WO2017048843A1 - Compositions et méthodes permettant d'inhiber l'expression du gène alas1 - Google Patents

Compositions et méthodes permettant d'inhiber l'expression du gène alas1 Download PDF

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WO2017048843A1
WO2017048843A1 PCT/US2016/051737 US2016051737W WO2017048843A1 WO 2017048843 A1 WO2017048843 A1 WO 2017048843A1 US 2016051737 W US2016051737 W US 2016051737W WO 2017048843 A1 WO2017048843 A1 WO 2017048843A1
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dsrna
antisense
sequence
once
nucleotides
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PCT/US2016/051737
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William Querbes
Amy Chan
Amy SIMON
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Alnylam Pharmaceuticals, Inc.
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Publication of WO2017048843A1 publication Critical patent/WO2017048843A1/fr

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    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • 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
    • 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
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • the invention relates to the specific inhibition of the expression of the ALASl gene.
  • the inherited porphyrias are a family of disorders resulting from the deficient activity of specific enzymes in the heme biosynthetic pathway, also referred to herein as the porphyrin pathway. Deficiency in the enzymes of the porphyrin pathway leads to insufficient heme production and to an accumulation of porphyrin precursors and porphyrins, which are toxic to tissue in high concentrations.
  • AIP acute intermittent porphyria
  • VP variegate porphyria
  • HCP copropophyria or HCP, e.g., autosomal dominant HCP
  • 5' aminolevulinic acid also known as ⁇ - aminolevulinic acid or ALA
  • ADP autohydratase deficiency porphyria
  • hepatic 5 '-aminolevulinic acid synthase 1 (ALAS1 ), the first and rate-limiting enzyme of the heme biosynthetic pathway.
  • AIP hepatic 5 '-aminolevulinic acid synthase 1
  • HCP hepatic 5 '-aminolevulinic acid synthase 1
  • the respective enzyme deficiencies result in hepatic production and accumulation of one or more substances (e.g., porphyrins and/or porphyrin precursors, e.g., ALA and/or PBG) that can be neurotoxic and can result in the occurrence of acute attacks. See, e.g., Balwani, M and Desnick, .J., Blood, 120:4496-4504, 2012.
  • Hemin Panhematin®, Lundbeck or Normosang®, Orphan Europe
  • ALAS 1 ALAS 1
  • hemin is used for the treatment during an acute attack and for prevention of attacks, particularly in women with the actue porphyrias who experience frequent attacks with the hormonal changes during their menstrual cycles. While patients generally respond well, its effect is slow, typically taking two to four days or longer to normalize urinary ALA and PBG concentrations towards normal levels.
  • the intravenous hemin is rapidly metabolized, three to four infusions are usually necessary to effectively treat or prevent an acute attack.
  • AIP also referred to as porphobilinogen deaminase (PBGD) deficiency, or
  • HMBS hydroxymethylbilane synthase
  • AIP hydroxymethylbilane synthase
  • ⁇ is an autosomal dominant disorder caused by mutations in the HMBS gene that result in reduced, e.g., half-normal activity of the enzyme.
  • a mouse model of ⁇ that has -30% of wiidtype HMBS activity was generated by homologous recombination. Like human patients, these mice increase hepatic ALAS 1 activity and accumulate large quantities of plasma and urinary ALA and PBG when administered porphyrinogenic drugs, such as phenobarbital. Thus, they serve as an excellent model to evaluate the efficacy of novel therapeutics for the acute hepatic porphyrias.
  • the present invention describes methods and iRNA compositions for modulating the expression of an ALAS l gene.
  • expression of an ALAS l gene is reduced or inhibited using an ALAS l -specific iRNA. Such inhibition can be useful in treating disorders related to ALAS l expression, such as porphyrias.
  • compositions and methods that effect the RNA- induced silencing complex (RlSC)-mediated cleavage of RNA transcripts of the ALASl gene, such as in a cell or in a subject (e.g., in a mammal, such as a human subject).
  • RlSC RNA- induced silencing complex
  • compositions and methods for treating a disorder related to expression of an ALAS l gene such as a porphyria, e.g., X-linked sideroblastic anemia (XLS A), ALA deyhdratase deficiency porphyria (Doss porphyria or ADP), acute intermittent porphyria (AIP), congenital erythropoietic porphyria (CEP), prophyria cutanea tarda (PCT), hereditary coproporphyria (coproporphyria, or HCP), variegate porphyria (VP), erythropoietic protoporphyria (EPP), or transient
  • a porphyria e.g., X-linked sideroblastic anemia (XLS A), ALA deyhdratase deficiency porphyria (Doss porphyria or ADP), acute intermittent porphyria (AIP), con
  • the disorder is an acute hepatic porphyria, e.g. , ALA deyhdratase deficiency porphyria (ADP), AIP, HCP, or VP.
  • the disorder is ALA deyhdratase deficiency porphyria (ADP) or ATP.
  • the porphyria is a hepatic porphyria, e.g., a porphyria selected from acute intermittent porphyria (AIP) hereditary coproporphyria (HCP), variegate porphyria (VP), ALA deyhdratase deficiency porphyria (ADP), and hepatoerythropoietic porphyria.
  • AIP acute intermittent porphyria
  • HCP hereditary coproporphyria
  • VP variegate porphyria
  • ADP ALA deyhdratase deficiency porphyria
  • the porphyria is a homozygous dominant hepatic porphyria (e.g. , homozygous dominant AIP, HCP, or VP) or hepatoerythropoietic porphyria.
  • the porphyria is a dual porphyria.
  • RNAi RNA-induced silencing complex
  • RISC RNA-induced silencing complex
  • the iRNAs included in the compositions featured herein encompass a dsR A having an RNA strand (the antisense strand) having a region, e.g., a region that is 30 nucleotides or less, generally 19-24 nucleotides in length, that is substantially complementary to at least part of an mRNA transcript of an ALAS 1 gene (e.g., a mouse or human ALAS 1 gene) (also referred to herein as an "ALAS 1 -specific iRNA").
  • ALAS 1 gene e.g., a mouse or human ALAS 1 gene
  • iRNAs encompass a dsRNA having an RNA strand (the antisense strand) having a region that is 30 nucleotides or less, generally 19-24 nucleotides in length, that is substantially complementary to at least part of an mRNA transcript of an ALAS 1 gene (e.g., a human variant 1 or 2 of an ALAS1 gene) (also referred to herein as a "ALAS 1 -specific iRNA").
  • ALAS 1 gene e.g., a human variant 1 or 2 of an ALAS1 gene
  • the iRNA (e.g, dsRNA) described herein comprises an antisense strand having a region that is substantially complementary to a region of a human ALAS 1.
  • the human ALAS 1 has the sequence of NM_0()0688.4 (SEQ ID NO: l ) or
  • NM_000688.5 (SEQ ID NO:382).
  • the human ALAS 1 has the sequence of NMJ 99166.1.
  • the antisense sequence of the iRNA targets within the region 871 to 895 (plus or minus 5, 4, 3, 2, or 1 nucleotides in either or both directions on the 5' and/or 3' end) on the ALAS 1 transcript NM_0()0688.4.
  • the antisense sequence targets the nucleotides 871 to 893, 871 to 892, or 873 to 895 on the ALAS 1 transcript
  • the antisense sequence comprises or consists of a sequence that is fully complementary or substantially complementary to nucleotides 871 to 893, 871 to 892, or 873 to 895 on the ALAS1 transcript NM_000688.4.
  • a method of treating a porphyria comprises administering to a subject in need of such treatment a therapeutically effective amount of a double-stranded ribonucleic acid (dsRNA), e.g. , for inhibiting expression of ALAS 1, wherein said dsRNA is administered at a dose of 0.02 to 10 mg/kg, e.g., 0.5 to 10 mg/kg, e.g., 0.5 to 5 mg/kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg/kg, bodyweight of the subject once every four weeks or once every twelve weeks, thereby treating the porphyria.
  • dsRNA double-stranded ribonucleic acid
  • said dsRNA is administered at a dose of 0.5 to 1.5, 0.5 to 1, 1 to 1.5, 1.5 to 2 mg kg, 2 to 2.5 mg kg, 2.5 to 3 mg/kg, or 2.5 to 5 mg/kg, e.g., 0.5, 1, 1.5, 2. 2.5. 3, or 5 mg/kg, bodyweight of the subject once every four weeks or once every twelve weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every four weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once ever ⁇ ? twelve weeks.
  • said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every four weeks. In some embodiments, said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg kg) once every twelve weeks. In some embodiments, said dsRNA is administered at a dose of 4 to 6 mg/kg (e.g., 5 mg/kg) once every twelve weeks.
  • said dsRNA is administered to the subject subcutaneously.
  • said dsRNA comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS 1 RNA transcript (e.g., SEQ ID NO: l), which antisense strand comprises at least 20 contiguous nucleotides from the antisense sequence of UAAGAUGAGACACUCUUUCUGGU (SEQ ID NO: 4153) or
  • said dsRNA comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS 1 RNA transcript (e.g.,
  • SEQ ID NO: l which antisense strand comprises at least 20 contiguous nucleotides from (i) an antisense sequence listed in any one of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g. , an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237), or (ii) an unmodified version of an antisense sequence listed in any one of Tables 21 to 40 of WO
  • said dsRNA comprises at least one modified nucleotide.
  • at least one modified nucleotide is chosen from a 2'-0-methyl, a 2'-fluoro modified nucleotide, and optionally one or more 5'-phosphorothioate groups, or any combination thereof.
  • the duplex region is 17-23 nucleotide pairs in length. In some embodiments, at least one strand comprises a 3' overhang of at least 2 nucleotides. In some embodiments, each strand is no more than 26 nucleotides in length.
  • the dsRNA further comprises a ligand, optionally wherein the ligand is conjugated to the 3' end of the sense strand of the dsRNA. In some embodiments, the ligand comprises a carbohydrate, optionally wherein the ligand is a GalNAc ligand.
  • the ligand is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the ligand is attached via a bivalent or trivalent branched linker.
  • the ligand and linker are as shown in Formula XXIV:
  • the dsRNA is conjugated to ligand L96 via a linker as shown below
  • the ligand targets the dsRNA to hepatocytes.
  • the dsRNA comprises a sense strand consisting of a sense sequence selected from the sense sequences listed in Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an sense sequence corresponding to SEQ ID NO: 4149 or 4151 , or one of the even numbered sequences identified as SEQ ID NOs: 4172 to 5236), and an antisense strand consisting of an antisense sequence selected from the antisense sequences listed in Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g. , an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237).
  • the dsRNA has an IC5 of less than 1 nM, less than 0.05 nM, less than 0.02 nM, or less than 0.01 nM. In some embodiments, the dsRNA has a single dose ED50 of less than about 10 mg/kg or less than about 5 mg/kg.
  • the dsRNA shows improved activity compared with AD-58632 or AD-60489, optionally wherein the dsRNA is selected from the dsRNAs listed in Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., comprising or consisting of a sense sequence corresponding to SEQ ID NO: 4149 and an antisense sequence
  • the sense strand comprises or consists of the sequence of CAGAAAGAGUGUCUCAUCUUA (SEQ ID NO: 4155).
  • the antisense strand comprises the antisense sequence of AD- 60519, wherein the antisense sequence comprises all of the modified nucleotides of AD-60519. In some embodiments, the antisense strand consists of the antisense sequence of AD-60519, wherein the antisense sequence comprises all of the modified nucleotides of AD-60519. In some embodiments, the sense strand comprises the sense sequence of AD-60519, wherein the sense sequence comprises all of the modified nucleotides of AD-60519. In some embodiments, the sense strand consists of the sense sequence of AD-60519, wherein the sense sequence comprises all of the modified nucleotides of AD-60519.
  • the sense strand comprises the sense sequence of AD-60519
  • the antisense strand comprises the antisense sequence of AD-60519, wherein the sense and antisense sequences comprise all of the modified nucleotides of AD-60519.
  • the sense strand consists of the sense sequence of AD- 60519
  • the antisense strand consists of the antisense sequence of AD-60519, wherein the sense and antisense sequences comprise all of the modified nucleotides of AD-60519.
  • the antisense strand comprises the antisense sequence of AD-
  • the sense strand comprises the sense sequence of AD-60489, wherein the antisense and/or sense sequence comprises all of the modified nucleotides of AD-60489.
  • the antisense strand consists of the antisense sequence of AD-60489, and/or the sense strand consists of the sense sequence of AD-60489, wherein the antisense and/or sense sequence comprises all of the modified nucleotides of AD-60489.
  • the antisense strand comprises the antisense sequence of AD-
  • the sense strand comprises the sense sequence of AD-61 193, wherein the antisense and/or sense sequence comprises all of the modified nucleotides of AD-61193.
  • the antisense strand consists of the antisense sequence of AD-61 193, and/or the sense strand consists of the sense sequence of AD-61 193, wherein the antisense and/or sense sequence comprises all of the modified nucleotides of AD-61 193.
  • the antisense strand comprises the antisense sequence of AD- 60819, and/or the sense strand comprises the sense sequence of AD-60819, wherein the antisense and/or sense sequence comprises all of the modified nucleotides of AD-60819.
  • the antisense strand consists of the antisense sequence of AD-60819, and/or the sense strand consists of the sense sequence of AD-60819, wherein the antisense and/or sense sequence comprises all of the modified nucleotides of AD-60819.
  • said dsRNA is administered in an unbuffered saline or water solution.
  • the subject is at risk for developing, or is diagnosed with, a porphyria.
  • the porphyria is acute intermittent porphyria or ALA- dehydratase deficiency porphyria.
  • the dsRNA is administered after an acute attack of porphyria. In some embodiments, the dsRNA is administered during an acute attack of porphyria. In some embodiments, the dsRNA is administered prophylactically to prevent an acute attack of porphyria.
  • the method decreases a level of a porphyrin or a porphyrin precursor (e.g., ⁇ -aminolevulinic acid (ALA) or porphopilinogen (PBG)) and/or inhibits ALAS l expression in the subject.
  • a level of a porphyrin or a porphyrin precursor e.g., ⁇ -aminolevulinic acid (ALA) or porphopilinogen (PBG)
  • the level of ALA and/or PBG e.g., urine ALA and/or PBG
  • the level of ALA and/or PBG is decreased by 30% or more, 35% or more, 40% or more, 45% or more, 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75% or more, 80% or more, 85% or more, 90% or more, or 95% or more, in the subject, compared to the level before the treatment.
  • the method inhibits ALAS l expression, e.g., by 40% or more, 45% or more, 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75% or more, 80% or more, 85% or more, 90% or more, or 95% or more, in the subject, compared to the level before the treatment.
  • the method (i) ameliorates a symptom associated with an ALAS l related disorder (e.g., a porphyria), (ii) decreases frequency of acute attacks of symptoms associated with a porphyria in the subject, and/or (iii) decreases incidence of acute attacks of symptoms associated with a porphyria in the subject when the subject is exposed to a precipitating factor, e.g., the premenstrual phase.
  • an ALAS l related disorder e.g., a porphyria
  • decreases frequency of acute attacks of symptoms associated with a porphyria in the subject and/or
  • iii) decreases incidence of acute attacks of symptoms associated with a porphyria in the subject when the subject is exposed to a precipitating factor, e.g., the premenstrual phase.
  • the dsRNA is administered before an acute attack of porphyria, e.g., during a prodrome.
  • the subject has an elevated level (e.g., plasma or urine level) of ALA and/or PBG, compared to a nomial subject. In some embodiments, the subject suffers from chronic pain. In some embodiments, the method decreases the elevated level of ALA and/or PBG, e.g., by 30% or more, 35% or more, 40% or more, 45% or more, 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75% or more, 80% or more, 85% or more, 90% or more, or 95% or more.
  • an elevated level e.g., plasma or urine level
  • the subject suffers from chronic pain.
  • the method decreases the elevated level of ALA and/or PBG, e.g., by 30% or more, 35% or more, 40% or more, 45% or more, 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75% or more, 80% or more, 85% or more, 90% or more, or 95%
  • the subject has an elevated level of ALAS l (e.g., liver or serum ALAS l level, e.g., ALASl mRNA level) that is at least 2, 3, 4, or 5 fold higher compared to the level of ALAS l in a normal subject.
  • ALAS l e.g., liver or serum ALAS l level, e.g., ALASl mRNA level
  • the method decreases or prevents pain, neuropathy, and/or nerve damage. In some embodiments, the method prevents acute attacks of porphyria.
  • the dsRNA is administered repeatedly, e.g., every four weeks or every twelve weeks, for twenty-four or more weeks.
  • a method of treating a subject with an elevated level of ALA and/or PBG comprises administering to a subject in need of such treatment a therapeutically effective amount of a dsRNA, e.g., for inhibiting expression of ALAS l, and wherein said dsRNA is administered at a dose of 0.02 to 10 mg/kg, e.g., 0.5 to 10 mg kg, e.g., 0.5 to 5 mg kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg/kg bodyweight of the subject once every four weeks or once every twelve weeks.
  • a dsRNA e.g., for inhibiting expression of ALAS l
  • said dsRNA is administered at a dose of 0.02 to 10 mg/kg, e.g., 0.5 to 10 mg kg, e.g., 0.5 to 5 mg kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg/kg bodyweight of the subject once every four weeks or once every twelve weeks.
  • said dsRNA is administered at a dose of 0.5 to 1.5, 0.5 to 1, 1 to 1.5, 1.5 to 2 mg/kg, 2 to 2.5 mg kg, 2.5 to 3 mg/kg, or 2.5 to 5 mg kg, e.g., about 0.5, 1 , 1.5, 2, 2.5, 3, or 5 mg/kg, bodyweight of the subject once every four weeks or once every twelve weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every four weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every twelve weeks.
  • said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every four weeks. In some embodiments, said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every twelve weeks. In some embodiments, said dsRNA is administered at a dose of 4 to 6 mg/kg (e.g., 5 mg/kg) once every twelve weeks.
  • the method is effective to decrease the level of ALA and/or PBG.
  • said dsRNA comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS 1 RNA transcript (e.g., SEQ ID NO: l ), which antisense strand comprises at least 20 contiguous nucleotides from (i) an antisense sequence listed in any one of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237), or (ii) an unmodified version of an antisense sequence listed in any one of Tables 21 to 40 of WO
  • the level of ALA and/or PBG is decreased by 30% or more, 35 or more, 40% or more, 45% or more, 50% or more, 55% or more, 60% or more, 65% or more, 70% or more, 75% or more, 80%' or more, 85% or more, 90% or more, or 95% or more, compared to the level before the treatment.
  • a method of treating a subject having an increased level of ALA and/or PBG comprises administering to the subject a dsRNA, e.g., for inhibiting expression of ALAS 1, and wherein said dsRNA is administered at a dose of about 0.5, 1 , 1.5, 2, 2.5, or 5 mg/kg bodyweight of the subject once every four weeks or once every twelve weeks, e.g., for at least twenty-four weeks, thereby reducing the level of ALA and/or PBG in said subject.
  • a dsRNA e.g., for inhibiting expression of ALAS 1
  • said dsRNA is administered at a dose of about 0.5, 1 , 1.5, 2, 2.5, or 5 mg/kg bodyweight of the subject once every four weeks or once every twelve weeks, e.g., for at least twenty-four weeks, thereby reducing the level of ALA and/or PBG in said subject.
  • said dsRNA is administered at a dose of 0.5 to 1.5, 0.5 to 1 , 1 to 1.5, 1.5 to 2 mg/kg, 2 to 2,5 mg/kg, 2.5 to 3 mg kg, or 2.5 to 5 mg/kg, e.g., about 0.5, 1 , 1.5, 2, 2.5, 3, or 5 mg/kg, bodyweight of the subject once every four weeks or once every twelve weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every four weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every twelve weeks.
  • said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every four weeks. In some embodiments, said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every twelve weeks. In some embodiments, said dsRNA is administered at a dose of 4 to 6 mg/kg (e.g., 5 mg/kg) once every twelve weeks.
  • the dsRNA comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALASl RNA transcript (e.g., SEQ ID NO: l), which antisense strand comprises at least 20 contiguous nucleotides from (i) an antisense sequence listed in any one of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237), or (ii) an unmodified version of an antisense sequence listed in any one of Tables 21 to 40 of WO
  • a method of treating a human patient with AIP who has suffered from multiple recurrent attacks comprises administering a dsRNA, e.g., for inhibiting expression of ALASl, and wherein said dsRNA is administered at a dose of 0.02- 10 mg kg, e.g., 0.5 to 10 mg/kg, e.g., 0.5 to 5 mg/kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg kg bodyweight of the patient once every four weeks or once every twelve weeks, e.g., for at least twenty-four weeks, thereby treating said patient.
  • a dsRNA e.g., for inhibiting expression of ALASl
  • said dsRNA is administered at a dose of 0.02- 10 mg kg, e.g., 0.5 to 10 mg/kg, e.g., 0.5 to 5 mg/kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg kg bodyweight of the patient once every four weeks or once every twelve weeks, e.g., for
  • said dsRNA is administered at a dose of 0.5 to 1.5, 0.5 to 1 , 1 to
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every four weeks. In some embodiments, said dsRNA is administered at a dose of 0.5 to 2 mg kg once every twelve weeks. In some embodiments, said dsRNA is administered at a dose of 2 to 3 mg kg (e.g., 2.5 mg/kg) once every four weeks.
  • said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every twelve weeks. In some embodiments, said dsRNA is administered at a dose of 4 to 6 mg/kg (e.g., 5 mg/kg) once every twelve weeks.
  • the dsRNA comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS 1 RNA transcript (e.g.,
  • SEQ ID NO: l which antisense strand comprises at least 20 contiguous nucleotides from (i) an antisense sequence listed in any one of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237), or (ii) an unmodified version of an antisense sequence listed in any one of Tables 21 to 40 of WO
  • said method reduces the frequency of attacks, (ii) reduces hematin use, (iii) reduces hospitalization, and/or (iv) improves quality of life.
  • a method of treating a subject having a porphyria (e.g., AIP) or an elevated level of ALA and/or PBG comprises subcutaneously administering to the subject a composition (e.g., a pharmaceutical composition) comprising a dsRNA, e.g., for inhibiting expression of ALAS 1, and wherein said composition is administered at a dsRNA dose of 0.02-10 mg/kg, e.g., 0.5 to 10 mg/kg, e.g., 0.5 to 5 mg/kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg/kg bodyweight of the subject once every four weeks or once every twelve weeks, thereby treating the subject.
  • a composition e.g., a pharmaceutical composition
  • a dsRNA e.g., for inhibiting expression of ALAS 1
  • said composition is administered at a dsRNA dose of 0.02-10 mg/kg, e.g., 0.5 to 10 mg/kg, e.g., 0.5 to 5
  • the composition is administered at a dsRNA dose of 0.5 to 1.5, 0.5 to 1 , 1 to 1.5, 1.5 to 2, 2 to 2.5, or 2.5 to 5 mg/kg, e.g., about 0.5, 1 , 1.5, 2, 2.5, 3, or 5 mg/kg, bodyweight of the subject once every four weeks or once every twelve weeks.
  • the composition is administered at a dsRNA dose of 0.5 to 2 mg/kg once every four weeks.
  • the composition is administered at a dsRNA dose of 0.5 to 2 mg/kg once every twelve weeks.
  • the composition is administered at a dsRNA dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every four weeks.
  • the composition is administered at a dsRNA dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every twelve weeks, hi some embodiments, the composition is administered at a dsRNA dose of 4 to 6 mg kg (e.g., 5 mg/kg) once every twelve weeks.
  • said dsRNA comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS 1 RNA transcript (e.g., SEQ ID NO: l ), which antisense strand comprises at least 20 contiguous nucleotides from (i) an antisense sequence chosen from listed in any one of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237), or (ii) an unmodified version of an antisense sequence listed in any one of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237).
  • a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALAS l wherein said dsRNA comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS l RNA transcript, which antisense strand comprises at least 15 (e.g., at least 16, 17, 18, 19, 20, 21 , 22, or 23) contiguous nucleotides differing by no more than 3, 2 or 1 nucleotides from the sequence of
  • the antisense strand comprises the sequence of UAAGAUGAGACACUCUUUCUGGU (SEQ ID NO: 4153) or UAAGAUGAGACACUCTUUCUGGU (SEQ ID NO: 4154).
  • the sense strand comprises the sequence of CAGAAAGAGUGUCUCAUCUUA (SEQ ID NO: 4155).
  • one or more nucleotides of the antisense strand and/or sense strand are modified as described herein.
  • the dsRNA comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60489, AD-60519, or AD-61 193 and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD-60489, AD-60519, or AD-61193 (including one or more (e.g. , all) of the modifications of the antisense strand and/or antisense strand of AD-60489, AD-60519, or AD-61193).
  • the method comprises administering to a subject said dsRNA at a dose of 0.02-10 mg/kg, e.g., 0.5 to 10 mg kg, e.g., 0.5 to 5 mg kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg kg bodyweight of the patient once every four weeks or once every twelve weeks, e.g., for at least twenty- four weeks, thereby treating said patient.
  • a dose of 0.02-10 mg/kg e.g., 0.5 to 10 mg kg, e.g., 0.5 to 5 mg kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg kg bodyweight of the patient once every four weeks or once every twelve weeks, e.g., for at least twenty- four weeks, thereby treating said patient.
  • said dsRNA is administered at a dose of 0.5 to 1.5, 0.5 to 1 , 1 to 1.5, 1.5 to 2 mg/kg, 2 to 2.5 mg/kg, 2.5 to 3 mg/kg, or 2.5 to 5 mg/kg, e.g. , about 0.5, 1, 1.5, 2, 2.5, 3, or 5 mg/kg, bodyweight of the subject once every four weeks or once every twelve weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every four weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg kg once every twelve weeks.
  • said dsRNA is administered at a dose of 2 to 3 mg kg (e.g., 2.5 mg/kg) once every four weeks. In some embodiments, said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every twelve weeks. In some embodiments, said dsRNA is administered at a dose of 4 to 6 mg/kg (e.g., 5 mg/kg) once every twelve weeks.
  • a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALAS l comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS l RNA transcript, which antisense strand comprises at least 15 (e.g., at least 16, 17, 18, 19, 20, 21 , 22, or 23) contiguous nucleotides differing by no more than 3 (e.g., by no more than 0, 1 or 2) nucleotides from an antisense sequence listed in any one of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237), or an unmodified version of an antisense sequence (e.g., a version having the same nucleotide sequence
  • the antisense sequence comprises at least 15 (e.g., at least 16, 17, 18, 19, 20, 21 , 22, or 23) contiguous nucleotides differing by no more than 3 (e.g., by no more than 0, 1 or 2) nucleotides from (i) the antisense sequence of AD- 60489, AD-60519, or AD-61 193 or (ii) an unmodified version of any one of these sequences.
  • the antisense strand comprises at least 15 (e.g., at least 16, 17, 18, 19, 20, 21 , 22, or 23) contiguous nucleotides differing by no more than 3 (e.g., by no more than 0, 1 or 2) nucleotides from the sequence of UAAGAUGAGACACUCUUUCUGGU (SEQ ID NO: 4153) or UAAGAUGAGACACUCTUUCUGGU (SEQ ID NO: 4154).
  • the antisense sequence targets positions 871 -893 of NM_000688.4 (SEQ ID NO: l).
  • the sense strand comprises the sequence of CAGAAAGAGUGUCUCAUCUUA (SEQ ID NO: 4155).
  • one or more nucleotides of the antisense strand and/or sense strand are modified as described herein.
  • the dsRNA is not a sense and/or antisense sequence listed in any one of Tables 2, 3, 6, 7, 8, 9, 14, 15, 18 or 20 of WO 2015/051318 and the Sequence Listing attached herewith.
  • a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALAS l comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS l RNA transcript, which antisense strand comprises at least 15 (e.g., at least 16, 17, 18, 19, 20, 21 , 22, or 23) contiguous nucleotides differing by no more than 3 nucleotides, no more than 2 nucleotides, or no more than one nucleotide, from the antisense sequence of AD-60519.
  • one or more nucleotides are modified as described herein.
  • a double- stranded ribonucleic acid (dsRNA) for inhibiting expression of ALAS l wherein said dsRNA comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS l RNA transcript, which antisense strand comprises at least 15 (e.g. , at least 16, 17, 18, 19, 20, 21, 22, or 23) contiguous nucleotides differing by no more than 3 (e.g., by no more than 0, 1 or 2) nucleotides from the antisense sequence of AD-60489, or a derivative of AD-60489 as described herein.
  • dsRNA double- stranded ribonucleic acid
  • one or more nucleotides are modified as described herein, e.g., one or more (or all) nucleotides of AD-60489 are modified as described herein.
  • the derivative of AD-60489 is AD-60501, AD-60519, AD-60901 , AD-60495, AD-60900, AD-
  • the derivative of AD-60489 is AD-60519. In embodiments, the derivative of AD-60489 is AD-61 193.
  • a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALAS l comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS l RNA transcript, which antisense strand comprises at least 15 (e.g., at least 16, 17, 18, 19, 20, 21 , 22, or 23) contiguous nucleotides differing by no more than 3 (e.g., by no more than 0, 1 or 2) nucleotides from a derivative of AD-58632 described herein.
  • dsRNA double-stranded ribonucleic acid
  • one or more nucleotides are modified as described herein, e.g., one or more (or all) nucleotides of AD-58632 are modified as described herein.
  • the derivative of AD-58632 is AD-60405, AD-60887, AD-60923, AD-60434, AD-60892, AD-60419, AD-60924, AD-60445, AD-60925, and AD-60926, AD-60820, AD-60843, AD-60819, AD-61 140, AD-61141 , AD-61142, AD- 60835, AD-60839, AD-61 143, AD-61 144, AD-61 145, AD-61 146, AD-60892, or AD-60419.
  • the derivative of AD-58632 is AD-60819.
  • the dsRNA has an IC5 0 of less than InM. In some embodiments, the dsRNA has an IC 5 0 in the range of 0.01-lnM. In embodiments, the dsRNA has an IC5 of less than 0.05 nM. hi embodiments, the dsRNA has an IC50 of less than 0.02 nM. In
  • the dsRNA has an IC 5 0 of less than 0.01 nM.
  • the IC 5 0 is determined as described herein in the Examples.
  • the dsRNA has a single dose ED 5 of less than about 10 mg/kg. In some embodiments, the dsRNA has a single dose ED 5 0 of less than about 5 mg/kg. In embodiments, the EC 5 0 i determined as described herein in the Examples.
  • the dsRNA shows improved activity compared with AD-58632. In some embodiments, the dsRNA shows improved activity compared with AD-60489. In some embodiments, the dsRNA shows improved activity compared with AD-58632 and AD-60489.
  • the dsRNA is AD-60501, AD-60519, AD-60901, AD-60495, AD- 60900, AD-60935, AD-60879, AD-61 190, AD-61 191, AD-60865, AD-60861, AD-60876, AD- 61 193, AD-60519, AD-60519, AD-60901 , AD-60405, AD-60887. AD-60923.
  • the dsRNA comprises an antisense strand that comprises, or consists of, an antisense sequence (and/or one or more (e.g..
  • AD-60501 AD-60519, AD-60901 , AD- 60495, AD-60900, AD-60935, AD-60879, AD-61 190, AD-61 191, AD-60865, AD-60861 , AD- 60876, AD-61 193, AD-60519, AD-60519, AD-60901 , AD-60405. AD-60887.
  • the dsRNA comprises a sense strand that comprises, or consists of, a sense sequence (and/or one or more (e.g., all) of the modifications)) selected from AD-60501 , AD-60519, AD-60901 , AD-60495, AD-60900, AD-60935, AD-60879, AD-61 190, AD-61 191 , AD-60865, AD-60861 , AD-60876, AD-61193, AD-60519, AD-60519, AD-60901, AD-60405, AD-60887, AD-60923, AD-60434, AD-60892, AD-60419, AD-60924, AD-60445, AD-60925, AD-60926, AD-60820, AD-60843, AD-60819, AD-61 140, AD-61 141, AD-61 142, AD-60835, AD-60839, AD-61143, AD-61144, AD-61 145, AD-61 146, AD-60892, or AD-60419.
  • a sense sequence and/or one or more (e.g.,
  • a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALAS 1 comprises (i) an antisense strand that comprises, or consists of, the sequence of UAAGAUGAGACACUCUUUCUGGU (SEQ ID NO: 4153) or UAAGAUGAGACACUCTUUCUGGU (SEQ ID NO: 4154) and/or (ii) a sense strand that comprises, or consists of, the sequence of CAGAAAGAGUGUCUCAUCUUA (SEQ ID NO: 4155).
  • one or more nucleotides of the antisense strand and/or sense strand are modified as described herein.
  • a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALAS l comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60489 and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD-60489 (wherein the sense and/or antisense sequence includes one or more (e.g., all) of the modifications of the sense strand and/or antisense strand of AD-60489).
  • a double -stranded ribonucleic acid (dsRNA) for inhibiting expression of ALASl comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60519 and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD-60519 (wherein the sense and/or antisense sequence includes one or more (e.g., all) of the modifications of the sense strand and/or antisense strand of AD-60519).
  • a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALAS l comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-61 193 and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD-61 193 (wherein the sense and/or antisense sequence includes one or more (e.g., all) of the modifications of the sense strand and/or antisense strand of AD-61 193).
  • dsRNA double-stranded ribonucleic acid
  • ALAS l is provided, wherein the dsRNA comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60819 and/or (ii) a sense sequence that comprises, or consists of, the sense sequence of AD-60819 (wherein the sense and/or antisense sequence includes one or more (e.g., all) of the modifications of the sense strand and/or antisense strand of AD-60819).
