罕见病诊疗现状及发展展望
Current Status and Future Prospects of Diagnosis and Treatment for Rare Diseases
DOI: 10.12677/acm.2024.1441076, PDF,  被引量   
作者: 桂俊峰, 李京蔚, 宋 萃*:重庆医科大学附属儿童医院内分泌科,重庆
关键词: 罕见病诊疗现状未来展望Rare Diseases Current Diagnosis and Treatment Status Future Prospects
摘要: 随着分子诊断技术的发展,疾病精准诊疗取得重大进展。罕见病是对分子诊断依赖较大的一类疾病,尽管其患病率低,但由于病种繁多,累积发病人数仍然庞大。目前,受医疗技术、医生经验、患者意识及经济水平等因素的影响,罕见病患者在诊治过程中仍面临较多困境。但随着技术的进步,分子诊断效率的提高,罕见病的早期诊断和个体化治疗有了希望。同时,基因编辑等新兴治疗策略的发展也为罕见病患者带来了更多治疗机会。我们期待未来罕见病研究的深入,疾病治疗的创新以及全球合作的加强,以提高罕见病的诊断率和治疗效果,减轻患者和社会的负担。本文综述了当前罕见病诊疗的现状,并总结了对未来的展望。
Abstract: With the evolution of molecular diagnostic technologies, there has been a significant leap forward in the precision diagnosis and treatment of diseases. Rare diseases, which exhibit a high dependency on molecular diagnostics. Despite their relatively low prevalence, the extensive variety of these diseases results in a considerable overall number of individuals affected. Currently, the management of rare diseases is complicated by factors such as medical technological advancements, physician expertise, patient awareness, and socioeconomic status, leading to numerous challenges in the diagnostic and therapeutic journey of these patients. However, with technological advancements and improvements in the efficiency of molecular diagnostics, there is newfound hope for the early detection and personalized management of rare diseases. Additionally, the development of innovative therapeutic strategies, including gene editing, has expanded the therapeutic possibilities for patients suffering from rare diseases. The anticipation is for a deepened research focus on rare diseases, innovative approaches in disease management, and enhanced global collaboration to improve diagnostic accuracy and therapeutic outcomes for rare diseases, thereby alleviating the burden on both patients and society at large. This review delineates the current landscape of diagnosis and treatment for rare diseases and summarizes the future outlook.
文章引用:桂俊峰, 李京蔚, 宋萃. 罕见病诊疗现状及发展展望[J]. 临床医学进展, 2024, 14(4): 681-688. https://doi.org/10.12677/acm.2024.1441076

参考文献

[1] World Health Organization (2006) The Selection and Use of Essential Medicines: Report of the WHO Expert Committee, 2005; (Including the 14th Model List of Essential Medicines); [WHO Expert Committee on the Selection and Use of Essential Medicines, Geneva, 7-11 March 2005]. World Health Organization, Geneva.
[2] Franco, P. (2013) Orphan Drugs: The Regulatory Environment. Drug Discovery Today, 18, 163-172. [Google Scholar] [CrossRef] [PubMed]
[3] Arno, P.S., Bonuck, K. and Davis, M. (1995) Rare Diseases, Drug Development, and AIDS: The Impact of the Orphan Drug Act. The Milbank Quarterly, 73, 231-252. [Google Scholar] [CrossRef] [PubMed]
[4] 马端, 李定国, 张学. 中国罕见病防治的机遇与挑战[J]. 中国循证儿科杂志, 2011, 6(2): 81-82.
