Gadban Aseel, Gunapala Keith M, Taylor Verdon, Benvenisty Nissim
The Azrieli Center for Stem Cells and Genetic Research, Department of Genetics, the Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.
Department of Biomedicine, University of Basel, Basel, Switzerland.
Nat Genet. 2025 Jul 17. doi: 10.1038/s41588-025-02255-6.
Gene-silencing disorders, of which fragile X syndrome (FXS) is the most prevalent, are diseases caused by a blockade of gene transcription, usually due to DNA hypermethylation. FXS is a common form of inherited intellectual disability and autism. Unlike most hereditary diseases driven by mutations within the protein-coding region of a gene, FXS is caused by a trinucleotide expansion in the 5'-untranslated region of the FMR1 gene, leading to hypermethylation and transcriptional silencing. Modeling FXS with human pluripotent stem cells offers a clinically relevant platform to study disease mechanisms and explore potential therapies through reactivating FMR1 expression by genetic and epigenetic means or through drug screening. This Perspective reviews the various cellular models and therapeutic strategies proposed over the past decade, highlighting their potential to advance the treatment of FXS. We also discuss the benefits and challenges of gene activation therapies, drawing comparisons with other gene-silencing disorders, including imprinting diseases and X-linked disorders.
基因沉默障碍疾病中,脆性X综合征(FXS)最为常见,这类疾病通常由DNA高甲基化导致基因转录受阻引起。FXS是遗传性智力残疾和自闭症的常见形式。与大多数由基因蛋白质编码区域内突变驱动的遗传性疾病不同,FXS是由FMR1基因5'-非翻译区的三核苷酸扩增引起的,导致高甲基化和转录沉默。利用人类多能干细胞建立FXS模型,为研究疾病机制以及通过基因和表观遗传手段重新激活FMR1表达或通过药物筛选探索潜在治疗方法提供了一个具有临床相关性的平台。本观点综述了过去十年中提出的各种细胞模型和治疗策略,强调了它们在推进FXS治疗方面的潜力。我们还讨论了基因激活疗法的益处和挑战,并与其他基因沉默障碍疾病进行比较,包括印记疾病和X连锁疾病。