Epilepsy is a medical condition characterized by abnormal, uncontrolled electrical activity in the brain resulting in seizures. The seizures may be recurrent and unprovoked. In addition, the seizures may produce mild, episodic loss of attention or sleepiness, or severe convulsions with loss of consciousness. Accordingly, epileptic seizures may be disruptive and dangerous.
Drugs are available for treating epilepsy. However, the drugs are not effective in eliminating seizures for a substantial fraction of epilepsy patients. Epilepsy thus remains a major health problem.
Adenosine is an inhibitory substance in the brain with a potential role in preventing seizures. However, systemic administration of adenosine may produce strong side effects. Therefore, approaches to local and/or regional adenosine delivery are needed.
The present teachings provide a system, including methods and compositions, for treating medical conditions via adenosine therapy with interfering RNA that selectively inhibits adenosine metabolism.
The present teachings provide a system, including methods and compositions, for treating medical conditions via adenosine therapy with interfering RNA that selectively inhibits adenosine metabolism. The interfering RNA may be double-stranded, such as a small interfering RNA (siRNA), or single-stranded, such as a short hairpin RNA (shRNA) or a microRNA (miRNA). In addition, the interfering RNA may be configured to selectively inhibit production of the metabolic enzymes adenosine kinase, adenosine deaminase, or both, to increase a level of adenosine in a recipient of the interfering RNA, such as for treatment and/or prevention of epilepsy. Overall, the systems of the present teachings may provide various advantages, such as better selectivity, fewer side effects, improved local/regional targeting, and/or greater effectiveness for treating medical conditions characterized by an adenosine imbalance.
The method may include selecting a subject for treatment, indicated at 22. The subject may have a local, regional, and/or global adenosine imbalance and may have a medical condition, such as epilepsy, stroke, or brain trauma, among others, that is responsive to adenosine therapy. Further aspects of subject selection are described below in Section I.
The method also may include delivering an effective amount of an interfering RNA to the subject, indicated at 24. The interfering RNA may be configured to selectively inhibit expression of an enzyme for adenosine modification, particularly, adenosine kinase and/or adenosine deaminase. Further aspects of interfering RNA are described elsewhere in the present teachings, for example, in Section II.
Further aspects of the present teachings are described in the following sections, including (I) subject selection, (II) interfering RNA, (Ill) delivery of interfering RNA, and (IV) examples.
The present teachings involve selection of a subject for treatment via adenosine therapy. A “subject,” as used herein, generally includes any organism or creature selected for delivery of interfering RNA. The subject may be a person (i.e., a human subject), a mammal, a vertebrate animal, and/or the like.
The subject may be selected based on any suitable criteria. For example, the subject may be selected based on a current medical condition(s), a history of one or more past medical conditions, and/or a probability of a future medical condition(s) (e.g., predicted based on a current or previous health condition, genetic testing, a family medical history, etc.), among others. The medical condition may affect the brain and/or nervous system directly and/or other tissues, such as one or more tissues of the cardiovascular system, respiratory system, skeletomuscular system, digestive system, immune system, endocrine system, and/or the like. Exemplary current, past, and/or predicted future medical conditions that may warrant selection of a subject for treatment include any medical condition characterized by a local, regional, and/or systemic adenosine imbalance and/or responsive to a change in local, regional, and/or systemic adenosine levels. These exemplary medical conditions may be, for example, epilepsy (including any type of brain seizure), stroke, brain trauma, ischemia (e.g., cardiac, neural (such as brain), muscular, and/or intestinal ischemia), chronic pain, multiple sclerosis, and/or glaucoma, among others. The subject also may be selected for treatment (or may be declined treatment), at least in part, based on age, gender, general health and other heath factors, and/or the like.
Selecting, as used herein, refers to any approach by which a subject is identified, recruited, and/or obtained for treatment. Selection may be performed by any suitable person(s), establishment, and/or mechanism. For example, the selection may be performed by a health practitioner (or a group of practitioners), the staff of a medical facility, by the subject (e.g., self-referral or for self-treatment), by a data processor (e.g., selection by computer), and/or a combination thereof.
