This article was updated on 26th September 2017, in response to reader feedback, to clarify the important differences between total huntingtin removal in mice and partial reduction by
huntingtin lowering drugs.
The huntingtin lowering ASO trial is still in early safety stages, but the approach has shown promise so far.
Since the goal of
huntingtin lowering therapies like IONIS - HTTRx is to reduce the amount of the huntingtin protein in vulnerable brain cells, in theory this gives us a great way to tell whether the drug is doing what it's meant to do.
So, increasingly, you'll hear us call them «
huntingtin lowering» drugs.
However, we're excited and optimistic about
huntingtin lowering treatments, and WAVE's latest refinement looks like it could be a an exciting advance.
The current ASO trial in humans is
a huntingtin lowering, or gene silencing therapy, which works to disable both copies of the HD gene in short bursts.
It would be a form of «
huntingtin lowering» or «gene silencing», but one that doesn't reply on DNA - like or RNA - like drugs, which are difficult to deliver to the brain.
This approach is being used by WAVE Life Sciences, a company working on developing allele - specific
huntingtin lowering drugs for HD.
After huge leaps forward in recent years, we're edging ever closer to human trials of
huntingtin lowering or «gene silencing» as a potential treatment for Huntington's Disease.
An exciting «
huntingtin lowering» trial is currently underway using a drug called an antisense oligonucleotide (ASO) to reduce the amount of huntingtin protein in brain cells.
Features a clinical trials roundup, an exclusive interview with Prof Sarah Tabrizi about the first trial of
a huntingtin lowering «gene silencing» drug, and a surprise for EHDN president Prof Bernhard Landwehrmeyer.
We're excited about this novel approach to
huntingtin lowering therapies, but these are early days and we've got a long way to go to show they're safe and effective in people.
One of the most exciting avenues of HD research is
huntingtin lowering (also known as gene silencing), which aims to reduce levels of the huntingtin protein in cells.
Ionis has built a sort of model that enables them to make predictions about the relationship between
huntingtin lowering in the spinal fluid and in brain tissues.
This suggests that
huntingtin lowering in brain tissue might be quite high.
Not exact matches
Being able to detect and measure the amount of mutant
huntingtin present in the nervous system will be a valuable way of seeing whether the gene - silencing drug is hitting its target and has the intended effect,
lowering the amount of disease causing mHTT protein.
2015 will see the start of the first human clinical trial of a gene silencing or
huntingtin -
lowering drug, which specifically aims to reduce production of mutant
huntingtin in the brains of HD patients.
The test, called a «single molecule counting assay», combines fluorescent antibodies with a laser detection chamber to count individual molecules of mutant
huntingtin with a very
low detection threshold.
In an announcement likely to stand as one of the biggest breakthroughs in Huntington's disease since the discovery of the HD gene in 1993, Ionis and Roche today announced that the first human trial of a
huntingtin -
lowering drug, IONIS - HTTRx, demonstrates that it reduces mutant
huntingtin in the nervous system, and is safe and well - tolerated.
If what you've read here about zinc finger technology reminds you of «gene silencing» or «
huntingtin -
lowering» methods for treating Huntington's disease, give yourself a gold star.
Most
huntingtin -
lowering attempts so far have tried to «shoot the messenger» rather than attacking the source of the message - the DNA itself.
First things first - the news that IONIS - HTTRx
lowers the mutant
huntingtin protein is great - but it is not a cure.
There are many ways of achieving the goal of
lowering mutant
huntingtin, expected to start new trials soon or already in early trials.
Huntingtin -
lowering drugs are made from molecules similar to DNA, the stuff that makes up our genes.
Later, maybe in early 2018, there may be a separate announcement about some of the more experimental results of the safety trial - things like whether HTTRx
lowered the
huntingtin level in the spinal fluid.
HDBuzz Editor - in - Chief Ed Wild is a consultant to WAVE Life Sciences on their
huntingtin -
lowering programme, and to Ionis Pharmaceuticals and Roche on theirs.
Some of these approaches to attack mutant
huntingtin also reduce levels of the normal protein, including the Ionis
huntingtin -
lowering drug.
Ionis» trial, led in partnership with Prof Sarah Tabrizi of University College London, was the first time a targeted
huntingtin -
lowering drug had been tested in humans.
Edited to clarify the difference between complete reduction of
huntingtin in the mouse experiments, as opposed to partial reduction by
huntingtin -
lowering drugs
Importantly, both studies suggest that we need to continue our current cautious approach when
lowering normal
huntingtin in human studies.
Current
huntingtin -
lowering drugs, called ASOs, are also given as individual doses separated by several weeks, with normal protein production expected to bounce back somewhat in between.
That's not what we expect when patients are given
huntingtin -
lowering drugs, which might produce around 50 - 75 % reductions in the mutant and healthy protein.
We will need to continue to use caution when removing or
lowering normal
huntingtin in human studies
The therapy we're most excited about for Huntington's disease is called
huntingtin -
lowering.
The safety data may come first, but information about whether treatment with HTTRx
lowered the level of
huntingtin protein in the spinal fluid — a much - anticipated «biomarker» outcome — may take a little longer to materialise.
That's much more dramatic than what happens in a
huntingtin -
lowering treatment trial.
Doing that
lowered levels of the protein for which the gene is a recipe: mutant
huntingtin.
In the
huntingtin -
lowering trial that is currently underway, the treatment is reversible, and participants are being carefully monitored for safety.
We know that
lowering the level of mutant
huntingtin protein in HD mouse models significantly improves symptoms reminiscent of HD, providing hope that similar treatments in people may be effective.
As the short - term administration periods for the
huntingtin -
lowering drug are extended, clinicians will continue to be watchful and to collect data that is essential to determine whether the treatment is safe and effective.