Link: Pharm/Biotech Resources
United States Patent: 6,875,747
Issued: April 5, 2005
Inventors: Iversen; Patrick L. (Corvallis, OR); Mata; John E. (Corvallis, OR); Gattone, II; Vincent H. (Indianapolis, IN)
Assignee: AVI Bio Pharma, Inc. (Corvallis, OR); University of Kansas Medical Center (Kansas City, KS)
Appl. No.: 577250
Filed: May 24, 2000
A method of treating polycystic kidney disease by administering an oligonucleotide antisense to c-myc is described. The antisense oligonucleotide is preferably a morpholino oligonucleotide.
FIELD OF THE INVENTION
The invention relates to a method and antisense conjugate for treatment of Polycystic Kidney Disease (PKD), by administration of an oligomer, antisense to c-myc.
BACKGROUND OF THE INVENTION
Polycystic kidney disease (PKD) is a prevalent inherited disease in humans with a frequency of about 1 in 500. Adult PKD (ADPKD) is an autosomal dominant disorder affecting approximately 500,000 Americans with about 7,000 new patients identified each year. Infants with autosomal recessive (AR) PKD inherit a rapidly developing form, which can lead to renal insufficiency in the neonatal period.
The disease is characterized by the proliferation of epithelial cells, formation of renal cysts, liver cysts, intracranial aneurysm, and progression of renal insufficiency. PKD1, the gene that is mutated in approximately 85% of autosomal dominant polycystic kidney disease (ADPKD) cases in humans, has recently been identified (The European Polycystic Kidney Disease Consortium, 1994). Most mutations identified in affected families appear to be inactivating for the PKD1 and PKD2 genes. Recent evidence has suggested that a two-hit mechanism, in which the normal PKD1 allele is also inactivated, may be required for cyst growth.
The large number of genes showing abnormal expression in cystic kidneys from humans and rodents with PKD suggests that cellular processes associated with signal transduction, transcriptional regulation, and cell-cycle control are involved in cyst formation and that the cellular defect in PKD directly affects the regulation of epithelial differentiation (Calvet, 1998; Torres, 1998).
The role of c-myc in cystogenesis in the kidney and a correlation between high c-myc expression and PKD has been established. Rodent models are available to test possible therapeutic agents for efficacy against PKD (Calvet, 1998). These models take advantage of naturally occurring mutations, which confer the ARPKD and ADPKD phenotypes. The C57BL/6J-cpk/cpk mouse is a model of human ARPKD with similar renal pathology to that observed in human disease.
An approach to treating PKD based on the role of c-myc in the disease would therefore be highly desirable. To minimize complications, this approach should be efficacious in modulating the symptoms of PKD, easy to administer and without significant side effects.
SUMMARY OF THE INVENTION
The present invention addresses one or more of the drawbacks inherent in the prior art by providing methods for treatment of polycystic kidney disease (PKD) by administration of a morpholino-based oligomer, antisense to c-myc, where the oligomer is from 8 to 40 nucleotides in length, and has uncharged, phosphorous-containing intersubunit linkages.
In one embodiment, the intersubunit linkages of the morpholino-based antisense oligomer are selected from the group consisting of the structures presented in FIGS. 3A-A through 3E-E, preferably including the linkage represented at FIG. 3B-B, where X=NH2, Y=O, and Z=O.
In another preferred embodiment, the antisense oligomer has a length of from 12 to 25 bases, preferably having the sequence identified as SEQ ID NO:1.
In the methods of the invention, the antisense oligomer may be administered by injection, transdermal delivery, inhalation, or oral administration, and preferably the latter.
In a further preferred aspect, the subject is a human subject and the c-myc antisense oligomer is administered in a manner effective to reduce or eliminate a detectable symptom of PKD in the subject.
These and other objects and features of the invention will be more fully appreciated in conjunction with the following detailed description of the invention.
DETAILED DESCRIPTION OF THE INVENTION
Polycystic Kidney Disease (PKD)
Polycystic kidney disease (PKD) is a major cause of end stage renal disease in humans. PKD is characterized by severe dilations of collecting ducts and can be inherited as an autosomal dominant (AD) or autosomal recessive (AR) trait. In humans, ADPKD has a later onset and slower progression than ARPKD, which usually affects newborns or young children. ARPKD can cause massive bilateral enlargement of the kidneys. Most individuals surviving the neonatal period eventually develop renal failure.
