更新于：2024-05-01

Argininosuccinic Aciduria

精氨基琥珀酸尿

更新于：2024-05-01

基本信息

别名

ACIDURIA, ARGININOSUCCINIC、ARGININOSUCCINASE DEFICIENCY、ARGININOSUCCINATE LYASE DEFICIENCY

+ [63]

简介

Rare autosomal recessive disorder of the urea cycle which leads to the accumulation of argininosuccinic acid in body fluids and severe HYPERAMMONEMIA. Clinical features of the neonatal onset of the disorder include poor feeding, vomiting, lethargy, seizures, tachypnea, coma, and death. Later onset results in milder set of clinical features including vomiting, failure to thrive, irritability, behavioral problems, or psychomotor retardation. Mutations in the ARGININOSUCCINATE LYASE gene cause the disorder.

关联

项与精氨基琥珀酸尿相关的药物

EVX-102

靶点

ASL

作用机制

ASL刺激剂

在研机构-

原研机构

Evox Therapeutics Ltd.初创企业

在研适应症-

非在研适应症

精氨基琥珀酸尿

最高研发阶段终止

首次获批国家/地区-

首次获批日期1800-01-20

项与精氨基琥珀酸尿相关的临床试验

NCT05910151 / RecruitingN/AIIT

Introduction of Tandem Mass Spectrometry (MS/MS) Technology in the Program of Selective Screening of Hereditary Metabolic Diseases in Kazakhstan

Inborn errors of metabolism (IEM) are not have specific clinical signs, they masquerade as other diseases, and are difficult to diagnose using only clinical manifestations or routine laboratory tests. IEM most commonly manifest in early infancy and childhood. Despite the fact that most IEM are rare in the population, they occupy one of the first places in the structure of childhood pathology, early infant mortality and disability. IEM often remains undiagnosed, while timely diagnosis and timely treatment started can prevent severe systemic damage leading to death and disability. The appointment of a special treatment (diet therapy, cofactors, enzyme replacement therapy) prevents or significantly inhibits the development of the pathological process, especially if the diagnosis is made in the early stages of the disease. To start pathogenetic treatment as early as possible, it is necessary to diagnose IEM as accurately and as early as possible.
Among the diseases included in mass screening programs IEM are especially important due to the development of disability and early mortality in the absence of timely diagnosis and treatment, as well as a high risk of recurrence in burdened families. In this connection, the main goals of mass screening - the prevention of disability in children and the reduction of early infant mortality - dictate the need to introduce modern technologies for preclinical diagnosis of IEM.
Based on the results of the study, it is planned to scientifically substantiate the need for the introduction of selective screening of children for hereditary metabolic diseases using the technology of tandem mass spectrometry in the Republic of Kazakhstan for timely diagnosis, therapy of IEM and prevention of disability. The introduction of a selective newborn screening program for IEM should always be preceded by a study aimed at studying the prevalence of the disease in a certain region, determining regional reference values of the studied metabolites. Local incidence and outcome data can be used to persuade health officials to prioritize screening in health care spending.
The main scientific question and hypothesis of the project is whether it is necessary to introduce tandem mass spectrometry technology in the neonatal screening program for IEM.

开始日期2022-10-03

申办/合作机构-

NCT05687474 / RecruitingN/AIIT

Universal Genomic Newborn Screening in the Wallonia-Brussels Federation: Baby Detect

Newborn screening (NBS) is a global initiative of systematic testing at birth to identify babies with pre-defined severe but treatable conditions. With a simple blood test, rare genetic conditions can be easily detected, and the early start of transformative treatment will help avoid severe disabilities and increase the quality of life.
Baby Detect Project is an innovative NBS program using a panel of target sequencing that aims to identify 126 treatable severe early onset genetic diseases at birth caused by 361 genes. The list of diseases has been established in close collaboration with the Paediatricians of the University Hospital in Liege. The investigators use dedicated dried blood spots collected between the first day and 28 days of life of babies, after a consent sign by parents.

