1
|
Zanoteli E, França MC, Marques W. Gene-based therapies for neuromuscular disorders. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-10. [PMID: 38325390 PMCID: PMC10849828 DOI: 10.1055/s-0043-1777755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 02/09/2024]
Abstract
Neuromuscular diseases (NMD) include a broad group of medical conditions with both acquired and genetic causes. In recent years, important advances have been made in the treatment of genetically caused NMD, and most of these advances are due to the implementation of therapies aimed at gene regulation. Among these therapies, gene replacement, small interfering RNA (siRNA), and antisense antinucleotides are the most promising approaches. More importantly, some of these therapies have already gained regulatory approval or are in the final stages of approval. The review focuses on motor neuron diseases, neuropathies, and Duchenne muscular dystrophy, summarizing the most recent developments in gene-based therapies for these conditions.
Collapse
Affiliation(s)
- Edmar Zanoteli
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Marcondes Cavalcante França
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil.
| | - Wilson Marques
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| |
Collapse
|
2
|
Ward C, Beharry A, Tennakoon R, Rozik P, Wilhelm SDP, Heinemann IU, O'Donoghue P. Mechanisms and Delivery of tRNA Therapeutics. Chem Rev 2024. [PMID: 38801719 DOI: 10.1021/acs.chemrev.4c00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Transfer ribonucleic acid (tRNA) therapeutics will provide personalized and mutation specific medicines to treat human genetic diseases for which no cures currently exist. The tRNAs are a family of adaptor molecules that interpret the nucleic acid sequences in our genes into the amino acid sequences of proteins that dictate cell function. Humans encode more than 600 tRNA genes. Interestingly, even healthy individuals contain some mutant tRNAs that make mistakes. Missense suppressor tRNAs insert the wrong amino acid in proteins, and nonsense suppressor tRNAs read through premature stop signals to generate full length proteins. Mutations that underlie many human diseases, including neurodegenerative diseases, cancers, and diverse rare genetic disorders, result from missense or nonsense mutations. Thus, specific tRNA variants can be strategically deployed as therapeutic agents to correct genetic defects. We review the mechanisms of tRNA therapeutic activity, the nature of the therapeutic window for nonsense and missense suppression as well as wild-type tRNA supplementation. We discuss the challenges and promises of delivering tRNAs as synthetic RNAs or as gene therapies. Together, tRNA medicines will provide novel treatments for common and rare genetic diseases in humans.
Collapse
|
3
|
Malaga M, Rodriguez-Calienes A, Chavez-Ecos FA, Huerta-Rosario A, Alvarado-Gamarra G, Cabanillas-Lazo M, Moran-Ballon P, Velásquez-Rimachi V, Martinez-Esteban P, Alva-Diaz C. Clinical practice guidelines for the diagnosis and management of Duchenne muscular dystrophy: a scoping review. Front Neurol 2024; 14:1260610. [PMID: 38249725 PMCID: PMC10797703 DOI: 10.3389/fneur.2023.1260610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Our objective was to identify recent CPGs for the diagnosis and management of DMD and summarize their characteristics and reliability. Methods We conducted a scoping review of CPGs using MEDLINE, the Turning Research Into Practice (TRIP) database, Google Scholar, guidelines created by organizations, and other repositories to identify CPGs published in the last 5 years. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses for scoping reviews. To assess the reliability of the CPGs, we used all the domains included in the Appraisal of Guidelines Research and Evaluation II. Results We selected three CPGs published or updated between 2015 and 2020. All the guidelines showed good or adequate methodological rigor but presented pitfalls in stakeholder involvement and applicability domains. Recommendations were coherent across CPGs on steroid treatment, except for minor differences in dosing regimens. However, the recommendations were different for new drugs. Discussion There is a need for current and reliable CPGs that develop broad topics on the management of DMD and consider the challenges of developing recommendations for RDs.