  • a dsRNA for inhibiting expression of ALAS 1 comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60489, AD-60519, AD-61 193, or AD-60819 (or a corresponding unmodified antisense sequence) and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD- 60489, AD-60519, AD-61 193, or AD-60819 (or a corresponding unmodified antisense sequence).
  • the dsRNA comprises (i) an antisense strand that consists of the antisense sequence of AD-60489, AD-60519, AD-61 193, or AD-60819 and/or (ii) a sense strand that consists of the sense sequence of AD-60489, AD-60519, AD-61193, or AD-60819, except that the antisense strand and/or sense strand of the dsRNA differs by 1 , 2, or 3 nucleotides from the corresponding antisense and/or sense sequence of AD-60489, AD-60519, AD-61 193, or AD- 60819.
  • AD-60489, AD-60519, AD-61 193, and AD-60819 are shown in Table 2 below.
  • Table 2 Sequences and Modifications of AD-60489, AD-60519, AD-61193, AD-60819
  • a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALAS l comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60489, AD-60519, or AD-61 193 and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD-60489, AD-60519, or AD-61 193 (including the nucleotide sequence and one or more (e.g., all) of the modifications of the sense strand and/or antisense strand of AD-60489, AD-60519, or AD-61193).
  • the dsRNA comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60489, AD-60519, or AD-61 193 and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD-60489, AD-60519, or AD-61 193 (including the nucle
  • dsRNA double-stranded ribonucleic acid
  • ALAS l is provided, wherein the dsRNA is AD-60489, AD-60519, AD-61 193, or AD-60819.
  • a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALASl is provided, wherein the dsRNA is AD-60489, AD-60519, or AD-61 193 (e.g., including the nucleotide sequence and/or one or more (e.g., all) of the modifications of AD-60489, AD-60519, or AD-61 193).
  • the dsRNA is, comprises, or consists of, AD-60489 (e.g., including the nucleotide sequence and/or one or more (e.g., all) of the modifications of AD-60489).
  • the dsRNA is, comprises, or consists of, AD-60519 (e.g., including the nucleotide sequence and/or one or more (e.g., all) of the modifications of AD-60519).
  • the dsRNA is, comprises, or consists of, AD-61 193 (e.g., including the nucleotide sequence and/or one or more (e.g. , all) of the modifications of AD-61193).
  • the dsRNA is, comprises, or consists of, AD-60819 (e.g., including the nucleotide sequence and/or one or more (e.g., all) of the modifications of AD-60819).
  • the dsRNA (e.g., AD-60489, AD-60519, AD-61 193, AD-60819, or another dsRNA disclosed herein in any one of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., comprising or consisting of a sense sequence corresponding to SEQ ID NO: 4149 and an antisense sequence corresponding to SEQ ID NO: 4150; a sense sequence corresponding to SEQ ID NO: 4151 and an antisense sequence corresponding to SEQ ID NO: 4152; or a sense sequence corresponding to SEQ ID NO: X and an antisense sequence corresponding to SEQ ID NO: X+l , where X is any of the even numbers between 4172 and 5236)) is effective to suppress the liver level of ALAS l mRNA, e.g., to achieve silencing of at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, or 80% (e.g., such that ALAS l mRNA,
  • the dsRNA (e.g., AD-60489, AD-60519, AD-61 193, AD-60819, or another dsRNA disclosed herein in any one of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., comprising or consisting of a sense sequence corresponding to SEQ ID NO: 4149 and an antisense sequence corresponding to SEQ ID NO: 4150; a sense sequence corresponding to SEQ ID NO: 4151 and an antisense sequence corresponding to SEQ ID NO: 4152; or a sense sequence corresponding to SEQ ID NO: X and an antisense sequence corresponding to SEQ ID NO: X+l, where X is any of the even numbers between 4172 and 5236)) is effective to suppress the circulating level of ALAS l mRNA, e.g., to achieve silencing of at least 10%, 20%, 30%, 40%, 50%, 60%.
  • ALAS l mRNA e.g., to achieve silencing of
  • the effectiveness of the dsRNA in suppressing the circulating level of ALASl mRNA is assessed using a non-human primate model, e.g., as described herein in the Examples.
  • the circulating level of ALASl mRNA is assessed using a circulating extracellular RNA detection (cERD) assay, e.g., as described herein or in Sehgal, A. et al. Quantitation of tissue-specific target gene modulation using circulating RNA (Poster presented on February 9, 2012 at the Keystone Gene Silencing by small RNAs symposium (Vancouver, February 7-12, 2012) or Sehgal, A. et al. Tissue-specific gene silencing monitored in circulating RNA, RNA, 20: 1-7, published online December 19, 2013, or Chan et al.
  • cERD circulating extracellular RNA detection
  • the cERD method can be applied to any appropriate biological sample.
  • the circulating level of ALASl mRNA is assessed using a blood sample, e.g., a serum sample.
  • the circulating level of ALAS l mRNA is assessed using a urine sample.
  • the dsRNA is a derivative of AD-60489 that is disclosed herein, e.g., in any one of the tables of WO 2015/051318.
  • the dsRNA shows improved activity compared with AD-60489.
  • the dsRNA is AD-60519.
  • the dsRNA is a derivative of AD-58632 that is disclosed herein, e.g., in any one of the tables of WO 2015/051318. In embodiments, the dsRNA shows improved activity compared with AD-58632.
  • improved activity is indicated by a lower IC 5 0, e-g., as determined based on in vitro assays, e.g., as described herein, e.g., in the Examples.
  • improved activity is indicated by a lower effective dose.
  • the effective dose may be determined based on the administration of a single dose or multiple repeated doses. In embodiments, the effective dose is determined based on the single dose ED5 0 . In
  • the effective dose or the single dose ED 5 0 is determined based on an in vivo assay .
  • the in vivo assay is conducted in a non-human animal, e.g., in a rat, in a non- human primate, or in a mouse.
  • the effective dose is determined based on the dose required to obtain a reduction of in a level of ALAS l mRNA (e.g., a liver level of ALASl mRNA and/or a circulating level of ALASl mRNA), e.g., as described herein in the Examples.
  • circulating mRNA is assessed using the cERD assay.
  • the effective dose is determined based on the dose required to obtain a reduction of a level (e.g., a urine and/or plasma level) of ALA and/or PBG.
  • the effective dose is determined based on the dose required to obtain a particular treatment effect described herein, e.g., prevention or reduction of symptoms associated with a porphyria.
  • improved activity is indicated by the achievement of a higher liver level of the dsRNA.
  • a higher liver level is obtained after a single dose of dsRNA ⁇ e.g., a dose of about 0.02, 0.035, 0.1 , 0.35, 0.5, 1, 1.5, 2, 2.5, 3, or 5 mg/kg, or a dose of 0.3 to 2.5, 0.5 to 2, 0.5 to 1.5, 0.5 to 1, 1 to 1.5, 1.5 to 2, 2 to 2.5, or 2.5 to 5 mg/kg).
  • a higher liver level is obtained after multiple doses of dsRNA have been administered (e.g., once every two weeks, once every four weeks, once a month, once every eight weeks, one two months, once every twelve weeks, once every three months, once every sixteen weeks, once every twenty weeks, or once every twenty-four weeks) at doses of 0.02, 0.035, 0.1, 0.35, 0.5, 1 , 1.5, 2, 2.5, 3, or 5 mg/kg, or 0.3 to 2.5, 0.5 to 2, 0.5 to 1.5, 0.5 to 1 , 1 to 1.5, 1.5 to 2, 2 to 2.5, or 2.5 to 5 mg/kg).
  • a higher liver level is obtained after said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every four weeks.
  • a higher liver level is obtained after said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every twelve weeks. In embodiments, a higher liver level is obtained after said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every four weeks. In embodiments, a higher liver level is obtained after said dsRNA is administered at a dose of 2 to 3 mg kg (e.g., 2.5 mg/kg) once every twelve weeks. In embodiments, a higher liver level is obtained after said dsRNA is administered at a dose of 4 to 6 mg/kg (e.g., 5 mg/kg) once every twelve weeks. In
  • a higher liver level is obtained after said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every month. In embodiments, a higher liver level is obtained after said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every three months. In embodiments, a higher liver level is obtained after said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every month. In embodiments, a higher liver level is obtained after said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg kg) once every three months. In
  • the iRNA encompasses a dsRNA having an RNA strand (the antisense strand) having a region that is substantially complementary to a portion of an ALAS l mRNA, e.g., a human ALAS l mRNA (e.g., a human ALASl mRNA as provided in SEQ ID NO: l or SEQ ID NO:382).
  • an iRNA for inhibiting expression of an ALAS l gene includes at least two sequences that are complementary to each other.
  • the iRNA includes a sense strand having a first sequence and an antisense strand having a second sequence.
  • the antisense strand includes a nucleotide sequence that is substantially complementary to at least part of an mRNA encoding an ALAS l transcript, and the region of complementarity is 30 nucleotides or less, and at least 15 nucleotides in length.
  • the iRNA is 19 to 24 nucleotides in length.
  • the iRNA is 19-21 nucleotides in length. In some embodiments, the iRNA is 19-21 nucleotides in length and is in a lipid formulation, e.g. a lipid nanoparticle (LNP) formulation (e.g., an LNP1 1 formulation).
  • a lipid formulation e.g. a lipid nanoparticle (LNP) formulation (e.g., an LNP1 1 formulation).
  • the iRNA is 21-23 nucleotides in length. In some embodiments, the iRNA is 21-23 nucleotides in length and is in the form of a conjugate, e.g., conjugated to one or more GalNAc derivatives as described herein.
  • the iRNA is from about 15 to about 25 nucleotides in length, and in other embodiments the iRNA is from about 25 to about 30 nucleotides in length.
  • An iRNA targeting ALAS l upon contact with a cell expressing ALASl , inhibits the expression of an ALAS l gene by at least 10%, at least 20%, at least 25%, at least 30%, at least 35% or at least 40% or more, such as when assayed by a method as described herein.
  • the iRNA targeting ALAS l is formulated in a stable nucleic acid lipid particle (SNALP).
  • an iRNA e.g., a dsRNA
  • a first sequence of a dsRNA that is selected from the group consisting of the sense sequences of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an sense sequence corresponding to SEQ ID NO: 4149 or 4151 , or one of the even numbered sequences identified as SEQ ID NOs: 4172 to 5236) and a second sequence that is selected from the group consisting of the corresponding antisense sequences of Tables 21 to 40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237).
  • the iRNA molecules featured herein can include naturally occurring nucleotides or can include at least one modified nucleotide.
  • the at least one modified nucleotide include one or more of a modification on the nucleotide chosen from the group consisting of a locked nucleic acid (LNA), an acyclic nucleotide, a hexitol or hexose nucleic acid (HNA), a cyclohexene nucleic acid (CeNA), 2'-methoxyethyl, 2'-0-alkyl, 2'-0-ailyl, 2'-C- allyl, 2 ⁇ fluoro, 2'-deoxy, 2'-hydroxyl, or any combination thereof.
  • LNA locked nucleic acid
  • HNA hexitol or hexose nucleic acid
  • CeNA cyclohexene nucleic acid
  • the at least one modified nucleotide includes, but is not limited to a 2'-0-methyl modified nucleotide, 2'-fluoro modified nucleotide, a nucleotide having a 5'-phosphorothioate group, and a terminal nucleotide linked to a ligand, e.g., an N- acetylgalactosamine (GalNAc) or a cholesteryl derivative.
  • a ligand e.g., an N- acetylgalactosamine (GalNAc) or a cholesteryl derivative.
  • the modified nucleotide may be chosen from the group of: a 2'-deoxy-2'-fluoro modified nucleotide, a 2'-deoxy-modified nucleotide, a locked nucleotide, an acyclic nucleotide, an abasic nucleotide, 2'-amino-modified nucleotide, 2'-alkyl-modified nucleotide, morpholino nucleotide, a phosphoramidate, and a non-natural base comprising nucleotide.
  • Such a modified sequence can be based, e.g., on a first sequence of said iRNA selected from the group consisting of the sense sequences of disclosed in Tables 21-40 of WO 2015/051318 and the Sequence
  • an iRNA as described herein targets a wildtype ALAS 1 RNA transcript variant, and in another embodiment, the iRNA targets a mutant transcript (e.g., an ALAS l RNA carrying an allelic variant).
  • a mutant transcript e.g., an ALAS l RNA carrying an allelic variant.
  • an iRNA featured in the invention can target a polymorphic variant, such as a single nucleotide polymorphism (SNP), of ALAS 1 .
  • the iRNA targets both a wildtype and a mutant ALASl transcript.
  • the iRNA targets a particular transcript variant of ALAS l (e.g., human ALAS l variant 1).
  • the iRNA agent targets multiple transcript variants (e.g., both variant 1 and variant 2 of human ALAS l ).
  • an iRNA featured in the invention targets a non-coding region of an iRNA
  • an iRNA as described herein is in the form of a conjugate, e.g., a carbohydrate conjugate, which may serve as a targeting moiety and/or ligand, as described herein.
  • the conjugate is attached to the 3' end of the sense strand of the dsRNA.
  • the conjugate is attached via a linker, e.g., via a bivalent or trivalent branched linker.
  • the conjugate comprises one or more N-acetylgalactosamine (GalNAc) derivatives.
  • GalNAc N-acetylgalactosamine
  • the conjugate targets the R Ai agent to a particular cell, e.g., a liver cell, e.g., a hepatocyte.
  • the GalNAc derivatives can be attached via a linker, e.g., a bivalent or trivalent branched linker.
  • the conjugate is
  • the RNAi agent is attached to the carbohydrate conjugate via a linker, e.g., a linker as shown in the following schematic, wherein X is O or S
  • X is O. hi some embodiments, X is S.
  • the RNAi agent is conjugated to L96 as defined in Table 1 and shown below
  • the dsRNA has one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen or all of the following:
  • (i) is chemically synthesized, e.g., is synthesized by solid phase oligonucleotide synthesis
  • all the nucleotides in the dsRNA are modified, e.g., all the nucleotides are 2'-OMe or 2'-F modified, or a combination of 2'-OMe and 2' ⁇ F modified;
  • the sense strand comprises or consists of 21 nucleotides
  • the antisense sense strand comprises or consists of 23 nucleotides
  • (vii) has a 3'-overhang, e.g., has a two-nucleotide overhang, at the 3'-end of the antisense strand;
  • (viii) is covalently attached to a ligand containing three N-acetylgalactosamine (GalNAc) moieties;
  • the 3 " -end of the sense strand is conjugated to the triantennary GalNAc moiety (e.g., referred to herein as L96 as defined in Table 1 ).
  • the 3'-end is linked to the triantennary GalNAc moiety through a phosphodiester linkage;
  • (x) has an antisense strand that comprises one or more (e.g., four) phosphorothioate linkages, hi one embodiment, the phosphorothioate linkages are located at the 3' end and at the 5' end of the antisense strand. In one embodiment, two phosphorothioate linkages are located at the 3' end and two phosphorothioate linkages are located at the 5' end of the antisense strand;
  • (xi) has a sense strand that comprises one or more (e.g., two) phosphorothioate linkages.
  • the one or more (e.g., two) phosphorothioate linkages are located at the 5 ' end of the sense strand;
  • (xii) 21 nucleotides of the sense strand hybridize to the complementary 21 nucleotides of the antisense strand;
  • (xiii) forms 21 nucleotide base pairs and a two-base overhang at the 3'-end of the antisense strand;
  • (xiv) comprises, or consists of, a sense and antisense strand having the sequence of AD-
  • (xv) has a sense strand with 10, 12, 14, 16, 18, 19, 20 or all of the modifications of the sense strand of AD-60519;
  • the dsRNA is in the form of a conjugate having the following structure (also referred to herein as AD-60519 or ALN-60519) (SEQ ID NOs: 5238-5239, respectively, in order of appearance):
  • compositions e.g., a pharmaceutical composition, that includes one or more of the iRNAs described herein and a phamiaceuticaily acceptable carrier or delivery vehicle.
  • the composition is used for inhibiting the expression of an ALAS l gene in an organism, generally a human subject.
  • the composition is used for treating a porphyria, e.g., AIP.
  • an iRNA provided herein is a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALASl, wherein said dsRNA comprises a sense strand and a antisense strand 15-30 base pairs in length and the antisense strand is complementary to at least 15 contiguous nucleotides of SEQ ID NO: 1 or 382.
  • dsRNA double-stranded ribonucleic acid
  • an iRNA provided herein is a double stranded RNAi (dsRNA) comprising a sense strand complementaiy to an antisense strand, wherein said antisense strand comprises a region of complementarity to an ALASl RNA transcript, wherein each strand has about 14 to about 30 nucleotides, wherein said double stranded RNAi agent is represented by formula (III):
  • i, j, k, and 1 are each independently 0 or 1 ;
  • p, p', q, and q' are each independently 0-6;
  • each N a and N a ' independently represents an oligonucleotide sequence comprising 0-25 nucleotides which are either modified or unmodified or combinations thereof, each sequence comprising at least two differently modified nucleotides;
  • each N b and N b ' independently represents an oligonucleotide sequence comprising
  • nucleotides which are either modified or unmodified or combinations thereof;
  • each n p , n p ', n q , and n q ' independently represents an overhang nucleotide
  • XXX, YYY, ZZZ, ⁇ ' ⁇ ' ⁇ ', ⁇ ', and Z'Z'Z' each independently represent one motif of three identical modifications on three consecutive nucleotides
  • the sense strand is conjugated to at least one ligand.
  • k is 1; 1 is 1 ; or both k and 1 are 1.
  • XXX is complementary to X'X'X'
  • YYY is complementary to ⁇ '
  • ZZZ is complementary to Z'Z'Z'.
  • the Y'Y'Y' motif occurs at the 11, 12 and 13 positions of the antisense strand from the 5 '-end.
  • the Y' is 2'-0-methyl.
  • the duplex region is 15-30 nucleotide pairs in length.
  • the duplex region is 17-23 nucleotide pairs in length. In embodiments, the duplex region is 19-21 nucleotide pairs in length.
  • the duplex region is 21-23 nucleotide pairs in length.
  • the modification on the nucleotide is selected from the group consisting of a locked nucleic acid (LNA), an acyclic nucleotide, a hexitol or hexose nucleic acid (HNA), a cyclohexene nucleic acid (CeNA), 2'-methoxyethyl, 2'-0 ⁇ alkyl, 2'-0 ⁇ allyl, 2' ⁇ C- allyl, 2'-fluoro, 2'-deoxy, 2'-hydroxyl, and any combination thereof.
  • LNA locked nucleic acid
  • HNA hexitol or hexose nucleic acid
  • CeNA cyclohexene nucleic acid
  • the modifications on the nucleotides are selected from the group consisting of LNA, HNA, CeNA, 2'-methoxyethyl, 2'-0-alkyl, 2'-0-allyl, 2'-C- allyl, 2'-fluoro, 2'-deoxy, 2'-hydroxyl, and combinations thereof.
  • the modifications on the nucleotides are 2'-0-methyl, 2'-fluoro or both.
  • the ligand comprises a carbohydrate.
  • the ligand is attached via a linker.
  • the linker is a bivalent or trivalent branched linker.
  • the ligand is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the ligand and linker are as shown in Formula XXIV:
  • the ligand is attached to the 3' end of the sense strand.
  • the dsRNA consists of or comprises a nucleotide sequence selected from the group of sequences provided in Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an sense sequence corresponding to SEQ ID NO: 4149 or 4151, or one of the even numbered sequences identified as SEQ ID NOs: 4172 to 5236, and an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237).
  • a nucleotide sequence selected from the group of sequences provided in Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an sense sequence corresponding to SEQ ID NO: 4149 or 4151, or one of the even numbered sequences identified as SEQ ID NOs: 4172 to 5236, and an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ
  • an iRNA provided herein is a double-stranded ribonucleic acid (dsRNA) for inhibiting expression of ALASl, wherein said dsRNA comprises a sense strand and an antisense strand, the antisense strand comprising a region of complementarity to an ALAS l RNA transcript, which antisense strand comprises at least 15 contiguous nucleotides differing by no more than 3 nucleotides from one of the antisense sequences listed in any one of Tables 21- 40.
  • dsRNA double-stranded ribonucleic acid
  • the nucleotides of the antisense strand have fewer modifications, more modifications, or different modifications compared with the antisense sequences listed in any one of Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237).
  • the sense and antisense sequences are those of a duplex disclosed herein that suppresses ALAS 1 mRNA expression by at least 50%, 60%, 70%, 80%, 85% or 90%, e.g., as assessed using an assay disclosed in the Examples provided herein.
  • ALASl mRNA expression is assessed based on an ALAS l mRNA level in the liver, e.g., as assessed using a liver biopsy sample. In embodiments, ALASl mRNA expression is assessed based on an ALASl mRNA level in a biological fluid, e.g., blood, serum, plasma, cerebrospinal fluid, or urine. In embodiments, ALASl mRNA expression is assessed using a circulating extracellular RNA detection (cERD) assay, e.g., a cERD assay as described herein or in Sehgal, A. et al.
  • cERD circulating extracellular RNA detection
  • the dsRNA comprises at least one modified nucleotide.
  • At least one of the modified nucleotides is chosen from the group consisting of: a 2 -O-methyl modified nucleotide, a nucleotide comprising a 5'-phosphorothioate group, and a terminal nucleotide linked to a cholesteryl derivative or dodecanoic acid
  • the modified nucleotide is chosen from the group consisting of: a 2'-deoxy-2'-fluoro modified nucleotide, a 2'-deoxy-modified nucleotide, a locked nucleotide, an acyclic nucleotide, an abasic nucleotide, 2'-amino-modified nucleotide, 2'-alkyl-modified nucleotide, morpholino nucleotide, a phosphoramidate, and a non-natural base comprising nucleotide.
  • the region of complementarity is at least 17 nucleotides in length. In some embodiments, the region of complementarity is between 19 and 21 nucleotides in length. In some embodiments, the region of complementarity is 19 nucleotides in length. In some embodiments, each strand is no more than 30 nucleotides in length. In some embodiments, at least one strand comprises a 3' overhang of at least 1 nucleotide. In embodiments, the antisense strand comprises a 3' overhang of at least 1 nucleotide. In some embodiments, at least one strand comprises a 3' overhang of at least 2 nucleotides. In embodiments, the antisense strand comprises a 3' overhang.of at least 2 nucleotides. In embodiments, the antisense strand comprises a 3' overhang.of 2 nucleotides.
  • a dsRNA described herein further comprises a ligand.
  • the ligand is a GalNAc ligand.
  • the ligand targets the dsRNA to hepatocytes.
  • the ligand is conjugated to the 3' end of the sense strand of the dsRNA.
  • the region of complementarity consists of an antisense sequence selected from the antisense sequences listed in Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237), or a corresponding antisense sequence in which some or all of the nucleotides are unmodified.
  • the region of complementarity consists of the sequence UAAGAUGAGACACUCUUUCUGGU (SEQ ID NO: 4153) or
  • the region of complementarity consists of the antisense sequence of the duplex AD-60489. In some embodiments, the region of complementarity consists of the antisense sequence of the duplex AD-60519.
  • the region of complementarity consists of an antisense sequence selected from a duplex disclosed herein that suppresses ALAS 1 mRNA expression by at least 50%, 60%, 70%, 80%, 85% or 90%, e.g., as assessed using an assay disclosed in the Examples provided herein.
  • the dsRNA comprises a sense strand consisting of a sense strand sequence selected from Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g. , an sense sequence corresponding to SEQ ID NO: 4149 or 4151 , or one of the even numbered sequences identified as SEQ ID NOs: 4172 to 5236), and an antisense strand consisting of an antisense sequence selected from Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237).
  • the dsRNA comprises a pair of corresponding sense and antisense sequences selected from those of the duplexes disclosed in Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., a sense sequence corresponding to SEQ ID NO: 4149 and an antisense sequence corresponding to SEQ ID NO: 4150; a sense sequence corresponding to SEQ ID NO: 4151 and an antisense sequence corresponding to SEQ ID NO: 4152; or a sense sequence corresponding to SEQ ID NO: X and an antisense sequence corresponding to SEQ ID NO: X+l, where X is any of the even numbers between 4172 and 5236).
  • a sense sequence corresponding to SEQ ID NO: 4149 and an antisense sequence corresponding to SEQ ID NO: 4150 e.g., a sense sequence corresponding to SEQ ID NO: 4151 and an antisense sequence corresponding to SEQ ID NO: 4152; or a sense sequence corresponding to SEQ ID NO: X and an
  • the method comprises administering to a subject said dsRNA at a dose of 0.02-10 mg/kg, e.g. , 0.5 to 10 mg/kg, e.g., 0.5 to 5 mg/kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg/kg bodyweight of the patient once every four weeks or once every twelve weeks, e.g., for at least twenty-four weeks, thereby treating said patient.
  • a dose of 0.02-10 mg/kg e.g. , 0.5 to 10 mg/kg, e.g., 0.5 to 5 mg/kg, 0.5 to 3 mg/kg, or 0.5 to 2 mg/kg bodyweight of the patient once every four weeks or once every twelve weeks, e.g., for at least twenty-four weeks, thereby treating said patient.
  • said dsRNA is administered at a dose of 0.5 to 1.5, 0.5 to 1, 1 to 1.5, 1.5 to 2 mg/kg, 2 to 2.5 mg/kg, 2.5 to 3 mg/kg, or 2.5 to 5 mg/kg, e.g., about 0.5, 1, 1.5, 2, 2.5, 3, or 5 mg/kg, bodyweight of the subject once every four weeks or once every twelve weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every four weeks.
  • said dsRNA is administered at a dose of 0.5 to 2 mg/kg once every twelve weeks.
  • said dsRNA is administered at a dose of 2 to 3 mg kg (e.g., 2.5 mg/kg) once every four weeks. In some embodiments, said dsRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every twelve weeks. In some embodiments, said dsRNA is administered at a dose of 4 to 6 mg kg (e.g., 5 mg/kg) once every twelve weeks.
  • the invention provides a cell containing at least one of the iRNAs (e.g., dsRNAs) featured herein.
  • the cell is generally a mammalian cell, such as a human cell.
  • the cell is an erythroid cell.
  • the cell is a liver cell (e.g., a hepatocyte).
  • compositions for inhibiting expression of an ALAS l gene comprising an iRNA (e.g., a dsRNA) described herein, e.g., for use in a method described herein.
  • an iRNA e.g., a dsRNA
  • the iRNA e.g., dsRNA
  • the unbuffered solution is saline or water, e.g., water for injection.
  • the pharmaceutical composition comprises AD-60519 and water for injection.
  • the composition comprises about 100 to 300 mg mL, e.g., 200 mg/mL, of AD-60519.
  • the composition has a pH of 6.0-7.5, e.g. , about 7.0.
  • the composition is for subcutaneous injection.
  • the composition is for subcutaneous injection.
  • composition is packaged in a container (e.g., a glass vial, e.g., a 2 mL glass vial,) at a volume of about 0.3 to 1 mL, e.g., 0.55 mL.
  • a container e.g., a glass vial, e.g., a 2 mL glass vial,
  • the pharmaceutical composition is packaged in a container (e.g., a glass vial, e.g., a 2 mL glass vial,) at a volume of about 0.3 to 1 mL, e.g., 0.55 mL.
  • a container e.g., a glass vial, e.g., a 2 mL glass vial,
  • the pharmaceutical composition is packaged in a container at a volume of about 0.3 to 1 mL, e.g., 0.55 mL.
  • the pharmaceutical composition is packaged in a container (e.g., a glass vial,
  • composition is ALN-AS 1 as described herein in the examples.
  • the iRNA e.g., dsRNA is administered with a buffer solution.
  • the buffer solution comprises acetate, citrate, prolamine, carbonate, or phosphate or any combination thereof.
  • the buffer solution is phosphate buffered saline (PBS).
  • the iRNA e.g., dsRNA
  • the composition is administered intravenously.
  • the composition is administered subcutaneously.
  • a pharmaceutical composition comprises an iRNA (e.g., a dsRNA) described herein that comprises a ligand (e.g., a GalNAc ligand) that targets the iRNA (e.g., dsRNA) to hepatocytes.
  • a pharmaceutical composition comprises an iRNA (e.g., a dsRNA) described herein that comprises a ligand (e.g., a GalNAc ligand), and the pharmaceutical composition is administered subcutaneously.
  • the ligand targets the iRNA (e.g., dsRNA) to hepatocytes.
  • a pharmaceutical composition e.g., a composition described herein, includes a lipid formulation
  • the RNAi agent is in a LNP formulation, e.g., a MC3 formulation.
  • the LNP formulation targets the RNAi agent to a particular ceil, e.g., a liver cell, e.g., a hepatocyte.
  • the lipid formulation is a LNP1 1 formulation.
  • the composition is administered intravenously.
  • the pharmaceutical composition is formulated for administration according to a dosage regimen described herein, e.g., not more than once every four weeks, not more than once every three weeks, not more than once every two weeks, or not more than once every week.
  • the administration of the pharmaceutical composition can be maintained for a month or longer, e.g., one, two, three, or six months, or one year or longer.
  • a composition containing an iRNA featured in the invention is administered with a non-iRNA therapeutic agent, such as an agent known to treat a porphyria (e.g. , AW), or a symptom of a porphyria (e.g., pain).
  • a composition containing an iRNA featured in the invention e.g. , a dsRNA targeting AIP, is administered along with a non-iRNA therapeutic regimen, such as hemin or glucose (e.g., glucose infusion (e.g., IV glucose)).
  • an iRNA featured in the invention can be administered before, after, or concurrent with glucose, dextrose, or a similar treatment that serves to restore energy balance (e.g. , total parenteral nutrition).
  • An iRNA featured in the invention can also be administered before, after, or concurrent with the administration of a heme product (e.g., hemin, heme arginate, or heme albumin), and optionally also in combination with a glucose (e.g., IV glucose) or the like.
  • a heme product e.g., hemin, heme arginate, or heme albumin
  • a glucose e.g., IV glucose
  • glucose administered for the treatment of a porphyria is administered intravenously (IV).
  • IV glucose administration of glucose intravenously is referred to herein as "IV glucose.”
  • alternative embodiments in which glucose is administered by other means are also encompassed.
  • an ALAS1 iRNA is administered to a patient, and then the non- iRNA agent or therapeutic regimen (e.g., glucose and/or a heme product) is administered to the patient (or vice versa).
  • the non- iRNA agent or therapeutic regimen e.g., glucose and/or a heme product
  • an ALAS 1 iRNA and the non-iRNA therapeutic agent or therapeutic regimen are administered at the same time.
  • a method of inhibiting ALAS 1 expression in a cell comprising: (a) introducing into the cell an iRNA (e.g. a dsRNA) described herein and (b) maintaining the cell of step (a) for a time sufficient to obtain degradation of the mRNA transcript of an ALAS1 gene, thereby inhibiting expression of the ALASl gene in the cell.
  • an iRNA e.g. a dsRNA
  • a method for reducing or inhibiting the expression of an ALASl gene in a cell e.g., an erythroid cell or a liver cell, such as, e.g., a hepatocyte.
  • the method includes:
  • dsRNA double-stranded ribonucleic acid
  • the dsRNA has a sense strand having a first sequence and an antisense strand having a second sequence; the antisense strand has a region of complementarity that is substantially complementary to at least a part of an mRNA encoding ALASl, and where the region of complementarity is 30 nucleotides or less, i.e., 15-30 nucleotides in length, and generally 19-24 nucleotides in length, and where the dsRNA upon contact with a cell expressing ALASl, inhibits expression of an ALASl gene by at least 10%, e.g., at least 20%, at least 30%, at least 40% or more; and
  • step (b) maintaining the cell of step (a) for a time sufficient to obtain degradation of the mRNA transcript of the ALASl gene, thereby reducing or inhibiting expression of an ALASl gene in the cell.
  • the cell is treated ex vivo, in vitro, or in vivo.
  • the cell is a hepatocyte.
  • the cell is present in a subject in need of treatment, prevention and/or management of a disorder related to ALAS 1 expression.
  • the disorder is a porphyria.
  • the porphyria is acute intermittent porphyria or ALA-dehydratase deficiency porphyria.
  • the porphyria is a hepatic porphyria, e.g., a porphyria selected from acute intermittent porphyria (AIP) hereditary coproporphyria (HCP), variegate porphyria (VP), ALA deyhdratase deficiency porphyria (ADP), and hepatoerythropoietic porphyria.
  • AIP acute intermittent porphyria
  • HCP hereditary coproporphyria
  • VP variegate porphyria
  • ADP ALA deyhdratase deficiency porphyria
  • the porphyria is a homozygous dominant hepatic porphyria (e.g., homozygous dominant AIP, HCP, or VP) or hepatoerythropoietic porphyria.
  • the porphyria is a dual porphyria.
  • the expression of ALAS 1 is inhibited by at least 30%.
  • the iRNA e.g., dsRNA
  • the iRNA has an ⁇ 3 ⁇ 4 0 in the range of 0.01-lnM.
  • the cell e.g., the hepatocyte
  • the cell is a mammalian cell (e.g., a human, non-human primate, or rodent cell).
  • the cell is treated ex vivo, in vitro, or in vivo (e.g., the cell is present in a subject (e.g., a patient in need of treatment, prevention and/or management of a disorder related to ALAS 1 expression).
  • a subject e.g., a patient in need of treatment, prevention and/or management of a disorder related to ALAS 1 expression.
