Center of Basic Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece.
Med Res Rev. 2021 Sep;41(5):2656-2688. doi: 10.1002/med.21706. Epub 2020 Jul 13.
Movement disorders are a group of neurological conditions characterized by abnormalities of movement and posture. They are broadly divided into akinetic and hyperkinetic syndromes. Until now, no effective symptomatic or disease-modifying therapies have been available. However, since many of these disorders are monogenic or have some well-defined genetic component, they represent strong candidates for antisense oligonucleotide (ASO) therapies. ASO therapies are based on the use of short synthetic single-stranded ASOs that bind to disease-related target RNAs via Watson-Crick base-pairing and pleiotropically modulate their function. With information arising from the RNA sequence alone, it is possible to design ASOs that not only alter the expression levels but also the splicing defects of any protein, far exceeding the intervention repertoire of traditional small molecule approaches. Following the regulatory approval of ASO therapies for spinal muscular atrophy and Duchenne muscular dystrophy in 2016, there has been tremendous momentum in testing such therapies for other neurological disorders. This review article initially focuses on the chemical modifications aimed at improving ASO effectiveness, the mechanisms by which ASOs can interfere with RNA function, delivery systems and pharmacokinetics, and the common set of toxicities associated with their application. It, then, describes the pathophysiology and the latest information on preclinical and clinical trials utilizing ASOs for the treatment of Parkinson's disease, Huntington's disease, and ataxias 1, 2, 3, and 7. It concludes with issues that require special attention to realize the full potential of ASO-based therapies.
运动障碍是一组以运动和姿势异常为特征的神经科疾病。它们广泛分为无动性和多动性综合征。到目前为止,还没有有效的对症或疾病修饰疗法。然而,由于许多这些疾病是单基因的,或者有一些明确的遗传成分,它们是反义寡核苷酸(ASO)疗法的有力候选者。ASO 疗法基于使用短的合成单链 ASOs,通过沃森-克里克碱基配对与疾病相关的靶 RNA 结合,并多效性地调节其功能。仅根据 RNA 序列,可以设计不仅改变表达水平,而且改变任何蛋白质剪接缺陷的 ASOs,远远超过传统小分子方法的干预范围。继 2016 年 ASO 疗法在脊髓性肌萎缩症和杜氏肌营养不良症的监管批准之后,针对其他神经疾病测试此类疗法的势头非常强劲。这篇综述文章首先侧重于旨在提高 ASO 有效性的化学修饰,ASO 干扰 RNA 功能的机制、传递系统和药代动力学,以及与其应用相关的常见毒性。然后,它描述了帕金森病、亨廷顿病和共济失调 1、2、3、7 中使用 ASO 治疗的病理生理学和最新临床前和临床试验信息。最后,它总结了需要特别注意的问题,以实现 ASO 疗法的全部潜力。