Hansen Stine N, Holm Anja, Kauppinen Sakari, Klitgaard Henrik
NEUmiRNA Therapeutics, Copenhagen, Denmark.
Department of Clinical Medicine, Center for RNA Medicine, Aalborg University, Copenhagen, Denmark.
Epilepsia. 2023 Dec;64(12):3113-3129. doi: 10.1111/epi.17772. Epub 2023 Oct 10.
Drug discovery in epilepsy began with the finding of potassium bromide by Sir Charles Locock in 1857. The following century witnessed the introduction of phenotypic screening tests for discovering antiseizure medications (ASMs). Despite the high success rate of developing ASMs, they have so far failed in eliminating drug resistance and in delivering disease-modifying treatments. This emphasizes the need for new drug discovery strategies in epilepsy. RNA-based drugs have recently shown promise as a new modality with the potential of providing disease modification and counteracting drug resistance in epilepsy. RNA therapeutics can be directed either toward noncoding RNAs, such as microRNAs, long noncoding RNAs (ncRNAs), and circular RNAs, or toward messenger RNAs. The former show promise in sporadic, nongenetic epilepsies, as interference with ncRNAs allows for modulation of entire disease pathways, whereas the latter seem more promising in monogenic childhood epilepsies. Here, we describe therapeutic strategies for modulating disease-associated RNA molecules and highlight the potential of RNA therapeutics for the treatment of different patient populations such as sporadic, drug-resistant epilepsy, and childhood monogenic epilepsies.
癫痫药物研发始于1857年查尔斯·洛科克爵士发现溴化钾。在接下来的一个世纪里,出现了用于发现抗癫痫药物(ASMs)的表型筛选试验。尽管开发ASMs的成功率很高,但迄今为止,它们在消除耐药性和提供疾病修饰治疗方面均告失败。这凸显了癫痫新药研发策略的必要性。基于RNA的药物最近显示出作为一种新的治疗方式的潜力,有可能在癫痫中实现疾病修饰并对抗耐药性。RNA疗法可以针对非编码RNA,如微小RNA、长链非编码RNA(ncRNAs)和环状RNA,也可以针对信使RNA。前者在散发性、非遗传性癫痫中显示出前景,因为干扰ncRNAs可以调节整个疾病通路,而后者在儿童单基因癫痫中似乎更具前景。在此,我们描述了调节疾病相关RNA分子的治疗策略,并强调了RNA疗法在治疗不同患者群体(如散发性、耐药性癫痫和儿童单基因癫痫)方面的潜力。