Treatment of a selected subject may be performed for any suitable purpose relative to the medical condition. For example, treatment may be intended to alleviate, stabilize, or remove (e.g., cure) the medical condition. Alternatively, or in addition, the treatment may be intended to prevent (i.e., to avoid or alleviate) a consequent condition that may result from the medical condition, such as to prevent the development of epilepsy (i.e., to prevent epileptogenesis) that may follow another brain condition (such as stroke or traumatic brain injury, among others).
The present teachings involve delivery of interfering RNA to a subject. The term “interfering RNA,” as used herein, generally includes any molecule or complex including a polyribonucleotide (“an RNA”) that interferes selectively with (i.e., selectively inhibits) expression of a target gene or a set of target genes.
Inhibition of expression generally includes any mechanism that results in decreased levels of mRNA and/or protein encoded by the target gene or set of target genes. Accordingly, the inhibition may occur by any suitable mechanism, including an effect on (1) transcription (e.g., a change in the rate of initiation, elongation, termination, and/or the like), (2) RNA processing (e.g., a change in the efficiency or mode of splicing, polyadenylation, base modification, cleavage, ligation, complex formation, etc.), (3) RNA transport and/or subcellular localization, (4) RNA stability, (5) translation of mRNA to protein (e.g., a change in the frequency or rate of translational initiation, elongation, and/or termination), (6) protein stability, and/or (7) posttranslational protein processing, among others. However, in exemplary embodiments, the interfering RNA may function at least in part by a phenomenon referred to as “RNA interference.” For example, the interfering RNA may function with an RNA-Induced Silencing Complex (RISC) to facilitate selective effects on transcription, mRNA stability, and/or translation. Nevertheless, the mechanistic details of how the interfering RNA accomplishes its selective inhibition should not be construed as limiting the scope of the present teachings.
The interfering RNA may have any suitable structure. In some embodiments, the interfering RNA may have an engineered structure. A structure that is “engineered,” as used herein, refers to any structure that does not occur naturally (i.e., an artificial structure). The structure may be a primary structure, such as a sequence or chemical structure that is at least partially artificial, that is, not found in nature. Alternatively, or in addition, the engineered structure may be a secondary structure, such as a hairpin structure. An engineered hairpin structure is thus any hairpin structure created by artificial juxtaposition of sequences that are not normally juxtaposed in nature. For example, a sequence region may be juxtaposed to a spacer (a loop) and a perfect or imperfect inverted repeat of the sequence region to create an engineered hairpin structure. Engineered structures may be formed initially by, for example, chemical synthesis, enzyme activity (e.g., cleavage, ligation, and/or recombination), mutation, and/or the like.
The interfering RNA may be a single strand, a double strand, a triple strand, etc. The term “strand,” as used herein, refers to a polymer of nucleotide subunits covalently linked to one another, in a linear (or branched) arrangement. The polymer may have any suitable number of nucleotide subunits, generally at least about ten, fifteen, or twenty, to provide some degree of target selectivity and/or to facilitate inhibition by RNA interference. The nucleotide subunits of a strand may be ribonucleotide subunits only (i.e., adenosine, cytidine, guanosine, and/or uridine). Alternatively, the nucleotide subunits of a strand may include ribonucleotide subunits plus one or more other subunits (e.g., a dexoribonucleotide subunit(s) (such as deoxyadenosine, dexoycytidine, deoxyguanosine, and/or deoxythymidine), a nucleotide subunit(s) including a base analog, a modified backbone region, a nucleotide subunit including a nonribose sugar, and/or the like). In some embodiments, the strand may have a core of contiguous ribonucleotide subunits (a RNA portion) and one or more non-RNA portions disposed internally and/or at one or more end regions and formed by another type of subunit (e.g., see Examples 2 and 3). The non-RNA portion of a strand may be a fraction or a majority of the strand.