Collapse
Affiliation(s)
- Marco Malaga
- Facultad de Medicina Humana de la Universidad de San Martín de Porres, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
| | - Aaron Rodriguez-Calienes
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Fabian A. Chavez-Ecos
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de Ica, Universidad Nacional San Luis Gonzaga, Ica, Peru
| | - Andrely Huerta-Rosario
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Facultad de Medicina Humana, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Giancarlo Alvarado-Gamarra
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Peru
- Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Miguel Cabanillas-Lazo
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Sociedad Científica de San Fernando, Lima, Peru
| | - Paula Moran-Ballon
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Sociedad Científica Universidad San Martín de Porres, Lima, Peru
| | - Victor Velásquez-Rimachi
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | | | - Carlos Alva-Diaz
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
- Universidad Señor de Sipán, Chiclayo, Peru
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
| |
Collapse
|
4
|
Spagnoli C, Adorisio R, Bello L, D’Amico A, D’Angelo MG, Pane M, Penzo M, Riguzzi P, Sansone V, Vianello A, Fusco C. Continuitiy of care with ataluren in Duchenne Muscular Dystrophy patients with nonsense mutations after loss of ambulation. Personal experience. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2023; 42:118-122. [PMID: 38406379 PMCID: PMC10883323 DOI: 10.36185/2532-1900-396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 02/27/2024]
Abstract
Duchenne Muscular Dystrophy (DMD) includes predictable phases requiring dedicated standard treatments. Therapeutic strategies feature corticosteroids or the more recent gene therapy/stop codon read-through. Ataluren (Translarna®) is an oral drug promoting the readthrough of premature stop codons caused by nonsense mutation (nm) in order to produce full-length dystrophin. It was licensed by EMA in 2014 for ambulatory patients with nmDMD aged ≥ 5 years. Our aim is to report data on long-term ataluren use in Italian patients with nmDMD, with emphasis on continuity of the treatment after loss of ambulation (LoA). Four DMD patients aged between 16 and 24 years who lost ambulation between 12 and 14 years continued to take ataluren after LoA. The oldest patient, aged 24 years, is still taking a few steps. Even in those experiencing motor decline, PUL-test performances were stable and respiratory function satisfactory in all; two patients developed severe cardiomyopathy, stable in one. Therapeutic continuity with ataluren should be offered to all nmDMD patients after LoA given its favourable safety and efficacy profile. However, further research is recommended to identify additional clinically meaningful outcomes and treatment goals following LoA.
Collapse
Affiliation(s)
- Carlotta Spagnoli
- Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rachele Adorisio
- Heart Failure, Transplant and Mechanical Cardiocirculatory Support Unit, Department of Pediatric Cardiology and Cardiac Surgery, Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, Rome, Italy
| | - Luca Bello
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Adele D’Amico
- Department of Neuroscience, Catholic University, Rome, Italy
| | - Maria Grazia D’Angelo
- Istituto di Ricerca e Cura a Carattere Scientifico E. Medea, La Nostra Famiglia, Bosisio Parini, Italy
| | - Marika Pane
- Pediatric Neurology and Nemo Clinical Centre, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Martina Penzo
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Pietro Riguzzi
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Valeria Sansone
- Centro Clinico Nemo Milan, Neurorehabilitation Unit, Dipartimento di Scienze Biomediche della Salute, University of Milan, Milan, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University of Padua, Padua, Italy
| | - Carlo Fusco
- Child Neurology Unit, Presidio Ospedaliero Provinciale Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
5
|
Braga VLL, Lima DP, Mariano TC, Lima PLGDSB, Maia ABDA, da Silva Meireles WW, de Oliveira Pessoa KT, de Oliveira CM, Ribeiro EM, Nóbrega PR, Pessoa ALS. Higher Prevalence of Nonsense Pathogenic DMD Variants in a Single-Center Cohort from Brazil: A Genetic Profile Study That May Guide the Choice of Disease-Modifying Treatments. Brain Sci 2023; 13:1521. [PMID: 38002481 PMCID: PMC10669865 DOI: 10.3390/brainsci13111521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Dystrophinopathies are muscle diseases caused by pathogenic variants in DMD, the largest gene described in humans, representing a spectrum of diseases ranging from asymptomatic creatine phosphokinase elevation to severe Duchenne muscular dystrophy (DMD). Several therapeutic strategies are currently in use or under development, each targeting different pathogenic variants. However, little is known about the genetic profiles of northeast Brazilian patients with dystrophinopathies. We describe the spectrum of pathogenic DMD variants in a single center in northeast Brazil. This is an observational, cross-sectional study carried out through molecular-genetic analysis of male patients diagnosed with dystrophinopathies using Multiplex Ligation-dependent Probe Amplification (MLPA) followed by Next-Generation Sequencing (NGS)-based strategies. A total of 94 male patients were evaluated. Deletions (43.6%) and duplications (10.6%) were the most recurring patterns of pathogenic variants. However, small variants were present in 47.1% of patients, most of them nonsense variants (27.6%). This is the largest South American single-center case series of dystrophinopathies to date. We found a higher frequency of treatment-amenable nonsense single-nucleotide variants than most previous studies. These findings may have implications for diagnostic strategies in less-known populations, as a higher frequency of nonsense variants may mean a higher possibility of treating patients with disease-modifying drugs.
