Patent application title:

METHODS AND MEANS FOR EFFICIENT SKIPPING OF AT LEAST ONE OF THE FOLLOWING EXONS OF THE HUMAN DUCHENNE MUSCULAR DYSTROPHY GENE: 43, 46, 50-53

Publication number:

US20210139904A1

Publication date:
Application number:

17/129,117

Filed date:

2020-12-21

Abstract:

The invention relates to a method wherein a molecule is used for inducing and/or promoting skipping of at least one of exon 43, exon 46, or exons 50-53 of the DMD pre-mRNA in a patient, the method comprising providing the patient with the molecule. The invention also relates to the molecule as such.

Inventors:

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Classification:

A61K38/1719 »  CPC further

Medicinal preparations containing peptides; Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals Muscle proteins, e.g. myosin or actin

A61K48/00 »  CPC further

Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy

C12N15/113 »  CPC main

Mutation or genetic engineering; DNA or RNA concerning genetic engineering, vectors, e.g. plasmids, or their isolation, preparation or purification; Use of hosts therefor; Recombinant DNA-technology; DNA or RNA fragments; Modified forms thereof Non-coding nucleic acids modulating the expression of genes, e.g. antisense oligonucleotides

A61K31/56 »  CPC further

Medicinal preparations containing organic active ingredients Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids

A61K31/57 »  CPC further

Medicinal preparations containing organic active ingredients; Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone

A61K38/17 IPC

Medicinal preparations containing peptides; Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans

A61K31/7088 »  CPC further

Medicinal preparations containing organic active ingredients; Carbohydrates; Sugars; Derivatives thereof Compounds having three or more nucleosides or nucleotides

A61K45/06 »  CPC further

Medicinal preparations containing active ingredients not provided for in groups  -  Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca

A61K31/573 »  CPC further

Medicinal preparations containing organic active ingredients; Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone

A61K31/58 »  CPC further

Medicinal preparations containing organic active ingredients; Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids containing heterocyclic rings, e.g. danazol, stanozolol, pancuronium or digitogenin

Description

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 16/024,558, filed Jun. 29, 2018, which is a continuation of U.S. application Ser. No. 15/289,053, filed Oct. 7, 2016, which is a continuation of U.S. application Ser. No. 14/631,686, filed Feb. 25, 2015, now U.S. Pat. No. 9,499,818, which is a continuation of U.S. application Ser. No. 13/094,571, filed Apr. 26, 2011, which is a continuation of PCTNL2009/050113, filed Mar. 11, 2009, which is a continuation-in-part of PCT/NL2008/050673, filed Oct. 27, 2008. The disclosures of each of the above-referenced applications are incorporated by reference herein in their entirety.

SEQUENCE LISTING

This specification is being filed with a Sequence Listing in Computer Readable Form (CFR), which is entitled “0105_07 US1CN4_SL.txt” of 128885 bytes in size and was created on Dec. 14, 2020, the content of which is incorporated herein by reference in its entirety.

FIELD

The invention relates to the field of genetics, more specifically human genetics. The invention in particular relates to modulation of splicing of the human Duchenne Muscular Dystrophy pre-mRNA.

BACKGROUND

Myopathies are disorders that result in functional impairment of muscles. Muscular dystrophy (MD) refers to genetic diseases that are characterized by progressive weakness and degeneration of skeletal muscles. Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are the most common childhood forms of muscular dystrophy. They are recessive disorders and because the gene responsible for DMD and BMD resides on the X-chromosome, mutations mainly affect males with an incidence of about 1 in 3500 boys.

DMD and BMD are caused by genetic defects in the DMD gene encoding dystrophin, a muscle protein that is required for interactions between the cytoskeleton and the extracellular matrix to maintain muscle fiber stability during contraction. DMD is a severe, lethal neuromuscular disorder resulting in a dependency on wheelchair support before the age of 12 and DMD patients often die before the age of thirty due to respiratory- or heart failure. In contrast, BMD patients often remain ambulatory until later in life, and have near normal life expectancies. DMD mutations in the DMD gene are characterized by frame shifting insertions or deletions or nonsense point mutations, resulting in the absence of functional dystrophin. BMD mutations in general keep the reading frame intact, allowing synthesis of a partly functional dystrophin.

During the last decade, specific modification of splicing in order to restore the disrupted reading frame of the dystrophin transcript has emerged as a promising therapy for Duchenne muscular dystrophy (DMD) (van Ommen, van Deutekom, Aartsma-Rus, Curr Opin Mol Ther. 2008; 10(2):140-9, Yokota, Duddy, Partidge, Acta Myol. 2007; 26(3):179-84, van Deutekom et al., N Engl J Med. 2007; 357(26):2677-86).

Using antisense oligonucleotides (AONs) interfering with splicing signals the skipping of specific exons can be induced in the DMD pre-mRNA, thus restoring the open reading frame and converting the severe DMD into a milder BMD phenotype (van Deutekom et al. Hum Mol Genet. 2001; 10: 1547-54; Aartsma-Rus et al., Hum Mol Genet 2003; 12(8):907-14.). In vivo proof-of-concept was first obtained in the mdx mouse model, which is dystrophin-deficient due to a nonsense mutation in exon 23. Intramuscular and intravenous injections of AONs targeting the mutated exon 23 restored dystrophin expression for at least three months (Lu et al. Nat Med. 2003; 8: 1009-14; Lu et al., Proc Natl Acad Sci US A. 2005; 102(1):198-203). This was accompanied by restoration of dystrophin-associated proteins at the fiber membrane as well as functional improvement of the treated muscle. In vivo skipping of human exons has also been achieved in the hDMD mouse model, which contains a complete copy of the human DMD gene integrated in chromosome 5 of the mouse (Bremmer-Bout et al. Molecular Therapy. 2004; 10: 232-40; ′t Hoen et al. J Biol Chem. 2008; 283: 5899-907).

Recently, a first-in-man study was successfully completed where an AON inducing the skipping of exon 51 was injected into a small area of the tibialis anterior muscle of four DMD patients. Novel dystrophin expression was observed in the majority of muscle fibers in all four patients treated, and the AON was safe and well tolerated (van Deutekom et al. N Engl J Med. 2007; 357: 2677-86).

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. In human control myotubes, a series of AONs (PS237, PS238, and PS240; SEQ ID NO 65, 66, 16 respectively) targeting exon 43 was tested at 500 nM. PS237 (SEQ ID NO 65) reproducibly induced highest levels of exon 43 skipping. (M: DNA size marker; NT: non-treated cells)

FIG. 2. In myotubes from a DMD patient with an exon 45 deletion, a series of AONs (PS177, PS179, PS181, and PS182; SEQ ID NO 91, 70, 110, and 117 respectively) targeting exon 46 was tested at two different concentrations (50 and 150 nM). PS182 (SEQ ID NO 117) reproducibly induced highest levels of exon 46 skipping. (M: DNA size marker)

FIG. 3. In human control myotubes, a series of AONs (PS245, PS246, PS247, and PS248; SEQ ID NO 167, 165, 166, and 127 respectively) targeting exon 50 was tested at 500 nM. PS248 (SEQ ID NO 127) reproducibly induced highest levels of exon 50 skipping. (M: DNA size marker; NT: non-treated cells).

FIG. 4. In human control myotubes, two novel AONs (PS232 and PS236; SEQ ID NO 246 and 299 respectively) targeting exon 52 were tested at two different concentrations (200 and 500 nM) and directly compared to a previously described AON (52-1). PS236 (SEQ ID NO 299) reproducibly induced highest levels of exon 52 skipping. (M: DNA size marker; NT: non-treated cells).

DETAILED DESCRIPTION

Method

In a first aspect, the present invention provides a method for inducing, and/or promoting skipping of at least one of exons 43, 46, 50-53 of the DMD pre-mRNA in a patient, preferably in an isolated cell of a patient, the method comprising providing said cell and/or said patient with a molecule that binds to a continuous stretch of at least 8 nucleotides within said exon. It is to be understood that said method encompasses an in vitro, in vivo or ex vivo method.

Accordingly, a method is provided for inducing and/or promoting skipping of at least one of exons 43, 46, 50-53 of DMD pre-mRNA in a patient, preferably in an isolated cell of said patient, the method comprising providing said cell and/or said patient with a molecule that binds to a continuous stretch of at least 8 nucleotides within said exon.

As defined herein a DMD pre-mRNA preferably means the pre-mRNA of a DMD gene of a DMD or BMD patient.

A patient is preferably intended to mean a patient having DMD or BMD as later defined herein or a patient susceptible to develop DMD or BMD due to his or her genetic background. In the case of a DMD patient, an oligonucleotide used will preferably correct one mutation as present in the DMD gene of said patient and therefore will preferably create a DMD protein that will look like a BMD protein: said protein will preferably be a functional dystrophin as later defined herein. In the case of a BMD patient, an oligonucleotide as used will preferably correct one mutation as present in the BMD gene of said patient and therefore will preferably create a dystrophin which will be more functional than the dystrophin which was originally present in said BMD patient.

Exon skipping refers to the induction in a cell of a mature mRNA that does not contain a particular exon that is normally present therein. Exon skipping is performed by providing a cell expressing the pre-mRNA of said mRNA with a molecule capable of interfering with essential sequences such as for example the splice donor of splice acceptor sequence that required for splicing of said exon, or a molecule that is capable of interfering with an exon inclusion signal that is required for recognition of a stretch of nucleotides as an exon to be included in the mRNA. The term pre-mRNA refers to a non-processed or partly processed precursor mRNA that is synthesized from a DNA template in the cell nucleus by transcription.

Within the context of the invention, inducing and/or promoting skipping of an exon as indicated herein means that at least 1%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or more of the DMD mRNA in one or more (muscle) cells of a treated patient will not contain said exon. This is preferably assessed by PCR as described in the examples.

Preferably, a method of the invention by inducing and/or promoting skipping of at least one of the following exons 43, 46, 50-53 of the DMD pre-mRNA in one or more (muscle) cells of a patient, provides said patient with a functional dystrophin protein and/or decreases the production of an aberrant dystrophin protein in said patient and/or increases the production of a functional dystrophin is said patient.

Providing a patient with a functional dystrophin protein and/or decreasing the production of an aberrant dystrophin protein in said patient is typically applied in a DMD patient. Increasing the production of a functional dystrophin is typically applied in a BMD patient.

Therefore, a preferred method is a method, wherein a patient or one or more cells of said patient is provided with a functional dystrophin protein and/or wherein the production of an aberrant dystrophin protein in said patient is decreased and/or wherein the production of a functional dystrophin is increased in said patient, wherein the level of said aberrant or functional dystrophin is assessed by comparison to the level of said dystrophin in said patient at the onset of the method.

Decreasing the production of an aberrant dystrophin may be assessed at the mRNA level and preferably means that 99%, 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 10%, 5% or less of the initial amount of aberrant dystrophin mRNA, is still detectable by RT PCR. An aberrant dystrophin mRNA or protein is also referred to herein as a non-functional dystrophin mRNA or protein. A non-functional dystrophin protein is preferably a dystrophin protein which is not able to bind actin and/or members of the DGC protein complex. A non-functional dystrophin protein or dystrophin mRNA does typically not have, or does not encode, a dystrophin protein with an intact C-terminus of the protein.

Increasing the production of a functional dystrophin in said patient or in a cell of said patient may be assessed at the mRNA level (by RT-PCR analysis) and preferably means that a detectable amount of a functional dystrophin mRNA is detectable by RT PCR. In another embodiment, 1%, 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or more of the detectable dystrophin mRNA is a functional dystrophin mRNA. Increasing the production of a functional dystrophin in said patient or in a cell of said patient may be assessed at the protein level (by immunofluorescence and western blot analyses) and preferably means that a detectable amount of a functional dystrophin protein is detectable by immunofluorescence or western blot analysis. In another embodiment, 1%, 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or more of the detectable dystrophin protein is a functional dystrophin protein.

As defined herein, a functional dystrophin is preferably a wild type dystrophin corresponding to a protein having the amino acid sequence as identified in SEQ ID NO: 1. A functional dystrophin is preferably a dystrophin, which has an actin binding domain in its N terminal part (first 240 amino acids at the N terminus), a cysteine-rich domain (amino acid 3361 till 3685) and a C terminal domain (last 325 amino acids at the C terminus) each of these domains being present in a wild type dystrophin as known to the skilled person. The amino acids indicated herein correspond to amino acids of the wild type dystrophin being represented by SEQ ID NO:1. In other words, a functional dystrophin is a dystrophin which exhibits at least to some extent an activity of a wild type dystrophin. “At least to some extent” preferably means at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95% or 100% of a corresponding activity of a wild type functional dystrophin. In this context, an activity of a functional dystrophin is preferably binding to actin and to the dystrophin-associated glycoprotein complex (DGC) (Aartsma-Rus A et al, (2006), Entries in the leiden Duchenne Muscular Dystrophy mutation database: an overview of mutation types and paradoxical cases that confirm the reading-frame rule, Muscle Nerve, 34: 135-144). Binding of dystrophin to actin and to the DGC complex may be visualized by either co-immunoprecipitation using total protein extracts or immunofluorescence analysis of cross-sections, from a muscle biopsy, as known to the skilled person.

Individuals or patients suffering from Duchenne muscular dystrophy typically have a mutation in the gene encoding dystrophin that prevent synthesis of the complete protein, i.e of a premature stop prevents the synthesis of the C-terminus. In Becker muscular dystrophy the DMD gene also comprises a mutation compared to the wild type gene, but the mutation does typically not induce a premature stop and the C-terminus is typically synthesized. As a result, a functional dystrophin protein is synthesized that has at least the same activity in kind as the wild type protein, not although not necessarily the same amount of activity. The genome of a BMD individual typically encodes a dystrophin protein comprising the N terminal part (first 240 amino acids at the N terminus), a cysteine-rich domain (amino acid 3361 till 3685) and a C terminal domain (last 325 amino acids at the C terminus) but its central rod shaped domain may be shorter than the one of a wild type dystrophin (Aartsma-Rus A et al, (2006), Entries in the leiden Duchenne Muscular Dystrophy mutation database: an overview of mutation types and paradoxical cases that confirm the reading-frame rule, Muscle Nerve, 34: 135-144). Exon skipping for the treatment of DMD is typically directed to overcome a premature stop in the pre-mRNA by skipping an exon in the rod-shaped domain to correct the reading frame and allow synthesis of remainder of the dystrophin protein including the C-terminus, albeit that the protein is somewhat smaller as a result of a smaller rod domain. In a preferred embodiment, an individual having DMD and being treated by a method as defined herein will be provided a dystrophin which exhibits at least to some extent an activity of a wild type dystrophin. More preferably, if said individual is a Duchenne patient or is suspected to be a Duchenne patient, a functional dystrophin is a dystrophin of an individual having BMD: typically said dystrophin is able to interact with both actin and the DGC, but its central rod shaped domain may be shorter than the one of a wild type dystrophin (Aartsma-Rus A et al, (2006), Entries in the leiden Duchenne Muscular Dystrophy mutation database: an overview of mutation types and paradoxical cases that confirm the reading-frame rule, Muscle Nerve, 34: 135-144). The central rod-shaped domain of wild type dystrophin comprises 24 spectrin-like repeats (Aartsma-Rus A et al, (2006), Entries in the leiden Duchenne Muscular Dystrophy mutation database: an overview of mutation types and paradoxical cases that confirm the reading-frame rule, Muscle Nerve, 34: 135-144). For example, a central rod-shaped domain of a dystrophin as provided herein may comprise 5 to 23, 10 to 22 or 12 to 18 spectrin-like repeats as long as it can bind to actin and to DGC.

