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Onasemnogene Abeparvovec: First Global Approval
Abstract
Onasemnogene abeparvovec (onasemnogene abeparvovec-xioi; formerly AVXS-101; ZOLGENSMA ® ) is an adeno-associated viral vector-based gene therapy designed to deliver a functional copy of the human survival motor neuron (SMN) gene to the motor neuron cells of patients with spinal muscular atrophy (SMA). It has been developed by AveXis, a Novartis company, and was approved in May 2019 in the USA for the treatment of paediatric patients aged 14 vector genomes per kg of bodyweight, administered as a single intravenous infusion over 60 min. Regulatory assessments for this formulation of onasemnogene abeparvovec are underway in the EU and Japan; an intrathecal formulation is currently undergoing clinical development in the USA. This article summarizes the milestones in the development of onasemnogene abeparvovec leading to this first approval for the treatment of paediatric patients aged < 2 years with SMA and bi-allelic mutations in SMN1.
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“In 2019, Onasemnogene Abeparvovec was commercialized under the brand name of Zolgensma to treat children with the lethal motor neuron disease Spinal Muscular Atrophy (SMA) [89].”
From Circumventing the packaging limit of AAV-mediated gene replacement therapy for neurological disorders (2022) · cites this paper as [89]
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“Molec This is an open access article under the CC BY-NC-N has approved a therapeutic approach based on the stable replacement of SMN1 using viral vectors, called onasemnogene abeparvovec (Zolgensma).(9,10)”
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“This is the case of onasemnogene abeparvovec (Zolgensma®), which, if administered early in life seems to cure spinal muscular atrophy (Hoy, 2019).”
BackgroundBosio, C. G. P., Bettiol, V. L., Alencar‐Silva, T., Franco, O. L., Pogue, R. E., Carvalho, J. L., & Felipe, M. S. S. (2021) · Clinical Therapeutics · doi:10.1016/j.clinthera.2021.02.006 · Cited by 39
Brooks, P., Ottinger, E., Portero, D., Lomash, R. M., Alimardanov, A., Terse, P., Xu, X., Chandler, R., Hauserman, J., Esposito, E., et al. (2020) · Human Gene Therapy · doi:10.1089/hum.2020.259 · Cited by 33
“Food and Drug Administration (FDA) has now approved gene therapy products for treating an RPE65 mutation-associated retinal disease, Leber congenital amaurosis,(3) and a neurodegenerative disease, spinal muscular atrophy.(4)”
BackgroundZappa, G., LoMauro, A., Baranello, G., Cavallo, E., Corti, P., Mastella, C., & Costantino, M. A. (2021) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-021-09355-4 · Cited by 36
Adeno-Associated Virus (AAV-DJ)—Cryo-EM Structure at 1.56 Å Resolution
Xie, Q., Yoshioka, C., & Chapman, M. S. (2020) · Viruses · doi:10.3390/v12101194 · Cited by 30
“Three decades of development have culminated in the use of recombinant forms as vectors for the first FDA-approved in vivo gene therapies of genetic diseases, most notably in 2019 for a treatment of spinal muscular atrophy (SMA) [17,18].”
BackgroundUpdated review of therapeutic strategies for Charcot-Marie-Tooth disease and related neuropathies
Pisciotta, C., Saveri, P., & Pareyson, D. (2021) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2021.1935242 · Cited by 34
“This is also true for repeat gene silencing approaches, like those with ASOs and siRNAs, as for ATTRv and SMA, which however are lethal diseases as compared to most CMT forms which do not shorten the life span.”
BackgroundInfluentialEfficacy of risdiplam in spinal muscular atrophy: A systematic review and meta‐analysis
Pascual-Morena, C., Martínez-Vizcaíno, V., Cavero-Redondo, I., Martínez-García, I., Moreno-Herráiz, N., Álvarez-Bueno, C., & Saz-Lara, A. (2023) · Pharmacotherapy · doi:10.1002/phar.2866 · Cited by 28
Kok, C., Tsurusaki, S., Cabanes‐Creus, M., Igoor, S., Rao, R., Skelton, R. J. P., Liao, S. H. Y., Ginn, S. L., Knight, M., Scott, S., et al. (2023) · Molecular Therapy — Methods & Clinical Development · doi:10.1016/j.omtm.2023.08.010 · Cited by 32
Genome Editing for CNS Disorders
Duarte, F. T., & Déglon, N. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.579062 · Cited by 36
“, 2017), and spinal muscular atrophy (SMA) with Zolgensma (a rAAV9 encoding the survival motor neuron 1 protein; Hoy, 2019) provide examples of approved products.”
