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Huntington's disease (HD) is a late-onset neurological disorder for which therapeutics are not available. Its key pathological mechanism involves the proteolysis of polyglutamine-expanded (polyQ-expanded) mutant huntingtin (mHTT), which generates N-terminal fragments containing polyQ, a key contributor to HD pathogenesis. Interestingly, a naturally occurring spliced form of HTT mRNA with truncated exon 12 encodes an HTT (HTTΔ12) with a deletion near the caspase-6 cleavage site. In this study, we used a multidisciplinary approach to characterize the therapeutic potential of targeting HTT exon 12. We show that HTTΔ12 was resistant to caspase-6 cleavage in both cell-free and tissue lysate assays. However, HTTΔ12 retained overall biochemical and structural properties similar to those of wt-HTT. We generated mice in which HTT exon 12 was truncated and found that the canonical exon 12 was dispensable for the main physiological functions of HTT, including embryonic development and intracellular trafficking. Finally, we pharmacologically induced HTTΔ12 using the antisense oligonucleotide (ASO) QRX-704. QRX-704 showed predictable pharmacology and efficient biodistribution. In addition, it was stable for several months and inhibited pathogenic proteolysis. Furthermore, QRX-704 treatments resulted in a reduction of HTT aggregation and an increase in dendritic spine count. Thus, ASO-induced HTT exon 12 splice switching from HTT may provide an alternative therapeutic strategy for HD.

Cystic fibrosis (CF) is caused by mutations in the gene encoding the epithelial chloride channel CF transmembrane conductance regulator (CFTR) protein. The most common mutation is a deletion of three nucleotides leading to the loss of phenylalanine at position 508 (p.Phe508del) in the protein. This study evaluates eluforsen, a novel, single-stranded, 33-nucleotide antisense oligonucleotide designed to restore CFTR function, in in vitro and in vivo models of p.Phe508del CF. The aims of the study were to demonstrate cellular uptake of eluforsen, and its efficacy in functional restoration of p.Phe508del-CFTR both in vitro and in vivo. In vitro, the effect of eluforsen was investigated in human CF pancreatic adenocarcinoma cells and human bronchial epithelial cells. Two mouse models were used to evaluate eluforsen in vivo. In vitro, eluforsen improved chloride efflux in CF pancreatic adenocarcinoma cell cultures and increased short-circuit current in primary human bronchial epithelial cells, both indicating restoration of CFTR function. In vivo, eluforsen was taken up by airway epithelium following oro-tracheal administration in mice, resulting in systemic exposure of eluforsen. In female F508del-CFTR mice, eluforsen significantly increased CFTR-mediated saliva secretion (used as a measure of CFTR function, equivalent to the sweat test in humans). Similarly, intranasal administration of eluforsen significantly improved nasal potential difference (NPD), and therefore CFTR conductance, in two CF mouse models. These findings indicate that eluforsen improved CFTR function in cell and animal models of p.Phe508del-CFTR-mediated CF and supported further development of eluforsen in human clinical trials, where eluforsen has also been shown to improve CFTR activity as measured by NPD.

Background QRX-704 is a novel antisense oligonucleotide-based therapeutic approach, aiming to mitigate mutant Huntingtin (mHTT) toxicity, while maintaining physiological HTT function. Proteolytic cleavage of mHTT generates toxic N-terminal fragments that are hypothesized to be the main contributor to the pathogenesis of Huntington disease (HD). These fragments are formed from a cascade of proteolytic cleavages, initiated by caspase-6 cleavage at position D586. Importantly, HTT586 cleavage is required for HD-like phenotypes in the YAC128 mouse model. Moreover, mHTT cleavage in turn increases caspase-6 activity, driving pathology in a toxic forward-feedback loop. While toxicity stemming from mHTT cleavage is the primary pathogenic mechanism, data indicates that HTT loss-of-function exacerbates pathology. In addition, maintaining wild type HTT function may be critical for safety of HTT-targeted therapeutics when treating patients for a long period of time. Aims QRX-704 functions at the pre-mRNA level by activating an alternative HTT splice-isoform (HTT Δ12), disrupting the critical HTT586 caspase-6 cleavage site, thus preventing formation of toxic N-terminal fragments. The aim of the study is to pharmacologically characterize QRX-704 for preclinical development, and describe the novel HTT Δ12 isoform. Methods/techniques Biodistribution, tolerability, immunogenicity, and pharmacodynamic activity of QRX-704, administered by intracerebroventricular (ICV) injection was assessed in wild type and YAC128 mice. Biophysical and biochemical characterization of HTT Δ12 was performed using purified protein, with caspase-6 cleavage assays, CD-spectroscopy, and post-translational modification mapping. Results/outcome ICV administration of QRX-704 was well tolerated and lead to efficient distribution and cellular uptake throughout the brain. QRX-704 induced formation of HTT Δ12 mRNA and protein in striatum and cortex in a dose-dependent manner. In vitro, recombinant HTT Δ12 is fully resistant to HTT586 caspase-6 cleavage and does not display major differences in biochemical and biophysical assays, compared to canonical HTT. Conclusions QRX-704 constitutes a novel therapeutic approach to HD, potentially preventing toxicity of mHTT while maintaining HTT function.