A method of the invention may alleviate one or more characteristics of a myogenic or muscle cell of a patient or alleviate one or more symptoms of a DMD patient having a deletion including but not limited to exons 44, 44-46, 44-47, 44-48, 44-49, 44-51, 44-53 (correctable by exon 43 skipping), 19-45, 21-45, 43-45, 45, 47-54, 47-56 (correctable by exon 46 skipping), 51, 51-53, 51-55, 51-57 (correctable by exon 50 skipping), 13-50, 19-50, 29-50, 43-50, 45-50, 47-50, 48-50, 49-50, 50, 52 (correctable by exon 51 skipping), exons 8-51, 51, 53, 53-55, 53-57, 53-59, 53-60, (correctable by exon 52 skipping) and exons 10-52, 42-52, 43-52, 45-52, 47-52, 48-52, 49-52, 50-52, 52 (correctable by exon 53 skipping) in the DMD gene, occurring in a total of 68% of all DMD patients with a deletion (Aartsma-Rus et al., Hum. Mut. 2009).

Alternatively, a method of the invention may improve one or more characteristics of a muscle cell of a patient or alleviate one or more symptoms of a DMD patient having small mutations in, or single exon duplications of exon 43, 46, 50-53 in the DMD gene, occurring in a total of 36% of all DMD patients with a deletion (Aartsma-Rus et al, Hum. Mut. 2009)

Furthermore, for some patients the simultaneous skipping of one of more exons in addition to exon 43, exon 46 and/or exon 50-53 is required to restore the open reading frame, including patients with specific deletions, small (point) mutations, or double or multiple exon duplications, such as (but not limited to) a deletion of exons 44-50 requiring the co-skipping of exons 43 and 51, with a deletion of exons 46-50 requiring the co-skipping of exons 45 and 51, with a deletion of exons 44-52 requiring the co-skipping of exons 43 and 53, with a deletion of exons 46-52 requiring the co-skipping of exons 45 and 53, with a deletion of exons 51-54 requiring the co-skipping of exons 50 and 55, with a deletion of exons 53-54 requiring the co-skipping of exons 52 and 55, with a deletion of exons 53-56 requiring the co-skipping of exons 52 and 57, with a nonsense mutation in exon 43 or exon 44 requiring the co-skipping of exon 43 and 44, with a nonsense mutation in exon 45 or exon 46 requiring the co-skipping of exon 45 and 46, with a nonsense mutation in exon 50 or exon 51 requiring the co-skipping of exon 50 and 51, with a nonsense mutation in exon 51 or exon 52 requiring the co-skipping of exon 51 and 52, with a nonsense mutation in exon 52 or exon 53 requiring the co-skipping of exon 52 and 53, or with a double or multiple exon duplication involving exons 43, 46, 50, 51, 52, and/or 53.

In a preferred method, the skipping of exon 43 is induced, or the skipping of exon 46 is induced, or the skipping of exon 50 is induced or the skipping of exon 51 is induced or the skipping of exon 52 is induced or the skipping of exon 53 is induced. An induction of the skipping of two of these exons is also encompassed by a method of the invention. For example, preferably skipping of exons 50 and 51, or 52 and 53, or 30 43 and 51, or 43 and 53, or 51 and 52. Depending on the type and the identity (the specific exons involved) of mutation identified in a patient, the skilled person will know which combination of exons needs to be skipped in said patient.

In a preferred method, one or more symptom(s) of a DMD or a BMD patient is/are alleviated and/or one or more characteristic(s) of one or more muscle cells from a DMD or a BMD patient is/are improved. Such symptoms or characteristics may be assessed at the cellular, tissue level or on the patient self

An alleviation of one or more characteristics may be assessed by any of the following assays on a myogenic cell or muscle cell from a patient: reduced calcium uptake by muscle cells, decreased collagen synthesis, altered morphology, altered lipid biosynthesis, decreased oxidative stress, and/or improved muscle fiber function, integrity, and/or survival. These parameters are usually assessed using immunofluorescence and/or histochemical analyses of cross sections of muscle biopsies.

The improvement of muscle fiber function, integrity and/or survival may be assessed using at least one of the following assays: a detectable decrease of creatine kinase in blood, a detectable decrease of necrosis of muscle fibers in a biopsy cross-section of a muscle suspected to be dystrophic, and/or a detectable increase of the homogeneity of the diameter of muscle fibers in a biopsy cross-section of a muscle suspected to be dystrophic. Each of these assays is known to the skilled person.

Creatine kinase may be detected in blood as described in Hodgetts et al (Hodgetts S., et al, (2006), Neuromuscular Disorders, 16: 591-602.2006). A detectable decrease in creatine kinase may mean a decrease of 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or more compared to the concentration of creatine kinase in a same DMD or BMD patient before treatment.

A detectable decrease of necrosis of muscle fibers is preferably assessed in a muscle biopsy, more preferably as described in Hodgetts et al (Hodgetts S., et al (2006), Neuromuscular Disorders, 16: 591-602.2006) using biopsy cross-sections. A detectable decrease of necrosis may be a decrease of 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or more of the area wherein necrosis has been identified using biopsy cross-sections. The decrease is measured by comparison to the necrosis as assessed in a same DMD or BMD patient before treatment.

A detectable increase of the homogeneity of the diameter of a muscle fiber is preferably assessed in a muscle biopsy cross-section, more preferably as described in Hodgetts et al (Hodgetts S., et al, (2006), Neuromuscular Disorders, 16: 591-602.2006). The increase is measured by comparison to the homogeneity of the diameter of a muscle fiber in a same DMD or BMD patient before treatment. An alleviation of one or more symptoms may be assessed by any of the following assays on the patient self: prolongation of time to loss of walking, improvement of muscle strength, improvement of the ability to lift weight, improvement of the time taken to rise from the floor, improvement in the nine-meter walking time, improvement in the time taken for four-stairs climbing, improvement of the leg function grade, improvement of the pulmonary function, improvement of cardiac function, improvement of the quality of life. Each of these assays is known to the skilled person. As an example, the publication of Manzur et al. (Manzur A Y et al, (2008), Glucocorticoid corticosteroids for Duchenne muscular dystrophy (review), Wiley publishers, The Cochrane collaboration.) gives an extensive explanation of each of these assays. For each of these assays, as soon as a detectable improvement or prolongation of a parameter measured in an assay has been found, it will preferably mean that one or more symptoms of Duchenne Muscular Dystrophy or Becker Muscular Dystrophy has been alleviated in an individual using a method of the invention. Detectable improvement or prolongation is preferably a statistically significant improvement or prolongation as described in Hodgetts et al (Hodgetts S., et al, (2006), Neuromuscular Disorders, 16: 591-602.2006). Alternatively, the alleviation of one or more symptom(s) of Duchenne Muscular Dystrophy or Becker Muscular Dystrophy may be assessed by measuring an improvement of a muscle fiber function, integrity and/or survival as later defined herein.

A treatment in a method according to the invention may have a duration of at least one week, at least one month, at least several months, at least one year, at least 2, 3, 4, 5, 6 years or more.

Each molecule or oligonucleotide or equivalent thereof as defined herein for use according to the invention may be suitable for direct administration to a cell, tissue and/or an organ in vivo of individuals affected by or at risk of developing DMD or BMD, and may be administered directly in vivo, ex vivo or in vitro. The frequency of administration of a molecule or an oligonucleotide or a composition of the invention may depend on several parameters such as the age of the patient, the mutation of the patient, the number of molecules (dose), the formulation of said molecule. The frequency may be ranged between at least once in a two weeks, or three weeks or four weeks or five weeks or a longer time period.

A molecule or oligonucleotide or equivalent thereof can be delivered as is to a cell. When administering said molecule, oligonucleotide or equivalent thereof to an individual, it is preferred that it is dissolved in a solution that is compatible with the delivery method. For intravenous, subcutaneous, intramuscular, intrathecal and/or intraventricular administration it is preferred that the solution is a physiological salt solution. Particularly preferred for a method of the invention is the use of an excipient that will further enhance delivery of said molecule, oligonucleotide or functional equivalent thereof as defined herein, to a cell and into a cell, preferably a muscle cell. Preferred excipients are defined in the section entitled “pharmaceutical composition”.

In a preferred method of the invention, an additional molecule is used which is able to induce and/or promote skipping of another exon of the DMD pre-mRNA of a patient. Preferably, the second exon is selected from: exon 6, 7, 11, 17, 19, 21, 43, 44, 45, 50, 51, 52, 53, 55, 57, 59, 62, 63, 65, 66, 69, or 75 of the DMD pre-mRNA of a patient. Molecules which can be used are depicted in any one of Table 1 to 7. This way, inclusion of two or more exons of a DMD pre-mRNA in mRNA produced from this pre-mRNA is prevented. This embodiment is further referred to as double- or multi-exon skipping (Aartsma-Rus A, Janson A A, Kaman W E, et al. Antisense-induced multiexon skipping for Duchenne muscular dystrophy makes more sense. Am J Hum Genet 2004; 74(1):83-92, Aartsma-Rus A, Kaman W E, Weij R, den Dunnen J T, van Ommen G J, van Deutekom J C. Exploring the frontiers of therapeutic exon skipping for Duchenne muscular dystrophy by double targeting within one or multiple exons. Mol Ther 2006; 14(3):401-7). In most cases double-exon skipping results in the exclusion of only the two targeted exons from the DMD pre-mRNA. However, in other cases it was found that the targeted exons and the entire region in between said exons in said pre-mRNA were not present in the produced mRNA even when other exons (intervening exons) were present in such region. This multi-skipping was notably so for the combination of oligonucleotides derived from the DMD gene, wherein one oligonucleotide for exon 45 and one oligonucleotide for exon 51 was added to a cell transcribing the DMD gene. Such a set-up resulted in mRNA being produced that did not contain exons 45 to 51. Apparently, the structure of the pre-mRNA in the presence of the mentioned oligonucleotides was such that the splicing machinery was stimulated to connect exons 44 and 52 to each other.

It is possible to specifically promote the skipping of also the intervening exons by providing a linkage between the two complementary oligonucleotides. Hence, in one embodiment stretches of nucleotides complementary to at least two dystrophin exons are separated by a linking moiety. The at least two stretches of nucleotides are thus linked in this embodiment so as to form a single molecule.

In case, more than one compounds or molecules are used in a method of the invention, said compounds can be administered to an individual in any order. In one embodiment, said compounds are administered simultaneously (meaning that said compounds are administered within 10 hours, preferably within one hour). This is however not necessary. In another embodiment, said compounds are administered sequentially.

Molecule

In a second aspect, there is provided a molecule for use in a method as described in the previous section entitled “Method”. A molecule as defined herein is preferably an oligonucleotide or antisense oligonucleotide (AON).

It was found by the present investigators that any of exon 43, 46, 50-53 is specifically skipped at a high frequency using a molecule that preferably binds to a continuous stretch of at least 8 nucleotides within said exon. Although this effect can be associated with a higher binding affinity of said molecule, compared to a molecule that binds to a continuous stretch of less than 8 nucleotides, there could be other intracellular parameters involved that favor thermodynamic, kinetic, or structural characteristics of the hybrid duplex. In a preferred embodiment, a molecule that binds to a continuous stretch of at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 nucleotides within said exon is used.

In a preferred embodiment, a molecule or an oligonucleotide of the invention which comprises a sequence that is complementary to a part of any of exon 43, 46, 50-53 of DMD pre-mRNA is such that the complementary part is at least 50% of the length of the oligonucleotide of the invention, more preferably at least 60%, even more preferably at least 70%, even more preferably at least 80%, even more preferably at least 90% or even more preferably at least 95%, or even more preferably 98% and most preferably up to 100%. “A part of said exon” preferably means a stretch of at least 8 nucleotides. In a most preferred embodiment, an oligonucleotide of the invention consists of a sequence that is complementary to part of said exon DMD pre-mRNA as defined herein. For example, an oligonucleotide may comprise a sequence that is complementary to part of said exon DMD pre-mRNA as defined herein and additional flanking sequences. In a more preferred embodiment, the length of said complementary part of said oligonucleotide is of at least 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 nucleotides. Preferably, additional flanking sequences are used to modify the binding of a protein to said molecule or oligonucleotide, or to modify a thermodynamic property of the oligonucleotide, more preferably to modify target RNA binding affinity.

A preferred molecule to be used in a method of the invention binds or is complementary to a continuous stretch of at least 8 nucleotides within one of the following nucleotide sequences selected from:

(SEQ ID NO: 2)
5′-AGAUAGUCUACAACAAAGCUCAGGUCGGAUUGACAUUAUUCAUAGCA
AGAAGACAGCAGCAUUGCAAAGUGCAACGCCUGUGG-3′
for skipping of exon 43;
(SEQ ID NO: 3)
5′-UUAUGGUUGGAGGAAGCAGAUAACAUUGCUAGUAUCCCACUUGAACC
UGGAAAAGAGCAGCAACUAAAAGAAAAGC-3′
for skipping of exon 46;
(SEQ ID NO: 4)
5′-GGCGGUAAACCGUUUACUUCAAGAGCUGAGGGCAAAGCAGCCUGACC
UAGCUCCUGGACUGACCACUAUUGG-3′
for skipping of exon 50;
(SEQ ID NO: 5)
5′-CUCCUACUCAGACUGUUACUCUGGUGACACAACCUGUGGUUACUAAG
GAAACUGCCAUCUCCAAACUAGAAAUGCCAUCUUCCUUGAUGUUGGAGGU
AC-3′
for skipping of exon 51;
(SEQ ID NO: 6)
5′-AUGCAGGAUUUGGAACAGAGGCGUCCCCAGUUGGAAGAACUCAU
UACCGCUGCCCAAAAUUUGAAAAACAAGACCAGCAAUCAAGAGGCU-3′
for skipping of exon 52;
and
(SEQ ID NO: 7)
5′-AAAUGUUAAAGGAUUCAACACAAUGGCUGGAAGCUAAGGAAGAA
GCUGAGCAGGUCUUAGGACAGGCCAGAG-3′
for skipping of exon 53.

Of the numerous molecules that theoretically can be prepared to bind to the continuous nucleotide stretches as defined by SEQ ID NO 2-7 within one of said exons, the invention provides distinct molecules that can be used in a method for efficiently skipping of at least one of exon 43, exon 46 and/or exon 50-53. Although the skipping effect can be addressed to the relatively high density of putative SR protein binding sites within said stretches, there could be other parameters involved that favor uptake of the molecule or other, intracellular parameters such as thermodynamic, kinetic, or structural characteristics of the hybrid duplex.

It was found that a molecule that binds to a continuous stretch comprised within or consisting of any of SEQ ID NO 2-7 results in highly efficient skipping of exon 43, exon 46 and/or exon 50-53 respectively in a cell and/or in a patient provided with this molecule. Therefore, in a preferred embodiment, a method is provided wherein a molecule binds to a continuous stretch of at least 8, 10, 12, 15, 18, 20, 25, 30, 35, 40, 45, 50 nucleotides within SEQ ID NO 2-7.

In a preferred embodiment for inducing and/or promoting the skipping of any of exon 43, exon 46 and/or exon 50-53, the invention provides a molecule comprising or consisting of an antisense nucleotide sequence selected from the antisense nucleotide sequences depicted in any of Tables 1 to 6. A molecule of the invention preferably comprises or consist of the antisense nucleotide sequence of SEQ ID NO 16, SEQ ID NO 65, SEQ ID NO 70, SEQ ID NO 91, SEQ ID NO 110, SEQ ID NO 117, SEQ ID NO 127, SEQ ID NO 165, SEQ ID NO 166, SEQ ID NO 167, SEQ ID NO 246, SEQ ID NO 299, SEQ ID NO:357.

