Claims for Patent: 9,399,775

Summary for Patent: 9,399,775

Title:	RNAi agents, compositions and methods of use thereof for treating transthyretin (TTR) associated diseases
Abstract:	The present invention provides RNAi agents, e.g., double stranded RNAi agents, that target the transthyretin (TTR) gene and methods of using such RNAi agents for treating or preventing TTR-associated diseases.
Inventor(s):	Rajeev; Kallanthottathil G. (Cambridge, MA), Zimmermann; Tracy (Cambridge, MA), Manoharan; Muthiah (Cambridge, MA), Maier; Martin (Cambridge, MA), Kuchimanchi; Satyanarayana (Cambridge, MA), Charisse; Klaus (Cambridge, MA)
Assignee:	Alnylam Pharmaceuticals, Inc. (Cambridge, MA)
Application Number:	14/358,972
Patent Claims:	1. A double stranded RNAi agent comprising a sense strand complementary to an antisense strand, wherein said antisense strand comprises a sequence that is complementary to nucleotides 504 to 526 of the transthyretin (TTR) gene (SEQ ID NO:1), wherein the sense strand is 21 nucleotides in length and the antisense strand is 23 nucleotides in length, wherein said double stranded RNAi agent is represented by formula (III): TABLE-US-00017 (III) sense: 5' n.sub.p -N.sub.a -(X X X).sub.i-N.sub.b -Y Y Y -N.sub.b -(Z Z Z).sub.j- N.sub.a-n.sub.q 3' antisense: 3' n.sub.p'-N.sub.a'-(X'X'X').sub.k-N.sub.b'-Y'Y'Y'-N.sub.b'- (Z'Z'Z').sub.l-N.sub.a'- n.sub.q' 5' wherein: j=1; and i, k, and l are 0; p' is 2; p, q, and q' are 0; each N.sub.a and N.sub.a' independently represents an oligonucleotide sequence comprising 2-10 nucleotides which are modified nucleotides; each N.sub.b and N.sub.b' independently represents an oligonucleotide sequence comprising 0-7 nucleotides which are modified nucleotides; n.sub.p' represents an overhang nucleotide; YYY, ZZZ, and Y'Y'Y', each independently represent one motif of three identical modifications on three consecutive nucleotides, wherein the Y nucleotides contain a 2'-fluoro modification, the Y' nucleotides contain a 2'-O-methyl modification, and the Z nucleotides contain a 2'-O-methyl modification; and wherein the sense strand is conjugated to at least one ligand, wherein the ligand is one or more GalNAc derivatives attached through a bivalent or trivalent branched linker. 2. The RNAi agent of claim 1, wherein the YYY motif occurs at or near the cleavage site of the sense strand; or wherein the Y'Y'Y' motif occurs at the 11, 12 and 13 positions of the antisense strand from the 5'-end. 3. The RNAi agent of claim 1, wherein the modifications on the N.sub.a, N.sub.a', N.sub.b and N.sub.b' nucleotides are each independently selected from the group consisting of LNA, HNA, CeNA, 2'-methoxyethyl, 2'-O-alkyl, 2'-O-allyl, 2'-C-allyl, 2'-fluoro, 2'-deoxy, 2'-hydroxyl, and combinations thereof. 4. The RNAi agent of claim 3, wherein the modifications on the N.sub.a, N.sub.a', N.sub.b and N.sub.b' nucleotides are 2'-O-methyl, 2'-fluoro or both. 5. The RNAi agent of claim 1, wherein the ligand is ##STR00014## 6. The RNAi agent of claim 1, wherein the ligand is attached to the 3' end of the sense strand. 7. The RNAi agent of claim 6, wherein the RNAi agent is conjugated to the ligand as shown in the following schematic ##STR00015## wherein X is O or S. 8. The RNAi agent of claim 7, wherein the RNAi agent is conjugated to the ligand as shown in the following schematic ##STR00016## 9. The RNAi agent of claim 1 further comprising at least one phosphorothioate or methylphosphonate internucleotide linkage. 10. The RNAi agent of claim 9, wherein the phosphorothioate or methylphosphonate internucleotide linkage is at the 3'-terminal of one strand. 11. The RNAi agent of claim 10, wherein said strand is the antisense strand or the sense strand. 12. The RNAi agent of claim 1, wherein the base pair at the 1 position of the 5'-end of the antisense strand of the duplex is an AU base pair. 13. The RNAi agent of claim 1, wherein the p' overhang nucleotides are complementary to the target mRNA or wherein the p' overhang nucleotides are non-complementary to the target mRNA. 14. The RNAi agent of claim 1, wherein at least one np' is linked to a neighboring nucleotide via a phosphorothioate linkage. 