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WO 2017/062816 A2 13 April 2017 (13.04.2017) P O P C T

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WO 2017/062816 A2 13 April 2017 (13.04.2017) P O P C T (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2017/062816 A2 13 April 2017 (13.04.2017) P O P C T (51) International Patent Classification: AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, A61K 48/00 (2006.01) C07H 21/02 (2006.01) BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DJ, DK, DM, DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (21) International Application Number: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, PCT/US20 16/056068 KW, KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, (22) International Filing Date: MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, 7 October 2016 (07. 10.2016) OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, (25) Filing Language: English TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (26) Publication Language: English ZW. (30) Priority Data: (84) Designated States (unless otherwise indicated, for every 62/238,83 1 8 October 201 5 (08. 10.2015) US kind of regional protection available): ARIPO (BW, GH, GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ, (71) Applicant: IONIS PHARMACEUTICALS, INC. TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, [US/US]; 2855 Gazelle Court, Carlsbad, CA 92010 (US). TJ, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, (72) Inventors: MULLICK, Adam; 2855 Gazelle C , Carls LV, MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK, bad, CA 92010 (US). GRAHAM, Mark, J.; 2855 Gazelle SM, TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, Ct., Carlsbad, CA 92010 (US). SETH, Punit, P.; 2855 GW, KM, ML, MR, NE, SN, TD, TG). Gazelle Ct., Carlsbad, CA 92010 (US). FREIER, Susan, M.; 2855 Gazelle Ct., Carlsbad, CA 92010 (US). Published: (74) Agents: GINGRICH, Brenden et al; Knobbe Martens without international search report and to be republished LLP, 2040 Main Street, 14th Floor, Irvine, CA 92614 upon receipt of that report (Rule 48.2(g)) (US). with sequence listing part of description (Rule 5.2(a)) (81) Designated States (unless otherwise indicated, for every kind of national protection available): AE, AG, AL, AM, < 00 o o (54) Title: COMPOUNDS AND METHODS FOR MODULATING ANGIOTENSINOGEN EXPRESSION (57) Abstract: Disclosed herein are compositions and compounds comprising modified oligonucleotides for modulating AGT and modulating a RAAS pathway related disease, disorder and/or condition in an individual in need thereof. A RAAS pathway related disease, disorder and/or condition in an individual such as hypertension can be treated, ameliorated, delayed or prevented with the administration of antisense compounds targeted to AGT. COMPOUNDS AND METHODS FOR MODULATING ANGIOTENSINOGEN EXPRESSION SEQUENCE LISTING The present application is being filed along with a Sequence Listing in electronic format. The Sequence Listing is provided as a file entitled BIOL0270WOSEQ_ST25.txt created October 3, 2016, which is 456 kb in size. The information in the electronic format of the sequence listing is incorporated herein by reference in its entirety FIELD OF THE INVENTION The present invention provides compounds, compositions and methods for modulating angiotensinogen (AGT) expression for the purpose of modulating a RAAS pathway related disease, disorder or condition in an animal. The present invention also provides compounds, compositions and methods for reducing hypertension and organ damage by administering an AGT inhibitor to an animal BACKGROUND OF THE INVENTION Angiotensinogen (AGT), also known as SERPINA8 or ANHU, is a member of the serpin family and is a component of the renin-angiotensin-aldosterone system (RAAS). It is primarily produced in the liver and is released into the circulation where renin converts it into angiotensin I. Angiotensin I is subsequently converted into angiotensin II by angiotension converting enzyme (ACE). Angiotensin II is a peptide hormone which causes vasoconstriction which, in turn, can increase blood pressure. Angiotensin II also stimulates secretion of the hormone aldosterone from the adrenal cortex. Aldosterone causes t e kidneys to increase reabsorption of sodium and water leading to an increase of the fluid volume in a body which, in turn, can increase blood pressure. Over stimulation or activity of the RAAS pathway can lead to high blood pressure. Chronic high blood pressure is known as hypertension. The high blood pressure in a hypertensive subject requires t e heart to work harder to circulate blood through the blood vessels. The World Health Organization (WHO) has identified hypertension as a leading cause of cardiovascular morbidity. Hypertension is a major risk factor for various disease, disorders and conditions such as shortened life expectancy, chronic kidney disease, stroke, myocardial infarction, heart failure, aneurysms of the blood vessels (e.g. aortic aneurysm), peripheral artery disease, heart damage (e.g., heart