罕见病治疗药物研发进展与先进疗法的应用前景

陈硕, 赵临襄, 钟武, 郭文

中国新药杂志 ›› 2026, Vol. 35 ›› Issue (18) : 1905 -1914.

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中国新药杂志 ›› 2026, Vol. 35 ›› Issue (18) : 1905 -1914. DOI: 10.20251/j.cnki.1003-3734.2026.18.001
新药述评与论坛

罕见病治疗药物研发进展与先进疗法的应用前景

    陈硕1,2, 赵临襄1*, 钟武2*, 郭文3*
作者信息 +

Research progress in therapeutic drugs for rare diseases and application prospects of advanced therapies

    CHEN Shuo1,2, ZHAO Lin-xiang1*, ZHONG Wu2*, GUO Wen3*
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摘要

罕见病通常表现为患病率低、种类繁多且病情严重,大多数与基因突变密切相关。随着生物技术和人工智能的迅速发展,基因治疗、细胞治疗等先进疗法为罕见病药物的研发带来了新的突破。本文从适应证和治疗方式2个维度对2024—2025年美国FDA下属生物制品评价与研究中心批准的15款孤儿药进行了系统梳理,重点阐述CRISPR-Cas9基因编辑技术、类器官模型等先进疗法在罕见病药物研发领域的应用、面临的挑战以及未来发展趋势,并探讨我国在罕见病药物研发领域的现状。

Abstract

Rare diseases are typically characterized by low prevalence, a wide variety, and severe conditions, most closely related to gene mutations. With the rapid development of biotechnology and artificial intelligence, advanced therapies such as gene therapy and cell therapy have brought new breakthroughs in the research and development of drugs for rare diseases. This article systematically reviews 15 orphan drugs approved by the CBER under the FDA in 2024—2025 from two dimensions: indications and treatment modalities, with a focus on the application, challenges, and future trends of advanced therapies such as CRISPR-Cas9 gene editing technology and organoid models in the field of rare disease drug development. Additionally, the current status of China's rare disease drug research and development is discussed.

关键词

罕见病 / 孤儿药 / 基因编辑 / 类器官 / 腺相关病毒 / 寡核苷酸 / 人工智能

Key words

rare disease / orphan drug / gene editing / organoid / adeno-associated virus / oligonucleotide / artificial intelligence

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陈硕, 赵临襄, 钟武, 郭文. 罕见病治疗药物研发进展与先进疗法的应用前景[J]. 中国新药杂志, 2026, 35(18): 1905-1914 DOI:10.20251/j.cnki.1003-3734.2026.18.001

