Nucleic acid therapies for CNS diseases: Pathophysiology, targets, barriers, and delivery strategies

J Control Release. 2022 Dec:352:121-145. doi: 10.1016/j.jconrel.2022.10.018. Epub 2022 Oct 19.

Abstract

Nucleic acid therapeutics have emerged as one of the very advanced and efficacious treatment approaches for debilitating health conditions, including those diseases affecting the central nervous system (CNS). Precise targeting with an optimal control over gene regulation confers long-lasting benefits through the administration of nucleic acid payloads via viral, non-viral, and engineered vectors. The current review majorly focuses on the development and clinical translational potential of non-viral vectors for treating CNS diseases with a focus on their specific design and targeting approaches. These carriers must be able to surmount the various intracellular and extracellular barriers, to ensure successful neuronal transfection and ultimately attain higher therapeutic efficacies. Additionally, the specific challenges associated with CNS administration also include the presence of blood-brain barrier (BBB), the complex pathophysiological and biochemical changes associated with different disease conditions and the existence of non-dividing cells. The advantages offered by lipid-based or polymeric systems, engineered proteins, particle-based systems coupled with various approaches of neuronal targeting have been discussed in the context of a variety of CNS diseases. The possibilities of rapid yet highly efficient gene modifications rendered by the breakthrough methodologies for gene editing and gene manipulation have also opened vast avenues of research in neuroscience and CNS disease therapy. The current review also underscores the extensive scientific efforts to optimize specialized, efficacious yet non-invasive and safer administration approaches to overcome the therapeutic delivery challenges specifically posed by the CNS transport barriers and the overall obstacles to clinical translation.

Keywords: CNS delivery; CNS diseases; Gene editing; Gene therapy; Non-viral vectors; Nucleic acid therapeutics; RNAi; Viral vectors.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Blood-Brain Barrier / metabolism
  • Central Nervous System Diseases* / drug therapy
  • Central Nervous System Diseases* / genetics
  • Drug Delivery Systems / methods
  • Genetic Therapy / methods
  • Humans
  • Nucleic Acids* / therapeutic use
  • Transfection

Substances

  • Nucleic Acids