开始日期2022-09-01

申办/合作机构

Centre Hospitalier Universitaire de Liege

[+5]

NCT04908319 / RecruitingN/AIIT

Hepatic Histopathology in Urea Cycle Disorders

This is a multi-site, retrospective chart review as well as a prospective study to evaluate histopathologic findings in liver samples from individuals with any UCD diagnosis. This study will be conducted at all Urea Cycle Disorders Consortium (UCDC) sites: Baylor College of Medicine in Houston, TX and Children's National Medical Center in Washington D.C.

开始日期2022-02-24

申办/合作机构

Baylor College of Medicine

[+1]

100 项与精氨基琥珀酸尿相关的临床结果

登录后查看更多信息

100 项与精氨基琥珀酸尿相关的转化医学

登录后查看更多信息

0 项与精氨基琥珀酸尿相关的专利（医药）

登录后查看更多信息

402

项与精氨基琥珀酸尿相关的文献（医药）

2024-01-10·Science translational medicine

mRNA therapy corrects defective glutathione metabolism and restores ureagenesis in preclinical argininosuccinic aciduria.

Article

作者: Sonam Gurung ; Oskar Vilhelmsson Timmermand ; Dany Perocheau ; Ana Luisa Gil-Martinez ; Magdalena Minnion ; Loukia Touramanidou ; Sherry Fang ; Martina Messina ; Youssef Khalil ; Justyna Spiewak ; Abigail R Barber ; Richard S Edwards ; Patricia Lipari Pinto ; Patrick F Finn ; Alex Cavedon ; Summar Siddiqui ; Lisa Rice ; Paolo G V Martini ; Deborah Ridout ; Wendy Heywood ; Ian Hargreaves ; Simon Heales ; Philippa B Mills ; Simon N Waddington ; Paul Gissen ; Simon Eaton ; Mina Ryten ; Martin Feelisch ; Andrea Frassetto ; Timothy H Witney ; Julien Baruteau

The urea cycle enzyme argininosuccinate lyase (ASL) enables the clearance of neurotoxic ammonia and the biosynthesis of arginine. Patients with ASL deficiency present with argininosuccinic aciduria, an inherited metabolic disease with hyperammonemia and a systemic phenotype coinciding with neurocognitive impairment and chronic liver disease. Here, we describe the dysregulation of glutathione biosynthesis and upstream cysteine utilization in ASL-deficient patients and mice using targeted metabolomics and in vivo positron emission tomography (PET) imaging using (S)-4-(3-¹⁸F-fluoropropyl)-l-glutamate ([¹⁸F]FSPG). Up-regulation of cysteine metabolism contrasted with glutathione depletion and down-regulated antioxidant pathways. To assess hepatic glutathione dysregulation and liver disease, we present [¹⁸F]FSPG PET as a noninvasive diagnostic tool to monitor therapeutic response in argininosuccinic aciduria. Human hASL mRNA encapsulated in lipid nanoparticles improved glutathione metabolism and chronic liver disease. In addition, hASL mRNA therapy corrected and rescued the neonatal and adult Asl-deficient mouse phenotypes, respectively, enhancing ureagenesis. These findings provide mechanistic insights in liver glutathione metabolism and support clinical translation of mRNA therapy for argininosuccinic aciduria.

2023-12-10·Molecular genetics and metabolism

Impact of supplementation with L-citrulline/arginine after liver transplantation in individuals with Urea Cycle Disorders.

Article

作者: Roland Posset ; Sven F Garbade ; Florian Gleich ; Sandesh C S Nagamani ; Andrea L Gropman ; Friederike Epp ; Nesrine Ramdhouni ; Ann-Catrin Druck ; Georg F Hoffmann ; Stefan Kölker ; Matthias Zielonka ; Urea Cycle Disorders Consortium (UCDC) and the European registry and network for Intoxication type Metabolic Diseases (E-IMD) consortia study group

OBJECTIVE:

Liver transplantation (LTx) is an intervention when medical management is not sufficiently preventing individuals with urea cycle disorders (UCDs) from the occurrence of hyperammonemic events. Supplementation with L-citrulline/arginine is regularly performed prior to LTx to support ureagenesis and is often continued after the intervention. However, systematic studies assessing the impact of long-term L-citrulline/arginine supplementation in individuals who have undergone LTx is lacking to date.

