用于治疗雷特综合征的先进基因疗法:现状与未来展望。
Advanced genetic therapies for the treatment of Rett syndrome: state of the art and future perspectives.
作者信息
Palmieri Michela, Pozzer Diego, Landsberger Nicoletta
机构信息
Rett Research Unit, Division of Neuroscience, San Raffaele Hospital (IRCCS), Milan, Italy.
Department of Medical Biotechnology and Translational Medicine, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.
出版信息
Front Neurosci. 2023 May 25;17:1172805. doi: 10.3389/fnins.2023.1172805. eCollection 2023.
Loss and gain of functions mutations in the X-linked (methyl-CpG-binding protein 2) gene are responsible for a set of generally severe neurological disorders that can affect both genders. In particular, deficiency is mainly associated with Rett syndrome (RTT) in girls, while duplication of the gene leads, mainly in boys, to the duplication syndrome (MDS). No cure is currently available for related disorders. However, several studies have reported that by re-expressing the wild-type gene is possible to restore defective phenotypes of null animals. This proof of principle endorsed many laboratories to search for novel therapeutic strategies to cure RTT. Besides pharmacological approaches aimed at modulating MeCP2-downstream pathways, genetic targeting of or its transcript have been largely proposed. Remarkably, two studies focused on augmentative gene therapy were recently approved for clinical trials. Both use molecular strategies to well-control gene dosage. Notably, the recent development of genome editing technologies has opened an alternative way to specifically target without altering its physiological levels. Other attractive approaches exclusively applicable for nonsense mutations are the translational read-through (TR) and t-RNA suppressor therapy. Reactivation of the locus on the silent X chromosome represents another valid choice for the disease. In this article, we intend to review the most recent genetic interventions for the treatment of RTT, describing the current state of the art, and the related advantages and concerns. We will also discuss the possible application of other advanced therapies, based on molecular delivery through nanoparticles, already proposed for other neurological disorders but still not tested in RTT.
X连锁(甲基CpG结合蛋白2)基因功能丧失和获得性突变会导致一系列通常较为严重的神经疾病,男女均可受影响。具体而言,该基因缺陷主要与女孩的雷特综合征(RTT)相关,而该基因的重复主要在男孩中导致甲基CpG结合蛋白2重复综合征(MDS)。目前尚无针对与甲基CpG结合蛋白2相关疾病的治愈方法。然而,多项研究报告称,通过重新表达野生型基因有可能恢复甲基CpG结合蛋白2缺失动物的缺陷表型。这一原理证明促使许多实验室寻找治疗雷特综合征的新治疗策略。除了旨在调节MeCP2下游通路的药理学方法外,对甲基CpG结合蛋白2或其转录本进行基因靶向也被大量提出。值得注意的是,两项专注于增强基因治疗的研究最近被批准用于临床试验。两者都使用分子策略来很好地控制基因剂量。值得注意的是,基因组编辑技术的最新发展开辟了一种在不改变其生理水平的情况下特异性靶向甲基CpG结合蛋白2的替代方法。其他仅适用于无义突变的有吸引力的方法是翻译通读(TR)和tRNA抑制疗法。沉默X染色体上甲基CpG结合蛋白2基因座的重新激活是该疾病的另一个有效选择。在本文中,我们打算综述治疗雷特综合征的最新基因干预措施,描述当前的技术水平以及相关的优点和问题。我们还将讨论其他先进疗法基于纳米颗粒分子递送的可能应用,这些疗法已被提议用于其他神经疾病,但尚未在雷特综合征中进行测试。