Deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) are simple linear polymers that have been the subject of considerable research in the last two decades and have now moved into the realm of being stand-alone therapeutic agents. Much of this has stemmed from the appreciation that they carry out myriad functions that go beyond mere storage of genetic information and protein synthesis. Therapy with nucleic acids either uses unmodified DNA or RNA or closely related compounds. From both a development and regulatory perspective, they fall somewhere between small molecules and biologics. Several of these compounds are in clinical development and many have received regulatory approval for human use. This review addresses therapeutic uses of DNA based on antisense oligonucleotides, DNA aptamers and gene therapy; and therapeutic uses of RNA including micro RNAs, short interfering RNAs, ribozymes, RNA decoys and circular RNAs. With their specificity, functional diversity and limited toxicity, therapeutic nucleic acids hold enormous promise. However, challenges that need to be addressed include targeted delivery, mass production at low cost, sustaining efficacy and minimizing off-target toxicity. Technological developments will hold the key to this and help accelerate drug approvals in the years to come.
IntroductionDeoxyribonucleic acid (DNA) and ribonucleic acid (RNA) are simple linear polymers that consist of only four major subunits, yet these molecules carry out myriad functions both within the cell and in the laboratory [1]. Early assessment of nucleic acid function was rather narrow and restricted, but research in the past few decades has seen remarkable progress in developing nucleic acid-based therapeutics. The progress has covered diverse fields of research and a significant number of scientists and engineers are now involved in this area [2]. A series of pivotal discoveries in the last three decades has made this possible. First, a large body of work has obviously followed the decoding of the human genome that unlocked several molecular pathways that are important in disease. Secondly, several types of RNA with complex biological functions have been discovered in addition to messenger RNA (mRNA) and transfer RNA (tRNA) [1]. For example, two non-coding RNA types that were not considered essential but are now extremely relevant to therapeutics are the microRNA (miRNA) and the short interfering RNA (siRNA). Thirdly, the appreciation that RNAs can act as enzymes has led to the development of RNA analogues with useful or unusual properties. Of the analogues, the locked nucleic acids or LNAs have found therapeutic applications. In view of their polar nature, the cellular delivery of nucleic acids is poor relative to conventional low molecular weight drugs. The fourth major advance has been enhancing the bioavailability of nucleic acid-based drugs. None of these would have been possible without technological advances in DNA synthesis, including the de novo synthesis of increasingly longer DNA British Journal of Cli...