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  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7088—Compounds having three or more nucleosides or nucleotides
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/50—Microcapsules having a gas, liquid or semi-solid filling; Solid microparticles or pellets surrounded by a distinct coating layer, e.g. coated microspheres, coated drug crystals
  • A61K9/51—Nanocapsules; Nanoparticles
  • A61K9/5107—Excipients; Inactive ingredients
  • A61K9/5123—Organic compounds, e.g. fats, sugars
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
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  • C12N15/00—Mutation or genetic engineering; DNA or RNA concerning genetic engineering, vectors, e.g. plasmids, or their isolation, preparation or purification; Use of hosts therefor
  • C12N15/09—Recombinant DNA-technology
  • C12N15/11—DNA or RNA fragments; Modified forms thereof; Non-coding nucleic acids having a biological activity
  • C12N15/113—Non-coding nucleic acids modulating the expression of genes, e.g. antisense oligonucleotides; Antisense DNA or RNA; Triplex- forming oligonucleotides; Catalytic nucleic acids, e.g. ribozymes; Nucleic acids used in co-suppression or gene silencing
• • C—CHEMISTRY; METALLURGY
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  • C12N2310/00—Structure or type of the nucleic acid
  • C12N2310/10—Type of nucleic acid
  • C12N2310/14—Type of nucleic acid interfering nucleic acids [NA]

Definitions

• the present disclosure relates generally to combination therapy using a nucleic acid inhibitor molecule that reduces expression of the ⁇ -catenin gene and an inhibitor of a downstream ⁇ -catenin effector, such as c-Myc, or at least one inhibitor of the RAS/RAF/MEK/ERK signaling cascade, such as an MEK inhibitor.
• a nucleic acid inhibitor molecule that reduces expression of the ⁇ -catenin gene and an inhibitor of a downstream ⁇ -catenin effector, such as c-Myc, or at least one inhibitor of the RAS/RAF/MEK/ERK signaling cascade, such as an MEK inhibitor.
• ⁇ -catenin an oncogene, is a key mediator of Wnt signaling in cells
• ⁇ -catenin serves several cellular functions at multiple cellular locations, including the plasma membrane, where ⁇ -catenin contributes to the stabilization of intercellular adhesive complexes, the cytoplasm where ⁇ -catenin levels are regulated, and the nucleus where ⁇ -catenin is involved in transcriptional regulation and chromatin interactions.
• the ⁇ -catenin/Wnt pathway (see, e.g., Figure 1 ) is consistently activated in over 80% of colorectal cancers.
• the role of ⁇ -catenin in the development of colorectal cancer has been shown to be regulated by the expression product of the APC (adenomatous polyposis of the colon) gene, a tumor suppressor. (Korinek et al., Science, 1997, 275: 1784-1787; Morin et al., Science, 1997, 275: 1787-1790).
• the APC protein normally binds ⁇ -catenin in conjunction with TCF/LEF forming a transcription factor complex. Morin et al.
• Mutations in the ⁇ -catenin gene can be either truncations that lead to deletion of part of the N-terminus of ⁇ -catenin or point mutations that affect the serine and threonine residues that are targeted by components of the cytoplasmic destruction complex, such as GSKSa/ ⁇ or CKIa, that mediate the phosphorylation of ⁇ -catenin and target its degradation by the proteosome.
• These mutant ⁇ -catenin proteins are refractory to phosphorylation and thus escape proteasomal degradations. Consequently, ⁇ -catenin accumulates within affected cells. Stabilized and nuclear-localized ⁇ -catenin is a hallmark of nearly all cases of colon cancer.
• KRAS The KRAS gene is also commonly mutated in colorectal cancers (about 30-40%).
• KRAS is a member of the Ras family of oncogenes. It encodes a GTPase involved in intracellular signal transduction pathways. When activated, it recruits other signaling molecules, like c-Raf and PI 3-kinase. Mutations of KRAS also occur in over 90% of pancreatic cancers.
• the ⁇ -catenin/Wnt pathway is consistently activated in over 50% of hepatocellular carcinoma (HCC) patients.
• HCC hepatocellular carcinoma
• Activated Wnt signaling and nuclear ⁇ - catenin correlate with recurrence of disease and poor prognosis (Takigawa et al. 2008, Curr Drug Targets November; 9 (1 1 ): 1013-24).
• Elevated nuclear ⁇ -catenin staining has been documented in 17-66% of HCC patients (Zulehner et al. 2010, Am J Pathol. January; 176 (1 ):472-81 ; Yu et al. 2009, J Hepatol. May; 50 (50):948-57).
• ⁇ -catenin-associated disease or disorder comprising administering to a subject a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule and a therapeutically effective amount of an MEK inhibitor (such as trametinib) or a c-Myc nucleic acid inhibitor molecule.
• Administration of a ⁇ -catenin nucleic acid inhibitor molecule and a MEK inhibitor or a c-Myc nucleic acid inhibitor molecule can produce synergetic effects as compared to the administration of each agent individually.
• the subject is a human.
• compositions comprising a ⁇ -catenin nucleic acid inhibitor molecule for use in treating a ⁇ -catenin-associated disease or disorder, wherein the composition is administered in combination with a MEK inhibitor (such as trametinib) or a c-Myc nucleic acid inhibitor molecule.
• a MEK inhibitor such as trametinib
• c-Myc nucleic acid inhibitor molecule a MEK inhibitor
• the ⁇ -catenin-associated disease or disorder is cancer, such as colorectal cancer, hepatocellular carcinoma, or melanoma.
• the ⁇ -catenin-associated disease or disorder is a ⁇ -catenin-associated cancer, such as colorectal cancer, hepatocellular carcinoma, or melanoma.
• the ⁇ -catenin-associated cancer has metastasized.
• the ⁇ -catenin- associated cancer is colorectal cancer that has metastasized.
• the colorectal cancer has metastasized to the liver.
• the MEK inhibitor is trametinib (GSK1 120212), selumetinib, binimetinib (MEK162), cobimetinib (XL518), refametinib (BAY 86-9766), pimasertib, PD-325901 , RO5068760, CI-1040 (PD035901 ), AZD8330 (ARRY- 424704), R04987655 (CH4987655), R05126766, WX-554, E6201 , and TAK-733.
• the MEK inhibitor is trametinib.
• the ⁇ -catenin nucleic acid inhibitor molecule or the c-Myc nucleic acid inhibitor molecule is formulated with a lipid nanoparticle.
• compositions comprising a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule; a therapeutically effective amount of an MEK inhibitor or a c-Myc nucleic acid inhibitor molecule; and at least one pharmaceutical excipient.
• Certain embodiments of the invention provide methods of treating a ⁇ - catenin-associated cancer in a subject, comprising administering to the subject: a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule; and a therapeutically effective amount of a MEK inhibitor, wherein prior to administering the ⁇ -catenin nucleic acid inhibitor molecule, the subject has undergone prior treatment for the ⁇ -catenin-associated cancer and developed resistance to that prior treatment.
• the prior treatment is administration of a MEK inhibitor.
• the MEK inhibitor of the prior treatment is trametinib.
• the MEK inhibitor administered to the subject is trametinib.
• Certain embodiments of the invention provide methods of treating a ⁇ - catenin-associated cancer in a subject, comprising administering to the subjects a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule; and a therapeutically effective amount of a MEK inhibitor, wherein prior to administering the ⁇ -catenin nucleic acid inhibitor molecule, the subject has undergone at least two administrations of a prior treatment for the ⁇ -catenin-associated cancer. In certain of those embodiments, the subject has undergone at least three, four, five, six, or seven administrations of the prior treatment. In certain embodiments, the prior treatment is administration of a MEK inhibitor. In certain embodiments, the MEK inhibitor of the prior treatment is trametinib. In certain embodiments, the MEK inhibitor administered to the subject is trametinib.