A strand of an interfering RNA may have any suitable overall maximum length. In some embodiments, the strand may form a hairpin structure (e.g., a shRNA) and may, for example, be less than about one-hundred nucleotides or about forty to seventy nucleotides in length. In some embodiments, the strand may form a duplex (e.g., a siRNA) with a complementary strand and may, for example, be less than about thirty or twenty-five nucleotides in length.
A strand(s) of an interfering RNA may have one or more targeting portions (also termed selectivity regions) corresponding to a target region of a target gene (and/or target RNA), such that the targeting portion has a substantial or perfect identity or complementarity with the target region (with the U of RNA and the T of DNA being considered equal). The targeting portion thus may correspond perfectly to the target region and/or may include one or more deviations from perfect correspondence (e.g., mismatches when base-paired to the target region or its complement). In any case, the targeting portion should have sufficient identity or complementarity to achieve selective targeting for a therapeutic effect, generally at least about 90% identity or complementarity.
The targeting portion may have any suitable properties. The length of the targeting portion may be at least about ten or fifteen nucleotides in length. In exemplary embodiments, the targeting portion may be about 16 to 25 nucleotides or about 19 to 21 nucleotides in length. The targeting portion may be directed to any suitable portion of a gene or gene transcript. If directed against a gene transcript (e.g., a mRNA), the targeting portion may be directed to a 5′ untranslated target region, a target region in an open reading frame, and/or a 3′ untranslated target region, among others, of the gene transcript. A target region within an open reading frame may be in any suitable position relative to an initiator codon thereof, such as within about 200 or 500 nucleotides, among others.
In some examples, a strand of an interfering RNA may have a complementary pair of regions to form an intra-strand stem. In some embodiments, the intra-strand stem may include at least a majority or all of the targeting portion of the interfering RNA. The intra-strand stem may have any suitable length, such as about fifteen to thirty base pairs or about twenty base pairs. Furthermore, the intra-strand stem may have no mismatches or may have one or more mismatches. In some embodiments, the stem may include at least about eight, ten, twelve, or fifteen contiguous base pairs. Formation of an intra-strand stem may create an internal loop adjacent the stem. The loop may have any suitable length, such as about 1 to 100, 2 to 20, 3 to 15, or 4 to 10 nucleotides, among others.
The hairpin structure (stem plus loop) of an interfering RNA may represent any suitable nucleotide portion of the interfering RNA. For example, the stem and/or the stem and loop collectively may represent a major portion of the interfering RNA, and thus may be formed by at least about one-half of the nucleotides of the interfering RNA.
The present teachings involve delivery of interfering RNA to a subject. The terms “deliver” and “delivery,” as used herein, refer to any process or mechanism that causes an interfering RNA to be present (or elevated) in the subject. Delivery may be by administration of an interfering-RNA medicament, that is, administration of the interfering RNA itself to a subject and/or by administration to the subject of an agent that directs production of the interfering RNA (e.g., before, during, and/or after administration).
The terms “administer” and “administration,” as used herein, refer to any process or mechanism that results in application and/or exposure of a medicament to a subject. Administration may be by any suitable route into the body, such as through the skin and/or mucosa (e.g., through the lining of the mucosa of the nose, mouth, throat, lungs, gastrointestinal system, etc.). Exemplary routes through the skin may include absorption (e.g., topical application to provide percutaneous entry) or injection (such as intracerebrally (i.e., into the brain), subcutaneously, intramuscularly, intrathecally, intradermally, intravenously, intra-arterially, intrathoracically, epidurally, intraperitoneally, intraocularly, and/or the like). Injection may be via penetration of the skin with a conduit (such as a needle or other cannula), pressurized fluid (e.g., needleless/jet injection), and/or projectiles (e.g., by firing particles carrying the medicament at the skin). Exemplary routes through the mucosa may include inhalation (e.g., from an inhaler, nebulizer, atomizer, etc.) and/or oral intake.
