Nucleic Acids Research Advance Access originally published online on November 2, 2007
Nucleic Acids Research 2007 35(21):e139; doi:10.1093/nar/gkm935
Nucleic Acids Research, 2007, Vol. 35, No. 21 e139
© 2007 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
A versatile method for the preparation of conjugates of peptides with DNA/PNA/analog by employing chemo-selective click reaction in water
Khirud Gogoi,
Meenakshi V. Mane,
Sunita S. Kunte and
Vaijayanti A. Kumar*
Division of Organic Chemistry, National Chemical Laboratory, Pune, India, 411008
*To whom correspondence should be addressed. Tel: +91 20 25902340; Fax: +91 20 25902624; Email: va.kumar{at}ncl.res.in
Received August 14, 2007. Revised September 21, 2007. Accepted October 11, 2007.
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ABSTRACT
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The specific 1,3 dipolar Hüisgen cycloaddition reaction
known as click-reaction between azide and alkyne
groups is employed for the synthesis of peptide–oligonucleotide
conjugates. The peptide nucleic acids (PNA)/DNA and peptides
may be appended either by azide or alkyne groups. The cycloaddition
reaction between the azide and alkyne appended substrates allows
the synthesis of the desired conjugates in high purity and yields
irrespective of the sequence and functional groups on either
of the two substrates. The versatile approach could also be
employed to generate the conjugates of peptides with thioacetamido
nucleic acid (TANA) analog. The click reaction is catalyzed
by Cu (I) in either water or in organic medium. In water,

3-fold
excess of the peptide-alkyne/azide drives the reaction to completion
in 2 h with no side products.
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INTRODUCTION
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Uncharged, achiral peptide nucleic acids (PNAs) are DNA mimics
that show unprecedented affinity towards complementary RNA and
DNA sequences(
1,
2). PNA and other modified oligonucleotides
(ONs) (
3–7) are currently being developed as DNA mimics
to target disease-causing mRNA (
8,
9), using the principle of
antisense action. This is gaining further importance because
of corrective antisense therapies that do not require activation
of RNase H enzyme or cleavage of the target mRNA (
10). The success
or failure of any such candidate in antisense therapeutics depends
on a number of factors such as sequence-specific recognition
of target mRNA, intracellular stability, water solubility (
3)
and cell penetration (
11). Application of PNA and analogous
uncharged DNA mimics is stymied by the fact that PNAs show very
low cell penetration for any observable antisense effect (
12).
Several strategies are being developed for the delivery of modified
ONs into cells (
13,
14). For uncharged ON mimics such as PNAs,
the best option seems to be the covalent conjugation of PNA
oligomers with cell-penetrating peptides (CPP) (
15–17).
Conjugation of peptides to DNA and DNA analogs with sugar-phosphate
backbone ONs is also gaining importance for their biological
applications (
13,
14). The CPPs are mostly positively charged
peptides containing lysine (
18) or arginine (
19,
20) or other
peptides having specific cell receptors (
21). Several other
uses of peptide conjugation with ONs are known in the literature(
13).
The conjugation is achieved by tedious continuous solid-phase
synthesis of PNA and peptide (
22–25). The other methods
for conjugation could be post-synthetic via disulfide bridge
(
26,
27) or more stable thioether linkages (
21) at either C-
or N- terminus. A recent review (
13) not only summarizes the
present methods of synthesizing ON–peptide conjugates
that are common to ONs and their analogs but also points out
the need to develop straightforward methods to synthesize such
conjugates. The highly functionalized nature of these biomolecules
and their mimics such as PNA, render them susceptible for side
reactions during conjugation and yield and purity of structurally
defined conjugated biomolecules is often low. The (4+2) Diels-Alder
cycloaddition approach was employed recently for the conjugation
of DNA and CPP (
28). This involved the reaction between diene
and dienophile present on the respective biomolecules to get
the conjugates. The maleimide dienophile used in this reaction
is susceptible for Michael addition reactions with other nucleophilic
centers on peptides or ONs and may give rise to side reactions.
The current literature clearly indicates the need for a simple
and straightforward strategy for generating highly pure ON/PNA–peptide
conjugates in high yield (
13).