• Certain embodiments of the invention provide methods of treating a ⁇ - catenin-associated cancer in a subject, comprising administering to the subject: a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule; and a therapeutically effective amount of a MEK inhibitor, wherein the ⁇ -catenin associated cancer (e.g., colorectal cancer) has metastasized, for example, to the liver.
• the MEK inhibitor administered to the subject is trametinib.
• Fig. 1 shows a simplified diagram of the Wnt signaling pathway.
• the left side depicts a cell where the Wnt ligand is not bound to its surface receptor, ⁇ - catenin is sequestered in a destruction complex and targeted for degradation, and target genes are repressed.
• the right side depicts a cell after the Wnt ligand has bound its surface receptor, where the destruction complex disassembles, stabilized ⁇ -catenin is released and travels to the nucleus, and target genes are activated.
• Figs. 2A-D demonstrate BCAT1 anti-tumor efficacy at different dosages and frequency of administration in Wnt active LS41 1 N tumors.
• BCAT1 was administered at 1 .0 mg/kg, every day for 3 days (2 cycles) (Fig. 2A); 3 mg/kg, every week (2 cycles) (Fig. 2B); 0.3 mg/kg, every day for 3 days (2 cycles) (Fig. 2C); or 3 mg/kg, every day for 3 days (2 cycles) (Fig. 2D).
• Figs. 3A-C show that BCAT1 selectively targets Wnt signaling.
• BCAT1 effectively reduces tumor volume in the Wnt active tumor cells: SW403 (APC and KRAS mutations; Fig. 3A) and LS174t (CTNNB1 and KRAS mutations; Fig. 3B) but not in the RKO colorectal tumor (Fig. 3C) having wild type APC and ⁇ -catenin genes.
• Figs. 4A-B show that combination therapy with BCAT1 and a MEK inhibitor (trametinib) enhance the anti-tumor efficacy as compared to treatment with either of BCAT1 or trametinib individually.
• a MEK inhibitor trametinib
• Fig. 4C shows that combination therapy with BCAT1 and a MEK inhibitor (trametinib) caused significant downregulation of c-Myc mRNA in LS174t tumor cells.
• the c-Myc mRNA was measured at 72 hours following administration of the combination therapy.
• Figs. 5A-B show that combination therapy with BCAT1 and a MEK inhibitor (trametinib) at lower dosages exhibits synergistic anti-tumor efficacy in a model of CRC using human LS41 1 N tumor cells.
• a MEK inhibitor trametinib
• Figs. 5C-D show that combination therapy with BCAT1 and a MEK inhibitor (trametinib) at lower dosages exhibits synergistic anti-tumor efficacy in a model of CRC using human SW403 tumor cells.
• a MEK inhibitor trametinib
• Figs. 5E-F show that resistance to trametinib in a model of CRC using SW403 tumor cells is overcome by the administration of trametinib and BCAT1 in combination.
• the data represent the average tumor volume of the entire treatment groups (Fig. 5E) or each individual mouse in the treatment group (Fig. 5F).
• Figs. 6A-C show that combination therapy with BCAT1 and MYC1 enhances anti-tumor efficacy as compared to treatment with either of BCAT1 or MYC1 individually. Note that when the BCAT1 and MYC1 are given in combination, the doses are one-half of the dose used when each is given individually.
• Fig. 7 shows one non-limiting embodiment of a double-stranded ⁇ - catenin nucleic acid inhibitor molecule, having of a sense (or passenger) strand (SEQ ID NO: 1 ) and an antisense (guide) strand (SEQ ID NO: 2).
• This ⁇ -catenin nucleic acid inhibitor molecule is referred to herein as BCAT1.
• Fig. 8 shows one non-limiting embodiment of a double-stranded c- Myc nucleic acid inhibitor molecule, having of a sense (or passenger) strand (SEQ ID NO: 3) and an antisense (guide) strand (SEQ ID NO: 4).
• This c-Myc nucleic acid inhibitor molecule is referred to herein as MYC2.
• Fig. 9 shows one non-limiting embodiment of a double-stranded c- Myc nucleic acid inhibitor molecule, having of a sense (or passenger) strand (SEQ ID NO: 5) and an antisense (guide) strand (SEQ ID NO: 6).
• This c-Myc nucleic acid inhibitor molecule is referred to herein as MYC1 .
• Fig. 10 shows one non-limiting embodiment of a lipid nanoparticle that can used to formulate the ⁇ -catenin or c-Myc nucleic acid inhibitor molecule.
• the LNP includes the following core lipids: DL-048 (cationic lipid) and DSG-MPEG (pegylated lipid), and the following envelope lipids: DL-103 (cationic lipid), DSPC, cholesterol, and DSPE-MPEG (pegylated lipid).
• FIG. 11A-B show that administration of BCAT1 (qdx3, 3 mg/kg/dose, 3 cycles) improves survival as compared to PBS or placebo in a Ls174t CRC liver metastases model (Fig. 1 1 A) or a LS41 1 N CRC liver metastases model (Fig. 1 1 B).
• Fig. 11C shows that administration of trametinib (qdx3, 1 or 3 mg/kg/dose, 3 cycles) improves survival in a Ls174t CRC liver metastases model as compared to PBS.
• Fig. 11 D compares combination therapy with BCAT1 and trametinib (qdx3, 2 mg/kg/dose, 3 cycles) to individual treatment with BCAT1 or trametinib in a Ls174t CRC liver metastases model and suggests a synergistic response for the combination therapy.
• Administering means to give, apply or bring the composition into contact with the subject. Administration can be accomplished by any of a number of routes, including, for example, topical, oral, subcutaneous, intramuscular, intraperitoneal, intravenous, intrathecal and intradermal.
• ⁇ -catenin refers either to a polypeptide or a nucleic acid sequence encoding such a ⁇ -catenin protein.
• ⁇ -catenin refers to the polypeptide gene product of a ⁇ -catenin gene/transcript (CTNNB1 ) (Genbank Accession Nos.
• NM_001904.3 human ⁇ - catenin transcript variant 1
• NM_001098209.1 human ⁇ -catenin transcript variant 2
• NM_001098210.1 human ⁇ -catenin transcript variant 3
• NM_007614.2 & NM_007614.3 mouse ⁇ -catenin
• ⁇ -catenin-associated disease or disorder refers to a disease or disorder that is associated with altered ⁇ - catenin expression, level and/or activity.
• a " ⁇ -catenin-associated" disease or disorder includes cancer and/or proliferative diseases, conditions, or disorders, including colorectal, desmoid, endometrial, gastric, hepatocellular, hepatoblastoma, kidney (Wilms' tumor), medulloblastoma, melanoma, ovarian (endometrioid), pancreatic, pilomatricoma, prostate, thyroid (anaplastic) and uterine (endometrium) cancers.
• the ⁇ -catenin-associated disease or disorder is colorectal cancer, hepatocellular carcinoma, or melanoma.
• BCAT1 refers to a nucleic acid inhibitor molecule that targets the ⁇ -catenin gene and has a sense strand with a nucleic acid sequence consisting of SEQ ID NO: 1 and an antisense strand with a nucleic acid sequence consisting of SEQ ID NO:2.
• C-Myc refers to either to a polypeptide or a nucleic acid sequence encoding such a c-Myc protein (such as Genbank Accession Nos. NP_002458.2 and NP_034979.3).
• c-Myc transcripts include the sequences of Genbank Accession Nos. NM_002467.4 and NM_010849.4.
• MYC1 refers to a nucleic acid inhibitor molecule that targets the c-Myc gene and has a sense strand with a nucleic acid sequence consisting of SEQ ID NO:5 and an antisense strand with a nucleic acid sequence consisting of SEQ ID NO:6.
• MYC2 refers to a nucleic acid inhibitor molecule that targets the c-Myc gene and has a sense strand with a nucleic acid sequence consisting of SEQ ID NO: 3 and an antisense strand with a nucleic acid sequence consisting of SEQ ID NO: 4.