METHODS:

Using longitudinal data collected systematically, a comparative analysis was carried out by studying the effects of long-term L-citrulline/arginine supplementation vs. no supplementation on health-related outcome parameters (i.e., anthropometric, neurological, and cognitive outcomes) in individuals with UCDs who have undergone LTx. Altogether, 52 individuals with male ornithine transcarbamylase deficiency, citrullinemia type 1 and argininosuccinic aciduria and a pre-transplant "severe" disease course who have undergone LTx were investigated by using recently established and validated genotype-specific in vitro enzyme activities.

RESULTS:

Long-term supplementation of individuals with L-citrulline/arginine who have undergone LTx (n = 16) does neither appear to alter anthropometric nor neurocognitive endpoints when compared to their severity-adjusted counterparts that were not supplemented (n = 36) after LTx with mean observation periods between four to five years. Moreover, supplementation with L-citrulline/arginine was not associated with an increase of disease-specific plasma arithmetic mean values for the respective amino acids when compared to the non-supplemented control cohort.

CONCLUSION:

Although supplementation with L-citrulline/arginine is often continued after LTx, this pilot study does neither identify altered long-term anthropometric or neurocognitive health-related outcomes nor does it find an adequate biochemical response as reflected by the unaltered plasma arithmetic mean values for L-citrulline or L-arginine. Further prospective analyses in larger samples and even longer observation periods will provide more insight into the usefulness of long-term supplementation with L-citrulline/arginine for individuals with UCDs who have undergone LTx.

2023-12-04·Journal of inherited metabolic disease

The incidence of movement disorder increases with age and contrasts with subtle and limited neuroimaging abnormalities in argininosuccinic aciduria.

Article

作者: Sonam Gurung ; Saketh Karamched ; Dany Perocheau ; Kiran K Seunarine ; Tom Baldwin ; Haya Al-Rashidi ; Loukia Touramanidou ; Claire Duff ; Nour Elkhateeb ; Karolina M Stepien ; Reena Sharma ; Andrew Morris ; Thomas Hartley ; Laura Crowther ; Stephanie Grunewald ; Maureen Cleary ; Helen Mundy ; Anupam Chakrapani ; Spyros Batzios ; James Davison ; Emma Footitt ; Karin Tuschl ; Robin Lachmann ; Elaine Murphy ; Saikat Santra ; Mari-Liis Uudelepp ; Mildrid Yeo ; Patrick F Finn ; Alex Cavedon ; Summar Siddiqui ; Lisa Rice ; Paolo G V Martini ; Andrea Frassetto ; Simon Heales ; Philippa B Mills ; Paul Gissen ; Jonathan D Clayden ; Christopher A Clark ; Simon Eaton ; Tammy L Kalber ; Julien Baruteau

Argininosuccinate lyase (ASL) is integral to the urea cycle detoxifying neurotoxic ammonia and the nitric oxide (NO) biosynthesis cycle. Inherited ASL deficiency causes argininosuccinic aciduria (ASA), a rare disease with hyperammonemia and NO deficiency. Patients present with developmental delay, epilepsy and movement disorder, associated with NO-mediated downregulation of central catecholamine biosynthesis. A neurodegenerative phenotype has been proposed in ASA. To better characterise this neurodegenerative phenotype in ASA, we conducted a retrospective study in six paediatric and adult metabolic centres in the UK in 2022. We identified 60 patients and specifically looked for neurodegeneration-related symptoms: movement disorder such as ataxia, tremor and dystonia, hypotonia/fatigue and abnormal behaviour. We analysed neuroimaging with diffusion tensor imaging (DTI) magnetic resonance imaging (MRI) in an individual with ASA with movement disorders. We assessed conventional and DTI MRI alongside single photon emission computer tomography (SPECT) with dopamine analogue radionuclide ¹²³ I-ioflupane, in Asl-deficient mice treated by hASL mRNA with normalised ureagenesis. Movement disorders in ASA appear in the second and third decades of life, becoming more prevalent with ageing and independent from the age of onset of hyperammonemia. Neuroimaging can show abnormal DTI features affecting both grey and white matter, preferentially basal ganglia. ASA mouse model with normalised ureagenesis did not recapitulate these DTI findings and showed normal ¹²³ I-ioflupane SPECT and cerebral dopamine metabolomics. Altogether these findings support the pathophysiology of a late-onset movement disorder with cell-autonomous functional central catecholamine dysregulation but without or limited neurodegeneration of dopaminergic neurons, making these symptoms amenable to targeted therapy.

