Muntoni Francesco, Wells Dominic
Dubowitz Neuromuscular Centre, Department of Paediatrics, Hammersmith Hospital Campus, Imperial College London, London, UK.
Curr Opin Neurol. 2007 Oct;20(5):590-4. doi: 10.1097/WCO.0b013e3282efc157.
The search for a cure for Duchenne muscular dystrophy and other muscular dystrophies is progressing rapidly despite significant challenges posed by some genes and the complexity of targeting all skeletal muscles. This review focuses on three areas in which experimental clinical studies are in progress.
Two Phase I/IIa gene-therapy trials using adeno-associated viral vectors have recently started, one in limb-girdle muscular dystrophy and one in Duchenne muscular dystrophy. They will assess the safety of the intramuscular administration of the relevant adeno-associated viral vectors, and local efficacy. Two more Phase I/IIa studies are underway in Duchenne muscular dystrophy, focused on the intramuscular administration of antisense oligonucleotides to induce exon skipping. A third study is evaluating efficacy and tolerability of a drug which induces read-through of stop codons in Duchenne muscular dystrophy patients carrying nonsense mutations.
These studies should provide proof of principle of these experimental approaches in humans. It is likely that further refinement will be required before extending their use to the wider community of patients with muscular dystrophy. In the meantime it is important to prepare accurate registries of molecularly characterized patients to facilitate their recruitment in future studies.
尽管某些基因带来了重大挑战以及针对所有骨骼肌的复杂性,但寻找杜氏肌营养不良症和其他肌营养不良症的治愈方法仍在迅速推进。本综述聚焦于正在进行实验性临床研究的三个领域。
两项使用腺相关病毒载体的I/IIa期基因治疗试验最近已启动,一项针对肢带型肌营养不良症,另一项针对杜氏肌营养不良症。它们将评估肌肉注射相关腺相关病毒载体的安全性以及局部疗效。另外两项针对杜氏肌营养不良症的I/IIa期研究正在进行中,重点是肌肉注射反义寡核苷酸以诱导外显子跳跃。第三项研究正在评估一种药物对携带无义突变的杜氏肌营养不良症患者的疗效和耐受性,该药物可诱导终止密码子通读。
这些研究应能为这些实验方法在人体中的原理提供证据。在将其应用扩展到更广泛的肌营养不良症患者群体之前,可能需要进一步完善。与此同时,重要的是建立准确的分子特征患者登记册,以便于他们参与未来的研究。