更新于：2024-05-01

SMN2

运动神经元存活蛋白

更新于：2024-05-01

基本信息

别名

SMN复合蛋白类、BCD541、Component of gems 1

+ [11]

简介

The SMN complex catalyzes the assembly of small nuclear ribonucleoproteins (snRNPs), the building blocks of the spliceosome, and thereby plays an important role in the splicing of cellular pre-mRNAs (PubMed:9845364, PubMed:18984161). Most spliceosomal snRNPs contain a common set of Sm proteins SNRPB, SNRPD1, SNRPD2, SNRPD3, SNRPE, SNRPF and SNRPG that assemble in a heptameric protein ring on the Sm site of the small nuclear RNA to form the core snRNP (Sm core) (PubMed:18984161). In the cytosol, the Sm proteins SNRPD1, SNRPD2, SNRPE, SNRPF and SNRPG are trapped in an inactive 6S pICln-Sm complex by the chaperone CLNS1A that controls the assembly of the core snRNP (PubMed:18984161). To assemble core snRNPs, the SMN complex accepts the trapped 5Sm proteins from CLNS1A forming an intermediate (PubMed:18984161). Within the SMN complex, SMN1 acts as a structural backbone and together with GEMIN2 it gathers the Sm complex subunits (PubMed:21816274, PubMed:22101937, PubMed:17178713). Binding of snRNA inside 5Sm ultimately triggers eviction of the SMN complex, thereby allowing binding of SNRPD3 and SNRPB to complete assembly of the core snRNP (PubMed:31799625). Ensures the correct splicing of U12 intron-containing genes that may be important for normal motor and proprioceptive neurons development (PubMed:23063131). Also required for resolving RNA-DNA hybrids created by RNA polymerase II, that form R-loop in transcription terminal regions, an important step in proper transcription termination (PubMed:26700805). May also play a role in the metabolism of small nucleolar ribonucleoprotein (snoRNPs).

关联

项与 SMN2 相关的药物

Risdiplam

利司扑兰

靶点

SMN2

作用机制

SMN2调节剂

在研机构

Hoffmann-La Roche, Inc. [+8]

原研机构

PTC Therapeutics, Inc.

在研适应症

脊髓性肌萎缩 [+2]

非在研适应症

肝功能衰竭

最高研发阶段批准上市

首次获批国家/地区

美国

首次获批日期2020-08-07

Nusinersen sodium

诺西那生钠

靶点

SMN2

作用机制

SMN2刺激剂 [+1]

在研机构

Biogen, Inc. [+6]

原研机构

Ionis Pharmaceuticals, Inc.

在研适应症

神经肌肉疾病 [+1]

非在研适应症

I型脊髓性肌萎缩症

最高研发阶段批准上市

首次获批国家/地区

美国

首次获批日期2016-12-23

Branaplam

靶点

SMN1 x SMN2

作用机制

SMN1基因调节剂 [+1]

在研机构

Novartis Pharmaceuticals Corp.

原研机构

Novartis Pharma AG

在研适应症

亨廷顿舞蹈病 [+1]

非在研适应症-

最高研发阶段临床2期

首次获批国家/地区-

首次获批日期1800-01-20

项与 SMN2 相关的临床试验

NCT05861999 / Recruiting临床4期

A Phase IV Open-Label Study Evaluating the Effectiveness and Safety of Risdiplam Administered in Pediatric Patients With Spinal Muscular Atrophy Who Experienced a Plateau or Decline in Function After Gene Therapy

This is an open-label, single-arm, multicenter clinical study to evaluate the effectiveness and safety of risdiplam administered in pediatric participants with SMA and 2 SMN2 copies who previously received onasemnogene abeparvovec and experience a plateau or decline in function. Participants to be enrolled are children <2 years of age genetically diagnosed with SMA.

开始日期2024-05-31

申办/合作机构

Hoffmann-La Roche Ltd.

NCT05861986 / Recruiting临床4期

A Phase IV Open-Label Study Evaluating the Effectiveness and Safety of Risdiplam Administered as an Early Intervention in Pediatric Patients With Spinal Muscular Atrophy After Gene Therapy

This is an open-label, single-arm, multicenter clinical study to evaluate the effectiveness and safety of risdiplam administered as an early intervention in pediatric participants with spinal muscular atrophy (SMA) and 2 SMN2 copies who have previously received onasemnogene abeparvovec. Participants are children < 2 years of age genetically diagnosed with SMA.

开始日期2024-04-29

申办/合作机构

Hoffmann-La Roche Ltd.

NCT05808764 / Not yet recruiting临床2期

A Phase II, Open-label Study to Investigate the Pharmacokinetics and Safety of Risdiplam in Infants With Spinal Muscular Atrophy

This study will evaluate the pharmacokinetics (PK) and safety of risdiplam in participants with spinal muscular atrophy (SMA) under 20 days of age at first dose.

开始日期2024-04-15

申办/合作机构

Hoffmann-La Roche Ltd.

100 项与 SMN2 相关的临床结果

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100 项与 SMN2 相关的转化医学

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0 项与 SMN2 相关的专利（医药）

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1,211

项与 SMN2 相关的文献（医药）

2024-02-22·Biochemical genetics

NAIP Gene Deletion and SMN2 Copy Number as Molecular Tools in Predicting the Severity of Spinal Muscular Atrophy.

