牛子冉, 胡扬, 刘清扬, 马元元, 刘佳宁, 刘鑫, 张波. RNA靶向和基因编辑药物在转甲状腺素蛋白淀粉样变心肌病中的研究进展[J]. 罕见病研究, 2023, 2(1): 98-104. DOI: 10.12376/j.issn.2097-0501.2023.01.013
引用本文: 牛子冉, 胡扬, 刘清扬, 马元元, 刘佳宁, 刘鑫, 张波. RNA靶向和基因编辑药物在转甲状腺素蛋白淀粉样变心肌病中的研究进展[J]. 罕见病研究, 2023, 2(1): 98-104. DOI: 10.12376/j.issn.2097-0501.2023.01.013
NIU Ziran, HU Yang, LIU Qingyang, MA Yuanyuan, LIU Jianing, LIU Xin, ZHANG Bo. Progress in RNA-targeting and Gene Editing Therapies for Transthyretin Amyloidosis Cardiomyopathy[J]. Journal of Rare Diseases, 2023, 2(1): 98-104. DOI: 10.12376/j.issn.2097-0501.2023.01.013
Citation: NIU Ziran, HU Yang, LIU Qingyang, MA Yuanyuan, LIU Jianing, LIU Xin, ZHANG Bo. Progress in RNA-targeting and Gene Editing Therapies for Transthyretin Amyloidosis Cardiomyopathy[J]. Journal of Rare Diseases, 2023, 2(1): 98-104. DOI: 10.12376/j.issn.2097-0501.2023.01.013

RNA靶向和基因编辑药物在转甲状腺素蛋白淀粉样变心肌病中的研究进展

Progress in RNA-targeting and Gene Editing Therapies for Transthyretin Amyloidosis Cardiomyopathy

  • 摘要: 转甲状腺素蛋白(TTR)是一种主要由肝脏合成的四聚体蛋白,可错误折叠并沉积为淀粉样原纤维,沉积于心肌间质导致转甲状腺素蛋白淀粉样变心肌病(ATTR-CM)。ATTR-CM列入中国《第一批罕见病目录》,治疗策略包括阻断肝脏中TTR合成、稳定TTR四聚体和破坏TTR原纤维。氯苯唑酸、二氟尼柳等小分子药物为患者提供新的治疗选择。其中氯苯唑酸成为首个美国食品药品监督管理局(FDA)批准用于治疗ATTR-CM的药物。小干扰RNA(siRNA)patisiran和反义寡核苷酸(ASO)inotersen阻断肝脏TTR表达,并已批准用于治疗变异ATTR多发性神经病(ATTRv-PN),用于治疗ATTR-CM正在进行Ⅲ期试验,其他siRNA药物vutrisiran和ASO制剂eplontersen临床效果正在评估中。本文介绍RNA靶向治疗药物及使用CRISPR-Cas9进行基因编辑药物的研究进展。

     

    Abstract: Transthyretin(TTR) protein is a tetramer protein, synthesized mainly by the liver. TTR can be misfolded and deposited as amyloid fibrilae and deposited in the myocardial interstroma leading to transthyroxin amyloidosis cardiomyopathy (ATTR-CM). ATTR-CM was included in China's First List of Rare Diseases. Therapeutic strategies for ATTR-CM include blocking TTR synthesis in the liver, stabilizing TTR tetramers and destroying TTR fibra. Small molecule drugs such as tafamidis and diflunisal offer new treatment options for patients. Chlorobenzolic acid became the first drug approved by the U.S. Food and Drug Administration for the treatment of ATTR-CM. Small interfering RNA(siRNA)patisiran and antisense oligonucleotide (ASO)inotersen block TTR expression in the liver and have been approved for the treatment of ATTR variant polyneuropathy (ATTRv-PN)and are in phase Ⅲ trials for the treatment of ATTR-CM. Other siRNA drugs, vutrisiran, and ASO, eplontersen, are being evaluated for clinical efficacy. This article reviews the development of RNA-targeted therapeutics and gene-editing drugs using CRISPR-Cas9.

     

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