Meanwhile, we find that the applications of highly selective orthogonal Cu (I) catalyzed Hüisgen 1, 3 dipolar cycloadddition reaction, recognized as click chemistry (29–32), are expanding the scope of synthesis of variety of other bioconjugates such as DNA-glycoconjugates (33), peptide–protein conjugates (34), carbohydrate–vaccine conjugates (35) or protein modification and protein microarray fabrication (36). This reaction between high-energy organic azides and terminal alkynes can give rise to unlimited array of inert triazole containing architectures (Scheme 1). The reaction is highly predictable, fast and resistant to side reactions. Addition of Cu(I) accelerates the reaction (31,32). Some of these reactions could be carried out in aqueous medium and can be employed post-synthetically on purified units decorated with a variety of functional groups, without additional functional group protecting strategies. Recently, click reaction has also found applications for the synthesis of circular DNA (37,38), and DNA-template-directed ON strand ligation (38). With this background we envisaged a very simple possibility of synthesizing peptide–DNA/PNA conjugates using click chemistry i.e. a specific cycloaddition reaction between terminal azide and alkyne functionalities on PNA/DNA or peptide as per the synthesis design. These two functional groups are absent in the biomolecules of current interest and no predictable side reaction can be envisaged. This approach has not been previously applied to the synthesis of such conjugates and has potential to lead to a variety of CPP–DNA/PNA conjugates from various combinations of azide and alkyne derivatized peptides-ON substrates in aqueous solution without going into the rigors of continuous synthesis. In this paper, we report successful application of this proposal to generate the CPP conjugates with DNA/PNA ONs and thioacetamido nucleic acid (TANA, Figure 1) (39,40).
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MATERIALS AND METHODS
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N 
-Fmoc
L-amino acids and resins for peptide and PNA synthesis
were obtained from Novabiochem(Fmoc, 9-fluorenyl methoxy-carbonyl).
The Fmoc amino acid used were Fmoc -Lys(Boc)-OH, Fmoc-Arg(Mtr)-OH
and
N 
-Fmoc-Aha-OH.(Mtr, 4-methoxy-2,3,6-trimethylbenzenesulfonyl;
Boc,
tert-butoxycarbonyl; Aha, 6-aminohexanoic acid (or

-aminocaproic
acid). 6-aminohexanoic acid was obtained from Aldrich chemicals
and
N-Fmoc protection was done using standard procedure. The
concentrations of DNA/PNAs and their conjugates were determined
spectrophotometrically and the concentration of the peptides
was assumed approximately. Propynoic acid was procured from
Trade (TCI) Mark, Tokyo Kasei.
N-Boc-(2
S, 4
S)-4-azidoproline
was synthesized according to the reported procedure (
41). The
Boc and Fmoc protected PNA monomers were obtained from Applied
Biosystems, USA. TANA monomers were synthesized in the laboratory
following the reported procedures (
39). Propyne substituted
19-mer DNA sequence was synthesized using the phosphoramidite
approach and an Applied Biosystems 3900 DNA synthesizer.
Reverse phase high-performance liquid chromatography analyses were carried out on VARIAN Analytical Semi-prep HPLC system consisting of Varian Pro-star 210 Binary solvent delivery system. Linear gradients of A: 0.1% TFA in water and B: 55/45: Acetonitrile/Water, 0.1% TFA (Linear gradient from A to B in 30 min Flow- 1.5 ml/min.). Rainin Dynamax UV D-II Absorbance Detector Star Ver.5 at detection wavelength 254 nm or 220 nm was employed during the experimentation. Chromatography Workstation Rheodyne 7725I with manual injector and Lichrocart Lichrispher 100RP-18 250 x 4 mm id. Particle size-5 µm column were used.
Mass spectral analysis was performed on a Voyager-De-STR (Applied Biosystems) MALDI-TOF. A nitrogen laser (337 nm) was used for desorption. The matrixes used for analysis were CHCA (
-Cyano-4-hydroxycinnamic Acid), THAP (2', 4',and 6'-trihydroxyacetophenone) and HPA (3-hydroxypicolinic acid). Diammonium citrate was used as additive when THAP and HPA were used as matrix.