Article

作者: Abdel Nasser H Abd El Mutaleb ; Fawziya A R Ibrahim ; Fayed A K Megahed ; Ahmed Atta ; Bahy A Ali ; Tarek E I Omar ; Mona M Rashad

Spinal muscular atrophy (SMA) is one of the most prevalent autosomal recessive illnesses with type I being the most severe type. Genomic alterations including survival motor neuron (SMN) copy number as well as deletions in SMN and Neuronal Apoptosis Inhibitory Protein (NAIP) are greatly implicated in the emergence of SMA. However, the association of such alterations with the severity of the disease is yet to be investigated. This study was directed to elucidate the molecular assessment of NAIP and SMN genomic alterations as a useful tool in predicting the severity of SMA among patients. This study included 65 SMA pediatric patients (30 type I and 35 type II) and 65 healthy controls. RFLP-PCR was employed to determine the genetic polymorphisms of the SMN1, SMN2, and NAIP genes. In addition, qRT-PCR was used to identify the expression of the SMN1 and SMN2 genes, and serum levels of creatine kinase were measured using a colorimetric method. DNA sequencing was performed on some samples to detect any single nucleotide polymorphisms in SMN1, SMN2, and NAIP genes. All SMA patients had a homozygous deficiency of SMN1 exon 7. The homozygous deficiency of SMN1 exons 7 and 8, with the deletion of NAIP exon 5 was found among the majority of Type I patients. In contrast, patients with the less severe condition (type II) had SMN1 exons 7 and 8 deleted but did not have any deletions in NAIP, additionally; 65.7% of patients had multiple copies of SMN2. Analysis of NAIP deletion alongside assessing SMN2 copy number might enhance the effectiveness of the diagnosis that can predict severity among Spinal Muscular Atrophy patients.

2024-02-19·Orphanet journal of rare diseases

RegistrAME: the Spanish self-reported patient registry of spinal muscular atrophy.

Article

作者: Maria Grazia Cattinari ; Mencía de Lemus ; Eduardo Tizzano

BACKGROUND:

Spinal Muscular Atrophy (SMA) is a rare neuromuscular disorder characterized by progressive degeneration of motor neurons and muscle weakness resulting in premature death or severe motor disability. Over the last decade, SMA has dramatically changed thanks to new advances in care and the emergence of disease-specific treatments. RegistrAME is a self-reported specific disease registry with an accurate curation system. It has collected data on SMA patients in Spain since 2015, gathering demographic, clinical, and patient-reported outcome data, all of which are patient-relevant. RegistrAME is part of the TREAT NMD network. This study aims to describe the advantages and disadvantages of a self-reported SMA registry, as well as the different variables of interest in the health status of RegistrAME patients.

RESULTS:

In total, 295 living patients with a confirmed diagnosis of SMA-5q were included (aged 1 to 77 years; mean 20.28). Half of the patients (50.2%) were ≥ 16 years old; 22.03% were type 1, 48.47% were type 2, 28.82% were type 3, and 0.7% were type 4. All functional statuses (non-sitter, sitter, and walkers) could be observed in each SMA type. Adult patients harbored the least aggressive SMA types, however, they presented the greatest level of disability. Patients with SMA type 1 had scoliosis surgery about five years earlier than patients with SMA type 2. None of the type 1 patients who achieved ambulation were wheelchair-free outdoors. This was also evident in 62.5% of type 2 walker patients and 44% of type 3 walker patients. Of the SMA type 1 patients, 40% had a gastrostomy (of which 84% had two SMN2 copies). One in five children with SMA type 1 (one to seven years of age) were ventilation-free.

CONCLUSIONS:

The information provided by RegistrAME in a "real-world" setting allows better management of family expectations, an adequate approach to the disease and patients' needs, as well as a better understanding of the impact of the disease. It also helps monitor the evolution of care, which will result in the need for updated guidelines.

2024-02-07·Brain & development

'Reading the palm' - A pilot study of grip and finger flexion strength as an outcome measure in 5q spinal muscular atrophy.

Article

作者: Constanze Weber ; Anne Müller ; Maren Freigang ; Maja von der Hagen ; René Günther

BACKGROUND:

Innovative RNA modifying and gene replacement therapies are currently revolutionizing the therapeutic landscape in 5q-associated spinal muscular atrophy (SMA). In order to provide individual recommendations for choice of treatment and therapy (dis-) continuation, objective outcome measures are needed. The purpose of this study was to determine whether maximum isometric voluntary grip and finger flexion strength is a useful sensitive outcome measure in children and adult patients with SMA.

METHODS:

In this non-interventional, longitudinal pilot study, we assessed grip and finger flexion strength on 39 patients with SMA II and III (n = 16 children, mean age = 10.0; n = 23 adults, mean age = 38.4) using the Weber hand and finger dynamometer HFD 200. Grip and finger flexion strength, clinical examinations and motor function scores (Revised Upper Limb Module, Hammersmith Functional Motor Scale Expanded) were assessed over a 12-month treatment period concurrent with the nusinersen treatment.

RESULTS:

Grip and finger flexion strength was highly associated with motor function and disease severity, SMA type and SMN2 copy number. During nusinersen treatment, grip and finger flexion strength significantly increased in children and adults with SMA.

CONCLUSION:

Grip and finger flexion strength measured with the HFD 200 is a promising sensitive outcome measure for SMA.

