Antisense therapy

Antisense therapy is a form of treatment that uses antisense oligonucleotides (ASOs) to target messenger RNA (mRNA). ASOs are capable of altering mRNA expression through a variety of mechanisms, including ribonuclease H mediated decay of the pre-mRNA, direct steric blockade, and exon content modulation through splicing site binding on pre-mRNA.[1] Several ASOs have been approved in the United States, European Union, and elsewhere.

Nomenclature

The common stem for antisense oligonucleotides drugs is -rsen. The substem -virsen designates antiviral antisense oligonucleotides.[2]

Pharmacokinetics and pharmacodynamics

Half-life and stability

ASO-based drugs employ highly modified, single-stranded chains of synthetic nucleic acids that achieve wide tissue distribution with very long half-lives.[3][4][5] For instance, many ASO-based drugs contain phosphorothioate substitutions and 2' sugar modifications to inhibit nuclease degradation enabling vehicle-free delivery to cells.[6][7]

In vivo delivery

Phosphorothioate ASOs can delivered to cells without the need of a delivery vehicle. ASOs do not penetrate the blood brain barrier when delivered systemically but they can distribute across the neuraxis if injected in the cerebrospinal fluid typically by intrathecal administration. Newer formulations using conjugated ligands greatly enhances delivery efficiency and cell-type specific targeting.[8]

Approved therapies

Batten disease

Milasen was a novel individualized therapeutic agent that was designed and approved by the FDA for the treatment of Batten disease. This therapy serves as an example of personalized medicine.[9][10]

In 2019, a report was published detailing the development of milasen, an antisense oligonucleotide drug for Batten disease, under an expanded-access investigational clinical protocol authorized by the Food and Drug Administration (FDA).[9] Milasen "itself remains an investigational drug, and it is not suited for the treatment of other patients with Batten's disease" because it was customized for a single patient's specific mutation.[9] However it is an example of individualized genomic medicine therapeutical intervention.[9][11]

Cytomegalovirus retinitis

Fomivirsen (marketed as Vitravene), was approved by the U.S. FDA in Aug 1998 as a treatment for cytomegalovirus retinitis.

Duchenne muscular dystrophy

Several morpholino oligos have been approved to treat specific groups of mutations causing Duchenne muscular dystrophy. In September 2016, eteplirsen (ExonDys51) received FDA approval[12] for the treatment of cases that can benefit from skipping exon 51 of the dystrophin transcript. In December 2019, golodirsen (Vyondys 53) received FDA approval[13] for the treatment of cases that can benefit from skipping exon 53 of the dystrophin transcript. In August 2020, viltolarsen (Viltepso) received FDA approval for the treatment of cases that can benefit from skipping exon 53 of the dystrophin transcript.[14]

Familial chylomicronaemia syndrome

Volanesorsen was approved by the European Medicines Agency (EMA) for treatment of familial chylomicronaemia syndrome in May 2019.[15]

Familial hypercholesterolemia

In January 2013 mipomersen (marketed as Kynamro) was approved by the FDA for the treatment of homozygous familial hypercholesterolemia.[16][17]

Hereditary transthyretin-mediated amyloidosis

Inotersen received FDA approval for the treatment of hereditary transthyretin-mediated amyloidosis in October 2018.[18] The application for inotersen was granted orphan drug designation.[18] It was developed by Ionis Pharmaceuticals and licensed to Akcea Therapeutics.

Spinal muscular atrophy

In 2004, development of an antisense therapy for spinal muscular atrophy began. Over the following years, an antisense oligonucleotide later named nusinersen was developed by Ionis Pharmaceuticals under a licensing agreement with Biogen. In December 2016, nusinersen received regulatory approval from FDA[19][20] and soon after, from other regulatory agencies worldwide.

Investigational therapies

Current clinical trials

As of 2020 more than 50 antisense oligonucleotides were in clinical trials, including over 25 in advanced clinical trials (phase II or III).[21][22]

Phase III trials
Amyotrophic lateral sclerosis

Tofersen (also known as IONIS-SOD1Rx and BIIB067) is currently being tested in a phase 3 trial for amyotrophic lateral sclerosis (ALS) due to mutations in the SOD1 gene.[23] Results from a phase 1/2 trial have been promising.[24] It is being developed by Biogen under a licensing agreement with Ionis Pharmaceuticals.