Administration may be directed to the brain of the subject. Exemplary modes of brain administration may include stereotaxic injections, application during open brain surgery, application by intracerebral pump systems, administration by local implants of encapsulated cells, and/or the like.
Administration may provide relatively long term or relatively short term delivery of interfering RNA. Relatively long term delivery of interfering RNA may be sustained over the course of at least about one week, one month, one year, or longer, to provide relatively permanent down-regulation of an enzyme of adenosine metabolism. Such sustained delivery may be provided, for example, by expression from an administered agent (e.g., a virus or cells) by sustained release of interfering RNA from a pump system or a slow-release matrix. Relatively short term delivery may be sustained for less than about one week or less than about one day, among others, to provide transient down-regulation of an enzyme of adenosine metabolism. Transient down-regulation might be beneficial during, for example, surgery, such as to protect the brain from ischemic insults during heart surgery. In these cases, interfering RNA may be administered in a “naked” form, may be released from a fast-release matrix, and/or from a pump system, among others.
The medicament, whether including an interfering RNA or an agent therefor, may be administered in any suitable vehicle. The vehicle may include a fluid carrier, such as a physiologically buffered solution, a saline solution, and/or a medium (such as a culture medium for cells). The fluid carrier may function to dissolve (as a solvent), dilute (as a diluent), suspend, disperse, keep alive (for cells), and/or propel, among others, the interfering RNA/agent and/or other components of the vehicle. For example, the vehicle also may include a penetration enhancer that facilitates binding and/or uptake of the interfering RNA or agent by the tissue/cells of a subject. Exemplary penetration enhancers may include a lipid, particles, beads, a precipitate, a transported peptide or protein, an organic liquid (e.g., dimethylsulfoxide, ethanol, isopropyl alcohol, etc.), an amphiphile (such as a surfactant, fatty acid, fatty ester, etc.), a dendrimer, and/or the like. One or more other components of the vehicle may perform any other suitable function. Such components may include anesthetics, antimicrobials, buffers, colorants, emulsifiers, flavoring agents (imparting taste and/or smell), salts, stabilizers, and/or the like. Further aspects of medicament vehicles and components thereof are described in Remington: The Science and Practice of Pharmacy, University of the Sciences Philadelphia, ed., 21st Edition, (2005).
The interfering RNA or agent may be administered to deliver an effective amount (or concentration) of the interfering RNA to a subject. The term “effective amount” (or “effective concentration”), as used herein, is any quantity (or concentration) known or expected to be sufficient to generate an effect in the subject, generally a desired effect or therapeutic effect. Accordingly, the effective amount (or concentration) also may be a “therapeutic amount” (or “therapeutic concentration”), that is, a quantity (or concentration) known or expected to be sufficient to treat a medical condition (e.g., to alleviate, stabilize, or cure the medical condition, and/or to prevent a consequent condition). An effective amount (or concentration) may be determined by any suitable approach including clinical trials, studies in animal model systems, tests on cultured cells, biochemical analyses, calculations, computer modeling, and/or a combination thereof, among others.
Administration of a medicament may be performed at any suitable site. The site may be, for example, a medical facility (e.g., a hospital, a medical practitioner's office, an outpatient clinic, a veterinarian's office, etc.) or a residence (e.g., the subject's home), among others.
Interfering RNA may be delivered directly and/or by administration of an agent that directs production of the interfering RNA. The agent may be an expression vector, a virus, and/or cells, among others. The agent generally includes a template region corresponding to an interfering RNA to be produced (expressed).
Any suitable expression vector may be administered. An expression vector, as used herein, is any relatively small nucleic acid molecule that templates production of an interfering RNA. The nucleic acid molecule may be linear or circular and is generally longer than the interfering RNA that it templates. For example, the expression vector may be about 100 to 500,000 nucleotides in length (or more). The expression vector may be a plasmid or viral vector, among others, and may include suitable control sequences, such as a promoter(s), a terminator(s), one or more replication origins, a selection marker(s) (such as a drug resistance gene(s)), a packaging signal(s) (such as for packaging into viral particles), etc. The expression vector may be administered in a packaged form inside a biological particle (i.e., within a cell or viral particle), in an encapsulated and releasable form, and/or may be administered in an unpackaged form.