项与精氨基琥珀酸尿相关的新闻（医药）

2024-04-04

·Science Daily

An hereditary liver disease cured with the help of gene scissors

Researchers have succeeded in correcting a gene defect that causes a hereditary liver disease and its adverse effects on cells. Researchers at the University of Helsinki and HUS Helsinki University Hospital have succeeded in correcting a gene defect that causes a hereditary liver disease and its adverse effects on cells. Argininosuccinate lyase deficiency (ASLD), also known as argininosuccinic aciduria, is a disease that has been enriched in the Finnish genetic heritage. In this severe metabolic disease, the body does not process proteins normally, instead resulting in a very dangerous accumulation of argininosuccinic acid and ammonia. Excess ammonia causes disturbances of consciousness, coma and even death. In Finland, infants are screened for ASLD to determine the disease risk before symptoms develop. The treatment is an extremely strict lifelong diet and, in severe cases, a liver transplant. Researchers from the University of Helsinki and HUS Helsinki University Hospital have succeeded in correcting the gene defect associated with argininosuccinic aciduria and demonstrated that the harmful metabolism caused by the disease can be cured. In their recently completed study, they initially modified the skin cells of patients with ASLD into stem cells. Subsequently, the researchers reprogrammed the disease-causing gene defects in the stem cells using the CRISPR-Cas9 technique, known as gene scissors. Finally, the researchers guided the corrected stem cells to differentiate into liver cells to see whether the disease that impairs hepatic function was actually cured and that the fixed cells no longer produced the harmful argininosuccinic acid. "In our study, we demonstrated for the first time that the gene defect causing ASLD can be corrected with gene scissors without any adverse effects visible in the cells. The gene-corrected cells were also metabolically improved," says Docent of Stem Cell Biology Kirmo Wartiovaara, specialist in medical genetics, from the University of Helsinki and HUS. The study was published in the American Journal of Human Genetics. Researchers discover a suitable "gene mixture" in a drug already in use In the study, the researchers used mRNA encapsulated inside lipid nanoparticles to get the gene scissors inside the cultured cells. "This 'gene mixture' we produced is based on the formula of a pharmaceutical product already in use, which may facilitate its clinical use in the future. Our next goal is to cure ASLD in mice," says Doctoral Researcher Timo Keskinen from the University of Helsinki. "The same gene editing technique works on living animals and humans, but we don't yet know how safe it is. This is why the matter has to be investigated first in laboratory animals," Keskinen adds. Therapeutic potential at last for hereditary diseases There are already more than 7,000 hereditary diseases in the world. Finns, as well as other populations originating in small groups of people, have their own genetic disease variants that are more common in the population than elsewhere in the world. Many of these gene variants of our distant ancestors are such that if a child inherits the same variant from both parents, they may develop a severe disease. Treatments are available for only a handful of hereditary diseases, and curative therapies are even more rare. "However, a cure could be possible if the gene defect causing the disease is eliminated entirely. Thanks to basic research carried out with the help of gene scissors and other precise gene-editing techniques, permanent fixes are gradually starting to emerge," Wartiovaara says. The study is part of the doctoral theses of Sami Jalil and Timo Keskinen, supervised at the Biomedicum Stem Cell Center of the Biomedicum Helsinki research institute by Docent Kirmo Wartiovaara and Mervi Hyvönen, DMedSc.