Hereditary transthyretin-mediated amyloidosis

A follow-on drug to Inotersen is being developed by Ionis Pharmaceuticals and under license to Akcea Therapeutics for hereditary transthyretin-mediated amyloidosis. In this formulation the ASO is conjugated to N-Acetylgalactosamine enabling hepatocyte-specific delivery, greatly reducing dose requirements and side effect profile while increasing the level of transthyretin reduction in patients.

Huntington's disease

Tominersen (also known as IONIS-HTTRx and RG6042) is currently being tested in a phase 3 trial for Huntington's disease.[24] It is being developed by Roche under a licensing agreement with Ionis Pharmaceuticals.

Phase I & II trials

Clinical trials are ongoing for several diseases and conditions including:

Acromegaly, age related macular degeneration, Alzheimer's disease, amyotrophic lateral sclerosis, autosomal dominant retinitis pigmentosa, beta thalassemia, cardiovascular disease, centronuclear myopathy, coagulopathies, cystic fibrosis, Duchenne muscular dystrophy, diabetes, epidermolysis bullosa dystrophica, familial chylomicronemia syndrome, frontotemporal dementia, Fuchs' dystrophy, hepatitis B, hereditary angioedema, hypertension, IgA nephropathy, Leber's hereditary optic neuropathy, multiple system atrophy, non-alcoholic fatty liver disease, Parkinson's disease, prostate cancer, Stargardt disease, STAT3-expressing cancers, Usher syndrome.

Preclinical development

Several ASOs are currently being investigated in disease models for Alexander disease,[25] ATXN2 (gene) and FUS (gene) amyotrophic lateral sclerosis, Angelman syndrome,[26] Lafora disease, lymphoma, multiple myeloma, myotonic dystrophy, Parkinson's disease,[27] Pelizaeus–Merzbacher disease,[28][29] and prion disease,[30] Rett syndrome,[31] spinocerebellar Ataxia Type 3.

gollark: Oh, this is a good idea, yes.
gollark: Do you need some OTHER data structure?
gollark: Can this actually be done whatsoever?!
gollark: i.e. imagine you have some documents which say "bee" lots, and some which say "apio" lots, and you want to look up ones with "apio" and "bee", *without* just retrieving all the documents for each and computing the intersection.
gollark: So I know approximately how inverted index things work, but HOW the APIO FORM do you efficiently do intersectiony queries on them?