A preferred molecule of the invention comprises a nucleotide-based or nucleotide or an antisense oligonucleotide sequence of between 8 and 50 nucleotides or bases, more preferred between 10 and 50 nucleotides, more preferred between 20 and 40 nucleotides, more preferred between 20 and 30 nucleotides, such as 20 nucleotides, 21 nucleotides, 22 nucleotides, 23 nucleotides, 24 nucleotides, 25 nucleotides, 26 nucleotides, 27 nucleotides, 28 nucleotides, 29 nucleotides, 30 nucleotides, 31 nucleotides, 32 nucleotides, 33 nucleotides, 34 nucleotides, 35 nucleotides, 36 nucleotides, 37 nucleotides, 38 nucleotides, 39 nucleotides, 40 nucleotides, 41 nucleotides, 42 nucleotides, 43 nucleotides, 44 nucleotides, 45 nucleotides, 46 nucleotides, 47 nucleotides, 48 nucleotides, 49 nucleotides or 50 nucleotides. A most preferred molecule of the invention comprises a nucleotide-based sequence of 25 nucleotides.

Furthermore, none of the indicated sequences is derived from conserved parts of splice-junction sites. Therefore, said molecule is not likely to mediate differential splicing of other exons from the DMD pre-mRNA or exons from other genes.

In one embodiment, a molecule of the invention is a compound molecule that binds to the specified sequence, or a protein such as an RNA-binding protein or a non-natural zinc-finger protein that has been modified to be able to bind to the corresponding nucleotide sequence on a DMD pre-RNA molecule. Methods for screening compound molecules that bind specific nucleotide sequences are, for example, disclosed in PCT/NL01/00697 and U.S. Pat. No. 6,875,736, which are herein incorporated by reference. Methods for designing RNA-binding Zinc-finger proteins that bind specific nucleotide sequences are disclosed by Friesen and Darby, Nature Structural Biology 5: 543-546 (1998) which is herein incorporated by reference.

A preferred molecule of the invention binds to at least part of the sequence of SEQ ID NO 2: 5′-AGAUAGUCUACAACAAAGCUCAGGUCGGAUUGACAUUAUUCAU AGCAAGAAGACAGCAGCAUUGCAAAGUGCAACGCCUGUGG-3′ which is present in exon 43 of the DMD gene. More preferably, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 8 to SEQ ID NO 69.

In an even more preferred embodiment, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO:16 and/or SEQ ID NO:65. In a most preferred embodiment, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 65. It was found that this molecule is very efficient in modulating splicing of exon 43 of the DMD pre-mRNA in a muscle cell and/or in a patient.

Another preferred molecule of the invention binds to at least part of the sequence of SEQ ID NO 3: 5′-UUAUGGUUGGAGGAAGCAGAUAACAUUGCUAGUAUCCCACUUG AACCUGGAAAAGAGCAGCAACUAAAAGAAAAGC-3′ which is present in exon 46 of the DMD gene. More preferably, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 70 to SEQ ID NO 122.

In an even more preferred embodiment, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 70, SEQ ID NO 91, SEQ ID NO 110, and/or SEQ ID N0117.

In a most preferred embodiment, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 117. It was found that this molecule is very efficient in modulating splicing of exon 46 of the DMD pre-mRNA in a muscle cell or in a patient.

Another preferred molecule of the invention binds to at least part of the sequence of SEQ ID NO 4: 5′-GGCGGUAAACCGUUUACUUCAAGAGCU GAGGGCAAAGCAGCCUG ACCUAGCUCCUGGACUGACCACUAUUGG-3′ which is present in exon 50 of the DMD gene. More preferably, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 123 to SEQ ID NO 167 and/or SEQ ID NO 529 to SEQ ID NO 535.

In an even more preferred embodiment, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 127, or SEQ ID NO 165, or SEQ ID NO 166 and/or SEQ ID NO 167.

In a most preferred embodiment, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 127. It was found that this molecule is very efficient in modulating splicing of exon 50 of the DMD pre-mRNA in a muscle cell and/or in a patient.

Another preferred molecule of the invention binds to at least part of the sequence of SEQ ID NO 5: 5′-CUCCUACUCAGACUGUUACUCUGGUGACACAACCUGUGGUUACU AAGGAAACUGCCAUCUCCAAACUAGAAAUGCCAUCUUCCUUGAUG UUGGAGGUAC-3′ which is present in exon 51 of the DMD gene. More preferably, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 168 to SEQ ID NO 241.

Another preferred molecule of the invention binds to at least part of the sequence of SEQ ID NO 6: 5′-AUGCAGGAUUUGGAACAGAGGCGUCCCCAGUUGGAAGAACUCAU UACCGCUGCCCAAAAUUUGAAAAACAAGACCAGCAAUCAAGAGGCU-3′ which is present in exon 52 of the DMD gene. More preferably, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 242 to SEQ ID NO 310. In an even more preferred embodiment, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 246 and/or SEQ ID NO 299. In a most preferred embodiment, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 299. It was found that this molecule is very efficient in modulating splicing of exon 52 of the DMD pre-mRNA in a muscle cell and/or in a patient.

Another preferred molecule of the invention binds to at least part of the sequence of SEQ ID NO 7: 5′-AAAUGUUAAAGGAUUCAACACAAUGGCUGGAAGCUAAGGAAGAA GCUGAGCAGGUCUUAGGACAGGCCAGAG-3′ which is present in exon 53 of the DMD gene. More preferably, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 311 to SEQ ID NO 358.

In a most preferred embodiment, the invention provides a molecule comprising or consisting of the antisense nucleotide sequence of SEQ ID NO 357. It was found that this molecule is very efficient in modulating splicing of exon 53 of the DMD pre-mRNA in a muscle cell and/or in a patient.

A nucleotide sequence of a molecule of the invention may contain RNA residues, or one or more DNA residues, and/or one or more nucleotide analogues or equivalents, as will be further detailed herein below.

It is preferred that a molecule of the invention comprises one or more residues that are modified to increase nuclease resistance, and/or to increase the affinity of the antisense nucleotide for the target sequence. Therefore, in a preferred embodiment, the antisense nucleotide sequence comprises at least one nucleotide analogue or equivalent, wherein a nucleotide analogue or equivalent is defined as a residue having a modified base, and/or a modified backbone, and/or a non-natural internucleoside linkage, or a combination of these modifications.

In a preferred embodiment, the nucleotide analogue or equivalent comprises a modified backbone. Examples of such backbones are provided by morpholino backbones, carbamate backbones, siloxane backbones, sulfide, sulfoxide and sulfone backbones, formacetyl and thioformacetyl backbones, methyleneformacetyl backbones, riboacetyl backbones, alkene containing backbones, sulfamate, sulfonate and sulfonamide backbones, methyleneimino and methylenehydrazino backbones, and amide backbones. Phosphorodiamidate morpholino oligomers are modified backbone oligonucleotides that have previously been investigated as antisense agents. Morpholino oligonucleotides have an uncharged backbone in which the deoxyribose sugar of DNA is replaced by a six membered ring and the phosphodiester linkage is replaced by a phosphorodiamidate linkage. Morpholino oligonucleotides are resistant to enzymatic degradation and appear to function as antisense agents by arresting translation or interfering with pre-mRNA splicing rather than by activating RNase H. Morpholino oligonucleotides have been successfully delivered to tissue culture cells by methods that physically disrupt the cell membrane, and one study comparing several of these methods found that scrape loading was the most efficient method of delivery; however, because the morpholino backbone is uncharged, cationic lipids are not effective mediators of morpholino oligonucleotide uptake in cells. A recent report demonstrated triplex formation by a morpholino oligonucleotide and, because of the non-ionic backbone, these studies showed that the morpholino oligonucleotide was capable of triplex formation in the absence of magnesium.

It is further preferred that that the linkage between the residues in a backbone do not include a phosphorus atom, such as a linkage that is formed by short chain alkyl or cycloalkyl internucleoside linkages, mixed heteroatom and alkyl or cycloalkyl internucleoside linkages, or one or more short chain heteroatomic or heterocyclic internucleoside linkages.

A preferred nucleotide analogue or equivalent comprises a Peptide Nucleic Acid (PNA), having a modified polyamide backbone (Nielsen, et al. (1991) Science 254, 1497-1500). PNA-based molecules are true mimics of DNA molecules in terms of base-pair recognition. The backbone of the PNA is composed of N-(2-aminoethyl)-glycine units linked by peptide bonds, wherein the nucleobases are linked to the backbone by methylene carbonyl bonds. An alternative backbone comprises a one-carbon extended pyrrolidine PNA monomer (Govindaraju and Kumar (2005) Chem. Commun, 495-497). Since the backbone of a PNA molecule contains no charged phosphate groups, PNA-RNA hybrids are usually more stable than RNA-RNA or RNA-DNA hybrids, respectively (Egholm et al (1993) Nature 365, 566-568).

A further preferred backbone comprises a morpholino nucleotide analog or equivalent, in which the ribose or deoxyribose sugar is replaced by a 6-membered morpholino ring. A most preferred nucleotide analog or equivalent comprises a phosphorodiamidate morpholino oligomer (PMO), in which the ribose or deoxyribose sugar is replaced by a 6-membered morpholino ring, and the anionic phosphodiester linkage between adjacent morpholino rings is replaced by a non-ionic phosphorodiamidate linkage.

In yet a further embodiment, a nucleotide analogue or equivalent of the invention comprises a substitution of one of the non-bridging oxygens in the phosphodiester linkage. This modification slightly destabilizes base-pairing but adds significant resistance to nuclease degradation. A preferred nucleotide analogue or equivalent comprises phosphorothioate, chiral phosphorothioate, phosphorodithioate, phosphotriester, aminoalkylphosphotriester, H-phosphonate, methyl and other alkylphosphonate including 3′-alkylene phosphonate, 5′-alkylene phosphonate and chiral phosphonate, phosphinate, phosphoramidate including 3′-amino phosphoramidate and aminoalkylphosphoramidate, thionophosphoramidate, thionoalkylphosphonate, thionoalkylphosphotriester, selenophosphate or boranophosphate.

A further preferred nucleotide analogue or equivalent of the invention comprises one or more sugar moieties that are mono- or disubstituted at the 2′, 3′ and/or 5′ position such as a —OH; —F; substituted or unsubstituted, linear or branched lower (C1-C10) alkyl, alkenyl, alkynyl, alkaryl, allyl, aryl, or aralkyl, that may be interrupted by one or more heteroatoms; O-, S-, or N-alkyl; O-, S-, or N-alkenyl; O-, S- or N-alkynyl; O-, S-, or N-allyl; O-alkyl-O-alkyl, -methoxy, -aminopropoxy; -aminoxy; methoxyethoxy; -dimethylaminooxyethoxy; and -dimethylaminoethoxyethoxy. The sugar moiety can be a pyranose or derivative thereof, or a deoxypyranose or derivative thereof, preferably a ribose or a derivative thereof, or a deoxyribose or a derivative thereof. Such preferred derivatized sugar moieties comprise Locked Nucleic Acid (LNA), in which the 2′-carbon atom is linked to the 3′ or 4′ carbon atom of the sugar ring thereby forming a bicyclic sugar moiety. A preferred LNA comprises 2′-0,4′-C-ethylene-bridged nucleic acid (Morita et al. 2001. Nucleic Acid Res Supplement No. 1: 241-242). These substitutions render the nucleotide analogue or equivalent RNase H and nuclease resistant and increase the affinity for the target RNA.

It is understood by a skilled person that it is not necessary for all positions in an antisense oligonucleotide to be modified uniformly. In addition, more than one of the aforementioned analogues or equivalents may be incorporated in a single antisense oligonucleotide or even at a single position within an antisense oligonucleotide. In certain embodiments, an antisense oligonucleotide of the invention has at least two different types of analogues or equivalents.

A preferred antisense oligonucleotide according to the invention comprises a 2′-O alkyl phosphorothioate antisense oligonucleotide, such as 2′-O-methyl modified ribose (RNA), 2′-O-ethyl modified ribose, 2′-O-propyl modified ribose, and/or substituted derivatives of these modifications such as halogenated derivatives.

A most preferred antisense oligonucleotide according to the invention comprises of 2′-O-methyl phosphorothioate ribose.

A functional equivalent of a molecule of the invention may be defined as an oligonucleotide as defined herein wherein an activity of said functional equivalent is retained to at least some extent. Preferably, an activity of said functional equivalent is inducing exon 43, 46, 50, 51, 52, or 53 skipping and providing a functional dystrophin protein. Said activity of said functional equivalent is therefore preferably assessed by detection of exon 43, 46, 50, 51, 52, or 53 skipping and by quantifying the amount of functional dystrophin protein. A functional dystrophin is herein preferably defined as being a dystrophin able to bind actin and members of the DGC protein complex. The assessment of said activity of an oligonucleotide is preferably done by RT-PCR or by immunofluorescence or Western blot analyses. Said activity is preferably retained to at least some extent when it represents at least 50%, or at least 60%, or at least 70% or at least 80% or at least 90% or at least 95% or more of corresponding activity of said oligonucleotide the functional equivalent derives from. Throughout this application, when the word oligonucleotide is used it may be replaced by a functional equivalent thereof as defined herein.

It will be understood by a skilled person that distinct antisense oligonucleotides can be combined for efficiently skipping any of exon 43, exon 46, exon 50, exon 51, exon 52 and/or exon 53 of the human DMD pre-mRNA. It is encompassed by the present invention to use one, two, three, four, five or more oligonucleotides for skipping one of said exons (i.e., exon, 43, 46, 50, 51, 52, or 53). It is also encompassed to use at least two oligonucleotides for skipping at least two, of said exons. Preferably two of said exons are skipped. More preferably, these two exons are:

−43 and 51, or
−43 and 53, or
−50 and 51, or
−51 and 52, or
−52 and 53.

The skilled person will know which combination of exons is preferred to be skipped depending on the type, the number and the location of the mutation present in a DMD or BMD patient.

An antisense oligonucleotide can be linked to a moiety that enhances uptake of the antisense oligonucleotide in cells, preferably muscle cells. Examples of such moieties are cholesterols, carbohydrates, vitamins, biotin, lipids, phospholipids, cell-penetrating peptides including but not limited to antennapedia, TAT, transportan and positively charged amino acids such as oligoarginine, poly-arginine, oligolysine or polylysine, antigen-binding domains such as provided by an antibody, a Fab fragment of an antibody, or a single chain antigen binding domain such as a cameloid single domain antigen-binding domain.

A preferred antisense oligonucleotide comprises a peptide-linked PMO.

A preferred antisense oligonucleotide comprising one or more nucleotide analogs or equivalents of the invention modulates splicing in one or more muscle cells, including heart muscle cells, upon systemic delivery. In this respect, systemic delivery of an antisense oligonucleotide comprising a specific nucleotide analog or equivalent might result in targeting a subset of muscle cells, while an antisense oligonucleotide comprising a distinct nucleotide analog or equivalent might result in targeting of a different subset of muscle cells. Therefore, in one embodiment it is preferred to use a combination of antisense oligonucleotides comprising different nucleotide analogs or equivalents for inducing skipping of exon 43, 46, 50, 51, 52, or 53 of the human DMD pre-mRNA.