[5] Richter, T., Nestler-Parr, S., Babela, R., et al. (2015) Rare Disease Terminology and Definitions—A Systematic Global Review: Report of the ISPOR Rare Disease Special Interest Group. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 18, 906-914. [Google Scholar] [CrossRef] [PubMed]
[6] Nguengang, W.S., Lambert, D.M., Olry, A., et al. (2020) Estimating Cumulative Point Prevalence of Rare Diseases: Analysis of the Orphanet Database. European Journal of Human Genetics: EJHG, 28, 165-173. [Google Scholar] [CrossRef] [PubMed]
[7] Ferreira, C.R. (2019) The Burden of Rare Diseases. American Journal of Medical Genetics. Part A, 179, 885-892. [Google Scholar] [CrossRef] [PubMed]
[8] Hall, J.G., Powers, E.K., Mcllvaine, R.T., et al. (1978) The Frequency and Financial Burden of Genetic Disease in a Pediatric Hospital. American Journal of Medical Genetics, 1, 417-436. [Google Scholar] [CrossRef] [PubMed]
[9] Yoon, P.W. (1997) Contribution of Birth Defects and Genetic Diseases to Pediatric Hospitalizations: A Population-Based Study. Archives of Pediatrics & Adolescent Medicine, 151, 1096-1103. [Google Scholar] [CrossRef] [PubMed]
[10] Angelis, A., Tordrup, D. and Kanavos, P. (2015) Socio-Economic Burden of Rare Diseases: A Systematic Review of Cost of Illness Evidence. Health Policy (Amsterdam, Netherlands), 119, 964-979. [Google Scholar] [CrossRef] [PubMed]
[11] Cohen, J.S. and Biesecker, B.B. (2010) Quality of Life in Rare Genetic Conditions: A Systematic Review of the Literature. American Journal of Medical Genetics. Part A, 152, 1136-1156. [Google Scholar] [CrossRef] [PubMed]
[12] Pelentsov, L.J., Fielder, A.L., Laws, T.A., et al. (2016) The Supportive Care Needs of Parents with a Child with a Rare Disease: Results of an Online Survey. BMC Family Practice, 17, Article No. 88. [Google Scholar] [CrossRef] [PubMed]
[13] The Lancet Diabetes Endocrinology (2019) Spotlight on Rare Diseases. The Lancet. Diabetes & Endocrinology, 7, 75. [Google Scholar] [CrossRef
[14] Kvarnung, M. and Nordgren, A. (2017) Intellectual Disability & Rare Disorders: A Diagnostic Challenge. In: de la Paz, M.P., Taruscio, D. and Groft, S.C., Eds., Rare Diseases Epidemiology: Update and Overview, Springer, Berlin, 39-54. [Google Scholar] [CrossRef] [PubMed]
[15] Almalki, Z.S., Alahmari, A.K., Guo, J.J., et al. (2012) Access to Orphan Drugs in the Middle East: Challenge and Perspective. Intractable & Rare Diseases Research, 1, 139-143. [Google Scholar] [CrossRef] [PubMed]
[16] Giovannini, M., Luzzati, M., Ferrara, G., et al. (2018) Common Symptoms for a Rare Disease in a Girl with Sarcoidosis: A Case Report. Italian Journal of Pediatrics, 44, Article No. 74. [Google Scholar] [CrossRef] [PubMed]
[17] Girirajan, S., Rosenfeld, J.A., Coe, B.P., et al. (2012) Phenotypic Heterogeneity of Genomic Disorders and Rare Copy-Number Variants. The New England Journal of Medicine, 367, 1321-1331. [Google Scholar] [CrossRef
[18] Anderson, M., Elliott, E.J. and Zurynski, Y.A. (2013) Australian Families Living with Rare Disease: Experiences of Diagnosis, Health Services Use and Needs for Psychosocial Support. Orphanet Journal of Rare Diseases, 8, Article No. 22. [Google Scholar] [CrossRef] [PubMed]
[19] Zurynski, Y., Deverell, M., Dalkeith, T., et al. (2017) Australian Children Living with Rare Diseases: Experiences of Diagnosis and Perceived Consequences of Diagnostic Delays. Orphanet Journal of Rare Diseases, 12, Article No. 68. [Google Scholar] [CrossRef] [PubMed]
[20] Kempf, L., Goldsmith, J.C. and Temple, R. (2018) Challenges of Developing and Conducting Clinical Trials in Rare Disorders. American Journal of Medical Genetics. Part A, 176, 773-783. [Google Scholar] [CrossRef] [PubMed]
[21] Asbury, C.H. (1991) The Orphan Drug Act. The First 7 Years. JAMA, 265, 893-897. [Google Scholar] [CrossRef] [PubMed]
[22] Fantini, B. and Vaccaro, C.M. (2019) Value Based Healthcare for Rare Diseases: Efficiency, Efficacy, Equity. Annali DellIstituto Superiore Di Sanita, 55, 251-257.