  • the subject is a mammal (e.g., a human) at risk, or diagnosed with a porphyria, e.g., X-linked sideroblastic anemia (XLSA), ALA deyhdratase deficiency porphyria (ADP or Doss porphyria), acute intermittent porphyria (AIP), congenital erythropoietic porphyria (CEP), prophyria cutanea tarda (PCT), hereditary coproporphyria (coproporphyria, or HCP), variegate porphyria (VP), erythropoietic protoporphyria (EPP), or transient erythroporphyria of infancy.
  • a porphyria e.g., X-linked sideroblastic anemia (XLSA), ALA deyhdratase deficiency porphyria (ADP or Doss por
  • the disorder is ALA deyhdratase deficiency porphyria (ADP) or ⁇ .
  • the porphyria is a hepatic porphyria, e.g., a porphyria selected from acute intermittent porphyria (AIP) hereditary coproporphyria (HCP), variegate porphyria (VP), ALA deyhdratase deficiency porphyria (ADP), and hepatoerythropoietic porphyria.
  • AIP acute intermittent porphyria
  • HCP hereditary coproporphyria
  • VP variegate porphyria
  • ADP ALA deyhdratase deficiency porphyria
  • the porphyria is a homozygous dominant hepatic porphyria (e.g., homozygous dominant AIP, HCP, or VP) or hepatoerythropoietic porphyria.
  • the porphyria is a dual porphyria.
  • the dsRNA introduced reduces or inhibits expression of an ALAS 1 gene in the cell.
  • the dsRNA introduced reduces or inhibits expression of an ALASl gene, or the level of one or more porphyrins or porphyrin precursors (e.g., ⁇ - aminolevulinic acid (ALA), porphopilinogen (PBG), hydroxymethylbilane (HMB),
  • ALA ⁇ - aminolevulinic acid
  • PBG porphopilinogen
  • HMB hydroxymethylbilane
  • protoporphyrin IX or porphyrin products or metabolites, by at least 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50% or more compared to a reference, (e.g., an untreated cell or a cell treated with a non-targeting control dsRNA).
  • a reference e.g., an untreated cell or a cell treated with a non-targeting control dsRNA.
  • ALASl is the first enzyme of the porphyrin pathway.
  • reducing expression of the ALASl gene is likely to reduce the level of one or more porphyrin precursors, porphyrins or porphyrin products or metabolites.
  • the invention provides methods for treating, preventing or managing pathological processes related to ALAS l expression (e.g., pathological processes involving porphyrins, porphyrin precuorsors, or defects in the porphyrin pathway, such as, for example, porphyrias).
  • the method includes administering to a subject, e.g., a patient in need of such treatment, prevention or management, an effective (e.g. , a therapeutically or prophylactically effective) amount of one or more of the iRNAs featured herein.
  • a method of treating and/or preventing a disorder related to ALASl expression comprising administering to a subject in need of such treatment a therapeutically effective amount of an iRNA (e.g., a dsRNA) described herein, or a composition comprising an iRNA (e.g., a dsRNA) described herein.
  • an iRNA e.g., a dsRNA
  • a composition comprising an iRNA (e.g., a dsRNA) described herein.
  • a method of treating and/or preventing a porphyria comprising administering to a subject in need of such treatment a double- stranded ribonucleic acid (dsRNA), wherein said dsRNA comprises a sense strand and an antisense strand 15-30 base pairs in length and the antisense strand is complementary to at least 15 contiguous nucleotides of SEQ JD NO: l or SEQ ID NO:382.
  • dsRNA double- stranded ribonucleic acid
  • subject e.g., the patient
  • the subject e.g., patient
  • administration of the iRNA targeting ALAS l alleviates or relieves the severity of at least one symptom of a disorder related to ALAS l in the patient.
  • the subject is a mammal (e.g., a human) at risk, or that has been diagnosed with, a disorder related to ALAS 1 expression, e.g., a porphyria, e.g., X-linked sideroblastic anemia (XLSA), ALA devhdratase deficiency porphyria (Doss porphyria), acute intermittent porphyria (AIP), congenital erythropoietic porphyria (CEP), prophyria cutanea tarda (PCT), hereditary coproporphyria (coproporphyria, or HCP), variegate porphyria (VP), erythropoietic protoporphyria (EPP), or transient erythroporphyria of infancy.
  • a porphyria e.g., X-linked sideroblastic anemia (XLSA), ALA devhdratase
  • the porphyria is an acute hepatic porphyria, e.g. , ALA deyhdratase deficiency porphyria (ADP), AIP, HCP, or VP.
  • the disorder is ALA deyhdratase deficiency porphyria (ADP) or AIP.
  • the subject has, or is at risk for developing, a porphyria.
  • the porphyria is a hepatic porphyria, e.g., a porphyria selected from acute intermittent porphyria (AIP) hereditary coproporphyria (HCP), variegate porphyria (VP), ALA deyhdratase deficiency porphyria (ADP), and hepatoerythropoietic porphyria.
  • AIP acute intermittent porphyria
  • HCP hereditary coproporphyria
  • VP variegate porphyria
  • ADP ALA deyhdratase deficiency porphyria
  • the porphyria is a homozygous dominant hepatic porphyria (e.g., homozygous dominant ⁇ , HCP, or VP) or hepatoerythropoietic porphyria.
  • the porphyria is a dual porphyria.
  • a porphyria, a symptom of porphyria, a prodrome, or an attack of porphyria is induced by exposure to a precipitating factor, as described herein.
  • the precipitating factor is a chemical exposure.
  • the precipitating factor is a drug, e.g., a prescription drug or an over the counter drug.
  • the precipitating factor is the menstrual cycle, e.g., a particular phase of the menstrual cycle, e.g., the luteal phase.
  • the iRNA (e.g., dsRNA) or composition comprising the iRNA is administered after an acute attack of porphyria. In embodiments, the iRNA (e.g., dsRNA) or composition comprising the iRNA is administered during an acute attack of porphyria. In embodiments, the iRNA (e.g., dsRNA) or composition comprising the iRNA is administered prophylactically to prevent an acute attack of porphyria.
  • the iRNA (e.g., dsRNA) is formulated as an LNP formulation.
  • the iRNA e.g., dsRNA
  • the iRNA is in the form of a GalNAc conjugate.
  • the iRNA (e.g., dsRNA) is administered at a dose of 0.02-10 mg/kg, e.g., 0.02-5 mg/kg or 0.02-3 mg/kg, e.g., about 0.02, 0.035, 0.1 , 0.35, 0.5, 1 , 1.5, 2, 2.5, 3, or 5 mg/kg, or 0.3-2.5, 0.5-1, 0.5-1.5, 1-1.5, 1-2.5, 1.5-2, 0.5-2, 2-2.5, or 2,5-5 mg/kg.
  • the iRNA (e.g., dsRNA) is administered once every two weeks, once every four weeks, once every eight weeks, once every twelve weeks, once every sixteen weeks, once every twenty weeks, or once every twenty-four weeks.
  • the iRNA (e.g., dsRNA) is administered once every month, once every two months, once every three months, once every four months, once every five months, or once every six months.
  • the iRNA e.g., dsRNA
  • the iRNA is administered at a concentration of
  • the iRNA e.g., dsRNA
  • the iRNA is administered once every four weeks, once every eight weeks, or once every tweleve weeks
  • the iRNA e.g., dsRNA
  • the iRNA is administered once every month, once every two months, or once every three months
  • the iRNA is administered at a concentration of 0.5 mg kg to 2 mg/kg bodyweight of the subject once every four weeks or once every twelve weeks.
  • the iRNA e.g., dsRNA
  • the iRNA is administered at a concentration of 0.5 mg/kg to 2 mg kg bodyweight of the subject once every month or once every three months.
  • the iRNA (e.g., dsRNA) is administered at a concentration of 2 to 3 mg/kg (e.g., 2,5 mg/kg) bodyweight of the subject, hi embodiments, the iRNA (e.g., dsRNA) is administered once every four weeks, once every eight weeks, or once every tweleve weeks. In embodiments, the iRNA (e.g., dsRNA) is administered once every month, once every two months, or once every three months. In embodiments, the iRNA (e.g., dsRNA) is administered at a concentration of 2 to 3 mg/kg (e.g., 2.5 mg kg) mg/kg bodyweight of the subject once every four weeks or once every twelve weeks. In embodiments, the iRNA (e.g., dsRNA) is administered at a concentration of 2 to 3 mg/kg (e.g., 2.5 mg kg) bodyweight of the subject once every month or once every three months.
  • the iRNA e.g., ds
  • the iRNA (e.g., dsRNA) is administered at a concentration of 4 to 6 mg/kg (e.g., 5 mg/kg) bodyweight of the subject.
  • the iRNA e.g., dsRNA
  • the iRNA is administered once every four weeks, once every eight weeks, or once every tweleve weeks.
  • the iRNA e.g., dsRNA
  • the iRNA is administered once every month, once every two months, or once every three months.
  • the iRNA (e.g., dsRNA) is administered at a concentration of 4 to 6 mg/kg (e.g., 5 mg kg) mg/kg bodyweight of the subject once every four weeks or once every twelve weeks.
  • the iRNA e.g., dsRNA
  • the iRNA (e.g., dsRNA) is formulated as an LNP formulation and is administered at a dose of 0.02-10 mg/kg, e.g., 0.02-5 mg/kg or 0.02-3 mg/kg, e.g., 0.02, 0.035, 0.1, 0.35, 0.5, 1.5, 2, 2.5, 3, or 5 mg/kg. or 0.3-2.5, 0.5-2, 2-2.5. or 2.5-5 mg/kg.
  • the iRNA e.g., dsRNA
  • the iRNA is administered once every two weeks, once every four weeks, once every eight weeks, once every twelve weeks, once every sixteen weeks, once every twenty weeks, or once every twenty-four weeks.
  • the iRNA (e.g., dsRNA) is administered once every month, once every two months, once every three months, once every four months, once every five months, or once every six months.
  • the iRNA (e.g., dsRNA) is in the form of a GalNAc conjugate and is administered at a dose of 0.02-10 mg kg, e.g., 0.02-5 mg kg or 0.02-3 mg kg, e.g., at a dose of 0.3-2.5, 0.5-1 , 0.5-1.5, 1-1.5, 1-2.5, 1.5-2, 0.5-2, 2-2,5, or 2.5-5 mg/kg.
  • the iRNA in the GalNAc conjugate is administered at a dose of 5 mg kg or less, e.g., 2.5 mg kg or less than 2.5 mg/kg (e.g., 2 mg/kg or less) e.g., once every four weeks, once every eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months; e.g., a dose of 1.5 mg/kg or less, 1 mg/kg or less, or 0.5 mg/kg or less, e.g., once every four weeks, once every eight weeks, once every twelve weeks, or once every month, once every two months, or once every three months.
  • a dose of 5 mg kg or less e.g., 2.5 mg kg or less than 2.5 mg/kg (e.g., 2 mg/kg or less) e.g., once every four weeks, once every eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months.
  • the iRNA in the GalNAc conjugate is administered at a dose of about 1 mg/kg or less, e.g., once every four weeks, once ever ⁇ ? eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months.
  • the iRNA in the GalNAc onjugate is administered at a dose of about 2 to 3 mg kg (e.g. , 2.5 mg/kg) once every four weeks, once every twelve weeks, once every month, or once every three months.
  • the iRNA in the GalNAc onjugate is administered at a dose of about 4 to 6 mg/kg (e.g., 5 mg kg) once every twelve weeks or once every three months.
  • the administration of the iRNA in the GalNAc conjugate is subcutaneous.
  • the iRNA (e.g., dsRNA) is in the form of a GalNAc conjugate and is administered, e.g., subcutaneously, at a dose of 0.5-2 mg/kg, e.g. 0.5-1.5, 0.5-1 mg kg, 1 to 1.5 mg kg, or 1.5-2 mg kg.
  • the iRNA is administered once every four weeks, once every eight weeks, or once every twelve months.
  • the iRNA is administered once every month, once every two months, or once every three months.
  • the iRNA (e.g., dsRNA) is in the form of a GalNAc conjugate and is administered, e.g.,
  • the iRNA (e.g., dsRNA) is in the form of a GalNAc conjugate and is administered, e.g., subcutaneously, at a dose of 4-6 mg/kg, e.g. 5 mg/kg, e.g., once every twelve weeks or once every three months.
  • the iRNA is administered as a composition comprising the iRNA and water for injection.
  • the iRNA is AD-60519.
  • the composition comprises the iRNA, e.g. , AD-60519, at a concentration of about 200 mg/mL.
  • the method decreases a level of a porphyrin or a porphyrin precursor in the subject.
  • the level is decreased by at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90%.
  • the level is decreased by at least 30%.
  • the porphyrin precursor is ⁇ -aminolevulinic acid (ALA) or porphopilinogen (PBG).
  • the iRNA e.g., dsRNA
  • the iRNA has an IC 5 in the range of 0.01-lnM.
  • an ALAS 1 related disorder e.g., a symptom associated with an ALAS 1 related disorder
  • (v) decreases incidence of acute attacks of symptoms associated with a porphyria in the subject when the subject is exposed to a precipitating factor (e.g., the premenstrual phase or the luteal phase).
  • a precipitating factor e.g., the premenstrual phase or the luteal phase.
  • the method ameliorates pain and/or progressive neuropathy.
  • the iRNA e.g., dsRNA
  • composition comprising the iRNA is administered according to a dosing regimen.
  • the iRNA (e.g., dsRNA) or composition comprising the iRNA is administered before or during an acute attack of porphyria. In some embodiments, the iRNA is administered before an acute attack of porphyria. In some embodiments, the iRNA (e.g., dsRNA) or composition comprising the iRNA is administered during a prodrome. In
  • the prodrome is characterized by abdominal pain, nausea, psychological symptoms (e.g., anxiety), restlessness and/or insomnia.
  • the iRNA e.g., dsRNA
  • composition comprising the iRNA is administered during a particular phase of the menstrual cycle, e.g., during the luteal phase.
  • the method ameliorates or prevents cyclical attacks of porphyria, e.g., by reducing the severity, duration, or frequency of attacks.
  • the cyclical attacks are associated with a precipitating factor.
  • the precipitating factor is the menstrual cycle, e.g., a particular phase of the menstrual cycle, e.g., the luteal phase.
  • the subject has an elevated level of ALA and/or PBG.
  • the level of ALA and/or PBG is elevated in plasma or urine from the subject.
  • the subject has or is at risk for developing a porphyria, e.g., a hepatic porphyria.
  • the subject is asymptomatic.
  • the subject carries a genetic alteration (e.g., a gene mutation) associated with a porphyria, as described herein.
  • a genetic alteration e.g., a gene mutation
  • the subject has or is at risk for developing a porphyria and suffers from pain (e.g., chronic pain, e.g., chronic neuropathic pain) and/or neuropathy (e.g., progressive neuropathy).
  • pain e.g., chronic pain, e.g., chronic neuropathic pain
  • neuropathy e.g., progressive neuropathy
  • the subject does not suffer from acute attacks but suffers from pain (e.g., chronic pain, e.g., chronic neuropathic pain) and/or neuropathy (e.g., progressive neuropathy).
  • the pain is abdominal pain.
  • the subject (a) has an elevated level of ALA and/or PBG and (b) suffers from pain (e.g., chronic pain, e.g., chronic neuropathic pain) and/or neuropathy (e.g., progressive neuropathy).
  • pain e.g., chronic pain, e.g., chronic neuropathic pain
  • neuropathy e.g., progressive neuropathy
  • the pain is abdominal pain.
  • the subject has a plasma level and/ or a urine level of ALA and/or PBG that is elevated.
  • the elevated level of ALA and/or PBG is accompanied by other symptoms, e.g., pain (e.g., chronic pain, e.g., chronic neuropathic pain) or neuropathy (e.g., progressive neuropathy).
  • the pain is abdominal pain, hi embodiments, the subject is asymptomatic.
  • the subject has a genetic mutation associated with a porphyria, e.g., a mutation as described herein.
  • the subject has a level (e.g., a plasma level or a urine level) of a porphyrin precursor, e.g., ALA and/or PBG, that is elevated, e.g., the level is greater than, or greater than or equal to, a reference value.
  • a reference value e.g., ALA and/or PBG
  • the level is greater than the reference value.
  • the reference value is two standard deviations above the mean level in a sample of healthy individuals.
  • the reference value is an upper reference limit.
  • the subject has a plasma level and/or a urine level of ALA and/or PBG that is greater than, or greater than or or equal to, 2 times, 3 times, 4 times, or 5 times that of an upper reference limit.
  • an ''upper reference limit refers to a level that is the upper limit of the 95% confidence interval for a reference sample, e.g., a sample of normal (e.g., wild type) or healthy individuals, e.g., individuals who do not carry a genetic mutation associated with a porphyria and/or individuals who do not suffer from a porphyria.
  • the subject has a urine level of ALA and/or PBG that is greater than 2 to 4 times that of an upper reference limit. In embodiments, the subject has a urine level of ALA and/or PBG that is greater than 4 times that of an upper reference limit.
  • the reference value for plasma PBG is 0.12 ⁇ /L.
  • the subject is a human and has a plasma PBG level that is greater than, or greater than or equal to, 0.12 ⁇ /L, 0.24 mol/L, 0.36 ⁇ /L, 0.48 ⁇ /L, or 0.60 ⁇ /L.
  • the subject is a human and has a plasma level of PBG that is greater than, or greater than or equal to, 0.48 ⁇ /L.
  • the reference value for urine PBG is 1.2 mmol/mol creatinine.
  • the subject is a human and has a urine PBG level that is greater than, or greater than or equal to, 1.2 mmol/mol creatinine, 2.4 mmol/mol creatinine, 3.6 mmol/mol creatinine, 4.8 mmol/mol creatinine, or 6.0 mmol mol creatinine.
  • the subject is a human and has a urine level of PBG that is greater than, or greater than or equal to, 4.8 mmol/mol creatinine.
  • the reference value for plasma ALA is 0.12 ⁇ L.
  • the subject is a human and has a plasma ALA level that is greater than, or greater than or equal to, 0.12 ⁇ /L, 0.24 ⁇ ⁇ /L, 0.36 ⁇ /L, 0.48 ⁇ /L, or 0.60 ⁇ /L.
  • the subject is a human and has a plasma ALA level that is greater than, or greater than or equal to 0.48 ⁇ /L.
  • the reference value for urine ALA is 3.1 mmol/mol creatinine.
  • the subject is a human and has a urine ALA level that is greater than, or greater than or equal to, 3.1 mmol/mol creatinine, 6.2 mmol/mol creatinine, 9.3 mmol/mol creatinine, 12.4 mmol/mol creatinine, or 15.5 mmol/mol creatinine.
  • the method decreases one or more signs or symptoms of a porphyria. In embodiments, the method decreases an elevated level of ALA and/or PBG. In embodiments, the method decreases pain (e.g., chronic pain, e.g. chronic neuropathic pain) and/or neuropathy (e.g., progressive neuropathy). In embodiments, the pain is abdominal pain. In embodiments, the pain is neuropathic pain (e.g., pain associated with the progressive neuropathy of acute porphyrias). The decrease in pain can include, e.g., prevention of pain, delay in the onset of pain, reduction in the frequency of pain, and/or reduction in severity of pain. In embodiments, the decrease in pain is assessed based on the subject's use of pain medication.
  • pain e.g., chronic pain, e.g. chronic neuropathic pain
  • neuropathy e.g., progressive neuropathy
  • the pain is abdominal pain.
  • the pain is neuropathic pain (e.g., pain associated with
  • the method ameliorates or prevents acute attacks of porphyria, e.g., by reducing the severity, duration, or frequency of attacks. In embodiments, the method decreases or prevents nerve damage.
  • the method prevents deterioration (e.g., prevents development of abnormalities) of or results in an improvement of clinical measures, e.g., clinical measures of muscle and/or nerve function, e.g., EMG and/or nerve conduction velocities.
  • clinical measures e.g., clinical measures of muscle and/or nerve function, e.g., EMG and/or nerve conduction velocities.
  • the method decreases heme use by the subject. In embodiments, the method decreases pain medication use by the subject. In embodiments, the method reduces hospitalization.
  • the method is effective to reduce a level of ALA and/or PBG (e.g., a plasma or urine level of ALA and/or PBG). In embodiments, the method is effective to produce a predetermined reduction in the elevated level of ALA and/or PBG.
  • a level of ALA and/or PBG e.g., a plasma or urine level of ALA and/or PBG.
  • the predetermined reduction is a reduction to a value that is less than or equal to a reference value.
  • the reference value is an upper reference limit.
  • the reference value is the value that is two standard deviations above the mean level in a reference sample.
  • the method is effective to reduce the level of ALA and/or PBG in a subject to a level that is below two times the upper reference limit. In embodiments, the method is effective to reduce the level of ALA to below two times the upper reference limit. In embodiments, the method is effective to reduce the level of PBG to below two times the upper reference limit.
  • the iRNA (e.g., dsRNA) or composition comprising the iRNA is administered as a single dose or at multiple doses, e.g., according to a dosing regimen. For example, the iRNA (e.g., dsRNA) or composition comprising the iRNA is administered once every four weeks, once every twelve weeks, once every month, once every three months.
  • the iRNA (e.g., dsRNA) or composition comprising the iRNA is administered prophylactically to a subject who is at risk for developing a porphyria.
  • the iRNA (e.g., dsRNA) or composition comprising the iRNA is administered prophylactically beginning at puberty.
  • the subject carries a genetic mutation associated with a porphyria and/or has an elevated level of ALA and/or PBG (e.g., an elevated plasma or urine level of ALA and/or PBG).
  • the mutation makes an individual susceptible to an acute attack (e.g., upon exposure to a precipitating factor, e.g., a drug, dieting or other precipitating factor, e.g., a precipitating factor as disclosed herein).
  • a precipitating factor e.g., a drug, dieting or other precipitating factor, e.g., a precipitating factor as disclosed herein.
  • the mutation is associated with elevated levels of a porphyrin or a porphyrin precursor (e.g., ALA and/or PBG).
  • the mutation is associated with chronic pain (e.g., chronic neuropathic pain) and/or neuropathy (e.g., progressive neuropathy).
  • the mutation is a mutation in the ALAS l gene. In embodiments, the mutation is a mutation in the ALASl gene promoter, or in regions upstream or downstream from the ALAS l gene. In embodiments, the mutation is a mutation in transcription factors or other genes that interact with ALAS l . In embodiments, the mutation is a mutation in a gene that encodes an enzyme in the heme biosynthetic pathway.
  • the iRNA e.g., dsRNA or a conjugate thereof
  • composition comprising the iRNA is administered subcutaneousiy.
  • the iRNA is in the form of a GalNAc conjugate.
  • the iRNA e.g., the dsRNA
  • the iRNA is administered at a dose of 0.02-10 mg/kg, e.g., 0.02-5 mg/kg or 0.02-3 mg/kg, e.g., at a dose of 0.3-2.5, 0.5-2, 0.5-1.5, 0.5- 1, 1-1.5, 1-2.5, 2.5-5, or 1.5-2 mg/kg.
  • the iRNA is administered at a dose of 5 mg kg or less, e.g., 2.5 mg/kg or less than 2.5 mg/kg (e.g., 2 mg/kg or less) once every four weeks, once every eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months; e.g., a dose of 1.5 mg/kg or less, 1 mg kg or less, or 0.5 mg kg or less, e.g., once every four weeks, once every eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months.
  • a dose of 5 mg kg or less e.g., 2.5 mg/kg or less than 2.5 mg/kg (e.g., 2 mg/kg or less) once every four weeks, once every eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months.
  • the iRNA is administered at a dose of about 1 mg/kg or less, e.g., once every four weeks, once every eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months.
  • the iRNA is administered is administered at a dose of 0.5 to 2 mg/kg once every four weeks.
  • the iRNA is administered at a dose of 0.5 to 2 mg kg once every twelve weeks.
  • the iRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg kg) once every four weeks.
  • the iRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every twelve weeks.
  • the iRNA is administered at a dose of 4 to 6 mg/kg (e.g., 5 mg/kg) once every twelve weeks. In embodiments, the iRNA is administered at a dose of 0.5 to 2 mg/kg once every month. In embodiments, the iRNA is administered at a dose of 0.5 to 2 mg/kg once every three months. In embodiments, the iRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every month. In embodiments, the iRNA is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every three months. In embodiments, the iRNA is administered at a dose of 4 to 6 mg/kg (e.g., 5 mg/kg) once every three months.
  • 4 to 6 mg/kg e.g., 5 mg/kg
  • the subject to be treated is asymptomatic and has an elevated level of ALA and/or PBG.
  • the subject has a porphyria, e.g., AIP.
  • the patient suffers from recurrent porphyric attacks.
  • the iRNA (e.g., AD-60519) is administered at a dose of less than 10 mg/kg, e.g., less than 6 mg/kg or 3 mg/kg, e.g., at about 0.02, 0.035, 0.1 , 0.35, 0.5, 1 , 1.5, 2, 2.5, 3, or 5 mg/kg, or at a dose of 0.3-2.5, 0.5-2, 0.5-1.5, 0.5-1, 1-1.5, 1 -2.5. 2.5-5, or 1.5-2 mg/kg.
  • the iRNA (e.g., AD-60519) is administered in repeated doses, e.g., once every four weeks, once every eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months.
  • the subject is asymptomatic and has an elevated level of ALA and/or PBG, and the iRNA (e.g., AD-60519) is administered at single doses, e.g., at about 0.02, 0.035, 0.1 , 0.35, 0.5, 1, 1.5, 2, 2.5, 3, or 5 mg/kg, or at a dose of 0.3-2.5, 0.5-2, 0.5-1.5, 0.5-1, 1-1.5, 1- 2.5, 2.5-5, or 1.5-2 mg/kg; or in repeatedly once every four weeks, once every eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months, e.g., of 0.5 and 2 mg/kg for several months (e.g., for 3, 6, 9, 12, 18, 24, 36, 48, or more months).
  • the iRNA e.g., AD-60519
  • the iRNA (e.g., AD-60519) is administered once every four weeks, once every twelve weeks, once every month, or once every three months.
  • the subject has AIP, e.g., is an A i P patient, the iRNA (e.g., AD- 60519) is administered at a dose of 0.02- 10 mg/kg, e.g., 0.02-5 mg/kg or 0.02-3 mg/kg, e.g., 0.3- 2.5, 0.5-2, 0.5-1.5, 0.5-1 , 1-1.5, 1.5-2, 2-2.5, or 2.5-5 mg kg, once every four weeks, once every eight weeks, or once every twelve weeks, or once every month, once every two months, or once every three months.
  • the iRNA (e.g., AD-60519) is administered is administered at a dose of 0.5 to 2 mg/kg once every four weeks. In embodiments, the iRNA (e.g., AD-60519) is administered at a dose of 0.5 to 2 mg/kg once every twelve weeks. In embodiments, the iRNA (e.g., AD-60519) is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every four weeks. In embodiments, the iRNA (e.g., AD-60519) is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every twelve weeks. In embodiments, the iRNA (e.g., AD-60519) is administered at a dose of 4 to 6 mg/kg (e.g., 5 mg/kg) once every twelve weeks. In
  • the iRNA (e.g., AD-60519) is administered at a dose of 0.5 to 2 mg/kg once every month. In embodiments, the iRNA (e.g. , AD-60519) is administered at a dose of 0.5 to 2 mg/kg once every three months. In embodiments, the iRNA (e.g., AD-60519) is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every month. In embodiments, the iRNA (e.g., AD- 60519) is administered at a dose of 2 to 3 mg/kg (e.g., 2.5 mg/kg) once every three months.
  • the iRNA (e.g., AD-60519) is administered at a dose of 4 to 6 mg/kg (e.g. , 5 mg kg) once every three months.
  • a treatment regimen is employed in which the iRNA is initially administered more frequently, followed by less frequent administration.
  • the iRNA is initially administered once per day for multiple days (e.g., for 2-14 days, e.g., for 2, 3, 4, 5, 6, or 7 days).
  • the iRNA is subsequently administered once per week.
  • the iRNA is subsequently administered once every two weeks.
  • the iRNA is subsequently administered once every two weeks.
  • the iRNA is subsequently administered once every four weeks. In embodiments, the iRNA is subsequently administered once every eight weeks. In embodiments, the iRNA is subsequently administered once every twelve weeks. In embodiments, the iRNA is subsequently administered once every sixteen weeks. In embodiments, the iRNA is subsequently administered once every twenty weeks, hi embodiments, the iRNA is subsequently administered once every twenty-four weeks. In embodiments, the iRNA is subsequently administered once every month. In embodiments, the iRNA is subsequently administered once every two months, hi embodiments, the iRNA is subsequently administered once every three months. In embodiments, the iRNA is subsequently administered once every four months. In embodiments, the iRNA is subsequently administered once every five months. In embodiments, the iRNA is subsequently administered once every six months. In embodiments, the iRNA is subsequently administered at a frequency that is effecti e to reduce one or more signs or symptoms of a porphyria.
  • a method of treating a subject with an elevated level of ALA and/or PBG comprising administering to the subject a double-stranded ribonucleic acid (dsRNA), wherein said dsRNA comprises a sense strand and an antisense strand 15-30 base pairs in length and the antisense strand is complementary to at least 15 contiguous nucleotides of SEQ ID NO: l or SEQ ID NO:382.
  • dsRNA double-stranded ribonucleic acid
  • a method of treating a subject with an elevated level of ALA and/or PBG comprising administering to the subject a therapeutically effective amount of a dsRNA or a composition comprising a dsRNA, as described herein.
  • the methods described herein are effective to decrease the level of ALA and/or PBG.
  • the level of ALA and/or PBG is decreased such that it is less than, or less than or equal to, a reference value, e.g., an upper reference limit.
  • the subject to be treated is asymptomatic and has an elevated level of ALA and/or PBG.
  • the subject has a porphyria, e.g., AIP.
  • the iRNA is administered at a dose of less than 10 mg/kg, e.g., less than 6 mg kg or 3 mg/kg, e.g., at about 0.02. 0.035, 0.1 , 0.35, 0.5, 1 , 1.5, 2, 2.5, 3, or 5 mg/kg, or at a dose of 0.3-2,5, 0.5-2, 0.5-1.5, 0.5-1, 1 -1.5, 1-2.5, 2.5-5, or 1.5-2 mg/kg.
  • the iRNA is administered in repeated doses, e.g., once every four weeks, once every eight weeks, once every twelve months, once every sixteen weeks, once every twenty months, or once every twenty- four months.
  • the iRNA is administered in repeated doses, e.g., , once every month, once every two months, once every three months, once every four months, once every five months, or once every six months.
  • the invention provides methods for decreasing a level of a porphyrin or a porphyrin precursor in a cell (e.g., an erythroid cell or a liver cell, such as, e.g., a hepatocyte).
  • a cell e.g., an erythroid cell or a liver cell, such as, e.g., a hepatocyte.
  • the cell is treated ex vivo, in vitro, or in vivo (e.g., the cell is present in a subject (e.g., a patient in need of treatment, prevention and/or management of a disorder related to ALAS l expression).
  • the method includes contacting the cell with an effective amount of one or more of the iRNAs targeting ALASl, e.g., one or more of the iRNAs disclosed herein, thereby decreasing the level of a porphyrin or a porphyrin precursor in the cell; or decreasing the level of a porphyrin or a porphyrin precursor in other cells, tissues, or fluids within a subject in which the cell is located; relative to the level prior to contacting.
  • Such methods can be used to treat (e.g., ameliorate the severity) of disorders related to ALASl expression, such as porphyrias, e.g., ⁇ or ALA dehydratase deficiency porphyria.
  • the contacting step is effected ex vivo, in vitro, or in vivo.
  • the cell can be present in a subject, e.g., a mammal (e.g., a human) at risk, or that has been diagnosed with, a porphyria.
  • the porphyria is an acute hepatic porphyria.
  • the porphyria is a hepatic porphyria, e.g., a porphyria selected from acute intermittent porphyria (AIP), hereditary coproporphyria (HCP), variegate porphyria (VP), ALA deyhdratase deficiency porphyria (ADP), and hepatoerythropoietic porphyria.
  • AIP acute intermittent porphyria
  • HCP hereditary coproporphyria
  • VP variegate porphyria
  • ADP ALA deyhdratase deficiency porphyria
  • the porphyria is a homozygous dominant hepatic porphyria (e.g., homozygous dominant ⁇ , HCP, or VP) or hepatoerythropoietic porphyria.
  • the porphyria is a dual porphyria.
  • a method for decreasing a level of a porphyrin or a porphyrin precursor (e.g., ALA or PBG) in a cell comprising contacting the cell with an iRNA (e.g., a dsRNA), as described herein, in an amount effective to decrease the level of the porphyrin or the porphyrin precursor in the cell.
  • an iRNA e.g., a dsRNA
  • the cell is a hepatocyte.
  • the porphyrin or porphyrin precursor is ⁇ - aminolevulinic acid (ALA), porphopilinogen (PBG), hydroxymethylbilane (HMB), uroporphyrinogen I or ⁇ , coproporphyrinogen I or III, protoporphrinogen IX, or protoporphyrin IX.
  • the porphyrin precursor is ALA or PBG.
  • the cell is an erythroid cell. In a further embodiment, the cell is a liver cell (e.g., a hepatocyte).
  • a vector encoding at least one strand of an iRNA (e.g., a dsRNA) as described herein.
  • an iRNA e.g., a dsRNA
  • a vector encoding at least one strand of a dsRNA, wherein said dsRNA comprises a region of complementarity to at least a part of an mRNA encoding ALAS l , wherein said dsRNA is 30 base pairs or less in length, and wherein said dsR A targets said mRNA for cleavage.