A cell can be provided with a molecule capable of interfering with essential sequences that result in highly efficient skipping of exon 43, exon 46, exon 50, exon 51, exon 52 or exon 53 of the human DMD pre-mRNA by plasmid-derived antisense oligonucleotide expression or viral expression provided by adenovirus- or adeno-associated virus-based vectors. In a preferred embodiment, there is provided a viral-based expression vector comprising an expression cassette that drives expression of a molecule as identified herein. Expression is preferably driven by a polymerase III promoter, such as a U1, a U6, or a U7 RNA promoter. A muscle or myogenic cell can be provided with a plasmid for antisense oligonucleotide expression by providing the plasmid in an aqueous solution. Alternatively, a plasmid can be provided by transfection using known transfection agentia such as, for example, LipofectAMINE™ 2000 (Invitrogen) or polyethyleneimine (PEI; ExGen500 (MBI Fermentas)), or derivatives thereof.

One preferred antisense oligonucleotide expression system is an adenovirus associated virus (AAV)-based vector. Single chain and double chain AAV-based vectors have been developed that can be used for prolonged expression of small antisense nucleotide sequences for highly efficient skipping of exon 43, 46, 50, 51, 52 or 53 of the DMD pre-mRNA.

A preferred AAV-based vector comprises an expression cassette that is driven by a polymerase III-promoter (Pol III). A preferred Pol III promoter is, for example, a Ul, a U6, or a U7 RNA promoter.

The invention therefore also provides a viral-based vector, comprising a Pol III-promoter driven expression cassette for expression of one or more antisense sequences of the invention for inducing skipping of exon 43, exon 46, exon 50, exon 51, exon 52 or exon 53 of the human DMD pre-mRNA.

Pharmaceutical Composition

If required, a molecule or a vector expressing an antisense oligonucleotide of the invention can be incorporated into a pharmaceutically active mixture or composition by adding a pharmaceutically acceptable carrier.

Therefore, in a further aspect, the invention provides a composition, preferably a pharmaceutical composition comprising a molecule comprising an antisense oligonucleotide according to the invention, and/or a viral-based vector expressing the antisense sequence(s) according to the invention and a pharmaceutically acceptable carrier.

A preferred pharmaceutical composition comprises a molecule as defined herein and/or a vector as defined herein, and a pharmaceutical acceptable carrier or excipient, optionally combined with a molecule and/or a vector as defined herein which is able to induce skipping of exon 6, 7, 11, 17, 19, 21, 43, 44, 45, 50, 51, 52, 53, 55, 57, 59, 62, 63, 65, 66, 69, or 75 of the DMD pre-mRNA. Preferred molecules able to induce skipping of any of these exon are identified in any one of Tables 1 to 7.

Preferred excipients include excipients capable of forming complexes, vesicles and/or liposomes that deliver such a molecule as defined herein, preferably an oligonucleotide complexed or trapped in a vesicle or liposome through a cell membrane. Many of these excipients are known in the art. Suitable excipients comprise polyethylenimine and derivatives, or similar cationic polymers, including polypropyleneimine or polyethylenimine copolymers (PECs) and derivatives, ExGen 500, synthetic amphiphils (SAINT-18), lipofectin, DOTAP and/or viral capsid proteins that are capable of self-assembly into particles that can deliver such molecule, preferably an oligonucleotide as defined herein to a cell, preferably a muscle cell. Such excipients have been shown to efficiently deliver (oligonucleotide such as antisense) nucleic acids to a wide variety of cultured cells, including muscle cells. Their high transfection potential is combined with an excepted low to moderate toxicity in terms of overall cell survival. The ease of structural modification can be used to allow further modifications and the analysis of their further (in vivo) nucleic acid transfer characteristics and toxicity.

Lipofectin represents an example of a liposomal transfection agent. It consists of two lipid components, a cationic lipid N-[1-(2,3 dioleoyloxy)propyl]-N,N,N-trimethylammonium chloride (DOTMA) (cp. DOTAP which is the methylsulfate salt) and a neutral lipid dioleoylphosphatidylethanolamine (DOPE). The neutral component mediates the intracellular release. Another group of delivery systems are polymeric nanoparticles.

Polycations such like diethylaminoethylaminoethyl (DEAE)-dextran, which are well known as DNA transfection reagent can be combined with butylcyanoacrylate (PBCA) and hexylcyanoacrylate (PHCA) to formulate cationic nanoparticles that can deliver a molecule or a compound as defined herein, preferably an oligonucleotide across cell membranes into cells.

In addition to these common nanoparticle materials, the cationic peptide protamine offers an alternative approach to formulate a compound as defined herein, preferably an oligonucleotide as colloids. This colloidal nanoparticle system can form so called proticles, which can be prepared by a simple self-assembly process to package and mediate intracellular release of a compound as defined herein, preferably an oligonucleotide. The skilled person may select and adapt any of the above or other commercially available alternative excipients and delivery systems to package and deliver a compound as defined herein, preferably an oligonucleotide for use in the current invention to deliver said compound for the treatment of Duchenne Muscular Dystrophy or Becker Muscular Dystrophy in humans.

In addition, a compound as defined herein, preferably an oligonucleotide could be covalently or non-covalently linked to a targeting ligand specifically designed to facilitate the uptake into the cell, cytoplasm and/or its nucleus. Such ligand could comprise (i) a compound (including but not limited to peptide(-like) structures) recognizing cell, tissue or organ specific elements facilitating cellular uptake and/or (ii) a chemical compound able to facilitate the uptake into cells and/or the intracellular release of a compound as defined herein, preferably an oligonucleotide from vesicles, e.g. endosomes or lysosomes.

Therefore, in a preferred embodiment, a compound as defined herein, preferably an oligonucleotide are formulated in a medicament which is provided with at least an excipient and/or a targeting ligand for delivery and/or a delivery device of said compound to a cell and/or enhancing its intracellular delivery. Accordingly, the invention also encompasses a pharmaceutically acceptable composition comprising a compound as defined herein, preferably an oligonucleotide and further comprising at least one excipient and/or a targeting ligand for delivery and/or a delivery device of said compound to a cell and/or enhancing its intracellular delivery. It is to be understood that a molecule or compound or oligonucleotide may not be formulated in one single composition or preparation. Depending on their identity, the skilled person will know which type of formulation is the most appropriate for each compound.

In a preferred embodiment, an in vitro concentration of a molecule or an oligonucleotide as defined herein, which is ranged between 0.1 nM and 1 μM is used. More preferably, the concentration used is ranged between 0.3 to 400 nM, even more preferably between 1 to 200 nM. A molecule or an oligonucleotide as defined herein may be used at a dose which is ranged between 0.1 and 20 mg/kg, preferably 0.5 and 10 mg/kg. If several molecules or oligonucleotides are used, these concentrations may refer to the total concentration of oligonucleotides or the concentration of each oligonucleotide added. The ranges of concentration of oligonucleotide(s) as given above are preferred concentrations for in vitro or ex vivo uses. The skilled person will understand that depending on the oligonucleotide(s) used, the target cell to be treated, the gene target and its expression levels, the medium used and the transfection and incubation conditions, the concentration of oligonucleotide(s) used may further vary and may need to be optimized any further.

More preferably, a compound preferably an oligonucleotide to be used in the invention to prevent, treat DMD or BMD are synthetically produced and administered directly to a cell, a tissue, an organ and/or patients in formulated form in a pharmaceutically acceptable composition or preparation. The delivery of a pharmaceutical composition to the subject is preferably carried out by one or more parenteral injections, e.g., intravenous and/or subcutaneous and/or intramuscular and/or intrathecal and/or intraventricular administrations, preferably injections, at one or at multiple sites in the human body.

A preferred oligonucleotide as defined herein optionally comprising one or more nucleotide analogs or equivalents of the invention modulates splicing in one or more muscle cells, including heart muscle cells, upon systemic delivery. In this respect, systemic delivery of an oligonucleotide comprising a specific nucleotide analog or equivalent might result in targeting a subset of muscle cells, while an oligonucleotide comprising a distinct nucleotide analog or equivalent might result in targeting of a different subset of muscle cells.

In this respect, systemic delivery of an oligonucleotide comprising a specific nucleotide analog or equivalent might result in targeting a subset of muscle cells, while an oligonucleotide comprising a distinct nucleotide analog or equivalent might result in targeting a different subset of muscle cells. Therefore, in this embodiment, it is preferred to use a combination of oligonucleotides comprising different nucleotide analogs or equivalents for modulating splicing of the DMD mRNA in at least one type of muscle cells.

In a preferred embodiment, there is provided a molecule or a viral-based vector for use as a medicament, preferably for modulating splicing of the DMD pre-mRNA, more preferably for promoting or inducing skipping of any of exon 43, 46, 50-53 as identified herein.

Use

In yet a further aspect, the invention provides the use of an antisense oligonucleotide or molecule according to the invention, and/or a viral-based vector that expresses one or more antisense sequences according to the invention and/or a pharmaceutical composition, for modulating splicing of the DMD pre-mRNA. The splicing is preferably modulated in a human myogenic cell or muscle cell in vitro. More preferred is that splicing is modulated in a human muscle cell in vivo. Accordingly, the invention further relates to the use of the molecule as defined herein and/or the vector as defined herein and/or or the pharmaceutical composition as defined herein for modulating splicing of the DMD pre-mRNA or for the preparation of a medicament for the treatment of a DMD or BMD patient.

In this document and in its claims, the verb “to comprise” and its conjugations is used in its non-limiting sense to mean that items following the word are included, but items not specifically mentioned are not excluded. In addition, the verb “to consist” may be replaced by “to consist essentially of’ meaning that a molecule or a viral-based vector or a composition as defined herein may comprise additional component(s) than the ones specifically identified, said additional component(s) not altering the unique characteristic of the invention. In addition, reference to an element by the indefinite article “a” or “an” does not exclude the possibility that more than one of the element is present, unless the context clearly requires that there be one and only one of the elements. The indefinite article “a” or “an” thus usually means “at least one”. Each embodiment as identified herein may be combined together unless otherwise indicated. All patent and literature references cited in the present specification are hereby incorporated by reference in their entirety.

The following examples are offered for illustrative purposes only, and are not intended to limit the scope of the present invention in any way.

EXAMPLES

Examples 1-4

Materials and Methods

AON design was based on (partly) overlapping open secondary structures of the target exon RNA as predicted by them-fold program, on (partly) overlapping putative SR— protein binding sites as predicted by the ESE-finder software. AONs were synthesized by Prosensa Therapeutics B.V. (Leiden, Netherlands), and contain 2′-O-methyl RNA and full-length phosphorothioate (PS) backbones.

Tissue Culturing, Transfection and RT-PCR Analysis

Myotube cultures derived from a healthy individual (“human control”) (examples 1, 3, and 4; exon 43, 50, 52 skipping) or a DMD patient carrying an exon 45 deletion (example 2; exon 46 skipping) were processed as described previously (Aartsma-Rus et al., Neuromuscul. Disord. 2002; 12: S71-77 and Hum Mol Genet 2003; 12(8): 907-14). For the screening of AONs, myotube cultures were transfected with 50 nM and 150 nM (example 2), 200 nM and 500 nM (example 4) or 500 nM only (examples 1 and 3) of each AON. Transfection reagent UNIFectylin (Prosensa Therapeutics BV, Netherlands) was used, with 2 μl UNIFectylin per AON. Exon skipping efficiencies were determined by nested RT-PCR analysis using primers in the exons flanking the targeted exons (43, 46, 50, 51, 52, or 53). PCR fragments were isolated from agarose gels for sequence verification. For quantification, the PCR products were analyzed using the DNA 1000 LabChips Kit on the Agilent 2100 bioanalyzer (Agilent Technologies, USA).

Results

DMD Exon 43 Skipping.

A series of AONs targeting sequences within exon 43 were designed and transfected in healthy control myotube cultures. Subsequent RT-PCR and sequence analysis of isolated RNA demonstrated that almost all AONs targeting a continuous nucleotide stretch within exon 43 herein defined as SEQ ID NO 2, was indeed capable of inducing exon 43 skipping. PS237 (SEQ ID NO: 65) reproducibly induced highest levels of exon 43 skipping (up to 66%) at 500 nM, as shown in FIG. 1. For comparison, also PS238 and PS240 are shown, inducing exon 43 skipping levels up to 13% and 36% respectively (FIG. 1). The precise skipping of exon 43 was confirmed by sequence analysis of the novel smaller transcript fragments. No exon 43 skipping was observed in non-treated cells (NT).

DMD Exon 46 Skipping.

A series of AONs targeting sequences within exon 46 were designed and transfected in myotube cultures derived from a DMD patient carrying an exon 45 deletion in the DMD gene. For patients with such mutation antisense-induced exon 46 skipping would induce the synthesis of a novel, BMD-like dystrophin protein that may indeed alleviate one or more symptoms of the disease. Subsequent RT-PCR and sequence analysis of isolated RNA demonstrated that almost all AONs targeting a continuous nucleotide stretch within exon 46 herein defined as SEQ ID NO 3, was indeed capable of inducing exon 46 skipping, even at relatively low AON concentrations of 50 nM. PS182 (SEQ ID NO: 117) reproducibly induced highest levels of exon 46 skipping (up to 50% at 50 nM and 74% at 150 nM), as shown in FIG. 2. For comparison, also PS177, PS179, and PS181 are shown, inducing exon 46 skipping levels up to 55%, 58% and 42% respectively at 150 nM (FIG. 2). The precise skipping of exon 46 was confirmed by sequence analysis of the novel smaller transcript fragments. No exon 46 skipping was observed in non-treated cells (NT).

DMD Exon 50 Skipping.

A series of AONs targeting sequences within exon 50 were designed and transfected in healthy control myotube cultures. Subsequent RT-PCR and sequence analysis of isolated RNA demonstrated that almost all AONs targeting a continuous nucleotide stretch within exon 50 herein defined as SEQ ID NO 4, was indeed capable of inducing exon 50 skipping. PS248 (SEQ ID NO: 127) reproducibly induced highest levels of exon 50 skipping (up to 35% at 500 nM), as shown in FIG. 3. For comparison, also PS245, PS246, and PS247 are shown, inducing exon 50 skipping levels up to 14-16% at 500 nM (FIG. 3). The precise skipping of exon 50 was confirmed by sequence analysis of the novel smaller transcript fragments. No exon 50 skipping was observed in non-treated cells (NT).

DMD Exon 51 Skipping

A series of AONs targeting sequences within exon 51 were designed and transfected in healthy control myotube cultures. Subsequent RT-PCR and sequence analysis of isolated RNA demonstrated that almost all AONs targeting a continuous nucleotide stretch within exon 51 herein defined as SEQ ID NO 5, was indeed capable of inducing exon 51 skipping. The AON with SEQ ID NO 180 reproducibly induced highest levels of exon 51 skipping (not shown).

DMD Exon 52 Skipping.

A series of AONs targeting sequences within exon 52 were designed and transfected in healthy control myotube cultures. Subsequent RT-PCR and sequence analysis of isolated RNA demonstrated that almost all AONs targeting a continuous nucleotide stretch within exon 52 herein defined as SEQ ID NO 6, was indeed capable of inducing exon 52 skipping. PS236 (SEQ ID NO: 299) reproducibly induced highest levels of exon 52 skipping (up to 88% at 200 nM and 91% at 500 nM), as shown in FIG. 4. For comparison, also PS232 and AON 52-1 (previously published by Aartsma-Rus et al. Oligonucleotides 2005) are shown, inducing exon 52 skipping at levels up to 59% and 10% respectively when applied at 500 nM (FIG. 4). The precise skipping of exon 52 was confirmed by sequence analysis of the novel smaller transcript fragments. No exon 52 skipping was observed in non-treated cells (NT).