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参考文献

[1] DAWKINS HJS, DRAGHIA-AKLI R, LASKO P, et al. Progress in rare diseases research 2010-2016: an IRDiRC perspective[J]. Clinical Translational Sci, 2018, 11(1): 11-20.
[2] LANCET T. Hope for rare diseases[J]. Lancet, 2024, 404(10464): 1701.
[3] JIN XW, CHEN L. Orphan drug development in China-Turning challenges into opportunities[J]. Intractable Rare Dis Res, 2016, 5(4): 308-313.
[4] SCHIEPPATI A, HENTER JI, DAINA E, et al. Why rare diseases are an important medical and social issue[J]. Lancet, 2008, 371(9629): 2039-2041.
[5] LU YQ, HAN JX. The definition of rare disease in China and its prospects[J]. Intractable Rare Dis Res, 2022, 11(1): 29-30.
[6] BALDOVINO S, MOLINER AM, TARUSCIO D, et al. Rare Diseases in Europe: from a Wide to a Local Perspective[J]. Isr Med Assoc J, 2016, 18(6): 359-363.
[7] FRANGOUL H, LOCATELLI F, SHARMA A, et al. Exagamglogene autotemcel for severe sickle cell disease[J]. N Engl J Med, 2024, 390(18): 1649-1662.
[8] LOCATELLI F, LANG P, WALL D, et al. Exagamglogene autotemcel for transfusion-dependent β-thalassemia[J]. N Engl J Med, 2024, 390(18): 1663-1676.
[9] DEVERMAN BE, RAVINA BM, BANKIEWICZ KS, et al. Gene therapy for neurological disorders: progress and prospects[J]. Nat Rev Drug Discov, 2018, 17(9): 641-659.
[10] SRIVASTAVA A. In vivo tissue-tropism of adeno-associated viral vectors[J]. Curr Opin Virol, 2016, 21: 75-80.
[11] RASKO JEJ, SAMELSON-JONES BJ, GEORGE LA, et al. Fidanacogene elaparvovec for hemophilia B: a multiyear follow-up study[J]. N Engl J Med, 2025, 392(15): 1508-1517.
[12] KEAM SJ. Eladocagene exuparvovec: first approval[J]. Drugs, 2022, 82(13): 1427-1432.
[13] MENDELL JR, AL-ZAIDY S, SHELL R, et al. Single-dose gene-replacement therapy for spinal muscular atrophy[J]. N Engl J Med, 2017, 377(18): 1713-1722.
[14] FUMAGALLI F, CALBI V, NATALI SORA MG, et al. Lentiviral haematopoietic stem-cell gene therapy for early-onset metachromatic leukodystrophy: long-term results from a non-randomised, open-label, phase 1/2 trial and expanded access[J]. Lancet, 2022, 399(10322): 372-383.
[15] LEE A. Prademagene zamikeracel: first approval[J]. Mol Diagn Ther, 2025, 29(5): 701-704.
[16] LEE A. Zopapogene imadenovec: first approval[J]. Mol Diagn Ther, 2026, 30(1): 169-171.
[17] HAN J, ZHANG BW, ZHENG SY, et al. The progress and prospects of immune cell therapy for the treatment of cancer[J]. Cell Transplant, 2024, 33: 09636897241231892.
[18] 王雪懿, 李本尚. CAR-T细胞治疗自身免疫性疾病的研究述评[J]. 上海交通大学学报(医学版), 2025, 45(11): 1432-1442.
[19] RODDIE C, SANDHU KS, THOLOULI E, et al. Obecabtagene autoleucel in adults with B-cell acute lymphoblastic leukemia[J]. N Engl J Med, 2024, 391(23): 2219-2230.
[20] WANG M, SIDDIQI T, GORDON LI, et al. Lisocabtagene maraleucel in relapsed/refractory mantle cell lymphoma: primary analysis of the mantle cell lymphoma cohort from TRANSCEND NHL 001, a phase I multicenter seamless design study[J]. J Clin Oncol, 2024, 42(10): 1146-1157.
[21] GAO GF, RAO ZH, BELL JI. Molecular coordination of αβ T-cell receptors and coreceptors CD8 and CD4 in their recognition of peptide-MHC ligands[J]. Trends Immunol, 2002, 23(8): 408-413.
[22] CHANDRAN SS, KLEBANOFF CA. T cell receptor-based cancer immunotherapy: Emerging efficacy and pathways of resistance[J]. Immunol Rev, 2019, 290(1): 127-147.