基因疗法

2024-03-16

·精准药物

孤儿药开发最新突破盘点

来源：药渡撰文：哥哈骎编辑：维他命国际罕见病日2月29日是国际罕见病日，是由欧洲罕见病组织eurordis在2008年2月29日发起并组织的。之所以选择这个特殊的日子，就是彰显罕见病的特殊性，唤起人们对于罕见病群体和开发孤儿药的关注。在没有2月29日的年份中，罕见病日为2月28日。罕见病的定义在不同的地区有不同的标准，但都是基于疾病的发生频率。欧盟将罕见病定义为患病率小于2000分之一的疾病。在美国，1983年《孤儿药法案》将影响美国人数少于20万的疾病视为罕见病。2021年，在中国罕见病/孤儿药定义第三次多学科专家研讨会上《中国罕见病定义研究报告2021》发布，将中国罕见病定义为“新生儿发病率低于1/10000，患病率低于1/10000，患病人数低于14万的疾病”。罕见病的特点是诊断困难、潜在的严重性（通常可能危及生命）以及缺乏有效的治疗方法。例如，婴儿Tay–Sachs病（由HEXA基因中α亚基的双等位突变引起），它是一种罕见但严重的神经系统遗传疾病。这种疾病导致酶活性降低，从而影响神经细胞的功能，最终导致神经系统退化和许多严重的症状，患者的预期寿命为3-5年，目前尚无治疗方法。据估计全球约有8000种已知罕见疾病影响着全球6%的人口，即1亿人左右。罕见病患者及其家人面临着巨大的身体、心理和社会挑战。从经济角度考虑，减少罕见（通常是遗传）疾病的负担仍然是一个重大挑战。例如在澳大利亚，患有单基因或染色体疾病的人占人口的0.5%，但占住院人数的1.9%和住院费用的1.5%。在美国，患有罕见疾病苯丙酮尿症的治疗费用，对受影响的家庭来说是一个相当沉重的负担。2023年CDER批准的55款新药中，有超过半数为针对罕见病和超罕见病的孤儿药（30款），具体情况见表1。表1. 2023年CDER批准的孤儿药除了表1中介绍的CDER批准的孤儿药之外，CDER在2023年也批准了多款针对罕见病的先进疗法，其中最引人瞩目的当属Sarepta的针对杜氏肌营养不良症（DMD）的基因疗法Elevidys。下文整理了2024年罕见病疗法的最新突破，以供读者交流。01mRNA疗法针对罕见肝病由伦敦大学学院（UCL）、伦敦国王学院和Moderna科学家领导组成的研究小组发现，mRNA可用于在小鼠模型中纠正一种罕见的遗传性肝病：精氨基琥珀酸尿症（argininosuccinic aciduria）。精氨基琥珀酸尿症是一种遗传性代谢紊乱，会影响身体分解蛋白质的方式，可能导致血液中氨含量升高。受到这种疾病影响的患者，还存在谷胱甘肽调节失衡的情况。Moderna赞助的mRNA疗法已经在其它罕见遗传性代谢病，诸如丙酸血症和甲基丙二酸血症中进行临床研究。mRNA疫苗在Covid-19流行期间发挥的中流砥柱作用帮助这种疗法登堂入室，它不仅对疫苗开发产生了革命性影响，同时也在罕见病疗法的开发中产生了重要的推动作用。同mRNA疫苗类似，治疗性的mRNA药物也需要借助脂质微滴的保护进行小鼠静脉注射，并靶向肝细胞，这是由于mRNA分子本身的高度不稳定性所决定的。对于小鼠来说，每次mRNA治疗的效果只能持续大约7天，因此在长达8周的时间内每周进行一次注射。但研究人员认为，在人体使用的情况下可以增加两次注射之间的间隔。研究人员发现，所有出生时患有精氨基琥珀酸尿症且未经治疗的小鼠都会在出生后的前两周内死亡，而出生时接受mRNA治疗的小鼠则存活了三个月以上。他们认为mRNA疗法对于无法治愈的遗传性疾病，尤其是肝脏疾病具有巨大的治疗潜力。02晚期胰腺癌疗法BPM315102024年1月18日至20日在旧金山举行的ASCO胃肠癌年度研讨会上，BPGbio宣布了其主要候选药物BPM31510在晚期胰腺癌患者中进行的IIa期临床试验的新数据。BPGbio是一家专注于肿瘤学、神经学和罕见疾病的人工智能生物制药公司。BPM31510是一种胰腺癌治疗药物，已获得FDA孤儿药资格认定。BPM31510被纳米脂质封装，靶向肿瘤微环境并以最小的毒性诱导癌细胞死亡。它通过调节高度侵袭性实体瘤中的线粒体氧化磷酸化来实现这一点，对BCL-2蛋白家族产生直接影响。BPGbio计划继续研究BPM31510在胰腺癌中的IIb期研究，观察其与吉西他滨联合作为一线疗法的效果。