GENE THERAPY IN DUCHENNE MUSCULAR DYSTROPHY: ADVANCES, CHALLENGES AND PERSPECTIVES
PDF (Portuguese)

Keywords

Gene Therapy; Duchenne Muscular Dystrophy; Viral Vectors; Genetic Mutations; Immunogenicity, CRISPR-Cas9, exon-skipping.

How to Cite

Cintia Thomaz da Silva Amorim, M. ., Ramos de Paula, F. ., & César Ferreira , T. . (2026). GENE THERAPY IN DUCHENNE MUSCULAR DYSTROPHY: ADVANCES, CHALLENGES AND PERSPECTIVES. Advanced Studies on Health and Nature, 20. https://doi.org/10.51249/easn20.2026.2789

Abstract

Introduction: Duchenne Muscular Dystrophy (DMD) is a progressive genetic disease characterized by muscle degeneration due to the absence of the dystrophin protein. This study conducts a literature review focusing on advances in gene therapy for the treatment of DMD, addressing four main areas: the efficacy of various viral vectors, genetic variants of the DMD gene, immunogenicity risks, and emerging technologies. Methodology: Using a qualitative approach, articles and clinical studies on techniques such as exon-skipping, CRISPR-Cas9, as well as viral vector-based therapies (such as AAV) and the use of antisense oligonucleotides (AONs) were analyzed. Theoretical Framework: The review highlights efficacy results, technical challenges, such as the immune response to vectors and limitations in gene delivery, as well as potential and obstacles, including variability in results, the need for repeated administrations, and issues related to cost and accessibility. Final Considerations: Despite the great potential of gene therapy for DMD, there are still challenges to be overcome, both technical and social. This article provides a comprehensive overview of the current state of research and reinforces the importance of the continued development and improvement of these therapeutic approaches.

PDF (Portuguese)

References

AARTSMA-RUS, A. et al. Theoretical applicability of antisense-mediated exon skipping for Duchenne muscular dystrophy mutations. Human Mutation, v. 30, n. 3, p. 293–299, 2009.

AARTSMA-RUS, A.; KRIEG, A. M. FDA Approves Eteplirsen for Duchenne Muscular Dystrophy: The Next Chapter in the Eteplirsen Saga. Nucleic Acid Therapeutics, v. 27, n. 1, p. 1–3, 2017.

ADAMS, R. D.; VICTOR, M. Princípios de neurologia. 6. ed. Rio de Janeiro: Guanabara Koogan, 1996.

ANVISA. Agência Nacional de Vigilância Sanitária. Medicamento de terapia gênica Elevidys® é registrado no Brasil. Brasília: Anvisa, 2024. Disponível em: https://www.gov.br/anvisa.

ARECHAVALA-GOMEZA, V.; LEE, J.; JONES, P. L.; et al. Immortalized muscle cell model to assess the efficacy of exon skipping in vitro. Methods in Molecular Biology, [S.l.], v. 1687, p. 47–57, 2018. DOI: https://doi.org/10.1007/978-1-4939-7374-3_4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/29035327/. Acesso em: 30 jun. 2025.

BEHRMAN, R. E.; KLIEGMAN, R. M.; JENSON, H. B. Tratado de pediatria. 16. ed. Rio de Janeiro: Guanabara Koogan, 2002.

BRADLEY, D.; PARSONS, E. Newborn screening for Duchenne muscular dystrophy. Semin Neonatol, v. 3, p. 27-34, 1998.

BUSHBY, K. M.; HILL, A.; STEELE, J. G. Failure of early diagnosis in symptomatic Duchenne muscular dystrophy. Lancet, v. 353, p. 55-78, 1999.

BUSHBY, K. et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management. Lancet Neurol, v. 9, p. 77-93, 2010.

CALCEDO, R. et al. Worldwide epidemiology of neutralizing antibodies to adeno-associated viruses. Journal of Infectious Diseases, v. 199, n. 3, p. 381-390, 2009.

CLINICALTRIALS.GOV. Search results for Duchenne muscular dystrophy and gene therapy. U.S. National Library of Medicine, 2024. Disponível em: https://clinicaltrials.gov.

DOUGLAS, A. G. L.; WOOD, M. J. A. Splicing therapy for neuromuscular disease. Briefings in Functional Genomics, v. 10, n. 3, p. 151-164, 2011.

DROUSIOTOU, A. et al. Neonatal screening for Duchenne muscular dystrophy. Genet Test, v. 2, p. 55-60, 1998.

DOUDNA, J. A.; CHARPENTIER, E. The new frontier of genome engineering with CRISPR-Cas9. Science, v. 346, n. 6213, p. 1258096, 2014.

ELANGKOVAN, N.; DICKSON, G. Gene therapy for Duchenne muscular dystrophy. Curr Opin Pharmacol, v. 7, n. 3, p. 326-331, 2007.

ELANGKOVAN, N.; DICKSON, G. Emerging gene therapies for muscular dystrophies. Expert Opin Biol Ther, v. 21, n. 9, p. 1191-1202, 2021.

EMERY, A. E. Population frequencies of inherited neuromuscular diseases—a world survey. Neuromuscul Disord, v. 1, p. 19-29, 1991.

EMERY, A. E. Neuromuscular disorders: clinical and molecular genetics. 3. ed. Oxford: Oxford University Press, 2002.

FALZARANO, M. S. et al. Duchenne muscular dystrophy: from diagnosis to therapy. Molecules, v. 20, n. 10, p. 18168-18184, 2015.