• MEK Inhibitor refers to a compound or agent that reduces an activity of the mitogen-activated protein kinase kinase enzyme MEK1 and/or MEK2.
• Excipient refers to a non- therapeutic agent that may be included in a composition, for example to provide or contribute to a desired consistency or stabilizing effect.
• nucleic acid inhibitor molecule refers to an oligonucleotide molecule that reduces or eliminates the expression of a target gene wherein the oligonucleotide molecule contains a region that specifically targets a sequence in the target gene mRNA.
• the targeting region of the nucleic acid inhibitor molecule comprises a sequence that is sufficiently complementary to a sequence on the target gene mRNA to direct the effect of the nucleic acid inhibitor molecule to the specified target gene.
• a " ⁇ -catenin nucleic acid inhibitor molecule” reduces or eliminates the expression of a CTNNB1 gene
• a "c-Myc nucleic acid inhibitor molecule” reduces or eliminates the expression of a c-Myc gene.
• the nucleic acid inhibitor molecule may include natural ribonucleotides, natural deoxyribonucleotides, and/or modified nucleotides.
• the modified nucleotides include modifications such as substitution on positions on the sugar ring, modifications of the phosphoester linkages between nucleotides, non- natural bases, and non-natural alternative carbon structures such as locked nucleic acids (“LNA”) (see below) and unlocked nucleic acids (“UNA”) (see below).
• Reduce(s) refers to its meaning as is generally accepted in the art. With reference to exemplary nucleic acid inhibitor molecules (e.g., ⁇ -catenin and c-Myc siNA molecules) or exemplary inhibitors (e.g., MEK inhibitor), the term generally refers to the reduction in the expression of a gene, or level of RNA molecules or equivalent RNA molecules encoding one or more proteins or protein subunits, or activity of one or more proteins or protein subunits, below that observed in the absence of the nucleic acid inhibitor molecules or inhibitor.
• exemplary nucleic acid inhibitor molecules e.g., ⁇ -catenin and c-Myc siNA molecules
• exemplary inhibitors e.g., MEK inhibitor
• Resistance refers to the condition that occurs when a treatment that previously reduced or inhibited tumor growth in a subject no longer reduces or inhibits tumor growth in that subject.
• RNAi inhibitor molecule refers to either (a) a double stranded nucleic acid inhibitor molecule (“dsRNAi inhibitor molecule”) having a sense strand (passenger) and antisense strand (guide), where the antisense strand is used by the Argonaute 2 (Ago 2) endonuclease in the cleavage of the target mRNA or (b) a single stranded nucleic acid inhibitor molecule (“ssRNAi inhibitor molecule”) having a single antisense strand that is used by Ago2; where the RNAi inhibitor molecule makes use of at least part of the cell's RNA interference (“RNAi”) machinery to reduce or eliminate expression of the target gene.
• dsRNAi inhibitor molecule double stranded nucleic acid inhibitor molecule having a sense strand (passenger) and antisense strand (guide), where the antisense strand is used by the Argonaute 2 (Ago 2) endonuclease in the cleavage of the target
• subject means any mammal, including mice, rabbits, and humans. In one embodiment, the subject is a human.
• the terms "individual” or “patient” are intended to be interchangeable with “subject.”
• nucleic acid inhibitor molecules Various structures have been used for nucleic acid inhibitor molecules. For example, early work focused on double-stranded nucleic acid molecules with each strand having sizes of 19-25 nucleotides with at least one 3' overhang of 1 to 5 nucleotides (see, e.g., U S Patent No. 8,372,968). Subsequently, longer double-stranded RNA molecules that get processed in vivo by the Dicer enzyme to active siRNA molecules were developed (see, e.g., U.S. Patent No. 8,883,996).
• ⁇ -catenin and c-Myc nucleic acid inhibitor molecules of the present invention can be based on any of the above structures and their variations described in the literature, ⁇ -catenin and c-Myc nucleic acid inhibitor molecules also include micro-RNA (miRNA) and short hairpin RNA (shRNA) molecules, such as those described in U.S. Published Application No. 2009/00991 15.
• miRNA micro-RNA
• shRNA short hairpin RNA
• nucleotide subunits of the nucleic acid inhibitor molecules are modified to improve various characteristics of the molecule such as resistance to nucleases or lowered immunogenicity, (see, e.g., Bramsen et al. (2009), Nucleic Acids Res., 37, 2867-2881 ).
• every nucleotide of a nucleic acid inhibitor molecule is modified.
• substantially all of the nucleotides of a nucleic acid inhibitor molecule are modified.
• more than half of the nucleotides of a nucleic acid inhibitor molecule are modified.
• nucleotides of a nucleic acid inhibitor molecule are modified. In certain embodiments, none of the nucleotides of a nucleic acid inhibitor molecule are modified. Modifications can occur in groups on the oligonucleotide chain or different modified nucleotides can be interspersed.
• nucleic acid inhibitor molecules of the invention include one or more deoxyribonucleotides. Typically, the nucleic acid inhibitor molecules contain fewer than 5 deoxyribonucleotides. In certain embodiments, the nucleic acid inhibitor molecules of the invention include one or more ribonucleotides.
• the ring structure of the sugar moiety is modified, including, but not limited to, Locked Nucleic Acids (“LNA”) (see, e.g., Koshkin et al. (1998), Tetrahedron 54, 3607-3630) and Unlocked Nucleic Acids (“UNA”) (see, e.g., Snead et al. (2013), Molecular Therapy - Nucleic Acids, 2, e103 (doi: 10.1038/mtna.2013.36)).
• LNA Locked Nucleic Acids
• NDA Unlocked Nucleic Acids
• the 5' end of the oligonucleotide is an oft modified position.
• a hydroxyl group is attached to the 5' end of the oligonucleotide of a nucleic acid inhibitor molecule of the invention.
• a phosphate group is attached to the 5' end of the oligonucleotide of a nucleic acid inhibitor molecule of the invention.
• the 5' end is attached to chemical moiety that mimics the electrostatic and steric properties of a phosphate group ("phosphate mimic") (see, e.g., Prakash et al.
• a ⁇ -catenin nucleic acid inhibitor molecule can be combined with an MEK inhibitor or a c-Myc nucleic acid inhibitor molecule for treating ⁇ -catenin-associated disease or disorders, such as cancer.
• MEK inhibitor a c-Myc nucleic acid inhibitor molecule for treating ⁇ -catenin-associated disease or disorders, such as cancer.
• ⁇ -catenin nucleic acid inhibitor molecules are known, as disclosed, for example, in U.S. Published Application Nos. 2015/0291954 and 2015/0291956 and U.S. Patent Nos. 6,066,500; 8, 198,427; 8,835,623; or 9,243,244, which are incorporated by reference for their disclosure of these ⁇ -catenin nucleic acid inhibitor molecules.
• the ⁇ -catenin nucleic acid inhibitor molecule is a molecule disclosed in U.S Patent No. 9,243,244.
• the ⁇ -catenin nucleic acid inhibitor molecules of the invention are dsRNAi inhibitor molecules where the double-stranded region of the molecule is between 15 and 40 nucleotides in length. In certain of those embodiments, the double-stranded region is between 20 and 30 nucleotides in length. In certain of those embodiments, the double-stranded region is 21 , 22, 23, 24, 25, or 26 nucleotides in length.
• the ⁇ -catenin nucleic acid inhibitor molecules of the invention are dsRNAi inhibitor molecules where the sense strand is between 18 and 66 nucleotides in length. In certain of those embodiments, the sense strand is between 25 and 45 nucleotides in length. In certain embodiments, the sense strand is between 30 and 40 nucleotides in length. In certain embodiments, the sense strand is 36, 37, 38, 39, or 40 nucleotides in length. In certain embodiments, the sense strand is between 25 and 30 nucleotides in length. In certain of those embodiments, the sense strand is 25, 26, or 27 nucleotides in length.
