Wednesday, January 08, 2020

New molecular mechanism can reverse genetic defect responsible for Friedreich's ataxia

Scientists at Tufts University have identified a molecular mechanism that could reverse the genetic defect responsible for Friedreich's ataxia, a neurodegenerative disease that leaves its victims with difficulty walking, a loss of sensation in the arms and legs and impaired speech caused by degeneration of nerve tissue in the spinal cord.

The researchers report today in the Proceedings of the National Academy of Sciences that the genetic anomaly that causes the disease -- the multiple repetition of a three letter DNA sequence -- could potentially be reversed by enhancing a natural process that contracts the repetitive sequences in living tissue.

Friedreich's ataxia is a genetic disease caused by the presence of an expanded repetition of a three letter genetic sequence, GAA in the FXN gene, which encodes for frataxin, a protein required for proper function of the mitochondria -- the cell's "batteries" that generate the fuel to keep all other cell functions running.

Healthy people usually have 8 to 34 GAA repeats, carriers have 35 to 70 repeats, and individuals that exhibit disease symptoms have more than 70 -- and commonly have hundreds of repeats.

With more DNA repeats, it becomes increasingly difficult for the cells to "read" the FXN gene and produce the protein required by the mitochondria, which in turn cease to function properly. One in 40,000 individuals has this condition.

The DNA repeats literally gum up the works. They can also cause other mutations in the surrounding DNA, or make chromosomes extremely fragile, breaking into pieces, or rearranging themselves. If we can shrink the DNA repetition in tissues to levels found in healthy people, we might be able to stabilize the DNA and reduce the effects of disease."
Sergei Mirkin, professor and chair, Department of Biology, School of Arts & Sciences, Tufts University

It is known that in patients' tissues, the GAA repeats are unstable and continuously expand and contract. Understanding the mechanism of GAA repeat expansion and contraction -- especially contraction -- is important to developing this strategy for battling the currently incurable disease.
Numerous theories have been advanced as to how the DNA repeats contract, although the precise details of the mechanism remained largely unknown.

In order to pinpoint the actual mechanism, the authors of the study developed an experimental system in yeast (Saccharormyces cerevisiae) to quantitatively measure the effects of different interventions on contractions of DNA repeats, and found that contractions happened usually during the process of DNA replication, in the course of what is referred to as "lagging strand synthesis."

When the two strands of DNA are copied, one strand is replicated in a continuous manner, while the other must be assembled from smaller pieces stitched together.

This is the lagging strand, so named because its more complex synthesis limits the rate at which the DNA can be copied.

The Tufts researchers found that the contraction of repeats depends on the ability of the DNA repeat to form an unusual triple-helical DNA structure along the laggin strand.

The normal structure of DNA is a double helix consisting of two strands winding around each other. A triple helix, in contrast, consists of three strands wrapped in a helical twist.

As the replication machinery moves across the lagging strand, it cannot easily bypass a triplex formed by the repeat.

When the replication machinery jumps over this triple helix hurdle, the copied DNA strand ends up with fewer GAA repeats.

"While these results were uncovered in a yeast model, they do provide us with a clue into the mechanism of DNA repeat instability in Friedreich's ataxia," said Alexandra Khristich, graduate student in Mirkin's lab and first author of the study.

"I hope that our discovery would become a starting point for the potential development of therapeutic strategies that tip the balance toward DNA repeat contraction in patient tissues."



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Tuesday, August 06, 2019

New Tech Helps At-Risk Couples Ensure Their Kids Don't Inherit Their Illnesses

To be born with the right genes used to be a blessing. But thanks to technological advances, it is possible today for at-risk couples undergoing in-vitro fertilisation (IVF) to have their embryos subjected to genetic screening before being implanted in the womb. This way, the couple will know the child doesn’t have any genetic or chromosomal defects.

A Dr. shared a case study. Two partners – both carrying the genes for thalassemia, a life-limiting blood disorder – had tried to have a baby thrice but failed. The first two pregnancies had to be medically terminated after doctors diagnosed the foetuses with thalassemia and the third was a miscarriage.

Doctors then advised the couple to undergo IVF followed by pre-implantation genetic diagnosis (PGD). Two IVF cycles later, they had six embryos at the day-5 stage. An embryologist performed biopsies and sent the cell samples to a genetic lab to be analysed; the embryos were kept frozen. When the results arrived, they showed three embryos were ‘normal’ and three had inherited the genes for thalassemia. So doctors transferred the ‘normal’ embryos to the womb. Later, an amniocentesis confirmed that the child did not have thalassemia, and the mother delivered a healthy baby.

A diagram illustrating how IVF works: After ovulation, the egg is collected from the woman's reproductive organs, fused with sperm and the resulting fertilised ovum is reinserted into the uterus. Image: Manu5/Wikimedia Commons, CC BY-SA 4.0

A diagram illustrating how IVF works: After ovulation, the egg is collected from the woman’s reproductive organs, fused with sperm and the resulting fertilised ovum is reinserted into the uterus. 