DMD Exon 53 Skipping

A series of AONs targeting sequences within exon 53 were designed and transfected in healthy control myotube cultures. Subsequent RT-PCR and sequence analysis of isolated RNA demonstrated that almost all AONs targeting a continuous nucleotide stretch within exon 53 herein defined as SEQ ID NO 7, was indeed capable of inducing exon 53 skipping. The AON with SEQ ID NO 328 reproducibly induced highest levels of exon 53 skipping (not shown).

SEQUENCE LISTING:
DMD GENE AMINO ACID SEQUENCE
SEO ID NO 1:
MLWWEEVEDCYEREDVQKKTFTKWVNAQFSKEGKQHIENLFSDLQDGRR
LLDLLEGLTGQKLPKEKGSTRVHALNNVNKALRVLQNNNVDLVNIGSTD
IVDGNHKLTLGLIWNIILHWQVKNVMKNIMAGLQQTNSEKILLSWVRQS
TRNYPQVNVINFTTSWSDGLALNALIHSHRPDLFDWNSVVCQQSATQRL
EHAFNIARYQLGIEKLLDPEDVDTTYPDKKSILMYITSLFQVLPQQVSI
EAIQEVEMLPRPPKVTKEEHFQLHHQMHYSQQITVSLAQGYERTSSPKP
RFKSYAYTQAAYVTTSDPTRSPFPSQHLEAPEDKSEGSSLMESEVNLDR
YQTALEEVLSWLLSAEDTLQAQGEISNDVEVVKDQFHTHEGYMMDLTAH
QGRVGNILQLGSKLIGTGKLSEDEETEVQEQMNLLNSRWECLRVASMEK
QSNLHRVLMDLQNQKLKELNDWLTKTEERTRKMEEEPLGPDLEDLKRQV
QQHKVLQEDLEQEQVRVNSLTHMVVVVDESSGDHATAALEEQLKVLGDR
WANICRWTEDRWVLLQDILLKWQRLTEEQCLFSAWLSEKEDAVNKIHTT
GFKDQNEMLSSLQKLAVLKADLEKKKQSMGKLYSLKQDLLSTLKNKSVT
QKTEAWLDNFARCWDNLVQKLEKSTAQISQAVTTTQPSLTQTTVMETVT
TVTTREQILVKHAQEELPPPPPQKKRQITVDSEIRKRLDVDITELHSWI
TRSEAVLQSPEFAIFRKEGNFSDLKEKVNAIEREKAEKERKLQDASRSA
QALVEQMVNEGVNADSIKQASEQLNSRWIEFCQLLSERLNWLEYQNNII
AFYNQLQQLEQMTTTAENWLKIQPTTPSEPTAIKSQLKICKDEVNRLSG
LQPQIERLKIQSIALKEKGQGPMFLDADFVAFTNHFKQVFSDVQAREKE
LQTIFDTLPPMRYQETMSAIRTWVQQSETKLSIPQLSVTDYEIMEQRLG
ELQALQSSLQEQQSGLYYLSTTVKEMSKKAPSEISRKYQSEFEEIEGRW
KKLSSQLVEHCQKLEEQMNKLRKIQNHIQTLKKWMAEVDVFLKEEWPAL
GDSEILKKQLKQCRLLVSDIQTIQPSLNSVNEGGQKIKNEAEPEFASRL
ETELKELNTQWDHMCQQVYARKEALKGGLEKTVSLQKDLSEMHEWMTQA
EEEYLERDFEYKTPDELQKAVEEMKRAKEEAQQKEAKVKLLTESVNSVI
AQAPPVAQEALKKELETLTTNYQWLCTRLNGKCKTLEEVWACWHELLSY
LEKANKWLNEVEFKLKTTENIPGGAEEISEVLDSLENLMRHSEDNPNQI
RILAQTLTDGGVMDELINEELETFNSRWRELHEEAVRRQKLLEQSIQSA
QETEKSLHLIQESLTFIDKQLAAYIADKVDAAQMPQEAQKIQSDLTSHE
ISLEEMKKHNQGKEAAQRVLSQIDVAQKKLQDVSMKFRLFQKPANFEQR
LQESKMILDEVKMHLPALETKSVEQEVVQSQLNHCVNLYKSLSEVKSEV
EMVIKTGRQIVQKKQTENPKELDERVTALKLHYNELGAKVTERKQQLEK
CLKLSRKMRKEMNVLTEWLAATDMELTKRSAVEGMPSNLDSEVAWGKAT
QKEIEKQKVHLKSITEVGEALKTVLGKKETLVEDKLSLLNSNWIAVTSR
AEEWLNLLLEYQKHMETFDQNVDHITKWIIQADTLLDESEKKKPQQKED
VLKRLKAELNDIRPKVDSTRDQAANLMANRGDHCRKLVEPQISELNHRF
AAISHRIKTGKASIPLKELEQFNSDIQKLLEPLEAEIQQGVNLKEEDFN
KDMNEDNEGTVKELLQRGDNLQQRITDERKREEIKIKQQLLQTKHNALK
DLRSQRRKKALEISHQWYQYKRQADDLLKCLDDIEKKLASLPEPRDERK
IKEIDRELQKKKEELNAVRRQAEGLSEDGAAMAVEPTQIQLSKRWREIE
SKFAQFRRLNFAQIHTVREETMMVMTEDMPLEISYVPSTYLTEITHVSQ
ALLEVEQLLNAPDLCAKDFEDLFKQEESLKNIKDSLQQSSGRIDIIHSK
KTAALQSATPVERVKLQEALSQLDFQWEKVNKMYKDRQGRFDRSVEKWR
RFHYDIKIFNQWLTEAEQFLRKTQIPENWEHAKYKWYLKELQDGIGQRQ
TVVRTLNATGEEIIQQSSKTDASILQEKLGSLNLRWQEVCKQLSDRKKR
LEEQKNILSEFQRDLNEFVLWLEEADNIASIPLEPGKEQQLKEKLEQVK
LLVEELPLRQGILKQLNETGGPVLVSAPISPEEQDKLENKLKQTNLQWI
KVSRALPEKQGEIEAQIKDLGQLEKKLEDLEEQLNHLLLWLSPIRNQLE
IYNQPNQEGPFDVQETEIAVQAKQPDVEEILSKGQHLYKEKPATQPVKR
KLEDLSSEWKAVNRLLQELRAKQPDLAPGLTTIGASPTQTVTLVTQPVV
TKETAISKLEMPSSLMLEVPALADFNRAWTELTDWLSLLDQVIKSQRVM
VGDLEDINEMIIKQKATMQDLEQRRPQLEELITAAQNLKNKTSNQEART
IITDRIERIQNQWDEVQEHLQNRRQQLNEMLKDSTQWLEAKEEAEQVLG
QARAKLESWKEGPYTVDAIQKKITETKQLAKDLRQWQTNVDVANDLALK
LLRDYSADDTRKVHMITENINASWRSIHKRVSEREAALEETHRLLQQFP
LDLEKFLAWLTEAETTANVLQDATRKERLLEDSKGVKELMKQWQDLQGE
IEAHTDVYHNLDENSQKILRSLEGSDDAVLLQRRLDNMNFKWSELRKKS
LNIRSHLEASSDQWKRLHLSLQELLVWLQLKDDELSRQAPIGGDFPAVQ
KQNDVHRAFKRELKTKEPVIMSTLETVRIFLTEQPLEGLEKLYQEPREL
PPEERAQNVTRLLRKQAEEVNTEWEKLNLHSADWQRKIDETLERLQELQ
EATDELDLKLRQAEVIKGSWQPVGDLLIDSLQDHLEKVKALRGEIAPLK
ENVSHVNDLARQLTTLGIQLSPYNLSTLEDLNTRWKLLQVAVEDRVRQL
HEAHRDFGPASQHFLSTSVQGPWERAISPNKVPYYINHETQTTCWDHPK
MTELYQSLADLNNVRFSAYRTAMKLRRLQKALCLDLLSLSAACDALDQH
NLKQNDQPMDILQIINCLTTIYDRLEQEHNNLVNVPLCVDMCLNWLLNV
YDTGRTGRIRVLSFKTGIISLCKAHLEDKYRYLFKQVASSTGFCDQRRL
GLLLHDSIQIPRQLGEVASFGGSNIEPSVRSCFQFANNKPEIEAALFLD
WMRLEPQSMVWLPVLHRVAAAETAKHQAKCNICKECPIIGFRYRSLKHF
NYDICQSCFFSGRVAKGHKMHYPMVEYCTPTTSGEDVRDFAKVLKNKFR
TKRYFAKHPRMGYLPVQTVLEGDNMETPVTLINFWPVDSAPASSPQLSH
DDTHSRIEHYASRLAEMENSNGSYLNDSISPNESIDDEHLLIQHYCQSL
NQDSPLSQPRSPAQILISLESEERGELERILADLEEENRNLQAEYDRLK
QQHEHKGLSPLPSPPEMMPTSPQSPRDAELIAEAKLLRQHKGRLEARMQ
ILEDHNKQLESQLHRLRQLLEQPQAEAKVNGTTVSSPSTSLQRSDSSQP
MLLRVVGSQTSDSMGEEDLLSPPQDTSTGLEEVMEQLNNSFPSSRGRNT
PGKPMREDTM
SEQ ID NO 2 (EXON 43):
AGAUAGUCUACAACAAAGCUCAGGUCGGAUUGACAUUAUUCAUAGCAAG
AAGACAG CAGCAUUGCAMGUGCAACGCCUGUGG
SEQ ID NO 3 (EXON 46):
UUAUGGUUGGAGGAAGCAGAUAACAUUGCUAGUAUCCCACUUGAACCUG
GAMAGAGCAGCAACUAAAAGAMAGC
SEQ ID NO 4 (EXON 50):
GGCGGUAMCCGUUUACUUCAAGAGCUGAGGGCAAAGCAGCCUGACCUAG
CUCCUGGACUGACCACUAUUGG
SEQ ID NO 5 (EXON 51):
CUCCUACUCAGACUGUUACUCUGGUGACACAACCUGUGGUUACUAAGGA
MCUGCCAUCUCCAAACUAGAAAUGCCAUCUUCCUUGAUGUUGGAGGUAC
SEQ ID NO 6 (EXON 52):
AUGCAGGAUUUGGAACAGAGGCGUCCCCAGUUGGAAGAACUCAUUACCG
CUGCCCAAAAUUU GAAAAACAAGACCAGCAAUCAAGAGGCU
SEQ ID NO 7 (EXON 53):
AAAUGUUAAAGGAUUCAACACAAUGGCUGGAAGCUAAGGAAGAAGCUGA
GCAGGUCUUAGGA CAGGCCAGAG

TABLE 1
OLIGONUCLEOTIDES FOR SKIPPING DMD
GENE EXON 43
SEQ ID CCACAGGCGUUGCACUUUGCA
NO 8 AUGC
SEQ ID CACAGGCGUUGCACUUUGCAA
NO 9 UGCU
SEQ ID ACAGGCGUUGCACUUUGCAAU
NO 10 GCUG
SEQ ID CAGGCGUUGCACUUUGCAAUG
NO 11 CUGC
SEQ ID AGGCGUUGCACULTUGCAAUGC
NO 12 UGCU
SEQ ID GGCGUUGCACULTUGCAAUGCU
NO 13 GCUG
SEQ ID GCGUUGCACULTUGCAAUGCUG
NO 14 CUGU
SEQ ID CGUUGCACUUUGCAAUGCUGC
NO 15 UGUC
SEQ ID CGUUGCACULTUGCAAUGCUGC
NO 16 UG
PS240
SEQ ID GUUGCACUUUGCAAUGCUGCU
NO 17 GUCU
SEQ ID UUGCACUUUGCAAUGCUGCUG
NO 18 UCUU
SEQ ID UGCACUUUGCAAUGCUGCUGU
NO 19 CUUC
SEQ ID GCACUUUGCAAUGCUGCUGUC
NO 20 UUCU
SEQ ID CACUUUGCAAUGCUGCUGUCU
NO 21 UCUU
SEQ ID ACUUUGCAAUGCUGCUGUCUU
NO 22 CUUG
SEQ ID CUUUGCAAUGCUGCUGUCUUC
NO 23 UUGC
SEQ ID UUUGCAAUGCUGCUGUCUUCU
NO 24 UGCU
SEQ ID UUGCAAUGCUGCUGUCUUCUU
NO 25 GCUA
SEQ ID UGCAAUGCUGCUGUCUUCUUG
NO 26 CUAU
SEQ ID GCAAUGCUGCUGUCUUCUUGC
NO 27 UAUG
SEQ ID CAAUGCUGCUGUCUUCUUGCU
NO 28 AUGA
SEQ ID AAUGCUGCUGUCUUCUUGCUA
NO 29 UGAA
SEQ ID AUGCUGCUGUCUUCUUGCUAU
NO 30 GAAU
SEQ ID UGCUGCUGUCUUCUUGCUAUG
NO 31 AAUA
SEQ ID GCUGCUGUCUUCUUGCUAUGA
NO 32 AUAA
SEQ ID CUGCUGUCUUCUUGCUAUGAA
NO 33 UAAU
SEQ ID UGCUGUCUUCUUGCUAUGAAU
NO 34 AAUG
SEQ ID GCUGUCUUCUUGCUAUGAAUA
NO 35 AUGU
SEQ ID CUGUCUUCUUGCUAUGAAUAA
NO 36 UGUC
SEQ ID UGUCUUCUUGCUAUGAAUAAU
NO 37 GUCA
SEQ ID GUCUUCUUGCUAUGAAUAAUG
NO 38 UCAA
SEQ ID UCUUCUUGCUAUGAAUAAUGUC
NO 39 AAU
SEQ ID CUUCUUGCUAUGAAUAAUGUCA
NO 40 AUC
SEQ ID UUCUUGCUAUGAAUAAUGUCAA
NO 41 UCC
SEQ ID UCUUGCUAUGAAUAAUGUCAAU
NO 42 CCG
SEQ ID CUUGCUAUGAAUAAUGUCAAUC
NO 43 CGA
SEQ ID UUGCUAUGAAUAAUGUCAAUCC
NO 44 GAC
SEQ ID UGCUAUGAAUAAUGUCAAUCCG
NO 45 ACC
SEQ ID GCUAUGAAUAAUGUCAAUCCGA
NO 46 CCU
SEQ ID CUAUGAAUAAUGUCAAUCCGACC
NO 47 UG
SEQ ID UAUGAAUAAUGUCAAUCCGACC
NO 48 UGA
SEQ ID AUGAAUAAUGUCAAUCCGACCU
NO 49 GAG
SEQ ID UGAAUAAUGUCAAUCCGACCUG
NO 50 AGC
SEQ ID GAAUAAUGUCAAUCCGACCUGA
NO 51 GCU
SEQ ID AAUAAUGUCAAUCCGACCUGAGC
NO 52 UU
SEQ ID AUAAUGUCAAUCCGACCUGAGCU
NO 53 UU
SEQ ID UAAUGUCAAUCCGACCUGAGCUU
NO 54 UG
SEQ ID AAUGUCAAUCCGACCUGAGCUUU
NO 55 GU
SEQ ID AUGUCAAUCCGACCUGAGCUUUG
NO 56 UU
SEQ ID UGUCAAUCCGACCUGAGCUUUGU
NO 57 UG
SEQ ID GUCAAUCCGACCUGAGCUUUGUU
NO 58 GU
SEQ ID UCAAUCCGACCUGAGCUUUGUUG
NO 59 UA
SEQ ID CAAUCCGACCUGAGCUUUGUUGU
NO 60 AG
SEQ ID AAUCCGACCUGAGCUUUGUUGU
NO 61 AGA
SEQ ID AUCCGACCUGAGCUUUGUUGUA
NO 62 GAC
SEQ ID UCCGACCUGAGCUUUGUUGUAG
NO 63 ACU
SEQ ID CCGACCUGAGCUUUGUUGUAGAC
NO 64 UA
SEQ ID CGACCUGAGCUUUGUUGUAG
NO 65
PS237
SEQ ID CGACCUGAGCUUUGUUGUAGAC
NO 66 UAU
PS238
SEQ ID GACCUGAGCUUUGUUGUAGACU
NO 67 AUC
SEQ ID ACCUGAGCUUUGUUGUAGACUA
NO 68 UCA
SEQ ID CCUGAGCUUUGUUGUAGACU
NO 69 AUC