See also

References
  1. Morcos PA (June 2007). "Achieving targeted and quantifiable alteration of mRNA splicing with Morpholino oligos". Biochemical and Biophysical Research Communications. 358 (2): 521–7. doi:10.1016/j.bbrc.2007.04.172. PMID 17493584.
  2. International Nonproprietary Names (INN) for biological and biotechnological substances
  3. Weiss, B. (ed.): Antisense Oligodeoxynucleotides and Antisense RNA : Novel Pharmacological and Therapeutic Agents, CRC Press, Boca Raton, FL, 1997. ISBN 0849385520 ISBN 9780849385520
  4. Weiss B, Davidkova G, Zhou LW (March 1999). "Antisense RNA technology for studying and modulating biological processes". Cellular and Molecular Life Sciences. 55 (3): 334–58. doi:10.1007/s000180050296. PMID 10228554.
  5. Goodchild J (2011). "Therapeutic oligonucleotides". Methods in Molecular Biology. 764: 1–15. doi:10.1007/978-1-61779-188-8_1. ISBN 978-1-61779-187-1. PMID 21748630.
  6. Bennett CF, Swayze EE (2010). "RNA targeting therapeutics: molecular mechanisms of antisense oligonucleotides as a therapeutic platform". Annual Review of Pharmacology and Toxicology. 50: 259–93. doi:10.1146/annurev.pharmtox.010909.105654. PMID 20055705.
  7. Xu L, Anchordoquy T (January 2011). "Drug delivery trends in clinical trials and translational medicine: challenges and opportunities in the delivery of nucleic acid-based therapeutics". Journal of Pharmaceutical Sciences. 100 (1): 38–52. doi:10.1002/jps.22243. PMC 3303188. PMID 20575003.
  8. Bennett CF, Swayze EE (2010). "RNA targeting therapeutics: molecular mechanisms of antisense oligonucleotides as a therapeutic platform". Annual Review of Pharmacology and Toxicology. 50: 259–93. doi:10.1146/annurev.pharmtox.010909.105654. PMID 20055705.
  9. Kim, Jinkuk; Hu, Chunguang; Moufawad El Achkar, Christelle; Black, Lauren E.; Douville, Julie; Larson, Austin; Pendergast, Mary K.; Goldkind, Sara F.; Lee, Eunjung A.; Kuniholm, Ashley; Soucy, Aubrie (2019-10-09). "Patient-Customized Oligonucleotide Therapy for a Rare Genetic Disease". New England Journal of Medicine. 0 (17): 1644–1652. doi:10.1056/NEJMoa1813279. ISSN 0028-4793. PMC 6961983. PMID 31597037.
  10. Gallagher, James (2019-10-12). "Unique drug for a girl with deadly brain disease". Retrieved 2019-10-14.
  11. "A Drug Was Made For Just One Child, Raising Hopes About Future Of Tailored Medicine". www.wbur.org. Retrieved 2019-10-14.
  12. U.S. Food and Drug Administration, Silver Springs, Maryland. News Release: FDA grants accelerated approval to first drug for Duchenne muscular dystrophy, September 19, 2016. Archived August 2, 2019, at the Wayback Machine
  13. "FDA grants accelerated approval to first targeted treatment for rare Duchenne muscular dystrophy mutation". U.S. Food and Drug Administration (FDA) (Press release). 12 December 2019. Archived from the original on 13 December 2019. Retrieved 12 December 2019.
  14. "FDA Approves Targeted Treatment for Rare Duchenne Muscular Dystrophy Mutation". U.S. Food and Drug Administration (FDA) (Press release). 12 August 2020. Retrieved 12 August 2020.
  15. https://www.globenewswire.com/news-release/2019/05/07/1818393/0/en/Akcea-and-Ionis-Announce-Approval-of-WAYLIVRA-volanesorsen-in-the-European-Union.html
  16. Pollack A (29 January 2013). "F.D.A. Approves Genetic Drug to Treat Rare Disease". The New York Times.
  17. Staff (29 January 2013). "FDA approves new orphan drug Kynamro to treat inherited cholesterol disorder". U.S. Food and Drug Administration.CS1 maint: uses authors parameter (link)
  18. "Inotersen Orphan Drug Designation and Approval". U.S. Food and Drug Administration (FDA). 24 July 2012. Archived from the original on 19 December 2019. Retrieved 18 December 2019. This article incorporates text from this source, which is in the public domain.