此外，BPGbio也在进行一项IIb期试验（NCT04752813），研究BPM31510联合维生素K和标准放化疗治疗多形性胶质母细胞瘤（GBM）患者。03急性髓系白血病疗法PTX-252Pleco Therapeutics治疗急性髓系白血病（AML）的先导化合物PTX-252获得了FDA授予的孤儿药资格。AML是一种异源性血液恶性肿瘤，起源于骨髓中未成熟的白细胞。AML通常会迅速扩散到血液，然后扩散到身体的其他部位，包括淋巴结、脾脏、中枢神经系统和睾丸。AML主要是一种成年疾病，新诊断的AML患者的中位年龄约为67岁。全球范围内AML的发病率估计为每年35万例。PTX-252是一种新型分子实体，可以提高癌细胞对化疗的敏感性。04骨髓纤维化疗法Omjjara欧盟委员会2月8日授予了GSK的Omjjara（momelotinib）营销授权。Omjjara是一款每日一次的口服JAK1/JAK2和激活素A受体1型（ACVR1）抑制剂。它是欧盟首个获得授权治疗原发性骨髓纤维化、真性红细胞增多症后骨髓纤维化，或原发性血小板增多症后骨髓纤维化，以及患有Janus激酶（JAK）的中度至重度贫血成人患者的药物。图1. momelotinib结构式骨髓纤维化是一种罕见的血癌，会破坏人体正常的血细胞生成。欧盟每1万人中有1 人患有骨髓纤维化，大约40%的患者在诊断时患有中度至重度贫血。输血依赖的患者预后不良，生存期缩短。Omjjara的批准为患有中度至重度贫血的成人骨髓纤维化患者提供了治疗的灵活性。Momelotinib具有独特的作用机制，对三个关键信号通路具有抑制能力：Janus激酶（JAK）1、JAK2和I型激活素A受体（ACVR1）。JAK1和JAK2的抑制可能改善全身症状和脾肿大。此外，抑制ACVR1会导致循环铁调素水平降低，可能有助于贫血相关症状的缓解。Momelotinib在2023年9月已经获得了FDA的批准。参考资料（可上下滑动）：1.Dye, D. E., Brameld, K. J., Maxwell, S., Goldblatt, J. & O’Leary, P. The impact of single gene and chromosomal disorders on hospital admissions in an adult population. J. Community Genet. 2, 81–90 (2011).2.Rose, A. M. et al. The financial and time burden associated with phenylketonuria treatment in the United States. Mol. Genet. Metab. Rep. 21, 100523 (2019).3.Study reveals therapeutic potential of mRNA in rare diseases. DDW. 11. 11. 2024.4.Phase IIa results for combination pancreatic cancer therapy. DDW. 19. 01. 2024.5.Orphan Drug Designation Granted to PTX-252 by U.S. FDA for the 6.Treatment of Acute Myeloid Leukaemia (AML). BioSpace. 16. 01. 2024.7.European Commission authorises GSK’s Omjjara (momelotinib). GSK Press Release. 29. 01. 2024.专栏作者哥哈骎南开大学本科、硕士，德国比勒菲尔德大学博士。多肽化学、多肽API GMP生产专家、欧洲制药公司首席科学家；拥有Lean Six Sigma黑带认证；著有专著《Side Reactions in Peptide Synthesis》。声明：发表/转载本文仅仅是出于传播信息的需要，并不意味着代表本公众号观点或证实其内容的真实性。据此内容作出的任何判断，后果自负。若有侵权，告知必删！长按关注本公众号粉丝群/投稿/授权/广告等请联系公众号助手觉得本文好看，请点这里↓

