Department of Human Genetics and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Genes (Basel). 2020 Feb 5;11(2):169. doi: 10.3390/genes11020169.
Inherited retinal diseases (IRDs) are a group of progressive disorders that lead to severe visual impairment or even complete blindness. IRDs display a vast heterogeneity, clinically as well as genetically, with over 250 genes identified in which mutations can cause one or more clinical subtypes of IRD. Long considered incurable diseases, intense research over the last two decades, combined with major technological advancements, have enabled the development of the first therapeutic approaches for these diseases. The approval of LuxturnaTM (voretigene neparvovec), a gene augmentation therapy vector for RPE65-associated IRD, by the US Food and Drug Administration and the European Medicines Agency, is considered a true milestone in the field, and has led to the development of similar, or different therapeutic strategies for many other subtypes of IRD. Despite these major achievements, there are still many aspects that can-and need to-be improved, including more insights into the relationship between genetic variation and cellular dysfunction, optimization of the vectors and sequences used, improving delivery methods, as well as understanding and modulating the (local) immune response. In addition, the extreme rarity of some genetic subtypes of IRDs poses an enormous challenge on the development of novel therapies, in terms of e.g., costs and regulatory affairs.[...].
遗传性视网膜疾病(IRDs)是一组进行性疾病,可导致严重视力损害甚至完全失明。IRDs 在临床上和遗传上具有巨大的异质性,已有超过 250 个基因被确定,其突变可导致一种或多种临床亚型的 IRD。尽管长期以来被认为是无法治愈的疾病,但过去二十年来的深入研究,结合重大技术进步,使这些疾病的第一种治疗方法得以开发。美国食品和药物管理局和欧洲药品管理局批准 LuxturnaTM(voretigene neparvovec),一种针对 RPE65 相关 IRD 的基因增强治疗载体,被认为是该领域的真正里程碑,并为许多其他 IRD 亚型的类似或不同的治疗策略的发展奠定了基础。尽管取得了这些重大成就,但仍有许多方面可以而且需要改进,包括对遗传变异与细胞功能障碍之间关系的更深入了解,优化使用的载体和序列,改进输送方法,以及了解和调节(局部)免疫反应。此外,一些 IRD 的遗传亚型极为罕见,这给新疗法的开发带来了巨大的挑战,例如成本和监管事务方面的挑战。