Solid-phase synthesis of azide functionalized PNA oligomers 2, 3 and 4
The azide functionalized PNA oligomers 2 and 3 were synthesized on Rink-amide resin (100 mg, loading 0.3 mmol/g) following the standard procedures of solid-phase peptide synthesis (42) (20 min treatment with 20% piperidine in N,N-dimethyl formamide and reaction with 3 equivalents of Fmoc-PNA monomer, HBTU, HOBt and DIPEA for 6 h, were used for the deprotection and coupling steps, respectively). The last coupling reaction was done with N-Boc-(2S,4S)-4-azidoproline. The progress of the coupling reaction was tested by Kaiser test at each step. Cleavage and deprotection were effected by reaction with TFA/DCM/TIS (10:85:5) for 30 min. The resulting oligomer was precipitated by addition of cold ether and purification was done by gel filtration followed by RP–HPLC and characterized by MALDI-TOF mass spectrometry (Table 1, entry 3, 6).
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Table 1. The RP-HPLC-tR and MALDI-TOF mass characterization and purity found by HPLC of the peptide, PNA and TANA sequences and peptide–PNA and peptide–TANA conjugates
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The azide functionalized mixed PNA oligomer
4 was synthesized
using side chain
N-Cbz protected Boc-
L-Lysine functionalized
MBHA resin (100 mg, loading 0.2 mmol/g) following the standard
procedures of solid-phase peptide synthesis (30 min treatment
with 50% TFA in DCM and reaction with three equivalents of Boc-PNA
monomer, HBTU, HOBt and DIPEA for 6 h, were used for the deprotection
and coupling steps, respectively). The last coupling reaction
was done with
N-Boc-(2
S,4
S)-4-azidoproline. Cleavage and deprotection
were carried out by the reaction with TFA-TFMSA, thioanisole,
ethanedithiol for 2 h. The resulting oligomer was precipitated
by addition of cold ether and purification was done by gel filtration
followed by RP–HPLC and characterized by MALDI-TOF mass
spectrometry (
Table 1, entry 9).
Solid-phase synthesis of alkyne functionalized lysine peptide HO-(Lys)6-alkyne 1
The alkyne functionalized lysine peptide was synthesized on Rink-amide resin (100 mg, loading 0.3 mmol/g) following the standard procedures of solid-phase peptide synthesis (42) (20 min treatment with 20% piperidine in N,N-dimethyl formamide and the reaction with 3 eqivalent of Fmoc-Lys(Boc)-OH, HBTU, HOBt and DIPEA for 4 h, were used for the deprotection and coupling steps, respectively). The last coupling was done with propynoic acid using HBTU, HOBt and DIPEA as the coupling agent. The peptide was cleaved from the resin by treatment with TFA/DCM/TIS (10:85:5) for 30 min and the deprotection of side chain was effected by 50% TFA-DCM (TIS used as scavenger) for 1 h. The resulting peptide was precipitated by addition of cold ether. The product was purified by HPLC and characterized by MALDI-TOF mass spectrometry (Table 1, entry 1).
Click reaction on solid phase: synthesis of HO-(Lys)6-triazole-proline 5
Twenty milligrams of resin bound to protected (Lys)6-alkyne 1, N-Boc-(2S,4S)-4-azidoproline (5 mg) (37), CuI(1 mg), DIPEA(5 µl) and DMF(0.3 ml) were reacted together in a reaction vessel for 8 h (Scheme 2). The excess reagents were washed out with DMF followed by DCM. Five milligrams of resin was cleaved by using the standard conditions and the product formed was purified by HPLC and characterized by MALDI-TOF mass spectrometry (Table 1, entry 2).
Solution phase reaction between PNA-proline azides 2, 3 and 4 and HO-(Lys)6-alkyne 1: synthesis of conjugates 6, 7 and 8
General procedure
HO-β-ala-TTTTTTTT-Pro-N
3 2 (or HO-Lys-TCACTAGATG-Pro-N
3 4 or HO-β-ala-t-t-t-t-t-t-t-t-Pro-N
3 3) (1 µmol)
and HO-(Lys)
6-alkyne
1 (

3 µmol) were dissolved in 50 µl
water:
tert. butanol(1:1). CuSO
4.5H
2O (1.0 equivalent, 1 µmol,
10 µl of a 100 mM solution in water) and freshly prepared
solution of sodium ascorbate (4 equivalents, 4 µmol, 8
µl of 500 mM solution in water) was then added. The mixture
was stirred in a spinix vortex at room temperature (
Scheme 3).