  • the region of complementarity is at least 15 nucleotides in length. In embodiments, the region of complementarity is 19 to 21 nucleotides in length.
  • the invention provides a vector for inhibiting the expression of an ALASl gene in a cell.
  • the vector comprises an iRNA as described herein.
  • the vector includes at least one regulatory sequence operably linked to a nucleotide sequence that encodes at least one strand of an iRNA as described herein.
  • the vector comprises at least one strand of an ALAS 1 iRNA.
  • a cell comprising a vector as described herein.
  • a cell containing a vector for inhibiting the expression of an ALAS l gene in a cell.
  • the vector includes a regulatory sequence operably linked to a nucleotide sequence that encodes at least one strand of one of the iRNAs as described herein.
  • the cell is a liver ceil (e.g., a hepatocyte).
  • the cell is an erythroid cell.
  • a method for assaying the level of circulating extracellular
  • ALAS l mRNA in a subject comprising detecting (e.g. , measuring) the level of
  • ALAS l mRNA in a biological fluid sample e.g. , a blood sample (e.g., a serum or plasma
  • ALASl mRNA a biological fluid sample comprising the ALASl mRNA, thereby assaying the level of circulating extracellular ALASl mRNA in the subject.
  • RNA e.g., extracellular
  • RNA from a biological fluid sample (e.g. , blood or plasma sample) from the subject, said
  • a biological fluid sample comprising the ALAS l mRNA; (ii) obtaining an ALASl cDNA from the ALAS l mRNA; (iii) contacting the ALAS l cDNA with a nucleic acid complementary (e.g., probe and/or primer) to the ALASl cDNA or a portion thereof, thereby producing a reaction
  • a nucleic acid complementary e.g., probe and/or primer
  • said biological fluid sample is a blood sample.
  • said biological fluid sample is a serum sample.
  • said biological fluid sample is a urine sample.
  • the method comprises PCR, qPCR or 5 '-RACE.
  • said nucleic acid is a probe or primer.
  • said nucleic acid comprises a detectable moiety and the level of ALAS 1 mRNA is detemiined by detection of the amount of the detectable moiety.
  • said method further comprises obtaining the biological fluid sample from the subject.
  • the biological fluid sample is separate from the tissue and contains exosomes.
  • the efficacy of a porphyria treatment is assessed based on a comparison of the level of circulating extracellular ALASl mRNA in the subject relative to a reference value.
  • a decrease in the level of circulating extracellular ALAS 1 mRNA in the subject in response to the porphyria treatment, relative to the reference value, indicates that the porphyria treatment is efficacious.
  • the reference value is the level of circulating extracellular ALASl mRNA in the subject prior to the porphyria treatment.
  • FIG. 1 is a graph that shows percentages of ALASl mRNA levels in ASHE patients compared to normal healthy volunteers.
  • FIG. 2A is a graph that shows mean (SEM) % changes in ALASl mRNA levels from baseline in patients treated with placebo, or 0.035 mg/kg, 0.1 mg/kg, or 0.35 mg/kg ALN-AS 1.
  • FIG. 2B is a graph that shows mean (SEM) % changes in serum ALASl mRNA levels from baseline in patients treated with placebo, or 0.035 mg/kg, 0.1 mg/kg, 0.35 mg/kg, 1.0 mg kg, or 2.5 mg/kg ALN-AS 1.
  • FIG. 2C is a graph that shows mean (SEM) % changes in urinary ALASl mRNA levels from baseline in patients treated with placebo, or 0.035 mg/kg, 0.1 mg/kg, 0.35 mg/kg, 1.0 mg kg, or 2.5 mg/kg ALN-ASl .
  • FIG. 3A is a graph that shows mean (SEM) % changes in ALA levels from baseline in patients treated with placebo, or 0.035 mg kg, 0.1 mg/kg, 0.35 mg kg, or 1.0 mg kg ALN-AS 1.
  • FIG. 3B is a graph that shows mean (SEM) % changes in ALA levels from baseline in patients treated with placebo, or 0.035 mg/kg, 0.1 mg/kg, 0.35 mg/kg, 1.0 mg/kg, or 2.5 mg/kg ALN-ASl.
  • FIG. 4A is a graph that shows mean (SEM) % changes in PBG levels from baseline in patients treated with placebo, or 0.035 mg/kg, 0.1 mg/kg, 0.35 mg/kg, or 1.0 mg/kg ALN-AS 1.
  • FIG. 4B is a graph that shows mean (SEM) % changes in PBG levels from baseline in patients treated with placebo, or 0.035 mg/kg, 0.1 mg/kg, 0.35 mg/kg, 1.0 mg kg, or 2.5 mg kg ALN-ASl.
  • FIG. 5A is a graph that shows the correlation between % changes in liver ALASl mRNA levels from baseline and % changes in urine ALA levels from baseline in patients treated with placebo, or 0.035 mg kg, 0.1 mg/kg, or 0.35 mg/kg ALN-ASl.
  • FIG. 5B is a graph that shows the correlation between % changes in liver ALASl mRNA levels from baseline and % changes in urine ALA levels from baseline in patients treated with placebo, or 0.035 mg kg, 0.1 mg kg, 0.35 mg kg, 1.0 mg kg, or 2.5 mg/kg ALN-ASl .
  • FIG. 6A is a graph that shows the correlation between % changes in liver ALAS 1 mRNA levels from baseline and % changes in urine PBG levels from baseline in patients treated with placebo, or 0.035 mg/kg, 0.1 mg/kg, or 0.35 mg/kg ALN-ASl.
  • FIG. 6B is a graph that shows the correlation between % changes in liver ALASl mRNA levels from baseline and % changes in urine PBG levels from baseline in patients treated with placebo, or 0.035 mg kg, 0.1 mg/kg, 0.35 mg kg, 1.0 mg/kg, or 2.5 mg/kg ALN-AS 1.
  • FIG. 7 is a graph that shows mean (SEM) % changes in serum ALASl mRNA levels from baseline in patients treated with multiple (2) doses of placebo, or 0.35 mg/kg or 1.0 mg/kg ALN-ASl .
  • FIG. 8 is a graph that shows mean (SEM) % changes in ALA levels from baseline in patients treated with multiple (2) doses of placebo, or 0.35 mg kg or 1.0 mg/kg ALN-ASl .
  • FIG. 9 is a graph that shows mean (SEM) % changes in PBG levels from baseline in patients treated with with multiple (2) doses of placebo, or 0.35 mg/kg or 1.0 mg kg ALN-AS 1.
  • compositions and Methods for Inhibiting Expression of the ALAS l Gene are incorporated by reference herein in their entirety.
  • iRNA directs the sequence-specific degradation of mRNA through a process known as RNA interference (RNAi). Described herein are iRNAs and methods of using them for inhibiting the expression of an ALAS 1 gene in a cell or a mammal where the iRNA targets an ALAS 1 gene.
  • RNAi RNA interference
  • compositions and methods for disorders related to ALAS 1 expression such as porphyrias (e.g., ALA deyhdratase deficiency porphyria (ADP or Doss porphyria), acute intermittent porphyria, congenital erythropoietic porphyria, prophyria cutanea tarda, hereditary coproporphyria (coproporphyria), variegate porphyria, erythropoietic protoporphyria (EPP), X-linked sideroblastic anemia (XLS A), and transient
  • Porphyrias are inherited or acquired disorders that can be caused by decreased or enhanced activity of specific enzymes in the heme biosynthetic pathway, also referred to herein as the porphyrin pathway (See FIG. 1 of WO 2015/051318). Porphyrins are the main precursors of heme. Porphyrins and porphyrin precursors include ⁇ -aminolevulinic acid (ALA), porphopilinogen (PBG), hydroxymethylbilane (HMB), uroporphyrinogen I or III,
  • ALA ⁇ -aminolevulinic acid
  • PBG porphopilinogen
  • HMB hydroxymethylbilane
  • uroporphyrinogen I or III include ⁇ -aminolevulinic acid (ALA), porphopilinogen (PBG), hydroxymethylbilane (HMB), uroporphyrinogen I or III,
  • Heme is an essential part of hemoglobin, myoglobin, catalases, peroxidases, and cytochromes, the latter including the respiratory and P450 liver cytochromes. Heme is synthesized in most or all human cells. About 85% of heme is made in erythroid cells, primarily for hemoglobin. Most of the remaining heme is made in the liver, 80% of which is used for the synthesis of cytochromes. Deficiency of specific enzymes in the porphyrin pathway leads to insufficient heme production and also to an accumulation of porphyrin precursors and/or porphyrins, which can be toxic to cell or organ function in high concentrations.
  • Porphyrias may manifest with neurological complications ("acute"), skin problems
  • Porphyrias may be classified by the primary site of the overproduction and accumulation of porphyrins or their precursors. In hepatic porphyrias, porphyrins and porphyrin precursors are overproduced predominantly in the liver, whereas in erythropoietic porphyrias, porphyrins are overproduced in the erythroid cells in the bone.
  • the acute or hepatic porphyrias lead to dysfunction of the nervous system and neurologic manifestations that can affect both the central and peripheral nervous system, resulting in symptoms such as, for example, pain (e.g., abdominal pain and/or chronic neuropathic pain), vomiting, neuropathy (e.g., acute neuropathy, progressive neuropathy), muscle weakness, seizures, mental disturbances (e.g., hallucinations, depression anxiety, paranoia), cardiac arrhythmias, tachycardia,
  • pain e.g., abdominal pain and/or chronic neuropathic pain
  • neuropathy e.g., acute neuropathy, progressive neuropathy
  • muscle weakness e.g., depression anxiety, paranoia
  • seizures e.g., depression anxiety, paranoia
  • mental disturbances e.g., hallucinations, depression anxiety, paranoia
  • cardiac arrhythmias e.g., tachycardia
  • the cutaneous or erythropoietic porphyrias primarily affect the skin, causing symptoms such as photosensitivity that can be painful, blisters, necrosis, itching, swelling, and increased hair growth on areas such as the forehead. Subsequent infection of skin lesions can lead to bone and tissue loss, as well as scarring, disfigurement, and loss of digits (e.g., fingers, toes). Most porphyrias are caused by mutations that encode enzymes in the heme biosynthetic pathway. A summary of porphyrias associated with genetic errors in heme metabolism is provided in FIG. 2 of WO 2015/051318.
  • porphyrias are genetic.
  • patients with liver disease may develop porphyria as a result of liver dysfunction, and a transient form of erythroporphria (transient erythroporphyria of infancy) has been described in infancy (see Crawford, R.I. et al, J Am Acad Dermatol. 1995 Aug; 33(2 Pt 2):333-6.)
  • Patients with PCT can acquire the deficient activity of uroporphyrinogen decarboxylase (URO-D), due to the formation of a ORO-D enzyme with lower than normal enzymatic activity (see Phillips et al. Blood, 98:3179-3185, 2001.)
  • URO-D uroporphyrinogen decarboxylase
  • Acute intermittent porphyria (also be referred to as porphobilinogen (PBG) deaminase deficiency, or hydroxymethylbilane synthase (HMBS) deficiency), is the most common type of acute hepatic porphyria.
  • Other types of acute hepatic porphyrias include hereditary coproporphyria (HCP), variegate porphyria (VP), and ALA deyhdratase deficiency porphyria (ADP).
  • HCP hereditary coproporphyria
  • VP variegate porphyria
  • ADP ALA deyhdratase deficiency porphyria
  • AIP is typically an autosomal dominant disease that is characterized by a deficiency of the enzyme porphobilinogen deaminase (PBG deaminase); this enzyme is also known as hydroxymethylbilane synthase (HMB synthase or HMBS).
  • PBG deaminase is the third enzyme of the heme biosynthetic pathway (see FIG. 1 of WO 2015/051318) and catalyzes the head to tail condensation of four porphobilinogen molecules into the linear tetrapyrrole,
  • HMB hydroxymethylbilane
  • spliced transcript variants encoding different isoforms of PBG deaminase have been described. Mutations in the PBG deaminase gene are associated with AIP. Such mutations may lead to decreased amounts of PBG deaminase and/or decreased activity of PBG deaminase (affected individuals typically have a -50% reduction in PBG deaminase activity).
  • AIP has been found to have a prevalence as high as 1 in 10,000 in certain populations (e.g., in Northern Sweden; see Floderus Y, et al. Clin Genet. 2002; 62:288-97). The prevalence in the general population in United States and Europe, excluding the U.K., is estimated to be about 1 in 10,000 to 1 in 20,000. Clinical disease manifests itself in only approximately 10-15% of individuals who carry mutations that are known to be associated with AIP. However, the penetrance is as high as 40% in individuals with certain mutations (e.g. , the W198X mutation). AIP is typically latent prior to puberty. Symptoms are more common in females than in males.
  • AIP affects, for example, the visceral, peripheral, autonomic, and central nervous systems.
  • Symptoms of AIP are variable and include gastrointestinal symptoms (e.g., severe and poorly localized abdominal pain, na sea/ vomiting, constipation, diarrhea, ileus), urinary symptoms (dysuria, urinary retention/incontinence, or dark urine, e.g., dark red urine), neurologic symptoms (e.g., sensory neuropathy, motor neuropathy (e.g., affecting the cranial nerves and/or leading to weakness in the arms or legs), seizures, neuropathic pain (e.g., pain associated with progressive neuropathy, e.g., chronic neuropathic pain), neuropsychiatric symptoms (e.g., mental confusion, anxiety, agitation, hallucination, hysteria, delirium, apathy, depression, phobias, psychosis, insomnia, somnolence, coma), autonomic nervous system involvement (resulting e.g.,
  • Neurological manifestations include motor and autonomic neuropathy and seizures. Patients frequently have chronic neuropathic pain and develop a progressive neuropathy. Patients with recurring attacks often have a prodrome. Permanent paralysis may occur after a severe attack. Recovery from severe attacks that are not promptly treated may take weeks or months. An acute attack may be fatal, for example, due to paralysis of respiratory muscles or cardiovascular failure from electrolyte imbalance. (See, e.g., Thunell S. Hydroxymethylbilane Synthase Deficiency. 2005 Sep 27
  • Attacks of acute porphyria may be precipitated by endogenous or exogenous factors.
  • the mechanisms by which such factors induce attacks may include, for example, increased demand for hepatic P450 enzymes and/or induction of ALASl activity in the liver.
  • Increased demand for hepatic P450 enzymes results in decreased hepatic free heme, thereby inducing the synthesis of hepatic ALASl.
  • Precipitating factors include fasting (or other forms of reduced or inadequate caloric intake, due to crash diets, long-distance athletics, etc), metabolic stresses (e.g., infections, surgery, international air travel, and psychological stress), endogenous hormones (e.g., progesterone), cigarette smoking, lipid-soluble foreign chemicals (including, e.g., chemicals present in tobacco smoke, certain prescription drugs, organic solvents, biocides, components in alcoholic beverages), endocrine factors (e.g., reproductive hormones (women may experience exacerbations during the premenstrual period), synthetic estrogens, progesterones, ovulation stimulants, and hormone replacement therapy). See, for example, Thunell (1993).
  • Over 1000 drugs are contraindicated in the acute hepatic porphyrias (e.g., AIP, HCP, ADP, and VP) including, for example, alcohol, barbiturates, Carbamazepine, Carisoprodol, Clonazepam (high doses), Danazol, Diclofenac and possibly other NSAIDS, Ergots, estrogens, Ethvclorvynol, Glutethimide, Griseofulvin, Mephenytoin, Meprobamate (also mebutamate and tybutamate), Methyprylon, Metodopramide, Phenytoin, Primidone, progesterone and synthetic progestins, Pyrazinamide, Pyrazolones (aminopyrine and antipyrine), Rifampin, Succinimides (ethosuximide and methsuximide), sulfonamide antibiotics, and Valproic acid.
  • AIP acute hepatic
  • Objective signs of AIP include discoloration of the urine during an acute attack (the urine may appear red or red-brown), and increased concentrations of PBG and ALA in urine during an acute attack.
  • Molecular genetic testing identifies mutations in the PBG deaminase (also known as HMBS) gene in more than 98% of affected individuals. See, for example, Thunell (1993). See also, Lundin et al. Two new mutations in the porphobilinogen deaminase gene and a screening method using PCR amplification of specific alleles. Hum Genet. 1994 Jan; 93( 1 ):59- 62, Lundin et al. Four mutations in the porphobilinogen deaminase gene in patients with acute intermittent porphyria. Med Genet. 1995 Dec; 32(12): 979-81.
  • Diagnosis of porphria can involve assessment of family history, assessment of porphyrin precursor levels in urine, blood, or stool, and/or assessment of enzyme activity and DNA mutation analysis.
  • the differential diagnosis of porphyrias may involve determining the type of porphyria by measuring individual levels of porphyrins or porphyrin precursors (e.g., ALA, PBG) in the urine, feces, and/or plasma (e.g., by chromatography and fluorometry) during an attack.
  • the diagnosis of ⁇ can be confirmed by establishing that erythrocyte PBG deaminase activity is at 50% or less of the normal level.
  • DNA testing for mutations may be carried out in patients and at-risk family members.
  • the diagnosis of ⁇ is typically confirmed by DNA testing to identify a specific caustative gene mutation (e.g., an HMBS mutation).
  • Treatment of acute attacks of AIP involves hospitalization, monitoring of symptoms, and removal of unsafe drugs.
  • Treatment of acute attacks typically requires hospitalization to control and treat acute sysmptoms, including, e.g., abdominal pain, seizures, dehydration/hyponatremia, nausea/vomiting, tachycardia/hypertension, urinary retention/ileus.
  • abdominal pain may be treated, e.g., with narcotic analgesics
  • seizures may be treated with seizure precautions and possibly medications (although many anti-seizure medications are contraindicated)
  • nausea/vomiting may be treated, e.g., with phenothiazines
  • tachycardia/hypertension may be treated, e.g., with beta blockers.
  • Treatment may include withdrawal of unsafe medications, monitoring of respiratory function, as well as muscle strength and neurological status.
  • Mild attacks e.g. , those with no paresis or hyponatremia
  • Severe attacks are typically treated as soon as possible with intravenous hemin (3-4 mg/kg daily for 4- 14 days) and with IV glucose while waiting for the IV hemin to take effect.
  • attacks are treated with IV hemin for 4 days and with IV glucose while waiting for administration of the IV hemin.
  • Within 3-4 days following the start of hemin administration there is usually clinical improvement accompanying by lowering of ALA and PBG levels.
  • Hemin (Panhematin® or hemin for injection, previously known as hematin) is the only heme product approved for use in the United States and was the first drug approved under the Orphan Drug Act.
  • Panhematin® is hemin derived from processed red blood cells (PRBCs), and is Protoporphyrin IX containing a feme iron ion (Heme B) with a chloride ligand. Heme acts to limit the hepatic and/or marrow synthesis of porphyrin.
  • hemin produces symptomatic improvement in patients with acute episodes of the hepatic porphyrias
  • its action is likely due to the (feedback) inhibition of ⁇ - aminolevulinic acid (ALA) synthase, the enzyme which limits the rate of the porphyrin/heme biosynthetic pathway.
  • ALA ⁇ - aminolevulinic acid
  • Inhibition of ALA synthase should result in reduced production of ALA and PBG as well as porphyrins and porphyrin intermediates.
  • Drawbacks of heme products include delayed impact on clinical symptoms and failure to prevent the recurrence of attacks.
  • Adverse reactions associated with heme (e.g., hemin) administration may include phlebitis (e.g., thrombophlebitis), difficulty with venous access, anticoagulation (or coagulopathies), thrombocytopenia, renal shut down, or iron overload, which is particularly likely in patients requiring multiple courses of hemin treatment for recurrent attacks.
  • phlebitis e.g., thrombophlebitis
  • difficulty with venous access e.g., anticoagulation (or coagulopathies)
  • thrombocytopenia thrombocytopenia
  • renal shut down or iron overload
  • iron overload which is particularly likely in patients requiring multiple courses of hemin treatment for recurrent attacks.
  • an indwelling venous catheter is needed for access in patients with recurrent attacks. Renal damage can occur with high doses.
  • Heme is difficult to prepare in a stable form for intravenous administration. It is insoluble at neutral pH but can be prepared as heme hydroxide at pH 8 or higher.
  • Panhematin is a lyophilized hemin preparation. When lyophilized hemin is solubilized for intravenous administration, degradation products form rapidly; these degradation products are responsible for a transient anticoagulant effect and for phlebitis at the site of infusion.
  • Heme albumin and heme arginate Normal-ang, the European version of hemin
  • heme arginate is not approved for use in the United States.
  • Panhemin may be stabilized by solubilizing it for infusion in 30% human albumin rather than in sterile water; however, albumin adds intravascular volume- expanding effects and increases the cost of treatment as well as risk of pathogens since it is isolated from human blood. See, e.g., Anderson supra.
  • liver transplantation can restore normal excretion of ALA and PBG and prevent acute attacks. See, e.g., Dar, F.S. et al. Hepatobiliary Pancreat. Dis. Int., 9(l):93-96 (2010). Furthermore, if the liver of a patient with ⁇ is transplanted into another patient ("domino transplant"), the patient receiving the transplant may develop ALP.
  • neuropathic pain that may result from a progressive neuropathy due to neurotoxic effects, e.g., of elevated porphyrin precursors ⁇ e.g., ALA and/or PBG).
  • the neurotoxic effects can be associated with toxic heme intermediate production, for example, altered GABA signaling and/or production of iron- mediated oxidation and reactive oxygen species (ROS).
  • ROS reactive oxygen species
  • Patients may suffer from neuropathic pain prior to or during an acute attack. Older patients may experience increased neuropathic pain with age for which various narcotic drugs are typically prescribed. Electromyogram abnormalities and decreased conduction times have been documented in patients with acute hepatic porphyrias.
  • Treatment e.g., chronic treatment (e.g., periodic treatment with iRNA as described herein, e.g., treatment according to a dosing regimen as described herein, e.g., weekly or biweekly treatment) can continuously reduce the ALAS 1 expression in acute porphyria patients who have elevated levels of porphyrin precursors, porphyrins, porphyrin products or their metabolites.
  • Such treatment may be provided as needed to prevent or reduce the frequency or severity of an individual patient's symptoms (e.g., pain and/or neuropathy) and/or to reduce a level of a porphyrin precursor, porphyrin, porphyrin product or metabolite.
  • Novel therapeutics such as those described herein can address these drawbacks and the unmet needs of patients acting faster, not inducing phlebitis, providing the convenience of subcutaneous administration, successfully preventing recurrent attacks, preventing or ameliorating pain (e.g., chronic neuropathic pain) and/or progressive neuropathy, and/or not causing certain adverse effects associated with hemin (e.g., iron overload, increased risk of hepatocellular cancer).
  • pain e.g., chronic neuropathic pain
  • progressive neuropathy e.g., progressive neuropathy
  • Patients with AIA include those who suffer from recurrent attacks and those who suffer from acute, sporadic attacks. In the pateints who suffer from recurrent attacks, about 5-10% have recurrent intermittent attacks (2-3 attacks per year) or recurrent attacks (>4 attacks per year). These patients are most likely to consider liver transplant or to receive prophylactic heme (e.g., heniin) infusions. The recurrent attack patients are likely to have poor quality of life due to long hospital stays, opiate addiction, and/or venous network toxicity. Chronic heme
  • heme oxygenase heme oxygenase
  • HO-1 heme oxygenase
  • ALAS1 mRNA is strongly upregulated during an attack; panhematin down modulates ALAS-1 ; and addition of heme to liver cells in culture leads to reduced ALAS-1 mRNA.
  • Several findings also indicate that suppression of ALAS 1 mRNA can be achieved by targeting the liver. For example, liver transplant has been shown to be curative; and liver derived metabolites drive attacks (see e.g., Dar et al. Hepatobiliaij Pancreat Dis Int. 9:93-6 (2010); Dowman et al. Ann Intern Med 154:571-2 (2011); and Wu et al. Genes Dev 23:2201-2209 (2009).
  • iRNA compositions can be used for prophylaxis and acute treatment of porphyrias.
  • iRNA compositions can be used prophylactically in a recurrent attack setting to induce long-term or chronic suppression of ALASl expression (leading to long-term or chronic suppression of ALA/PBG), and thus blunting the recurrent ALASl upregulation that drives the attacks.
  • prophylactic treatment can reduce the number and the severity of the attacks.
  • administration of an iRNA composition can treat an acute attack, e.g., by reducing the levels of ALA/PBG.
  • the present disclosure provides methods and iRNA compositions for modulating the expression of an ALAS 1 gene.
  • expression of ALAS1 is reduced or inhibited using an ALAS 1 -specific iRNA, thereby leading to a decreased expression of an ALAS 1 gene.
  • Reduced expression of an ALAS 1 gene may reduce the level of one or more porphyrin precursors, porphyrins, or porphyrin products or metabolites.
  • Decreased expression of an ALASl gene, as well as related decreases in the level of one or more porphyrin precursors and/or porphyrins can be useful in treating disorders related to ALAS l expression, e.g., porphyrias.
  • the iRNAs of the compositions featured herein include an RNA strand (the antisense strand) having a region which is 30 nucleotides or less in length, i.e., 15-30 nucleotides in length, generally 19-24 nucleotides in length, which region is substantially complementary to at least part of an mRNA transcript of an ALASl gene (also referred to herein as an "ALAS 1 -specific iRNA").
  • iRNA enables the targeted degradation of mRNAs of genes that are implicated in pathologies associated with ALASl expression in mammals, e.g., porphyrias such as ALA dehydratase deficiency porphyria (also known as Doss porphyria or plumboporphyria) or acute intermittent porphyria.
  • porphyrias such as ALA dehydratase deficiency porphyria (also known as Doss porphyria or plumboporphyria) or acute intermittent porphyria.
  • Very low dosages of ALASl -specific iRNAs can specifically and efficiently mediate RNAi, resulting in significant inhibition of expression of an ALASl gene.
  • iRNAs targeting ALAS l can specifically and efficiently mediate RNAi, resulting in significant inhibition of expression of an ALASl gene, e.g., in cell based assays.
  • porphyrias e.g. , X-linked sideroblastic anemia (XLS A), ALA deyhdratase deficiency porphyria (Doss porphyria), acute intermittent porphyria (AIP), congenital erythropoietic porphyria, prophyria cutanea tarda, hereditary coproporphyria
  • XLS A X-linked sideroblastic anemia
  • Doss porphyria ALA deyhdratase deficiency porphyria
  • AIP acute intermittent porphyria
  • congenital erythropoietic porphyria prophyria cutanea tarda
  • compositions containing iRNAs to inhibit the expression of an ALAS l gene, as well as compositions and methods for treating diseases and disorders caused by or modulated by the expression of this gene.
  • Embodiments of the pharmaceutical compositions featured in the invention include an iRNA having an antisense strand comprising a region which is 30 nucleotides or less in length, generally 19-24 nucleotides in length, which region is substantially complementary to at least part of an RNA transcript of an ALAS1 gene, together with a pharmaceutically acceptable carrier.
  • Embodiments of compositions featured in the invention also include an iRNA having an antisense strand having a region of complementarity which is 30 nucleotides or less in length, generally 19-24 nucleotides in length, and is substantially complementary to at least part of an RNA transcript of an ALAS 1 gene.
  • compositions containing an ALASl iRNA and a pharmaceutically acceptable carrier methods of using the compositions to inhibit expression of an ALASl gene, and methods of using the pharmaceutical compositions to treat disorders related to ALASl expression are featured in the invention.
  • G,” “C,” “A,” “T” and “U” each generally stand for a nucleotide that contains guanine, cytosine, adenine, thymidine and uracil as a base, respectively.
  • ribonucleotide or “nucleotide” can also refer to a modified nucleotide, as further detailed below, or a surrogate replacement moiety.
  • guanine, cytosine, adenine, and uracil may be replaced by other moieties without substantially altering the base pairing properties of an oligonucleotide comprising a nucleotide bearing such replacement moiety.
  • a nucleotide comprising inosine as its base may base pair with nucleotides containing adenine, cytosine, or uracil.
  • nucleotides containing uracil, guanine, or adenine may be replaced in the nucleotide sequences of dsRNA featured in the invention by a nucleotide containing, for example, inosine.
  • adenine and cytosine anywhere in the oligonucleotide can be replaced with guanine and uracil, respectively to form G-U Wobble base pairing with the target mRNA. Sequences containing such replacement moieties are suitable for the compositions and methods featured in the invention.
  • ALASl also known as ALAS-1 ; ⁇ -aminolevulinate synthase 1; ⁇ -ALA synthase 1; 5 '-aminolevulinic acid synthase 1 ; ALAS-H; ALASH; ALAS-N; ALAS3;
  • OTTHUMP00000212622 refers to a nuclear-encoded mitochondrial enzyme that is the first and typically rate-limiting enzyme in the mammalian heme biosynthetic pathway.
  • ALASl catalyzes the condensation of glycine with succinyl-CoA to form ⁇ -aminolevulinic acid (ALA).
  • ALA ⁇ -aminolevulinic acid
  • the human ALASl gene is expressed ubiquitously, is found on chromosome 3p21.1 and typically encodes a sequence of 640 amino acids.
  • an "ALASl protein” means any protein variant of ALASl from any species (e.g., human, mouse, non-human primate), as well as any mutants and fragments thereof that retain an ALAS 1 activity.
  • an "ALASl transcript” refers to any transcript variant of ALASl , from any species (e.g., human, mouse, non-human primate).
  • a sequence of a human ALAS 1 mRNA transcript can be found at NM_000688.4 (FIG. 3A and FIG.
  • ALASl mRNA transcript can be found at NM_00()688.5 (FIG. 4A and FIG. 4B of WO 2015/051318; SEQ ID NO:382).
  • the level of the mature encoded ALAS l protein is regulated by heme: high levels of heme down-regulate the mature enzyme in mitochondria while low heme levels up-regulate. Multiple alternatively spliced valiants, encoding the same protein, have been identified.
  • RNAi RNAi agent
  • RNAi agent an agent that contains RNA as that term is defined herein, and which mediates the targeted cleavage of an RNA transcript, e.g., via an RNA-induced silencing complex (RISC) pathway.
  • RISC RNA-induced silencing complex
  • an iRNA as described herein effects inhibition of ALASl expression. Inhibition of ALASl expression may be assessed based on a reduction in the level of ALASl mRNA or a reduction in the level of the ALAS l protein.
  • target sequence refers to a contiguous portion of the nucleotide sequence of an mRNA molecule formed during the transcription of an ALAS 1 gene, including mRNA that is a product of RNA processing of a primary transcription product.
  • the target portion of the sequence will be at least long enough to serve as a substrate for iRNA-directed cleavage at or near that portion.
  • the target sequence will generally be from 9-36 nucleotides in length, e.g., 15-30 nucleotides in length, including all sub-ranges therebetween.
  • the target sequence can be from 15-30 nucleotides, 15-26 nucleotides, 15-23 nucleotides, 15-22 nucleotides, 15-21 nucleotides, 15-20 nucleotides, 15-19 nucleotides, 15-18 nucleotides, 15-17 nucleotides, 18-30 nucleotides, 18-26 nucleotides, 18-23 nucleotides, 18-22 nucleotides, 18-21 nucleotides, 18-20 nucleotides, 19-30 nucleotides, 19-26 nucleotides, 19-23 nucleotides, 19-22 nucleotides, 19-21 nucleotides, 19-20 nucleotides, 20-30 nucleotides, 20-26 nucleotides, 20-25 nucleotides, 20-24 nucleotides,2()-23 nucleotides, 20-22 nucleotides, 20-21 nucleotides, 21-30 nucleotides, 21-26 nucleotides
  • strand comprising a sequence refers to an oligonucleotide comprising a chain of nucleotides that is described by the sequence referred to using the standard nucleotide nomenclature.
  • the term "complementary,” when used to describe a first nucleotide sequence in relation to a second nucleotide sequence, refers to the ability of an oligonucleotide or polynucleotide comprising the first nucleotide sequence to hybridize and form a duplex structure under certain conditions with an oligonucleotide or polynucleotide comprising the second nucleotide sequence, as will be understood by the skilled person.
  • Such conditions can, for example, be stringent conditions, where stringent conditions may include: 400 mM NaCl, 40 mM PIPES pH 6.4. 1 mM EDTA, 50°C or 70°C for 12-16 hours followed by washing.
  • Complementary sequences within an iRNA include base-pairing of the oligonucleotide or polynucleotide comprising a first nucleotide sequence to an oligonucleotide or polynucleotide comprising a second nucleotide sequence over the entire length of one or both nucleotide sequences.
  • Such sequences can be referred to as "fully complementary” with respect to each other herein.
  • first sequence is referred to as “substantially complementary” with respect to a second sequence herein
  • the two sequences can be fully complementary, or they may form one or more, but generally not more than 5, 4, 3 or 2 mismatched base pairs upon hybridization for a duplex up to 30 base pairs, while retaining the ability to hybridize under the conditions most relevant to their ultimate application, e.g., inhibition of gene expression via a RISC pathway.
  • two oligonucleotides are designed to form, upon hybridization, one or more single stranded overhangs, such overhangs shall not be regarded as mismatches with regard to the determination of complementarity.
  • a dsRNA comprising one oligonucleotide 21 nucleotides in length and another oligonucleotide 23 nucleotides in length, wherein the longer oligonucleotide comprises a sequence of 21 nucleotides that is fully complementary to the shorter oligonucleotide, may yet be referred to as "fully complementary" for the purposes described herein.