“Any additional embryos that are free of genetic problems are kept frozen for possible use later while embryos with problematic genes are destroyed,” the Dr.  said.

“PGD enables identification of genetic defects in the early embryo before the embryo is transferred to the uterus in an IVF program,” the head of the department of reproductive medicine explained.


The founder and scientific director  said that, “according to the Human Fertilisation and Embryology Authority, UK, PGD has been approved for testing over 600 genetic conditions.”


There are “numerous tests,” in Dr.’s words, that enable PGD. For example, scientists developed PGT-M – pre-implantation genetic testing for monogenic defects – to prevent the birth of a baby with genetic defects “when the previous baby was affected” or when the parents have “a history of inheritable disease in the family.”

Another kind is PGT-A, where the ‘A’ stands for aneuploidy, a condition where the body’s cells don’t have the normal number of chromosomes, 46. This gives rise to chromosomal disorders like Down syndrome. In PGT-A, embryos from parents presumed to be ‘chromosomally normal’ are screened to check whether the cells in each embryo contain 46 chromosomes. Such screening is called pre-genetic screening (PGS).

“At present, PGS and PGD are the only options available to parents trying to avoid the risk of having a child affected with a genetic disease, prior to implantation,” Dr. added.

PGD has been gaining traction of late. “Screening the embryo for possible life-threatening and debilitating genetic diseases before transfer changes reproductive options for families at risk,” the Dr.  told. “In some cases, further testing is needed during pregnancy to ascertain if a genetic factor is still possible.”

But “overall, PGD has been able to diagnose genetic defects with approximately 98% accuracy,” she added.

This is the result of major advancements in the last three decades, such as being able to visualise specific chromosomes using fluorescence in situ hybridisation, to produce thousands of copies of a DNA fragment using the polymerase chain reaction, and to profile genomes rapidly using next-gen sequencing (NGS).

This isn’t to say the procedure is entirely free of issues. For example, according to a review published by the American Society for Reproductive Medicine (ASRM) in 2017, IVF embryos sometimes have a condition called mosaicism – where all cells in the embryos don’t have identical sets of chromosomes. When these abnormal cells proliferate, it could result in a miscarriage or severe birth defects.

However, Dr. said, “Techniques like NGS have allowed for very high-fold coverage,” allowing scientists to detect “even low levels of mosaic mutations” and ensure only the healthiest embryos are transferred. In general, according to the review, NGS can eliminate mosaic cells when they make up fewer than a fifth of all cells in the embryo but fail when the extent of mosaicism crosses 50%. In the latter case, the embryo is deemed aneuploid and discarded.


According to Dr., the most frequently diagnosed disorders include those of blood and muscles, and other rare conditions such as cystic fibrosis, beta thalassemia, sickle-cell disease, spinal muscular atrophy, myotonic dystrophy, haemophilia A and Duchenne muscular dystrophy.


Since the requisite testing facilities aren’t widely available in India, results can take up to three weeks to arrive. But this hasn’t put people off from opting for it, especially since the procedure seems safe. According to the Centre for Advanced Reproductive Services, Connecticut, there has thus far been no increase in the rate of congenital abnormalities or pregnancy complications due to embryo biopsies.
Nonetheless, Dr Natarajamani hopes that non-invasive techniques will replace biopsies soon, given the inescapable risk the latter procedure carries in some cases.


Then there are the potential ethical issues. However, the Dr. is quick to defend PGD and draws a line between PGD and PGS as well as other, more morally fraught practices.


“PGD is clearly and absolutely indicated in certain circumstances, like in couples with a previous child with abnormalities, with a family history of abnormalities, etc.,” he said. “The debate is only about routine screening of all embryos, as in PGS, before embryo transfer or when [the technique] is used to identify the sex of the embryo.”


In his telling, the doctors’ decisions aren’t arbitrary but are guided by the recommendations of bodies like the ethics committee of the ASRM. For example, in an opinion published last year, entitled ‘Disclosure of sex when incidentally revealed as part of … PGT’, this committee reached the following conclusion:


“When patients undergo [assisted reproductive therapy] and PGT for medical reasons, embryo sex could be a common secondary finding. Patients should be informed of this possibility before undergoing PGT. Patients have the right to information about an embryo’s sex, as well as the right to request not to be given this information. Clinics may have policies not to take an embryo’s sex into account in making transfer decisions. Clinics must have nondiscrimination policies regarding embryo transfer when the sex of the embryo is known. Patients should be informed about these policies.”


Indeed, all genetic labs in India are required to follow guidelines set by the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition Of Sex Selection) Act 2003.