139

项与 SMN2 相关的新闻（医药）

2024-03-26

·CPHI制药在线

浅谈脊髓性肌萎缩症（SMA）的研究现状与前景

关注并星标智药公会脊髓性肌萎缩症（Spinal Muscular Atrophy，简称SMA）是一种罕见的遗传性疾病，主要影响肌肉和运动神经。SMA的发生与SMN1基因的突变有关，该基因对生产抑制肌肉萎缩的蛋白质至关重要。SMA患者通常在婴儿期或幼儿期发病，病情进展可分为四种类型，从轻度肌肉无力的I型到严重残疾和寿命缩短的IV型。随着病情的恶化，患者可能会出现肌肉无力、呼吸困难和吞咽困难等症状，严重影响生活质量。 SMA的病理生理机制与临床表现 SMA的病理生理机制主要涉及运动神经元（即运动神经元病）的损失，这些神经元负责从大脑传递信号到肌肉，从而控制肌肉收缩。由于SMN1基因突变，患者体内的SMN蛋白质产量减少，导致运动神经元逐渐死亡，肌肉失去收缩能力。这种萎缩和无力现象在四肢、躯干和面部肌肉中都可能出现。在临床表现方面，SMA患者的症状随着病程的发展而逐渐加重。在婴儿期，患者可能表现出肌无力、肌肉萎缩、呼吸困难等症状。随着病情恶化，患者可能在儿童期出现严重的运动障碍，导致行走困难、四肢无力。在晚期，患者可能需要依赖轮椅或呼吸器生活，生活质量严重受损。此外，SMA患者还可能遭受并发症的影响，如肺部感染、营养不良和睡眠呼吸暂停等。这些都对患者的生存率和日常生活带来极大影响。 Zolgensma基因疗法的研发与作用原理 Zolgensma是一种针对SMA的基因疗法，由瑞士诺华（Novartis）公司研发。该疗法的研发基于对SMA病理生理机制的深入理解，即SMN1基因突变导致SMN蛋白质产量减少，进而引发运动神经元损失。Zolgensma的作用原理是通过一次性注射，将正常功能的SMN2基因引入患者的体内，以补偿SMN1基因的缺陷。这种基因疗法旨在提高患者体内的SMN蛋白质水平，从而改善运动神经元的功能，缓解肌肉无力和生存率。 Zolgensma对SMA患者的治疗效果及生存率改善临床研究表明，Zolgensma基因疗法对SMA患者具有显著的治疗效果。在接受治疗的患者中，许多人在注射后表现出肌肉功能的改善，生活质量得到提高。早期研究还表明，Zolgensma可以延长SMA患者的生存期，降低并发症的风险。这些成果为SMA患者带来了新的希望，让他们有望过上更健康、更独立的生活。然而，尽管Zolgensma基因疗法在临床研究中取得了显著的效果，但长期的治疗效果和安全性仍需进一步观察。此外，由于该疗法的高昂成本，许多家庭难以承担。这也使得Zolgensma在广泛应用于SMA患者之前，仍面临一定的挑战和局限性。在未来，随着医学研究的深入和成本降低，Zolgensma有望为更多的SMA患者带来福祉。 Zolgensma基因疗法的安全性与持续效果尽管Zolgensma基因疗法在临床研究中取得了显著的效果，但其长期的安全性和持续效果仍需进一步观察。目前的研究表明，该疗法在短期内具有良好的安全性，但长期效果仍不确定。这主要是由于基因疗法作为一种新型治疗方法，其长期影响尚不明确。此外，基因疗法可能引发免疫反应，导致炎症和副作用，如发热、肌肉疼痛等。然而，随着疗法的不断优化和临床研究的深入，对其安全性和持续效果的了解将更加全面，为SMA患者提供更可靠的治疗选择。 SMA患者接受Zolgensma治疗的前景与挑战 Zolgensma基因疗法为SMA患者带来了新的希望，使他们有望改善生活质量并延长生存期。然而，在广泛应用于患者之前，仍面临一定的挑战和局限性。首先，高昂的治疗成本使得许多家庭难以承担，进而限制了该疗法在广大患者群体中的普及。其次，尽管临床研究取得了积极成果，但长期的安全性和持续效果仍需进一步研究。此外，针对不同类型和阶段的SMA患者，Zolgensma的治疗效果可能存在差异，因此需要个体化治疗策略。此外，基因疗法在临床应用中还面临监管和伦理方面的挑战。由于该疗法的高昂成本和潜在风险，监管部门需要对其进行严格的审查和监测。同时，伦理问题也引起了广泛关注，如基因疗法的公平分配、知情同意和隐私保护等。在我国，随着医学研究的不断推进，政府和医疗机构正努力解决这些挑战，为SMA患者提供更好的治疗环境和条件。总之，尽管Zolgensma基因疗法在应用于SMA患者的过程中仍面临诸多挑战，但其在改善患者生活质量、延长生存期方面的潜力令人期待。随着科研和医疗水平的不断提高，我们有理由相信，未来SMA患者将受益于更为先进和全面的治疗手段。参考文献： [1]王康,赵慧,时倩等.脊髓性肌萎缩症的靶向治疗研究进展[J].中国神经免疫学和神经病学杂志,2024,31(01):46-51. [2]李伟,仲一涵,李扬等.脊髓性肌萎缩症研究进展[J].东南大学学报(医学版),2023,42(06):955-959. [3]蔡建湖,蒋乐,杨梦园等.信息不对称下考虑风险规避的绿色供应链博弈模型[J/OL].系统工程理论与实践,1-23[2024-03-06]. 【智药研习社近期课程预告】来源：CPHI制药在线声明：本文仅代表作者观点，并不代表制药在线立场。本网站内容仅出于传递更多信息之目的。如需转载，请务必注明文章来源和作者。投稿邮箱：Kelly.Xiao@imsinoexpo.com▼更多制药资讯，请关注CPHI制药在线▼点击阅读原文，进入智药研习社~