  • “Complementary” sequences may also include, or be formed entirely from, non -Watson-Crick base pairs and/or base pairs formed from non -natural and modified nucleotides, in as far as the above requirements with respect to their ability to hybridize are fulfilled.
  • Such non-Watson-Crick base pairs includes, but are not limited to, G:U Wobble or Hoogstein base pairing.
  • a polynucleotide that is "substantially complementary to at least part of" a messenger RNA (mRNA) refers to a polynucleotide that is substantially complementary to a contiguous portion of the mRNA of interest (e.g., an mRNA encoding an ALAS 1 protein).
  • mRNA messenger RNA
  • a polynucleotide is complementary to at least a part of an ALAS 1 mRNA if the sequence is substantially complementary to a non -interrupted portion of an mRNA encoding ALAS 1.
  • a polynucleotide is complementary to at least a part of an ALAS 1 mRNA if the sequence is substantially complementary to a non-interrupted portion of an mRNA encoding ALAS 1.
  • double-stranded RNA refers to an iRNA that includes an RNA molecule or complex of molecules having a hybridized duplex region that comprises two anti-parallel and substantially complementary nucleic acid strands, which will be referred to as having "sense” and “antisense” orientations with respect to a target RNA.
  • the duplex region can be of any length that permits specific degradation of a desired target RNA, e.g., through a RISC pathway, but will typically range from 9 to 36 base pairs in length, e.g., 15- 30 base pairs in length.
  • the duplex can be any length in this range, for example, 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, or 36 and any sub-range therein between, including, but not limited to 15-30 base pairs, 15-26 base pairs, 15-23 base pairs, 15-22 base pairs, 15-21 base pairs, 15-20 base pairs, 15-19 base pairs, 15-18 base pairs, 15-17 base pairs, 18-30 base pairs, 18-26 base pairs, 18-23 base pairs, 18-22 base pairs, 18-21 base pairs, 18-20 base pairs, 19-30 base pairs, 19-26 base pairs, 19-23 base pairs, 19-22 base pairs, 19-21 base pairs, 19-20 base pairs, 20-30 base pairs, 20-26 base pairs, 20-25 base pairs, 20-24 base pairs, 20-23 base pairs, 20-22 base pairs, 20-21 base pairs, 21-30 base pairs, 21-26 base pairs, 21-25 base pairs, 21-24 base pairs, 21-23 base pairs, or 21-22 base
  • the two strands forming the duplex structure can be from a single RNA molecule having at least one self-complementary region, or can be formed from two or more separate RNA molecules. Where the duplex region is formed from two strands of a single molecule, the molecule can have a duplex region separated by a single stranded chain of nucleotides (herein referred to as a "hairpin loop") between the 3'-end of one strand and the 5 '-end of the respective other strand forming the duplex structure.
  • a single stranded chain of nucleotides herein referred to as a "hairpin loop
  • the hairpin loop can comprise at least one unpaired nucleotide; in some embodiments the hairpin loop can comprise at least 3, at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 20, at least 23 or more unpaired nucleotides.
  • the two substantially complementary strands of a dsRNA are comprised by separate RNA molecules, those molecules need not, but can be covalently connected.
  • the connecting structure is referred to as a "linker.”
  • the term "siRNA” is also used herein to refer to a dsRNA as described above.
  • the iRNA agent may be a "single-stranded siRNA" that is introduced into a cell or organism to inhibit a target mRNA.
  • Single -stranded RNAi agents bind to the RISC endonuclease Argonaute 2, which then cleaves the target mRNA.
  • the single- stranded siRNAs are generally 15-30 nucleotides and are chemically modified. The design and testing of single-stranded siRNAs are described in U.S. Patent No. 8,101,348 and in Lima et al, (2012) Cell 150: 883-894, the entire contents of each of which are hereby incorporated herein by reference.
  • any of the antisense nucleotide sequences described herein may be used as a single-stranded siRNA as described herein or as chemically modified by the methods described in Lima et al, (2012) Cell 150:883-894.
  • the RNA agent is a "single-stranded antisense RNA molecule".
  • An single-stranded antisense RNA molecule is complementary to a sequence within the target mRNA.
  • Single-stranded antisense RNA molecules can inhibit translation in a stoichiometric manner by base pairing to the mRNA and physically obstructing the translation machinery, see Dias, N. et al., (2002) Mol Cancer Ther 1 :347-355.
  • the single-stranded antisense molecules inhibit a target mRNA by hydridizing to the target and cleaving the target through an RNaseH cleavage event.
  • the single-stranded antisense RNA molecule may be about 10 to about 30 nucleotides in length and have a sequence that is complementary to a target sequence.
  • the single-stranded antisense RNA molecule may comprise a sequence that is at least about 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, or more contiguous nucleotides from any one of the antisense nucleotide sequences described herein, e.g., sequences provided in any one of Tables 2, 3, 6, 7, 8, 9, 14, 15, 18 and 20 of WO 2015/051318 and the Sequence Listing attached herewith or in Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith.
  • RNA molecule or "ribonucleic acid molecule” encompasses not only RNA molecules as expressed or found in nature, but also analogs and derivatives of RNA comprising one or more ribonucleotide/ribonucleoside analogs or derivatives as described herein or as known in the art.
  • a "ribonucleoside” includes a nucleoside base and a ribose sugar
  • a “ribonucleotide” is a ribonucleoside with one, two or three phosphate moieties.
  • the terms “ribonucleoside” and “ribonucleotide” can be considered to be equivalent as used herein.
  • RNA can be modified in the nucleobase structure, in the ribose structure, or in the ribose-phosphate backbone structure, e.g., as described herein below.
  • the molecules comprising ribonucleoside analogs or derivatives must retain the ability to form a duplex.
  • an RNA molecule can also include at least one modified ribonucleoside including but not limited to a 2'-0-methyl modified nucleostide, a nucleoside comprising a 5' phosphorothioate group, a terminal nucleoside linked to a cholesteryl derivative or dodecanoic acid bisdecylamide group, a locked nucleoside, an abasic nucleoside, an acyclic nucleoside, a 2'-deoxy-2'-fluoro modified nucleoside, a 2'-amino- modified nucleoside, 2'-alkyl-modified nucleoside, moipholino nucleoside, a phosphoramidate or a non-natural base comprising nucleoside, or any combination thereof.
  • a modified ribonucleoside including but not limited to a 2'-0-methyl modified nucleostide, a nucleoside comprising a 5' phosphorothioate group, a
  • an RNA molecule can comprise at least two modified ribonucleosides, at least 3, at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 15, at least 20 or more, up to the entire length of the dsRNA molecule.
  • the modifications need not be the same for each of such a plurality of modified ribonucleosides in an RNA molecule.
  • modified RNAs contemplated for use in methods and compositions described herein are peptide nucleic acids (PNAs) that have the ability to form the required duplex structure and that permit or mediate the specific degradation of a target RNA, e.g., via a RISC pathway.
  • PNAs peptide nucleic acids
  • a modified ribonucleoside includes a deoxyribonucleoside.
  • an iRNA agent can comprise one or more deoxynucleosides, including, for example, a deoxynucleoside overhang(s), or one or more deoxynucleosides within the double stranded portion of a dsRNA.
  • the RNA molecule comprises a percentage of deoxyribonucleoses of at least 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95% or higher (but not 100%) deoxyribonucleosides, e.g., in one or both strands.
  • an RNA interference agent includes a single stranded RNA that interacts with a target RNA sequence to direct the cleavage of the target RNA.
  • long double stranded RNA introduced into cells is broken down into siRNA by a Type III endonuclease known as Dicer (Sharp et al., Genes Dev. 2001, 15:485).
  • Dicer a ribonuclease-III-like enzyme, processes the dsRNA into 19-23 base pair short interfering RNAs with characteristic two base 3' overhangs (Bernstein, et al., (2001) Nature 409:363).
  • the siRNAs are then incorporated into an RNA-induced silencing complex (RISC) where one or more helicases unwind the siRNA duplex, enabling the complementary anti sense strand to guide target recognition (Nykanen, et al., (2001 ) Cell 107:309).
  • RISC RNA-induced silencing complex
  • the invention Upon binding to the appropriate target mRNA, one or more endonucleases within the RISC cleaves the target to induce silencing (Elbashir, et al., (2001) Genes Dev. 15: 188).
  • the invention relates to a single stranded RNA that promotes the formation of a RISC complex to effect silencing of the target gene.
  • nucleotide overhang refers to at least one unpaired nucleotide that protrudes from the duplex structure of an iRNA, e.g., a dsRNA.
  • a dsRNA can comprise an overhang of at least one nucleotide
  • the overhang can comprise at least two nucleotides, at least three nucleotides, at least four nucleotides, at least five nucleotides or more.
  • a nucleotide overhang can comprise or consist of a nucleotide/nucleoside analog, including a deoxymicleotide/nucleoside.
  • the overhang(s) may be on the sense strand, the anti sense strand or any combination thereof.
  • nucleotide(s) of an overhang can be present on the 5' end , 3' end or both ends of either an antisense or sense strand of a dsRNA.
  • the antisense strand of a dsRNA has a 1-10 nucleotide overhang at the 3' end and/or the 5' end. In one embodiment, the sense strand of a dsRNA has a 1-10 nucleotide overhang at the 3' end and/or the 5' end. In another embodiment, one or more of the nucleotides in the overhang is replaced with a nucleoside thiophosphate.
  • dsRNA dsRNA that there are no unpaired nucleotides or nucleotide analogs at a given terminal end of a dsRNA, i.e., no nucleotide overhang.
  • One or both ends of a dsRNA can be blunt. Where both ends of a dsRNA are blunt, the dsRNA is said to be blunt ended.
  • a "blunt ended" dsRNA is a dsRNA that is blunt at both ends, i.e., no nucleotide overhang at either end of the molecule. Most often such a molecule will be double-stranded over its entire length.
  • antisense strand or "guide strand” refers to the strand of an iRNA, e.g., a dsRNA, which includes a region that is substantially complementary to a target sequence.
  • region of complementarity refers to the region on the antisense strand that is substantially complementary to a sequence, for example a target sequence, as defined herein. Where the region of complementarity is not fully complementary to the target sequence, the mismatches may be in the internal or terminal regions of the molecule. Generally, the most tolerated mismatches are in the terminal regions, e.g., within 5, 4, 3, or 2 nucleotides of the 5' and/or 3' terminus.
  • SNALP refers to a stable nucleic acid-lipid particle.
  • a SNALP represents a vesicle of lipids coating a reduced aqueous interior comprising a nucleic acid such as an iRNA or a plasmid from which an iRNA is transcribed. SNALPs are described, e.g., in U.S. Patent Application Publication Nos. 2006/0240093, 2007/0135372, and in
  • iRNA when referring to an iRNA, means facilitating or effecting uptake or absorption into the cell, as is understood by those skilled in the art. Absorption or uptake of an iRNA can occur through unaided diffusive or active cellular processes, or by auxiliary agents or devices. The meaning of this term is not limited to cells in vitro; an iRNA may also be "introduced into a cell," wherein the cell is part of a living organism. In such an instance, introduction into the cell will include the delivery to the organism.
  • iRNA can be injected into a tissue site or administered systemically. In vivo delivery can also be by a ⁇ -glucan delivery system, such as those described in U.S.
  • In vitro introduction into a cell includes methods known in the art such as electroporation and lipofection. Further approaches are described herein below or known in the art.
  • the term "modulate the expression of,” refers to at an least partial “inhibition” or partial “activation” of an ALAS1 gene expression in a cell treated with an iRNA composition as described herein compared to the expression of ALAS 1 in a control cell.
  • a control cell includes an untreated cell, or a ceil treated with a non-targeting control iRNA.
  • activate activate
  • increase p-regulate the expression of
  • increase in so far as they refer to an ALAS1 gene
  • herein refer to the at least partial activation of the expression of an ALAS 1 gene, as manifested by an increase in the amount of ALAS 1 mRNA, which may be isolated from or detected in a first cell or group of cells in which an ALAS 1 gene is transcribed and which has or have been treated such that the expression of an ALAS l gene is increased, as compared to a second cell or group of cells substantially identical to the first cell or group of cells but which has or have not been so treated (control cells).
  • expression of an ALASl gene is activated by at least about 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, or 50% by administration of an iRNA as described herein.
  • an ALASl gene is activated by at least about 60%, 70%, or 80% by administration of an iRNA featured in the invention, hi some embodiments, expression of an ALASl gene is activated by at least about 85%, 90%, or 95% or more by administration of an iRNA as described herein, hi some embodiments, the ALASl gene expression is increased by at least 1-fold, at least 2-fold, at least 5-fold, at least 10-fold, at least 50-fold, at least 100-fold, at least 500-fold, at least 1000 fold or more in cells treated with an iRNA as described herein compared to the expression in an untreated cell.
  • ALASl gene refers to the at least partial suppression of the expression of an ALASl gene, as assessed, e.g., based on on ALASl mRNA expression, ALAS 1 protein expression, or another parameter functionally linked to ALASl gene expression (e.g., ALA or PBG concentrations in plasma or urine).
  • inhibition of ALASl expression may be manifested by a reduction of the amount of ALAS l mRNA which may be isolated from or detected in a first cell or group of cells in which an ALASl gene is transcribed and which has or have been treated such that the expression of an ALAS l gene is inhibited, as compared to a control.
  • the control may be a second cell or group of cells substantially identical to the first cell or group of cells, except that the second cell or group of cells have not been so treated (control cells).
  • the degree of inhibition is usually expressed as a percentage of a control level, e.g.,
  • the degree of inhibition may be given in terms of a reduction of a parameter that is functionally linked to ALASl gene expression, e.g., the amount of protein encoded by an ALAS 1 gene, or the level of one or more porphyrins.
  • the reduction of a parameter functionally linked to ALASl gene expression may similarly be expressed as a percentage of a control level.
  • ALAS l gene silencing may be determined in any cell expressing ALAS l , either constitutively or by genomic engineering, and by any appropriate assay.
  • the assays provided in the Examples below shall serve as such reference.
  • expression of an ALAS 1 gene is suppressed by at least about 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, or 50% by administration of an iRNA featured in the invention.
  • an ALAS 1 gene is suppressed by at least about 60%, 65%, 70%, 75%, or 80% by administration of an iRNA featured in the invention.
  • an ALASl gene is suppressed by at least about 85%, 90%, 95%, 98%, 99%, or more by administration of an iRNA as described herein.
  • the terms “treat,” “treating,” “treatment,” and the like refer to relief from or alleviation of pathological processes related to ALAS l expression (e.g., pathological processes involving porphyrins or defects in the porphyrin pathway, such as, for example, porphyrias).
  • pathological processes related to ALAS l expression e.g., pathological processes involving porphyrins or defects in the porphyrin pathway, such as, for example, porphyrias.
  • the terms “treat,” “treatment,” and the like mean to prevent, relieve or alleviate at least one symptom associated with such condition, or to slow or reverse the progression or anticipated progression of such condition.
  • the methods featured herein when employed to treat porphyria, may serve to reduce or prevent one or more symptoms associated with porphyria (e.g., pain), to reduce the severity or frequency of attacks associated with porphyria, to reduce the likelihood that an attack of one or more symptoms associated with porphyria will occur upon exposure to a precipitating condition, to shorten an attack associated with porphyria, and/or to reduce the risk of developing conditions associated with porphyria (e.g., hepatocellular cancer or neuropathy (e.g., progressive neuropathy)).
  • the terms "treat,” “treatment,” and the like are intended to encompass prophylaxis, e.g., prevention of disorders and/or symptoms of disorders related to ALAS l expression.
  • lower in the context of a disease marker or symptom is meant a statistically or clinically significant decrease in such level.
  • the decrease can be, for example, at least 10%, at least 20%, at least 30%, at least 40% ⁇ or more, and is typically down to a level accepted as within the range of normal for an individual without such disorder.
  • therapeutically effective amount refers to an amount that provides a therapeutic benefit in the treatment, prevention, or management of pathological processes related to ALAS 1 expression.
  • the specific amount that is therapeutically effective can be readily determined by an ordinary medical practitioner, and may vary depending on factors known in the art, such as, for example, the type of pathological process, the patient's history and age, the stage of pathological process, and the administration of other agents.
  • a “pharmaceutical composition” comprises a pharmacologically effective amount of an iRNA and a pharmaceutically acceptable carrier.
  • pharmacologically effective amount refers to that amount of an iRNA effective to produce the intended pharmacological, therapeutic or preventive result. For example, in a method of treating a disorder related to ALAS !
  • an effective amount includes an amount effective to reduce one or more symptoms associated with a porphyria, an amount effective to reduce the frequency of attacks, an amount effective to reduce the likelihood that an attack of one or more symptoms associated with porphyria will occur upon exposure to a precipitating factor, or an amount effective to reduce the risk of developing conditions associated with porphyria (e.g., neuropathy (e.g., progressive neuropathy), hepatocellular cancer).
  • an effective amount includes an amount effective to reduce one or more symptoms associated with a porphyria, an amount effective to reduce the frequency of attacks, an amount effective to reduce the likelihood that an attack of one or more symptoms associated with porphyria will occur upon exposure to a precipitating factor, or an amount effective to reduce the risk of developing conditions associated with porphyria (e.g., neuropathy (e.g., progressive neuropathy), hepatocellular cancer).
  • neuropathy e.g., progressive neuropathy
  • a therapeutically effective amount of a drug for the treatment of that disease or disorder is the amount necessary to effect at least a 10% reduction in that parameter.
  • a therapeutically effective amount of an iRNA targeting ALASl can reduce ALAS 1 protein levels by any measurable amount, e.g., by at least 10%, 20%, 30%, 40% or 50%.
  • pharmaceutically acceptable carrier refers to a carrier for administration of a therapeutic agent.
  • Such carriers include, but are not limited to, saline, buffered saline, dextrose, water, glycerol, ethanol, and combinations thereof.
  • the term specifically excludes cell culture medium.
  • pharmaceutically acceptable carriers include, but are not limited to pharmaceutically acceptable excipients such as inert diluents, disintegrating agents, binding agents, lubricating agents, sweetening agents, flavoring agents, coloring agents and preservatives.
  • suitable inert diluents include sodium and calcium carbonate, sodium and calcium phosphate, and lactose, while corn starch and alginic acid are suitable disintegrating agents.
  • Binding agents may include starch and gelatin, while the lubricating agent, if present, will generally be magnesium stearate, stearic acid or talc. If desired, the tablets may be coated with a material such as glyceryl monostearate or glyceryl distearate, to delay absorption in the gastrointestinal tract. Agents included in drug formulations are described further herein below.
  • the iRNA agent includes double-stranded ribonucleic acid (dsRNA) molecules for inhibiting the expression of an ALAS l gene in a cell or in a subject (e.g., in a mammal, e.g., in a human having a porphyria), where the dsRNA includes an antisense strand having a region of complementarity which is complementary to at least a part of an mRNA formed in the expression of an ALAS l gene, and where the region of complementarity is 30 nucleotides or less in length, generally 19-24 nucleotides in length, and where the dsRNA, upon contact with a cell expressing the ALAS l gene, inhibits the expression of the ALAS l gene by at least 10% as assayed by, for example, a PCR or branched DNA (bDNA)-based method, or by a protein-based method, such
  • dsRNA double-stranded ribonucleic acid
  • the iRNA agent activates the expression of an ALAS l gene in a cell or mammal.
  • Expression of an ALASl gene in cell culture such as in COS cells, HeLa cells, primary hepatocytes, HepG2 cells, primary cultured cells or in a biological sample from a subject can be assayed by measuring ALAS l mRNA levels, such as by bDNA or TaqMan assay, or by measuring protein levels, such as by immunofluorescence analysis, using, for example, Western Blotting or flow cytometric techniques.
  • a dsRNA includes two RNA strands that are sufficiently complementary to hybridize to form a duplex structure under conditions in which the dsRNA will be used.
  • One strand of a dsRNA (the antisense strand) includes a region of complementarity that is substantially complementary, and generally fully complementary, to a target sequence, derived from the sequence of an mRNA formed during the expression of an ALAS1 gene.
  • the other strand (the sense strand) includes a region that is complementary to the antisense strand, such that the two strands hybridize and form a duplex structure when combined under suitable conditions.
  • the duplex structure is between 15 and 30 inclusive, more generally between 18 and 25 inclusive, yet more generally between 19 and 24 inclusive, and most generally between 19 and 21 base pairs in length, inclusive.
  • the region of complementarity to the target sequence is between 15 and 30 inclusive, more generally between 18 and 25 inclusive, yet more generally between 19 and 24 inclusive, and most generally between 19 and 21 nucleotides in length, inclusive.
  • the dsRNA is between 15 and 20 nucleotides in length, inclusive, and in other embodiments, the dsRNA is between 25 and 30 nucleotides in length, inclusive.
  • RNA targeted for cleavage will most often be part of a larger RNA molecule, often an mRNA molecule.
  • a ''part" of an mRNA target is a contiguous sequence of an mRNA target of sufficient length to be a substrate for RNAi-directed cleavage (i.e., cleavage through a RISC pathway).
  • dsRNAs having duplexes as short as 9 base pairs can, under some
  • RNAi-directed RNA cleavage Most often a target will be at least 15 nucleotides in length, e.g., 15-30 nucleotides in length.
  • the duplex region is a primary functional portion of a dsRNA, e.g., a duplex region of 9 to 36, e.g., 15-30 base pairs.
  • a dsRNA RNA molecule or complex of RNA molecules having a duplex region greater than 30 base pairs.
  • an miRNA is a dsRNA.
  • a dsRNA is not a naturally occurring miRNA.
  • an iRNA agent useful to target ALASl expression is not generated in the target cell by cleavage of a larger dsR A.
  • a dsRNA as described herein may further include one or more single-stranded nucleotide overhangs.
  • the dsRNA can be synthesized by standard methods known in the art as further discussed below, e.g., by use of an automated DNA synthesizer, such as are commercially available from, for example, Biosearch, Applied Biosystems, Inc.
  • an ALAS 1 gene is a human ALAS 1 gene.
  • the ALAS 1 gene is a mouse or a rat ALAS 1 gene.
  • the first sequence is a sense strand of a dsRNA that includes a sense sequence disclosed herein, e.g., in Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an sense sequence corresponding to SEQ ID NO: 4149 or 4151 , or one of the even numbered sequences identified as SEQ ID NOs: 4172 to 5236), and the second sequence is an antisense strand of a dsRNA that includes an antisense sequence disclosed herein, e.g., in Tables 21 -40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237).
  • the first sequence is a sense strand of a dsRNA that includes a sense sequence from Table 2 or Table 3 of WO 2015/051318 and the Sequence Listing attached herewith
  • the second sequence is an antisense strand of a dsRNA that includes an antisense sequence from Table 2 or Table 3 of WO 2015/051318 and the Sequence Listing attached herewith
  • the first sequence is a sense strand of a dsRNA that includes a sense sequence from Table 2, 3, 6, 7, 8, 9, 14, or 15 of WO 2015/051318 and the Sequence Listing attached herewith
  • the second sequence is an antisense strand of a dsRNA that includes an antisense sequence from Table 2, 3, 6, 7, 8, 9, 14, or 15 of WO 2015/051318 and the Sequence Listing attached herewith.
  • the first sequence is a sense strand of a dsRNA that includes a sense sequence from Table 2, 3, 6, 7, 8, 9, 14, 15, 18 or 20 of WO 2015/051318 and the Sequence Listing attached herewith
  • the second sequence is an antisense strand of a dsRNA that includes an antisense sequence from Table 2, 3, 6, 7, 8, 9, 14, 15, 18 or 20 of WO 2015/051318 and the Sequence Listing attached herewith.
  • a dsRNA can include at least sense and antisense nucleotide sequences, whereby the sense strand is selected from the sense sequences provided herein, e.g., in Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith (e.g., an antisense sequence corresponding to SEQ ID NO: 4150 or 4152, or one of the odd numbered sequences identified as SEQ ID NOs: 4173 to 5237), and the corresponding antisense strand of the sense strand is selected from the antisense sequences provided herein, e.g., in Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith(e.g., an sense sequence corresponding to SEQ ID NO: 4149 or 4151, or one of the even numbered sequences identified as SEQ ID NOs: 4172 to 5236).
  • the sense strand is selected from the sense sequences provided herein, e.g., in Tables 21-40 of WO 2015/051318 and the Sequ
  • a dsRNA can include at least sense and antisense nucleotide sequences, whereby the sense strand is selected from the groups of sequences provided in Tables 2 and 3 of WO 2015/051318 and the Sequence Listing attached herewith, and the corresponding antisense strand of the sense strand is selected from Tables 2 and 3 of WO 2015/051318 and the Sequence Listing attached herewith.
  • a dsRNA can include at least sense and antisense nucleotide sequences, whereby the sense strand is selected from the groups of sequences provided in Tables 2, 3, 6, 7, 8, 9, 14, and 15 of WO 2015/051318 and the Sequence Listing attached herewith, and the corresponding antisense strand of the sense strand is selected from Tables 2, 3, 6, 7, 8, 9, 14, and 15 of WO 2015/051318 and the Sequence Listing attached herewith.
  • a dsRNA can include at least sense and antisense nucleotide sequences, whereby the sense strand is selected from the groups of sequences provided in Tables 2, 3, 6, 7.
  • the iRNA is AD-60501 , AD-60519, AD-60901, AD-60495, AD-60900, AD-60935, AD-60879, AD-61190, AD-61191 , AD-60865, AD-60861, AD-60876, AD-61193, AD-60519, AD-60519, AD-60901, AD-60405, AD-60887, AD-60923, AD-60434.
  • AD-60419 e.g., including the nucleotide sequence and/or one or more (e.g., all) of the modifications of the aforesaid dsRNAs).
  • the iRNA comprises an antisense strand that comprises, or consists of, an antisense sequence (including one or more (e.g., all the modifications)) selected from the antisense sequence of AD-60501 , AD-60519, AD- 60901 , AD-60495, AD-60900, AD-60935, AD-60879, AD-61 190, AD-61 191 , AD-60865, AD- 60861 , AD-60876, AD-61 193, AD-60519, AD-60519, AD-60901, AD-60405, AD-60887, AD- 60923, AD-60434, AD-60892, AD-60419, AD-60924, AD-60445. AD-60925.
  • an antisense sequence including one or more (e.g., all the modifications) selected from the antisense sequence of AD-60501 , AD-60519, AD- 60901 , AD-60495, AD-60900, AD-60935, AD-60879, AD-61 190, AD-61 191 , AD-60865, AD- 60861
  • the iRNA comprises a sense strand that comprises, or consists of, a sense sequence (and/or one or more (e.g., all) of the modifications)) selected from AD-60501, AD-60519, AD-60901, AD- 60495, AD-60900, AD-60935, AD-60879, AD-61 190, AD-61191, AD-60865, AD-60861 , AD- 60876, AD-61193, AD-60519.
  • the iRNA comprises (i) an antisense strand that comprises, or consists of, the sequence of UAAGAUGAG ACACUCUUUCUGGU or
  • one or more nucleotides of the antisense strand and/or sense strand are modified as described herein.
  • the iRNA comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60489 and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD-60489 (and/or one or more (e.g., all) of the modifications of the sense strand and/or antisense strand of AD-60489).
  • the iRNA comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60519 and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD-60519 (and/or one or more (e.g., all) of the modifications of the sense strand and/or antisense strand of AD-60489).
  • the iRNA comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-61 193 and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD-61 193 (and/or one or more (e.g., all) of the modifications of the sense strand and/or antisense strand of AD-60489).
  • the iRNA comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60819 and/or (ii) a sense sequence that comprises, or consists of, the sense sequence of AD-60819 (and/or one or more (e.g., all) of the modifications of the sense strand and/or antisense strand of AD-60489).
  • the iRNA for inhibiting expression of ALAS 1 comprises (i) an antisense strand that comprises, or consists of, the antisense sequence of AD-60489, AD-60519, AD-61193. or AD-60819 (or a corresponding unmodified antisense sequence) and/or (ii) a sense strand that comprises, or consists of, the sense sequence of AD- 60489, AD-60519, AD-61 193, or AD-60819 (or a corresponding unmodified antisense sequence).
  • the iRNA comprises (i) an antisense strand that consists of the antisense sequence of AD-60489, AD-60519, AD-61 193, or AD-60819 and/or (ii) a sense strand that consists of the sense sequence of AD-60489, AD-60519, AD-61 193, or AD-60819, except that the antisense strand and/or sense strand of the dsRNA differs by 1, 2, or 3 nucleotides from the corresponding antisense and/or sense sequence of AD-60489, AD-60519, AD-61193, or AD- 60819.
  • AD-60489, AD-60519, AD-61193, and AD-60819 are shown in Table 2 disclosed herein.
  • the iRNA is ALN-60519.
  • ALN-60519 is a chemically synthesized double stranded oligonucleotide covalently linked to a ligand containing three N- acetylgalactosamine (GalNAc) residues (depicted in FIG. 57 of WO 2015/051318).
  • all nucleotides of ALN-60519 are 2'-OMe or 2'-F modified and are connected through 3 '-5' phosphodiester linkages, thus forming the sugar-phosphate backbone of the oligonucleotide.
  • the sense strand and the antisense strand of ALN-60519 contain 21 and 23 nucleotides, respectively.
  • the 3'-end of the sense strand of ALN-60519 is conjugated to the triantennary GalNAc moiety (referred to as L96) through a phosphodiester linkage.
  • the antisense strand contains four phosphorothioate linkages - two at the 3' end and two at the 5' end.
  • the sense strand of ALN-60519 contains two phosphorothioate linkages at the 5' end.
  • the 21 nucleotides of the sense strand of ALN-60519 hybridize with the complementary 21 nucleotides of the antisense strand, thus forming 21 nucleotide base pairs and a two-base overhang at the 3'-end of the antisense strand.
  • the two single strands, the sense strand and the antisense strand, of ALN-60519 can be synthesized by conventional solid phase oligonucleotide synthesis, employing standard phosphoramidite chemistry with the 5 '-hydroxy! group protected as dimethoxytriphenylmethyl (DMT) ether. Each strand can be assembled from the 3' to the 5' terminus by sequential addition of protected nucleoside phosphoramidites.
  • one of the two sequences is complementary to the other of the two sequences, with one of the sequences being substantially complementary to a sequence of an mRNA generated by the expression of an ALAS 1 gene gene.
  • a dsRNA will include two oligonucleotides, where one oligonucleotide is described herein as the sense strand, and the second oligonucleotide is described as the corresponding antisense strand.
  • the complementary sequences of a dsRNA can also be contained as self-complementary regions of a single nucleic acid molecule, as opposed to being on separate oligonucleotides.
  • dsRNAs having a duplex structure of between 20 and 23, but specifically 21 , base pairs have been hailed as particularly effective in inducing RNA interference (Elbashir et al, EMBO . 2001, 20:6877-6888).
  • RNA duplex structures can be effective as well.
  • dsRNAs described herein can include at least one strand of a length of minimally 21 nucleotides.
  • dsRNAs having a partial sequence of at least 15, 16, 17, 18, 19, 20, or more contiguous nucleotides from one of the sequences disclosed herein, and differing in their ability to inhibit the expression of an ALAS 1 gene by not more than 5, 10, 15, 20, 25, or 30 % inhibition from a dsRNA comprising the full sequence are contemplated according to the invention.
  • RNAs provided in the tables of WO 2015/051318 and the Sequence Listing attached herewith identify a site in an ALAS1 transcript that is susceptible to RISC- mediated cleavage.
  • the present invention further features iRNAs that target within one of such sequences.
  • an iRNA is said to target within a particular site of an RNA transcript if the iRNA promotes cleavage of the transcript anywhere within that particular site.
  • Such an iRNA will generally include at least 15 contiguous nucleotides from one of the sequences provided herein, e.g., in Tables 2, 3, 6, 7, 8, 9, 14, 15, 18, 20 of WO 2015/051318 and the Sequence Listing attached herewith, and in Tables 21-40 of WO 2015/051318 and the Sequence Listing attached herewith, coupled to additional nucleotide sequences taken from the region contiguous to the selected sequence in an ALAS 1 gene.
  • target sequence is generally 15-30 nucleotides in length, there is wide variation in the suitability of particular sequences in this range for directing cleavage of any given target RNA.
  • Various software packages and the guidelines set out herein provide guidance for the identification of optimal target sequences for any given gene target, but an empirical approach can also be taken in which a "window” or “mask” of a given size (as a non-limiting example, 21 nucleotides) is literally or figuratively (including, e.g., in silico) placed on the target RNA sequence to identify sequences in the size range that may serve as target sequences.
  • the next potential target sequence can be identified, until the complete set of possible sequences is identified for any given target size selected.
  • This process coupled with systematic synthesis and testing of the identified sequences (using assays as described herein or as known in the art) to identify those sequences that perform optimally can identify those RNA sequences that, when targeted with an iRNA agent, mediate the best inhibition of target gene expression.
  • sequences identified for example, in the tables of WO 2015/051318 and the Sequence Listing attached herewith, represent effective target sequences, it is
  • optimized sequences can be adjusted by, e.g., the introduction of modified nucleotides as described herein or as known in the ait, addition or changes in overhang, or other modifications as known in the art and/or discussed herein to further optimize the molecule (e.g., increasing serum stability or circulating half-life, increasing thermal stability, enhancing transmembrane delivery, targeting to a particular location or cell type, increasing interaction with silencing pathway enzymes, increasing release from endosomes, etc.) as an expression inhibitor.