[23] KEAM SJ. Afamitresgene autoleucel: first approval[J]. Mol Diagn Ther, 2024, 28(6): 861-866.
[24] MANFREDI F, CIANCIOTTI BC, POTENZA A, et al. TCR redirected T cells for cancer treatment: achievements, hurdles, and goals[J]. Front Immunol, 2020, 11: 1689.
[25] JULVE M, LYTHGOE MP, LARKIN J, et al. Lifileucel: the first cellular therapy approved for solid tumours[J]. Trends Cancer, 2024, 10(6): 475-477.
[26] LE BLANC K, DAZZI F, ENGLISH K, et al. ISCT MSC committee statement on the US FDA approval of allogenic bone-marrow mesenchymal stromal cells[J]. Cytotherapy, 2025, 27(4): 413-416.
[27] ETRA A, FERRARA JLM, LEVINE JE. Remestemcel-L-rknd (Ryoncil): the first approved cellular therapy for steroid-refractory acute GVHD[J]. Blood, 2025, 146(16): 1897-1901.
[28] LASSITER M, LAIL C. Omidubicel-Onlv: The First Commercially Available Alternative Allogeneic Hematopoietic Stem Cell Transplantation Donor Source[J]. Clin J Oncol Nurs, 2025, 29(3): 230-236.
[29] WANG JL, FAN WH, LIU B, et al. Encapsulated cell technology: Delivering cytokines to treat posterior ocular diseases[J]. Pharmacol Res, 2024, 203: 107159.
[30] KAUPER K, MCGOVERN C, SHERMAN S, et al. Two-year intraocular delivery of ciliary neurotrophic factor by encapsulated cell technology implants in patients with chronic retinal degenerative diseases[J]. Invest Ophthalmol Vis Sci, 2012, 53(12): 7484.
[31] URNOV F, KASSIM S, MUSUNURU K, et al. Advancing gene-editing platforms to improve the viability of rare-disease therapeutics: key insights from a 2024 Scientific Exchange hosted by ARM ISCT and Danaher[J]. Cytotherapy, 2025, 27(10): 1151-1163.
[32] PACESA M, PELEA O, JINEK M. Past, present, and future of CRISPR genome editing technologies[J]. Cell, 2024, 187(5): 1076-1100.
[33] WOOD AJ, LO TW, ZEITLER B, et al. Targeted genome editing across species using ZFNs and TALENs[J]. Science, 2011, 333(6040): 307.
[34] DOUDNA JA, CHARPENTIER E. The new frontier of genome engineering with CRISPR-Cas9[J]. Science, 2014, 346(6213): 1258096.
[35] JIANG HB, TANG MY, XU ZD, et al. CRISPR/Cas9 system and its applications in nervous system diseases[J]. Genes Dis, 2024, 11(2): 675-686.
[36] US Food and Drug Administration. FDA approves first gene therapies to treat patients with sickle cell disease[BE/OL].(2023-08-12)[2026-03-10].https://www.fda.gov/news-events/press-announcements/fda-approves-first-gene-therapies-treat-patients-sickle-cell-disease.
[37] LIU SC, FENG YL, SUN XN, et al. Target residence of Cas9-sgRNA influences DNA double-strand break repair pathway choices in CRISPR/Cas9 genome editing[J]. Genome Biol, 2022, 23(1): 165.
[38] CAMPBELL ST. Approval of the first CRISPR-Cas9 gene editing therapy for sickle cell disease[J]. Clin Chem, 2024, 70(10): 1298.
[39] GILLMORE JD, GANE E, TAUBEL J, et al. CRISPR-Cas9 in vivo gene editing for transthyretin amyloidosis[J]. N Engl J Med, 2021, 385(6): 493-502.
[40] ANZALONE AV, KOBLAN LW, LIU DR. Genome editing with CRISPR-Cas nucleases, base editors, transposases and prime editors[J]. Nat Biotechnol, 2020, 38(7): 824-844.
[41] ANZALONE AV, RANDOLPH PB, DAVIS JR, et al. Search-and-replace genome editing without double-strand breaks or donor DNA[J]. Nature, 2019, 576(7785): 149-157.