基因疗法

2024-03-25

·同写意

罕见病的治疗模式、临床进展与挑战

据估计，全球约有3.5亿患者受罕见病影响，是艾滋病和癌症患者总数的两倍多。尽管当前罕见病研究取得重大进展，使得更深入理解其分子机制，同时也通过立法保证了监管和经济激励，从而推动罕见病特定疗法的开发。然而，将罕见病知识转化为疗法的速度远远落后于这些知识的生成速度。解决这一转化差距是一项多方面的挑战，其关键方面之一是选择最佳的治疗方式。来自比利时罕见病联盟的Erik Tambuyzer和Marco Prunotto研究团队在期刊《Nature Reviews Drug Discovery》上发表了题为“Therapies for rare diseases: therapeutic modalities, progress and challenges ahead”的文章，详细探讨了罕见病的主要治疗方式的技术基础和其适用性，包括小分子药物、抗体药物、蛋白质替代疗法、寡核苷酸疗法、基因和细胞疗法，以及药物再利用。对于每种治疗方式，作者比较了不同模式下的分子靶向机制（图1），描述了基于该平台的药物开发的临床进展，并分析了其作为罕见病疗法开发平台的优缺点。希望本文能为罕见病领域的药物发现提供入门介绍，并推动科学进步转化为新型疗法。图1 不同治疗模式的特点和监管批准数据（图片来源：Tambuyzer E et al, Nat Rev Drug Discov, 2020）1小分子药物小分子药物因多样的给药途径、可控的剂量、高稳定性、合成规模大以及相对较低的成本等优势，是罕见病药物研发中最成熟的药物平台。罕见病的小分子药物的发现通常来源于对模式细胞系的大规模筛选。在将候选小分子筛选转化用于临床疗法时，建立高通量筛选是局限性之一。近期，包括诱导多能干细胞（induced pluripotent stem cells, iPS）、基因编辑技术（CRISPR-Cas systems）和类器官（Organoids）在内的几项最新发展有效提升了筛选通量及效率。理论上，可以从患者的皮肤活检样本中建立iPS细胞，并分化为表达疾病表型特征的细胞类型。类器官3D培养更能模拟组织结构和功能，特别是当需要针对特定突变的药物时，它是筛选小分子药物的绝佳模型。模式生物筛选也正在成为重要的遗传和化学发现平台，特别是对于可能改变疾病表型的小分子药物。这些筛选还考虑到药物进入细胞中的摄取和毒性因素。CRISPR-Cas9基因编辑技术和转基因技术的出现使得可以引入特定的突变。同时，在几种模式生物中进行验证可以加速潜在疗法向临床的转化。对于囊性纤维化，根据对CFTR基因中潜在突变的了解，通过细胞筛选可获得治疗性小分子药物。当前FDA已批准两种抑制缺陷酶底物生物合成的小分子疗法（用于戈谢病的miglustat和eliglustat）和一种作为伴侣蛋白稳定并恢复突变酶功能的小分子疗法（用于法布里病的migalastat），还有其他候选药物正在进行临床试验，包括用于治疗法布里病的CNS穿透性化合物ibiglustat。在杜氏肌营养不良（duchenne muscular dystrophy, DMD）患者中，抗肌萎缩蛋白的编码基因存在终止密码子突变，小分子ataluren能够在小鼠模型中促进终止密码子通读，目前已在欧盟获得批准。小分子药物也可用于提升蛋白质水平，如促进肌营养相关蛋白表达，在动物模型中也可以减缓DMD。另外，几种处理下游效应(如炎症和纤维化)的小分子药物也在DMD临床试验中显示出疗效，可以联合使用。最后，目前正在开发用于LSDs的小分子蛋白稳态调节剂，可增强内源性细胞对应激的反应，并上调HSP70（heat shock protein 70）以促进蛋白质折叠。小分子药物在药物研发中仍处于前沿地位，其靶向广泛，生产成本合理且可大规模生产。对于罕见病而言，该平台有着丰富的科学、临床和监管经验。对于分子病因不明或有多重因素参与的罕见病，表型筛选也会对发现有效小分子起到正面作用。但同时，找到既具备好的药理学效应和药代动力学效应又能使脱靶效应低的小分子较为艰难，需要经历复杂的优化过程。当然，目前一些已被证明安全的其他药物可以应用于罕见病，随着对罕见病机理研究的深入，类似于靶向不同病因的联合疗法也将成为可能。2抗体药物抗体药物主要通过调节信号通路、募集细胞或蛋白质至特定部位、传递细胞毒素或中和及调节循环因子来发挥作用。单克隆抗体（monoclonal antibody, mAbs）由B淋巴细胞产生，能够在体液免疫反应中识别抗原。mAbs的两个关键特性是对特定抗原的特异性和这种特异性的持续性。针对第一批鼠源性mAbs具有免疫原性和较短的半衰期问题，研究者们设计了人-鼠混合mAbs、人源化小鼠mAbs或人源mAbs来开发有效mAbs治疗药物。另外，抗体工程的进步使得抗体可以以naked mAbs或更小的工程化抗原结合片段（antigen-binding fragments, Fab）的形式生产，帮助提高限定区域（如眼底）的药物浓度，降低全局生物活性，并降低毒性。工程技术还允许生产双特异性抗体（bispecific antibody, BsAb），相比mAbs更有优势，能够直接引导免疫系统靶向肿瘤细胞或同时阻断两个不同的靶点，迄今为止已有2种BsAb获批上市。