Gene Therapy for Spinal Muscular Atrophy (SMA)
What is spinal muscular atrophy?
Spinal muscular atrophy (SMA) is a genetic disease that affects the spinal cord and nerves, resulting in muscle wasting and weakness. Untreated, it is a neurodegenerative, progressive disease, which can be fatal in its more severe forms. Children with the most common forms, type 1 and type 2 SMA, either never achieve sitting or can sit unassisted but will not be able to walk without genetically targeted treatment.
Read more about the causes, symptoms, and diagnosis of SMA here.
How is gene therapy used to treat spinal muscular atrophy?
Spinal muscular atrophy is caused by mutations in a gene called survival motor neuron 1 (or SMN1). In more than 95% of cases of SMA, the mutation is a deletion of a whole genetic segment called exon 7. Less commonly, the mutation is a spelling error (also called “point mutation”) or other genetic variants in SMN1.
There have been recent advancements in treating SMA with gene therapy. Gene therapy for SMA is called onasemnogene abeparvovec-xioi (brand name Zolgensma®).
Zolgensma delivers a new, working copy of a human SMN gene that is administered in a one-time infusion to children under 2 years old. Zolgensma makes up for the missing or nonworking SMN1 gene, which helps motor neurons work properly. The new gene tells motor neuron cells to produce more survival motor neuron (SMN) protein, which motor neuron cells need to survive and support muscle functions.
Spinal muscular atrophy treatment options at CHOP
Children’s Hospital of Philadelphia currently offers the one and only FDA-approved gene therapy for SMA: onasemnogene abeparvovec-xioi (brand name Zolgensma®). If your child is a candidate for SMA gene replacement therapy, we’ll walk you through the process, so that you know what to expect at every step. You can read more about the gene therapy process here.
CHOP also offers nusinersen (brand name Spinraza®) and risdiplam (brand name Evrysdia®) for the treatment of SMA in children and adults. Nusinersen and risdiplam are not gene therapy. Each is a medication that is used to increase production of the survival of motor neuron (SMN) protein, increasing the amount of functional protein produced from the SMN2 gene.
SMA is treated through our Division of Neurology, headed by Dr. Brenda L. Banwell, MD, and in collaboration with CHOP’s Neuromuscular treatment team.
Advocating for patients with spinal muscular atrophy
Research so far shows that the earlier children receive treatment, the better their outcomes. Once a motor neuron dies, the type of nerve cell affected in SMA, it’s gone forever.
In July 2018, the U.S. Department of Health and Human Services approved SMA as an addition to the Recommended Uniform Screening Panel for newborns. CHOP neurologists Elizabeth Kichula, MD, PhD, and John Brandsema, MD, were on the committee that guided Pennsylvania through the complicated process of ensuring all newborns in the state were tested for SMA and referred promptly to appropriate treatment centers.
Because of their efforts, babies like Millie were able to be diagnosed within days of being born and treated quickly.
FDA approved gene therapy for spinal muscular atrophy
In May 2019, Zolgensma was approved by the FDA for treatment of children under age 2 years with all forms and types of SMA.
If your child is under 2 years of age and has genetically confirmed SMA, we will complete a clinical evaluation and additional testing to determine if they are a candidate to receive SMA gene therapy.
Additional clinical trials with Zolgensma are ongoing, including studies to see if it helps children older than 2. We encourage you to ask your child’s medical team any questions you may have, and we will share new information as it becomes available.
Clinical trials for spinal muscular atrophy
While the approved therapies for SMA are limited at this time, there are many medications currently being studied with the hope they may also become treatment options. CHOP has long been a site for research studies and clinical trials, continually seeking to find the next breakthrough in the treatment of SMA.
There are currently several active clinical trials for spinal muscular atrophy:
- Check back for an up-to-date list of trials