TABLE 2
OLIGONUCLEOTIDES FOR SKIPPING DMD
GENE EXON 46
SEQ ID GCUUUUCUUUUAGUUGCUGCUC
NO 70 UUU
PS179
SEQ ID CUUUUCUUUUAGUUGCUGCUCU
NO 71 UUU
SEQ ID UUUUCUUUUAGUUGCUGCUCU
NO 72 UUUC
SEQ ID UUUCUUUUAGUUGCUGCUCUU
NO 73 UUCC
SEQ ID UUCUUUUAGUUGCUGCUCUUU
NO 74 UCCA
SEQ ID UCUUUUAGUUGCUGCUCUUUUC
NO 75 CAG
SEQ ID CUUUUAGUUGCUGCUCUUUUCC
NO 76 AGG
SEQ ID UUUUAGUUGCUGCUCUUUUCCA
NO 77 GGU
SEQ ID UUUAGUUGCUGCUCUUUUCCAG
NO 78 GUU
SEQ ID UUAGUUGCUGCUCUUUUCCAGG
NO 79 UUC
SEQ ID UAGUUGCUGCUCUUUUCCAGGU
NO 80 UCA
SEQ ID AGUUGCUGCUCUUUUCCAGGUU
NO 81  CAA
SEQ ID GUUGCUGCUCUUUUCCAGGUUC
NO 82 AAG
SEQ ID UUGCUGCUCUUUUCCAGGUUCA
NO 83 AGU
SEQ ID UGCUGCUCUUUUCCAGGUUCAA
NO 84 GUG
SEQ ID GCUGCUCUUUUCCAGGUUCAAG
NO 85 UGG
SEQ ID CUGCUCUUUUCCAGGUUCAAGU
NO 86 GGG
SEQ ID UGCUCUUUUCCAGGUUCAAGUG
NO 87 GGA
SEQ ID GCUCUUUUCCAGGUUCAAGUGG
NO 88 GAC
SEQ ID CUCUUUUCCAGGUUCAAGUGGG
NO 89 AUA
SEQ ID UCUUUUCCAGGUUCAAGUGGG
NO 90 AUAC
SEQ ID UCUUUUCCAGGUUCAAGUGG
NO 91
PS177
SEQ ID CUUUUCCAGGUUCAAGUGGGA
NO 92 UACU
SEQ ID UUUUCCAGGUUCAAGUGGGAU
NO 93 ACUA
SEQ ID UUUCCAGGUUCAAGUGGGAUA
NO 94 CUAG
SEQ ID UUCCAGGUUCAAGUGGGAUAC
NO 95 UAGC
SEQ ID UCCAGGUUCAAGUGGGAUACU
NO 96 AGCA
SEQ ID CCAGGUUCAAGUGGGAUACUA
NO 97 GCAA
SEQ ID CAGGUUCAAGUGGGAUACUAG
NO 98 CAAU
SEQ ID AGGUUCAAGUGGGAUACUAGC
NO 99 AAUG
SEQ ID GGUUCAAGUGGGAUACUAGCA
NO 100 AUGU
SEQ ID GUUCAAGUGGGAUACUAGCAA
NO 101 UGUU
SEQ ID UUCAAGUGGGAUACUAGCAAU
NO 102 GUUA
SEQ ID UCAAGUGGGAUACUAGCAAUG
NO 103 UUAU
SEQ ID CAAGUGGGAUACUAGCAAUGU
NO 104 UAUC
SEQ ID AAGUGGGAUACUAGCAAUGUU
NO 105 AUCU
SEQ ID AGUGGGAUACUAGCAAUGUUA
NO 106 UCUG
SEQ ID GUGGGAUACUAGCAAUGUUAU
NO 107 CUGC
SEQ ID UGGGAUACUAGCAAUGUUAUC
NO 108 UGCU
SEQ ID GGGAUACUAGCAAUGUUAUCU
NO 109 GCUU
SEQ ID GGAUACUAGCAAUGUUAUCUG
NO 110 CUUC
PS181
SEQ ID GAUACUAGCAAUGUUAUCUGC
NO 111 UUCC
SEQ ID AUACUAGCAAUGUUAUCUGCU
NO 112 UCCU
SEQ ID UACUAGCAAUGUUAUCUGCUU
NO 113 CCUC
SEQ ID ACUAGCAAUGUUAUCUGCUUCC
NO 114 UCC
SEQ ID CUAGCAAUGUUAUCUGCUUCCU
NO 115 CCA
SEQ ID UAGCAAUGUUAUCUGCUUCCUC
NO 116 CAA
SEQ ID AGCAAUGUUAUCUGCUUCCUCC
NO 117 AAC
PS182
SEQ ID GCAAUGUUAUCUGCUUCCUCCA
NO 118 ACC
SEQ ID CAAUGUUAUCUGCUUCCUCCAA
NO 119 CCA
SEQ ID AAUGUUAUCUGCUUCCUCCAAC
NO 120 CAU
SEQ ID AUGUUAUCUGCUUCCUCCAACC
NO 121 AUA
SEQ ID UGUUAUCUGCUUCCUCCAACCA
NO 122 UAA

TABLE 3
OLIGONUCLEOTIDES FOR SKIPPING DMD
GENE EXON 50
SEQ ID CCAAUAGUGGUCAGUCCAGGA
NO 123 GCUA
SEQ ID CAAUAGUGGUCAGUCCAGGAG
NO 124 CUAG
SEQ ID AAUAGUGGUCAGUCCAGGAGC
NO 125 UAGG
SEQ ID AUAGUGGUCAGUCCAGGAGCU
NO 126 AGGU
SEQ ID AUAGUGGUCAGUCCAGGAGCU
NO 127
PS248
SEQ ID UAGUGGUCAGUCCAGGAGCUA
NO 128 GGUC
SEQ ID AGUGGUCAGUCCAGGAGCUAG
NO 129 GUCA
SEQ ID GUGGUCAGUCCAGGAGCUAGG
NO 130 UCAG
SEQ ID UGGUCAGUCCAGGAGCUAGGU
NO 131 CAGG
SEQ ID GGUCAGUCCAGGAGCUAGGUC
NO 132 AGGC
SEQ ID GUCAGUCCAGGAGCUAGGUCA
NO 133 GGCU
SEQ ID UCAGUCCAGGAGCUAGGUCAG
NO 134 GCUG
SEQ ID CAGUCCAGGAGCUAGGUCAGG
NO 135 CUGC
SEQ ID AGUCCAGGAGCUAGGUCAGGC
NO 136 UGCU
SEQ ID GUCCAGGAGCUAGGUCAGGCU
NO 137 GCUU
SEQ ID UCCAGGAGCUAGGUCAGGCUG
NO 138 CUUU
SEQ ID CCAGGAGCUAGGUCAGGCUGC
NO 139 UUUG
SEQ ID  CAGGAGCUAGGUCAGGCUGCU
NO 140 UUGC
SEQ ID AGGAGCUAGGUCAGGCUGCUU
NO 141 UGCC
SEQ ID GGAGCUAGGUCAGGCUGCUUU
NO 142 GCCC
SEQ ID GAGCUAGGUCAGGCUGCUUUG
NO 143 CCCU
SEQ ID AGCUAGGUCAGGCUGCUUUGC
NO 144 CCUC
SEQ ID GCUAGGUCAGGCUGCUUUGCC
NO 145 CUCA
SEQ ID CUAGGUCAGGCUGCUUUGCCCU
NO 146 CAG
SEQ ID UAGGUCAGGCUGCUUUGCCCUC
NO 147 AGC
SEQ ID AGGUCAGGCUGCUUUGCCCUCA
NO 148 GCU
SEQ ID GGUCAGGCUGCUUUGCCCUCAG
NO 149 CUC
SEQ ID GUCAGGCUGCUUUGCCCUCAGC
NO 150 UCU
SEQ ID UCAGGCUGCUUUGCCCUCAGCU
NO 151 CUU
SEQ ID CAGGCUGCUUUGCCCUCAGCUC
NO 152 UUG
SEQ ID AGGCUGCUUUGCCCUCAGCUCU
NO 153 UGA
SEQ ID GGCUGCUUUGCCCUCAGCUCUU
NO 154 GAA
SEQ ID GCUGCUUUGCCCUCAGCUCUUG
NO 155 AAG
SEQ ID CUGCUUUGCCCUCAGCUCUUGA
NO 156 AGU
SEQ ID UGCUUUGCCCUCAGCUCUUGAA
NO 157 GUA
SEQ ID GCUUUGCCCUCAGCUCUUGAAG
NO 158 UAA
SEQ ID CUUUGCCCUCAGCUCUUGAAGU
NO 159 AAA
SEQ ID UUUGCCCUCAGCUCUUGAAGU
NO 160 AAAC
SEQ ID UUGCCCUCAGCUCUUGAAGUA
NO 161 AACG
SEQ ID UGCCCUCAGCUCUUGAAGUAA
NO 162 ACGG
SEQ ID GCCCUCAGCUCUUGAAGUAAAC
NO 163 GGU
SEQ ID CCCUCAGCUCUUGAAGUAAACG
NO 164 GUU
SEQ ID CCUCAGCUCUUGAAGUAAAC
NO 165
PS246
SEQ ID CCUCAGCUCUUGAAGUAAACG
NO 166
PS247
SEQ ID CUCAGCUCUUGAAGUAAACG
NO 167
PS245
SEQ ID CCUCAGCUCUUGAAGUAAACG
NO 529 GUUU
SEQ ID CUCAGCUCUUGAAGUAAACGG
NO 530 UUUA
SEQ ID UCAGCUCUUGAAGUAAACGGU
NO 531 UUAC
SEQ ID CAGCUCUUGAAGUAAACGGUU
NO 532 UACC
SEQ ID AGCUCUUGAAGUAAACGGUUU
NO 533 ACCG
SEQ ID GCUCUUGAAGUAAACGGUUUA
NO 534 CCGC
SEQ ID CUCUUGAAGUAAACGGUUUAC
NO 535 CGCC

TABLE 4
OLIGONUCLEOTIDES FOR SKIPPING DMD
GENE EXON 51
SEQ ID GUACCUCCAACAUCAAGGAAGA
NO 168 UGG
SEQ ID UACCUCCAACAUCAAGGAAGAU
NO 169 GGC
SEQ ID ACCUCCAACAUCAAGGAAGAUG
NO 170 GCA
SEQ ID CCUCCAACAUCAAGGAAGAUGG
NO 171 CAU
SEQ ID CUCCAACAUCAAGGAAGAUGGC
NO 172 AUU
SEQ ID UCCAACAUCAAGGAAGAUGGCA
NO 173 UUU
SEQ ID CCAACAUCAAGGAAGAUGGCAU
NO 174 UUC
SEQ ID CAACAUCAAGGAAGAUGGCAUU
NO 175 UCU
SEQ ID AACAUCAAGGAAGAUGGCAUUU
NO 176 CUA
SEQ ID ACAUCAAGGAAGAUGGCAUUUC
NO 177 UAG
SEQ ID CAUCAAGGAAGAUGGCAUUUCU
NO 178 AGU
SEQ ID AUCAAGGAAGAUGGCAUUUCUA
NO 179 GUU
SEQ ID UCAAGGAAGAUGGCAUUUCUAG
NO 180 UUU
SEQ ID CAAGGAAGAUGGCAUUUCUAGU
NO 181 UUG
SEQ ID AAGGAAGAUGGCAUUUCUAGUU
NO 182 UGG
SEQ ID AGGAAGAUGGCAUUUCUAGUUU
NO 183 GGA
SEQ ID GGAAGAUGGCAUUUCUAGUUUG
NO 184 GAG
SEQ ID GAAGAUGGCAUUUCUAGUUUGG
NO 185 AGA
SEQ ID AAGAUGGCAUUUCUAGUUUGGA
NO 186 GAU
SEQ ID AGAUGGCAUUUCUAGUUUGGAG
NO 187 AUG
SEQ ID GAUGGCAUUUCUAGUUUGGAGA
NO 188 UGG
SEQ ID AUGGCAUUUCUAGUUUGGAGAU
NO 189 GGC
SEQ ID UGGCAUUUCUAGUUUGGAGAUG
NO 190 GCA
SEQ ID GGCAUUUCUAGUUUGGAGAUGG
NO 191 CAG
SEQ ID GCAUUUCUAGUUUGGAGAUGGC
NO 192 AGU
SEQ ID CAUUUCUAGUUUGGAGAUGGCA
NO 193 GUU
SEQ ID AUUUCUAGUUUGGAGAUGGCAG
NO 194 UUU
SEQ ID UUUCUAGUUUGGAGAUGGCAGU
NO 195 UUC
SEQ ID UUCUAGUUUGGAGAUGGCAGUU
NO 196 UCC
SEQ ID UCUAGUUUGGAGAUGGCAGUUU
NO 197 CCU
SEQ ID CUAGUUUGGAGAUGGCAGUUUC
NO 198 CUU
SEQ ID UAGUUUGGAGAUGGCAGUUUCC
NO 199 UUA
SEQ ID AGUUUGGAGAUGGCAGUUUCCU
NO 200 UAG
SEQ ID GUUUGGAGAUGGCAGUUUCCUU
NO 201 AGU
SEQ ID UUUGGAGAUGGCAGUUUCCUUA
NO 202 GUA
SEQ ID UUGGAGAUGGCAGUUUCCUUAG
NO 203 UAA
SEQ ID UGGAGAUGGCAGUUUCCUUAGU
NO 204 AAC
SEQ ID GAGAUGGCAGUUUCCUUAGUAA
NO 205 CCA
SEQ ID AGAUGGCAGUUUCCUUAGUAAC
NO 206 CAC
SEQ ID GAUGGCAGUUUCCUUAGUAACC
NO 207 ACA
SEQ ID AUGGCAGUUUCCUUAGUAACCA
NO 208 CAG
SEQ ID UGGCAGUUUCCUUAGUAACCAC
NO 209 AGG
SEQ ID GGCAGUUUCCUUAGUAACCACA
NO 210 GGU
SEQ ID GCAGUUUCCUUAGUAACCACAG
NO 211 GUU
SEQ ID CAGUUUCCUUAGUAACCACAGG
NO 212 UUG
SEQ ID AGUUUCCUUAGUAACCACAGGU
NO 213 UGU
SEQ ID GUUUCCUUAGUAACCACAGGUU
NO 214 GUG
SEQ ID UUUCCUUAGUAACCACAGGUUG
NO 215 UGU
SEQ ID UUCCUUAGUAACCACAGGUUGU
NO 216 GUC
SEQ ID UCCUUAGUAACCACAGGUUGUG
NO 217 UCA
SEQ ID CCUUAGUAACCACAGGUUGUGU
NO 218 CAC
SEQ ID CUUAGUAACCACAGGUUGUGUC
NO 219 ACC
SEQ ID UUAGUAACCACAGGUUGUGUCA
NO 220 CCA
SEQ ID UAGUAACCACAGGUUGUGUCAC
NO 221 CAG
SEQ ID AGUAACCACAGGUUGUGUCACC
NO 222 AGA
SEQ ID GUAACCACAGGUUGUGUCACCA
NO 223 GAG
SEQ ID UAACCACAGGUUGUGUCACCAG
NO 224 AGU
SEQ ID AACCACAGGUUGUGUCACCAGA
NO 225 GUA
SEQ ID ACCACAGGUUGUGUCACCAGAG
NO 226 UAA
SEQ ID CCACAGGUUGUGUCACCAGAGU
NO 227 AAC
SEQ ID CACAGGUUGUGUCACCAGAGUA
NO 228 ACA
SEQ ID ACAGGUUGUGUCACCAGAGUAA
NO 229 CAG
SEQ ID CAGGUUGUGUCACCAGAGUAAC
NO 230 AGU
SEQ ID AGGUUGUGUCACCAGAGUAACA
NO 231 GUC
SEQ ID GGUUGUGUCACCAGAGUAACAG
NO 232 UCU
SEQ ID GUUGUGUCACCAGAGUAACAGU
NO 233 CUG
SEQ ID UUGUGUCACCAGAGUAACAGUC
NO 234 UGA
SEQ ID UGUGUCACCAGAGUAACAGUCU
NO 235 GAG
SEQ ID GUGUCACCAGAGUAACAGUCUG
NO 236 AGU
SEQ ID UGUCACCAGAGUAACAGUCUGA
NO 237 GUA
SEQ ID GUCACCAGAGUAACAGUCUGAG
NO 238 UAG
SEQ ID UCACCAGAGUAACAGUCUGAGU
NO 239 AGG
SEQ ID CACCAGAGUAACAGUCUGAGUA
NO 240 GGA
SEQ ID ACCAGAGUAACAGUCUGAGUA
NO 241 GGAG

