Achondroplasia: pathogenesis and implications for future treatment

@article{Laederich2010AchondroplasiaPA,
  title={Achondroplasia: pathogenesis and implications for future treatment},
  author={Melanie B. Laederich and William A. Horton},
  journal={Current Opinion in Pediatrics},
  year={2010},
  volume={22},
  pages={516–523}
}
Purpose of review Although the genetic defect underlying achondroplasia has been known for over a decade, no effective therapies to stimulate bone growth have emerged. Here we review the recent literature and summarize the molecular mechanisms underlying disease pathology and examine their potential as therapeutic targets. Currently used preclinical models are discussed in the context of recent advances with a special focus on C-type natriuretic peptide. Recent findings Research on the mutation… 
Molecular Genetics of Achondroplasia
TLDR
The major goal in developing treatments for achondroplasia has been to safely reduce the output of FGFR3 signals to or towards normal, and the most promising strategy at present involves administration of the peptide, CNP, which antagonises MAPK signals initiated byFGFR3.
Advances in treatment of achondroplasia and osteoarthritis.
TLDR
Preliminary results of Phase 2 studies show a substantial increase in growth rate of ACH children after six months of therapy with no serious adverse effects, and the application of gene therapy in osteoarthritis offers insights because it faces similar technical obstacles.
Evaluation of FGFR inhibitor ASP5878 as a drug candidate for achondroplasia
TLDR
A new FGFR inhibitor, ASP5878, which was originally developed as an anti-cancer drug, elongated the bone of achondroplasia model male mice at the dose of 300 μg/kg, which confers an AUC of 275 ng·h/ml in juvenile mice, and was less effective in bone elongation than a CNP analogue.
FGFR3 targeting strategies for achondroplasia
TLDR
Several therapeutic strategies designed to target the mutant receptor or its signalling pathways are examined, including the use of kinase inhibitors, blocking antibodies, physiologic antagonists, RNAi and chaperone inhibitors.
Improvement of molecular-genetic diagnostics of the most common skeletal dysplasias.
TLDR
The reliable diagnostics was developed and made it available for achondroplasia and hypochondroPLasia suspected patients and it confirmed the diagnosis of ACH due to 1138G→A transition in 7 patients and the identified 1620C→A transversion responsible for HCH in 2 patients.
Neutral Endopeptidase-Resistant C-Type Natriuretic Peptide Variant Represents a New Therapeutic Approach for Treatment of Fibroblast Growth Factor Receptor 3–Related Dwarfism
Achondroplasia (ACH), the most common form of human dwarfism, is caused by an activating autosomal dominant mutation in the fibroblast growth factor receptor-3 gene. Genetic overexpression of C-type
Therapeutic effect of CNP on renal osteodystrophy by antagonizing the FGF-23/MAPK pathway
TLDR
It is reasonable to propose a direct interaction of their signaling pathways during the progression of ROD, in agreement with recent studies demonstrating a down-regulatory role of the mitogen-activated protein kinase activity by CNP.
Statin treatment rescues FGFR3 skeletal dysplasia phenotypes
TLDR
It is found that statin treatment can rescue patient-specific induced pluripotent stem cell (iPSC) models and a mouse model of FGFR3 skeletal dysplasia and suggest that statins could represent a medical treatment for infants and children with TD1 and ACH.
Helping parents of children with monogenetic disorders understand developmental trajectories: lessons from achondroplasia
  • M. Msall
  • Medicine
    Developmental medicine and child neurology
  • 2012
TLDR
Thirty-eight families from Australia and New Zealand with children born in the last decade were prospectively studied every 3 months to understand gross motor, fine motor, communication, and feeding skills, reflecting that self-mobility for exploring the environment was occurring throughout the first 2 years of life.
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TLDR
Treatment with systemic CNP is a potential therapeutic strategy for skeletal dysplasias, including Ach, in humans as demonstrated by results demonstrated that increased plasma CNP from the liver or by iv administration of synthetic CNP-22 rescued the impaired bone growth phenotype of Ach mice without significant adverse effects.
Overexpression of CNP in chondrocytes rescues achondroplasia through a MAPK-dependent pathway
TLDR
It is demonstrated that activation of the CNP–GC-B system in endochondral bone formation constitutes a new therapeutic strategy for human achondroplasia.
Fibroblast growth factor receptor-3 as a therapeutic target for Achondroplasia--genetic short limbed dwarfism.
TLDR
It is highly conceivable that drug development strategies aimed either towards blocking extracellular ligand binding or towards intracellular checkpoints along the FGF signal transduction cascade, may prove successful in the treatment of Achondroplasia.
Achondroplasia is defined by recurrent G380R mutations of FGFR3.
TLDR
The homogeneity of mutations in achondroplasia is unprecedented for an autosomal dominant disorder and may explain the relative lack of heterogeneity in the achonderized phenotype.
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TLDR
It appears that recurrent mutations of a single amino acid in the transmembrane domain of the FGFR3 protein account for all cases of achondroplasia in the series of sporadic cases reported.
The achondroplasia mutation does not alter the dimerization energetics of the fibroblast growth factor receptor 3 transmembrane domain.
TLDR
It is shown that the Gly380 --> Arg mutation does not alter theDimerization energetics of the FGFR3 transmembrane domain in detergent micelles or in lipid bilayers, indicating that pathogenesis in achondroplasia cannot be explained simply by a higher dimerization propensity of the mutantFGFR3 TM domain, thus highlighting the importance of the observed slow downregulation in phenotype induction.
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TLDR
The results suggest that the molecular basis of achondroplasia is unregulated signal transduction through FGFR3, which may result in inappropriate cartilage growth plate differentiation and thus abnormal long bone development.
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TLDR
It is reported that activating mutations in FGFR3 increase the stability of the receptor and the lysosomal targeting defect is additive to other mechanisms proposed to explain the pathogenesis of ACH.
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TLDR
It is shown that mutant TDII FGFR3 has a constitutive tyrosine kinase activity which can specifically activate the transcription factor Statl, which may be used as a mediator of growth retardation in bone development in achondroplasia class of chondrodysplasias.
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