[23] Ahmed, M.A., Okour, M., Brundage, R., et al. (2019) Orphan Drug Development: The Increasing Role of Clinical Pharmacology. Journal of Pharmacokinetics and Pharmacodynamics, 46, 395-409. [Google Scholar] [CrossRef] [PubMed]
[24] Divino, V., DeKoven, M., Kleinrock, M., et al. (2016) Orphan Drug Expenditures in the United States: A Historical and Prospective Analysis, 2007-18. Health Affairs (Project Hope), 35, 1588-1594. [Google Scholar] [CrossRef] [PubMed]
[25] Senior, M. (2022) Orphan Drugs: From Niche to Mainstream. MJH Life Sciences, 42, 32-33.
[26] Kölker, S., Gleich, F., Mütze, U., et al. (2022) Rare Disease Registries Are Key to Evidence-Based Personalized Medicine: Highlighting the European Experience. Frontiers in Endocrinology, 13, Article ID: 832063. [Google Scholar] [CrossRef] [PubMed]
[27] 张波, 张抒扬, 屈静晗, 等. 多准则决策分析应用于罕见病药品临床综合评价的专家共识(2022) [J]. 罕见病研究, 2022, 1(2): 158-177.
[28] Marwaha, S., Knowles, J.W. and Ashley, E.A. (2022) A Guide for the Diagnosis of Rare and Undiagnosed Disease: Beyond the Exome. Genome Medicine, 14, Article No. 23. [Google Scholar] [CrossRef] [PubMed]
[29] 顾学范, 韩连书, 余永国. 中国新生儿遗传代谢病筛查现状及展望[J]. 罕见病研究, 2022, 1(1): 13-19.
[30] Fernández-Marmiesse, A., Gouveia, S. and Couce, M.L. (2018) NGS Technologies as a Turning Point in Rare Disease Research, Diagnosis and Treatment. Current Medicinal Chemistry, 25, 404-432. [Google Scholar] [CrossRef] [PubMed]
[31] Souche, E., Beltran, S., Brosens, E., et al. (2022) Recommendations for Whole Genome Sequencing in Diagnostics for Rare Diseases. European Journal of Human Genetics, 30, 1017-1021. [Google Scholar] [CrossRef] [PubMed]
[32] Choi, M., Scholl, U.I., Ji, W., et al. (2009) Genetic Diagnosis by Whole Exome Capture and Massively Parallel DNA Sequencing. Proceedings of the National Academy of Sciences of the United States of America, 106, 19096-19101. [Google Scholar] [CrossRef] [PubMed]
[33] Neveling, K., Feenstra, I., Gilissen, C., et al. (2013) A Post-Hoc Comparison of the Utility of Sanger Sequencing and Exome Sequencing for the Diagnosis of Heterogeneous Diseases. Human Mutation, 34, 1721-1726. [Google Scholar] [CrossRef] [PubMed]
[34] 喻长顺, 于世辉. 罕见病及其基因诊断的发展现状[J]. 海南医学, 2019, 30(S1): 56-67.
[35] Lunke, S., Bouffler, S.E., Patel, C.V., et al. (2023) Integrated Multi-Omics for Rapid Rare Disease Diagnosis on a National Scale. Nature Medicine, 29, 1681-1691. [Google Scholar] [CrossRef] [PubMed]
[36] Birgmeier, J., Haeussler, M., Deisseroth, C.A., et al. (2020) AMELIE Speeds Mendelian Diagnosis by Matching Patient Phenotype and Genotype to Primary Literature. Science Translational Medicine, 12, Eaau9113. [Google Scholar] [CrossRef] [PubMed]
[37] Sundaram, L., Gao, H., Padigepati, S.R., et al. (2018) Predicting the Clinical Impact of Human Mutation with Deep Neural Networks. Nature Genetics, 50, 1161-1170. [Google Scholar] [CrossRef] [PubMed]
[38] Jaganathan, K., Panagiotopoulou, S.K., McRae, J.F., et al. (2019) Predicting Splicing from Primary Sequence with Deep Learning. Cell, 176, 535-548.E24. [Google Scholar] [CrossRef] [PubMed]
[39] Brasil, S., Pascoal, C., Francisco, R., et al. (2019) Artificial Intelligence (AI) in Rare Diseases: Is the Future Brighter? Genes, 10, Article No. 978. [Google Scholar] [CrossRef] [PubMed]
[40] Carter, H., Douville, C., Stenson, P.D., et al. (2013) Identifying Mendelian Disease Genes with the Variant Effect Scoring Tool. BMC Genomics, 14, S3. [Google Scholar] [CrossRef