The reaction mixture was analyzed by HPLC after 2 h. HPLC showed
complete consumption of the starting material in the case of
3 giving product
7 (
Table 1, entry 7). In the case of either
2 or
4 the differences in HPLC-t
R was not very clear from the
starting materials. In these cases the product (
6 or
8) after
HPLC purification were characterized by MALDI-TOF mass spectrometry
(
Table 1, entry 4 and 10). Complete conversion of the starting
material
2 and
4 was established by the disappearance of the
corresponding mass peak in MALDI-TOF analysis (Supplementary
Data).
Solid-phase synthesis of the peptide HO-(Arg-Aha-Arg)4-alkyne 9
The arginine peptide
9 was synthesized on Rink-amide resin (200
mg, loading 0.3 mmol/g) following the standard procedures of
solid-phase peptide synthesis: 20 min treatment with 20% piperidine
in
N,N-dimethyl formamide and reaction with 3 equivalent of
Fmoc-Arg(Mtr)-OH (or
N 
-Fmoc-Aha-OH), HBTU, HOBt and DIPEA for
4 h, were used for the deprotection and coupling steps, respectively.
The final coupling was done with propynoic acid using HBTU,
HOBt and DIPEA as the coupling agent. Cleavage of the peptide
from resin was effected by reaction with TFA/DCM/TIS (10:85:5)
for 30 min. The deprotection of side-chain protecting group
(Mtr) was effected by 100% TFA and thioanisole as the scavenger
for 5 h. The resulting peptide was precipitated by addition
of cold ether and oligomer was purified by RP–HPLC. The
product was further characterized by MALDI-TOF mass spectrometry
(
Table 1, entry 12).
Solution phase reaction between PNA- proline azides 3, 4 and HO-(Arg-Aha-Arg)4-alkyne 9: synthesis of conjugates 10 and 11
General procedure
HO-Lys-TCACTAGATG-Pro-N3 4 or HO-β-ala-t-t-t-t-t-t-t-t-Pro-N3 3 (1 µmol) and (Arg-Aha-Arg)4-alkyne 9 (
3 µmol) were dissolved in 50 µl water:tert. Butanol (1:1). CuSO4.5H2O (1.0 equivalent, 1 µmol, 10 µl of a 100 mM solution in water) and freshly prepared solution of sodium ascorbate (4 equivalents, 4 µmol, 8 µl of 500 mM solution in water) was then added (Scheme 3). The mixture was stirred in a spinix vortex at room temperature. The reaction mixture was analyzed by RP–HPLC after 2 h. HPLC showed complete conversion of stating materials to the products. The products (10 and 11) formed were purified by RP–HPLC and characterized by MALDI-TOF mass spectrometry (Table 1, entry 13 and 14).
Synthesis of alkyne substituted DNA oligomer 12
The DNA sequence 12 was synthesized using commercially available monomeric units using phoaphoramidite chemistry on automated DNA synthesizer. The last coupling was done using 5'-O-(propynyl-N-3-benzoyl-thymidin)-3'-O-(N,N-diisopropylamino-O-cyanoethyl -phosphoramidite) (Figure 2). (Supplementary Data). The ON 12 was deprotected and cleaved from the solid support. It was further purified by RP–HPLC and characterized by MALDI-TOF mass spectrometry (Table 1, entry 15).
Solid-phase synthesis of the peptide HO-(Arg-Aha-Arg)4-azide 13
The arginine peptide
13 was synthesized on Rink-amide resin
(200 mg, loading 0.3 mmol/g) following the standard procedures
of solid-phase peptide synthesis: 20 min treatment with 20%
piperidine in
N,N-dimethyl formamide and reaction with 3 eqivalent
of Fmoc-Arg(Mtr)-OH (or
N 
-Fmoc-Aha-OH), HBTU, HOBt and DIPEA
for 4 h, were used for the deprotection and coupling steps,
respectively. The final coupling was done with
N-Boc-4-azido-proline
using HBTU, HOBt and DIPEA as the coupling agent. Cleavage of
the peptide from resin was effected by reaction with TFA/DCM/TIS
(10:85:5) for 30 min. The deprotection of side chain protecting
group (Mtr) was effected by 100% TFA and thioanisole as the
scavenger for 5 h. The resulting peptide was precipitated by
addition of cold ether and was purified by RP–HPLC. The
product was further characterized by MALDI-TOF mass spectrometry
(
Table 1, entry 16).