• the ⁇ -catenin nucleic acid inhibitor molecules of the invention are dsRNAi inhibitor molecules where the antisense strand is between 18 and 66 nucleotides in length.
• the antisense strand comprises a sequence that is sufficiently complementary to a sequence in the target gene mRNA to direct the effect of the nucleic acid inhibitor molecule to the target gene.
• the antisense strand comprises a sequence that is fully complementary with a sequence contained in the target gene mRNA where the fully complementary sequence is between 18 and 40 nucleotides long. In certain of those embodiments, the antisense strand is between 20 and 50 nucleotides in length.
• the antisense strand is between 20 and 30 nucleotides in length. In certain embodiments, the antisense strand is 21 , 22, 23, 24, 25, 26, 27, or 28 nucleotides in length. In certain embodiments, the antisense strand is between 35 and 40 nucleotides in length. In certain of those embodiments, the antisense strand is 36, 37, 38, or 39 nucleotides in length.
• the ⁇ -catenin nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule comprising a sense and an antisense strand and a duplex region of between 18 and 34 nucleotides, wherein the sense strand is 25-34 nucleotides in length and the antisense strand is 26-38 nucleotides in length and comprises 1 -5 single-stranded nucleotides at its 3' terminus.
• the antisense strand comprises 2 single-stranded nucleotides at its 3' terminus.
• the antisense strand comprises 1 -5 single- stranded nucleotides at its 3' terminus and 5-12 single-stranded nucleotides at is 5' terminus. In certain embodiments, the antisense strand comprises 2 single-stranded nucleotides at its 3' terminus and 10 single-stranded nucleotides at is 5' terminus.
• the ⁇ -catenin nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule comprising a sense and an antisense strand and a duplex region of 26 nucleotides, wherein the sense strand is 26 nucleotides in length and the antisense strand is 38 nucleotides in length and comprises 2 single-stranded nucleotides at its 3' terminus and 10 single-stranded nucleotides at its 5' terminus.
• the ⁇ -catenin nucleic acid inhibitor molecules of the invention are ssRNAi inhibitor molecules.
• the antisense strand of the ⁇ -catenin nucleic acid inhibitor molecule comprises the sequence of SEQ ID NO: 2. In certain embodiments, the antisense strand of the ⁇ -catenin nucleic acid inhibitor molecule consists of the sequence of SEQ ID NO: 2. In certain embodiments, the ⁇ -catenin nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand comprises the sequence of SEQ ID NO: 1 . In certain embodiments, the ⁇ -catenin nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand consists of the sequence of SEQ ID NO: 1 .
• the ⁇ -catenin nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand comprises the sequence of SEQ ID NO: 1 and the antisense strand comprises the sequence of SEQ ID NO: 2.
• the ⁇ -catenin nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule where the sense strand consists of the sequence of SEQ ID NO: 1 and the antisense strand consists of the sequence of SEQ ID NO: 2.
• the level or activity of a ⁇ -catenin RNA can be determined by a suitable method now known in the art or that is later developed. It can be appreciated that the method used to measure a target RNA and/or the "expression" of a target gene can depend upon the nature of the target gene and its encoded RNA. For example, where the target ⁇ -catenin RNA sequence encodes a protein, the term "expression" can refer to a protein or the ⁇ -catenin RNA/transcript derived from the ⁇ -catenin gene (either genomic or of exogenous origin).
• the expression of the target ⁇ -catenin RNA can be determined by measuring the amount of ⁇ -catenin RNA/transcript directly or by measuring the amount of ⁇ -catenin protein. Protein can be measured in protein assays such as by staining or immunoblotting or, if the protein catalyzes a reaction that can be measured, by measuring reaction rates. All such methods are known in the art and can be used. Where target ⁇ - catenin RNA levels are to be measured, art-recognized methods for detecting RNA levels can be used (e.g., RT-PCR, Northern Blotting, etc.).
• ⁇ -catenin RNAs In targeting ⁇ -catenin RNAs, it is also anticipated that measurement of the efficacy of the nucleic acid inhibitor molecule in reducing levels of ⁇ -catenin RNA or protein in a subject, tissue, in cells, either in vitro or in vivo, or in cell extracts can also be used to determine the extent of reduction of ⁇ -catenin-associated phenotypes (e.g., disease or disorders, e.g., cancer or tumor formation, growth, metastasis, spread, etc.). The above measurements can be made on cells, cell extracts, tissues, tissue extracts or other suitable source material.
• ⁇ -catenin-associated phenotypes e.g., disease or disorders, e.g., cancer or tumor formation, growth, metastasis, spread, etc.
• MEK refers to the mitogen-activated protein kinase kinase enzymes MEK1 and/or MEK2.
• MEK is also known as MAP2K and MAPKK.
• MEK is a member of the RAS/RAF/MEK/ERK signaling cascade that is activated in certain cancers, such as melanoma. The pathway is activated through the binding of a number of growth factors and cytokines to receptors on the cell surface, which activate receptor tyrosine kinases. Activation of the receptor tyrosine kinases results in activation of RAS, which then recruits RAF, which is in turn activated by multiple phosphorylation events.
• Activated RAF phosphorylates and activates MEK kinase, which in turn phosphorylates and activates ERK kinase (also known as mitogen-activated protein kinase "MAPK").
• MEK kinase also known as mitogen-activated protein kinase "MAPK”
• MAPK mitogen-activated protein kinase
• the phosphorylated ERK can then translocate to the nucleus, where it phosphorylates and activates directly or indirectly various transcription factors, such as c-Myc and CREB. This process leads to altered gene transcription of genes that are important for cellular growth and proliferation.
• MEK1 and MEK2 play crucial roles in tumorigenesis, cell proliferation, and inhibition of apoptosis.
• MEK1/2 are themselves rarely mutated, constitutively active MEK has been found in more than 30% of primary tumor cell lines tested.
• One of the ways of halting this cascade is the inhibition of MEK. When MEK is inhibited, cell proliferation is blocked and apoptosis is induced. Inhibition of MEK has, therefore, been an attractive target for development of pharmaceutical therapies.
• MEK inhibitors include, but are not limited to, trametinib (GSK1 120212), selumetinib, binimetinib (MEK162), cobimetinib (XL518), refametinib (BAY 86-9766), pimasertib, PD-325901 , RO5068760, CI-1040 (PD035901 ), AZD8330 (ARRY-424704), RO4987655 (CH4987655), RO5126766, WX-554, E6201 , and TAK-733.
• the MEK inhibitor is trametinib.
• Trametinib is a small molecule kinase inhibitor and is approved for use as a single agent or in combination with dabrafenib for the treatment of subjects with unresectable or metastatic melanoma with a V600E or V600K mutation in the BRAF gene.
• BRAF encodes a serine/threonine kinase called B-Raf that is involved in intracellular signaling.
• the c-Myc gene is a key molecular regulator of cellular growth and differentiation.
• the c-Myc protein is a transcription factor that activates expression of many genes via binding of consensus sequences (Enhancer Box sequences (E- boxes)) and recruitment of histone acetyltransferases (HATs).
• the c-Myc protein can also act as a transcriptional repressor.
• Miz-1 transcription factor By binding Miz-1 transcription factor and displacing the p300 co-activator, Myc inhibits expression of Miz-1 target genes.
• Myc has a direct role in the control of DNA replication (Dominguez-Sola et al. Nature 448 (7152): 445-51 ).
• c-Myc Various mitogenic signaling pathways, including Wnt, Shh and EGF (via the RAS/RAF/MEK/ERK pathway), have been demonstrated to activate c-Myc.
