Stavrou Marina, Kleopa Kleopas A
Neuroscience Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
Neuroscience Department, The Cyprus Institute of Neurology and Genetics; Center for Neuromuscular Disorders, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
Neural Regen Res. 2023 Jul;18(7):1434-1440. doi: 10.4103/1673-5374.361538.
Charcot-Marie-Tooth neuropathies (CMT) constitute a group of common but highly heterogeneous, non-syndromic genetic disorders affecting predominantly the peripheral nervous system. CMT type 1A (CMT1A) is the most frequent type and accounts for almost ~50% of all diagnosed CMT cases. CMT1A results from the duplication of the peripheral myelin protein 22 (PMP22) gene. Overexpression of PMP22 protein overloads the protein folding apparatus in Schwann cells and activates the unfolded protein response. This leads to Schwann cell apoptosis, dys- and de- myelination and secondary axonal degeneration, ultimately causing neurological disabilities. During the last decades, several different gene therapies have been developed to treat CMT1A. Almost all of them remain at the pre-clinical stage using CMT1A animal models overexpressing PMP22. The therapeutic goal is to achieve gene silencing, directly or indirectly, thereby reversing the CMT1A genetic mechanism allowing the recovery of myelination and prevention of axonal loss. As promising treatments are rapidly emerging, treatment-responsive and clinically relevant biomarkers are becoming necessary. These biomarkers and sensitive clinical evaluation tools will facilitate the design and successful completion of future clinical trials for CMT1A.
夏科-马里-图思病(CMT)是一组常见但高度异质性的非综合征性遗传性疾病,主要影响周围神经系统。1A型CMT(CMT1A)是最常见的类型,占所有已确诊CMT病例的近50%。CMT1A是由外周髓鞘蛋白22(PMP22)基因重复引起的。PMP22蛋白的过度表达使施万细胞中的蛋白质折叠装置过载,并激活未折叠蛋白反应。这导致施万细胞凋亡、脱髓鞘和髓鞘脱失以及继发性轴突变性,最终导致神经功能障碍。在过去几十年中,已经开发了几种不同的基因疗法来治疗CMT1A。几乎所有这些疗法都仍处于临床前阶段,使用过表达PMP22的CMT1A动物模型。治疗目标是直接或间接实现基因沉默,从而逆转CMT1A的遗传机制,使髓鞘再生并防止轴突丢失。随着有前景的治疗方法迅速涌现,治疗反应性和临床相关的生物标志物变得必不可少。这些生物标志物和敏感的临床评估工具将有助于设计并成功完成未来针对CMT1A的临床试验。