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Patient-Customized Oligonucleotide Therapy for a Rare Genetic Disease
Jinkuk Kim1, Chunguang Hu1, Christelle Moufawad El Achkar1
1From the Divisions of Genetics and Genomics (J.K., C.H., E.A.L., A.S., J.V., R.L.D., J.C., P.B.A., A.H.B., S.E.W., O.B., T.W.Y.), Newborn Medicine (P.B.A., P.E.G.), and Neuroradiology (P.E.G.), the Departments of Neurology (C.M.E.A., D.K.U., A. Poduri), Anesthesiology, Critical Care and Pain Medicine (L.C., C.B.B.), Physical and Occupational Therapy (A. Pasternak, E.R.B., K.A.P.), and Pharmacy (S.C., A. Patterson), the Institutional Centers for Clinical and Translational Research (A.K., B.B., L.W.), and the Manton Center for Orphan Disease Research (C.A.G., P.B.A., A.H.B.), Boston Children's Hospital (A.K., A.T., M.A., L.M.P., K.D., B.B., L.W., B.D.G., B.L.R., A.B.), the Department of Biomedical Informatics (J.K., P.J.P.), Harvard Medical School (J.K., C.M.E.A., E.A.L., L.C., B.D.G., B.L.R., P.B.A., A.H.B., P.E.G., D.K.U., S.E.W., P.J.P., A. Patterson, A.B., O.B., C.B.B., T.W.Y.), and the Gene Therapy Program (A.B.), Boston Children's and Dana-Farber Cancer and Blood Disorders Center (A.K., B.B., L.W.), Boston, Charles River Laboratories, Wilmington (L.E.B.), and Broad Institute of MIT and Harvard (E.A.L., O.B., T.W.Y.), Cambridge - all in Massachusetts; Charles River Laboratories, Montreal (J.D.); University of Colorado School of Medicine, Aurora (A.L.); Pendergast Consulting, Washington, DC (M.K.P.); Goldkind Consulting, Potomac, MD (S.F.G.); the Department of Neurology Feinberg School of Medicine, Northwestern University, Chicago (N.R.B., K.F., I.S., J.R.M.); the Department of Neurology, University of Rochester Medical Center, Rochester, NY (E.F.A.); Brain Hz Consulting, Del Mar, CA (C.R.); Tyndall Consulting, Wake Forest, NC (K.T.); and Brammer Bio, Alachua, FL (R.O.S.).
Molecular diagnosis enabled the creation of milasen, a custom antisense oligonucleotide drug. This N-of-1 study showed milasen effectively reduced seizures in a rare neurodegenerative disease patient.
Area of Science:
- Genetics
- Neuroscience
- Pharmacology
Background:
- Rare diseases often lack targeted treatments despite advances in genome sequencing for diagnosis.
- Developing patient-specific therapies presents significant challenges in terms of speed and efficacy.
Observation:
- A rare, fatal neurodegenerative condition was diagnosed using genome sequencing.
- Initial experiments in patient-derived cell lines provided a foundation for drug development.
Findings:
- Milasen, a splice-modulating antisense oligonucleotide, was rationally designed and manufactured for an individual patient.
- An N-of-1 clinical study demonstrated milasen's safety and efficacy, with a reduction in seizures.
- The treatment was developed and administered within one year of initial patient contact.
Implications:
- This case presents a potential model for the rapid, personalized development of treatments for rare genetic disorders.
- Patient-customized therapies, like milasen, offer hope for conditions previously deemed untreatable.
- The successful N-of-1 study highlights the power of integrating molecular diagnostics with targeted therapeutic design.
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