• the role of c-Myc in modifying the expression of its target genes has been shown to cause numerous biological effects. The first to be discovered was its capability to drive cell proliferation (upregulates cyclins, downregulates p21 ), but c-Myc also plays an important role in regulating cell growth (upregulates ribosomal RNA and proteins), apoptosis (downregulates Bcl-2), differentiation and stem cell self-renewal.
• c-Myc is a strong proto-oncogene and its upregulation has been described in many types of cancers.
• c-Myc overexpression stimulates gene amplification (Denis et al. Oncogene 6 (8): 1453-7), via a mechanism believed to involve DNA over-replication.
• ⁇ -catenin nucleic acid inhibitor molecules can be combined with c-Myc nucleic acid inhibitor molecules.
• various oligonucleotide structures have been used as nucleic acid inhibitor molecules and are known in the art.
• Specific c-Myc nucleic acid inhibitor molecules are known, as disclosed for example in U.S. Published Application Nos. 2014/0107178 and 2009/00991 15, which are incorporated by reference for their disclosure of these c- Myc nucleic acid inhibitor molecules.
• the c-Myc nucleic acid inhibitor molecule is a molecule disclosed in U.S. Published Application No. 2014/0107178.
• the c-Myc nucleic acid inhibitor molecules of the invention are dsRNAi inhibitor molecules where the double-stranded region of the molecule is between 15 and 40 nucleotides in length. In certain of those embodiments, the double-stranded region is between 20 and 30 nucleotides in length. In certain of those embodiments, the double-stranded region is 21 , 22, 23, 24, 25, or 26 nucleotides in length.
• the c-Myc nucleic acid inhibitor molecules of the invention are dsRNAi inhibitor molecules where the sense strand is between 18 and 66 nucleotides in length. In certain of those embodiments, the sense strand is between 25 and 45 nucleotides in length. In certain embodiments, the sense strand is between 30 and 40 nucleotides in length. In certain embodiments, the sense strand is 36, 37, 38, 39, or 40 nucleotides in length. In certain embodiments, the sense strand is between 25 and 30 nucleotides in length. In certain of those embodiments, the sense strand is 25, 26, or 27 nucleotides in length.
• the c-Myc nucleic acid inhibitor molecules of the invention are dsRNAi inhibitor molecules where the antisense strand is between 18 and 66 nucleotides in length.
• the antisense strand comprises a sequence that is sufficiently complementary to a sequence in the target gene mRNA to direct the effect of the nucleic acid inhibitor molecule to the target gene.
• the antisense strand comprises a sequence that is fully complementary with a sequence contained in the target gene mRNA where the fully complementary sequence is between 18 and 40 nucleotides long. In certain of those embodiments, the antisense strand is between 20 and 50 nucleotides in length.
• the antisense strand is between 20 and 30 nucleotides in length. In certain embodiments, the antisense strand is 21 , 22, 23, 24, 25, 26, 27, or 28 nucleotides in length. In certain embodiments, the antisense strand is between 35 and 40 nucleotides in length. In certain of those embodiments, the antisense strand is 36, 37, 38, or 39 nucleotides in length.
• the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule comprising a sense and an antisense strand and a duplex region of between 18 and 40 nucleotides, wherein the sense strand is 25-34 nucleotides in length and the antisense strand is 26-38 nucleotides in length and comprises 1 -5 single-stranded nucleotides at its 3' terminus.
• the antisense strand comprises 2 single-stranded nucleotides at its 3' terminus.
• the antisense strand comprises 1 -5 single- stranded nucleotides at its 3' terminus and 5-12 single-stranded nucleotides at is 5' terminus. In certain embodiments, the antisense strand comprises 2 single-stranded nucleotides at its 3' terminus and 10 single-stranded nucleotides at is 5' terminus.
• the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule comprising a sense and an antisense strand and a duplex region of 26 nucleotides, wherein the sense strand is 26 nucleotides in length and the antisense strand is 38 nucleotides in length and comprises 2 single-stranded nucleotides at its 3' terminus and 10 single-stranded nucleotides at its 5' terminus.
• the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule comprising a sense and an antisense strand and a duplex region of 25 nucleotides, wherein the sense strand is 25 nucleotides in length and the antisense strand is 27 nucleotides in length and comprises 2 single-stranded nucleotides at its 3' terminus.
• the c-Myc nucleic acid inhibitor molecules of the invention are ssRNAi inhibitor molecules.
• the antisense strand of the c-Myc nucleic acid inhibitor molecule comprises the sequence of SEQ ID NO: 4. In certain embodiments, the antisense strand of the c-Myc nucleic acid inhibitor molecule consists of the sequence of SEQ ID NO: 4. In certain embodiments, the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand comprises the sequence of SEQ ID NO: 3. In certain embodiments, the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand consists of the sequence of SEQ ID NO: 3.
• the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand comprises the sequence of SEQ ID NO: 3 and the antisense strand comprises the sequence of SEQ ID NO: 4.
• the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule where the sense strand consists of the sequence of SEQ ID NO: 3 and the antisense strand consists of the sequence of SEQ ID NO: 4. See Figure 8.
• the antisense strand of the c-Myc nucleic acid inhibitor molecule comprises the sequence of SEQ ID NO: 6. In certain embodiments, the antisense strand of the c-Myc nucleic acid inhibitor molecule consists of the sequence of SEQ ID NO: 6. In certain embodiments, the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand comprises the sequence of SEQ ID NO: 5. In certain embodiments, the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand consists of the sequence of SEQ ID NO: 5.
• the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand comprises the sequence of SEQ ID NO: 5 and the antisense strand comprises the sequence of SEQ ID NO: 6.
• the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule and the sense strand consists of the sequence of SEQ ID NO: 5 and the antisense strand consists of the sequence of SEQ ID NO: 6. See Figure 9.
• a nucleic acid inhibitor molecule is conjugated to a ligand to direct delivery of the nucleic acid inhibitor molecule to the targeted tumor.
• Ligands that may be used include, but are not limited to, antibodies, peptides, small molecules, and carbohydrates.
• the ligand may be a folate, an RGD peptide, a PSMA binding ligand (see, e.g., WO 2010/045598), transferrin (see, e.g. ,Yhee et al. (2013), Bioconjugate Chem., 24, 1850-1860), or an aptamer (see, e.g., Dassie (2013), Ther Deliv, 4(12): 1527-1546).
• a nucleic acid inhibitor molecule is covalently linked to a nucleic acid targeting molecule, such as a DNA or RNA aptamer, to achieve tumor targeting.
• a nucleic acid inhibitor molecule is linked to the targeting nucleic acid molecule by a nucleic acid linker.
• a strand of the nucleic acid inhibitor molecule and the targeting nucleic acid molecule comprise a continuous oligonucleotide.
• the targeting nucleic acid molecule links the two strands of a dsRNAi inhibitor molecule.
• the level or activity of a c-Myc RNA can be determined by a suitable method now known in the art or that is later developed. It can be appreciated that the method used to measure a target RNA and/or the "expression" of a target gene can depend upon the nature of the target gene and its encoded RNA. For example, where the target c-Myc RNA sequence encodes a protein, the term "expression" can refer to a protein or the c-Myc RNA/transcript derived from the c-Myc gene (either genomic or of exogenous origin). In such instances the expression of the target c- Myc RNA can be determined by measuring the amount of c-Myc RNA/transcript directly or by measuring the amount of c-Myc protein.
• Protein can be measured in protein assays such as by staining or immunoblotting or, if the protein catalyzes a reaction that can be measured, by measuring reaction rates. All such methods are known in the art and can be used. Where target c-Myc RNA levels are to be measured, art-recognized methods for detecting RNA levels can be used (e.g., RT- PCR, Northern Blotting, etc.).