抗体恒定区（fragment crystallizable, Fc）也可与其他非抗体相关蛋白结构域融合，作为单独的治疗性抗体，或将全长抗体与小分子融合，形成ADCs。Fc融合蛋白具有IgG的优势，能促进体内稳定性，实现特异性治疗，目前已有8种Fc融合蛋白被批准。ADCs利用mAbs的特异性，选择性地将细胞毒性药物递送至肿瘤细胞，从而减少对健康组织的损伤。目前只有少数ADCs被批准用于血液肿瘤，但该领域较为活跃，有超过50种ADCs正在进行临床试验。依库珠单抗（eculizumab）是一种靶向末端补体蛋白C5的mAb，10多年前首次被批准用于治疗阵发性睡眠性血红蛋白尿症（paroxysmal nocturnal hemoglobinuria，PNH），此后又被批准用于非典型溶血性尿毒综合征（atypical haemolytic uraemic syndrome）和重症肌无力（myasthenia gravis）。卡那单抗（canakinumab）最初是为类风湿性关节炎（rheumatoid arthritis）开发的一种靶向关键炎性细胞因子IL-1β的mAb，2009年被重新应用并批准用于治疗cryopyrin相关周期性综合征，该项目临床试验还为批准其用于治疗其他三种与IL-1β相关的罕见周期性发热综合征提供了依据。IL-1β也是利纳西普（rilonacept）的靶点，于2008年被批准用于治疗cryopyrin相关周期性综合征。目前已批准的两种BsAbs中，分别是血友病（hemophilia）治疗药物艾米珠单抗（Emicizumab）和获得性血栓性血小板减少性紫癜（acquired thrombotic thrombocytopenic purpura, ATTP）治疗药物卡普赛珠单抗（caplacizumab）。基于mAb的治疗平台具有高度特异性，脱靶毒性低，稳定性高，有助于降低给药频率。对于获能突变引发的罕见病，已经建立了合适的mAb疗法。然而，mAbs的大尺寸限制了其对组织和细胞的穿透，从而阻碍了对某些理论上理想靶点(如细胞内蛋白)的结合。由于需要在良好生产规范条件下大规模培养哺乳动物细胞并进行大量纯化步骤，因此mAbs的制造成本也非常高。此外，mAbs需要注射给药，因此在制剂阶段需要非常高的无菌标准，并且可能引发注射部位的不良反应。当前mAb平台研发部署较少，但高效、安全地识别和制造mAbs的能力正在“普及”，再加上在生产环节可实现更高的mAb滴度，这大大降低了商品成本。其次，mAbs的廉价生物仿制药进入市场可能有助于重新利用该抗体。3蛋白质替代疗法蛋白质替代疗法，长期以来一直是治疗特定蛋白质功能丧失相关的罕见病的重要基石。较为成功的方向是使用外源补充的酶来替代缺失或者功能缺陷的酶进行治疗—ERT疗法，ERT的研究主要靶向溶酶体酶相关的LSDs。应用于ERT的酶大部分来源于重组蛋白。ERTs通常使用哺乳动物细胞系生产，最常见的是中国仓鼠卵巢(CHO)细胞。与所有重组蛋白疗法一样，从生物反应器发酵液纯化制备的酶是复杂的，需要高度控制，以保持最终产品的生物活性和足够的产量。此外，制造参数(如生物反应器的规模)的变化可能导致最终产品出现特性差异，这可能会被监管机构认为有临床意义。迄今为止，全球已开发并批准了11种不同的重组ERTs，包括戈谢病、法布里病、Hurler-Scheie综合征（黏多糖贮积症Ⅰ型（MPSⅠ））、亨特综合征（MPS Ⅱ）、庞贝病、Maroteaux-Lamy综合征（MPS Ⅵ）、溶酶体酸性脂肪酶缺乏症（沃尔曼病）、巴顿病（神经蜡样质脂褐质沉积症2型）、Morquio A综合征（MPS ⅣA）以及最近的Sly综合征（MPS Ⅶ）和α-甘露糖苷贮积症。在LSDs领域，目前正在为圣菲利柏A综合征（MPS ⅢA）和圣菲利柏B综合征（MPS ⅢB）开发多种ERT。在LSDs领域之外，使用天然(人类和动物)酶的ERTs已被批准用于A1AT增强疗法和与腺苷脱氨酶（adenosine deaminase, ADA）缺乏相关的重症联合性免疫缺陷病（severe combined immunodefiency, SCID），重组ERTs也被批准用于低磷酸酯酶症（FDA和EMA）和苯丙酮尿症（FDA）。在病程的早期（即在重大不可逆器官损伤发生之前），替代酶能够以合适的剂量被输送到合适的组织和细胞，ERT就会非常有效。酶递送是受体介导并具有剂量依赖性，在戈谢病中，酶表面的甘露糖分子有助于酶进入相关细胞类型，即巨噬细胞。然而，对于其他LSDs，如黏多糖病、法布里病等，ERT的开发较为困难，因为病理性底物积聚发生在缺乏或表达低水平甘露糖受体的其他细胞类型中。此外，当酶需要被输送到血管系统服务较少的器官或组织时，需要较高的剂量才能达到正确的治疗效果。而静脉注射ERT对神经病变亚型的神经学表现无效，因为酶体积太大，无法穿过血脑屏障。因此，在一些LSDs试验中正在测试向CNS实现鞘内注射ERT。ERT疗法安全性高，很少有患者出现不良反应。但是可能会引起过敏，从而限制治疗的效果，并且对于受到不可逆器官损伤的重症患者，ERT治疗效果非常差。当前，ERT技术仍存在局限性，包括制造和纯化重组酶的成本，以及建立新产品制造能力所需的时间。4寡核苷酸疗法目前已经开发出几种靶向RNA的方法，其中研究最广泛的是ASOs和siRNAs，寡核苷酸疗法是通过序列特异的碱基配对与RNA靶点结合的合成核酸序列，从而以各种方式影响基因表达。