TABLE 5
OLIGONUCLEOTIDES FOR SKIPPING DMD
GENE EXON 52
SEQ ID AGCCUCUUGAUUGCUGGUCUUG
NO 242 UUU
SEQ ID GCCUCUUGAUUGCUGGUCUUGU
NO 243 UUU
SEQ ID CCUCUUGAUUGCUGGUCUUGUU
NO 244 UUU
SEQ ID CCUCUUGAUUGCUGGUCUUG
NO 245
SEQ ID CUCUUGAUUGCUGGUCUUGUU
NO 246 UUUC
PS232
SEQ ID UCUUGAUUGCUGGUCUUGUUU
NO 247 UUCA
SEQ ID CUUGAUUGCUGGUCUUGUUUU
NO 248 UCAA
SEQ ID UUGAUUGCUGGUCUUGUUUUU
NO 249 CAAA
SEQ ID UGAUUGCUGGUCUUGUUUUUC
NO 250 AAAU
SEQ ID GAUUGCUGGUCUUGUUUUUCA
NO 251 AAUU
SEQ ID GAUUGCUGGUCUUGUUUUUC
NO 252
SEQ ID AUUGCUGGUCUUGUUUUUCAA
NO 253 AUUU
SEQ ID UUGCUGGUCUUGUUUUUCAAA
NO 254 UUUU
SEQ ID UGCUGGUCUUGUUUUUCAAAU
NO 255 UUUG
SEQ ID GCUGGUCUUGUUUUUCAAAUU
NO 256 UUGG
SEQ ID CUGGUCUUGUUUUUCAAAUUU
NO 257 UGGG
SEQ ID UGGUCUUGUUUUUCAAAUUUU
NO 258 GGGC
SEQ ID GGUCUUGUUUUUCAAAUUUUG
NO 259 GGCA
SEQ ID GUCUUGUUUUUCAAAUUUUGG
NO 260 GCAG
SEQ ID UCUUGUUUUUCAAAUUUUGGG
NO 261 CAGC
SEQ ID CUUGUUUUUCAAAUUUUGGGC
NO 262 AGCG
SEQ ID UUGUUUUUCAAAUUUUGGGCA
NO 263 GCGG
SEQ ID UGUUUUUCAAAUUUUGGGCAG
NO 264 CGGU
SEQ ID GUUUUUCAAAUUUUGGGCAGC
NO 265 GGUA
SEQ ID UUUUUCAAAUUUUGGGCAGCG
NO 266 GUAA
SEQ ID UUUUCAAAUUUUGGGCAGCGG
NO 267 UAAU
SEQ ID UUUCAAAUUUUGGGCAGCGGU
NO 268 AAUG
SEQ ID UUCAAAUUUUGGGCAGCGGUA
NO 269 AUGA
SEQ ID UCAAAUUUUGGGCAGCGGUAA
NO 270 UGAG
SEQ ID CAAAUUUUGGGCAGCGGUAAU
NO 271 GAGU
SEQ ID AAAUUUUGGGCAGCGGUAAUG
NO 272 AGUU
SEQ ID AAUUUUGGGCAGCGGUAAUGA
NO 273 GUUC
SEQ ID AUUUUGGGCAGCGGUAAUGAG
NO 274 UUCU
SEQ ID UUUUGGGCAGCGGUAAUGAGU
NO 275 UCUU
SEQ ID UUUGGGCAGCGGUAAUGAGUU
NO 276 CUUC
SEQ ID UUGGGCAGCGGUAAUGAGUUCU
NO 277 UCC
SEQ ID UGGGCAGCGGUAAUGAGUUCUU
NO 278 CCA
SEQ ID GGGCAGCGGUAAUGAGUUCUUC
NO 279 CAA
SEQ ID GGCAGCGGUAAUGAGUUCUUCC
NO 280 AAC
SEQ ID GCAGCGGUAAUGAGUUCUUCCA
NO 281 ACU
SEQ ID CAGCGGUAAUGAGUUCUUCCAA
NO 282 CUG
SEQ ID AGCGGUAAUGAGUUCUUCCAAC
NO 283 UGG
SEQ ID GCGGUAAUGAGUUCUUCCAACU
NO 284 GGG
SEQ ID CGGUAAUGAGUUCUUCCAACUG
NO 285 GGG
SEQ ID GGUAAUGAGUUCUUCCAACUGG
NO 286 GGA
SEQ ID GGUAAUGAGUUCUUCCAACUGG
NO 287
SEQ ID GUAAUGAGUUCUUCCAACUGGG
NO 288 GAC
SEQ ID UAAUGAGUUCUUCCAACUGGGG
NO 289 ACG
SEQ ID AAUGAGUUCUUCCAACUGGGGA
NO 290 CGC
SEQ ID AUGAGUUCUUCCAACUGGGGAC
NO 291 GCC
SEQ ID UGAGUUCUUCCAACUGGGGACG
NO 292 CCU
SEQ ID GAGUUCUUCCAACUGGGGACGC
NO 293 CUC
SEQ ID AGUUCUUCCAACUGGGGACGCC
NO 294 UCU
SEQ ID GUUCUUCCAACUGGGGACGCCU
NO 295 CUG
SEQ ID UUCUUCCAACUGGGGACGCCUC
NO 296 UGU
SEQ ID UCUUCCAACUGGGGACGCCUCU
NO 297 GUU
SEQ ID CUUCCAACUGGGGACGCCUCUG
NO 298 UUC
SEQ ID UUCCAACUGGGGACGCCUCUGU
NO 299 UCC
PS236
SEQ ID UCCAACUGGGGACGCCUCUGUU
NO 300 CCA
SEQ ID CCAACUGGGGACGCCUCUGUUC
NO 301 CAA
SEQ ID CAACUGGGGACGCCUCUGUUCC
NO 302 AAA
SEQ ID AACUGGGGACGCCUCUGUUCCA
NO 303 AAU
SEQ ID ACUGGGGACGCCUCUGUUCCAA
NO 304 AUC
SEQ ID CUGGGGACGCCUCUGUUCCAAA
NO 305 UCC
SEQ ID UGGGGACGCCUCUGUUCCAAAU
NO 306 CCU
SEQ ID GGGGACGCCUCUGUUCCAAAUC
NO 307 CUG
SEQ ID GGGACGCCUCUGUUCCAAAUCC
NO 308 UGC
SEQ ID GGACGCCUCUGUUCCAAAUCCU
NO 309 GCA
SEQ ID GACGCCUCUGUUCCAAAUCCUG
NO 310 CAU

TABLE 6
OLIGONUCLEOTIDES FOR SKIPPING DMD
GENE EXON 53
SEQ ID CUCUGGCCUGUCCUAAGACCU
NO 311 GCUC
SEQ ID UCUGGCCUGUCCUAAGACCUG
NO 312 CUCA
SEQ ID CUGGCCUGUCCUAAGACCUGC
NO 313 UCAG
SEQ ID UGGCCUGUCCUAAGACCUGCU
NO 314 CAGC
SEQ ID GGCCUGUCCUAAGACCUGCUC
NO 315 AGCU
SEQ ID GCCUGUCCUAAGACCUGCUCA
NO 316 GCUU
SEQ ID CCUGUCCUAAGACCUGCUCAG
NO 317 CUUC
SEQ ID CUGUCCUAAGACCUGCUCAGC
NO 318 UUCU
SEQ ID UGUCCUAAGACCUGCUCAGCU
NO 319 UCUU
SEQ ID GUCCUAAGACCUGCUCAGCUU
NO 320 CUUC
SEQ ID UCCUAAGACCUGCUCAGCUUC
NO 321 UUCC
SEQ ID CCUAAGACCUGCUCAGCUUCU
NO 322 UCCU
SEQ ID CUAAGACCUGCUCAGCUUCUU
NO 323 CCUU
SEQ ID UAAGACCUGCUCAGCUUCUUC
NO 324 CUUA
SEQ ID AAGACCUGCUCAGCUUCUUCC
NO 325 UUAG
SEQ ID AGACCUGCUCAGCUUCUUCCU
NO 326 UAGC
SEQ ID GACCUGCUCAGCUUCUUCCUU
NO 327 AGCU
SEQ ID ACCUGCUCAGCUUCUUCCUUA
NO 328 GCUU
SEQ ID CCUGCUCAGCUUCUUCCUUAG
NO 329 CUUC
SEQ ID CUGCUCAGCUUCUUCCUUAGC
NO 330 UUCC
SEQ ID UGCUCAGCUUCUUCCUUAGCU
NO 331 UCCA
SEQ ID GCUCAGCUUCUUCCUUAGCUU
NO 332 CCAG
SEQ ID CUCAGCUUCUUCCUUAGCUUC
NO 333 CAGC
SEQ ID UCAGCUUCUUCCUUAGCUUCC
NO 334 AGCC
SEQ ID CAGCUUCUUCCUUAGCUUCCAG
NO 335 CCA
SEQ ID AGCUUCUUCCUUAGCUUCCAGC
NO 336 CAU
SEQ ID GCUUCUUCCUUAGCUUCCAGCC
NO 337 AUU
SEQ ID CUUCUUCCUUAGCUUCCAGCCA
NO 338 UUG
SEQ ID UUCUUCCUUAGCUUCCAGCCAU
NO 339 UGU
SEQ ID UCUUCCUUAGCUUCCAGCCAUU
NO 340 GUG
SEQ ID CUUCCUUAGCUUCCAGCCAUUG
NO 341 UGU
SEQ ID UUCCUUAGCUUCCAGCCAUUGU
NO 342 GUU
SEQ ID UCCUUAGCUUCCAGCCAUUGUG
NO 343 UUG
SEQ ID CCUUAGCUUCCAGCCAUUGUGU
NO 344 UGA
SEQ ID CUUAGCUUCCAGCCAUUGUGUU
NO 345 GAA
SEQ ID UUAGCUUCCAGCCAUUGUGUUG
NO 346 AAU
SEQ ID UAGCUUCCAGCCAUUGUGUUGA
NO 347 AUC
SEQ ID AGCUUCCAGCCAUUGUGUUGAA
NO 348 UCC
SEQ ID GCUUCCAGCCAUUGUGUUGAAU
NO 349 CCU
SEQ ID CUUCCAGCCAUUGUGUUGAAUC
NO 350 CUU
SEQ ID UUCCAGCCAUUGUGUUGAAUCC
NO 351 UUU
SEQ ID UCCAGCCAUUGUGUUGAAUCCU
NO 352 UUA
SEQ ID CCAGCCAUUGUGUUGAAUCCUU
NO 353 UAA
SEQ ID CAGCCAUUGUGUUGAAUCCUUU
NO 354 AAC
SEQ ID AGCCAUUGUGUUGAAUCCUUUA
NO 355 ACA
SEQ ID GCCAUUGUGUUGAAUCCUUUAA
NO 356 CAU
SEQ ID CCAUUGUGUUGAAUCCUUUAAC
NO 357 AUU
SEQ ID CAUUGUGUUGAAUCCUUUAACA
NO 358 UUU