The human ARPKD gene is located on chromosome 61, but has not yet been cloned. The large number of genes showing abnormal expression in cystic kidneys from humans and rodents with PKD suggests that cellular processes associated with signal transduction, transcriptional regulation, and cell-cycle control are involved in cyst formation and that the cellular defect in PKD directly affects the regulation of epithelial differentiation (Calvet, 1998; Torres, 1998). A model of cyst development has been proposed which involves an autocrine loop where cyst epithelial cells synthesize epidermal growth factor (EGF) which is secreted into cyst lumens activating EGF receptors leading to increased proliferation. The human ADPKD kidney has been shown to overexpress c-myc mRNA (Lanoix et al., 1996).
The proto-oncogene c-myc is thought to act synergistically with EGF to increase proliferation by shortening of the GI phase of the cell cycle following EGF-- induced cell growth (Nass and Dickson, 1998).
It has been demonstrated that overexpression of c-myc in transgenic mice causes a greater than 4-fold increase in the expression of hepatic EGF receptors which is consistent with the hypothesis that proliferation increases with greater triggering of the EGF receptor signaling cascade (Woitach et al., 1997). This pathway for aberrant proliferation of hepatocytes may be similar in human cyst epithelium where overexpression of EGF and EGF receptors have been described for cyst-lining epithelial cells (Klingel et al., 1991).
A. Rodent Models of PKD
The C57BL/6J mouse homozygous for the congenital polycystic kidney (cpk) gene mutation is one of the most widely utilized models of ARPKD (Gattone, V. H. et al., 1988).
While the cpk gene is not analogous to the human ARPKD gene, the PKD in this well characterized mouse model exhibits bilateral renal cysts in a pattern very similar to human ARPKD. The collecting duct cysts are the predominant pathology and replace the normal renal parenchyma leading to morbid urea by four to five weeks of age.
The c-myc gene, located on mouse chromosome 15, encodes 64 to 67 kDa proteins containing domains that function in nuclear localization, non-specific and sequence-specific DNA binding, and oligomerization (Thompson, E. B., 1998). C-myc functions as a transcription factor which dimerizes with other proteins and binds DNA (Ryan, K. M. and Birnie, G. D., 1996). These heterodimeric DNA-binding complexes both activate and repress transcription of a number of genes (Hoang, A. T. et al., 1994). Increased expression of c-myc is seen in proliferating cells and regulates cell growth, transformation, inhibition of differentiation, and apoptosis (Thompson, E. B., 1998; Ryan, K. M. and Birnie, G. D., 1996).
C57BL/6J-cpk/cpk mice have previously been shown to overexpress renal c-myc mRNA (Cowley, B. D. et al., Proc. Natl. Acad. Sci. USA 84, 8394-8398, 1987; Cowley, B. D. et al., J Am Soc Nephrol, 1048-1053, 1991). The c-myc mRNA is overexpressed in epithelia from cystic as well as normal sized tubules. Renal c-myc mRNA is also overexpressed in other rodent models of PKD such as Han:SPRD-coy/cy rats, CD-1-pcy/pcy mice, and Balb-c-cpk/cpk mice. Mice that overexpress a c-myc transgene have been observed to develop PKD and die of renal failure by six weeks to three months of age (Trudel, M. et al., Kidney Int 39:665-671, 1991; Trudel, M. et al., Am J Pathol 152:219-229, 1998).
In addition, mice which have been genetically engineered to overexpress genes involved in signal transduction, cell cycle control or cellular differentiation through insertion of genes driven by active promoters often produce the PKD phenotype. For example overexpression of c-erbB-2 (Stocklin et al., 1993), c-myc (Barisoni et al., 1995), human growth hormone (hGH) (Wanke et al., 1991), human keratinocyte growth factor (hKGF) (Nguyen et al., 1996), H-rasT24 (Schaffner et al., 1993), Pax-2 (Dressier et al., 1993) and TGF-.alpha. (Lowden et al., 1994) produce renal cysts in the mouse. While PKD in the rodent appears to be genetically complicated there is reason to believe that disregulation of c-myc expression is a primary factor in the pathogenesis of PKD. ADPKD has been produced in transgenic mice bearing the murine c-myc gene driven by the SV40 enhancer and the adult beta-globin promoter producing the SBM mouse. These mice develop PKD and die of renal failure which appears to result from the overexpression of c-myc in the renal tubular epithelium leading to abnormal cell proliferation and cystogenesis (Barisoni, et al., 1995). It has been observed that in the course of continuous breeding, such transgenic lines undergo spontaneous transgene mutations characterized by partial deletion and probable rearrangement of the transgene insert, and that revertant mice and their progeny have no evidence of the disease suggesting the overexpression of c-myc is integral to the PKD phenotype in the SBM mice (Trudel et al., 1994).