ASOs是单链分子，并通过核糖核酸酶H引发其选择性降解，导致相应蛋白的表达下调。siRNAs属于内源性基因调控机制，为双链结构，通过整合修饰后的化学骨架以增强其药物特性。它们通常会与脂质纳米颗粒或N-乙酰半乳糖胺等载体结合实现肝脏递送。此外，单链RNA阻断剂通过与前体mRNA或mRNA杂交，也有助于基因功能障碍相关的罕见病的治疗，且能够恢复基因功能，而不是只像ASO和siRNA一样起到抑制作用。1998年，第一种获得FDA批准的ASO药物是用于治疗免疫受损患者（包括艾滋病患者）巨细胞病毒视网膜炎的福米韦森（fomivirsen）。虽然福米韦森后来已被撤市，但其他ASO药物也随之出现，例如米泊美生（ASO mipomersen）于2013年被批准用于治疗家族性纯合子高胆固醇血症。寡核苷酸疗法在罕见神经系统疾病中的应用或许最具前景，近年来获得数项开创性批准。其中Patisiran是一种与脂质相结合的siRNA，成为FDA批准的首个siRNA疗法，随后不久FDA批准了ASO药物Inotersen。这两种药物均是通过降解编码TTR的mRNA发挥作用。另外两种RNA阻断型寡核苷酸疗法Nusinersen和Eteplirsen也已被批准用于罕见的神经系统疾病。Nusinersen通过增加SMN2 mRNA转录本中的外显子7包含物发挥作用，从而生成SMN蛋白，已在美国和欧盟获批上市。Eteplirsen旨在校正翻译阅读框并生成缩短但仍具功能的抗肌萎缩蛋白，主要用于治疗DMD。然而Eteplirsen的效果一直存在争议。寡核苷酸疗法具有高度特异性，能够解决传统疗法无法触及的靶标，并且由于全身暴露有限而降低了毒性。这极大扩展了可选目标的数量和类型。由于大多数已知的罕见病是遗传性的，寡核苷酸疗法通过靶向RNA为降低罕见病所引发的较大的发病率和死亡率提供了关键机会。然而，寡核苷酸不易穿过血脑屏障，因此需要采取有创的给药方式（如鞘内或脑室内途径），这仍然是其在CNS疾病临床应用的最大障碍之一。尽管如此，近期获得监管机构批准的成功案例数量可能会推动其针对其他罕见病的研究和开发。例如，靶向亨廷顿蛋白（HTT）mRNA的ASO药物（RG6042），最近已进入临床Ⅲ期试验，希望这能成为针对这种神经退行性疾病的首个疾病修饰疗法。5基因与细胞治疗基因治疗在罕见病中的作用原理主要为两种，一种是表达所需蛋白以弥补特定蛋白质功能丧失，另一种是利用RNA干扰机制抑制基因表达。腺相关病毒（adeno-associated virus, AAV）载体和逆转录病毒（retrovirus）/慢病毒（lentivirus）载体是目前常用于罕见病临床研究的两种基因治疗平台。重组AAV载体可以插入小于5000个碱基的治疗性转基因以进行基因治疗。目前已鉴别出13种AAV血清型，不同的AAV血清型具有不同的组织趋向性。例如，AAV8已在三项临床试验中用于将基因递送至肝脏；AAV9已用于四项神经系统疾病的临床试验中。治疗用的AAV不会将基因整合进人体细胞，保证了安全性，但其会在细胞复制中丢失信息，因此只能用于非分裂（或分裂缓慢）细胞类型的基因治疗。AAV载体具有良好的安全性，在200多项临床试验中没有死亡或致癌记录。在人体内引起的最常见严重不良反应是肝转氨酶水平升高（表明肝损伤），与对AAV衣壳蛋白的免疫反应有关，通常可以通过类固醇治疗来控制。逆转录病毒包含单链RNA基因组，通过逆转录将基因整合到人类基因组中，实现基因组的永久修饰。慢病毒是逆转录病毒家族的一个属，不依赖有丝分裂进入细胞核，其感染效率更高且可以自我灭活，因此可用于递送基因至分裂或非分裂细胞中。根据最初的细胞来源，细胞疗法可分为患者特异性来源（通常是自体的）或已制备好的细胞来源这两类。可用的细胞类型包括T细胞、树突状细胞（dendritic cell, DC）、间充质基质细胞（mesenchymal stromal cell, MSC）、成纤维细胞、自然杀伤（natural killer，NK）细胞、神经干细胞、诱导多能干细胞（induced pluripotent stem cell, iPSC）等，通过靶细胞分离（选择、分选）、培养（扩增、激活）、洗涤、体积减少和其他配制组合的过程进一步修饰源细胞。离体修饰通常是通过使用病毒载体实现的。与体内基因组编辑相比，体外编辑的脱靶风险将大大降低。在临床应用方面，AAV疗法已被证实在脊髓性肌萎缩症（spinal muscular atrophy, SMA）、A型和B型血友病（hemophilia）、芳香族L-氨基酸脱羧酶缺乏症（aromatic L-amino acid decarboxylase deficiency, AADCd）等多种罕见病中有效，目前有8种AAV基因疗法已被批准上市（表1）。表1 全球获批上市的8款AAV基因治疗产品在单基因罕见疾病方面，AAV载体已经体现出临床优越性。相关研究表明，AAV载体可在非分裂细胞中持续多年地表达基因。但其生产制造的复杂性和成本远高于小分子，其他局限包括免疫应答导致的AAV转导细胞的丢失、缺乏用于其他相关组织和细胞类型的载体血清型、以及基因组的有限荷载。另外，基因组编辑完成后相关基因的长期表达可能会带来负面影响，但是其中的致癌问题可通过自灭活慢病毒载体解决。而细胞疗法的一个关键局限性是目前尚无法确定产品的特征以确保一致性，其确切作用机制可能也不清楚，因此提高了使用的成本。