle that comprises a fusigenic F-protein. 54 23. The composition of any one of claims 15-22 , in which the oligonucleobase comprises: a. a first and a second homologous region that are together at least 16 and not more than 60 nucleobases in length, which regions are homologous with a target gene of a mammal; and b. a heterologous region that is disposed between the first and second homologous region and is at least 1 and not more than 20 nucleobases in length, which is heterologous with the target gene and which contains the alteration. 24. A method of treatment and/or prophylaxis in a subject comprising altering an Apo E gene of a hepatocyte of the subject by introducing a substitution selected from the group (Arg→Cys) 112 , (Arg→Cys) 158 and (Cys- Arg) 158 . 25. The method of claim 24, wherein the subject is homozygous for Apo E4 and the alteration comprises the substitution (Arg→Cys) 112 . 26. The method of claim 24 or 25, which comprises administering a chimeric mutational vector having a sequence which comprises SEQ ID No: 22. 27. The method of claim 24, wherein the treatment or prophylaxis comprises reducing the subject's fasting serum LDL cholesterol level and the alteration comprises the substitution (Arg→Cys) 28. The method of claim 24 or 27, which comprises administering a chimeric mutational vector having a sequence which comprises SEQ ID No: 23. 29. The method of claim 24, wherein the subject suffers from Type III hyperlipidemia and the alteration comprises the substitution (Cys→Arg) 55 30. The method of claim 24 or 29, which comprises administering a recombinagenic oligonucleobase having a sequence which comprises SEQ ID No: 24. 31. A composition for the alteration of a human Apo E gene comprising a recombinagenic oligonucleobase having a sequence comprising the sequence of at least a 21 nucleobase fragment of any one of SEQ ID No. 22 - 25 or the complement thereof. 32. A method of ameliorating atherosclerosis in a subject comprising altering an Apo A1 gene of a hepatocyte of the subject such that the altered Apo A1 protein forms dimers. 33. The method of claim 32, which further comprises the steps of determining the effect on the level of HDL of the alteration of the Apo A1 genes in the subject and subsequently adjusting the number of altered Apo A1 genes in the subject. 34. The method of claim 32, wherein the altered gene encodes a protein having a cysteine for arginine substitution at a position selected from the group consisting of residue 149, 151 , 153, 171 and 1 73. 35. The method of claim 34, wherein the method comprises the administration of a recombinagenic oligonucleobase having a sequence comprising the sequence of at least 20 nucleotides of SEQ ID No. 54, No. 55, No. 56, No. 57 and No. 58. 36. The method of claim 35, which comprises the step of administering to the subject a composition comprising: a) the recombinagenic oligonucleobase; b) an aqueous carrier; and c) a macromolecular carrier selected from the group consisting of 56 (i) an aqueous-cored lipid vesicle, wherein the aqueous core contains the oligonucleobase, (ii) a lipid nanosphere, which comprises a lipophilic salt of the oligonucleobase, and (iii) a polycation having an average molecular weight of between 500 daltons and 1.3 Md wherein the polycation forms a salt with the oligonucleobase. 37. The method of claim 36, wherein the macromolecular carrier is a negatively charged, aqueous-cored lipid vesicle. 38. The method of claim 36, wherein the macromolecular carrier further comprises a ligand for a clathrin-coated pit receptor. 39. The method of claim 38, wherein the clathrin-coated pit receptor is an asialoglycoprotein receptor. 40. The method of claim 32, which comprises administering to the subject a composition comprising: a) a recombinagenic oligonucleobase; b) an aqueous carrier; and c) a macromolecular carrier selected from the group consisting of (i) an aqueous-cored lipid vesicle, wherein the aqueous core contains the oligonucleobase, (ii) a lipid nanosphere, which comprises a lipophilic salt of the oligonucleobase, and (iii) a polycation having an average molecular weight of between 500 daltons and 1.3 Md wherein the polycation forms a salt with the oligonucleobase. 41. The method of claim 40, wherein the macromolecular carrier is a negatively charged, aqueous-cored lipid vesicle. 57 42. The method of claim 40, wherein the macromolecular carrier further comprises a ligand for a clathrin-coated pit receptor. 43. The method of claim 42, wherein the clathrin-coated pit receptor is an asialoglycoprotein receptor. 44. A composition for the modification of a human Apo A1 gene comprising an oligonucleobase which oligonucleobase contains a sequence which comprises a fragment having the sequence selected from the group consisting of SEQ ID No. 54, No. 55, No. 56, No.57 and No. 58. 45. The composition of claim 44, which further comprises: a) an aqueous carrier; and b) a macromolecular carrier selected from the group consisting of (i) an aqueous-cored lipid vesicle, wherein the aqueous core contains the oligonucleobase, (ii) a lipid nanosphere, which comprises a lipophilic salt of the oligonucleobase, and (iii) a polycation having an average molecular weight of between 500 daltons and 1 .3 Md wherein the polycation forms a salt with the oligonucleobase. 46. The composition of claim 45, in which the macromolecular carrier further comprises a ligand for a clathrin-coated pit receptor. 47. The composition of claim 46, in which the clathrin-coated pit receptor is selected from the group consisting of the receptors for transferrin, nicotinic acid, carnitine, insulin and insulin like growth factor-1 . 48. The composition of claim 46, in which the clathrin-coated pit receptor is an asialoglycoprotein receptor. 58 49. The composition of any one of claims 45-48, in which the macromolecular carrier is a negatively charged, aqueous-cored lipid vesicle. 50. The composition of any one of claims 46-48, in which the aqueous-cored lipid vesicle further comprises a cerebroside. 51. The composition of any one of claims 45-50, in which the aqueous-cored lipid vesicle comprises dioleoylphosphatidylcholine and dioleoylphosphatidylserine. 52. The composition of any one of claims 46, 48, 49 and 51 wherein the macromolecular carrier is an aqueous-cored lipid vesicle that comprises a fusigenic F-protein. 59

Inventors: BANDYOPADHYAY PARAMITA T, KREN BETSY T, ROY-CHOWDHURY JAYANTA, STEER CLIFFORD J, BANDYOPADHYAY, PARAMITA, T., KREN, BETSY, T., ROY-CHOWDHURY, JAYANTA, STEER, CLIFFORD, J.
Applicants: BANDYOPADHYAY PARAMITA T, EINSTEIN COLL MED, KREN BETSY T, ROY CHOWDHURY JAYANTA, STEER CLIFFORD J, UNIV MINNESOTA, ALBERT EINSTEIN COLLEGE OF MEDICINE OF YESHIVA UNIVERSITY, BANDYOPADHYAY, PARAMITA, T., KREN, BETSY, T., REGENTS OF THE UNIVERSITY OF MINNESOTA, ROY-CHOWDHURY, JAYANTA, STEER, CLIFFORD, J.
Application year: 1998
Main classification: A01N43
IPC codes: A01N43, A61K9, A61K31, A61K47, A61K48, A61P3, C07H21, C12N15, C12Q1