口服拼接调节器branaplam在亨廷顿病:一个2期随机对照试验
Beth Borowsky1, Harry Ramos2, Angelika Caputo3
1Novartis Pharmaceuticals Corp., East Hanover, NJ, USA. beth.borowsky@novartis.com.
Nature medicine
|January 6, 2026
概括
一个新的拼接调节器Branaplam是第一个降低亨廷顿突变型亨廷丁 (HTT) 的.
科学领域:
- 神经科学是一个神经科学.
- 遗传学 遗传学 是一个
- 药理学 药理学是指药理学的学科.
背景情况:
- 亨廷顿病 (HD) 是一种由亨廷 (HTT) 基因扩大突变引起的单一性神经退行性疾病.
- 降低突变HTT蛋白水平是HD的关键治疗策略.
- 布兰普拉姆是一种口服可用的HTT信使RNA拼接调节器,旨在降低HTT蛋白水平.
研究的目的:
- 评估branaplam在亨廷顿病患者中的安全性和有效性.
- 评估branaplam降低脑脊液 (CSF) 中突变HTT水平的能力.
- 通过使用临床前和临床数据,研究布拉纳普兰的潜在神经毒性作用.
主要方法:
- 一个随机的2b期研究 (VIBRANT-HD) 进行,其创新设计基于临床前数据.
- 有针对性的安全监测包括神经丝光链 (NfL) 测量和神经传导研究.
- 用分层队伍来早期检测潜在的神经毒性.
主要成果:
- 在最初的队列中,每周服用branaplam56毫克的参与者中有85.7%表现出外围神经病变的迹象.
- 与安慰剂相比,布兰帕拉姆是第一个显示CSF突变HTT水平降低的拼接调节器.
- 观察到高NfL水平,表明神经毒性,但在停止治疗后逆转.
结论:
- 由于与branaplam相关的外围神经病变的安全信号,VIBRANT-HD研究被提前终止.
- 尽管早期终止,branaplam成功降低了HD患者的CSF中的突变HTT水平.
- 需要进一步的研究来理解和减轻HTT拼接调节器的神经毒性潜力.
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