enlargement or hypertrophy) and other cardiovascular related diseases, disorders and/or conditions. The prevelance of resistant hypertension (RHTN), hypertension resistant to drug treatment, has steadily increased in number likely due to an ageing population and an ever increasing incidence of obesity. The current projection of approximately 10 million RHTN adults in the United States is expected to continue to rise. Anti-hypertensive drugs, renal denervation, baroreceptor activation therapy, diet changes and lifestyle changes may reduce hypertension and reduce the diseases, disorders and/or conditions associated with hypertension (Paulis et al., Nat Rev Cardiol, 2012, 9:276-285). However, there are limitations to the therapies currently approved for treating hypertension as a significant subset of all hypertensive patients do not achieve adequate blood pressure control. For example, drugs such as ACE inhibitors and angiotensin receptor blockers (ARBs) that target parts of the renin-angiotensin system (RAS) pathway are limited in their ability to inhibit the RAAS pathway (Nobakht et al., Nat Rev Nephrol, 201 1, 7:356-359). Additionally, certain anti-hypertensive drugs such as ACE inhibitors are contra-indicated in hypertensive patients with renal disease due to their potential to compromise renal function in patients. Accordingly, there is a need to find alternative treatments to inhibit the RAAS pathway and treat hypertension. Antisense technology is emerging as an effective means for reducing the expression of certain gene products. However, early antisense oligonucleotides targeting AGT provided limited benefit (WO 1997/33623) or targeted non-human AGT (WO 2014/018930). The compounds and compositions herein provide novel, highly potent and tolerable compounds to inhibit human AGT and are suitable for use in human subjects. Additionally, compounds disclosed herein, by using a conjugate strategy that delivers antisense compounds to the liver and limits their renal distribution and activity, are predicted to mitigate the tolerability issues of traditional RAS blockers in patients at risk for hyperkalemia and/or renal disease. All documents, or portions of documents, cited in this application, including, but not limited to, patents, patent applications, articles, books, and treatises, are hereby expressly incorporated-by-reference for the portions of the document discussed herein, as well as in their entirety. SUMMARY OF THE INVENTION Provided herein are compositions, compounds and methods for lowering the levels of AGT mRNA and/or protein in an animal. Certain embodiments disclosed herein provide a compound comprising a modified oligonucleotide targeting a nucleic acid sequence encoding AGT. In certain embodiments, the compound targets an AGT sequence as shown in the nucleobase sequences of any of SEQ ID NOs: 1-6. Certain embodiments disclosed herein provide a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides having a nucleobase sequence comprising a portion of at least 8 contiguous nucleobases complementary to an equal length portion of nucleobases 2250 to 2337 of SEQ ID NO: 1, wherein the nucleobase sequence of the modified oligonucleotide is at least 80% complementary to SEQ ID NO: 1. Certain embodiments disclosed herein provide a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides having a nucleobase sequence comprising a portion of at least 8 contiguous nucleobases complementary to an equal length portion of nucleobases 228 1to 2300 of SEQ ID NO: 1, wherein the nucleobase sequence of the modified oligonucleotide is at least 80% complementary to SEQ ID O: 1. Certain embodiments disclosed herein provide a compound comprising a modified oligonucleotide consisting of 12 to 30 linked nucleosides and having a nucleobase sequence comprising at least 8 contiguous nucleobases of any of the nucleobase sequences of SEQ ID NOs: 46, 53-54, 61, 68, 76, 83, 85, 93, 96-97, 109, 127, 129-130, 132, 134-15, 137-39, 142, 163-172, 180-184, 186, 189, 234, 236, 238-239, 267, 313, 411, 452, 463-470, 475-478, 480, 500-503, 512, 517-518, 524-526, 654, 689, 702, 725-726, 728, 738, 779, 786- 787, 800, 808, 810-811, 825, 865, 868, 889, 894, 903, 905, 909, 954, 966, 1011, 1015, 1021, 1024, 1080, 1085, 1258-1259, 1261-1262, 1293-1294, 1299, 1325, 1470, 1472-1473, 1522, 1542, 1604, 1623-1624, 1667, 1670, 1682-1683, 1687, 1700, 1703-1704, 1708, 1714, 1716, 1719-1720, 1724-1726, 1729-1730, 1827, 1936, 1843-1844, 1846, 1886, 1893-1894, 1914, 1923, 1925, 1932, 1979, 1986, 1988, 1990, 2003, 2015, 2018, 2020, 2027-2028, 2035, 2037, 2039, 2044. Certain embodiments disclosed herein provide a compound comprising a modified oligonucleotide according to the following formula: mCes Aes mCes Aes Aes Ads mCds Ads Ads Gds mCds Tds Gds Gds Tds mCes Ges Ges Tes Te (SEQ ID NO: 1914); wherein, A is an adenine, mC is a 5'-methylcytosine, G is a guanine, T is a thymine, e is a 2'-0-methoxyethyl modified nucleoside, d is a 2'-deoxynucleoside, and s is a phosphorothioate internucleoside linkage.
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