Collapse
Affiliation(s)
- Vitor Lucas Lopes Braga
- Division of Pediatry, Hospital Infantil Albert Sabin, Fortaleza 60410-794, CE, Brazil; (V.L.L.B.); (A.B.d.A.M.)
| | - Danielle Pessoa Lima
- Division of Geriatry, Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza 60430-372, CE, Brazil;
| | - Tamiris Carneiro Mariano
- Division of Neurogenetics and Neuromuscular Disorders, Hospital Infantil Albert Sabin, Fortaleza 60410-794, CE, Brazil;
| | | | - Ana Beatriz de Almeida Maia
- Division of Pediatry, Hospital Infantil Albert Sabin, Fortaleza 60410-794, CE, Brazil; (V.L.L.B.); (A.B.d.A.M.)
| | | | | | | | | | - Paulo Ribeiro Nóbrega
- Division of Neurology, Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza 60430-372, CE, Brazil
- Campus Parque Ecológico, Centro Universitário Christus, Fortaleza 60160-230, CE, Brazil
| | - André Luiz Santos Pessoa
- Albert Sabin Children’s Hospital, Fortaleza 60410-794, CE, Brazil;
- Faculty of Medicine, State University of Ceará (UECE), Fortaleza 60714-903, CE, Brazil
| |
Collapse
|
6
|
D'Ambrosio ES, Mendell JR. Evolving Therapeutic Options for the Treatment of Duchenne Muscular Dystrophy. Neurotherapeutics 2023; 20:1669-1681. [PMID: 37673849 PMCID: PMC10684843 DOI: 10.1007/s13311-023-01423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is the most common childhood form of muscular dystrophy. It is caused by mutations in the DMD gene, leading to reduced or absent expression of the dystrophin protein. Clinically, this results in loss of ambulation, cardiomyopathy, respiratory failure, and eventually death. In the past decades, the use of corticosteroids has slowed down the disease progression. More recently, the development of genetically mediated therapies has emerged as the most promising treatment for DMD. These strategies include exon skipping with antisense oligonucleotides, gene replacement therapy with adeno-associated virus, and gene editing with CRISPR (clustered regularly interspaced short palindromic repeats) technology. In this review, we highlight the most up-to-date therapeutic progresses in the field, with emphasis on past and recent experiences, as well as the latest clinical results of DMD micro-dystrophin gene therapy. Additionally, we discuss the lessons learned along the way and the challenges encountered, all of which have helped advance the field, with the potential to finally alleviate such a devastating disease.
Collapse
Affiliation(s)
- Eleonora S D'Ambrosio
- Center for Gene Therapy, Department of Pediatrics, Abigail Wexner Research Institute, Nationwide Children's Hospital, Ohio State University, Columbus, OH, 43205, USA. eleonora.d'
| | - Jerry R Mendell
- Center for Gene Therapy, Department of Pediatrics, Abigail Wexner Research Institute, Nationwide Children's Hospital, Ohio State University, Columbus, OH, 43205, USA
| |
Collapse
|