• c-Myc RNAs In targeting c-Myc RNAs, it is also anticipated that measurement of the efficacy of the nucleic acid inhibitor molecule in reducing levels of c-Myc RNA or protein in a subject, tissue, in cells, either in vitro or in vivo, or in cell extracts can also be used to determine the extent of reduction of c-Myc - associated phenotypes (e.g., disease or disorders, e.g., cancer or tumor formation, growth, metastasis, spread, etc.). The above measurements can be made on cells, cell extracts, tissues, tissue extracts or other suitable source material.
• c-Myc - associated phenotypes e.g., disease or disorders, e.g., cancer or tumor formation, growth, metastasis, spread, etc.
• compositions comprising a ⁇ -catenin nucleic acid inhibitor molecule and a pharmaceutically acceptable excipient.
• the pharmaceutical composition comprising the ⁇ -catenin nucleic acid inhibitor molecule and the pharmaceutically acceptable excipient further comprises a MEK inhibitor or a nucleic acid inhibitor molecule that reduces expression of the c-Myc gene.
• compositions and formulations suitable for pharmaceutical delivery of one or more therapeutic compositions, including vaccines, and additional pharmaceutical agents include, for example, starch, glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silica gel, sodium stearate, glycerol monostearate, talc, sodium chloride, dried skim milk, glycerol, propylene, glycol, water, ethanol and the like.
• the nature of the excipient will depend on the particular mode of administration being employed.
• parenteral formulations usually comprise injectable fluids that include pharmaceutically and physiologically acceptable fluids such as water, physiological saline, balanced salt solutions, buffers, aqueous dextrose, glycerol or the like as a vehicle.
• pharmaceutically and physiologically acceptable fluids such as water, physiological saline, balanced salt solutions, buffers, aqueous dextrose, glycerol or the like as a vehicle.
• physiologically acceptable fluids such as water, physiological saline, balanced salt solutions, buffers, aqueous dextrose, glycerol or the like
• conventional non-toxic solid excipients can include, for example, pharmaceutical grades of mannitol, lactose, starch, or magnesium stearate.
• compositions to be administered can contain minor amounts of nontoxic auxiliary substances, such as wetting or emulsifying agents, a surface active agent, preservatives, and pH buffering agents and the like, for example sodium acetate or sorbitan monolaurate.
• auxiliary substances such as wetting or emulsifying agents, a surface active agent, preservatives, and pH buffering agents and the like, for example sodium acetate or sorbitan monolaurate.
• the pharmaceutically acceptable excipient is non-naturally occurring.
• the pharmaceutical composition according to certain embodiments disclosed herein may comprise at least one ingredient, which may belong to the same or different categories of excipients, including at least one disintegrant, at least one diluent, and/or at least one binder.
• Typical non-limiting examples of the at least one disintegrant that may be added to the pharmaceutical composition according to embodiments disclosed herein include, but are not limited to, povidone, crospovidone, carboxymethylcellulose, methylcellulose, alginic acid, croscarmellose sodium, sodium starch glycolate, starch, formaldehyde-casein, and combinations thereof.
• Typical non-limiting examples of the at least one diluents that may be added to the pharmaceutical composition according to embodiments disclosed herein include, but are not limited to, maltose, maltodextrin, lactose, fructose, dextrin, microcrystalline cellulose, pregelatinized starch, sorbitol, sucrose, silicified microcrystalline cellulose, powdered cellulose, dextrates, mannitol, calcium phosphate, and combinations thereof.
• Typical non-limiting examples of the at least one binder that may be added to the pharmaceutical composition according to embodiments disclosed herein, include, but are not limited to, acacia, dextrin, starch, povidone, carboxymethylcellulose, guar gum, glucose, hydroxypropyl methylcellulose, methylcellulose, polymethacrylates, maltodextrin, hydroxyethyl cellulose, and combinations thereof.
• Suitable preparation forms for the pharmaceutical compositions disclosed herein include, for example, tablets, capsules, soft capsules, granules, powders, suspensions, aerosols, emulsions, microemulsions, nanoemulsions, unit dosage forms, rings, films, suppositories, solutions, creams, syrups, transdermal patches, ointments, or gels.
• the ⁇ -catenin nucleic acid inhibitor molecule and/or the c-Myc nucleic acid inhibitor molecule may be admixed, encapsulated, conjugated or otherwise associated with other molecules, molecule structures or mixtures of compounds, including, for example, liposomes and lipids such as those disclosed in U.S. Patent Nos. 6,815,432, 6,586,410, 6,858,225, 7,81 1 ,602, 7,244,448 and 8, 158,601 ; polymeric materials such as those disclosed in U.S. Patent Nos. 6,835,393, 7,374,778, 7,737, 108, 7,718, 193, 8,137,695 and U.S. Published Patent Application Nos.
• the nucleic acid inhibitor molecules are formulated in a lipid nanoparticle.
• Lipid-nucleic acid nanoparticles typically form spontaneously upon mixing lipids with nucleic acid to form a complex.
• the resultant nanoparticle mixture can be optionally extruded through a polycarbonate membrane (e.g., 100 nm cut-off) using, for example, a thermobarrel extruder, such as Lipex Extruder (Northern Lipids, Inc).
• lipid nanoparticle for therapeutic use, it may desirable to remove solvent (e.g., ethanol) used to form the nanoparticle and/or exchange buffer, which can be accomplished by, for example, dialysis or tangential flow filtration.
• solvent e.g., ethanol
• Methods of making lipid nanoparticles containing nucleic acid inhibitor molecules are known in the art, as disclosed, for example in U.S. Published Patent Application Nos. 2015/0374842 and 2014/0107178.
• the LNP comprises a liposome comprising a cationic liposome and a pegylated lipid.
• the LNP can further comprise one or more envelope lipids, such as a cationic lipid, a structural lipid, a sterol, a pegylated lipid, or mixtures thereof.
• Cationic lipids for use in LNPs are known in the art, as discussed for example in U.S. Published Patent Application Nos. 2015/0374842 and 2014/0107178.
• the cationic lipid is a lipid having a net positive charge at physiological pH.
• the cationic liposome is DODMA, DOTMA, DL-048, or DL-103.
• the structural lipid is DSPC, DPPC or DOPC.
• the sterol is cholesterol.
• the pegylated lipid is DMPE-PEG, DSPE-PEG, DSG-PEG, DMPE-PEG2K, DSPE- PEG2K, DSG-PEG2K, or DSG-MPEG.
• the cationic lipid is DL- 048
• the pegylated lipid is DSG-MPEG and the one or more envelope lipids are DL- 103, DSPC, cholesterol, and DSPE-MPEG.
• compositions may be sterilized by conventional sterilization techniques, or may be sterile filtered.
• the resulting aqueous solutions may be packaged for use as is, or lyophilized, the lyophilized preparation being combined with a sterile aqueous carrier prior to administration.
• the pH of the preparations typically will be between 3 and 1 1 , more preferably between 5 and 9 or between 6 and 8, and most preferably between 7 and 8, such as 7 to 7.5.
• the resulting compositions in solid form may be packaged in multiple single dose units, each containing a fixed amount of the above mentioned agent or agents, such as in a sealed package of tablets or capsules.
• the composition in solid form can also be packaged in a container for a flexible quantity, such as in a squeezable tube designed for a topically applicable cream or ointment.
• the pharmaceutical compositions described herein are for use in treating a ⁇ -catenin-associated disease or disorder.
• the pharmaceutical composition for use in treating a ⁇ -catenin- associated disease or disorder comprises a ⁇ -catenin nucleic acid inhibitor molecule, wherein the composition is administered in combination with a MEK inhibitor (e.g., trametinib).
• the pharmaceutical composition for use in treating a ⁇ -catenin-associated disease or disorder comprises a ⁇ -catenin nucleic acid inhibitor molecule, wherein the composition is administered in combination with a c- Myc nucleic acid inhibitor molecule.
• the ⁇ -catenin- associated disease or disorder is cancer, such as colorectal cancer, hepatocellular carcinoma, or melanoma.
• the ⁇ -catenin-associated cancer has metastasized.