Rodent models which are available to test possible therapeutic agents against PKD take advantage of naturally occurring mutations which confer the ARPKD and ADPKD phenotypes. The increase in c-myc associated with PKD was first observed in kidneys from the C57BL/6J-cpk mouse model of autosomal recessive or infantile-type PKD (Cowley et al., 1989). Recently, several investigators have backbred the cpk gene onto other mouse strains (Gattone et al., 1996).
A Balb-c model with the cpk mutation has both renal and extrarenal pathology which are similar to human ARPKD. This model allows an assessment of the effect of treatment on renal as well as extrarenal pathology. Models of slowly progressive PKD similar to human ADPKD, the more common adult onset form of the disease, include a rat model of ADPKD the Han: SPRD cy/+rat which also overexpresses c-myc (Cowley et al., 1993), which has also been used extensively to evaluate treatment approaches (Cowley et al., 1997).
B. The Role of c-myc in PKD.
Renal c-myc mRNA is overexpressed in many animal models of PKD (Trudel, M. et al., Am J Pathol 152:219-229, 1998; Gattone, V. H. et al., J Lab Clin Med 12 7:214-222, 1996). In the kidney, c-myc plays an important role in both apoptosis (Lanoix et al., Oncogene 13:1153-1160, 1996; Sakamuro, D. et al. Oncogene 11:2411-2418, 1995; Trudel, M. et al., J Exp Med 18 (6)1873-1884, 1997; Zhan, Y. et al., Mol Cell Biol 17:6755-6764, 1997), and proliferation (Lanoix et al., Oncogene 13:1153-1160, 1996; Zhan, Y. et al., Mol Cell Biol 17:6755-6764, 1997). In vitro, overexpression of c-myc promotes proliferation of cells in the presence of normal serum, but leads to apoptosis of cells in the absence of growth factors (Thompson, E. B., Annu Rev Physiol 60, 575-600, 1998). Therefore, c-myc antisense oligonucleotide (ASO) treatment has been proposed as a strategy to decrease cellular proliferation and/or apoptosis, which appear to play a role in PKD initiation and progression (Grantham, JJ et al., Kidney Int 31:1145-1152, 1987; Woo, D., N EngI J Med 333:1825, 1995).
Trudel et al., 1994, further characterized the influence of c-myc in the regulation of apoptosis through pathways involving p53 and members of the bcl-2 family, which induce and inhibit apoptosis, respectively. The SBM kidney tissues, which overexpress c-myc, displayed a markedly elevated (10-100 fold) apoptotic index while no significant difference in bcl-2, bax, or p53 expression was observed compared with control kidney tissue. Successive matings between SBM and p53(-/-) mice provided direct proof that the heightened renal cellular apoptosis in PKD is not occurring through p53. All SBM offspring, irrespective of their p53 genotype, developed PKD with increased renal epithelial apoptotic index. It was further observed that overexpression of both bcl-2 and c-myc in double transgenic mice (SBB+/SBM+) produced a similar PKD phenotype with a high apoptotic rate, showing that c-myc can bypass bcl-2 in vivo, suggesting that the in vivo c-myc apoptotic pathway in SBM mice occurs through a p53- and bcl-2-independent mechanism (Trudel et al., 1997).