Any suitable virus that templates production of an interfering RNA may be administered. The virus may be replication competent (i.e., capable of replication after infection) or replication defective. Accordingly, the virus may be attenuated or inactivated to reduce the risk of an uncontrolled infection. In addition, the virus may be capable of infecting dividing and/or nondividing cells. Furthermore, the virus may be configured to selectively infect particular types of cells (and/or may be targeted via local/regional administration). Exemplary cells types for which the virus may be selective include neurons and/or neural cell types (e.g., neurons, glia, astroctyes, oligodendrocytes, etc.). In addition to the tropism of the virus, cell type selectivity of interfering RNA production may be achieved by tissue- and/or cell-type selective promoters, e.g., expression of interfering RNA could be directed selectively to astrocytes by using a GFAP promoter to drive expression of the interfering RNA. Viruses that may be suitable include DNA or RNA viruses, such as retroviruses (e.g., lentiviruses (such as human immunodeficiency virus)), poxviruses, herpesviruses, parvoviruses, hepadnaviruses (e.g., hepatitis viruses), reoviruses, adenoviruses, papillomaviruses, rhabdoviruses (e.g., rabies viruses), paramyxoviruses, orthomyxoviruses (e.g., influenza viruses), bunyaviruses, picornaviruses, deltaviruses, flaviviruses, etc. In some embodiments, lentiviruses may have particular advantages due to their ability to infect nondividing brain cells.
The virus may be administered in any suitable form. For example, virus may be administered as viral particles in fluid, encapsulated in a degradable/dissolvable matrix, adsorbed to beads or other particles (e.g., cells), and/or disposed in cells (e.g., as viral particles, and/or viral nucleic acid that is integrated into the host cell genome and/or episomal, among others).
Any suitable cells capable of producing interfering RNA may be administered. The cells may be obtained from the subject (autogeneic cells), a different member of the subject's species (allogeneic cells), or a different species (xenogeneic cells). Any suitable type of cells may be used, including stem cells (e.g., pluripotent or multipotent cells) or differentiated cells.
The cells may be obtained by any suitable approach. Exemplary approaches including isolating cells in a tissue biopsy, fluid aspirate, blood sample, from bone marrow, tissue explant, etc. The cells may be cultured and/or stored any suitable amount of time between collection and administration. In some examples, the cells may divide between collection and administration and/or may be sorted, filtered, washed, irradiated, and/or the like. Furthermore, in some cases, the cells may be an established cell line that has been transformed and/or immortalized by any suitable approach.
The cells may be contacted with any suitable nucleic acids between collection and administration. Exemplary nucleic acids that may be suitable, such as an expression vector, template production of an interfering RNA. Exposure to the nucleic acids may result in introduction of the nucleic acids into the cells. Introduction may be facilitated by any suitable approach, such as infection with a viral carrier and/or transfection via a lipid, a precipitate, electroporation, etc.
The cells may be administered in any suitable form. Exemplary forms may include dispersed, aggregated (e.g., as a cell pellet and/or as cells held together by an extracellular matrix), encapsulated in a matrix, and/or the like.
The following examples described selected aspects and embodiments of the present teachings, particularly experiments involving delivery of interfering RNA against adenosine kinase (Adk) to cell and animal model systems. These examples are intended for illustration and should not be interpreted as limiting the entire scope of the present teachings.
This example describes experiments performed to test the inhibitory capability of interfering adenosine kinase (Adk) RNA expressed as a hairpin structure in mouse cells; see
The base vector may include an insertion site 142 (such as a restriction enzyme site, a polylinker site, and/or a recombination site, among others) for receiving a template cassette 144 that at least partially templates production of the interfering RNA. The cassette may include an inverted repeat 146 such that transcription templated by the cassette forms a stem 148 of hairpin structure 134. The cassette also may include one or more control regions (e.g., a promoter and/or terminator region).
