Precision Medicine through Antisense Oligonucleotide-Mediated Exon Skipping

Clinical implementation of two recently approved antisense RNA therapeutics – Exondys51^® to treat Duchenne muscular dystrophy (Duchenne MD) and Spinraza^® as a treatment for spinal muscular atrophy (SMA) – highlights the therapeutic potential of antisense oligonucleotides (ASOs). As shown in the Duchenne and Becker cases, the identification and specific removal of ‘dispensable’ exons by exon-skipping ASOs could potentially bypass lethal mutations in other genes and bring clinical benefits to affected individuals carrying amenable mutations. In this review, we discuss the potential of therapeutic alternative splicing, with a particular focus on targeted exon skipping using Duchenne MD as an example, and speculate on new applications for other inherited rare diseases where redundant or dispensable exons may be amenable to exon-skipping ASO intervention as precision medicine.