2022年稀有病日:我们如何改善稀有疾病的研究?

In a blog for稀有疾病日2022, Cheney Drew discusses theDomino-HD研究中,注册的ISRCTN registry,,,,which aims to provide new insights into lifestyle and genetic risk factors in Huntington’s disease.

亨廷顿氏病(HD)是一种遗传性神经退行性疾病,其中具有病因基因的人经历了运动,思维和行为的问题逐渐恶化,症状通常在中年出现。这是由于突变蛋白的产生引起的,该突变蛋白导致大脑中特定细胞的丧失。尽管我们知道哪个基因会导致高清,并且对发生这种情况的原因有很多了解,但仍然没有可用的治疗方法可以减慢疾病的病程或完全治愈。

高清在英国影响10,000人中约有1人,这将其归类为一种罕见疾病。这使得对新疗法进行研究更具挑战性,因为我们仍然需要大量的人参与研究以证明新疗法有效。话虽如此,全球高清社区的研究非常活跃,拥有高清的人会自愿时间和身体来促进高清研究,希望有一天能找到一些可能有助于减慢或阻止这种毁灭性疾病的东西。

例如,许多拥有高清的人正在参加注册HD学习。这是一项全球大型研究,参与者对症状进行年度评估。然后,高清研究人员可以应用该数据,以了解高清在长期内如何发展和影响人们,这对于像HD这样的罕见疾病非常重要。入学HD的另一个巨大好处是,它也充当研究型人的注册表,可用于帮助招募临床研究。对于所有临床研究而言,招募是一个真正的问题,但对于稀有疾病特别困难。

虽然注册HD提供了一个非常有价值的平台,用于在HD上进行研究,但我们仍然面临着少数被要求接受许多研究访问和测试以收集所需信息的问题。我们需要找到减轻那些自愿参加的人的负担,以使社区不会被研究所淹没。

我们需要找到减轻那些自愿参加的人的负担,以使社区不会被研究所淹没。

HD的临床研究似乎已经进入了一个新时代,新兴的潜在新疗法从更传统的“一日药”方法转移到需要直接传递给中枢神经系统的治疗方法上。目前,有许多研究在临床试验中调查了许多这样的治疗的潜力,但是诊所中改良疾病的治疗的可用性仍然是现实的一面。

Whilst work continues to identify and test new drug treatments for HD, it is important to continue investigating other ways that the disease course may be altered and for ways to improve the quality of life of people living with HD. Previous research has shown that point at which symptoms start to become apparent and how quickly the symptoms worsen can be influenced by things other than the disease-causing mutation alone. These factors include other genes (known as genetic modifiers), physical activity and a person’s environment.

Our group have conducted a number of studies looking at how physical activity interventions may benefit people with HD. Given the potential of other lifestyle factors to influence the progression of HD, we wanted to extend this work to see if a holistic lifestyle intervention might provide benefit and improve the quality of life of people with HD. However, there are lots of things we do not know about the general lifestyle of people with HD which we need to understand first, and this is the subject of theDomino-HD研究(多域生活方式目标,用于改善亨廷顿氏病的预后)。

Domino-HD

Domino-HD是一个由神经退行性疾病联合计划资助的项目,是由莫妮卡·布斯(Monica Busse)在卡迪夫(Cardiff)领导的财团努力,由爱尔兰,西班牙,德国,瑞士,波兰,兰德公司,兰德公司和欧洲亨廷顿协会的合作伙伴捐款。在这个项目中,我们要衡量一个人的生活方式和预先确定的遗传概况如何结合起来,以影响HD的进展方式。同时,我们正在研究使用市售数字设备来衡量生活方式的这些方面的方法,以最大程度地提高数据收集,同时减少参与者的负担。

查看生活方式和遗传因素如何影响高清进步的速度,我们要求人们参加一项为期12个月的观察性研究。研究开始时,将要求来自英国,西班牙,德国,瑞士和波兰的参与者完成一些有关体育锻炼,饮食,睡眠和生活质量的问卷。我们将这些访问将这些访问链接到最近的入学HD研究访问,以便我们可以将收集的临床数据用作注册的一部分,并减少参与者在每次研究访问时所要做的数量。然后,将在研究的其余部分中给参与者佩戴fitbit,以便我们可以在12个月内衡量体育锻炼和睡眠。然后,我们将将数据与12个月的注册HD获得的临床指标相结合,以研究生活方式因素如何影响HD的进展。

It is really important to highlight that commercially available devices like Fitbit have been developed for use by ‘average’ people. We do not know if the devices will record sleep and physical activity in people with a movement disorder with the same degree of reliability as those it was designed for. Therefore, we are also running a number of sub-studies across all the consortium partners to investigate this further. The sub-studies include a closer examination of using Fitbit to record sleep, physical activity and energy expenditure (i.e. calorie burn) as well as a deeper exploration into the role of nutrition and diet.

Once all the data has been collected and analyzed, we want to use it to develop a lifestyle intervention, which would include advice and guidance on physical activity, sleep and nutrition which we could then test to see if it helps improve quality of life in HD. We also hope to understand more about how digital technologies can be employed in longer-term research to reduce the burden on those volunteering to take part. This can then be applied to long-term research in other conditions and rare diseases to maximize research efficiency and potential.

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