[42] ERION DM, LIU LY, BROWN CR, et al. Editing approaches to treat alpha-1 antitrypsin deficiency[J]. Chest, 2025, 167(2): 444-452.
[43] BEAM THERAPEUTICS. Beam Therapeutics Announces Positive Initial Data for BEAM-302 in the Phase 1/2 Trial in Alpha-1 Antitrypsin Deficiency (AATD), Demonstrating First Ever Clinical Genetic Correction of a Disease-causing Mutation[EB/OL].(2025-03-10)[2026-03-10].https://investors.beamtx.com/news-releases/news-release-details/beam-therapeutics-announces-positive-initial-data-beam-302-phase/.
[44] RIDER NL, JAMESON MB, CREECH CB. Chronic granulomatous disease: epidemiology, pathophysiology, and genetic basis of disease[J]. J Pediatr Infect Dis Soc, 2018, 7(suppl_1): S2-S5.
[45] KUHNS DB, HSU AP, SUN D, et al. NCF1 (p47phox)-deficient chronic granulomatous disease: comprehensive genetic and flow cytometric analysis[J]. Blood Adv, 2019, 3(2): 136-147.
[46] GORI JL, HADDAD E, FRANGOUL H, et al. Prime Editing for p47phox-Deficient Chronic Granulomatous Disease[J]. N Engl J Med, 2025, 394: 1195-1203.
[47] MOLLA G, BITEW M. Revolutionizing personalized medicine: synergy with multi-omics data generation, main hurdles, and future perspectives[J]. Biomedicines, 2024, 12(12): 2750.
[48] BATES TR, LEWIS BD, BURNETT JR, et al. Late-onset carbamoyl phosphate synthetase 1 deficiency in an adult cured by liver transplantation[J]. Liver Transplant, 2011, 17(12): 1481-1484.
[49] MUSUNURU K, GRANDINETTE SA, WANG X, et al. Patient-specific in vivo gene editing to treat a rare genetic disease[J]. N Engl J Med, 2025, 392(22): 2235-2243.
[50] KAMIMURA K, SUDA T, ZHANG GS, et al. Advances in gene delivery systems[J]. Pharm Med, 2011, 25(5): 293-306.
[51] DANAEIFAR M. Recent advances in gene therapy: genetic bullets to the root of the problem[J]. Clin Exp Med, 2023, 23(4): 1107-1121.
[52] NASO MF, TOMKOWICZ B, PERRY WL, et al. Adeno-associated virus (AAV) as a vector for gene therapy[J]. BioDrugs, 2017, 31(4): 317-334.
[53] ZWI-DANTSIS L, MOHAMED S, MASSARO G, et al. Adeno-associated virus vectors: principles, practices, and prospects in gene therapy[J]. Viruses, 2025, 17(2): 239.
[54] ISSA SS, SHAIMARDANOVA AA, SOLOVYEVA VV, et al. Various AAV serotypes and their applications in gene therapy: an overview[J]. Cells, 2023, 12(5): 785.
[55] RODRIGUES GA, SHALAEV E, KARAMI TK, et al. Pharmaceutical development of AAV-based gene therapy products for the eye[J]. Pharm Res, 2018, 36(2): 29.
[56] UPADHYAY AK, QAMAR H, MATLOOB S, et al. Safety and efficacy results from a phase 1/2 clinical trial of ocu400 modifier gene therapy for treatment of retinitis pigmentosa[J]. Cytotherapy, 2024, 26(6): S18.
[57] BATTY P, LILLICRAP D. Advances and challenges for hemophilia gene therapy[J]. Hum Mol Genet, 2019, 28(R1): R95-R101.
[58] RANGARAJAN S, WALSH L, LESTER W, et al. AAV5-factor VIII gene transfer in severe hemophilia A[J]. N Engl J Med, 2017, 377(26): 2519-2530.
[59] HEO YA. Etranacogene dezaparvovec: first approval[J]. Drugs, 2023, 83(4): 347-352.
[60] AL-ZAIDY SA, MENDELL JR. From clinical trials to clinical practice: practical considerations for gene replacement therapy in SMA type 1[J]. Pediatr Neurol, 2019, 100: 3-11.
[61] HOY SM. Delandistrogene moxeparvovec: first approval[J]. Drugs, 2023, 83(14): 1323-1329.