  19. Wadman M (23 December 2016). "Updated: FDA approves drug that rescues babies with fatal neurodegenerative disease". Science. doi:10.1126/science.aal0476.
  20. Grant C (2016-12-27). "Surprise Drug Approval Is Holiday Gift for Biogen". Wall Street Journal. ISSN 0099-9660. Retrieved 2016-12-27.
  21. Bennett CF, Swayze EE (2010). "RNA targeting therapeutics: molecular mechanisms of antisense oligonucleotides as a therapeutic platform". Annual Review of Pharmacology and Toxicology. 50: 259–93. doi:10.1146/annurev.pharmtox.010909.105654. PMID 20055705.
  22. Watts JK, Corey DR (January 2012). "Silencing disease genes in the laboratory and the clinic". The Journal of Pathology. 226 (2): 365–79. doi:10.1002/path.2993. PMC 3916955. PMID 22069063.
  23. Miller, Timothy M.; Pestronk, Alan; David, William; Rothstein, Jeffrey; Simpson, Ericka; Appel, Stanley H.; Andres, Patricia L.; Mahoney, Katy; Allred, Peggy; Alexander, Katie; Ostrow, Lyle W. (2013-05-01). "An antisense oligonucleotide against SOD1 delivered intrathecally for patients with SOD1 familial amyotrophic lateral sclerosis: a phase 1, randomised, first-in-man study". The Lancet Neurology. 12 (5): 435–442. doi:10.1016/S1474-4422(13)70061-9. ISSN 1474-4422. PMID 23541756.
  24. Miller, Timothy; Cudkowicz, Merit; Shaw, Pamela J.; Andersen, Peter M.; Atassi, Nazem; Bucelli, Robert C.; Genge, Angela; Glass, Jonathan; Ladha, Shafeeq; Ludolph, Albert L.; Maragakis, Nicholas J. (2020-07-09). "Phase 1–2 Trial of Antisense Oligonucleotide Tofersen for SOD1 ALS". New England Journal of Medicine. 383 (2): 109–119. doi:10.1056/NEJMoa2003715. ISSN 0028-4793.
  25. Hagemann, Tracy L.; Powers, Berit; Mazur, Curt; Kim, Aneeza; Wheeler, Steven; Hung, Gene; Swayze, Eric; Messing, Albee (2018). "Antisense suppression of glial fibrillary acidic protein as a treatment for Alexander disease". Annals of Neurology. 83 (1): 27–39. doi:10.1002/ana.25118. ISSN 1531-8249. PMC 5876100. PMID 29226998.
  26. Meng, Linyan; Ward, Amanda J.; Chun, Seung; Bennett, C. Frank; Beaudet, Arthur L.; Rigo, Frank (February 2015). "Towards a therapy for Angelman syndrome by targeting a long non-coding RNA". Nature. 518 (7539): 409–412. doi:10.1038/nature13975. ISSN 1476-4687.
  27. Qian, Hao; Kang, Xinjiang; Hu, Jing; Zhang, Dongyang; Liang, Zhengyu; Meng, Fan; Zhang, Xuan; Xue, Yuanchao; Maimon, Roy; Dowdy, Steven F.; Devaraj, Neal K. (June 2020). "Reversing a model of Parkinson's disease with in situ converted nigral neurons". Nature. 582 (7813): 550–556. doi:10.1038/s41586-020-2388-4. ISSN 1476-4687.
  28. Elitt, Matthew S.; Barbar, Lilianne; Shick, H. Elizabeth; Powers, Berit E.; Maeno-Hikichi, Yuka; Madhavan, Mayur; Allan, Kevin C.; Nawash, Baraa S.; Gevorgyan, Artur S.; Hung, Stevephen; Nevin, Zachary S. (2020-07-01). "Suppression of proteolipid protein rescues Pelizaeus-Merzbacher disease". Nature: 1–9. doi:10.1038/s41586-020-2494-3. ISSN 1476-4687.
  29. "Research finds new approach to treating certain neurological diseases". medicalxpress.com. Retrieved 2020-07-23.
  30. Raymond, Gregory J.; Zhao, Hien Tran; Race, Brent; Raymond, Lynne D.; Williams, Katie; Swayze, Eric E.; Graffam, Samantha; Le, Jason; Caron, Tyler; Stathopoulos, Jacquelyn; O’Keefe, Rhonda (2019-08-22). "Antisense oligonucleotides extend survival of prion-infected mice". JCI Insight. 4 (16). doi:10.1172/jci.insight.131175. ISSN 0021-9738.
  31. Sztainberg, Yehezkel; Chen, Hong-mei; Swann, John W.; Hao, Shuang; Tang, Bin; Wu, Zhenyu; Tang, Jianrong; Wan, Ying-Wooi; Liu, Zhandong; Rigo, Frank; Zoghbi, Huda Y. (December 2015). "Reversal of phenotypes in MECP2 duplication mice using genetic rescue or antisense oligonucleotides". Nature. 528 (7580): 123–126. doi:10.1038/nature16159. ISSN 1476-4687.
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