Interfering RNA may be expressed by transcription initiated from the promoter. The length, content, and structure of the interfering RNA may be determined, for example, by the position of the promoter, the position of the terminator and/or other post-transcriptional processing signals, and by template cassette 144. In the present illustration, the interfering RNA is produced via transcription as a single strand 150 that folds back on itself to form intra-strand stem 148 (i.e., a base-paired stem structure). The stem may be flanked by a loop 152 and an unpaired extension 154 of any suitable length, such as a 3′ extension of one to five nucleotides, among others.
The duplexes of the present illustration have the following features. Each duplex has an Xhol overhang 166 and an Xbal overhang 168 (each indicated by lower case letters) disposed at opposing end of the duplex, for introduction into the base vector IMG-800 digested with Sall and Xbal restriction enzymes. The duplex also has an inverted repeat 169 (nineteen nucleotides for each repeat unit) flanking a loop region 170 (indicated by a string of eight lower-case letters). A series of T's 172 may follow the second inverted repeat to provide a cleavage site 174 at which the transcript may be terminated and/or truncated during and/or after its transcription to create a short hairpin RNA. Accordingly, the cleavage site may provide a 3′ overhang and/or unpaired region (here, of two nucleotides) adjacent a stem of the short hairpin RNA. Either or both repeat units for each of D1 to D5, respectively, may serve as a selectivity region (a targeting portion) and correspond to the mouse Adk mRNA sequence starting at about 80, 170, 220, 430, and 520 nucleotides downstream of the initiation codon of the mouse Adk open reading frame.
The five different shRNA expression vectors were tested as follows. Each expression vector was transfected separately into mouse P19 cells and into mouse ES-cell-derived glial precursor cells (N3EFL). Cells were selected with G418 for integration of the vectors. After selection, polyclonal colonies were analyzed for the enzyme activity of adenosine kinase (ADK) using an enzyme-coupled bioluminescent assay. The results are shown in
This example describes experiments performed to test the ability of Adk small interfering RNA to suppress seizures in a rat model system for epilepsy; see
This example describes experiments performed to test the ability of Adk small interfering RNA to suppress seizures and inhibit ADK expression in a mouse model system; see
The Adk siRNA solution was tested on kainic-acid treated mice, as an animal model for epilepsy. Three NMRI mice received a unilateral intrahippocampal injection of kainic acid. Two weeks after injection one animal reacted with chronic recurrent seizure activity. This animal then received an intrahippocampal injection of 1.0 μL of the siRNA solution. Electroencephalogram (EEG) recordings were monitored continuously.
Additional experiments were performed by immunohistochemistry for the ADK protein on brain sections of control and treated mice. The time window of transient siRNA-mediated seizure suppression in the mouse was reproduced by injection of the same Adk siRNA solution into the hippocampus of untreated control mice. Brains were taken at two and 48 hours after injection of the Adk siRNA solution and stained with an anti-ADK antibody. The results are shown in
The disclosure set forth above may encompass multiple distinct inventions with independent utility. Although each of these inventions has been disclosed in its preferred form(s), the specific embodiments thereof as disclosed and illustrated herein are not to be considered in a limiting sense, because numerous variations are possible. The subject matter of the inventions includes all novel and nonobvious combinations and subcombinations of the various elements, features, functions, and/or properties disclosed herein. The following claims particularly point out certain combinations and subcombinations regarded as novel and nonobvious. Inventions embodied in other combinations and subcombinations of features, functions, elements, and/or properties may be claimed in applications claiming priority from this or a related application. Such claims, whether directed to a different invention or to the same invention, and whether broader, narrower, equal, or different in scope to the original claims, also are regarded as included within the subject matter of the inventions of the present disclosure.