Human ADPKD exhibits abnormal expression of proto-oncogenes with renal c-myc expression consistently elevated, as much as 15-fold. High levels of c-myc expression have been correlated with a 10- to 100-fold increased proliferation index in cystic epithelium. In addition, in the human disease, increased apoptosis has been observed in ADPKD kidneys even though steady-state levels of bcl-2 mRNA were increased up to 20-fold and Bcl-2 protein was markedly elevated with expression of bax and p53 virtually unchanged. Consistent with these observations are results from studies in SBM mice wherein proliferation and apoptosis required for normal kidney homeostasis are deregulated in ADPKD, recapitulating the renal developmental program in epithelial cells which leads to cystogenesis (Lanoix et al., 1996).
III. Methods of the Invention
The invention provides a method of treating PKD by administering to a subject, an oligomer antisense to c-myc. The invention is based on the discovery that a nuclease-resistant oligonucleotide, capable of binding with high affinity to a complementary or near-complementary c-myc sequence, can be administered to a subject, and subsequently modulate expression of c-myc in vivo in the subject, without adverse side effects. The lack of toxicity and the kidney specific modulation of epithelial proliferation following administration of an oligomer antisense to c-myc, to a subject, was not predictable based on the prior art.
Although the mechanism underlying the discovery is not part of the claimed invention, the discovery does suggest that the administered antisense oligomer is able to (i) migrate to and enter cells in the body, (ii) bind with high-affinity by Watson-Crick base pairing to complementary or near-complementary target regions of the c-myc sequence, to form a heteroduplex in the target region in the RNA, and (iii) modulate the effects of c-myc expression on epithelial proliferation, such as that observed in PKD.
A. Antisense Oligomers
Antisense oligonucleotides bind to complementary sequences, e.g., mRNA and specifically prevent nucleic acid translation, thereby disrupting gene function (Haller, H. et al., Kidney Int 53:1550-1558, 1998; Gewirtz, A. M., Oncogene 18:3056-3062, 1999). Although a number of human clinical trials are currently underway (Agrawal, S. and Zhao, Q., Curr Opin Chem Biol 2:519-528, 1998), inhibition of gene expression by ASOs has been challenging (Flanagan, W. M., Cancer Metastasis Rev 17:169-176, 1998). Inadequate specificity, ineffective delivery, instability, and unpredictable activity in cells are among the problems that have been associated with treatments involving ASO technology (Summerton, J. and Weller, D., Antisense Nucleic Acid Drug Dev 7:187-195, 1997).
C-myc ASOs have been shown to effectively inhibit c-myc induced proliferation of renal epithelial cells (Koul, H. et al. Kidney Int 50:1525-1530, 1996) as well as proliferation of chronic myelogenous leukemia cells (Skorski, T. et al., Blood 88:1005-1012, 1996) in vitro. In vivo, neointimal proliferation in injured arteries has also been demonstrated by c-myc ASO treatment (Oberbauer, R. et al., Kidney Blood Press Res 19:221-224, 1996).
Antisense technology has recently been applied to renal conditions: rats treated with ICAM-1 ASOs have exhibited reduced renal inflammation and improved renal function following anoxia reperfusion injury (Haller, H. etal., Kidney Int 53:1550-1558, 1998). It has also been demonstrated that proximal tubule cells in the kidney have the capacity to efficiently take up circulating oligonucleotides without degrading them (Rappaport, J. et al., Kidney Int 47:1462-1469, 1995).
Antisense oligonucleotides have been developed as structural DNA mimics (Nielsen, P. E., Annu Rev Biophys Biomol Struct 24:167-183, 1995), which are capable of sequence specific gene inhibition in vitro (Summerton, J. et al., Antisense Nucleic Acid Drug Dev 7:63-70, 1997; Taylor, M. F. et al., Cytokine 9:672-681, 1997; Taylor, M. F. et al., Nucleic Acid Drug Dev 8:199-205, 1998). These ASOs have a morpholino backbone giving them a neutral charge, high water solubility (Summerton, J. and Weller, D., Antisense Nucleic Acid Drug Dev 7:187-195, 1997), and resistance to nucleases (Wages, J. M. et al., BioTechniques 23:1116-1121, 1997).
Antisense oligomers for use in the methods of the invention preferably have one or more properties including: (1) a backbone which is uncharged (e.g., Uhlmann, et al., 1990), (2) the ability to hybridize with the complementary sequence of a target RNA with high affinity, that is, at a Tm substantially greater than 37oC., (3) a subunit length of at least 8 bases, generally about 8-40 bases, preferably 12-25 bases, and (4) nuclease resistance (Hudziak, et al., 1996).