15. The RNAi agent of claim 14, wherein all np' are linked to neighboring nucleotides via phosphorothioate linkages. 16. The RNAi agent of claim 1, wherein said RNAi agent is selected from the group consisting of AD-51546 and AD-51547. 17. The RNAi agent of claim 1, wherein the RNAi agent is AD-51547. 18. The double stranded RNAi agent of claim 1, wherein the sense strand comprises the nucleotide sequence 5'-UGGGAUUUCAUGUAACCAAGA-3' (SEQ ID NO:2211). 19. The double stranded RNAi agent of claim 1, wherein the sense strand comprises the nucleotide sequence 5'-UfgGfgAfuUfuCfAfUfgUfaacCfaAfgAfL96-3' (SEQ ID NO:2) and the antisense strand comprises the nucleotide sequence 5'-uCfuUfgGfUfUfaCfaugAfaAfuCfcCfasUfsc-3' (SEQ ID NO:3), wherein a, g, c and u are 2'-O-methyl (2'-OMe) A, G, C, and U; Af, Gf, Cf, and Uf are 2'-fluoro A, G, C and U; s is a phosphorothioate linkage; and L96 is a GalNAc3 ligand. 20. A double stranded RNAi agent, comprising a sense strand and an antisense strand, wherein the sense strand comprises the nucleotide sequence 5'-UfgGfgAfuUfuCfAfUfgUfaacCfaAfgAfL96-3' (SEQ ID NO:2) and the antisense strand comprises the nucleotide sequence 5'-uCfuUfgGfUfUfaCfaugAfaAfuCfcCfasUfsc-3' (SEQ ID NO:3), wherein a, g, c, and u are 2'-O-methyl (2'-OMe) A, G, C, and U; Af, Gf, Cf, and Uf are 2'-fluoro A, G, C, and U; s is a phosphorothioate linkage; and L96 is a GalNAc3 ligand. 21. An isolated cell containing an RNAi agent of any one of claims 1, 17, or 20. 22. A pharmaceutical composition comprising an RNAi agent of any one of claims 1, 17, or 20. 23. The pharmaceutical composition of claim 22, wherein the RNAi agent is administered in an unbuffered solution. 24. The pharmaceutical composition of claim 23, wherein said unbuffered solution is saline or water. 25. The pharmaceutical composition of claim 22, wherein said RNAi agent is administered with a buffer solution. 26. The pharmaceutical composition of claim 25, wherein said buffer solution comprises acetate, citrate, prolamine, carbonate, or phosphate or any combination thereof. 27. The pharmaceutical composition of claim 26, wherein said buffer solution is phosphate buffered saline (PBS). 28. A method of inhibiting expression of a transthyretin (TTR) in a cell comprising contacting said cell with an RNAi agent of any one of claims 1, 17, or 20 in an amount effective to inhibit expression of said TTR in said cell, thereby inhibiting expression of said transthyretin (TTR) in said cell. 29. A kit for performing the method of claim 28, comprising a) said RNAi agent, and b) instructions for use. 30. A method of treating a TTR-associated disease in a subject, comprising administering to said subject a therapeutically effective amount of an RNAi agent of any one of claims 1, 17, or 20, thereby treating said TTR-associated disease in said subject. 31. The method of claim 30, wherein said subject is a human. 32. The method of claim 30, wherein said subject carries a TTR gene mutation that is associated with the development of a TTR-associated disease. 33. The method of claim 30, wherein said TTR-associated disease is selected from the group consisting of senile systemic amyloidosis (SSA), systemic familial amyloidosis, familial amyloidotic polyneuropathy (FAP), familial amyloidotic cardiomyopathy (FAC), leptomeningeal/Central Nervous System (CNS) amyloidosis, and hyperthyroxinemia. 34. The method of claim 30, wherein said subject has a TTR-associated amyloidosis and said method reduces an amyloid TTR deposit in said subject. 35. The method of claim 30, wherein said RNAi agent is administered to the subject subcutaneously. 36. A kit for performing the method of claim 30, comprising a) said RNAi agent, b) instructions for use, and c) optionally, means for administering said RNAi agent to said subject.