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. 2019 Dec 31;26:4. doi: 10.1186/s10020-019-0129-7

Table 1.

Different treatment strategies currently in use for conformational disorders

Treatment Strategies Description
Gene therapy Gene therapy involves replacing the mutant copy of the gene with a wild-type functional protein.
Gene editing CRISPR/Cas9 is a gene-editing strategy where only the mutated sequence of a mutant gene is edited and thereby corrected for proper function of the protein.
Gene correction in iPSCs Using specialized induced pluripotent stem cells (iPSCs), CRISPR/Cas9 editing allows the correction of the gene within iPSCs increasing effectiveness of the technique.
Modulator Therapies--using differing mechanisms of action- Modulators can be either potentiators, correctors [pharmacological chaperones & proteostasis regulators], stabilizers, or amplifiers.

Modulators are pharmaceutical agents that targets specific defects in the mutant protein and/or modulate the intracellular environment.

  • Modulators target protein errors that occur post-transcriptionally, such as during protein folding, anterograde trafficking and further assist protein function and signaling following protein expression.

    ○ Correctors improve intracellular processing of misfolded proteins and increase plasma membrane expression.

    ○ Potentiators and stabilizers help the misfolded protein once expressed. Combination therapies with different mechanisms of actions, show greater efficacy.

  • Proteostasis regulators improve the overall quality of the proteostasis network within a cell.

    ○ Regulators can be designed to increase the function and availability of molecular chaperones, and consequently promote protein folding and/or reduce misfolding.

    ○ Regulators targeting the ER quality control can enhance the elimination of non-native conformations of polypeptides.

Stem cell therapy Stem cell therapy is a tailored approach which is easy to proliferate and modify. It can further be coupled with CIRSPR/Cas9 and correct cells to a WT phenotype in the correct cell-line.
Antisense-oligonucleotide-mediated therapy Single-stranded synthetic RNA-like molecules known as antisense oligonucleotides (ASOs) selectively change gene expression.
Non-viral vectors Non-viral vectors have the ability to pack and deliver bulky DNA molecules with liposomal vectors.
mRNA-mediated therapy Wild-type nucleotide sequence is targeted to the cell and has the ability to encode wild-type protein.
Proteasome inhibitors Inhibition of proteasome, a unique proteolytic complex, prevents degradation of ubiquitinated proteins tagged for ERAD.