相较于小分子、抗体和蛋白质替代疗法，基因和细胞疗法尚处于早期发展阶段，然而，这种疗法可能是一次性治疗甚至可以治愈疾病，因此对罕见病具有深远的意义。— 总结 — 在详尽阐述了当前罕见病新药开发的主要技术平台之后，作者还简要概述了一些深刻影响此类药物研发环境的核心问题和关键因素，为全面理解罕见病药物研发领域提供了更为深入的视角。01孤儿药开发监管途径孤儿药开发的各种监管途径和经济激励措施，如今在美国、欧洲、日本和其他地方都已确立。为加快创新药的研发速度，解决重大未满足的医疗需求，已经出台了几项监管措施，包括美国的快速通道、加速审批、优先审查、突破性疗法认定和再生医学先进疗法认定，以及欧盟的有条件上市许可、特殊情况批准、加速评估、优先药物（PRIME）计划和先进疗法监管。对FDA和EMA的批准进行审查发现，这些项目更多地用于孤儿药，而非用于治疗非罕见病产品（表2）。表2 孤儿药的快速监管审查途径（图片来源：Tambuyzer E, Vandendriessche B, Austin CP, et. al, Nat Rev Drug Discov, 2020）02患者参与监管决策和孤儿药开发患者权益组织在孤儿药开发中将继续扩大其作为研究伙伴的角色，他们在确定临床终点、制定知情同意书、招募患者等方面提供专业知识，并参与监管机构会议，讨论研发活动以及医疗产品监管审查中的效益风险评估。同时在药物开发早期，患者的观点也极具价值。例如，在建立患者登记系统和生物样本库以及选择临床试验终点方面，这些在罕见病中往往未得到很好的确立。尽管已经努力选择适合目的的终点，但许多罕见病的异质性降低了候选药品的敏感性，再加上患者数量少，可能会导致假阴性。通过使用可以在临床试验前、中和后期实施的半结构化视频访谈，来捕捉患者及其看护者对变化的看法，可以防止这种假阴性。另外对于从事孤儿药开发的研究人员来说，与相关患者建立良好关系非常重要，并且应该尽早建立。03推动罕见病疗法的有效研究和开发罕见病患者群体多样，值得作为更高的公共卫生优先事项来对待。罕见病领域的所有利益相关者都需要协作，以弥合罕见病领域基础研究与治疗开发之间的巨大鸿沟。当前，对罕见病的高质量研究没有到达临床阶段就结束了。在美国和欧盟，尽管孤儿药的数量都在稳步增长(图2)，但仅有约5%的孤儿药获批。此外，一些疾病领域也存在巨大的偏倚，超过1/3的孤儿药被批准用于肿瘤适应证(图3)。图2 罕见病在科学知识和治疗方法之间的巨大差距（图片来源：Tambuyzer E, Vandendriessche B, Austin CP, et. al, Nat Rev Drug Discov, 2020）图3 罕见病和孤儿药的关键因素（图片来源：Tambuyzer E, Vandendriessche B, Austin CP, et. al, Nat Rev Drug Discov, 2020）对于肿瘤以外的罕见病，在将现有基础科学转化为治疗方法方面存在一个重大缺口。标准技术平台和就绪性的评估机制可以增强患者组织的能力，并促进治疗开发的进展。将罕见病的基础研究转化为治疗方法已成为公共和慈善事业的首要任务，提供资金支持，并为患者群体提供咨询和支持服务，这将有助于降低早期研究结果的风险，让更多行业参与推动新疗法。此外，在全球合作中共享诊断数据，能够保护患者隐私，将有助于更轻松、更快速地诊断罕见病，并推动跨疾病分析。数据的统一可以减少重复工作和成本，提高效率，增加领域专业知识。传感器技术的日益普及将提供更多研究数据，如识别具有相似症状的不同的疾病可能共享的药物反应模式等。在建立登记系统以及临床和自然史研究时，也应咨询患者组，以确保考虑患者的观点。最后，通过对罕见病药物研发中使用的技术平台的概述，希望这篇文章将成为帮助基础科学转化为此类疾病治疗开发的宝贵资源。同时还希望，这将引发人们对资助和培养转化科学文化的兴趣，以减轻全球罕见疾病患者的痛苦。关于劲帆医药劲帆生物医药科技（武汉）有限公司简称“劲帆医药”，创立于2022年，提供一站式基因治疗药物CRO/CDMO服务。拥有全球领先的AAV规模化制备专利技术平台及cGMP级病毒载体生产车间，致力于推进基因治疗更有效，更安全，更经济，更可及，赋能客户，造福患者。关于同写意同写意论坛是中国新药研发行业权威的多元化交流平台，二十年来共举办会议论坛百余期。“同写意新药英才俱乐部”基于同写意论坛而成立，早已成为众多新药英才的精神家园和中国新药思想的重要发源地之一。同写意在北京、苏州、深圳、成都设立多个管理中心负责同写意活动的运营。尊享多重企业/机构会员特权 ● 分享庞大新药生态圈资源库；● 同写意活动优享折扣；● 会员专属坐席及专家交流机会；● 同写意活动优先赞助权；● 机构品牌活动策划与全方位推广；● 秘书处一对一贴心服务。入会请联系同写意秘书处同写意创新链盟机构（上下滑动查看更多）森西赛智 | 汇芯生物 | 申科生物 | 方拓生物 | 东抗生物 | 科盛达 | 依利特 | 翊曼生物丨锐拓生物丨复百澳生物丨圆因生物丨普洛斯丨华润三九丨皓阳生物丨人福医药丨广生堂药业丨澳宗生物丨妙顺生物 | 荣捷生物丨行诚生物 | 宜联生物 | 生命资本 | 恒诺康丨益诺思 | 深圳细胞谷丨佰诺达生物 | 沃臻生物 | 金仪盛世 | 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基因疗法临床研究细胞疗法寡核苷酸

