Progress in understanding the genetic basis and pathophysiology of spinal muscular atrophy (SMA), along with continuous efforts in finding a way to increase survival motor neuron (SMN) protein levels have resulted in several strategies that have been proposed as potential directions for efficient drug development. Here we provide an overview on the current status of the following approaches: 1) activation of SMN2 gene and increasing full length SMN2 transcript level, 2) modulating SMN2 splicing, 3) stabilizing SMN mRNA and SMN protein, 4) development of neurotrophic, neuroprotective and anabolic compounds and 5) stem cell and gene therapy. The new preclinical advances warrant a cautious optimism for emergence of an effective treatment in the very near future. Unfortunately, studies indicate that the short half-life of sodium butyrate in human serum does not recommend its use in clinical trials [30].
KeywordsA derivative of sodium butyrate -sodium-4-phenyl-butyrate, also known as phenylbutyrate (PB), was also shown to increase SMN transcript expression, SMN protein and gem counts in fibroblast cells derived from SMA patients [31,32]. It has a well-known pharmacokinetic and safety profile and good penetration into the central nervous system, and so appeared to be a promising candidate for the treatment of SMA. In a small uncontrolled trial an improvement of motor function in 10 SMA type II patients was found after nine weeks of treatment with oral PB, with no apparent major side effects [33]. However, a placebo-controlled trial of intermittent treatment over 13 weeks suggested that there was no improvement in functional scores under the conditions used [34,35]. A phase I/II study initiated by the US
Other approachesThe base of treatment in SMA is still supportive care, which requires multidisciplinary medical care [21]. Due to intensive supportive care, such as ventilation, the use of mechanical insufflation-exsufflation device and tube feeding, the survival of patients with SMA type I has significantly increased in recent years [22]. Since forced exercise was found to be of benefit in ALS mouse models [147,148] it was recently studied in SMA mice. Type II SMA mice developed by were used in the interesting study of Grondard et al. [68].The mice were subjected to a training protocol of forced run on a wheel or no training. [1] Botta A., Tacconelli A., Bagni I., Giardina E., Bonifazi E., Pietropolli A., Neurology, 2007Neurology, , 69, 1931Neurology, -1936 [23] Wang C. H., Finkel R. S., Bertini E. S., Schroth M., Simonds A., Wong B.,