Nuclease-resistant antisense oligomers which may find utility in the methods of the invention are oligonucleotide analogs, such as morpholino, methyl-phosphonate and peptide oligonucleotides, which have uncharged backbones. (See, for example, Uhlmann, et al., 1990).
Preferred antisense oligomers are nuclease-resistant oligomers with uncharged backbones, and particularly morpholino oligomers having, in addition to a base sequence complementary to a region of a selected RNA target sequence, an oligomer backbone, defined by the oligomer subunits and linkages, that allow the oligomer to bind to the target RNA sequence by Watson-Crick base pairing between complementary bases in the target RNA and the oligomer. The synthesis, structures, and binding characteristics of morpholino oligomers are detailed in above-cited U.S. Pat. Nos. 5,698,685, 5,217,866, 5,142,047, 5,034,506, 5,166,315, 5,521,063, and 5,506,337, all of which are incorporated herein by reference.
Although double-stranded DNA may be targeted by antisense molecules, in general the target for modulation of gene expression using the antisense methods of the present invention comprises a sequence spanning the mRNA translational start codon for c-myc. However, in some cases, other regions of the c-myc mRNA may be targeted, including one or more of, an initiator or promoter site, an intron or exon junction site, a 3'-untranslated region, and a 5'-untranslated region. In addition, both spliced and unspliced RNA may serve as the template for design of antisense oligomers for use in the methods of the invention.
In the methods of the invention, the antisense oligomer is designed to hybridize to a region of the c-myc nucleic acid sequence, under physiological conditions with a Tm substantially greater than 37oC., e.g., at least 50oC. and preferably 60oC.-80oC. The oligomer is designed to have high-binding affinity to the nucleic acid and may be 100% complementary to the c-myc target sequence, or may include mismatches, e.g., to accommodate allelic variants, as long as the heteroduplex formed between the oligomer and c-myc target sequence is sufficiently stable to withstand the action of cellular nucleases and other modes of degradation during its transit from cell to body fluid. Mismatches, if present, are less destabilizing toward the end regions of the hybrid duplex than in the middle. The number of mismatches allowed will depend on the length of the oligomer, the percentage of G:C base pair in the duplex and the position of the mismatch(es) in the duplex, according to well understood principles of duplex stability.
Antisense oligonucleotides of 15-20 bases are usually long enough to have one complementary sequence in the mammalian genome. In addition, antisense compounds having a length of at least 17 nucleotides in length hybridize well with their target mRNA (Cohen, et al., 1991).
It will be appreciated that although such an antisense oligomer is not necessarily 100% complementary to the c-myc target sequence, it is effective to stably and specifically bind to the target sequence such that expression of c-myc is modulated. The appropriate length of the oligomer to allow stable, effective binding combined with good specificity is about 8-40 nucleotide base units, and preferably about 12-25 nucleotides. Oligomer bases that allow degenerate base pairing with target bases are also contemplated, assuming base-pair specificity with the target is maintained.
Candidate antisense oligomers are evaluated, according to well known methods, for acute and chronic cellular toxicity, such as the effect on protein and DNA synthesis as measured via incorporation of 3 H-leucine and 3 H-thymidine, respectively. In addition, various control oligonucleotides, e.g., control oligonucleotides such as sense, nonsense or scrambled antisense sequences, or sequences containing mismatched bases may be evaluated, in order to confirm the specificity of binding of candidate antisense oligomers. The outcome of such tests are important to discern specific effects of antisense inhibition of gene expression from indiscriminate suppression. (See, e.g. Bennett, et al., 1995). Accordingly, sequences may be modified as needed to limit non-specific binding of antisense oligomers to non-target sequences.
It is generally desirable that non-specific binding of the oligomeric molecule t6 non-target sequences be limited. Although some non-sequence-specific interactions of such oligomers may show therapeutic effects (e.g. Anderson, K. P., et al., 1996), such interactions often produce unwanted side effects. To test for non-specific binding, control sequences such as sense or nonsense sequences, or sequences containing mismatched bases, may be included in preliminary screening tests (in vitro). Excess targeted protein or mRNA may also be added to the cell culture to see if the effect of the antisense oligomer is reversed (Bennett, M. R., et al., 1995).