• the ⁇ -catenin-associated cancer is colorectal cancer that has metastasized.
• the colorectal cancer has metastasized to the liver.
• the nucleic acid inhibitor molecules of the invention are administered intravenously or subcutaneously.
• the pharmaceutical compositions disclosed herein may also be administered by any method known in the art, including, for example, oral, buccal, sublingual, rectal, vaginal, intraurethral, topical, intraocular, intranasal, and/or intraauricular, which administration may include tablets, capsules, granules, aqueous suspensions, gels, sprays, suppositories, salves, ointments, or the like.
• Administration may also be via injection, for example, intraperitoneally, intramuscularly, intradermal ⁇ , intraorbitally, intracapsularly, intraspinally, intrasternally, or the like.
• the therapeutically effective amount of the compounds disclosed herein may depend on the route of administration and the physical characteristics of the patient, such as general state, weight, diet, and other medications.
• a therapeutically effective amount means an amount of compound or compounds effective to prevent, alleviate or ameliorate disease or condition symptoms of the subject being treated. Determination of a therapeutically effective amount is well within the capability of those skilled in the art and generally range from about 0.5 mg to about 3000 mg of the small molecule agent or agents per dose per patient.
• the pharmaceutical compositions disclosed herein may be useful for the treatment or prevention of symptoms related to a ⁇ -catenin- associated disease or disorder.
• One embodiment is directed to a method of treating a ⁇ -catenin-associated disease or disorder, comprising administering to a subject a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule and a therapeutically effective amount of an MEK inhibitor.
• Another embodiment is directed to a method of treating a ⁇ -catenin-associated disease or disorder, comprising administering to a subject a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule and a therapeutically effective amount of a c-Myc nucleic acid inhibitor molecule.
• the nucleic acid inhibitor molecule is administered separately from, and on a different schedule than, a small molecule therapeutic that is in combination with the nucleic acid inhibitor molecule.
• a small molecule therapeutic typically in combination with the nucleic acid inhibitor molecule.
• trametinib when used as a single agent, trametinib is currently prescribed as a daily oral dose (typically about 1 -2 mg/day).
• the nucleic acid inhibitor molecule is likely to be administered through an intravenous or subcutaneous route with doses given once a week, once each two weeks, once a month, once every three months, twice a year, etc.
• the subject may already be taking the small molecule therapeutic at the initiation of the administration of the nucleic acid inhibitor molecule.
• the subject may begin administration of both the small molecule therapeutic and the nucleic acid inhibitor molecule at about the same time.
• the subject may begin taking the small molecule therapeutic after the initiation of administration of the nucleic acid inhibitor molecule.
• one pharmaceutical composition may comprise the ⁇ -catenin nucleic acid inhibitor molecule and a separate pharmaceutical composition may comprise the MEK inhibitor or the c-Myc nucleic acid inhibitor molecule.
• the ⁇ -catenin nucleic acid inhibitor molecule may be administered simultaneously with the MEK inhibitor or the c-Myc nucleic acid inhibitor molecule.
• a single pharmaceutical composition may comprise both the ⁇ - catenin nucleic acid inhibitor molecule and the MEK inhibitor or the c-Myc nucleic acid inhibitor molecule.
• a single pharmaceutical composition is administered to the subject, wherein the single pharmaceutical composition comprises both the ⁇ -catenin nucleic acid inhibitor molecule and the MEK inhibitor, such as trametinib.
• the single pharmaceutical composition comprises both the ⁇ -catenin nucleic acid inhibitor molecule and the c-Myc nucleic acid inhibitor molecule.
• the ⁇ -catenin nucleic acid inhibitor molecule or c-Myc nucleic acid inhibitor molecule is administered at a dosage of 20 micrograms to 10 milligrams per kilogram body weight of the recipient per day, 100 micrograms to 5 milligrams per kilogram, 0.25 milligrams to 2.0 milligrams per kilogram, or 0.5 to 2.0 milligrams per kilogram.
• the ⁇ -catenin nucleic acid inhibitor molecule or c-Myc nucleic acid inhibitor molecule is administered once daily, once weekly, once every two weeks, once monthly, once every two months, once a quarter, twice a year, or once yearly.
• the ⁇ -catenin nucleic acid inhibitor molecule or c-Myc nucleic acid inhibitor molecule is administered once or twice every 2, 3, 4, 5, 6, or 7 days.
• the compositions (containing both agents or a single, individual agent) can be administered once monthly, once weekly, once daily (QD), once every other day, or divided into multiple monthly, weekly, or daily doses, such as twice daily, three times a day or once every two weeks.
• the compositions can be administered once a day for two, three, four, five, six, or at least seven days.
• the agents can be administered simultaneously, typically each agent will be administered on a different schedule, particularly if the agents are administered via different routes.
• Treatment of a subject with a therapeutically effective amount of an agent can include a single treatment or, preferably, can include a series of treatments.
• the treatment schedule includes a first loading dosage or phase, which is typically a higher dosage or frequency, followed by a maintenance dosage or phase, which is typically a lower dosage or frequency than the loading dosage/phase.
• the treatment continues until disease progression or unacceptable toxicity occurs.
• the ⁇ -catenin or c-Myc nucleic acid inhibitor molecules can be inserted into expression constructs, e.g., viral vectors, retroviral vectors, expression cassettes, or plasmid viral vectors, e.g., using methods known in the art.
• Expression constructs can be delivered to a subject by, for example, inhalation, orally, intravenous injection, local administration (see U.S. Pat. No. 5,328,470) or by stereotactic injection (see e.g., Chen et al. (1994), Proc. Natl. Acad. Sci. USA, 91 , 3054-3057).
• the expression constructs may be constructs suitable for use in the appropriate expression system and include, but are not limited to retroviral vectors, linear expression cassettes, plasm ids and viral or virally-derived vectors, as known in the art.
• Such expression constructs may include one or more inducible promoters, RNA Pol III promoter systems such as U6 snRNA promoters or H1 RNA polymerase III promoters, or other promoters known in the art.
• the constructs can include one or both strands of the siRNA.
• Expression constructs expressing both strands can also include loop structures linking both strands, or each strand can be separately transcribed from separate promoters within the same construct. Each strand can also be transcribed from a separate expression construct, e.g., Tuschl (2002, Nature Biotechnol 20: 500-505).
• One aspect is directed to methods of treating a ⁇ -catenin-associated disease or disorder, comprising administering to a subject (preferably a human) a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule and a therapeutically effective amount of an MEK inhibitor or a c-Myc nucleic acid inhibitor molecule.
• the ⁇ -catenin nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule.
• the sense strand comprises or consists of the sequence of SEQ ID NO: 1 and the antisense strand comprises of comprises or consists of the sequence of SEQ ID NO: 2.
• the ⁇ -catenin nucleic acid inhibitor molecule is formulated with a lipid nanoparticle. In one embodiment, the ⁇ -catenin nucleic acid inhibitor molecule is administered intravenously.
• the method of treatment comprises administering to a subject (preferably a human) a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule and a therapeutically effective amount of an MEK inhibitor.
• the MEK inhibitor is trametinib.
• the trametinib is administered orally.
• trametinib is administered at a dosage of about 1 -2 mg daily or every other day.
• trametinib is administered at a dosage of 2 mg daily.
• the MEK inhibitor is trametinib, which is administered orally
• the ⁇ -catenin nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule, wherein the double-stranded region of the molecule is between 15 and 40 nucleotides in length, including, for example, a double stranded nucleic acid having a sense strand and an antisense strand, wherein the sense strand comprises or consists of the sequence of SEQ ID NO: 1 and the antisense strand comprises of consists of the sequence of SEQ ID NO: 2.
• the ⁇ -catenin dsRNAi inhibitor molecule can be formulated with a lipid nanoparticle and administered intravenously.