孤儿药信使RNA基因疗法

2024-03-14

·药渡

孤儿药开发最新突破盘点：让罕见病不再“无药可医”

来源：药渡撰文：哥哈骎编辑：维他命国际罕见病日2月29日是国际罕见病日，是由欧洲罕见病组织eurordis在2008年2月29日发起并组织的。之所以选择这个特殊的日子，就是彰显罕见病的特殊性，唤起人们对于罕见病群体和开发孤儿药的关注。在没有2月29日的年份中，罕见病日为2月28日。罕见病的定义在不同的地区有不同的标准，但都是基于疾病的发生频率。欧盟将罕见病定义为患病率小于2000分之一的疾病。在美国，1983年《孤儿药法案》将影响美国人数少于20万的疾病视为罕见病。2021年，在中国罕见病/孤儿药定义第三次多学科专家研讨会上《中国罕见病定义研究报告2021》发布，将中国罕见病定义为“新生儿发病率低于1/10000，患病率低于1/10000，患病人数低于14万的疾病”。罕见病的特点是诊断困难、潜在的严重性（通常可能危及生命）以及缺乏有效的治疗方法。例如，婴儿Tay–Sachs病（由HEXA基因中α亚基的双等位突变引起），它是一种罕见但严重的神经系统遗传疾病。这种疾病导致酶活性降低，从而影响神经细胞的功能，最终导致神经系统退化和许多严重的症状，患者的预期寿命为3-5年，目前尚无治疗方法。据估计全球约有8000种已知罕见疾病影响着全球6%的人口，即1亿人左右。罕见病患者及其家人面临着巨大的身体、心理和社会挑战。从经济角度考虑，减少罕见（通常是遗传）疾病的负担仍然是一个重大挑战。例如在澳大利亚，患有单基因或染色体疾病的人占人口的0.5%，但占住院人数的1.9%和住院费用的1.5%。在美国，患有罕见疾病苯丙酮尿症的治疗费用，对受影响的家庭来说是一个相当沉重的负担。2023年CDER批准的55款新药中，有超过半数为针对罕见病和超罕见病的孤儿药（30款），具体情况见表1。表1. 2023年CDER批准的孤儿药除了表1中介绍的CDER批准的孤儿药之外，CDER在2023年也批准了多款针对罕见病的先进疗法，其中最引人瞩目的当属Sarepta的针对杜氏肌营养不良症（DMD）的基因疗法Elevidys。下文整理了2024年罕见病疗法的最新突破，以供读者交流。01mRNA疗法针对罕见肝病由伦敦大学学院（UCL）、伦敦国王学院和Moderna科学家领导组成的研究小组发现，mRNA可用于在小鼠模型中纠正一种罕见的遗传性肝病：精氨基琥珀酸尿症（argininosuccinic aciduria）。精氨基琥珀酸尿症是一种遗传性代谢紊乱，会影响身体分解蛋白质的方式，可能导致血液中氨含量升高。受到这种疾病影响的患者，还存在谷胱甘肽调节失衡的情况。Moderna赞助的mRNA疗法已经在其它罕见遗传性代谢病，诸如丙酸血症和甲基丙二酸血症中进行临床研究。mRNA疫苗在Covid-19流行期间发挥的中流砥柱作用帮助这种疗法登堂入室，它不仅对疫苗开发产生了革命性影响，同时也在罕见病疗法的开发中产生了重要的推动作用。同mRNA疫苗类似，治疗性的mRNA药物也需要借助脂质微滴的保护进行小鼠静脉注射，并靶向肝细胞，这是由于mRNA分子本身的高度不稳定性所决定的。对于小鼠来说，每次mRNA治疗的效果只能持续大约7天，因此在长达8周的时间内每周进行一次注射。但研究人员认为，在人体使用的情况下可以增加两次注射之间的间隔。研究人员发现，所有出生时患有精氨基琥珀酸尿症且未经治疗的小鼠都会在出生后的前两周内死亡，而出生时接受mRNA治疗的小鼠则存活了三个月以上。他们认为mRNA疗法对于无法治愈的遗传性疾病，尤其是肝脏疾病具有巨大的治疗潜力。02晚期胰腺癌疗法BPM315102024年1月18日至20日在旧金山举行的ASCO胃肠癌年度研讨会上，BPGbio宣布了其主要候选药物BPM31510在晚期胰腺癌患者中进行的IIa期临床试验的新数据。BPGbio是一家专注于肿瘤学、神经学和罕见疾病的人工智能生物制药公司。BPM31510是一种胰腺癌治疗药物，已获得FDA孤儿药资格认定。BPM31510被纳米脂质封装，靶向肿瘤微环境并以最小的毒性诱导癌细胞死亡。它通过调节高度侵袭性实体瘤中的线粒体氧化磷酸化来实现这一点，对BCL-2蛋白家族产生直接影响。BPGbio计划继续研究BPM31510在胰腺癌中的IIb期研究，观察其与吉西他滨联合作为一线疗法的效果。