Solution phase reaction between DNA-alkyne 12 and HO-(Arg-Aha-Arg)4-azide 13: synthesis of conjugate 14
Alkyne functionalized ON 12 (1 µmol) and azide functionalized peptide 13 (
3 µmol) were dissolved in 50 µl water:tert. Butanol (1:1). CuSO4.5H2O (0.6 equivalent, 0.6 µmol, 6 µl of a 100 mM solution in water) and freshly prepared solution of sodium ascorbate (2.4 equivalents, 4 µmol, 6 µl of 500 mM solution in water) was then added (Scheme 4). The mixture was stirred in a spinix vortex at room temperature. After 1 h, a small portion of the reaction mixture was analyzed by RP–HPLC. HPLC showed complete conversion of stating materials to the product. The product 14 formed was purified by RP–HPLC and characterized by MALDI-TOF mass spectrometry (Table 1, entry 17).
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RESULTS AND DISCUSSION
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The aim of this study was to develop a simple and chemo-specific
method for the conjugation of peptides and ON mimics such as
PNA and TANA. The azide and acetylene carrier units were chosen
so that these could be installed online during the solid supported
peptide or PNA/TANA synthesis at the
N/
C-terminus through an
amide linkage that is stable towards conditions employed for
the deprotection and cleavage of the peptide/ON from the solid
support. The candidates chosen for this purpose were propynoic
acid and (2
S,4
S)- 4-azidoproline (
Figure 2) (
41). DNA ON was
functionalized at 5'-end using 5'-
O-propynyl-thymidine-phosphoramidite
(
Figure 2), (Supplementary Data). The 4-azidoproline was chosen
in this strategy, as it could also open up the possibility to
introduce the azide group at either
C/N-terminus or in the center
of the PNA or peptide sequences as desired. This could enable
the conjugation of peptide at either C- or N-terminus of PNA
or peptide. To assess the methodology and its application potential,
we chose three PNA sequences, a homopyrimidine PNA-T8, a mixed
purine-pyrimidine 10-mer PNA sequence and a recently developed
homothyminyl-oligomer with uncharged thioacetamido nucleic acid
(TANA) backbone (
39). The reaction medium was
tert.-butanol:water
that solubilizes all the reactants and is also capable of scavenging
hydroxy radicals (
44). The peptide sequence chosen was the lysine
(
18) or the arginine rich peptide (
19) that were known to act
as vehicle for PNAs to penetrate through the cell membrane.
The azide functionalized PNA oligomers
2 and
3 were synthesized
on Rink-amide resin following the standard procedures (
42) of
Fmoc based solid-phase peptide synthesis. The last coupling
reaction was done using
N-Boc-(2
S,4
S)-4-azidoproline monomer
unit. The azide functionalized mixed purine-pyrimidine PNA oligomer
4 was synthesized following the standard procedures of Boc-based
solid-phase peptide synthesis (
42). The final coupling reaction
was done with
N-Boc-(2
S,4
S)-4-azidoproline. The alkyne functionalized
lysine peptide
1 and arginine-rich peptide
9, were synthesized
on Rink-amide resin following the standard procedures of solid-phase
peptide synthesis. The final coupling was done with propynoic
acid. To install the azide functional group on DNA oligomer,
we attempted to synthesize 5'deoxy-5'-azido-thymidinyl-3'-
O-phosphoramidite,
but this was found to be quite unstable. We then synthesized
5'-
O-propynyl-
N3-benzoylthymidinyl-3'-
O-phosphoramidite (Supplementary
Data). The 5'-end alkyne substituted DNA sequence
12 was synthesized
using automated DNA synthesizer when the last coupling was with
5'-
O-propynyl-
N3-benzoylthymidinyl-3'-
O-phosphoramidite. N-terminal
azide containing arginine-rich peptide
13 was synthesized as
9, and
N-Boc-(2
S,4
S)-4-azidoproline was used for the last coupling
reaction. The installation of reactive alkyne and azide functionalities
on either the peptide or ON, was followed by the experiments
to study the feasibility of the click cycloaddition reaction.