FDA – U.S. Food and Drug Administration. FDA grants accelerated approval to first drug for Duchenne muscular dystrophy. 2016. Disponível em: https://www.fda.gov/news-events/press-announcements.

FDA – U.S. Food and Drug Administration. FDA approves Vyondys 53 for Duchenne muscular dystrophy. 2019. Disponível em: https://www.fda.gov/news-events/press-announcements.

FDA. U.S. Food and Drug Administration. FDA approves first gene therapy for Duchenne muscular dystrophy. 2023. Disponível em: https://www.fda.gov.

FRANTZ, A. Advances in muscle regeneration. J Cell Biol, v. 222, n. 5, p. e202302021, 2023.

GONZÁLES FERNANDEZ, M. et al. New perspectives in Duchenne muscular dystrophy. Neurology International, v. 12, n. 2, p. 50-61, 2020.

GOWERS, W. R. A lecture on pseudo-hypertrophic muscular paralysis. British Medical Journal, v. 1, p. 591-593, 1879.

GOWERS, W. R. Manual of diseases of the nervous system. London: Churchill, 1880.

HOFFMAN, E. P.; BROWN, R. H.; KUNKEL, L. M. Dystrophin: the protein product of the Duchenne muscular dystrophy locus. Cell, v. 51, p. 919-928, 1987.

HSU, P. D.; LANDER, E. S.; ZHANG, F. Development and applications of CRISPR-Cas9 for genome engineering. Cell, v. 157, n. 6, p. 1262–1278, 2014.

JEPPESEN, J. et al. The Duchenne muscular dystrophy population in Denmark, 1977–2001. Neuromuscul Disord, v. 13, p. 804-812, 2003.

JINEK, M. et al. A programmable dual-RNA–guided DNA endonuclease in adaptive bacterial immunity. Science, v. 337, n. 6096, p. 816–821, 2012.

JOHNSON, L. et al. Advances in DMD treatment. Muscle Nerve, v. 57, n. 4, p. 497-507, 2018.

JONES, R.; BROWN, T. Novel therapies for Duchenne muscular dystrophy. Neurol Clin Pract, v. 13, n. 1, p. 45-53, 2023.

LACOMIS, D. The utility of muscle biopsy. Curr Neurol Neurosci Rep, v. 1, p. 81-86, 2001. LEVY, R. J. Advances in neuromuscular diseases. Pediatrics, v. 84, p. 18-26, 1989.

LIM, K. R. Q.; MARUYAMA, R.; YOKOTA, T. Eteplirsen in the treatment of Duchenne muscular dystrophy. Drug Design, Development and Therapy, v. 11, p. 533–545, 2017.

MENDELL, J. R. et al. Gene therapy for muscular dystrophy: progress and challenges. Nat Rev Neurol, v. 6, p. 353-364, 2010.

MENDELL, J. R. et al. Gene therapy for Duchenne muscular dystrophy: safety and efficacy of delandistrogene moxeparvovec. New England Journal of Medicine, v. 388, n. 6, p. 545–558, 2023.

MOXLEY, R. T. III et al. Practice parameter: corticosteroid treatment of Duchenne dystrophy. Neurology, v. 64, p. 13-20, 2005.

MUNTONI, F.; WELLS, D. Genetic treatments in muscular dystrophies. Curr Opin Neurol, v. 20, p. 590-594, 2007.

MUNTONI, F. et al. Dystrophin and mutations: one gene, several proteins, multiple phenotypes. Lancet Neurol, v. 2, p. 731-740, 2003.

NELSON, C. E. et al. In vivo genome editing improves muscle function in a mouse model of Duchenne muscular dystrophy. Science, v. 351, n. 6271, p. 403–407, 2016.

NICHOLSON, L. V. B. et al. An integrated study of 100 patients with Xp21 linked muscular dystrophy: clinical, biochemical, and genetic data. Journal of Medical Genetics, v. 30, n. 9, p. 728-736, 1993.

PANE, M. et al. Efficacy and safety of Givinostat in boys with Duchenne muscular dystrophy: a randomized, double-blind, placebo-controlled trial. Lancet Neurology, v. 23, n. 2, p. 112–121, 2024.

ORGANIZAÇÃO MUNDIAL DA SAÚDE. Relatório mundial sobre doenças neuromusculares. Genebra: OMS, 2024.

PRIOR, T. W.; BRIDGEMAN, S. J. Experience and strategy for molecular testing of Duchenne muscular dystrophy. J Mol Diagn, v. 7, p. 317-326, 2005.

RAO, V. Koneti . et al. Advances in gene therapy for neuromuscular disorders. Mol Ther, v. 32, p. 123-135, 2024.

RICHARDS, C. S. et al. Skewed X inactivation in a female MZ twin results in Duchenne muscular dystrophy. Am J Hum Genet, v. 46, p. 672-681, 1990.

TOWBIN, J. A. The role of cytoskeletal proteins in cardiomyopathies. Curr Opin Cell Biol, v. 10, p. 131-139, 1998.

WALTON, J. N. Disorders of voluntary muscle. 5. ed. Edinburgh: Churchill Livingstone, 1988.

WANG, Z. et al. Adeno-associated virus serotype 9 efficiently transduces murine neonatal cardiomyocytes in vivo. Hum Gene Ther, v. 29, n. 1, p. 30-40, 2018.

WELLS, D. J. Gene therapy progress and prospects: gene therapy for muscular dystrophies. Gene Ther, v. 11, p. 1244-1249, 2004.