BackgroundAartsma-Rus, A. M., van Roon‐Mom, W., Lauffer, M. C., Siezen, C. L. E., Duijndam, B., Roo, T. C.-D., Schüle, R., Synofzik, M., & Graeßner, H. (2023) · RNA · doi:10.1261/rna.079540.122 · Cited by 32
Gene Transfer Therapy for Neurodevelopmental Disorders
Özlü, C., Bailey, R. M., Sinnett, S. E., & Goodspeed, K. (2021) · Developmental Neuroscience · doi:10.1159/000515434 · Cited by 31
Anti-ageing gene therapy: Not so far away?
Vaiserman, A. M., FALCO, E. D., Koliada, A. K., Maslova, O., & Balistreri, C. R. (2019) · Ageing Research Reviews · doi:10.1016/j.arr.2019.100977 · Cited by 33
Harkins, A. L., Ambegaokar, P. P., & Keeler, A. M. (2024) · Neurotherapeutics · doi:10.1016/j.neurot.2024.e00435 · Cited by 36
Battling Neurodegenerative Diseases with Adeno-Associated Virus-Based Approaches
Mijanović, O., Branković, A., Borovjagin, A. V., Butnaru, D. V., Bezrukov, E. A., Sukhanov, R. B., Shpichka, A. I., Timashev, P. S., & Ulasov, I. V. (2020) · Viruses · doi:10.3390/v12040460 · Cited by 32
“In contrast to the majority of viral vectors utilized for gene therapy interventions, AAV-based vectors exhibit the highest potential and success rate in the treatment of several monogenic diseases, as demonstrated by clinical trials [64,65].”
BackgroundVillalón, E., Kline, R., Smith, C. E., Lorson, Z. C., Osman, E. Y., O’Day, S., Murray, L. M., & Lorson, C. L. (2019) · Human Molecular Genetics · doi:10.1093/hmg/ddz188 · Cited by 31
“The most recent FDA approved therapeutic, Zolgensma, in contrast, employs a gene replacement approach in order to restore SMN expression (9).”
BackgroundConsiderations for Systemic Use of Gene Therapy
Byrne, B. J., Corti, M., & Muntoni, F. (2021) · Molecular Therapy · doi:10.1016/j.ymthe.2021.01.016 · Cited by 23
Vandamme, C., Xicluna, R., Hesnard, L., Devaux, M., Jaulin, N., Guilbaud, M., Le Duff, J., Couzinié, C., Moullier, P., Saulquin, X., et al. (2020) · Frontiers in Immunology · doi:10.3389/fimmu.2019.03110 · Cited by 23
Recent Progress in Gene-Targeting Therapies for Spinal Muscular Atrophy: Promises and Challenges
Haque, U. S., & Yokota, T. (2024) · Genes · doi:10.3390/genes15080999 · Cited by 27
“Two other patients had asymptomatic AST and ALT elevations that resolved without intervention [81,82].”
BackgroundInfluentialCurrent non-invasive strategies for brain drug delivery: overcoming blood–brain barrier transport
Zheng, X., Yang, J., Hou, Y., Fang, Y., Wu, K., Song, Y., Liu, K., & Zhu, J. (2023) · Molecular Biology Reports · doi:10.1007/s11033-023-08968-3 · Cited by 27
“The first successful AAV-based gene therapy for a CNS disorder (NCT03955679) is onasemnogene abe-parvovec (Zolgensma) approved for the treatment of paediatric patients aged 2 years with spinal muscular atrophy (SMA) by FDA [54].”
Thimm, A., Brakemeier, S., Kizina, K., Rosales, J. M., Stolte, B., Totzeck, A., Deuschl, C., Kleinschnitz, C., & Hagenacker, T. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2021.812063 · Cited by 28
Adeno-associated virus therapies: Pioneering solutions for human genetic diseases
Liu, D., Tian, L., Liu, L., Che, X., Li, X., Liu, C., & Wu, G. (2024) · Cytokine & Growth Factor Reviews · doi:10.1016/j.cytogfr.2024.09.003 · Cited by 29
Hidden regulators: the emerging roles of lncRNAs in brain development and disease
Alammari, F., Al-Hujaily, E. M., Alshareeda, A. T., Albarakati, N., & Al-Sowayan, B. S. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1392688 · Cited by 29
“Moreover, another AAV-based therapy targeting SMN gene, called Onasemnogene abeparvovec, is the first gene therapy for SMA approved in the United States and proves that AAV methods are effective in treating neurological diseases (Hoy, 2019).”
BackgroundGene therapy in pediatrics – Clinical studies and approved drugs (as of 2023)
Gol, T. M., Zahedipour, F., Trosien, P., Ureña-Bailén, G., Kim, M., Antony, J. S., & Mezger, M. (2024) · Life Sciences · doi:10.1016/j.lfs.2024.122685 · Cited by 30
Yang, D., Ruan, Y., & Chen, Y. (2023) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.16340 · Cited by 31
Emerging Perspectives on Gene Therapy Delivery for Neurodegenerative and Neuromuscular Disorders
Limia, C. E. G., Baird, M., Schwartz, M., Saxena, S., Meyer, K., & Wein, N. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12121979 · Cited by 28
“Survival has also been extended well beyond the two-year life expectancy [166].”