The peptide
1, attached to the solid support with all the side
chain lysine amino- and terminal carboxy- groups protected,
was treated with 3 equivalents of
N-Boc(2
S,4
S)-4-azidoproline
in DMF in the presence of CuI. The product
5 was isolated after
cleavage from the support. There was negligible difference in
RP–HPLC t
R but mass showed conjugation of proline unit
through the triazole linkage (
Scheme 2,
Table 1, entry 5).
After the formation of the desired product was established, the solution phase reactions of PNAs with N-terminal azidoproline (2 and 4) or TANA (3) and N-terminal-alkyne substituted lysine peptide 1 and arginine-rich peptide 9, were carried out in tert. butanol:water medium in presence of CuSO4 and sodium ascorbate as a catalyst (Scheme 3). The CuI catalyst was found to be less efficient as compared to CuSO4-sodium ascorbate under these conditions. The reactions were followed by HPLC. The reaction took longer time for PNA, TANA substrates (16–32 h) to completion withapproximately one equivalent of each substrate. With approximately three equivalents excess of 1 or 9 complete conversion to the conjugated products (6–8 and 10, 11) was observed within 2 h. The DNA substrate 12 was converted to the peptide–DNA conjugate 14 within 1 h with 3 equivalents of the peptide (Scheme 4). Cu(I) catalysis is known to degrade DNA due to the presence of hydroxy radicals and addition of Cu(I) stabilizing ligands such as polytriazoles is often recommended to circumvent the DNA degradation (38). Arginine side chain imine nitrogen is also known to efficiently stabilize Cu(I) (43). It is therefore possible that the arginine peptide used in this reaction could have contributed to the stabilization of Cu(I) similar to the Cu(I)-binding ligands as small percentage of DNA degradation was observed. Additionally, presence of tert.-butanol as solvent in this reaction would circumvent DNA degradation as tert.-butanol is known scavenger of hydroxy radicals (44). The yields of peptide–DNA conjugates may be further improved by the use of Cu(I)-stabilizing ligands such as polytriazoles (38) along with tert.-butanol as hydroxy radical scavenger (44). The results are tabulated in Table 1 (entry 4, 7, 10, 13 and 14). The peptide–ON conjugates with either the DNA (14), aegPNA backbone (6, 8 and 11) or TANA backbone (7, 10) were obtained in high purity using this simple cycloaddition reaction. The reaction seems to be very specific without interfering with other functional groups present, either on peptide or DNA/PNA/TANA segments of the conjugates.
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Conclusions
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The peptide–DNA/PNA/TANA conjugation chemistry presented
in this paper will prove to be a unique solution for CPP conjugation
to antisense/siRNA therapeutics. In this fast-developing field,
application is mainly restrained by the problems faced in cellular
delivery of modified ONs. The ease of conjugation and compatibility
of the strategy with various substrates and functional groups
will prove to be an attractive alternative to present methods
for the synthesis of peptide–PNA conjugates. It is sequence-independent
with respect to either peptide or PNA/DNA or other backbone
modified DNA mimics (such as TANA), which are being developed
for antisense applications. The reactive azide and alkyne groups
can be installed on either ON or peptide and the work presented,
has a potential for general application in nucleic acid–peptide
conjugation. This could be a method of choice when a peptide
of choice needs to be conjugated with several ON sequences or
different modifications of the same sequence for studying their
bioactivity. Alternatively, the chosen ON may be conjugated
with several peptides to establish the biological efficacy of
different peptides. Some recent work was carried out to evaluate
the ON–peptide conjugates as a potential alternative to
the use of transfection agents to improve the efficacy of siRNA
(
45). It will be very interesting to study the effects of the
chemistry of this new linkage on the intracellular performance
of the conjugates (
9,
19).
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SUPPLEMENTARY DATA
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Supplementary Data are available at NAR Online.
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ACKNOWLEDGEMENTS
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K.G. thanks CSIR, New Delhi and V.A.K. thanks DST, New Delhi
and CEFIPRA, New Delhi for supporting this work. The initial
work was presented as a poster in the Cell Penetrating Peptides
meeting held at Telford, UK during 9–11 May, 2007. Funding
to pay the Open Access publication charges for this article
was waived by Oxford University Press.
Conflict of interest statement. None declared.
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