The Dr. has no doubts: “PGD is an amazing technology and the application of next-gen sequencing [has been] a game-changer. It will reduce the incidence of genetic diseases and complications [associated with] multiple births.” She added that many IVF centres around the world have also been able to achieve “fantastic birth rates” after transferring “only one genetically normal embryo” into the womb.


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Tuesday, February 19, 2019

Gene therapy first to halt most common cause of blindness

Researchers claim to have carried out the world's first gene therapy operation to halt age-related macular degeneration (AMD), the leading cause of untreatable blindness in the developed world.

Dry AMD is a slow deterioration of the cells of the macula.

It affects the central part of a patient's vision with gaps or 'smudges', making everyday activities like reading and recognising faces difficult.

If successful, the treatment could have a beneficial impact of patients' quality of life and their ability to remain independent.


"A genetic treatment administered early on to preserve the vision in patients who would otherwise lose their sight would be a tremendous breakthrough and certainly something I hope to see in the near future," said a Prof.

The first person to undergo the procedure was  a lady, said  the Prof., who carried out the procedure.

Like many people with AMD,she has the condition in both eyes, but it is more advanced in her left eye.

As is typical with this condition, the central vision in her left eye has deteriorated and is very hazy, although her peripheral vision is better. 

The operation involves detaching the retina and injecting a solution containing a virus underneath.

The virus contains a modified DNA sequence, which infects cells, called the retinal pigment epithelium (RPE), and corrects a genetic defect that causes AMD.

Ideally if successful, gene therapy would only need to be performed once, as the effects are thought to be long-lasting.

A key factor in AMD is the complement system, a system of proteins in our immune system that fights bacteria.

In macular degeneration, these proteins are over-active and start to attack the retinal cells, in a similar way to how they would attack bacteria.

"We are harnessing the power of the virus, a naturally occurring organism, to deliver the DNA into the patient's cells," the Prof. said.

"When the virus opens up inside the retinal cell it releases the DNA of the gene we have cloned, and the cell starts making a protein that we think can modify the disease, correcting the imbalance of the inflammation caused by the complement system," he said.

"The idea of this gene therapy is to 'deactivate' the complement system, but at a very specific point at the back of the eye, so the patient would otherwise be unaffected by it, and we hope that in future it will slow down the progression of macular degeneration," he said .

"We have a better understanding now on the relationship between the complement system and the AMD disease which lead us to the discovery that restoring the balance of a hyperactive complement system could be a potential therapeutic approach in dry AMD," he said.

The aim of the therapy is to halt the progress of the condition and preserve what vision patients have remaining.

It is hoped that gene therapy can be used in the future on patients with early AMD and so halt the disease before their vision has started to deteriorate.

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Monday, December 11, 2017

New drug could offer first treatment for irreversible Huntington's disease

The unstoppable progression of the inherited disease Huntington’s could be slowed or even halted by an experimental new treatment which has proved “enormously successful” in early patient trials.

A trial led by researchers  has demonstrated for the first time that a treatment is capable of suppressing the genetic defect which causes toxic proteins to build up in the brain.

Huntington's sufferers currently face the deterioration of their motor skills, memory and eventually death.

Patients ultimately die from complications including pneumonia and heart failure.

Currently treatments only exist for the symptoms of Huntington’s, which usually begin to appear between the ages of 30 and 50, leading to their gradual decline over the next 10 to 25 years.

Huntington’s sufferers carry a mutation in the Huntington gene, which results in the production of a toxic form of the Huntington protein that attacks the neurons making up the brain and nervous system.

The trial, involving 46 patients with the disease, saw a new experimental drug injected into the spinal fluid to silence the defective section of the genetic code which produces this toxic protein.

Patients were from different countries and roughly a quarter were given a placebo treatment.
 
The participants in the trial saw a drop in the levels of Huntington in the nervous system and, crucially, the drug appeared to be safe without harmful side-effects for patients.

Roughly 10,000 people in the UK have Huntington's, and around 25,000 people have inherited a gene that means they are at risk of developing it later in life.

The trial’s lead investigators, a professor of clinical neurology said: "The results of this trial are of ground-breaking importance for Huntington's disease patients and families.

“For the first time, a drug has lowered the level of the toxic disease-causing protein in the nervous system, and the drug was safe and well tolerated.

“The key now is to move quickly to a larger trial to test whether the drug slows disease progression".
 
“We are encouraged by the performance of IONIS-HTTRx in the clinical study,” said a Dr.

He added that the treatment “substantially exceeded our expectations and we were equally encouraged by the safety profile of the drug".

A Dr.  said: “This is a potential game-changer, not only for Huntington's disease patients but also for genomic medicine in general.

"Though more work needs to be done, if gene silencing lives up to this promise we could be on the brink of some of the personalised treatments that patients with severe genetic diseases need so badly.
"But this will also raise further questions for society and for policy-makers about how best to use such a powerful technique.”


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