BackgroundChong, L. C., Gandhi, G., Lee, J. M., Yeo, W. W. Y., & Choi, S. B. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22168962 · Cited by 23
“Given its effectiveness in resolving the SMA molecular defect, it adversely affects the liver by increasing the level of serum aminotransferase, a liver enzyme [7,101,102].”
BackgroundSystemic Treatment of Fabry Disease Using a Novel AAV9 Vector Expressing α-Galactosidase A
Biferi, M. G., Cohen-Tannoudji, M., García-Silva, A., Souto-Rodríguez, O., Viéitez, I., Millán, B. S., Fernández‐Carrera, A., Pérez-Márquez, T., Teijeira, S., Barrera, S., et al. (2020) · Molecular Therapy — Methods & Clinical Development · doi:10.1016/j.omtm.2020.10.016 · Cited by 26
Suriano, C. M., Kumar, N., Verpeut, J. L., Ma, J., Jung, C., Dunn, C. E., Carvajal, B. V., Nguyen, A. V., & Boulanger, L. M. (2024) · Molecular Therapy · doi:10.1016/j.ymthe.2024.03.036 · Cited by 21
“…clinically to restore endogenous protein function in the nervous system to treat Leber ’ s congenital amaurosis 2 2,3 and spinal muscular atrophy, 4,5 and AAV-based clinical trials are under way to treat numerous other disorders of the nervous system, including Alzheimer ’ s disease, Canavan ’ s…”
Targeted-Deletion of a Tiny Sequence via Prime Editing to Restore SMN Expression
Zhou, M., Tang, S., Duan, N., Xie, M., Li, Z., Feng, M., Wu, L., Hu, Z., & Liang, D. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23147941 · Cited by 28
“Risdiplam, Spinraza, and onasemnogene abeparvovec, which are drugs based on these approaches, have been approved by the US Food and Drug Administration (FDA) for SMA treatment [32,38,39].”
BackgroundJohannsen, J., Fuhrmann, L., Grolle, B., Morgenstern, L., Wiegand‐Grefe, S., & Denecke, J. (2020) · Health and Quality of Life Outcomes · doi:10.1186/s12955-020-01467-0 · Cited by 27
Diving into progress: a review on current therapeutic advancements in spinal muscular atrophy
Bagga, P., Singh, S., Ram, G., Kapil, S., & Singh, A. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1368658 · Cited by 20
Soini, V., Schreiber, G., Wilken, B., & Hell, A. K. (2023) · Children · doi:10.3390/children10060998 · Cited by 19
Flexible endoscopic evaluation of swallowing in children with type 1 spinal muscular atrophy
Zang, J., Johannsen, J., Denecke, J., Weiss, D., Koseki, J., Niessen, A. C., Müller, F., Nienstedt, J. C., Flügel, T., & Pflug, C. (2022) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-022-07685-0 · Cited by 22
Meng, Y., Sun, D., Qin, Y., Dong, X., Luo, G., & Liu, Y. (2021) · Molecular Therapy — Methods & Clinical Development · doi:10.1016/j.omtm.2021.02.019 · Cited by 32
Metadata
- Authors
- Hoy, S. M.
- Affiliations
- Springer Nature (New Zealand) (NZ)
- Corresponding author
- Hoy, Sheridan M.
- Venue
- Drugs
- Published
- 2019-07
- Volume
- 79
- Issue
- 11
- Pages
- 1255-1262
- ISSN
- 0012-6667 (ISSN-L)
- 1179-1950
- OpenAlex
- W2955699452
- Cited by
- 337
- References
- 0
- Citations by year
- 2026: 31 · 2025: 36 · 2024: 54 · 2023: 42 · 2022: 38 · 2021: 68 · 2020: 58 · 2019: 9
- FWCI
- 23.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drugs (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Genetics (clinical) › Neurogenetic and Muscular Disorders Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Virus-based gene therapy research
- Health Sciences › Medicine › Genetics (clinical) › Lysosomal Storage Disorders Research
- Keywords
- onasemnogene abeparvovec, Zolgensma, spinal muscular atrophy, gene therapy, adeno-associated virus vectors, SMN1, survival motor neuron protein, pediatric patients, regulatory approval, drug development milestones
- MeSH terms
- Dependovirus, Genetic Vectors, Humans, Infant, Infant, Newborn, Infusions, Intravenous, Motor Neurons, Muscular Atrophy, Spinal, Mutation, United States, United States Food and Drug Administration, Genetic Therapy, Drug Approval, SMN Complex Proteins
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