Peptide conjugation of 2'-O-methyl phosphorothioate antisense oligonucleotides enhances cardiac uptake and exon skipping in mdx mice

Nucleic Acid Ther. 2014 Feb;24(1):25-36. doi: 10.1089/nat.2013.0448. Epub 2013 Dec 9.


Antisense oligonucleotide (AON)-mediated exon skipping is a promising therapeutic approach for Duchenne muscular dystrophy that is currently being tested in various clinical trials. This approach is based on restoring the open reading frame of dystrophin transcripts resulting in shorter but partially functional dystrophin proteins as found in patients with Becker muscular dystrophy. After systemic administration, a large proportion of AONs ends up in the liver and kidneys. Therefore, enhancing AON uptake by skeletal and cardiac muscle would improve the AONs' therapeutic effect. For phosphorodiamidate morpholino oligomer, AONs use nonspecific positively charged cell penetrating peptides to enhance efficacy. However, this is challenging for negatively charged 2'-O-methyl phosphorothioate oligomer. Therefore, we screened a 7-mer phage display peptide library to identify muscle and heart homing peptides in vivo in the mdx mouse model and found a promising candidate peptide capable of binding muscle cells in vitro and in vivo. Upon systemic administration in dystrophic mdx mice, conjugation of a 2'-O-methyl phosphorothioate AON to this peptide indeed improved uptake in skeletal and cardiac muscle, and resulted in higher exon skipping levels with a significant difference in heart and diaphragm. Based on these results, peptide conjugation represents an interesting strategy to enhance the therapeutic effect of exon skipping with 2'-O-methyl phosphorothioate AONs for Duchenne muscular dystrophy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Dystrophin / genetics
  • Exons
  • Humans
  • Male
  • Mice
  • Mice, Inbred mdx
  • Muscle, Skeletal / metabolism
  • Muscular Dystrophy, Animal / genetics
  • Muscular Dystrophy, Animal / metabolism
  • Muscular Dystrophy, Animal / therapy
  • Muscular Dystrophy, Duchenne / genetics
  • Muscular Dystrophy, Duchenne / metabolism
  • Muscular Dystrophy, Duchenne / therapy
  • Mutation
  • Myocardium / metabolism
  • Oligonucleotides, Antisense / chemistry*
  • Oligonucleotides, Antisense / genetics
  • Oligonucleotides, Antisense / therapeutic use*
  • Peptide Library
  • Peptide Nucleic Acids / chemistry
  • Peptide Nucleic Acids / genetics
  • Peptide Nucleic Acids / therapeutic use
  • Phosphorothioate Oligonucleotides / chemistry*
  • Phosphorothioate Oligonucleotides / genetics
  • Phosphorothioate Oligonucleotides / therapeutic use*
  • Targeted Gene Repair / methods


  • Dystrophin
  • Oligonucleotides, Antisense
  • Peptide Library
  • Peptide Nucleic Acids
  • Phosphorothioate Oligonucleotides
  • apo-dystrophin 1