Additional sequences may be prepared by one of skill in the art, having in mind one or more desired target sequences, with screening carried out according to methods routinely employed by those of skill in the art.
The effectiveness of a given oligomer molecule in forming a heteroduplex with the target RNA may be determined by screening methods known in the art. For example, the oligomer is incubated in vitro with cells that express c-myc, and the presence or absence of a heteroduplex detected using procedures known to those of skill in the art, or the presence or absence of the encoded protein determined by standard techniques such as ELISA or Western blotting (see, for example, Pari, G. S. et al., 1995; Anderson, K. P., et al., 1996). It is generally desirable that non-specific binding of the oligomeric molecule to non-target sequences is limited.
As noted above, the antisense oligomer should have a high affinity for its target sequence. In this regard, morpholino oligomers, such as illustrated below, afford exceptional target binding affinity, especially for RNA targets. They are also highly resistant to degradation by nucleases (Hudziak, R. M., et al., 1996). These compounds are composed of morpholino subunit structures of the form shown in FIGS. 2A-E and 3AA-EE and in the above cited patents, where (i) the morpholino groups are linked together by preferably uncharged linkages, one to three atoms long, joining the morpholino nitrogen of one subunit to the 5' exocyclic carbon of an adjacent subunit, and (ii) the base attached to the morpholino group is a purine or pyrimidine base-pairing moiety effective to bind, by base-specific hydrogen bonding, to a base in a polynucleotide. The purine or pyrimidine base-pairing moiety is typically adenine, cytosine, guanine, uracil or thymine. Preparation of such oligomers is described in detail in U.S. Pat. No. 5,185,444 (Summerton and Weller, 1993), which is hereby incorporated by reference in its entirety. As shown in this reference, several types of nonionic linkages may be used to construct a morpholino backbone.
Although targeting of a messenger RNA sequence is preferred, double-stranded DNA may be targeted by using a non-ionic probe designed for sequence-specific binding to major-groove sites in duplex DNA. Such probe types are described in U.S. Pat. No. 5,166,315 (Summerton and Weller, 1992), which is hereby incorporated by reference, and are also generally referred to herein as antisense oligomers, referring to their ability to block expression of target genes.
Morpholino oligomers can be linked in a polymeric form by stable, uncharged backbone linkages, and can hybridize with a complementary-base target nucleic acid, including target RNA, with high affinity. This combination of properties, which is related to subunit coupling through each morpholino subunit's ring nitrogen, is not found in natural polynucleotides or in polynucleotides containing various charged or uncharged linkages or in polynucleotides containing "one or more" analogs of naturally occurring nucleotides.
A preferred antisense oligomer for use in the methods of the invention has the sequence presented as 5'-ACG TTG AGG GGC ATC GTC GC-3' (oligonucleotide 1-22-126; SEQ ID NO:1).
B. In vivo Administration of Antisense Oligomers.
Effective delivery of the antisense oligomer to the target RNA is an important aspect of the methods of the invention. In accordance with the invention, such routes of antisense oligomer delivery include, but are not limited to, various systemic routes, including oral and parenteral routes, e.g., intravenous, subcutaneous, intraperitoneal, and intramuscular, as well as inhalation and transdermal delivery.
It is appreciated that any methods which are effective to deliver the c-myc antisense oligomer to the target cells or to introduce the drug into the bloodstream are also contemplated.
Transdermal delivery of antisense oligomers may be accomplished by use of a pharmaceutically acceptable carrier adapted for e.g., topical administration. One example of morpholino oligomer delivery is described in PCT patent application WO 97/40854, incorporated herein by reference.
In one preferred embodiment, the oligomer is a morpholino oligomer, contained in a pharmaceutically acceptable carrier, and delivered orally. In a further aspect of this embodiment, a morpholino c-myc antisense oligonucleotide is administered at regular intervals for a short time period, e.g., daily for two weeks or less. However, in some cases the antisense oligomer is administered intermittently over a longer period of time.
Typically, one or more doses of antisense oligomer are administered, generally at regular intervals for a period of about one to two weeks. Preferred doses for oral administration are from about 1 mg oligomer/patient to about 25 mg oligomer/patient (based on an adult weight of 70 kg). In some cases, doses of greater than 25 mg oligomer/patient may be necessary. For IV administration, the preferred doses are from about 0.5 mg oligomer/patient to about 10 mg oligomer/patient (based on an adult weight of 70 kg).