• the method of treatment comprises administering to a subject (preferably a human) a therapeutically effective amount of a ⁇ -catenin nucleic acid inhibitor molecule and a therapeutically effective amount of a c-Myc nucleic acid inhibitor molecule.
• the c-Myc nucleic acid inhibitor molecule is a dsRNAi inhibitor molecule.
• the sense strand comprises or consists of the sequence of SEQ ID NO: 3 and the antisense strand comprises of consists of the sequence of SEQ ID NO: 4.
• the sense strand comprises or consists of the sequence of SEQ ID NO: 5 and the antisense strand comprises of consists of the sequence of SEQ ID NO: 6.
• the c-Myc dsRNAi inhibitor molecule is formulated with a lipid nanoparticle.
• the c-Myc dsRNAi inhibitor molecule is administered intravenously.
• the ⁇ -catenin- associated disease or disorder is cancer, such as colorectal cancer, hepatocellular carcinoma, or melanoma, and the subject has a mutation in the ⁇ -catenin gene.
• the subject has colorectal cancer characterized by a mutation in the ⁇ -catenin gene (or another gene in the Wnt signaling pathway, such as APC) and the KRAS gene.
• the subject has a BRAF mutation.
• the subject has a BRAF mutation and a mutation in a gene that encodes a protein involved in the Wnt signaling pathway (e.g., APC).
• trametinib is administered as an MEK inhibitor
• the subject has a BRAF mutation (e.g., V600E or V600F).
• the subject with the BRAF mutation has melanoma.
• the ⁇ -catenin- associated cancer has metastasized.
• the ⁇ -catenin- associated cancer is colorectal cancer that has metastasized.
• the colorectal cancer has metastasized to the liver.
• the treatment reduces metastases, including, but not limited to, metastases in the liver, in the subject.
• the treatment with the combination of a ⁇ -catenin nucleic acid inhibitor molecule, such as a dsRNAi inhibitor molecule, and an MEK inhibitor, such as trametinib increases survival of the subject beyond the average survival of patients with metastasized cancer who receive treatment with either the ⁇ -catenin nucleic acid inhibitor molecule or the MEK inhibitor (individually rather than in combination).
• a ⁇ -catenin nucleic acid inhibitor molecule such as a dsRNAi inhibitor molecule
• an MEK inhibitor such as trametinib
• BCAT1 A nucleic acid inhibitor molecule that targets the ⁇ -catenin gene was constructed ("BCAT1 ").
• BCAT1 has a 26 base pair passenger strand and a 38 base pair guide strand that form a duplex region consisting of 26 base pairs.
• the 5' end of the passenger strand consists of a 10-base pair, single stranded overhang, and the 3' end of the guide strand consists of a two-base pair single-stranded, overhang.
• the BCAT1 construct was formulated in EnCore lipid nanoparticles (LNP).
• LNP EnCore lipid nanoparticles
• the LNP formulated BCAT1 effectively delivered the nucleic acid payload to multiple tumor types (see Table I below), including subcutaneous, orthotopic, disseminated and metastatic xenograft tumors, patient-derived xenografts (PDX), and genetically engineered models (GEM).
• Tumor type Description Tumor location in model
• Hsd:Athymic ude-Foxn1 nu mice (hereby referred to as nude mice) were injected subcutaneously with LS41 1 N (5x10 6 cells), SW403 (5x10 6 cells), Ls174t (5x10 6 cells) or Hep3B (5x10 6 cells+ matrigel) under the right shoulder. Tumor volume was measured twice a week to monitor tumor growth/suppression. Dosing was initiated when the tumors reached 200-250mm 3 . For tumor growth inhibition studies, animals were randomized and assigned to different cohorts and subjected to dosing cycles. BCAT1 or LNP was given intravenously via lateral tail vein at a total volume of 10 ml/kg. Trametinib was given orally at a volume of 10 ml/kg.
• CRC liver metastases models were generated by surgically implanting 1 -2 x 10 6 cells in the spleen of nude mice after midline abdominal incision. After surgery, the abdominal incision was closed with 5-0 to 6-0 absorbable, nonbraided suture and the skin was closed with a single wound clip. Mice were anesthetized with isoflurane before initiating the surgery and during surgery. Buprenorphine was given preoperatively and post-operatively at 0.1 mg/kg subcutaneously for pain relief. Mice were held in a pathogen-free environment and all procedures involving animals were performed according to protocols approved by Dicerna Pharmaceuticals' Institutional Animal Care and Use Committee (Dicerna- IACUC).
• Human cell lines LS41 1 N and SW403, Ls174t and Hep3B were obtained from ATCC (Manassas, VA) and grown in RPMI/DMEM medium supplemented with 10% FBS.
• LS41 1 N is a human colorectal cell line harboring mutations in the adenomatous polyposis coli (APC) and BRAF genes.
• APC is a component of the destruction complex in the Wnt signaling pathway. See Figure 1 .
• SW403 is a human colorectal cell line harboring mutations in the APC and KRAS genes.
• LS174t is a human colorectal cell line harboring mutations in the CTNNB1 and KRAS genes.
• tumors In these CRC models, tumors generally develop resistance to Trametinib over time. To investigate this resistance, SW403 tumors were continuously treated with Trametinib at 3 mg/kg doses (qdx3, 3 mg/kg x3) until the tumors stopped responding to the treatment. Once the tumors stopped responding and became resistant to Trametinib treatment, we treated the tumors with a combination of BCAT1 and Trametinib (qdx3, 3mpk+ qdx3, 3mpk) (around Day 42). Surprisingly, the tumors that failed to respond to Trametinib treatment responded nicely to the combination treatment and as a result, the average tumor volume of the treatment group was reduced by 60% within a few days after the combination treatment.
• EXAMPLE 5 Combined Inhibition of CTNNB1 and MYC
• MYC1 nucleic acid inhibitor molecule that targets the c-Myc gene
• BCAT1 a nucleic acid inhibitor molecule that targets the c-Myc gene
• MYC1 has a 25 base pair passenger strand and a 27 base pair guide strand that form a duplex region consisting of 25 base pairs, where the 3' end of the passenger strand and 5' end of the guide strand form a blunt end, and the 3' end of the guide strand consists of a single-stranded, two-base overhang.
• Figure 9 The MYC1 construct was formulated in EnCore LNP.
• EXAMPLE 6 Treatment of Liver Metastases with Combination of BCAT1 and Trametinib
• mice with LS41 1 N liver metastases were also treated with BCAT1 or controls (placebo or PBS) at the same dose levels for 3 weeks.
• BCAT1 or controls placed in the spleen.
• the treatment was initiated 18 days after the implantation of LS41 1 N cells in the spleen. It took 1 12 days for all the control treated mice to die.
• BCAT1 monotherapy however improved the survival of the mice bearing LS41 1 N liver metastases significantly compared to control treated groups, with 75% of BCAT1 -treated mice surviving at 1 12 days post-implant (Figure 1 1 B).
• BCAT treatment extended the survival of mice bearing LS41 1 N liver metastasis by up to two-fold compared to the control treatment groups (MST of PBS/Placebo treatment groups is 99-102 days, whereas the MST of the BCAT1 -treated group is 181 days).
• mice in both control groups died in 44 days (median survival of 37 days).
• 90% of the mice that had either BCAT1 , Trametinib, or Placebo and Trametinib treatment died around day 48 (median survival of 45, 44 or 42 days).
• One mouse in each of these groups survived a little longer and died on day 64.
• Strikingly, the BCAT1 and Trametinib combination provided a dramatic survival benefit (median survival of 74 days) with 2 mice surviving over 100 days and one mouse surviving over 200 days.
• mice with advanced liver metastases were treated effectively with the rational combination of BCAT1 and Trametinib.
• the combination of BCAT1 and Trametinib thus, provides tremendous clinical benefit for metastatic CRC patients with dual pathway activation.

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