Gene-Targeting Therapeutics for Neurological Disease: Lessons Learned from Spinal Muscular Atrophy

Bhavya Ravi, Michelle Harran Chan-Cortés, Charlotte J. Sumner

Research output: Contribution to journalReview articlepeer-review

Abstract

The last few decades have seen an explosion in identification of genes that cause monogenetic neurological diseases, as well as advances in gene-targeting therapeutics. Neurological conditions that were once considered incurable are now increasingly tractable. At the forefront is the motor neuron disease spinal muscular atrophy (SMA), historically the leading inherited cause of infant mortality. In the last 5 years, three SMA treatments have been approved by the US Food and Drug Administration (FDA): intrathecally delivered splice-switching antisense oligonucleotide (nusinersen), systemically delivered AAV9-based gene replacement therapy (onasemnogene abeparvovec), and an orally bioavailable, small-molecule, splice-switching drug (risdiplam). Despite this remarkable progress, clinical outcomes in patients are variable. Therapeutic optimization will require improved understanding of drug pharmacokinetics and target engagement in neurons, potential toxicities, and long-term effects. We review current progress in SMA therapeutics, clinical trials, shortcomings of current treatments, and implications for the treatment of other neurogenetic diseases.

Original languageEnglish (US)
Pages (from-to)1-14
Number of pages14
JournalAnnual review of medicine
Volume72
DOIs
StatePublished - Jan 27 2021

Keywords

  • Spinal muscular atrophy
  • antisense oligonucleotide
  • biomarkers
  • gene therapy
  • small molecules

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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