  • modified nucleotides as described herein or as known in the ait, addition or changes in overhang, or other modifications as known in the art and/or discussed herein to further optimize the molecule (e.g., increasing serum stability or circulating half-life, increasing thermal stability, enhancing transmembrane delivery, targeting to a particular location or cell type, increasing interaction with silencing pathway enzymes, increasing release from endosomes, etc.) as an expression inhibitor.
  • an iRNA as described herein can contain one or more mismatches to the target sequence. In one embodiment, an iRNA as described herein contains no more than 3 mismatches. If the antisense strand of the iRNA contains mismatches to a target sequence, it is preferable that the area of mismatch not be located in the center of the region of complementarity. If the antisense strand of the iRNA contains mismatches to the target sequence, it is preferable that the mismatch be restricted to be within the last 5 nucleotides from either the 5' or 3' end of the region of complementarity. For example, for a 23 nucleotide iRNA agent RNA strand which is
  • the RNA strand generally does not contain any mismatch within the central 13 nucleotides.
  • the methods described herein or methods known in the art can be used to determine whether an iRNA containing a mismatch to a target sequence is effective in inhibiting the expression of an ALAS1 gene. Consideration of the efficacy of iRNAs with mismatches in inhibiting expression of an ALAS1 gene is important, especialiy if the particular region of complementarity in an ALAS 1 gene is known to have polymorphic sequence variation within the population.
  • a dsRNA has a single-stranded nucleotide overhang of 1 to 4, generally 1 or 2 nucleotides. dsRNAs having at least one nucleotide overhang have unexpectedly superior inhibitory properties relative to their blunt-ended counterparts.
  • the RNA of an iRNA e.g., a dsRNA
  • the nucleic acids featured in the invention may be synthesized and/or modified by methods well established in the art, such as those described in "Current protocols in nucleic acid chemistry," Beaucage, S.L. et al.
  • Modifications include, for example, (a) end modifications, e.g., 5' end modifications (phosphorylation, conjugation, inverted linkages, etc.) 3' end modifications (conjugation, DNA nucleotides, inverted linkages, etc.), (b) base modifications, e.g., replacement with stabilizing bases, destabilizing bases, or bases that base pair with an expanded repertoire of partners, removal of bases (abasic nucleotides), or conjugated bases, (c) sugar modifications ⁇ e.g., at the 2' position or 4' position, or having an acyclic sugar) or replacement of the sugar, as well as (d) backbone modifications, including modification or replacement of the phosphodiester linkages.
  • end modifications e.g., 5' end modifications (phosphorylation, conjugation, inverted linkages, etc.) 3' end modifications (conjugation, DNA nucleotides, inverted linkages, etc.
  • base modifications e.g., replacement with stabilizing bases, destabilizing bases, or
  • RNA compounds useful in this invention include, but are not limited to RNAs containing modified backbones or no natural internucleoside linkages.
  • RNAs having modified backbones include, among others, those that do not have a phosphorus atom in the backbone.
  • modified RNAs that do not have a phosphorus atom in their internucleoside backbone can also be considered to be oligonucleosides.
  • the modified RNA will have a phosphorus atom in its intemucieoside backbone.
  • Modified RNA backbones include, for example, phosphorothioates, chiral
  • phosphorothioates phosphorodithioates, phosphotriesters, aminoalkylphosphotriesters, methyl and other alkyl phosphonates including 3'-alkylene phosphonates and chiral phosphonates, phosphinates, phosphoramidates including 3'-amino phosphoramidate and
  • aminoalkylphosphoramidates aminoalkylphosphoramidates , thionophosphoramidates, thionoalkylphosphonates ,
  • thionoalkylphosphotriesters having normal 3 -5' linkages, 2'-5' linked analogs of these, and those) having inverted polaiity wherein the adjacent pairs of nucleoside units are linked 3 -5' to 5'-3' or 2 -5' to 5 -2'.
  • Various salts, mixed salts and free acid forms are also included.
  • Modified RNA backbones that do not include a phosphorus atom therein have backbones that are formed by short chain alkyl or cycloalkyl intemucieoside linkages, mixed heteroatoms and alkyl or cycloalkyl intemucieoside linkages, or one or more short chain heteroatomic or heterocyclic intemucieoside linkages.
  • morpholino linkages formed in part from the sugar portion of a nucleoside
  • siioxane backbones siioxane backbones
  • sulfide, sulfoxide and sulfone backbones formacetyl and thiotormacetyl backbones
  • methylene formacetyl and thioformacetyl backbones alkene containing backbones; sulfamate backbones; methyleneimino and methylenehydrazino backbones; sulfonate and sulfonamide backbones; amide backbones; and others having mixed N, O, S and CH 2 component parts.
  • RNA mimetics suitable or contemplated for use in iRNAs both the sugar and the internucleoside linkage, i.e., the backbone, of the nucleotide units are replaced with novel groups.
  • the base units are maintained for hybridization with an appropriate nucleic acid target compound.
  • One such oligomeric compound, an RNA mimetic that has been shown to have excellent hybridization properties, is referred to as a peptide nucleic acid (PNA).
  • PNA peptide nucleic acid
  • the sugar backbone of an RNA is replaced with an amide containing backbone, in particular an aminoethylglycine backbone.
  • the nucleobases are retained and are bound directly or indirectly to aza nitrogen atoms of the amide portion of the backbone.
  • Representative U.S. patents that teach the preparation of PNA compounds include, but are not limited to, U.S. Pat.
  • RNAs with phosphorothioate backbones and oligonucleosides with heteroatom backbones and in particular— CH 2 ⁇ NH— CH 2 ⁇ , --CH 2 --N(CH 3 )--0--CH 2 --[known as a methylene (methylimino) or MMI backbone], ⁇ CH 2 -0- -N(CH 3 ) ⁇ CH 2 ⁇ , -CH2-N(CH 3 ) ⁇ N(CH 3 ) ⁇ CH2 ⁇ and -N(CH 3 )-CH2-CH 2 ⁇ fwherein the native phosphodiester backbone is represented as ⁇ 0— P—O—CH?—] of the above-referenced U.S. Pat. No.
  • RNAs featured herein have morpholino backbone structures of the above-referenced U.S. Pat. No. 5,034,506.
  • Modified RNAs may also contain one or more substituted sugar moieties.
  • the iRNAs, e.g., dsRNAs, featured herein can include one of the following at the 2' position: OH; F; 0-, S-, or N-alkyl; 0-, S-, or N-alkenyl; 0-, S- or N-alkynyl; or O-alkyl-O-alkyl, wherein the alkyl, alkenyl and alkynyl may be substituted or unsubstituted Ci to Cio alkyl or C 2 to Cio alkenyl and alkynyl.
  • Exemplary suitable modifications include Of(CH?) n O] m CH 3 , 0(CH 2 ).,iOCH3,
  • n and m are from 1 to about 10.
  • dsRNAs include one of the following at the 2' position: Q to Cjo lower alkyl, substituted lower alkyl, aikaryl, aralkyl, O-alkaryl or O-aralkyl, SH, SCH 3 , OCN, CI, Br, CN, CF 3 , OCF 3 , SOCH 3 , S0 2 CH 3 , ON0 2 , N0 2 , N 3 , NH 2 ,
  • heterocycloalkyl heterocycloalkaryl, aminoalkylamino, polyalkylamino, substituted silyl, an RNA cleaving group, a reporter group, an intercalator, a group for improving the
  • the modification includes a 2'-methoxyethoxy (2'-0— CH 2 CH 2 OCH , also known as 2'-0-(2- methoxyethyl) or 2'-MOE) (Martin et al, Helv. Chim. Acta, 1995, 78:486-504) i.e., an alkoxy- alkoxy group.
  • a 2'-methoxyethoxy 2'-0— CH 2 CH 2 OCH , also known as 2'-0-(2- methoxyethyl) or 2'-MOE) (Martin et al, Helv. Chim. Acta, 1995, 78:486-504)
  • Another exemplary modification is 2'-dimethylaminooxyethoxy, i.e., a
  • 0(CH 2 ) 2 ON(CFi 3 )2 group also known as 2'-DMAOE, as described in examples herein below
  • 2'-dimethylaminoethoxyethoxy also known in the art as 2'-0-dimethylaminoethoxyethyl or 2 -DMAEOE
  • 2'-0--CH 2 --0--CH 2 --N(CH 2 ) 2 also described in examples herein below.
  • an iRNA agent comprises one or more (e.g., about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more) acyclic nucleotides (or nucleosides).
  • the sense strand or the antisense strand, or both sense strand and antisense strand include less than five acyclic nucleotides per strand (e.g., four, three, two or one acyclic nucleotides per strand).
  • the one or more acyclic nucleotides can be found, for example, in the double-stranded region, of the sense or antisense strand, or both strands; at the 5'-end, the 3'-end, both of the 5' and 3'-ends of the sense or antisense strand, or both strands, of the iRNA agent. In one embodiment, one or more acyclic nucleotides are present at positions 1 to 8 of the sense or antisense strand, or both. In one embodiment, one or more acyclic nucleotides are found in the antisense strand at positions 4 to 10 (e.g., positions 6-8) from the 5'-end of the antisense strand. In another embodiment, the one or more acyclic nucleotides are found at one or both 3'-terminai overhangs of the iRNA agent.
  • acyclic nucleotide or "acyclic nucleoside” as used herein refers to any nucleotide or nucleoside having an acyclic sugar, e.g., an acyclic ribose.
  • An exemplary acyclic nucleotide or nucleoside can include a nucleobase, e.g., a naturally-occurring or a modified nucleobase (e.g., a nucleobase as described herein).
  • a bond between any of the ribose carbons (CI, C2, C3, C4, or C5), is independently or in combination absent from the nucleotide.
  • the bond between C2-C3 carbons of the ribose ring is absent, e.g., an acyclic 2'-3'-seco-nucleotide monomer.
  • the bond between C1-C2, C3-C4, or C4-C5 is absent ⁇ e.g., a V- , 3 -4' or 4'-5'-seco nucleotide monomer).
  • Exemplary acyclic nucleotides are disclosed in US 8,314,227, incorporated herein by reference in its entirely.
  • an acyclic nucleotide can include any of monomers D-J in Figures 1-2 of US 8,314,227.
  • the acyclic nucleotide includes the following monomer:
  • Base is a nucleobase, e.g., a naturally-occurring or a modified nucleobase (e.g., a nucleobase as described herein).
  • the acyclic nucleotide can be modified or derivatized, e.g., by coupling the acyclic nucleotide to another moiety, e.g., a ligand (e.g. , a GalNAc, a cholesterol ligand), an alkyl, a polyamine, a sugar, a polypeptide, among others.
  • a ligand e.g. , a GalNAc, a cholesterol ligand
  • the iRNA agent includes one or more acyclic nucleotides and one or more LNAs (e.g., an LNA as described herein).
  • one or more acyclic nucleotides and/or one or more LNAs can be present in the sense strand, the antisense strand, or both.
  • the number of acyclic nucleotides in one strand can be the same or different from the number of LNAs in the opposing strand.
  • the sense strand and/or the antisense strand comprises less than five LNAs (e.g., four, three, two or one LNAs) located in the double- stranded region or a 3' -overhang, In other embodiments, one or two LNAs are located in the double stranded region or the 3 '-overhang of the sense strand.
  • the sense strand and/or antisense strand comprises less than five acyclic nucleotides (e.g., four, three, two or one acyclic nucleotides) in the double-stranded region or a 3 '-overhang.
  • the sense strand of the iRNA agent comprises one or two LNAs in the 3'-overhang of the sense strand, and one or two acyclic nucleotides in the double- standed region of the antisense strand (e.g., at positions 4 to 10 (e.g., positions 6-8) from the 5'-end of the antisense strand) of the iRNA agent.
  • inclusion of one or more acyclic nucleotides (alone or in addition to one or more LNAs) in the iRNA agent results in one or more (or ali) of: (i) a reduction in an off-target effect; (ii) a reduction in passenger strand participation in RNAi; (iii) an increase in specificity of the guide strand for its target mRNA; (iv) a reduction in a microRNA off-target effect; (v) an increase in stability; or (vi) an increase in resistance to degradation, of the iRNA molecule.
  • RNA of an iRNA may also have sugar mimetics such as cyclobutyl moieties in place of the pentofuranosyl sugar.
  • An iRNA may also include nucleobase (often referred to in the art simply as “base”) modifications or substitutions.
  • nucleobases include the purine bases adenine (A) and guanine (G), and the pyrimidine bases thymine (T), cytosine (C) and uracil (U).
  • Modified nucleobases include other synthetic and natural nucleobases such as 5-methylcytosine (5-me-C), 5-hydroxymethyl cytosine, xanthine, hypoxanthine, 2- aminoadenine, 6-methyl and other alkyl derivatives of adenine and guanine, 2-propyl and other alkyl derivatives of adenine and guanine, 2-thiouracil, 2-thiothymine and 2-thiocytosine, 5- halouracii and cytosine, 5-propynyl uracil and cytosine, 6-azo uracil, cytosine and thymine, 5- uracil (pseudouracil), 4-thiouracil, 8-halo, 8-amino, 8-thiol, 8-thioalkyi, 8-hydroxyl anal other 8- substituted adenines and guanines, 5-halo, particularly 5-bromo, 5-trifluoromethyi and other 5- substituted
  • nucleobases include those disclosed in U.S. Pat. No. 3,687,808, those disclosed in Modified Nucleosides in Biochemistry, Biotechnology and Medicine, Herdewijn, P. ed. Wiley- VCH, 2008; those disclosed in The Concise Encyclopedia Of Polymer Science And Engineering, pages 858-859, Kroschwitz, J. L, ed. John Wiley & Sons, 1990, these disclosed by Englisch et al, Angewandte Chemie, International Edition, 1991, 30, 613, and those disclosed by Sanghvi, Y S., Chapter 15, dsRNA Research and Applications, pages 289-302, Crooke, S. T. and Lebleu, B., Ed., CRC Press, 1993.
  • nucleobases are particularly useful for increasing the binding affinity of the oligomeric compounds featured in the invention.
  • These include 5- substituted pyrimidines, 6-azapyrimidines and N-2, N-6 and 0-6 substituted purines, including 2- aminopropyladenine, 5-propynyluracil and 5-propynylcytosine.
  • 5-methylcytosine substitutions have been shown to increase nucleic acid duplex stability by 0.6-1.2°C (Sanghvi, Y. S., Crooke, S. T. and Lebleu, B., Eds., dsRNA Research and Applications, CRC Press, Boca Raton, 1993, pp. 276-278) and are exemplary base substitutions, even more particularly when combined with 2'-0-methoxyethyl sugar modifications.
  • RNA of an iRNA can also be modified to include one or more (e.g., about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more) locked nucleic acids (LNA), (also referred to herein as "locked nucleotides”)-
  • LNA locked nucleic acids
  • a locked nucleic acid is a nucleotide having a modified ribose moiety in which the ribose moiety comprises an extra bridge connecting, e.g., the 2' and 4' carbons. This structure effectively "locks" the ribose in the 3'-endo stiaictural conformation.
  • U.S. Patents that teach the preparation of locked nucleic acid nucleotides include, but are not limited to, the following: U.S. Pat. Nos. 6,268,490; 6,670,461 ; 6,794,499; 6,998,484; 7,053.207; 7,084,125; 7,399,845; and 8,314,227, each of which is herein incorporated by reference in its entirety.
  • Exemplary LNAs include but are not limited to, a 2', 4'-C methylene bicyclo nucleotide (see for example Wengel et a!., International PCT Publication No. WO
  • the iRNA agents include one or more (e.g., about 1 , 2, 3, 4, 5, 6, 7,
  • G-clamp nucleotides 8 9, 10, or more G-clamp nucleotides.
  • a G-clamp nucleotide is a modified cytosine analog wherein the modifications confer the ability to hydrogen bond both Watson-Crick and Hoogsteen faces of a complementary guanine within a duplex, see for example Lin and Matteucci, 1998, J.
  • oligonucleotide can result in substantially enhanced helical thermal stability and mismatch discrimination when hybridized to complementary oligonucleotides.
  • the inclusion of such nucleotides in the iRNA molecules can result in enhanced affinity and specificity to nucleic acid targets, complementary sequences, or template strands.
  • RNA molecules can include N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N
  • the sense strand sequence may be represented by formula (I):
  • i and j are each independently 0 or 1;
  • p and q are each independently 0-6;
  • each N a independently represents an oligonucleotide sequence comprising 0-25 modified nucleotides, each sequence comprising at least two differently modified nucleotides;
  • each Nb independently represents an oligonucleotide sequence comprising 0-10 modified nucleotides
  • each li p and n q independently represent an overhang nucleotide
  • Nb and Y do not have the same modification; and XXX, YYY and ZZZ each independently represent one motif of three identical modifications on three consecutive nucleotides.
  • YYY is all 2'-F modified
  • the N a and/or Nb comprise modifications of alternating pattern.
  • the YYY motif occurs at or near the cleavage site of the sense strand.
  • the YYY motif can occur at or the vicinity of the cleavage site (e.g. : can occur at positions 6, 7, 8; 7, 8, 9; 8, 9, 10; 9, 10, 1 1; 10, 1 1 ,12 or 11, 12, 13) of - the sense strand, the count starting from the 1 st nucleotide, from the 5' -end; or optionally, the count starting at the 1 st paired nucleotide within the duplex region, from the 5'- end.
  • the cleavage site e.g. : can occur at positions 6, 7, 8; 7, 8, 9; 8, 9, 10; 9, 10, 1 1; 10, 1 1 ,12 or 11, 12, 13
  • i is 1 and j is 0, or i is 0 and j is 1, or both i and j are 1.
  • the sense strand can therefore be represented by the following formulas:
  • N b represents an oligonucleotide sequence comprising 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides.
  • Each N a independently can represent an oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified nucleotides.
  • N b represents an oligonucleotide sequence comprising 0- 10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides.
  • Each N a can
  • oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified nucleotides.
  • each N b independently represents an oligonucleotide sequence comprising 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides.
  • N b is 0, 1, 2, 3, 4, 5 or 6.
  • Each N a can independently represent an oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified nucleotides.
  • Each of X, Y and Z may be the same or different from each other.
  • each N a independently can represent an oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified nucleotides.
  • the antisense strand sequence of the RNAi may be represented by formula (II):
  • k and 1 are each independently 0 or 1 ;
  • p' and q' are each independently 0-6;
  • each N a ' independently represents an oligonucleotide sequence comprising 0-25 modified nucleotides, each sequence comprising at least two differently modified nucleotides;
  • each Nb' independently represents an oligonucleotide sequence comprising 0-10 modified nucleotides
  • each n p ' and n q ' independently represent an overhang nucleotide
  • N b ' and Y' do not have the same modification
  • ⁇ ' ⁇ ' ⁇ ', ⁇ ' and Z'Z'Z' each independently represent one motif of three identical modifications on three consecutive nucleotides.
  • the N a ' and/or N ' comprise modifications of alternating pattern.
  • the Y'Y'Y' motif occurs at or near the cleavage site of the antisense strand.
  • the ⁇ ' motif can occur at positions 9, 10, 11 ;10, 1 1, 12; 1 1, 12, 13; 12, 13, 14 ; or 13, 14, 15 of the antisense strand, with the count starting from the 1 nucleotide, from the 5 '-end; or optionally, the count starting at the 1 st paired nucleotide within the duplex region, from the 5'- end.
  • the ⁇ ' ⁇ ' mot j occurs a t positions 11, 12, 13.
  • Y'Y'Y' motif is all 2'-OMe modified nucleotides.
  • k is 1 and 1 is 0, or k is 0 and 1 is 1, or both k and 1 are 1.
  • the antisense strand can therefore be represented by the following formulas:
  • N b represents an oligonucleotide sequence comprising 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides.
  • Each N a ' independently represents an oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified nucleotides.
  • N b ' represents an
  • oligonucleotide sequence comprising 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides.
  • Each N a ' independently represents an oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified nucleotides.
  • each N b ' independently represents an oligonucleotide sequence comprising 0-10, 0-7, 0-5, 0-4, 0-2 or 0 modified nucleotides.
  • Each N a ' independently represents an oligonucleotide sequence comprising 2-20, 2- 15, or 2-10 modified nucleotides.
  • N b is 0, 1, 2, 3, 4, 5 or 6.
  • k is 0 and 1 is 0 and the antisense strand may be represented by the formula:
  • each N a ' independently represents an oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified nucleotides.
  • Each of X', Y' and Z' may be the same or different from each other.
  • Each nucleotide of the sense strand and antisense strand may be independently modified with LNA, HNA, CeNA, 2'-methoxyethyl, 2'-0-methyI, 2'-0-allyI, 2'-C- allyl, 2'-hydroxyl, or 2'-fluoro.
  • each nucleotide of the sense strand and antisense strand is independently modified with 2'-0-methyI or 2'-fluoro.
  • Each X, Y, Z, X', Y' and Z' in particular, may represent a 2'-0-methyl modification or a 2'-fluoro modification.
  • the sense strand of the RNAi agent may contain YYY motif occurring at 9, 10 and 11 positions of the strand when the duplex region is 21 nt, the count starting from the 1 st nucleotide from the 5 '-end, or optionally, the count starting at the 1 st paired nucleotide within the duplex region, from the 5'- end; and Y represents 2'-F modification.
  • the sense strand may additionally contain XXX motif or ZZZ motifs as wing modifications at the opposite end of the duplex region; and XXX and ZZZ each independently represents a 2'-OMe modification or 2'-F modification.
  • the antisense strand may contain ⁇ ' ⁇ ' motif occurring at positions 11, 12, 13 of the strand, the count starting from the 1 nucleotide from the 5'-end, or optionally, the count starting at the 1 st paired nucleotide within the duplex region, from the 5'- end; and Y' represents 2'-0-methyI modification.
  • the antisense strand may additionally contain X'X3 ⁇ 4' motif or Z'Z'Z' motifs as wing modifications at the opposite end of the duplex region; and X3 ⁇ 4'X' and Z'Z'Z' each independently represents a 2'-OMe modification or 2'-F modification.
  • the sense strand represented by any one of the above formulas (la), (lb), (Ic), and (Id) forms a duplex with a antisense strand being represented by any one of formulas (Ila), (lib), (lie), and (lid), respectively.
  • RNAi agents for use in the methods of the invention may comprise a sense strand and an antisense strand, each strand having 14 to 30 nucleotides, the RNAi duplex represented by formula (III):
  • i, j, k, and 1 are each independently 0 or 1;
  • p, p', q, and q' are each independently 0-6:
  • each N a and N a independently represents an oligonucleotide sequence comprising 0-25 modified nucleotides, each sequence comprising at least two differently modified nucleotides; each N and N b independently represents an oligonucleotide sequence comprising 0-10 modified nucleotides;
  • each n p ', n p , n q ', and n q independently represents an overhang nucleotide
  • XXX, YYY, ZZZ, ⁇ ' ⁇ ' ⁇ ', ⁇ ' ⁇ ', and Z'Z'Z' each independently represent one motif of three identical modifications on three consecutive nucleotides.
  • i is 0 and j is 0; or i is 1 and j is 0; or i is 0 and j is 1 ; or both i and j are 0; or both i and j are 1.
  • k is 0 and I is 0; or k is 1 and I is 0; k is 0 and l is 1 ; or both k and 1 are 0; or both k and 1 are 1.
  • Exemplary combinations of the sense strand and antisense strand forming a RNAi duplex include the formulas below:
  • each N a independently represents an oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified nucleotides.
  • each N b independently represents an oligonucleotide sequence comprising 1-10, 1-7, 1-5 or 1-4 modified nucleotides.
  • Each N a independently represents an oligonucleotide sequence comprising 2-20, 2-15, or 2-10 modified nucleotides.
  • each N b , N b ' independently represents an oligonucleotide sequence comprising 0-10, 0-7, 0-5, 0-4, 0-2 or Omodified nucleotides.
  • Each N a independently represents an oligonucleotide sequence compiising 2-20, 2- 15, or 2-10 modified nucleotides.
  • each N b , N b ' independently represents an oligonucleotide sequence comprising 0-10, 0-7, 0-5, 0-4, 0-2 or Omodified nucleotides.
  • Each N a , N a independently represents an oligonucleotide sequence comprising 2- 20, 2-15, or 2-10 modified nucleotides.
  • Each of N a , N a ⁇ N b and N independently comprises modifications of alternating pattern.
  • Each of X, Y and Z in formulas (III), (Ilia), (Hlb), (IIIc), and (Hid) may be the same or different from each other.
  • the RNAi agent is represented by formula (III), (Ilia), (IHb), (HIc), and (Hid)
  • at least one of the Y nucleotides may form a base pair with one of the Y' nucleotides.
  • At least two of the Y nucleotides form base pairs with the corresponding Y' nucleotides; or all three of the Y nucleotides all form base pairs with the corresponding Y' nucleotides.
  • RNAi agent When the RNAi agent is represented by formula (IHb) or (Hid), at least one of the Z nucleotides may form a base pair with one of the Z' nucleotides. Alternatively, at least two of the Z nucleotides form base pairs with the corresponding Z' nucleotides; or all three of the Z nucleotides all form base pairs with the corresponding Z' nucleotides.
  • RNAi agent When the RNAi agent is represented as formula (IIIc) or (Hid), at least one of the X nucleotides may form a base pair with one of the X' nucleotides. Alternatively, at least two of the X nucleotides form base pairs with the corresponding X' nucleotides; or all three of the X nucleotides all form base pairs with the corresponding X' nucleotides.
  • the modification on the Y nucleotide is different than the
  • the modification on the Y' nucleotide is different than the modification on the Z' nucleotide
  • the modification on the X nucleotide is different than the modification on the X' nucleotide.
  • the N a modifications are 2 -0-methyl or 2 -fluoro modifications.
  • the N a modifications are 2'-0-methyl or 2'-fluoro modifications and n p ' >0 and at least one n p ' is linked to a neighboring nucleotide a via phosphorothioate linkage.
  • the N a modifications are 2'-0-methyl or 2'-fluoro modifications , n p ' >0 and at least one n p ' is linked to a neighboring nucleotide via phosphorothioate linkage, and the sense strand is conjugated to one or more GalNAc derivatives attached through a bivalent or trivalent branched linker.
  • the N a modifications are 2'-0-methyl or 2'-fluoro modifications , n p ' >0 and at least one n p ' is linked to a neighboring nucleotide via phosphorothioate linkage, the sense strand comprises at least one phosphorothioate linkage, and the sense strand is conjugated to one or more GalNAc derivatives attached through a bivalent or trivalent branched linker.
  • the N u modifications are 2'-0-methyl or 2'-fluoro modifications , n p ' >0 and at least one n p ' is linked to a neighboring nucleotide via phosphorothioate linkage, the sense strand comprises at least one phosphorothioate linkage, and the sense strand is conjugated to one or more GalNAc derivatives attached through a bivalent or trivalent branched linker.
  • the RNAi agent is a multimer containing at least two duplexes represented by formula (III), (Ilia), (Illb), (111c), and (Illd), wherein the duplexes are connected by a linker.
  • the linker can be cieavable or non-cleavable.
  • the multimer further comprises a ligand.
  • Each of the duplexes can target the same gene or two different genes; or each of the duplexes can target same gene at two different target sites.
  • the RNAi agent is a multimer containing three, four, five, six or more duplexes represented by formula (III), (Ilia), (Illb), (IIIc), and (IHd), wherein the duplexes are connected by a linker.
  • the linker can be cieavable or non-cleavable.
  • the multimer further comprises a ligand.
  • Each of the duplexes can target the same gene or two different genes; or each of the duplexes can target same gene at two different target sites.
  • two RNAi agents represented by formula (111), (Ilia), (Illb), (IIIc), and (Illd) are linked to each other at the 5' end, and one or both of the 3' ends and are optionally conjugated to to a ligand.
  • Each of the agents can target the same gene or two different genes; or each of the agents can target same gene at two different target sites.
  • the iRNA agents disclosed herein can be in the form of conj gates.
  • the conjugate may be attached at any suitable location in the iRNA molecule, e.g., at the 3' end or the 5' end of the sense or the antisense strand.
  • the conjugates are optionally attached via a linker.
  • an iRNA agent described herein is chemically linked to one or more ligands, moieties or conjugates, which may confer functionality, e.g., by affecting (e.g., enhancing) the activity, cellular distribution or cellular uptake of the iRNA.
  • moieties include but are not limited to lipid moieties such as a cholesterol moiety (Letsinger et al., Proc. Natl. Acid. Sci, USA, 1989, 86: 6553-6556), cholic acid (Manoharan et al., Biorg. Med, Chem.
  • a thioether e.g., beryi-S-tritylthiol (Manoharan et al, Ann, N. Y. Acad. Sci, 1992, 660:306-309; Manoharan et al, Biorg. Med. Chem. Let., 1993, 3:2765-2770), a thiocholesterol (Oberhauser et al., Nucl. Acids Res., 1992, 20:533-538), an aliphatic chain, e.g., dodecandioi or undecyl residues (Saison-Behmoaras et al., EMBO J, 1991, 10: 1111-1118;
  • a phospholipid e.g., di-hexadecyl-rac-glycerol or trie thyl- ammonium 1,2-di-O-hexadecyl-rac- glycero-3-phosphonate (Manoharan et al.. Tetrahedron Lett., 1995, 36:3651 -3654; Shea et al., Nucl.
  • Acids Res., 1990, 18:3777-3783 a olyamine or a polyethylene glycol chain (Manoharan et al, Nucleosides & Nucleotides, 1995, 14:969-973), or adamantane acetic acid (Manoharan et al.. Tetrahedron Lett., 1995, 36:36 1 -3654), a palmityl moiety (Mishra et al., Biochim. Biophys. Acta, 1995, 1264:229-237), or an octadecylamine or hexyiamino-carbonyloxycholesterol moiety (Crooke et al, ./. Pharmacol. Exp. Ther. , 1996, 277:923-937).
  • a ligand alters the distribution, targeting or lifetime of an iRNA agent into which it is incorporated.
  • a ligand provides an enhanced affinity for a selected target, e.g, molecule, cell or cell type, compartment, e.g., a cellular or organ compartment, tissue, organ or region of the body, as, e.g., compared to a species absent such a ligand.
  • Typical ligands will not take part in duplex pairing in a duplexed nucleic acid.
  • Ligands can include a naturally occurring substance, such as a protein (e.g., human serum albumin (HSA), low-density lipoprotein (LDL), or globulin); carbohydrate (e.g., a dextran, potulan, chitin, chitosan, inulin, cyciodextrin or hyaluronic acid); or a lipid.
  • HSA human serum albumin
  • LDL low-density lipoprotein
  • globulin carbohydrate
  • carbohydrate e.g., a dextran, memelulan, chitin, chitosan, inulin, cyciodextrin or hyaluronic acid
  • the ligand may also be a recombinant or synthetic molecule, such as a synthetic polymer, e.g., a synthetic polyamino acid.
  • polyamino acids examples include polyamino acid is a polylysine (PLL), poly L-aspartic acid, poly L-glutamic acid, styrene-maleic acid anhydride copolymer, poly(L- lactide-co-glycolied) copolymer, divinyl ether-maleic anhydride copolymer, N-(2- hydroxypropyi)methacrylamide copolymer (HMPA), polyethylene glycol (PEG), polyvinyl alcohol (PVA), polyurethane, poly(2-ethylacryliic acid), N-isopropylacrylamide polymers, or polyphosphazine.
  • PLL polylysine
  • poly L-aspartic acid poly L-glutamic acid
  • styrene-maleic acid anhydride copolymer poly(L- lactide-co-glycolied) copolymer
  • divinyl ether-maleic anhydride copolymer divinyl
  • Example of poiyamines include: polyeth lenimine, polylysine (PLL), spermine, spermidine, polyamine, pseudopeptide-polyamine, peptidomimetic polyamine, dendrimer polyamine, arginine, amidine, protamine, cationic lipid, cationic porphyrin, quaternary salt of a polyamine, or an a helical peptide.
  • PLL polylysine
  • spermine spermine
  • spermidine polyamine
  • polyamine pseudopeptide-polyamine
  • peptidomimetic polyamine dendrimer polyamine
  • arginine amidine
  • protamine cationic lipid
  • cationic porphyrin quaternary salt of a polyamine
  • quaternary salt of a polyamine or an a helical peptide.
  • Ligands can also include targeting groups, e.g., a cell or tissue targeting agent, e.g., a lectin, glycoprotein, lipid or protein, e.g., an antibody, that binds to a specified cell type such as a kidney cell.
  • a cell or tissue targeting agent e.g., a lectin, glycoprotein, lipid or protein, e.g., an antibody, that binds to a specified cell type such as a kidney cell.
  • a targeting group can be a thyrotropin, melanotropin, lectin, glycoprotein, surfactant protein A, Mucin carbohydrate, multivalent lactose, multivalent galactose, N-acetyl- gaiactos amine, N-acetyl-gulucosamine multivalent mannose, multivalent fucose, glycosylated polyaminoacids, multivalent galactose, transferrin, bisphosphonate, polyglutamate,
  • polyaspartate a lipid, cholesterol, a steroid, bile acid, folate, vitamin B 12, biotin, or an RGD peptide or RGD peptide mimetic.
  • the ligand is a GalNAc ligand that comprises one or more N- acetylgaiactosamine (GalNAc) derivatives. Additional description of GalNAc ligands is provided in the section titled Carbohydrate Conjugates.
  • ligands include dyes, intercalating agents (e.g. acridines), cross-linkers (e.g. psoralene, mitomycin C), porphyrins (TPPC4, texaphyrin, Sapphyrin), polycyclic aromatic hydrocarbons (e.g., phenazine, dihydrophenazine), artificial endonucleases (e.g.
