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杜氏肌营养不良症的基因治疗:最新临床进展综述

Gene therapy for Duchenne muscular dystrophy: an update on the latest clinical developments.

作者信息

Happi Mbakam Cedric, Tremblay Jacques P

机构信息

CHU de Québec research centre, Laval University, Québec, Canada.

Molecular Medicine Department, Faculty of Medicine, Laval University, Québec, Canada.

出版信息

Expert Rev Neurother. 2023 Jul-Dec;23(10):905-920. doi: 10.1080/14737175.2023.2249607. Epub 2023 Aug 21.

Abstract

INTRODUCTION

Duchenne muscular dystrophy (DMD) is one of the most severe and devastating neuromuscular hereditary diseases with a male newborn incidence of 20 000 cases each year. The disease caused by mutations (exon deletions, nonsense mutations, intra-exonic insertions or deletions, exon duplications, splice site defects, and deep intronic mutations) in the DMD gene, progressively leads to muscle wasting and loss of ambulation. This situation is painful for both patients and their families, calling for an emergent need for effective treatments.

AREAS COVERED

In this review, the authors describe the state of the gene therapy approach in clinical trials for DMD. This therapeutics included gene replacement, gene substitution, RNA-based therapeutics, readthrough mutation, and the CRISPR approach.

EXPERT OPINION

Only a few drug candidates have yet been granted conditional approval for the treatment of DMD. Most of these therapies have only a modest capability to restore the dystrophin or improve muscle function, suggesting an important unmet need in the development of DMD therapeutics. Complementary genes and cellular therapeutics need to be explored to both restore dystrophin, improve muscle function, and efficiently reconstitute the muscle fibers in the advanced stage of the disease.

摘要

引言

杜氏肌营养不良症(DMD)是最严重且极具破坏性的神经肌肉遗传性疾病之一,每年男性新生儿发病率为20000例。该疾病由DMD基因突变(外显子缺失、无义突变、外显子内插入或缺失、外显子重复、剪接位点缺陷及内含子深处突变)引起,会逐渐导致肌肉萎缩和行走能力丧失。这种情况对患者及其家庭而言都很痛苦,迫切需要有效的治疗方法。

涵盖领域

在本综述中,作者描述了DMD临床试验中基因治疗方法的现状。这些治疗方法包括基因替代、基因置换、基于RNA的治疗、通读突变及CRISPR方法。

专家观点

仅有少数候选药物已获得治疗DMD的有条件批准。这些疗法大多仅具有适度恢复抗肌萎缩蛋白或改善肌肉功能的能力,这表明在DMD治疗药物开发方面存在重大未满足需求。需要探索互补基因和细胞疗法,以在疾病晚期既恢复抗肌萎缩蛋白、改善肌肉功能,又能有效重建肌纤维。

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