此外，BPGbio也在进行一项IIb期试验（NCT04752813），研究BPM31510联合维生素K和标准放化疗治疗多形性胶质母细胞瘤（GBM）患者。03急性髓系白血病疗法PTX-252Pleco Therapeutics治疗急性髓系白血病（AML）的先导化合物PTX-252获得了FDA授予的孤儿药资格。AML是一种异源性血液恶性肿瘤，起源于骨髓中未成熟的白细胞。AML通常会迅速扩散到血液，然后扩散到身体的其他部位，包括淋巴结、脾脏、中枢神经系统和睾丸。AML主要是一种成年疾病，新诊断的AML患者的中位年龄约为67岁。全球范围内AML的发病率估计为每年35万例。PTX-252是一种新型分子实体，可以提高癌细胞对化疗的敏感性。04骨髓纤维化疗法Omjjara欧盟委员会2月8日授予了GSK的Omjjara（momelotinib）营销授权。Omjjara是一款每日一次的口服JAK1/JAK2和激活素A受体1型（ACVR1）抑制剂。它是欧盟首个获得授权治疗原发性骨髓纤维化、真性红细胞增多症后骨髓纤维化，或原发性血小板增多症后骨髓纤维化，以及患有Janus激酶（JAK）的中度至重度贫血成人患者的药物。图1. momelotinib结构式骨髓纤维化是一种罕见的血癌，会破坏人体正常的血细胞生成。欧盟每1万人中有1 人患有骨髓纤维化，大约40%的患者在诊断时患有中度至重度贫血。输血依赖的患者预后不良，生存期缩短。Omjjara的批准为患有中度至重度贫血的成人骨髓纤维化患者提供了治疗的灵活性。Momelotinib具有独特的作用机制，对三个关键信号通路具有抑制能力：Janus激酶（JAK）1、JAK2和I型激活素A受体（ACVR1）。JAK1和JAK2的抑制可能改善全身症状和脾肿大。此外，抑制ACVR1会导致循环铁调素水平降低，可能有助于贫血相关症状的缓解。Momelotinib在2023年9月已经获得了FDA的批准。参考资料（可上下滑动）：1.Dye, D. E., Brameld, K. J., Maxwell, S., Goldblatt, J. & O’Leary, P. The impact of single gene and chromosomal disorders on hospital admissions in an adult population. J. Community Genet. 2, 81–90 (2011).2.Rose, A. M. et al. The financial and time burden associated with phenylketonuria treatment in the United States. Mol. Genet. Metab. Rep. 21, 100523 (2019).3.Study reveals therapeutic potential of mRNA in rare diseases. DDW. 11. 11. 2024.4.Phase IIa results for combination pancreatic cancer therapy. DDW. 19. 01. 2024.5.Orphan Drug Designation Granted to PTX-252 by U.S. FDA for the 6.Treatment of Acute Myeloid Leukaemia (AML). BioSpace. 16. 01. 2024.7.European Commission authorises GSK’s Omjjara (momelotinib). GSK Press Release. 29. 01. 2024.专栏作者哥哈骎南开大学本科、硕士，德国比勒菲尔德大学博士。多肽化学、多肽API GMP生产专家、欧洲制药公司首席科学家；拥有Lean Six Sigma黑带认证；著有专著《Side Reactions in Peptide Synthesis》。*声明：本文仅是介绍医药疾病领域研究进展或简述研究概况或分享医药相关讯息，并非也不会进行治疗或诊断方案推荐，也不对相关投资构成任何建议。内容如有疏漏，欢迎沟通指出！药物研发新动向：靶向蛋白降解新型策略全盘点化学药进口注册概览：四种情形你了解多少？FDA批准首款可互换的地舒单抗生物仿制药

孤儿药信使RNA基因疗法