Development of anti-sense oligonucleotides as a therapeutic for cancer pain through selective block of sodium channel pain targets

项目摘要：开发反义寡核苷酸作为癌症疼痛的治疗药物 选择性降低钠通道的表达 癌症疼痛的有效治疗是一个巨大的未得到满足的医疗需求，作为阿片类药物，目前的护理标准缺乏 功效和致瘾因素。适用于临终癌症患者和雌激素受体阳性的乳腺癌 对于预期寿命较长的患者，需要更有效的疼痛治疗方法。反义 寡核苷酸(ASO)结合并诱导具有特定序列的RNA转录本的降解，使 选择性蛋白质击倒(KD)，作用时间长(几周或几个月)，可提供长期缓解。 ASOS也可以联合使用，以减少多种蛋白质的表达，以提高疗效。AS ASOS作为一种治疗手段，已成功应用于临床治疗严重的神经系统疾病。 我们针对背根神经节神经元选择性表达的电压门控性钠通道(NAV) (Nav1.7、Nav1.8和Nav1.9)，它们与疼痛传递有关，特别是与癌症疼痛有关。 减少通道表达旨在克服小分子状态依赖通道的局限性 阻滞剂，如果通道应该以状态独立的方式被阻断以达到疗效。初步结果： 我们设计的ASO显示了大鼠背根神经节感觉神经元(DRGs)中几种NAV的70%mRNAKD。 我们应用一种新的平台来设计针对特定NAV通道的击穿的ASO。对于疼痛目标和 适应症，QuellTx还拥有突破性技术的全球独家许可证：(I)体外细胞 癌症疼痛模型(由NCI通过SBIR资金开发)，其中初级DRG神经元沐浴在 由肿瘤分泌的与生理相关的炎性介质的混合物，或“癌症-SPARC”。SPARC- 经过处理的神经元变得极度兴奋，模仿细胞的疼痛反应。(Ii)全光电生理学 神经元兴奋性的高通量读数(Optopatch)，允许记录100个单个神经元 与高时间分辨率并行。这个平台使我们能够确定调制的影响 Nav1.7、1.8和1.9单独或联合表达于盘痛表型。 在第一阶段，我们建议利用我们的ASO设计能力，结合突破性技术来： (A)确定用于选择性调节NAV通道疼痛靶标表达的ASO，以及(B)确定 ASOS和%信使核糖核酸的组合在体外可获得最大的表型效应。我们将选择ASO 有效阻断NAV通道，逆转癌症引起的疼痛表型--SPARC。在第二阶段，我们 将确定大鼠的PK/PD(%信使核糖核酸Kd)，以及在大鼠癌症模型中疗效所需的%信使核糖核酸Kd 疼痛，同时优化人类与食蟹猴(Cyno)ASOS的交叉反应，以研究其对人DRG的疗效 疼痛的神经元模型。我们的最终目标是将优化的ASO推进到IND启用的大鼠毒性研究 和Cynos，导致了一种治疗癌症疼痛的方法。

Project Summary: Development of anti-sense oligonucleotides as a therapeutic for cancer pain by selectively reducing sodium channel expression Effective treatment of cancer pain is a large unmet medical need, as opioids, the current standard of care lack efficacy and cause addiction. For end-of-life cancer patients and estrogen receptor- positive breast cancer patients with long life expectancy, more effective therapeutic approaches for pain are needed. Antisense oligonucleotides (ASOs) bind to and induce degradation of RNA transcripts with specific sequences, enabling selective protein knockdown (KD) with long duration of action (weeks or months), to deliver long-term relief. ASOs can also be used in combination, to reduce the expression of multiple proteins for increased efficacy. As a modality, ASOs have been successfully applied in the clinic to treat severe neurological disease. We target the voltage gated sodium channels (Navs) selectively expressed in dorsal root ganglion neurons (Nav1.7, Nav1.8 and Nav1.9), which are implicated in pain transmission and specifically in cancer pain. Reduction of channel expression aims to overcome the limitations of small molecule state-dependent channel blockers, if the channel should be blocked in a state-independent manner for efficacy. Preliminary results with our designed ASOs show >70% mRNA KD for several Navs in rat dorsal root ganglion sensory neurons (DRGs). We apply a novel platform to design ASOs for specific knockdown of Nav channels. For pain targets and indications, QuellTx also has an exclusive worldwide license to breakthrough technology: (i) An in vitro cellular model for cancer pain (developed through SBIR funding by NCI), where primary DRG neurons are bathed in a physiologically-relevant mixture of inflammatory mediators secreted by tumors, or ‘cancer-SPARC’. The SPARC- treated neurons become hyperexcitable, mimicking the cellular pain response. (ii) An all optical electrophysiology high throughput readout for neuronal excitability (Optopatch), allowing recordings from 100s of individual neurons in parallel with high temporal resolution. This platform enables us to determine the impact of modulating expression of Nav1.7, 1.8 and 1.9, alone or in combination, on the pain-in-a-dish phenotype. In Phase I we propose to leverage our ASO design capabilities, combined with the breakthrough technology to: (a) identify ASOs for selective modulation of expression of Nav channel pain targets and (b) determine the combination of ASOs and %mRNA knock down for maximal phenotypic effect in vitro. We will select ASOs that efficiently knockdown Nav channels and reverse the pain phenotype induced by cancer-SPARC. In Phase II we will determine the PK/PD (%mRNA KD) in rats, and the % mRNA KD needed for efficacy in a rat model of cancer pain, while optimizing human cross-reacting with cynmolgous monkey (cyno) ASOs for efficacy in human DRG neuronal models of pain. Our ultimate goal is to advance optimized ASOs to IND enabling toxicity studies in rat and cynos, leading to a therapeutic to treat cancer pain in patients.