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Review of ASO treatment for IGHMBP2-related spinal muscular atrophy and Charcot-Marie-ToothOne treatment may fix rare nerve disease in kids

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Key Takeaway
Consider that ASO treatment corrected splicing for some but not all IGHMBP2 variants in an in vitro model.

This is a narrative review that synthesizes findings from a case series involving 12 patients with suspected IGHMBP2-related disease. The review focuses on the use of an antisense oligonucleotide (ASO) to correct aberrant splicing in patient-derived motor neurons.

The authors report that ASO treatment restored full-length IGHMBP2 protein by decreasing the use of a novel acceptor site for variants c.1235+894G>A and c.1235+1076G>A. However, the ASO treatment did not correct splicing for the c.1235+450G>A variant. The review also identifies pathways implicated in motor neuron vulnerability and notes corrections in RNP biogenesis and rRNA processing defects.

Key limitations acknowledged by the authors include that the ASO treatment did not correct splicing for the c.1235+450G>A variant, suggesting additional splice correction will be needed for this specific variant. The authors also caution not to infer clinical efficacy beyond the in vitro model of induced motor neurons or assume generalizability to all IGHMBP2 variants without further study.

The practice relevance noted is that characterizing deep intronic variants in disease-relevant cells can assist the diagnostic process and inform therapeutics development. The review does not report safety data, follow-up duration, or effect sizes.

The gene glitch that breaks nerve cells

Think of a gene like a recipe book. Cells read each page to build proteins. But sometimes, a typo hides in a blank space between real instructions. That’s what happens in IGHMBP2. A tiny change deep inside the gene adds a fake page—called a pseudoexon—into the recipe. The result? A broken protein that nerve cells can’t use.

In this study, scientists studied 12 children with suspected SMARD1. Each had one known harmful gene change—and one hidden change deep in the gene. Using skin cells from the kids, they created stem cells and turned them into motor neurons—the very cells that fail in the disease.

When they read the gene messages in these nerve cells, they saw the fake pages appear. Three different errors caused three different-sized insertions. One added 626 letters to the code. Another added just 77. But all three used the same exit point—a shared “donor site”—to sneak in.

That shared path is the key.

It means one drug could block that exit and stop all three errors. The drug is called an antisense oligonucleotide (ASO). It’s a tiny piece of genetic code designed to stick to the faulty spot and hide it from the cell’s machinery.

One drug, multiple errors

Scientists tested a single ASO on the lab-grown nerve cells. For two of the three variants—c.1235+1076G>A and c.1235+894C>A—the fix worked. The fake page disappeared. Full-length, healthy protein returned. The cells began to act more normal.

But the third variant—c.1235+450G>A—did not respond. The ASO blocked the shared donor site, but the error found another way in. This suggests that while one drug could help many children, some may need a second, tailored treatment.

Still, the idea that one ASO could help more than one genetic variant is powerful. Most rare diseases have many different gene errors. Treatments are often one-size-fits-one. This approach could be one-size-fits-several.

This doesn't mean this treatment is available yet.

The study also dug into why these nerve cells die. Using CRISPR screening, they found that when IGHMBP2 fails, two critical cell processes break down. One is ribonucleoprotein (RNP) biogenesis—the cell’s way of building machines that handle genetic messages. The other is processing of RNA needed for protein production. When these fail, nerve cells become vulnerable.

After ASO treatment, these broken systems began to recover. Proteins and gene activity returned toward normal. This shows the fix isn’t just cosmetic. It helps restore real cell function.

What this means for families is hope—but patience is needed. No child has received this ASO yet. The work was done in lab-grown cells. Animal studies must come next. Then safety trials in humans. That process takes years.

Also, the study only tested three variants. Many more may exist. Not all may respond to the same drug. And the ASO must reach the nervous system safely, which is a challenge for any gene-targeting drug.

Still, this research shifts the path forward. It shows that deep gene errors can be found—and fixed. It proves that studying patient cells in the lab can guide treatment design. And it supports screening for hidden gene changes in children with unexplained nerve disease.

The next step is turning this lab success into a real therapy. Researchers will refine the ASO, test it in animals, and work toward a trial. For families waiting, that timeline can’t move fast enough. But science moves step by step. Each one brings us closer.

Study Details

Sample sizen = 6
EvidenceLevel 5
PublishedApr 2026
View Original Abstract ↓
Biallelic disease-causing variants in IGHMBP2 cause spinal muscular atrophy with respiratory distress type I (SMARD1) and Charcot-Marie-Tooth type 2S (CMT2S). We present 12 unrelated patients with clinically suspected IGHMBP2-related-disease, each carrying a variant deep in intron 8 of IGHMBP2 (c.1235+1076G>A (n=6), c.1235+450G>A (n=5), and c.1235+894C>A (n=1)), along with a known deleterious variant in trans. To assess aberrant pathogenic splicing induced by these deep intronic variants in a relevant model, patient-derived induced pluripotent stem cells were differentiated into motor neurons (iMNs). Long-read RNA sequencing revealed introduction of different pseudoexons by each variant: c.1235+450G>A (626bp), c.1235+1076G>A (112bp and 77bp) and c.1235+894C>A (182bp). Although each variant utilizes a unique splice acceptor site, they all activate the same cryptic donor site, enabling a therapeutic approach to redirect aberrant splicing for all the variants using a single shared antisense oligonucleotide (ASO). Treatment of iMNs with this single ASO restored full-length IGHMBP2 protein in c.1235+894G>A and c.1235+1076G>A by decreasing the use of the novel acceptor site. In contrast, ASO treatment did not correct the splicing in c.1235+450G>A, suggesting that additional splice correction will be needed for this specific variant. A CRISPR interference screen of IGHMBP2 loss-of-function in iMNs identified ribonucleoprotein complex biogenesis (RNP), and rRNA and tRNA processing as top pathways implicated in motor neuron vulnerability. Proteomics and transcriptomics analysis of successfully treated patient iMNs revealed correction of RNP biogenesis and rRNA processing defects. This study highlights the importance of characterizing deep intronic variants in disease-relevant cells to assist the diagnostic process and inform therapeutics development.
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