  • intercalating agents e.g. acridines
  • cross-linkers e.g. psoralene, mitomycin C
  • porphyrins TPPC4, texaphyrin, Sapphyrin
  • polycyclic aromatic hydrocarbons e.g., phenazine, dihydrophenazine
  • artificial endonucleases e.g.
  • EDTA lipophilic molecules, e.g, cholesterol, cholic acid, adamantane acetic acid, 1 -pyrene butyric acid, dihydrotestosterone, l,3-Bis-0(hexadecyl)glycerol, geranyloxyhexyl group, hexadecylglvcerol, borneol, menthol, 1 ,3-propanediol, heptadecyl group, palmitic acid, myristic acid,03- (oleoyl)lithocholic acid, 03-(oleoyl)cholenic acid, dimethoxytntyl, or phenoxazine)and peptide conjugates (e.g., antennapedia peptide, Tat peptide), alkylating agents, phosphate, amino, mercapto, PEG (e.g., PEG-40K), MPEG, [MPEG] 2 , polyamino
  • biotin e.g., aspirin, vitamin E, folic acid
  • transport/absorption facilitators e.g., aspirin, vitamin E, folic acid
  • synthetic ribonucleases e.g., imidazole, bisimidazole, histamine, imidazole clusters, acridine-imidazole conjugates, Eu3+ complexes of tetraazamacrocycles), dinitrophenyl, HRP, or AP.
  • Ligands can be proteins, e.g., glycoproteins, or peptides, e.g., molecules having a specific affinity for a co-ligand, or antibodies e.g. , an antibody, that binds to a specified cell type such as a cancer cell, endothelial cell, or bone cell.
  • Ligands may also include hormones and hormone receptors. They can also include non-peptidic species, such as lipids, lectins, carbohydrates, vitamins, cofactors, multivalent lactose, multivalent galactose, N-acetyl-galactosamine, N-acetyl- gulucosamine multivalent mannose, or multivalent fucose.
  • the ligand can be, for example, a lipopolysaccharide, an activator of p38 MAP kinase, or an activator of NF- B.
  • the ligand can be a substance, e.g, a ding, which can increase the uptake of the iRNA agent into the cell, for example, by disrupting the cell's cytoskeleton, e.g., by disrupting the cell's microtubules, microfilaments, and/or intermediate filaments.
  • the drug can be, for example, taxon, vincristine, vinblastine, cytochalasin, nocodazole, japlakinolide, latrunculin A, phalloidin, swinholide A, indanocine, or myoservin.
  • a ligand attached to an iRNA as described herein acts as a pharmacokinetic modulator (PK modulator).
  • PK modulators include lipophiles, bile acids, steroids, phospholipid analogues, peptides, protein binding agents, PEG, vitamins etc.
  • Exemplary PK modulators include, but are not limited to, cholesterol, fatty acids, cholic acid, lithocholic acid, dialkylglycerides, diacylglyceride, phospholipids, sphingolipids, naproxen, ibuprofen, vitamin E, biotin etc.
  • Oligonucleotides that comprise a number of phosphorothioate linkages are also known to bind to serum protein, thus short oligonucleotides, e.g., oligonucleotides of about 5 bases, 10 bases, 15 bases or 20 bases, comprising multiple of phosphorothioate linkages in the backbone are also amenable to the present invention as ligands (e.g. as PK modulating ligands).
  • ligands e.g. as PK modulating ligands
  • aptamers that bind serum components are also suitable for use as PK modulating ligands in the embodiments described herein.
  • Ligand-conjugated oligonucleotides of the invention may be synthesized by the use of an oligonucleotide that bears a pendant reactive functionality, such as that derived from the attachment of a linking molecule onto the oligonucleotide (described below).
  • This reactive oligonucleotide may be reacted directly with commercially-available ligands, ligands that are synthesized bearing any of a variety of protecting groups, or ligands that have a linking moiety attached thereto.
  • oligonucleotides used in the conjugates of the present invention may be conveniently and routinely made through the well-known technique of solid-phase synthesis.
  • Equipment for such synthesis is sold by several vendors including, for example, Applied Biosystems (Foster City, Calif.). Any other means for such synthesis known in the art may additionally or alternatively be employed. It is also known to use similar techniques to prepare other
  • oligonucleotides such as the phosphorothioates and alkylated derivatives.
  • the oligonucleotides and oligonucleosides may be assembled on a suitable DNA synthesizer utilizing standard nucleotide or nucleoside precursors, or nucleotide or nucleoside conj gate precursors that already bear the linking moiety, ligand- nucleotide or nucleoside-conj gate precursors that already bear the ligand molecule, or non- nucleoside ligand-bearing building blocks.
  • the oligonucleotides or linked nucleosides of the present invention are synthesized by an automated synthesizer using phosphoramidites derived from ligand-nucleoside conjugates in addition to the standard phosphoramidites and non-standard phosphoramidites that are commercially available and routinely used in oligonucleotide synthesis.
  • the ligand is a lipid or Mpid-based molecule.
  • a lipid or lipid- based molecule can typically bind a serum protein, such as human serum albumin (HSA).
  • HSA human serum albumin
  • An HSA binding ligand allows for distribution of the conjugate to a target tissue, e.g., a non-kidney target tissue of the body.
  • the target tissue can be the liver, including parenchymal cells of the liver.
  • Other molecules that can bind HSA can also be used as ligands. For example, neproxin or aspirin can be used.
  • a lipid or lipid-based ligand can (a) increase resistance to degradation of the conjugate, (b) increase targeting or transport into a target cell or cell membrane, and/or (c) can be used to adjust binding to a serum protein, e.g., HSA.
  • a serum protein e.g., HSA.
  • a lipid based ligand can be used to modulate, e.g., control (e.g., inhibit) the binding of the conjugate to a target tissue.
  • control e.g., inhibit
  • a lipid or lipid-based ligand that binds to HSA more strongly will be less likely to be targeted to the kidney and therefore less likely to be cleared from the body.
  • a lipid or lipid-based ligand that binds to HSA less strongly can be used to target the conjugate to the kidney.
  • the lipid based ligand binds HSA.
  • the ligand can bind HSA with a sufficient affinity such that distribution of the conjugate to a non-kidney tissue is enhanced.
  • the affinity is typically not so strong that the HSA-ligand binding cannot be reversed.
  • the lipid based ligand binds HSA weakly or not at all, such that distribution of the conjugate to the kidney is enhanced.
  • Other moieties that target to kidney cells can also be used in place of or in addition to the lipid based ligand.
  • the ligand is a moiety, e.g., a vitamin, which is taken up by a target cell, e.g., a proliferating cell.
  • a target cell e.g., a proliferating cell.
  • vitamins include vitamin A, E, and K.
  • Other exemplary vitamins include are B vitamin, e.g., folic acid, B12, riboflavin, biotin, pyridoxal or other vitamins or nutrients taken up by cancer cells.
  • the iigand is a cell-permeation agent, such as a helical cell-permeation agent.
  • the agent is amphipathic.
  • An exemplary agent is a peptide such as tat or antennopedia. If the agent is a peptide, it can be modified, including a peptidylmimetic, invertomers, non-peptide or pseudo-peptide linkages, and use of D-amino acids.
  • the helical agent is typically an -helical agent, and can have a lipophilic and a lipophobic phase.
  • the ligand can be a peptide or peptidomimetic.
  • a peptidomimetic also referred to herein as an oligopeptidomimetic is a molecule capable of folding into a defined three- dimensional structure similar to a natural peptide. The attachment of peptide and
  • peptidomimetics to iRNA agents can affect pharmacokinetic distribution of the iRNA, such as by enhancing cellular recognition and absorption.
  • the peptide or peptidomimetic moiety can be about 5-50 amino acids long, e.g., about 5, 10, 15, 20, 25, 30, 35, 40, 45, or 50 amino acids long.
  • a peptide or peptidomimetic can be, for example, a cell permeation peptide, cationic peptide, amphipathic peptide, or hydrophobic peptide (e.g., consisting primarily of Tyr, Tip or Phe).
  • the peptide moiety can be a dendrimer peptide, constrained peptide or crosslinked peptide.
  • the peptide moiety can include a hydrophobic membrane translocation sequence (MTS).
  • An exemplary hydrophobic MTS-containing peptide is RFGF having the amino acid sequence AAVALLPAVLLALLAP (SEQ ID NO:3367).
  • An RFGF analogue e.g., amino acid sequence AALLPVLLAAP (SEQ ID NO:3368)
  • a hydrophobic MTS can also be a targeting moiety.
  • the peptide moiety can be a "delivery' * peptide, which can carry large polar molecules including peptides, oligonucleotides, and protein across cell membranes. For example, sequences from the HIV Tat protein
  • a peptide or peptidomimetic can be encoded by a random sequence of DNA, such as a peptide identified from a phage -display library, or one-bead-one-compound (OBOC) combinatorial library (Lam et al., Nature, 354:82-84, 1991).
  • OBOC one-bead-one-compound
  • the peptide or peptidomimetic tethered to a dsRNA agent via an incorporated monomer unit is a cell targeting peptide such as an arginine-glycine-aspartic acid (RGD)-peptide, or RGD mimic.
  • RGD arginine-glycine-aspartic acid
  • a peptide moiety can range in length from about 5 amino acids to about 40 amino acids.
  • the peptide moieties can have a structural modification, such as to increase stability or direct conformational properties. Any of the structural modifications described below can be utilized.
  • RGD peptide for use in the compositions and methods of the invention may be linear or cyclic, and may be modified, e.g., glycosylated or methylated, to facilitate targeting to a specific tissue(s).
  • RGD-containing peptides and peptidiomimemtics may include D-amino acids, as well as synthetic RGD mimics.
  • An RGD peptide moiety can be used to target a particular cell type, e.g., a tumor cell, such as an endothelial tumor cell or a breast cancer tumor cell (Zitzmann et al., Cancer Res., 62:5139-43, 2002).
  • a tumor cell such as an endothelial tumor cell or a breast cancer tumor cell
  • An RGD peptide can facilitate targeting of a dsRNA agent to tumors of a variety of other tissues, including the lung, kidney, spleen, or liver (Aoki et al., Cancer Gene Therapy 8:783-787, 2001).
  • the RGD peptide will facilitate targeting of an iRNA agent to the kidney.
  • the RGD peptide can be linear or cyclic, and can be modified, e.g., glycosylated or methylated to facilitate targeting to specific tissues.
  • a glycosylated RGD peptide can deliver an iRNA agent to a tumor cell expressing ⁇ (Haubner et al.. Jour. Nucl. Med., 42:326-336, 2001).
  • a "cell permeation peptide” is capable of permeating a cell, e.g., a microbial cell, such as a bacterial or fungal cell, or a mammalian cell, such as a human cell.
  • a microbial cell- permeating peptide can be, for example, an a-helical linear peptide (e.g., LL-37 or Ceropin PI), a disulfide bond-containing peptide (e.g., -defensin, ⁇ -defensin or bactenecin), or a peptide containing only one or two dominating amino acids (e.g., PR-39 or indolicidin).
  • a cell permeation peptide can also include a nuclear localization signal (NLS).
  • NLS nuclear localization signal
  • a cell permeation peptide can be a bipartite amphipathic peptide, such as MPG, which is derived from the fusion peptide domain of HIV- 1 gp41 and the NLS of SV40 large T antigen (Simeoni et al., Nucl. Acids Res. 31 :2717-2724, 2003).
  • MPG nuclear localization signal
  • an iRNA oligonucleotide further comprises a carbohydrate.
  • the carbohydrate conjugated iRNA are advantageous for the in vivo delivery of nucleic acids, as well as compositions suitable for in vivo therapeutic use, as described herein.
  • carbohydrate refers to a compound which is either a carbohydrate per se made up of one or more monosaccharide units having at least 6 carbon atoms (which can be linear, branched or cyclic) with an oxygen, nitrogen or sulfur atom bonded to each carbon atom; or a compound having as a part thereof a carbohydrate moiety made up of one or more monosaccharide units each having at least six carbon atoms (which can be lineai", branched or cyclic), with an oxygen, nitrogen or sulfur atom bonded to each carbon atom.
  • Representative carbohydrates include the sugars (mono-, di-, tri- and oligosaccharides containing from about 4, 5, 6, 7, 8, or 9 monosaccharide units), and polysaccharides such as starches, glycogen, cellulose and polysaccharide gums.
  • Specific monosaccharides include C5 and above (e.g., C5, C6, C7, or C8) sugars; di- and trisaccharides include sugars having two or three monosaccharide units (e.g., C5, C6, C7, or C8).
  • a carbohydrate conjugate comprises a monosaccharide.
  • the monosaccharide is an N-acetylgalactosamine (GalNAc).
  • GalNAc conjugates are described, for example, in U.S. Patent No. 8,106,022, the entire content of which is hereby incorporated herein by reference.
  • the GalNAc conjugate serves as a ligand that targets the iRNA to particular cells.
  • the GalNAc conjugate targets the iRNA to liver cells, e.g., by serving as a ligand for the asialoglycoprotein receptor of liver cells (e.g., hepatocytes).
  • the carbohydrate conjugate comprises one or more GalNAc derivatives.
  • the GalNAc derivatives may be attached via a linker, e.g., a bivalent or trivalent branched linker.
  • the GalNAc conjugate is conjugated to the 3' end of the sense strand,
  • the GalNAc conjugate is conjugated to the iRNA agent (e.g., to the 3' end of the sense strand) via a linker, e.g., a linker as described herein.
  • the GalNAc conjugate is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl
  • the RNAi agent is attached to the carbohydrate conjugate via a linker as shown in the following schematic, wherein X is O or S
  • the RNAi agent is conjugated to L96 as defined in Table 1 and shown below
  • a carbohydrate conjugate for use in the compositions and methods of the invention is selected from the group consisting of:
  • Formula XIX, Formula XX, Another representative carbohydrate conjugate for use in the embodiments described herein includes, but is not limited to.
  • the carbohydrate conjugate further comprises one or more additionai ligands as described above, such as, but not limited to, a PK modulator and/or a cell permeation peptide.
  • an iRNA of the invention is conjugated to a carbohydrate through a linker.
  • iRNA carbohydrate conjugates with linkers of the compositions and methods of the invention include, but are not limited to,
  • the conj gate or ligand described herein can be attached to an iRNA oligonucleotide with various linkers that can be cleavable or non-cleavable.
  • linker or “linking group” means an organic moiety that connects two parts of a compound, e.g., covalentiy attaches two parts of a compound.
  • Linkers typically comprise a direct bond or an atom such as oxygen or sulfur, a unit such as NR8, C(O), C(0)NH, SO, S0 2 , S0 2 NH or a chain of atoms, such as, but not limited to, substituted or unsubstituted alkyl, substituted or unsubstituted alkenyl, substituted or unsubstituted alkynyl, arvlalkyl, aryl alkenyl, arylalkynyl, heteroarylalkyl, heteroarylalkenyl, heteroarylalkynyl, heterocyclylalkyl,
  • alkylheteroarylalkyl aikylheteroarylalkenyl, alkylheteroarylalkynyl, aikenylheteroarylalkyl, alkenylheteroarylalkenyl, alkenylheteroarylalkynyl, alkynylheteroarylalkyl, aikynylheteroarylaikenyi , alkynylheteroaryl alkynyl , alkylheterocyclylalkyl ,
  • alkenylheterocyclylalkenyl alkenylheterocyclylalkynyl, alkynylheterocyc alkyl,
  • alkynylheterocyclylalkenyi alkynylheterocyclylalkynyl, alkylaryl, alkenylaryl, alkynylaryl, alkylheteroaryl, alkenylheteroaryl, alkynylhereroaryl, which one or more methylenes can be interrupted or terminated by O, S, S(O), S0 2 , N(R8), C(O), substituted or unsubstituted aryl, substituted or unsubstituted heteroaryl, substituted or unsubstituted heterocyclic; where R8 is hydrogen, acyl, aliphatic or substituted aliphatic, hi one embodiment, the linker is between about 1-24 atoms, 2-24, 3-24, 4-24, 5-24, 6-24, 6-18, 7-18, 8-18 atoms, 7-17, 8-17, 6-16, 7-16, or 8-16 atoms.
  • a dsRNA of the invention is conjugated to a bivalent or trivalent branched linker selected from the group of structures shown in any of formula (XXXI) - (XXXIV):
  • q2A, q2B, q3A, q3B, q4A, q4B, q5A, q5B and q5C represent independently for each occurrence 0-20 and wherein the repeating unit can be the same or different; 2B n 3A T,3B ⁇ ->4 ⁇ n 4B ⁇ n 5B n 5C 2. ⁇ ⁇ 2 ⁇ rp3A rp3B rp4A rp4B
  • P 2 , P B , P JA , ⁇ , ⁇ , P 4A , ⁇ 4 ⁇ , P 3A , P JB , P ⁇ , T / ⁇ T ts , T JA , r", A , ⁇ 4 ⁇ , A , n5B rp5C are each independently for each occurrence absent, CO, NH, O, S, OC(O), NHC(O), CH 2 , CH 2 NH or CH 2 0;
  • Q 2 ⁇ Q 2B , Q 'A , Q 3B , Q 4A , Q 4B , Q 5A , Q 5B , Q 5C are independently for each occurrence absent, alkylene, substituted alkylene wherin one or more methylenes can be interrupted or terminated by one or more of O, S, S(O), S0 2 , N(R N ), C(R C(R"), C ⁇ C or C(O);
  • R 2A , R 2B , R 3A , R 3B , R 4A , R 4B , R 5A , R 5B , R 5C are each independently for each occurrence absent,
  • L 2A , L 2B , L 3A , L 3B , L 4A , L 4B , L 5A , L 5B and L 5C represent the ligand; i. e. each independently for each occurrence a monosaccharide (such as GalNAc), disaccharide, trisaccharide,
  • RNAi agents for inhibiting the expression of a target gene, such as those of formula (XXXV):
  • L , L and L represent a monosaccharide, such as GalNAc derivative.
  • suitable bivalent and trivalent branched linker groups conjugating GalNAc derivatives include, but are not limited to, the structures recited above as formulas II, VII, XI, X, and XIII.
  • a cleavable linking group is one which is sufficiently stable outside the cell, but which upon entry into a target cell is cleaved to release the two parts the linker is holding together.
  • the cleavable linking group is cleaved at least about 10 times, 20, times, 30 times, 40 times, 50 times, 60 times, 70 times, 80 times, 90 times or more, or at least about 100 times faster in a target cell or under a first reference condition (which can, e.g., be selected to mimic or represent intracellular conditions) than in the blood of a subject, or under a second reference condition (which can, e.g., be selected to mimic or represent conditions found in the blood or serum).
  • a first reference condition which can, e.g., be selected to mimic or represent intracellular conditions
  • a second reference condition which can, e.g., be selected to mimic or represent conditions found in the blood or serum.
  • Cleavable linking groups are susceptible to cleavage agents, e.g., pH, redox potential or the presence of degradative molecules. Generally, cleavage agents are more prevalent or found at higher levels or activities inside cells than in serum or blood. Examples of such degradative agents include: redox agents which are selected for particular substrates or which have no substrate specificity, including, e.g., oxidative or reductive enzymes or reductive agents such as mercaptans, present in cells, that can degrade a redox cleavable linking group by reduction; esterases; endosomes or agents that can create an acidic environment, e.g., those that result in a pH of five or lower; enzymes that can hydrolyze or degrade an acid cleavable linking group by acting as a general acid, peptidases (which can be substrate specific), and phosphatases.
  • redox agents which are selected for particular substrates or which have no substrate specificity, including, e.g.,
  • a cleavable linkage group such as a disulfide bond can be susceptible to pH.
  • the pH of human serum is 7.4, while the average intracellular pH is slightly lower, ranging from about 7.1 - 7.3.
  • Endosomes have a more acidic pH, in the range of 5.5-6.0, and lysosomes have an even more acidic pH at around 5.0.
  • Some linkers will have a cleavable linking group that is cleaved at a preferred pH, thereby releasing a cationic lipid from the ligand inside the cell, or into the desired compartment of the cell.
  • a linker can include a cleavable linking group that is cleavable by a particular enzyme.
  • the type of cleavable linking group incorporated into a linker can depend on the cell to be targeted.
  • a liver-targeting ligand can be linked to a cationic lipid through a linker that includes an ester group.
  • Liver cells are rich in esterases, and therefore the linker will be cleaved more efficiently in liver cells than in cell types that are not esterase-rich.
  • Other cell- types rich in esterases include cells of the lung, renal cortex, and testis.
  • Linkers that contain peptide bonds can be used when targeting cell types rich in peptidases, such as liver cells and synoviocytes.
  • the suitability of a candidate cleavable linking group can be evaluated by testing the ability of a degradative agent (or condition) to cleave the candidate linking group. It will also be desirable to also test the candidate cleavable linking group for the ability to resist cleavage in the blood or when in contact with other non-target tissue.
  • a degradative agent or condition
  • the candidate cleavable linking group for the ability to resist cleavage in the blood or when in contact with other non-target tissue.
  • the evaluations can be carried out in cell free systems, in cells, in cell culture, in organ or tissue culture, or in whole animals.
  • useful candidate compounds are cleaved at least about 2, 4, 10, 20, 30, 40, 50, 60, 70, 80, 90, or about 100 times faster in the cell (or under in vitro conditions selected to mimic intracellular conditions) as compared to blood or serum (or under in vitro conditions selected to mimic extracellular conditions).
  • a cleavable linking group is a redox cleavable linking group that is cleaved upon reduction or oxidation.
  • An example of reductivelv cleavable linking group is a disulphide linking group (-S-S-).
  • a candidate can be evaluated by incubation with dithiothreitol (DTT), or other reducing agent using reagents know in the art, which mimic the rate of cleavage which would be observed in a cell, e.g., a target cell.
  • the candidates can also be evaluated under conditions which are selected to mimic blood or serum conditions.
  • candidate compounds are cleaved by at most about 10% in the blood.
  • useful candidate compounds are degraded at least about 2, 4, 10, 20, 30, 40, 50, 60, 70, 80, 90, or about 100 times faster in the cell (or under in vitro conditions selected to mimic intracellular conditions) as compared to blood (or under in vitro conditions selected to mimic extracellular conditions).
  • the rate of cleavage of candidate compounds can be determined using standard enzyme kinetics assays under conditions chosen to mimic intracellular media and compared to conditions chosen to mimic extracellular media. Phosphate-based cleavabie linking groups
  • a cleavabie linker comprises a phosphate-based cleavabie linking group.
  • a phosphate-based cleavabie linking group is cleaved by agents that degrade or hydrolyze the phosphate group.
  • An example of an agent that cleaves phosphate groups in cells are enzymes such as phosphatases in cells.
  • phosphate-based linking groups are -O- P(0)(ORk)-0-, -0-P(S)(ORk)-0-, -0-P(S)(SRk)-0, -S-P(0)(ORk)-0-, -0-P(0)(ORk)-S-, -S- P(0)(ORk)-S-, -0-P(S)(ORk)-S-, -S-P(S)(ORk)-0-, -0-P(0)(Rk)-0-, -0-P(S)(Rk)-0-, -S- P(0)(Rk)-CK -S-P(S)(Rk)-0-, -S-P(0)(Rk)-S-, -0-P(S)( Rk)-S-.
  • Preferred embodiments are -O- P(0)(OH)-0-, -0-P(S)(OH)-0-, -0-P(S)(SH)-0-, -S-P(0)(OH)-0-, -0-P(0)(OH)-S-, -S- P(0)(OH)-S-, -0-P(S)(OH)-S-, -S-P(S)(OH)-0-, -0- ⁇ (0)( ⁇ )-0-, -0-P(S)(H)-0-, -S-P(0)(H)-0, -S-P(S)(H)-0-, -S-P(0)(H)-S-, -0-P(S)(H)-S-.
  • a preferred embodiment is -0-P(0)(OH)-0-.
  • a cleavabie linker comprises an acid cleavabie linking group.
  • An acid cleavabie linking group is a linking group that is cleaved under acidic conditions.
  • acid cleavabie linking groups are cleaved in an acidic environment with a pH of about 6.5 or lower (e.g., about 6.0, 5.75, 5.5, 5.25, 5.0, or lower), or by agents such as enzymes that can act as a general acid.
  • specific low pH organelles such as endosomes and lysosomes can provide a cleaving environment for acid cleavabie linking groups.
  • Acid cleavabie linking groups include but are not limited to hydrazones, esters, and esters of amino acids.
  • a preferred embodiment is when the carbon attached to the oxygen of the ester (the aikoxy group) is an aryi group, substituted alkyl group, or tertiary alkyl group such as dimethyl pentyl or t-butyl.
  • a cleavabie linker comprises an ester-based cleavabie linking group.
  • An ester-based cleavabie linking group is cleaved by enzymes such as esterases and amidases in cells.
  • Examples of ester-based cleavabie linking groups include but are not limited to esters of alkylene, alkenylene and aikynylene groups.
  • Ester cleavabie linking groups have the general formula -C(0)0-, or -OC(O)-. These candidates can be evaluated using methods analogous to those described above. Peptide- based cleavable linking groups
  • a cleavable linker comprises a peptide-based cleavable linking group.
  • a peptide-based cleavable linking group is cleaved by enzymes such as peptidases and proteases in cells.
  • Peptide-based cleavable linking groups are peptide bonds formed between amino acids to yield oligopeptides (e.g., dipeptides, tripeptides etc.) and polypeptides.
  • Peptide-based cleavable groups do not include the amide group (-C(O)NH-).
  • the amide group can be formed between any alkylene, alkenylene or alkynelene.
  • a peptide bond is a special type of amide bond formed between amino acids to yield peptides and proteins.
  • the peptide based cleavage group is generally limited to the peptide bond (i.e., the amide bond) formed between amino acids yielding peptides and proteins and does not include the entire amide functional group.
  • Peptide-based cleavable linking groups have the general formula - NHCHRAC(0)NHCHRBC(0)-, where RA and RB are the R groups of the two adjacent amino acids. These candidates can be evaluated using methods analogous to those described above.
  • RNA conjugates include, but are not limited to, U.S. Pat. Nos. 4,828,979; 4,948,882; 5,218,105; 5,525,465; 5,541 ,313; 5,545,730; 5,552,538; 5,578,717, 5,580,731 ; 5,591 ,584; 5, 109,124; 5,118,802; 5, 138,045; 5,414,077;
  • the present invention also includes iRNA compounds that are chimeric compounds.
  • iRNA compounds e.g., dsRNAs, that contain two or more chemically distinct regions, each made up of at least one monomer unit, i.e., a nucleotide in the case of a dsRNA compound.
  • dsRNAs typically contain at least one region wherein the RNA is modified so as to confer upon the iRNA increased resistance to nuclease degradation, increased cellular uptake, and/or increased binding affinity for the target nucleic acid.
  • An additional region of the iRNA may serve as a substrate for enzymes capable of cleaving RNA:DNA or RNA:RNA hybrids.
  • RNase H is a cellular endonuclease which cleaves the RNA strand of an RNA:DNA duplex. Activation of RNase H, therefore, results in cleavage of the RNA target, thereby greatly enhancing the efficiency of iRNA inhibition of gene expression. Consequently, comparable results can often be obtained with shorter iRNAs when chimeric dsRNAs are used, compared to phosphorothioate deoxy dsRNAs hybridizing to the same target region. Cleavage of the RNA target can be routinely detected by gel electrophoresis and, if necessary, associated nucleic acid hybridization techniques known in the art.
  • the RNA of an iRNA can be modified by a non-ligand group.
  • non-ligand molecules have been conjugated to iRNAs in order to enhance the activity, cellular distribution or cellular uptake of the iRNA, and procedures for performing such conjugations are available in the scientific literature.
  • Such non-ligand moieties have included lipid moieties, such as cholesterol (Kubo, T. et al, Biochem. Biophys. Res. Comm., 2007, 365(1 ):54-61; Letsinger et al, Proc. Natl Acad, Sci. USA, 1989, 86:6553), cholic acid
  • a thiocholesterol (Oberhauser et al, Nucl Acids Res., 1992, 20:533), an aliphatic chain, e.g., dodecandiol or undecyl residues (Saison-Behmoaras et al, EMBO J., 1991, 10: 111; Kabanov et al, FEBS Lett., 1990, 259:327; Svinarchuk et al, Biochimie, 1993, 75:49), a phospholipid, e.g., di-hexadecyl-rac-glycerol or triethylammonium 1,2-di-O-hexadecyl-rac- glycero-3-H-phosphonate (Manoharan et al.
  • RNA conjugates have been listed above. Typical conjugation protocols involve the synthesis of an RNAs bearing an aminolinker at one or more positions of the sequence. The amino group is then reacted with the molecule being conjugated using appropriate coupling or activating reagents. The conjugation reaction may be performed either with the RNA still bound to the solid support or following cleavage of the RNA, in solution phase. Purification of the RNA conjugate by HPLC typically affords the pure conjugate.
  • an iRNA to a subject in need thereof can be achieved in a number of different ways. In vivo delivery can be performed directly by administering a composition comprising an iRNA, e.g. a dsRNA, to a subject. Alternatively, delivery can be performed indirectly by administering one or more vectors that encode and direct the expression of the iRNA. These alternatives are discussed further below.
  • any method of delivering a nucleic acid molecule can be adapted for use with an iRNA (see e.g., Akhtar S. and Julian RL. (1992) Trends Cell. Biol. 2(5): 139-144 and
  • WO94/02595 which are incorporated herein by reference in their entireties.
  • the non-specific effects of an iRNA can be minimized by local administration, for example by direct injection or implantation into a tissue (as a non-limiting example, a tumor) or topically administering the preparation.
  • Local administration to a treatment site maximizes local concentration of the agent, limits the exposure of the agent to systemic tissues that may otherwise be harmed by the agent or that may degrade the agent, and permits a lower total dose of the iRNA molecule to be administered.
  • VEGF dsRNA intraocular delivery of a VEGF dsRNA by intra vitreal injection in cynomolgus monkeys (Tolentino, MJ et al (2004) Retina 24: 132-138) and subretinai injections in mice (Reich, SJ., et al (2003) Mol. Vis. 9:210-216) were both shown to prevent neovascularization in an experimental model of age-related macular degeneration, in addition, direct intratumoral injection of a dsRNA in mice reduces tumor volume (Pille, J., et al (2005) Mol.
  • RNA interference has also shown success with local delivery to the CNS by direct injection (Dom, G., et al. (2004) Nucleic Acids 32:e49; Tan, PH., et al (2005) Gene Ther. 12:59-66; Makimura, H., et al (2002) BMC Neurosci.
  • RNA can be modified or alternatively delivered using a drug delivery system; both methods act to prevent the rapid degradation of the dsRNA by endo- and exo-nucleases in vivo.
  • RNA or the pharmaceutical carrier can also permit targeting of the iRNA composition to the target tissue and avoid undesirable off-target effects.
  • iRNA molecules can be modified by chemical conjugation to other groups, e.g., a lipid or carbohydrate group as described herein. Such conjugates can be used to target iRNA to particular cells, e.g., liver cells, e.g., hepatocytes.
  • Such conjugates can be used to target iRNA to particular cells, e.g., liver cells, e.g., hepatocytes.
  • GalNAc conjugates or lipid (e.g., LNP) formulations can be used to target iRNA to particular cells, e.g., liver cells, e.g., hepatocytes.
  • Lipophilic groups such as cholesterol to enhance cellular uptake and prevent degradation.
  • an iRNA directed against ApoB conjugated to a lipophilic cholesterol moiety was injected systemically into mice and resulted in knockdown of apoB mRNA in both the liver and jejunum (Soutschek, J., et al (2004) Nature 432: 173-178).
  • Conjugation of an iRNA to an aptamer has been shown to inliibit tumor growth and mediate tumor regression in a mouse model of prostate cancer (McNamara, JO., et al (2006) Nat. Biotechnol, 24: 1005-1015).
  • the iRNA can be delivered using drug delivery systems such as a nanoparticle, a dendrimer, a polymer, liposomes, or a cationic delivery system.
  • Positively charged cationic delivery systems facilitate binding of an iRNA molecule (negatively charged) and also enhance interactions at the negatively charged cell membrane to permit efficient uptake of an iRNA by the cell.
  • Cationic lipids, dendrimers, or polymers can either be bound to an iRNA, or induced to form a vesicle or micelle (see e.g., Kim SH., et al (2008) Journal of Controlled Release 129(2): 107-116) that encases an iRNA.
  • vesicles or micelles further prevents degradation of the iRNA when administered systemically.
  • Methods for making and administering cationic- iRNA complexes are well within the abilities of one skilled in the art (see e.g., Sorensen, DR., et al (2003) J. Mol, Biol 327:761-766; Vemia, UN., et al (2003) Clin.
  • RNA delivery systems useful for systemic delivery of iRNAs include DOTAP (Sorensen, DR., et al (2003), supra; Verma, UN., et al (2003), supra), Oligofectamine, "solid nucleic acid lipid particles” (Zimmermann, TS., et al (2006) Nature 441: 111-114), cardiolipin (Chien, PY., et al (2005) Cancer Gene Ther. 12:321-328; Pal, A., et al (2005) Int J. Oncol. 26: 1087-1091 ),
  • an iRNA forms a complex with cyclodextrin for systemic administration.
  • Methods for administration and pharmaceutical compositions of iRNAs and cyclodextrins can be found in U.S. Patent No. 7, 427, 605, which is herein incorporated by reference in its entirety.
