Krishna Lakshmi, Prashant Akila, Kumar Yogish H, Paneyala Shasthara, Patil Siddaramappa J, Ramachandra Shobha Chikkavaddaragudi, Vishwanath Prashant
Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India.
Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India.
Neurol Int. 2024 Jul 5;16(4):731-760. doi: 10.3390/neurolint16040055.
Significant progress has been achieved in understanding Duchenne muscular dystrophy (DMD) mechanisms and developing treatments to slow disease progression. This review article thoroughly assesses primary and secondary DMD therapies, focusing on innovative modalities. The primary therapy addresses the genetic abnormality causing DMD, specifically the absence or reduced expression of dystrophin. Gene replacement therapies, such as exon skipping, readthrough, and gene editing technologies, show promise in restoring dystrophin expression. Adeno-associated viruses (AAVs), a recent advancement in viral vector-based gene therapies, have shown encouraging results in preclinical and clinical studies. Secondary therapies aim to maintain muscle function and improve quality of life by mitigating DMD symptoms and complications. Glucocorticoid drugs like prednisone and deflazacort have proven effective in slowing disease progression and delaying loss of ambulation. Supportive treatments targeting calcium dysregulation, histone deacetylase, and redox imbalance are also crucial for preserving overall health and function. Additionally, the review includes a detailed table of ongoing and approved clinical trials for DMD, exploring various therapeutic approaches such as gene therapies, exon skipping drugs, utrophin modulators, anti-inflammatory agents, and novel compounds. This highlights the dynamic research field and ongoing efforts to develop effective DMD treatments.
在理解杜氏肌营养不良症(DMD)的发病机制以及开发减缓疾病进展的治疗方法方面已经取得了重大进展。这篇综述文章全面评估了原发性和继发性DMD治疗方法,重点关注创新模式。原发性治疗针对导致DMD的基因异常,特别是肌营养不良蛋白的缺失或表达减少。基因替代疗法,如外显子跳跃、通读和基因编辑技术,在恢复肌营养不良蛋白表达方面显示出前景。腺相关病毒(AAV)是基于病毒载体的基因治疗的最新进展,在临床前和临床研究中已显示出令人鼓舞的结果。继发性治疗旨在通过减轻DMD症状和并发症来维持肌肉功能并改善生活质量。泼尼松和地夫可特等糖皮质激素药物已被证明可有效减缓疾病进展并延缓行走能力丧失。针对钙调节异常、组蛋白脱乙酰酶和氧化还原失衡的支持性治疗对于维持整体健康和功能也至关重要。此外,该综述还包括一份DMD正在进行和已获批的临床试验的详细表格,探讨了各种治疗方法,如基因疗法、外显子跳跃药物、抗肌萎缩蛋白调节剂、抗炎药和新型化合物。这突出了这个充满活力的研究领域以及为开发有效的DMD治疗方法所做的持续努力。