TABLE 7
OLIGONUCLEOTIDES FOR SKIPPING OTHER
EXONS OF THE DMD GENE AS IDENTIFIED
DMD Gene Exon 6
SEQ ID CAUUUUUGACCUACAUGUGG
NO 359
SEQ ID UUUGACCUACAUGUGGAAAG
NO 360
SEQ ID UACAUUUUUGACCUACAUGUG
NO 361 GAAA G
SEQ ID GGUCUCCUUACCUAUGA
NO 362
SEQ ID UCUUACCUAUGACUAUGGAUG
NO 363 AGA
SEQ ID AUUUUUGACCUACAUGGGAAA
NO 364 G
SEQ ID UACGAGUUGAUUGUCGGACCCA
NO 365 G
SEQ ID GUGGUCUCCUUACCUAUGACUG
NO 366 UGG
SEQ ID UGUCUCAGUAAUCUUCUUACCU
NO 367 AU
DMD Gene Exon 7
SEQ ID UGCAUGUUCCAGUCGUUGUGU
NO 368 GG
SEQ ID CACUAUUCCAGUCAAAUAGGU
NO 369 CUGG
SEQ ID AUUUACCAACCUUCAGGAUCGA
NO 370 GUA
SEQ ID GGCCUAAAACACAUACACAUA
NO 371
DMD Gene Exon 11
SEQ ID CCCUGAGGCAUUCCCAUCUUG
NO 372 AAU
SEQ ID AGGACUUACUUGCUUUGUUU
NO 373
SEQ ID CUUGAAUUUAGGAGAUUCAUCU
NO 374 G
SEQ ID CAUCUUCUGAUAAUUUUCCUGU
NO 375 U
DMD Gene Exon 17
SEQ ID CCAUUACAGUUGUCUGUGUU
NO 376
SEQ ID UGACAGCCUGUGAAAUCUGUG
NO 377 AG
SEQ ID UAAUCUGCCUCUUCUUUUGG
NO 378
DMD Gene Exon 19
SEQ ID CAGCAGUAGUUGUCAUCUGC
NO 379
SEQ ID GCCUGAGCUGAUCUGCUGGCA
NO 380 UCUUGC
SEQ ID GCCUGAGCUGAUCUGCUGGCAU
NO 381 CUUGCA
GUU
SEQ ID UCUGCUGGCAUCUUGC
NO 382
DMD Gene Exon 21
SEQ ID GCCGGUUGACUUCAUCCUGUG
NO 383 C
SEQ ID GUCUGCAUCCAGGAACAUGGG
NO 384 UC
SEQ ID UACUUACUGUCUGUAGCUCUU
NO 385 UCU
SEQ ID CUGCAUCCAGGAACAUGGGUCC
NO 386
SEQ ID GUUGAAGAUCUGAUAGCCGGUU
NO 387 GA
DMD Gene Exon 44
SEQ ID UCAGCUUCUGUUAGCCACUG
NO 388
SEQ ID UUCAGCUUCUGUUAGCCACU
NO 389
SEQ ID UUCAGCUUCUGUUAGCCACUG
NO 390
SEQ ID UCAGCUUCUGUUAGCCACUGA
NO 391
SEQ ID UUCAGCUUCUGUUAGCCACUG
NO 392 A
SEQ ID UCAGCUUCUGUUAGCCACUGA
NO 393
SEQ ID UUCAGCUUCUGUUAGCCACUG
NO 394 A
SEQ ID UCAGCUUCUGUUAGCCACUGA
NO 395 U
SEQ ID UUCAGCUUCUGUUAGCCACUG
NO 396 AU
SEQ ID UCAGCUUCUGUUAGCCACUGA
NO 397 UU
SEQ ID UUCAGCUUCUGUUAGCCACUG
NO 398 AUU
SEQ ID UCAGCUUCUGUUAGCCACUGA
NO 399 UUA
SEQ ID UUCAGCUUCUGUUAGCCACUG
NO 400 AUA
SEQ ID UCAGCUUCUGUUAGCCACUGA
NO 401 UUAA
SEQ ID UUCAGCUUCUGUUAGCCACUG
NO 402 AUUAA
SEQ ID UCAGCUUCUGUUAGCCACUGA
NO 403 UUAAA
SEQ ID UUCAGCUUCUGUUAGCCACUG
NO 404 AUUAAA
SEQ ID CAGCUUCUGUUAGCCACUG
NO 405
SEQ ID CAGCUUCUGUUAGCCACUGAU
NO 406
SEQ ID AGCUUCUGUUAGCCACUGAUU
NO 407
SEQ ID CAGCUUCUGUUAGCCACUGAU
NO 408 U
SEQ ID AGCUUCUGUUAGCCACUGAUU
NO 409 A
SEQ ID CAGCUUCUGUUAGCCACUGAU
NO 410 UA
SEQ ID AGCUUCUGUUAGCCACUGAUU
NO 411 AA
SEQ ID CAGCUUCUGUUAGCCACUGAU
NO 412 UAA
SEQ ID AGCUUCUGUUAGCCACUGAUUA
NO 413 AA
SEQ ID CAGCUUCUGUUAGCCACUGAUU
NO 414 AAA
SEQ ID AGCUUCUGUUAGCCACUGAUUA
NO 415 AA
SEQ ID AGCUUCUGUUAGCCACUGAU
NO 416
SEQ ID GCUUCUGUUAGCCACUGAUU
NO 417
SEQ ID AGCUUCUGUUAGCCACUGAUU
NO 418
SEQ ID GCUUCUGUUAGCCACUGAUUA
NO 419
SEQ ID AGCUUCUGUUAGCCACUGAUUA
NO 420
SEQ ID GCUUCUGUUAGCCACUGAUUAA
NO 421
SEQ ID AGCUUCUGUUAGCCACUGAUUA
NO 422 A
SEQ ID GCUUCUGUUAGCCACUGAUUAA
NO 423 A
SEQ ID AGCUUCUGUUAGCCACUGAUUA
NO 424 AA
SEQ ID GCUUCUGUUAGCCACUGAUUAA
NO 425 A
SEQ ID CCAUUUGUAUUUAGCAUGUUCC
NO 426 C
SEQ ID AGAUACCAUUUGUAUUUAGC
NO 427
SEQ ID GCCAUUUCUCAACAGAUCU
NO 428
SEQ ID GCCAUUUCUCAACAGAUCUGUC
NO 429 A
SEQ ID AUUCUCAGGAAUUUGUGUCUUU
NO 430 C
SEQ ID UCUCAGGAAUUUGUGUCUUUC
NO 431
SEQ ID GUUCAGCUUCUGUUAGCC
NO 432
SEQ ID CUGAUUAAAUAUCUUUAUAUC
NO 433
SEQ ID GCCGCCAUUUCUCAACAG
NO 434
SEQ ID GUAUUUAGCAUGUUCCCA
NO 435
SEQ ID CAGGAAUUUGUGUCUUUC
NO 436
DMD Gene Exon 45
SEQ ID UUUGCCGCUGCCCAAUGCCAU
NO 437 CCUG
SEQ ID AUUCAAUGUUCUGACAACAGU
NO 438 UUGC
SEQ ID CCAGUUGCAUUCAAUGUUCUG
NO 439 ACAA
SEQ ID CAGUUGCAUUCAAUGUUCUGA
NO 440 C
SEQ ID AGUUGCAUUCAAUGUUCUGA
NO 441
SEQ ID GAUUGCUGAAUUAUUUCUUCC
NO 442
SEQ ID GAUUGCUGAAUUAUUUCUUCC
NO 443 CCAG
SEQ ID AUUGCUGAAUUAUUUCUUCCC
NO 444 CAGU
SEQ ID UUGCUGAAUUAUUUCUUCCCC
NO 445 AGUU
SEQ ID UGCUGAAUUAUUUCUUCCCCA
NO 446 GUUG
SEQ ID GCUGAAUUAUUUCUUCCCCAG
NO 447 UUGC
SEQ ID CUGAAUUAUUUCUUCCCCAGU
NO 448 UGCA
SEQ ID UGAAUUAUUUCUUCCCCAGUU
NO 449 GCAU
SEQ ID GAAUUAUUUCUUCCCCAGUUG
NO 450 CAUU
SEQ ID AAUUAUUUCUUCCCCAGUUGC
NO 451 AUUC
SEQ ID AUUAUUUCUUCCCCAGUUGCA
NO 452 UUCA
SEQ ID UUAUUUCUUCCCCAGUUGCAU
NO 453 UCAA
SEQ ID UAUUUCUUCCCCAGUUGCAUU
NO 454 CAAU
SEQ ID AUUUCUUCCCCAGUUGCAUUC
NO 455 AAUG
SEQ ID UUUCUUCCCCAGUUGCAUUCA
NO 456 AUGU
SEQ ID UUCUUCCCCAGUUGCAUUCAA
NO 457 UGUU
SEQ ID UCUUCCCCAGUUGCAUUCAAU
NO 458 GUUC
SEQ ID CUUCCCCAGUUGCAUUCAAUG
NO 459 UUCU
SEQ ID UUCCCCAGUUGCAUUCAAUGU
NO 460 UCUG
SEQ ID UCCCCAGUUGCAUUCAAUGUU
NO 461 CUGA
SEQ ID CCCCAGUUGCAUUCAAUGUUC
NO 462 UGAC
SEQ ID CCCAGUUGCAUUCAAUGUUCU
NO 463 GACA
SEQ ID CCAGUUGCAUUCAAUGUUCUG
NO 464 ACAA
SEQ ID CAGUUGCAUUCAAUGUUCUGA
NO 465 CAAC
SEQ ID AGUUGCAUUCAAUGUUCUGAC
NO 466 AACA
SEQ ID UCC UGU AGA AUA CUG GCA
NO 467 UC
SEQ ID UGCAGACCUCCUGCCACCGCAG
NO 468 AUUCA
SEQ ID UUGCAGACCUCCUGCCACCGCA
NO 469 GAUUC
AGGCUUC
SEQ ID GUUGCAUUCAAUGUUCUGACAA
NO 470 CAG
SEQ ID UUGCAUUCAAUGUUCUGACAAC
NO 471 AGU
SEQ ID UGCAUUCAAUGUUCUGACAACA
NO 472 GUU
SEQ ID GCAUUCAAUGUUCUGACAACAG
NO 473 UUU
SEQ ID CAUUCAAUGUUCUGACAACAGU
NO 474 UUG
SEQ ID AUUCAAUGUUCUGACAACAGUU
NO 475 UGC
SEQ ID UCAAUGUUCUGACAACAGUUUG
NO 476 CCG
SEQ ID CAAUGUUCUGACAACAGUUUGC
NO 477 CGC
SEQ ID AAUGUUCUGACAACAGUUUGCC
NO 478 GCU
SEQ ID  AUGUUCUGACAACAGUUUGCCG
NO 479 CUG
SEQ ID UGUUCUGACAACAGUUUGCCGC
NO 480 UGC
SEQ ID GUUCUGACAACAGUUUGCCGCU
NO 481 GCC
SEQ ID UUCUGACAACAGUUUGCCGCUG
NO 482 CCC
SEQ ID UCUGACAACAGUUUGCCGCUGC
NO 483 CCA
SEQ ID CUGACAACAGUUUGCCGCUGCC
NO 484 CAA
SEQ ID UGACAACAGUUUGCCGCUGCCC
NO 485 AAU
SEQ ID GACAACAGUUUGCCGCUGCCCA
NO 486 AUG
SEQ ID ACAACAGUUUGCCGCUGCCCAA
NO 487 UGC
SEQ ID CAACAGUUUGCCGCUGCCCAAU
NO 488 GCC
SEQ ID AACAGUUUGCCGCUGCCCAAUG
NO 489 CCA
SEQ ID ACAGUUUGCCGCUGCCCAAUGC
NO 490 CAU
SEQ ID CAGUUUGCCGCUGCCCAAUGCC
NO 491 AUC
SEQ ID AGUUUGCCGCUGCCCAAUGCCA
NO 492 UCC
SEQ ID GUUUGCCGCUGCCCAAUGCCAU
NO 493 CCU
SEQ ID UUUGCCGCUGCCCAAUGCCAUC
NO 494 CUG
SEQ ID UUGCCGCUGCCCAAUGCCAUCC
NO 495 UGG
SEQ ID UGCCGCUGCCCAAUGCCAUCCU
NO 496 GGA
SEQ ID GCCGCUGCCCAAUGCCAUCCUG
NO 497 GAG
SEQ ID CCGCUGCCCAAUGCCAUCCUGG
NO 498 AGU
SEQ ID CGCUGCCCAAUGCCAUCCUGGA
NO 499 GUU
SEQ ID UGUUUUUGAGGAUUGCUGAA
NO 500
SEQ ID UGUUCUGACAACAGUUUGCCGC
NO 501 UGCCCA AUGCCAUCCUGG
DMD Gene Exon 55
SEQ ID CUGUUGCAGUAAUCUAUGAG
NO 502
SEQ ID UGCAGUAAUCUAUGAGUUUC
NO 503
SEQ ID GAGUCUUCUAGGAGCCUU
NO 504
SEQ ID UGCCAUUGUUUCAUCAGCUCUU
NO 505 U
SEQ ID UCCUGUAGGACAUUGGCAGU
NO 506
SEQ ID CUUGGAGUCUUCUAGGAGCC
NO 507
DMD Gene Exon 57
SEQ ID UAGGUGCCUGCCGGCUU
NO 508
SEQ ID UUCAGCUGUAGCCACACC
NO 509
SEQ ID CUGAACUGCUGGAAAGUCGCC
NO 510
SEQ ID CUGGCUUCCAAAUGGGACCUGA
NO 511 AAAAGA
AC
DMD Gene Exon 59
SEQ ID CAAUUUUUCCCACUCAGUAUU
NO 512
SEQ ID UUGAAGUUCCUGGAGUCUU
NO 513
SEQ ID UCCUCAGGAGGCAGCUCUAAAU
NO 514
DMD Gene Exon 62
SEQ ID  UGGCUCUCUCCCAGGG
NO 515
SEQ ID GAGAUGGCUCUCUCCCAGGGA
NO 516 CCCUGG
SEQ ID GGGCACUUUGUUUGGCG
NO 517
DMD Gene Exon 63
SEQ ID GGUCCCAGCAAGUUGUUUG
NO 518
SEQ ID  UGGGAUGGUCCCAGCAAGUUG
NO 519 UUUG
SEQ ID GUAGAGCUCUGUCAUUUUGGG
NO 520
DMD Gene Exon 65
SEQ ID GCUCAAGAGAUCCACUGCAAA
NO 521 AAAC
SEQ ID  GCCAUACGUACGUAUCAUAAA
NO 522 CAUUC
SEQ ID UCUGCAGGAUAUCCAUGGGCUG
NO 523 GUC
DMD Gene Exon 66
SEQ ID GAUCCUCCCUGUUCGUCCCCUA
NO 524 UUAUG
DMD Gene Exon 69
SEQ ID UGCUUUAGACUCCUGUACCUG
NO 525 AUA
DMD Gene Exon 75
SEQ ID GGCGGCCUUUGUGUUGAC
NO 526
SEQ ID GGACAGGCCUUUAUGUUCGUG
NO 527 CUGC
SEQ ID CCUUUAUGUUCGUGCUGCU
NO 528

Claims

What is claimed is:

1. An antisense oligonucleotide whose base sequence consists of 5′-CUCUUGAUUGCUGGUCUUGUUUUUC-3′ (SEQ ID NO:246), wherein the oligonucleotide comprises a modification.

2. The antisense oligonucleotide of claim 1, wherein the modification comprises at least one nucleotide analogue, wherein the nucleotide analogue comprises a modified sugar moiety, a modified backbone, a modified internucleoside linkage, or a modified base, or a combination thereof.

3. The antisense oligonucleotide of claim 1, wherein the modification comprises a modified sugar moiety.

4. The antisense oligonucleotide of claim 3, wherein the modified sugar moiety is mono- or di-substituted at the 2′, 3′ and/or 5′ position.

5. The antisense oligonucleotide of claim 4, wherein the modified sugar moiety comprises a 2′-O-methyl ribose.

6. The antisense oligonucleotide of claim 1, wherein the modification comprises a modified backbone.

7. The antisense oligonucleotide of claim 6, wherein the modified backbone comprises a morpholino backbone, a carbamate backbone, a siloxane backbone, a sulfide backbone, a sulfoxide backbone, a sulfone backbone, a formacetyl backbone, a thioformacetyl backbone, a methyleneformacetyl backbone, a riboacetyl backbone, an alkene containing backbone, a sulfamate backbone, a sulfonate backbone, a sulfonamide backbone, a methyleneimino backbone, a methylenehydrazino backbone or an amide backbone, or a combination thereof.

8. The antisense oligonucleotide of claim 7, wherein the modified backbone comprises a morpholino backbone.

9. The antisense oligonucleotide of claim 1, wherein the modification comprises a modified internucleoside linkage.

10. The antisense oligonucleotide of claim 9, wherein the modified internucleoside linkage comprises a phosphorothioate linkage.

11. The antisense oligonucleotide of claim 1, wherein the modification comprises a modified base.

12. The antisense oligonucleotide of claim 1, wherein the oligonucleotide comprises a morpholino ring, a phosphorodiamidate internucleoside linkage, a peptide nucleic acid, a locked nucleic acid (LNA), or a combination thereof.

13. The antisense oligonucleotide of claim 1, wherein the oligonucleotide comprises a 2′-O-methyl phosphorothioate ribose.

14. The antisense oligonucleotide of claim 1, wherein the oligonucleotide comprises a phosphorodiamidate morpholino oligomer (PMO).

15. A pharmaceutical composition, comprising the antisense oligonucleotide of claim 1 and a pharmaceutically acceptable carrier.

16. A method of treating Duchenne muscular dystrophy or Becker muscular dystrophy in a subject, comprising administering to the subject the antisense oligonucleotide of claim 1.

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