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利用常见和罕见基因变异寻找肌萎缩侧索硬化症的药物重新利用候选药物。

Drug repurposing candidates for amyotrophic lateral sclerosis using common and rare genetic variants.

作者信息

Gerring Zachary F, Bhalala Oneil G, Fearnley Liam G, Oikari Lotta E, White Anthony R, Derks Eske M, Watson Rosie, Yassi Nawaf, Bahlo Melanie, Reay William R

机构信息

Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia.

Brain and Mental Health Research Program, Queensland Institute of Medical Research Berghofer, Herston, Queensland 4006, Australia.

出版信息

Brain Commun. 2025 May 9;7(3):fcaf184. doi: 10.1093/braincomms/fcaf184. eCollection 2025.

Abstract

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative condition for which novel disease modifying therapies are urgently needed. Given the increasing bottlenecks in drug discovery pipelines, repurposing existing drugs for ALS may represent a path to expedite translation and improve disease outcomes. However, ALS is a heterogeneous disease for which the aetiology remains poorly characterized, complicating efforts to effectively repurpose drugs. We propose that the polygenic architecture of ALS genetic liability, which ranges from ultra-rare, high-impact variation to common frequency loci of small-individual effect, could be leveraged to prioritize drug repurposing candidates which are more generalizable to the ALS clinical population. Here, we utilize common and rare frequency ALS genetic risk with a novel approach to uncover therapeutic classes that may be prospective repurposing opportunities in ALS. The common variant-led analyses integrated both positional-based and functional gene-based tests on SNP-genotype data from a genome-wide association study of ALS and implicated mitogen-activated protein kinase signalling related downregulation through B-Raf inhibitors as a prospective target for repurposing. The rare variant-led approaches leveraged rare variant burden testing of exonic variation on whole genome-sequencing data from a subset of the common variant genome-wide association study cohort and prioritized B-vitamin related candidates, such as cobalamin and niacin. Clinical characterization of these putative repurposing opportunities revealed genetic support to existing biology for which related compounds are actively proceeding through ALS clinical studies. Moreover, leveraging transcriptomic data from ALS derived cell lines carrying a selection of pathogenic variants in genes that cause familial forms of ALS (, , and ) suggested that the action of B-Raf inhibitors may be of particular relevance to carriers, whilst the signal for B-vitamin signalling related targets was strongest in carriers. In summary, we demonstrate the importance of considering the therapeutic actionability of both common and rare-variant mediated risk for ALS given the immense biological heterogeneity of this disorder. Future pre-clinical and clinical studies are now warranted to further characterize the tractability of these prioritized compounds.

摘要

肌萎缩侧索硬化症(ALS)是一种毁灭性的神经退行性疾病,迫切需要新的疾病修饰疗法。鉴于药物研发流程中日益增加的瓶颈,将现有药物用于ALS的再利用可能是加快转化并改善疾病结局的一条途径。然而,ALS是一种异质性疾病,其病因仍未得到充分表征,这使得有效进行药物再利用的努力变得复杂。我们提出,ALS遗传易感性的多基因结构,从超罕见、高影响变异到个体效应小的常见频率位点,可用于优先考虑更适用于ALS临床人群的药物再利用候选物。在此,我们采用一种新方法,利用常见和罕见频率的ALS遗传风险,来发现可能是ALS前瞻性再利用机会的治疗类别。基于常见变异的分析整合了对ALS全基因组关联研究中SNP基因型数据的基于位置和基于功能基因的测试,并表明通过B-Raf抑制剂介导的丝裂原活化蛋白激酶信号相关下调是一个前瞻性的再利用靶点。基于罕见变异的方法利用了来自常见变异全基因组关联研究队列子集的全基因组测序数据中外显子变异的罕见变异负担测试,并将与维生素B相关的候选物(如钴胺素和烟酸)列为优先。对这些假定的再利用机会的临床表征揭示了对现有生物学的遗传支持,相关化合物正在积极进行ALS临床研究。此外,利用来自携带导致家族性ALS形式的基因(、、和)中一系列致病变异的ALS衍生细胞系的转录组数据表明,B-Raf抑制剂的作用可能与携带者特别相关,而维生素B信号相关靶点的信号在携带者中最强。总之,鉴于这种疾病巨大的生物学异质性,我们证明了考虑常见和罕见变异介导的ALS风险的治疗可操作性的重要性。现在有必要进行未来的临床前和临床研究,以进一步表征这些优先化合物的可处理性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0608/12089939/6f71df44120d/fcaf184_ga.jpg

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