[41] Alirezaie, N., Kernohan, K.D., Hartley, T., et al. (2018) ClinPred: Prediction Tool to Identify Disease-Relevant Nonsynonymous Single-Nucleotide Variants. American Journal of Human Genetics, 103, 474-483. [Google Scholar] [CrossRef] [PubMed]
[42] Orange, J.S., Glessner, J.T., Resnick, E., et al. (2011) Genome-Wide Association Identifies Diverse Causes of Common Variable Immunodeficiency. The Journal of Allergy and Clinical Immunology, 127, 1360-1367.E6. [Google Scholar] [CrossRef] [PubMed]
[43] Liehr, T., Acquarola, N., Pyle, K., et al. (2018) Next Generation Phenotyping in Emanuel and Pallister-Killian Syndrome Using Computer-Aided Facial Dysmorphology Analysis of 2D Photos. Clinical Genetics, 93, 378-381. [Google Scholar] [CrossRef] [PubMed]
[44] Hoy, S.M. (2019) Elexacaftor/Ivacaftor/Tezacaftor: First Approval. Drugs, 79, 2001-2007. [Google Scholar] [CrossRef] [PubMed]
[45] Oldenburg, J., Mahlangu, J.N., Kim, B., et al. (2017) Emicizumab Prophylaxis in Hemophilia A with Inhibitors. The New England Journal of Medicine, 377, 809-818. [Google Scholar] [CrossRef
[46] Tambuyzer, E., Vandendriessche, B., Austin, C.P., et al. (2020) Therapies for Rare Diseases: Therapeutic Modalities, Progress and Challenges Ahead. Nature Reviews. Drug Discovery, 19, 93-111. [Google Scholar] [CrossRef] [PubMed]
[47] Li, C. and Samulski, R.J. (2020) Engineering Adeno-Associated Virus Vectors for Gene Therapy. Nature Reviews Genetics, 21, 255-272. [Google Scholar] [CrossRef] [PubMed]
[48] Scott, L.J. (2015) Alipogene Tiparvovec: A Review of Its Use in Adults with Familial Lipoprotein Lipase Deficiency. Drugs, 75, 175-182. [Google Scholar] [CrossRef] [PubMed]
[49] Shahryari, A., Saghaeian, J.M., Mohammadi, S., et al. (2019) Development and Clinical Translation of Approved Gene Therapy Products for Genetic Disorders. Frontiers in Genetics, 10, Article No. 868. [Google Scholar] [CrossRef] [PubMed]
[50] Smalley, E. (2017) First AAV Gene Therapy Poised for Landmark Approval. Nature Biotechnology, 35, 998-999. [Google Scholar] [CrossRef] [PubMed]
[51] Cavazzana-Calvo, M., Payen, E., Negre, O., et al. (2010) Transfusion Independence and HMGA2 Activation after Gene Therapy of Human β-Thalassaemia. Nature, 467, 318-322. [Google Scholar] [CrossRef] [PubMed]
[52] Aiuti, A., Slavin, S., Aker, M., et al. (2002) Correction of ADA-SCID by Stem Cell Gene Therapy Combined with Nonmyeloablative Conditioning. Science (New York, N.Y.), 296, 2410-2413. [Google Scholar] [CrossRef] [PubMed]
[53] Garrelfs, S.F., Frishberg, Y., Hulton, S.A., et al. (2021) Lumasiran, an RNAi Therapeutic for Primary Hyperoxaluria Type 1. The New England Journal of Medicine, 384, 1216-1226. [Google Scholar] [CrossRef
[54] Pai, S.-Y., Logan, B.R., Griffith, L.M., et al. (2014) Transplantation Outcomes for Severe Combined Immunodeficiency, 2000-2009. The New England Journal of Medicine, 371, 434-446. [Google Scholar] [CrossRef
[55] Chan, J.K.Y. and Götherström, C. (2014) Prenatal Transplantation of Mesenchymal Stem Cells to Treat Osteogenesis Imperfecta. Frontiers in Pharmacology, 5, Article No. 223. [Google Scholar] [CrossRef] [PubMed]
[56] Schwartz, S.D., Regillo, C.D., Lam, B.L., et al. (2015) Human Embryonic Stem Cell-Derived Retinal Pigment Epithelium in Patients with Age-Related Macular Degeneration and Stargardt’s Macular Dystrophy: Follow-Up of Two Open-Label Phase 1/2 Studies. The Lancet (London, England), 385, 509-516. [Google Scholar] [CrossRef