2024-03-06

·GlobeNewswire-Health Care

New Biomarker Data Add Further Evidence Supporting the Potential Benefit of SPINRAZA® (nusinersen) in Infants and Toddlers with Unmet Clinical Needs after Gene Therapy

New data from the RESPOND study show that neurofilament levels, an indicator of neurodegeneration, were reduced in nearly all study participants treated with SPINRAZAReductions in biomarker complement previously reported RESPOND efficacy results showing improved motor function in most participants treated with SPINRAZA after gene therapy CAMBRIDGE, Mass., March 06, 2024 (GLOBE NEWSWIRE) -- Biogen Inc. (Nasdaq: BIIB) announced interim 6-month biomarker data from the initial 29 participants in the open-label RESPOND study.* The Phase 4 study evaluates clinical outcomes and safety following treatment with SPINRAZA over a 2-year period in infants and toddlers with spinal muscular atrophy (SMA) who have unmet clinical needs after treatment with Zolgensma® (onasemnogene abeparvovec). The new data show that plasma neurofilament light chain (NfL) levels, an objective biomarker of axonal injury and neurodegeneration, were reduced in nearly all study participants treated with SPINRAZA. These data will be presented at the 2024 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference (March 3-6, 2024). “Our evolving understanding of gene therapy indicates there may be an opportunity for better outcomes,” said Crystal Proud, M.D., Pediatric Neurologist at Children’s Hospital of the King’s Daughters. “Improvements in motor function together with decreases in neurofilament levels seen after treatment with SPINRAZA in RESPOND show that we may be able to further maximize benefits for patients.” Today NfL data are being presented from study participants treated with SPINRAZA for 6 months showing: Among participants with 2 SMN2 copies: All participants had elevated baseline NfL levels relative to healthy children of similar ageIn infants (n=11) who were 9 months or younger at first SPINRAZA dose (mean baseline NfL: 148.3 pg/mL), NfL levels decreased by a mean of 70% from baseline.In children (n=11) over 9 months of age at first SPINRAZA dose (mean baseline NfL: 121.8 pg/mL), NfL levels decreased by a mean of 78% from baseline. Among participants with 3 SMN2 copies: Baseline NfL levels were elevated in 2 of 3 children (mean: 60.6 pg/mL).NfL reductions were observed in those with elevated levels at baseline and remained stable in the participant without an elevated level at baseline. “Biogen is at the forefront of pioneering research aimed at advancing biomarkers to accelerate development of drugs for people living with devastating neurodegenerative diseases like SMA and ALS,” said Priya Singhal, M.D., M.P.H., Head of Development and interim Chief Medical Officer at Biogen. “Prior to receiving SPINRAZA at the start of RESPOND, we saw that participants had elevated neurofilament levels, as compared to healthy children suggesting ongoing neuronal injury. The RESPOND findings underscore the value of neurofilament as an objective marker for assessing remaining unmet needs in SMA patients who have previously received gene therapy.” As reported at the SMA Research & Clinical Care Meeting in June 2023 from the same 29 participants, improvements in motor function were observed in most participants as measured by increased mean total Hammersmith Infant Neurological Examination Section 2 (HINE-2) score from baseline.1 No new emerging safety concerns have been identified in enrolled RESPOND participants who received SPINRAZA after Zolgensma. After a median of 230.5 days in the study, serious adverse events (AEs) were reported in 13/38 (34%) participants. Any AEs were reported in 31/38 (81.6%) participants. No serious AEs were considered related to SPINRAZA or led to study withdrawal, although some were related to administration. These data and additional data from the RESPOND study will be presented at subsequent conferences this year including the 4th International Congress on Spinal Muscular Atrophy hosted by SMA Europe. About SPINRAZA® (nusinersen)SPINRAZA is approved in more than 71 countries to treat infants, children and adults with spinal muscular atrophy (SMA). As a foundation of care in SMA, more than 14,000 individuals have been treated with SPINRAZA worldwide.2 SPINRAZA is an antisense oligonucleotide (ASO) that targets the root cause of SMA by continuously increasing the amount of full-length survival motor neuron (SMN) protein produced in the body.3 It is administered directly into the central nervous system, where motor neurons reside, to deliver treatment where the disease starts.3 SPINRAZA has demonstrated sustained efficacy across ages and SMA types with a well-established safety profile based on data in patients treated up to 8 years,3 combined with unsurpassed real-world experience. The nusinersen clinical development program encompasses more than 10 clinical studies, which have included more than 460 individuals across a broad spectrum of patient populations, including two randomized controlled studies (ENDEAR and CHERISH). The SHINE and NURTURE open-label extension studies are evaluating the long-term impact of SPINRAZA. The most common adverse events observed in clinical studies were respiratory infection, fever, constipation, headache, vomiting and back pain. Laboratory tests can monitor for renal toxicity and coagulation abnormalities, including acute severe low platelet counts, which have been observed after administration of some ASOs. Biogen licensed the global rights to develop, manufacture and commercialize SPINRAZA from Ionis Pharmaceuticals, Inc. (Nasdaq: IONS). Please click here for Important Safety Information and full Prescribing Information for SPINRAZA in the U.S., or visit your respective country’s product website. About BiogenFounded in 1978, Biogen is a leading biotechnology company that pioneers innovative science to deliver new medicines to transform patient’s lives and to create value for shareholders and our communities. We apply deep understanding of human biology and leverage different modalities to advance first-in-class treatments or therapies that deliver superior outcomes. Our approach is to take bold risks, balanced with return on investment to deliver long-term growth. We routinely post information that may be important to investors on our website at www.biogen.com. Follow us on social media - Facebook, LinkedIn, X, YouTube. Biogen Safe Harbor This news release contains forward-looking statements, the potential clinical effects of SPINRAZA; the potential benefits, safety and efficacy of SPINRAZA; the clinical development program for SPINRAZA; the identification and treatment of SMA; our research and development program for the treatment of SMA; the potential of our commercial business and pipeline programs, including SPINRAZA; and risks and uncertainties associated with drug development and commercialization. These forward-looking statements may be accompanied by words such as “aim,” “anticipate,” “believe,” “could,” “estimate,” “expect,” “forecast,” “intend,” “may,” “plan,” “potential,” “possible,” “will,” “would” and other words and terms of similar meaning. Drug development and commercialization involve a high degree of risk, and only a small number of research and development programs result in commercialization of a product. Results in early-stage clinical trials may not be indicative of full results or results from later stage or larger scale clinical trials and do not ensure regulatory approval. You should not place undue reliance on our forward-looking statements. These statements involve risks and uncertainties that could cause actual results to differ materially from those reflected in such statements, including without limitation, uncertainty of success in the development and potential commercialization of SPINRAZA; the risk that we may not fully enroll our clinical trials or enrollment will take longer than expected; unexpected concerns may arise from additional data, analysis or results obtained during our clinical trials; regulatory authorities may require additional information or further studies, or may fail or refuse to approve or may delay approval of our drug candidates, including SPINRAZA; the occurrence of adverse safety events; the risks of unexpected hurdles, costs or delays; failure to protect and enforce our data, intellectual property and other proprietary rights and uncertainties relating to intellectual property claims and challenges; product liability claims; results of operations and financial condition. The foregoing sets forth many, but not all, of the factors that could cause actual results to differ from our expectations in any forward-looking statement. Investors should consider this cautionary statement, as well as the risk factors identified in our most recent annual or quarterly report and in other reports we have filed with the U.S. Securities and Exchange Commission. These statements speak only as of the date of this news release. We do not undertake any obligation to publicly update any forward-looking statements. References: Proud C. Interim results from the ongoing RESPOND study evaluating nusinersen in children with spinal muscular atrophy previously treated with onasemnogene abeparvovec. June 2023. SMA Research & Clinical Care Meeting. Orlando, Fla.Based on commercial patients, early access patients, and clinical trial participants through December 31, 2022. SPINRAZA U.S. Prescribing Information. Available at: https://www.spinraza.com/content/dam/commercial/specialty/spinraza/caregiver/en_us/pdf/spinraza-prescribing-information.pdf. Accessed: February 2024.Core Data sheet, Version 13, October 2021. SPINRAZA. Biogen Inc, Cambridge, MA. * Clinical outcomes and NfL were analyzed in the 29 participants who had the opportunity for at least six months of treatment at the time of the interim analysis. Analysis of mean change in NfL includes participants with baseline and Day 183 assessments; a mean change from baseline was not reported in the 3 SMN2 copies group, due to the small number of participants. Safety data are reported in all participants (n=38) who received at least one dose of SPINRAZA in the trial. MEDIA CONTACT:BiogenJack Cox+ 1 781 464 3260public.affairs@biogen.comINVESTOR CONTACT:BiogenChuck Triano+1 781 464 2442IR@biogen.com

临床结果临床3期上市批准寡核苷酸基因疗法