  • iRNA targeting the ALAS 1 gene can be expressed from transcription units inserted into DNA or RNA vectors ⁇ see, e.g.. Couture, A, et al, TIG. (1996), 12:5-10; Skillern, A., et al, International PCT Publication No. WO 00/22113, Conrad, International PCT Publication No. WO 00/22114. and Conrad, U.S. Pat. No. 6,054,299). Expression can be transient (on the order of hours to weeks) or sustained (weeks to months or longer), depending upon the specific construct used and the target tissue or cell type.
  • transgenes can be introduced as a linear construct, a circular plasmid, or a viral vector, which can be an integrating or non-integrating vector.
  • the transgene can also be constructed to permit it to be inherited as an extrachromosomal plasmid (Gassmann, et al, Proc. Natl. Acad. Set USA ( 1995) 92: 1292).
  • the individual strand or strands of an iRNA can be transcribed from a promoter on an expression vector.
  • two separate strands are to be expressed to generate, for example, a dsRNA
  • two separate expression vectors can be co-introduced (e.g., by transfection or infection) into a target cell.
  • each individual strand of a dsRNA can be transcribed by promoters both of which are located on the same expression plasmid.
  • a dsRNA is expressed as an inverted repeat joined by a linker polynucleotide sequence such that the dsRNA has a stem and loop structure.
  • An iRNA expression vector is typically a DNA plasmid or viral vector.
  • An expression vector compatible with eukaryotic cells e.g., with vertebrate cells, can be used to produce recombinant constructs for the expression of an iRNA as described herein.
  • Eukaryotic cell expression vectors are well known in the art and are available from a number of commercial sources. Typically, such vectors contain convenient restriction sites for insertion of the desired nucleic acid segment. Delivery of iRNA expressing vectors can be systemic, such as by intravenous or intramuscular administration, by administration to target cells ex-planted from the patient followed by reintroduction into the patient, or by any other means that allows for introduction into a desired target cell.
  • An iRNA expression plasmid can be transfected into a target cell as a complex with a cationic lipid carrier (e.g., Oligofectamine) or a non-cationic lipid-based carrier (e.g.,
  • Transit-TKOTM Multiple lipid transfections for iRNA-mediated knockdowns targeting different regions of a target RNA over a period of a week or more are also contemplated by the invention.
  • Successful introduction of vectors into host cells can be monitored using various known methods.
  • transient transfection can be signaled with a reporter, such as a fluorescent marker, such as Green Fluorescent Protein (GFP).
  • GFP Green Fluorescent Protein
  • Stable transfection of cells ex vivo can be ensured using markers that provide the transfected cell with resistance to specific environmental factors (e.g., antibiotics and drugs), such as hygromycin B resistance.
  • Viral vector systems which can be utilized with the methods and compositions described herein include, but are not limited to, (a) adenovirus vectors; (b) retrovirus vectors, including but not limited to lentiviral vectors, moloney murine leukemia virus, etc.; (c) adeno- associated virus vectors; (d) herpes simplex virus vectors; (e) SV40 vectors; (f) polyoma virus vectors;
  • papilloma virus vectors (g) papilloma virus vectors; (h) picornavirus vectors; (i) pox virus vectors such as an orthopox, e.g., vaccinia virus vectors or avipox, e.g., canary pox or fowl pox; and (j) a helper-dependent or gutless adenovirus.
  • Replication-defective viruses can also be advantageous. Different vectors will or will not become incorporated into the cells' genome.
  • the constructs can include viral sequences for transfection, if desired. Alternatively, the construct may be incorporated into vectors capable of episomal replication, e.g EPV and EBV vectors.
  • Constructs for the recombinant expression of an iRNA will generally require regulatory elements, e.g., promoters, enhancers, etc., to ensure the expression of the iRNA in target cells.
  • regulatory elements e.g., promoters, enhancers, etc.
  • Other aspects to consider for vectors and constructs are further described below.
  • Vectors useful for the delivery of an iRNA will include regulatory elements (promoter, enhancer, etc.) sufficient for expression of the iRNA in the desired target cell or tissue.
  • the regulatory elements can be chosen to provide either constitutive or regulated/inducible expression.
  • Expression of the iRNA can be precisely regulated, for example, by using an inducible regulatory sequence that is sensitive to certain physiological regulators, e.g., circulating glucose levels, or hormones (Dochert et al., 1994, FASEB J. 8:20-24).
  • inducible expression systems suitable for the control of dsRNA expression in cells or in mammals include, for example, regulation by ecdysone, by estrogen, progesterone, tetracycline, chemical inducers of dimerization, and isopropyl-P-Dl-thiogalactopyranoside (IPTG).
  • IPTG isopropyl-P-Dl-thiogalactopyranoside
  • viral vectors that contain nucleic acid sequences encoding an iRNA can be used.
  • a retroviral vector can be used (see Miller et al., Meth.
  • retroviral vectors contain the components necessary for the correct packaging of the viral genome and integration into the host cell DNA.
  • the nucleic acid sequences encoding an iRNA are cloned into one or more vectors, which facilitates delivery of the nucleic acid into a patient. More detail about retroviral vectors can be found, for example, in Boesen et al., Biotherapy 6:291-302 (1994), which describes the use of a retroviral vector to deliver the mdrl gene to hematopoietic stem cells in order to make the stem cells more resistant to chemotherapy.
  • Other references illustrating the use of retroviral vectors in gene therapy are: Clowes et al, J. Clin. Invest. 93:644-651 (1994); Kiem et al. Blood 83: 1467-1473 (1994);
  • Lentiviral vectors contemplated for use include, for example, the HIV based vectors described in U.S. Patent Nos. 6,143,520; 5,665,557; and 5,981,276, which are herein incorporated by reference.
  • Adenoviruses are also contemplated for use in delivery of iRNAs.
  • Adenoviruses are especially attractive vehicles, e.g., for delivering genes to respiratory epithelia. Adenoviruses naturally infect respiratory epithelia where they cause a mild disease. Other targets for adenovirus-based delivery systems are liver, the central nervous system, endothelial cells, and muscle. Adenoviruses have the advantage of being capable of infecting non-dividing cells.
  • a suitable AV vector for expressing an iRNA featured in the invention a method for constructing the recombinant AV vector, and a method for delivering the vector into target cells, are described in Xia H et al (2002), Nat. Biotech. 20: 1006-1010.
  • Adeno-associated virus AAV
  • the iRNA can be expressed as two separate, complementary single-stranded RNA molecules from a recombinant AAV vector having, for example, either the U6 or HI RNA promoters, or the cytomegalovirus (CMV) promoter.
  • a recombinant AAV vector having, for example, either the U6 or HI RNA promoters, or the cytomegalovirus (CMV) promoter.
  • CMV cytomegalovirus
  • a pox virus such as a vaccinia virus, for example an attenuated vaccinia such as Modified Virus Ankara (MVA) or NYVAC, an avipox such as fowl pox or canary pox.
  • a pox virus such as a vaccinia virus, for example an attenuated vaccinia such as Modified Virus Ankara (MVA) or NYVAC, an avipox such as fowl pox or canary pox.
  • viral vectors can be modified by pseudotyping the vectors with envelope proteins or other surface antigens from other viruses, or by substituting different viral capsid proteins, as appropriate.
  • lentiviral vectors can be pseudotyped with surface proteins from vesicular stomatitis vims (VSV), rabies, Ebola, Mokola, and the like.
  • AAV vectors can be made to target different cells by engineering the vectors to express different capsid protein serotypes; see, e.g., Rabinowitz J E et al. (2002), ./ Virol 76:791-801 , the entire disclosure of which is herein incorporated by reference.
  • the pharmaceutical preparation of a vector can include the vector in an acceptable diluent, or can include a slow release matrix in which the gene delivery vehicle is imbedded.
  • the complete gene delivery vector can be produced intact from recombinant cells, e.g., retroviral vectors
  • the phai'maceutical prepai'ation can include one or more cells which produce the gene delivery system.
  • the invention provides pharmaceutical compositions containing an iRNA, as described herein, and a pharmaceutically acceptable carrier.
  • the pharmaceutical composition containing the iRNA is useful for treating a disease or disorder related to the expression or activity of an ALAS 1 gene (e.g., a disorder involving the porphyrin pathway).
  • Such pharmaceutical compositions are formulated based on the mode of delivery.
  • compositions can be formulated for systemic administration via parenteral delivery, e.g., by intravenous (IV) delivery.
  • a composition provided herein e.g., an LNP formulation
  • a composition provided herein e.g., a composition comprising a GaiNAc conjugate
  • subcutaneous delivery e.g., a composition comprising a GaiNAc conjugate
  • compositions featured herein are administered in a dosage sufficient to inhibit expression of an ALASl gene.
  • a suitable dose of iRNA will be in the range of 0.01 to 200.0 milligrams per kilogram body weight of the recipient per day, generally in the range of 1 to 50 mg per kilogram body weight per day.
  • the dsRNA can be administered at 0.035 mg/kg, 0.05 mg/kg, 0.35 mg/kg, 0.5 mg/kg, 1 mg/kg, 1.5 mg/kg, 2 mg/kg, 2.5 mg/kg, 3 mg/kg, 5 mg kg, 10 mg/kg, 20 mg/kg, 30 mg/kg, 40 mg kg, or 50 mg/kg per single dose.
  • the dsRNA can be administered at 0.02-3 mg/kg, e.g., 0.03-0.1 mg/kg, 0.1-0.5 mg kg, 0.3-1 mg/kg, 0.3-2.5 mg/kg, 0.5-2 mg/kg, 0.5-1.5 mg/kg, 0.1-0.2 mg/kg, 0.2-0.5 mg/kg, 0.5-1 mg kg, 1-1.5 mg/kg, 1.5-2 mg/kg, 1-2.5 mg kg, 2-2.5 mg/kg, 2.5-3 mg/kg, or 3-5 mg/kg, per single dose.
  • the pharmaceutical composition may be administered once daily, or the iRNA may be administered as two, three, or more sub-doses at appropriate intervals throughout the day or even using continuous infusion or delivery through a controlled release formulation.
  • the iRNA contained in each sub-dose must be correspondingly smaller in order to achieve the total daily dosage.
  • the dosage unit can also be compounded for delivery over several days, e.g., using a conventional sustained release formulation which provides sustained release of the iRNA over a several day period. Sustained release formulations are well known in the art and are particularly useful for delivery of agents at a particular site, such as can be used with the agents of the present invention. In this embodiment, the dosage unit contains a corresponding multiple of the daily dose.
  • compositions may be administered once every two weeks, once every four weeks, once every eight weeks, once every twelve weeks, once every sixteen weeks, once every twenty weeks, or once every twenty-four weeks. In certain embodiments, the pharmaceutical composition is administered once every four weeks or once every twelve weeks. In some embodiments, the pharmaceutical compositions may be administered once every month, once every two months, once every three months, once every four months, once every five months, or once every six months. In certain embodiments, the pharmaceutical composition is administered once every month or once every three months.
  • the effect of a single dose on ALAS 1 levels can be long lasting, such that subsequent doses are administered at not more than 3, 4, or 5 day intervals, at not more than I, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, or 24 week intervals, or at not more than 1, 2, 3, 4, 5, or 6 months interval.
  • treatment of a subject with a therapeutically effective amount of a composition can include a single treatment or a series of treatments.
  • Estimates of effective dosages and in vivo half-lives for the individual iRNAs encompassed by the invention can be made using conventional methodologies or on the basis of in vivo testing using an appropriate animal model, as described elsewhere herein.
  • Advances in mouse genetics have generated a number of mouse models for the study of various human diseases, such as pathological processes related to ALAS 1 expression (e.g., pathological processes involving porphyrins or defects in the poiphyrin pathway, such as, for example, porphyrias).
  • pathological processes related to ALAS 1 expression e.g., pathological processes involving porphyrins or defects in the poiphyrin pathway, such as, for example, porphyrias.
  • Such models can be used for in vivo testing of iRNA, as well as for determining a therapeutically effective dose and/or an effective dosing regimen.
  • a suitable mouse model is, for example, a mouse containing a transgene expressing human ALAS 1.
  • Mice that have knock-in mutations e.g., mutations that are associated with acute hepatic porphwias in humans
  • the present invention also includes pharmaceutical compositions and formulations that include the iRNA compounds featured in the invention.
  • the pharmaceutical compositions of the present invention may be administered in a number of ways depending upon whether local or systemic treatment is desired and upon the area to be treated.
  • Administration may be topical (e.g., by a transdermal patch), pulmonary, e.g., by inhalation or insufflation of powders or aerosols, including by nebulizer; intratracheal, intranasal, epidermal and transdermal, oral or parenteral.
  • Parenteral administration includes intravenous, intraarterial, subcutaneous, intraperitoneal or intramuscular injection or infusion; subdermal, e.g., via an implanted device; or intracranial, e.g., by intraparenchymal, intrathecal or intraventricular, administration.
  • the iRNA can be delivered in a manner to target a particular tissue, such as a tissue that produces erythrocytes.
  • a tissue that produces erythrocytes can be delivered to bone marrow, liver (e.g., hepatocyes of liver), lymph glands, spleen, lungs (e.g., pleura of lungs) or spine.
  • the iRNA is delivered to bone marrow.
  • compositions and formulations for topical administration may include transdermal patches, ointments, lotions, creams, gels, drops, suppositories, sprays, liquids and powders.
  • Conventional pharmaceutical carriers, aqueous, powder or oily bases, thickeners and the like may be necessary or desirable.
  • Coated condoms, gloves and the like may also be useful.
  • Suitable topical formulations include those in which the iRNAs featured in the invention are in admixture with a topical delivery agent such as lipids, liposomes, fatty acids, fatty acid esters, steroids, chelating agents and surfactants.
  • Suitable lipids and liposomes include neutral (e.g., dioleoylphosphatidyl DOPE ethanolamine, dimyristoylphosphatidyl choline DMPC,
  • distearolyphosphatidyl choline) negative e.g., dimyristoylphosphatidyl glycerol DMPG
  • cationic e.g., dioleoyltetramethylaminopropyl DOTAP and dioleoylphosphatidyl ethanolamine DOTMA
  • iRNAs featured in the invention may be encapsulated within liposomes or may form complexes thereto, in particular to cationic liposomes. Alternatively, iRNAs may be complexed to lipids, in particular to cationic lipids.
  • Suitable fatty acids and esters include but are not limited to arachidonic acid, oleic acid, eicosanoic acid, lauric acid, caprylic acid, capric acid, myristic acid, palmitic acid, stearic acid, linoleic acid, linolenic acid, dicaprate, tricaprate, monoolein, dilaurin, glyceryl 1 -monocaprate, l-dodecylazacycloheptan-2-one, an acylcarnitine, an acylcholine, or a C1.20 ail yl ester (e.g., isopropylmyristate IPM), monoglyceride, diglyceride or pharmaceutically acceptable salt thereof.
  • Topical formulations are described in detail in U.S. Patent No. 6,747,014, which is incorporated herein by reference.
  • liposome means a vesicle composed of amphophilic lipids arranged in a spherical bilayer or bilayers.
  • Liposomes are unilamellar or multilamellar vesicles which have a membrane formed from a lipophilic material and an aqueous interior. The aqueous portion contains the composition to be delivered. Cationic liposomes possess the advantage of being able to fuse to the cell wall. Non-cationic liposomes, although not able to fuse as efficiently with the cell wall, are taken up by macrophages in vivo.
  • lipid vesicles In order to traverse intact mammalian skin, lipid vesicles must pass through a series of fine pores, each with a diameter less than 50 nm, under the influence of a suitable transdermal gradient. Therefore, it is desirable to use a liposome which is highly deformable and able to pass through such fine pores.
  • liposomes obtained from natural phospholipids are biocompatible and biodegradable; liposomes can incorporate a wide range of water and lipid soluble drugs; liposomes can protect encapsulated drugs in their internal compartments from metabolism and degradation (Rosoff, in Pharmaceutical Dosage Forms, Lieberman, Rieger and Banker (Eds.), 1988, Marcel Dekker, Inc., New York, N.Y., volume 1, p. 245).
  • Important considerations in the preparation of liposome formulations are the lipid surface charge, vesicle size and the aqueous volume of the liposomes. Liposomes are useful for the transfer and delivery of active ingredients to the site of action.
  • the liposomal membrane is structurally similar to biological membranes, when liposomes are applied to a tissue, the liposomes start to merge with the cellular membranes and as the merging of the liposome and cell progresses, the liposomal contents are emptied into the cell where the active agent may act.
  • Liposomes present several advantages over other formulations. Such advantages include reduced side- effects related to high systemic absorption of the administered drug, increased accumulation of the administered drug at the desired target, and the ability to administer a wide variety of drugs, both hydrophilic and hydrophobic, into the skin.
  • liposomes to deliver agents including high- molecular weight DNA into the skin.
  • Compounds including analgesics, antibodies, hormones and high-molecular weight DNAs have been administered to the skin. The majority of applications resulted in the targeting of the upper epidermis.
  • Liposomes fall into two broad classes. Cationic liposomes are positively charged liposomes which interact with the negatively charged DNA molecules to form a stable complex. The positively charged DNA/liposome complex binds to the negatively charged cell surface and is internalized in an endosome. Due to the acidic pH within the endosome, the liposomes are ruptured, releasing their contents into the cell cytoplasm (Wang et ah, Biochem. Biophys. Res. Commun., 1987, 147, 980-985).
  • Liposomes which are pH-sensitive or negatively-charged, entrap DNA rather than complex with it. Since both the DNA and the lipid are similarly charged, repulsion rather than complex formation occurs. Nevertheless, some DNA is entrapped within the aqueous interior of these liposomes. pH-sensitive liposomes have been used to deliver DNA encoding the thymidine kinase gene to cell monolayers in culture. Expression of the exogenous gene was detected in the target cells (Zhou et al, Journal of Controlled Release, 1992, 19, 269-274).
  • liposomal composition includes phospholipids other than naturally- derived phosphatidylcholine.
  • Neutral liposome compositions can be formed from dimyristoyl phosphatidylcholine (DMPC) or dipalmitoyl phosphatidylcholine (DPPC).
  • Anionic liposome compositions generally are formed from dimyristoyl phosphatidylglycerol, while anionic fusogenic liposomes are formed primarily from dioleoyl phosphatidylethanol amine (DOPE).
  • Another type of liposomal composition is formed from phosphatidylcholine (PC) such as, for example, soybean PC, and egg PC.
  • PC phosphatidylcholine
  • Another type is formed from mixtures of phospholipid and/or phosphatidylcholine and/or cholesterol.
  • Non-ionic liposomal systems have also been examined to determine their utility in the delivery of drugs to the skin, in particular systems comprising non-ionic surfactant and cholesterol.
  • Non-ionic liposomal formulations comprising NovasomeTM I (glyceryl)
  • Liposomes also include "sterically stabilized'" liposomes, a term which, as used herein, refers to liposomes comprising one or more specialized lipids that, when incorporated into liposomes, result in enhanced circulation lifetimes relative to liposomes lacking such specialized lipids.
  • sterically stabilized liposomes are those in which part of the vesicle -forming lipid portion of the liposome (A) comprises one or more glycoiipids, such as
  • monosialoganglioside GM I is derivatized with one or more hydrophilic polymers, such as a polyethylene glycol (PEG) moiety.
  • PEG polyethylene glycol
  • the enhanced circulation half-life of these sterically stabilized liposomes derives from a reduced uptake into cells of the reticuloendothelial system (RES) (Allen et al, FEBS Letters, 1987, 223, 42; Wu et al. Cancer Research, 1993, 53, 3765).
  • RES reticuloendothelial system
  • Various liposomes comprising one or more glycolipids are known in the art. Papahadjopoulos et al. (Ann. N.Y. Acad. Sci., 1987, 507, 64) reported the ability of
  • Liposomes comprising sphingomyelin. Liposomes comprising 1 ,2-sn-dimyristoylphosphatidylcholine are disclosed in WO 97/13499 (Lim et al).
  • liposomes comprising lipids derivatized with one or more hydrophilic polymers, and methods of preparation thereof, are known in the art.
  • Sunamoto et al. (Bull. Chem, Soc. Jpn., 1980, 53, 2778) described liposomes comprising a nonionic detergent, 2C I 2 1 5G, that contains a PEG moiety.
  • Ilium et al. (FEBS Lett., 1984, 167, 79) noted that hydrophilic coating of polystyrene particles with polymeric glycols results in significantly enhanced blood half-lives.
  • Liposomes comprising a number of other lipid-polymer conjugates are disclosed in WO 91/05545 and U.S. Pat. No. 5,225,212 (both to Martin et al.) and in WO 94/20073 (Zalipsky et al.) Liposomes comprising PEG-modified ceramide lipids are described in WO 96/10391 (Choi et al). U.S. Pat. No. 5,540,935 (Miyazaki et al.) and U.S. Pat. No.
  • 5,556,948 (Tagawa et al.) describe PEG-containing liposomes that can be further derivatized with functional moieties on their surfaces.
  • a number of liposomes comprising nucleic acids are known in the art.
  • WO 96/40062 to Thierry et al. discloses methods for encapsulating high molecular weight nucleic acids in liposomes.
  • U.S. Pat. No. 5,264,221 to Tagawa et al. discloses protein-bonded liposomes and asserts that the contents of such liposomes may include a dsRNA.
  • U.S. Pat. No. 5,665,710 to Rahman et al. describes certain methods of encapsulating oligodeoxynucleotides in liposomes.
  • WO 97/04787 to Love et al. discloses liposomes comprising dsRNAs targeted to the raf gene.
  • Transfersomes are yet another type of liposomes, and are highly deformable lipid aggregates which are attractive candidates for drug delivery vehicles. Transfersomes may be described as lipid droplets which are so highly deformable that they are easily able to penetrate through pores which are smaller than the droplet. Transfersomes are adaptable to the
  • transfersomes it is possible to add surface edge -activators, usually surfactants, to a standard liposomal composition. Transfersomes have been used to deliver serum albumin to the skin. The transfersome-mediated delivery of serum albumin has been shown to be as effective as subcutaneous injection of a solution containing serum albumin.
  • HLB hydrophile/lipophile balance
  • Nonionic surfactants find wide application in pharmaceutical and cosmetic products and are usable over a wide range of pH values. In general their HLB values range from 2 to about 18 depending on their structure.
  • Nonionic surfactants include nonionic esters such as ethylene glycol esters, propylene glycol esters, glyceryl esters, polyglyceryl esters, sorbitan esters, sucrose esters, and ethoxylated esters.
  • Nonionic alkanolamides and ethers such as fatty alcohol ethoxylates, propoxylated alcohols, and ethoxylated/propoxylated block polymers are also included in this class.
  • the polyoxyethylene surfactants are the most popular members of the nonionic surfactant class.
  • Anionic surfactants include carboxylates such as soaps, acyl lactylates, acyl amides of amino acids, esters of sulfuric acid such as alkyl sulfates and ethoxylated alkyl sulfates, sulfonates such as alkyl benzene sulfonates, acyl isethionates, acyl taurates and sulfosuccinates, and phosphates.
  • the most important members of the anionic surfactant class are the alkyl sulfates and the soaps.
  • Cationic surfactants include quaternary ammonium salts and ethoxylated amines. The quaternary ammonium salts are the most used members of this class.
  • amphoteric surfactants include acrylic acid derivatives, substituted alkylamides, N-alkylbetaines and phosphatides.
  • an ALAS 1 dsRNA featured in the invention is fully encapsulated in the lipid formulation, e.g., to form a SPLP, pSPLP, SNALP, or other nucleic acid-lipid particle.
  • SNALP refers to a stable nucleic acid-lipid particle, including SPLP.
  • SPLP refers to a nucleic acid-lipid particle comprising plasmid DNA encapsulated within a lipid vesicle.
  • SNALPs and SPLPs typically contain a cationic lipid, a non- cationic lipid, and a lipid that prevents aggregation of the particle (e.g., a PEG-lipid conjugate).
  • SNALPs and SPLPs are extremely useful for systemic applications, as they exhibit extended circulation lifetimes following intravenous (i.v.) injection and accumulate at distal sites (e.g., sites physically separated from the administration site).
  • SPLPs include "pSPLP," which include an encapsulated condensing agent-nucleic acid complex as set forth in PCT Publication No. WO 00/03683.
  • the particles of the present invention typically have a mean diameter of about 50 nm to about 150 nm, more typically about 60 nm to about 130 nm, more typically about 70 nm to about 110 nm, most typically about 70 nm to about 90 nm, and are substantially nontoxic.
  • the nucleic acids when present in the nucleic acid- lipid particles of the present invention are resistant in aqueous solution to degradation with a nuclease. Nucleic acid- lipid particles and their method of preparation are disclosed in, e.g., U.S. Patent Nos. 5,976,567; 5,981 ,501 ; 6,534,484; 6,586,410; 6,815,432; and PCT Publication No. WO 96/40964.
  • the lipid to drug ratio (mass/mass ratio) (e.g., lipid to dsRNA ratio) will be in the range of from about 1: 1 to about 50: 1 , from about 1 : 1 to about 25: 1, from about 3: 1 to about 15: 1, from about 4: 1 to about 10: 1 , from about 5: 1 to about 9: 1 , or about 6: 1 to about 9: 1.
  • the cationic lipid may be, for example, N,N-dioleyl-N,N-dimethylammonium chloride
  • DODAC N,N-distearyl-N,N-dimethylammonium bromide
  • DDAB N-(I -(2,3- dioleoyloxy)propyl)-N,N,N-trimethylammonium chloride
  • DOTAP N-(I -(2,3- dioleyloxy)propyl)-N,N,N-trimethylammonium chloride
  • DODMA N,N-dimethyl-2,3- dioleyloxy)propylamine
  • DODMA N,2-DiLinoleyloxy-N,N-dimethylaminopropane
  • Dilinoleylcarbamoyloxy-3-dimethylaminopropane (DLin-C-DAP), 1 ,2-Dilinoleyoxy-3- (dimethylamino)acetoxypropane (DLin-DAC), 1 ,2-Dilmoleyoxy-3-morpholinopropane (DLin- MA), l,2-Dilinoleoyl-3-dimethylaminopropane (DLinDAP), l,2-Dilinoieylthio-3- dimethylaminopropane (DLin-S-DMA), l-Linoleoyl-2-linoleyloxy-3-dimethylaminopropane (DLin-2-DMAP), l ,2-Dilinoleyloxy-3-trimethylaminopropane chloride salt (DLin-TMA.Cl), l,2-Dilinoleoyl-3-trimethylaminopropane chloride salt (DLin-TAP.
  • the compound 2,2-Dilinoleyl-4-dimethylaminoethyl-f 1 ,3]- dioxolane can be used to prepare lipid-siRNA nanoparticles. Synthesis of 2,2-Dilinoleyl-4- dimethylaminoethyl-[l,3]-dioxolane is described in United States provisional patent application number 61/107,998 filed on October 23, 2008, which is herein incorporated by reference.
  • the lipid-siRNA particle includes 40% 2, 2-Dilinoleyl-4- dimethylaminoethyl-[l ,3]-dioxolane: 10% DSPC: 40% Cholesterol: 10% PEG-C-DOMG (mole percent) with a particle size of 63.0 ⁇ 20 nm and a 0.027 siRNA Lipid Ratio.
  • the non-cationic lipid may be an anionic lipid or a neutral lipid including, but not limited to, distearoylphosphatidylcholine (DSPC), dioleoylphosphatidylcholine (DOPC),
  • DSPC distearoylphosphatidylcholine
  • DOPC dioleoylphosphatidylcholine
  • DPPC dipalmitoylphosphatidylcholine
  • DOPG dioleoylphosphatidylglycerol
  • dipalmitoylphosphatidylglycerol DPPG
  • dioleoyl-phosphatidylethanolamine DOPE
  • palmitoyloleoylphosphatidylcholine POPC
  • palmitoyloleoylphosphatidylethanolamine POPE
  • dipalmitoyl phosphatidyl ethanolamine DPPE
  • dimyristoylphosphoethanolamine dimyristoylphosphoethanolamine
  • the non-cationic lipid may be from about 5 mol % to about 90 mol %, about 10 mol %, or about 58 mol % if cholesterol is included, of the total lipid present in the particle.
  • the conjugated lipid that inhibits aggregation of particles may be, for example, a polyethyleneglycol (PEG)-lipid including, without limitation, a PEG-diacylglycerol (DAG), a PEG-dialkyloxypropyl (DAA), a PEG-phospholipid, a PEG-ceramide (Cer), or a mixture thereof.
  • PEG-DAA conjugate may be, for example, a PEG-dilauryloxypropyl (Ci?), a PEG- dimyiistyloxypropyl (Ci 4 ), a PEG-dipalmityloxypropyl (Ci ⁇ ,), or a PEG- distearyloxypropyl
  • the conjugated lipid that prevents aggregation of particles may be from 0 mol % to about 20 mol % or about 2 mol % of the total lipid present in the particle.
  • the nucleic acid-lipid particle further includes cholesterol at, e.g., about 10 mol % to about 60 mol % or about 48 mol % of the total lipid present in the particle.
  • the iRNA is formulated in a lipid nanoparticle (LNP).
  • LNP01 lipid nanoparticle
  • the lipidoid ND98-4HC1 (MW 1487) (see U.S. Patent Application No. 12/056,230, filed 3/26/2008, which is herein incorporated by reference), Cholesterol (Sigma- Aldrich), and PEG-Ceramide C 16 (Avanti Polar Lipids) can be used to prepare lipid-dsRNA nanoparticles (e.g., LNP01 particles).
  • Stock solutions of each in ethanol can be prepared as follows: ND98, 133 mg/ml; Cholesterol, 25 mg/ml, PEG-Ceramide C16, 100 mg/ml.
  • the ND98, Cholesterol, and PEG-Ceramide C16 stock solutions can then be combined in a, e.g., 42:48: 10 molar ratio.
  • the combined lipid solution can be mixed with aqueous dsRNA (e.g., in sodium acetate pH 5) such that the final ethanol concentration is about 35-45% and the final sodium acetate concentration is about 100-300 mM.
  • aqueous dsRNA e.g., in sodium acetate pH 5
  • Lipid-dsRNA nanoparticles typically form spontaneously upon mixing.
  • the resultant nanoparticle mixture can be extruded through a polycarbonate membrane (e.g., 100 nm cut-off) using, for example, a thermobarrel extruder, such as Lipex Extruder (Northern Lipids, Inc). in some cases, the extrusion step can be omitted. Ethanol removal and simultaneous buffer exchange can be accomplished by, for example, dialysis or tangential flow filtration. Buffer can be exchanged with, for example, phosphate buffered saline (PBS) at about pH 7, e.g., about pH 6.9, about pH 7.0, about pH 7.1, about pH 7.2, about pH 7.3, or about pH 7.4.
  • PBS phosphate buffered saline
  • LNPOl formulations are described, e.g., in International Application Publication
  • PEG-DMG PEG-didimyristoyi glycerol (C14-PEG, or PEG-C14) (PEG with avg mol wt of 2000)
  • PEG-DSG PEG-distyryl glycerol (C 18-PEG, or PEG-C 18) (PEG with avg mol wt of 2000)
  • PEG-cDMA PEG-carbamoyl-l,2-dimyristyloxypropylamine (PEG with avg mol wt of 2000)
  • SNALP l,2-Dilinolenyloxy-N,N-dimethylaminopropane (DLinDMA)
  • DLinDMA l,2-Dilinolenyloxy-N,N-dimethylaminopropane
  • XTC comprising formulations are described, e.g., in U.S. Provisional Serial No.
  • MC3 comprising formulations are described, e.g., in U.S. Provisional Serial No.
  • ALNY-100 comprising formulations are described, e.g., International Application Publication No. WO 2010/054406 (International Application No. PCT/US09/63933, filed on November 10, 2009), which is hereby incorporated by reference.
  • any of the compounds, e.g., cationic lipids and the like, used in the nucleic acid-lipid particles featured in the invention may be prepared by known organic synthesis techniques, including the methods described in more detail in the Examples. All substituents are as defined below unless indicated otherwise.
  • Alkyl means a straight chain or branched, noncyclic or cyclic, saturated aliphatic hydrocarbon containing from 1 to 24 carbon atoms.
  • Representative saturated straight chain alkyls include methyl, ethyl, n-propyi, n-butyl, n-pentyl, n-hexyl, and the like; while saturated branched alkyls include isopropyl, sec-butyl, isobutyl, tert-butyl, isopentyl, and the like.
  • saturated cyclic alkyls include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, and the like; while unsaturated cyclic alkyls include cyclopentenyl and cyclohexenyl, and the like.

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Abstract

La présente invention concerne des compositions d'acide ribonucléique double brin (ARNdb) ciblant le gène ALAS1, ainsi que des méthodes d'utilisation desdites compositions d'ARNdb pour modifier (par exemple, inhiber) l'expression du gène ALAS1.
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US10125364B2 (en) 2012-04-10 2018-11-13 Alynylam Pharmaceuticals, Inc. Compositions and methods for inhibiting expression of the ALAS1 gene
US10968452B2 (en) 2014-10-17 2021-04-06 Alnylam Pharmaceuticals, Inc. Polynucleotide agents targeting aminolevulinic acid synthase-1 (ALAS1) and uses thereof
EP3651775A4 (fr) * 2017-07-13 2021-04-07 Alnylam Pharmaceuticals, Inc. Méthodes d'inhibition de l'expression génique d'hao1 (hydroxyacide oxydase 1 (glycolate oxydase))
CN113453727A (zh) * 2019-02-22 2021-09-28 国立大学法人东京医科齿科大学 异源核酸的最适ps修饰模式

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