The antisense compound is generally administered in an amount sufficient to result in a peak blood concentration of at least 200-400 nM c-myc antisense oligomer.
In general, the method comprises administering to a subject, in a suitable pharmaceutical carrier, an amount of an antisense agent effective to inhibit expression of the c-myc nucleic acid sequence in vivo in the kidney.
It follows that the antisense oligonucleotide composition may be administered in any convenient vehicle, which is physiologically acceptable. Such an oligonucleotide composition may include any of a variety of standard physiologically acceptable carrier employed by those of ordinary skill in the art. Examples of such pharmaceutical carriers include, but are not limited to, saline, phosphate buffered saline (PBS), water, aqueous ethanol, emulsions such as oil/water emulsions, triglyceride emulsions, wetting agents, tablets and capsules. It will be understood that the choice of suitable physiologically acceptable carrier will vary dependent upon the chosen mode of administration.
In some instances liposomes may be employed to facilitate uptake of the antisense oligonucleotide into cells. (See, e.g., Williams, 1996; Lappalainen, et al., 1994; Uhlmann, et al., 1990; Gregoriadis, 1979.) Hydrogels may also be used as vehicles for antisense oligomer administration, for example, as described in WO 93/01286. Alternatively, the oligonucleotides may be administered in microspheres or microparticles. (See, e.g., Wu and Wu, 1987).
Sustained release compositions are also contemplated within the scope of this application. These may include semipermeable polymeric matrices in the form of shaped articles such as films or microcapsules.
In preferred applications of the method, the subject is a human subject, previously diagnosed as having PKD or at risk for developing PKD.
It will be understood that the effective in vivo dose of the c-myc antisense oligonucleotides for use in the methods of the invention will vary according to the frequency and route of administration as well as the condition of the subject under treatment. Accordingly, such in vivo therapy will generally require monitoring by tests appropriate to the condition being treated and a corresponding adjustment in the dose or treatment regimen in order to achieve an optimal therapeutic outcome.
It will further be appreciated that the use of a c-myc antisense oligonucleotide to treat PKD may be used following, concurrently with and/or prior to additional therapeutic intervention, e.g., using a therapeutic approach typically used by those of skill in the art to treat PKD.
C. Monitoring Treatment.
The efficacy of a given therapeutic regimen involving the methods described herein, may be monitored by one or more of (1) histology or immunohistology, by staining kidney cells or tissue sections to evaluate the status of the kidney, e.g., with monoclonal or polyclonal antibodies to c-myc; (2) analysis of RNA to quantitate the transcription of c-myc or another mRNA, e.g., by dot blot, Northern blot or RT-PCR (reverse transcriptase polymerase chain reaction); (3) in situ hybridization, e.g., using c-myc as a probe; (4) western blot analysis; (5) a determination of total body weight, total kidney weight and kidney weight as a percent of body weight; (6) a determination of serum urea nitrogen (SU4), as an indicator of kidney function; (7) hematocrit; and (8) detection of cysts, e.g., by ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI). Numerous example of such methods are generally known in the art, some of which are further described below.
The antisense oligomer treatment regimen may be adjusted (dose, frequency, route, etc.), as indicated, based on the results of the various assays described above.
Additional information relevant to treatment with c-myc antisense oligonucleotides may be obtained by one or more of: (1) extraction and analysis of c-myc ASO levels in various tissues; (2) a determination of epidermal growth factor (EGF) expression, typically highly expressed in normal kidney, the expression of which is significantly diminished in cystic kidney; (3) evaluation of the expression of SGP-2, a marker of immature collecting ducts, typically overexpressed in cystic versus normal kidney; and (4) evaluation of the expression of renal proliferating cell nuclear antigen (PCNA), a marker of cell proliferation.
Claim 1 of 7 Claims
What is claimed is:
1. A method of treating polycystic kidney disease (PKD) in a human or murine subject, comprising:
administering to the subject a morpholino-based antisense oligomer having uncharged, phosphorous-containing intersubunit linkages, where the antisense oligomer contains the sequence identified as SEQ ID NO:1.