7 and 8. Molecular Therapies Flashcards

(45 cards)

1
Q

What type of defects can occur aberrant gene expression?

A

1) Defect in controlling region
2) Error in coding region
3) Known unknowns
- Trans-acting factors
- Modifying genes
- epigenetics

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2
Q

What therapy/intervention targets what stage of processing the code?

A

Transcription (DNA) = Gene therapy + Cell transplant

Transcription (pre-mRNA) = Conventional pharmaceuticals

Splicing (mature RNA) = Molecular therapy

Protein (translation) = Readthrough antibiotics + conventional pharmaceuticals

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3
Q

What are the two modes of treatment for inherited disorders?

A

Direct (molecular) treatments to address cause
- Mutation dependent

Indirect treatments (address impact of disease)
    - reduce inflammation etc
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4
Q

Do all diseases have a genetic component?

A

Basically yes

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5
Q

Is cystic fibrosis a monogenic inherited disease?

A

Yes

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6
Q

Does environment play a bigger role in monogenic or multiple gene diseases?

A

Polygenic diseases

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7
Q

What are some ways in which gene therapy works?

A

Replace defective genes

Deliver genes that cause destruction of cancer cells

Provide genes that impede tissue growth

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8
Q

What type of gene transfer therapy is available?

A

Somatic cell gene transfer

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9
Q

When did gene therapy begin?

A

1980s

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10
Q

How many people die in the US due to adverse drug reactions (ADR)?

A

100 000 deaths annually

  1. Stroke
  2. Heart disease
  3. Cancer
  4. ADR
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11
Q

How many people effected by rare diseases in Australia?

A

400 000

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12
Q

What is the difference between gene therapy and molecular therapies?

A

Gene therapy

  • Gene replacement
  • Gene repair

Molecular therapies

  • Modify gene output
  • Stop codon read-through
  • Use another gene
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13
Q

What are the first steps taken in any therapy?

A

1) Correct diagnosis
2) Identifying cause and mechanism
3) Rational design to replace/compensate/by - pass the problem
4) Can only be done if mutation is properly understood

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14
Q

What happens in a point mutation?

A

Single base is substituted, can result in any number of things happening to protein (truncated)

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15
Q

What occurs in a frameshift mutation?

A

A insertion of deletion of a number of nucleotides NOT divisible by three (e.g. 1) resulting in a shift in reading frame

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16
Q

What is an in-frame deletion?

A

Deletion of multiples of 3 codons

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17
Q

What are the potential molecular / genetic therapeutic approaches?

A

1) Replace missing or mutated genes
2) Repair faulty genes
3) Modify gene expression

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18
Q

How is gene expression modified?

A

1) Molecules that alter transcription
2) Alteration of pre mRNA splicing
3) Down regulate/destroy specific mRNAs
4) Enhance mRNA stability
5) Prevent transcription

Alter splicing
Down regulate
Enhance
Prevent

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19
Q

What is an antisense therapy?

A

Antisense transcripts occur naturally - contribute to cellular regulation

Synthetic antisense oligonucleotides (AOs) are used to Alter mRNA splicing
Degrade transcripts
Block translation

20
Q

How do synthetic anti-sense oligonucleotides in antisense therapies work?

A

Alter mRNA splicing
Degrade transcripts
Block translation

21
Q

How is mRNA splicing altered using anti-sense oligonucleotides?

A

Exons are skipped via splicing

Only really useful is shortened product is still functional

This is being used in Duchenne muscular dystrophy

22
Q

How are antisense sequences used to block translation?

A

Antisense translational blockade

Antisense sequences, target translation start sites

Examples are Neugene, Phosphorodiamidate morpholino oligomer (PMO)

Used to study zebrafish

23
Q

What diseases could be treated with translational blockade?

A

Bird flu
SARS
Ebola
Hep C

24
Q

How can transcript degradation be induced by AOs?

A

RNaseH - DNA antisense oligo annealed to RNA - induces RNaseH degradation of target RNA

RNA silencing

25
What does siRNA mean?
Small interfering or Silencing RNA
26
How does gene silencing work via siRNA?
~21 - 24 nucleotide double stranded RNA, induced degradation of mRNA:Dicer-RISK complex
27
What are two case studies associated with molecular therapies?
Duchenne muscular dystrophy | Spinal muscular atrophy
28
What are some issues associated with treating DMD?
``` Multi-system disorder Multiple isoforms Effects all muscle mass 2.4 megabase gene Many mutations 60% frameshifting mutations ```
29
What are the two types of muscular dystrophy and what is the severity of each?
DMD = fatal X-linked muscle wasting (1/3500 boys) - Frame shifting/nonsense mutation in dystrophin gene - Ultimate caridac and respiratory failure - Truncated protein BMD = milder allelic disorder - In fram deletion, dystrophin levels are > 3% normal - Large deletions may be associated with mild asymptomatic disease
30
What is the dystrophin associated complex?
Multiprotein complex including dystrophin
31
How much dystrophin do carriers of DMD begin with?
50% of muscle fibers Some dystrophin is better than none
32
What does MD prevent?
Reconstruction of muscle due to lack of dystrophin protein
33
What systems do MD effect?
CNS | Endocrine
34
What dystrophin isoforms are there?
Long - Skeletal, cardiac, smooth muscle, brain | Smaller - CNS, retina, kidney
35
How could DMD be repaired molecularly?
Improve muscle repair Put patch over gene lesion - AVI 4658
36
How is AVI 4658 treating DMD? (Eteplirsen)
nucelic acid analogue targeting dystrophin exon 51 Now in phase 2b
37
What is the main test to diagnose DMD?
6 minute walk test
38
What is eteplirsen a product of?
Sarepta therapeutics
39
What does SMA mean?
Spinal muscular atrophy
40
What causes SMA?
Loss of SMN1 on chromosome 5
41
What is SMN?
Survival motor neuron Loss of gene is incompatible with life
42
What is type 1 SMA caused by?
SMN1 deleted
43
What is SMA type 2 caused by?
Multiple SNM2 copies
44
What is the current treatment for SMA?
Antisense oligomers - alter pre-mRNA processing to generate BMD like mRNA and protein
45
What does BMD stand for?
Becker muscular dystrophy