[62] EGLI M, MANOHARAN M. Chemistry, structure and function of approved oligonucleotide therapeutics[J]. Nucleic Acids Res, 2023, 51(6): 2529-2573.
[63] TAMBUYZER E, VANDENDRIESSCHE B, AUSTIN CP, et al. Therapies for rare diseases: therapeutic modalities, progress and challenges ahead[J]. Nat Rev Drug Discov, 2020, 19(2): 93-111.
[64] CROOKE ST, BAKER BF, CROOKE RM, et al. Antisense technology: an overview and prospectus[J]. Nat Rev Drug Discov, 2021, 20(6): 427-453.
[65] KOTELIANSKI V, ZATSEPIN T, KOTELEVTSEV Y. Lipid nanoparticles for targeted siRNA delivery-going from bench to bedside[J]. Int J Nanomed, 2016, 11: 3077-3086.
[66] ADAMS D, GONZALEZ-DUARTE A, O'RIORDAN WD, et al. Patisiran, an RNAi therapeutic, for hereditary transthyretin amyloidosis[J]. N Engl J Med, 2018, 379(1): 11-21.
[67] BENSON MD, WADDINGTON-CRUZ M, BERK JL, et al. Inotersen treatment for patients with hereditary transthyretin amyloidosis[J]. N Engl J Med, 2018, 379(1): 22-31.
[68] MILLER TM, CUDKOWICZ ME, GENGE A, et al. Trial of antisense oligonucleotide tofersen forSOD1ALS[J]. N Engl J Med, 2022, 387(12): 1099-1110.
[69] MEANS JC, MARTINEZ-BENGOCHEA AL, LOUISELLE DA, et al. Rapid and scalable personalized ASO screening in patient-derived organoids[J]. Nature, 2025, 638(8049): 237-243.
[70] ROSSI G, MANFRIN A, LUTOLF MP. Progress and potential in organoid research[J]. Nat Rev Genet, 2018, 19(11): 671-687.
[71] CORRÒ C, NOVELLASDEMUNT L, LI VSW. A brief history of organoids[J]. Am J Physiol Cell Physiol, 2020, 319(1): C151-C165.
[72] CALÀ G, SINA B, DE COPPI P, et al. Primary human organoids models: Current progress and key milestones[J]. Front Bioeng Biotechnol, 2023, 11: 1058970.
[73] PARK SE, GEORGESCU A, HUH D. Organoids-on-a-chip[J]. Science, 2019, 364(6444): 960-965.
[74] BERKERS G, VAN MOURIK P, VONK AM, et al. Rectal organoids enable personalized treatment of cystic fibrosis[J]. Cell Rep, 2019, 26(7): 1701-1708.e3.
[75] DE POEL E, SPELIER S, HAGEMEIJER MC, et al. FDA-approved drug screening in patient-derived organoids demonstrates potential of drug repurposing for rare cystic fibrosis genotypes[J]. J Cyst Fibros, 2023, 22(3): 548-559.
[76] RUMSEY JW, LORANCE C, JACKSON M, et al. Classical complement pathway inhibition in a “human-on-A-chip” model of autoimmune demyelinating neuropathies[J]. Adv Ther, 2022, 5(6): 2200030.
[77] HUANG KX, CHANDAK P, WANG QW, et al. A foundation model for clinician-centered drug repurposing[J]. Nat Med, 2024, 30(12): 3601-3613.
[78] MUMAU MD, GONZALEZ MV, MA CY, et al. Identifying and targeting TNF signaling in idiopathic multicentric castleman's disease[J]. N Engl J Med, 2025, 392(6): 616-618.
[79] TONG S, MOYO B, LEE CM, et al. Engineered materials for in vivo delivery of genome-editing machinery[J]. Nat Rev Mater, 2019, 4(11): 726-737.
[80] GENTRY K, LIAN LM, KIM H, et al. Glycolipid nanoparticles target the spleen and detarget the liver without charge[J]. Proc Natl Acad Sci USA, 2025, 122(45): e2409569122.
[81] BOUTIN J, CAPPELLEN D, ROSIER J, et al. ON-target adverse events of CRISPR-Cas9 nuclease: more chaotic than expected[J]. CRISPR J, 2022, 5(1): 19-30.
[82] MAKKAR SK. Advances in RNA-based therapeutics: current breakthroughs, clinical translation, and future perspectives[J]. Front Genet, 2025, 16: 1675209.
[83] LI XL, PAN B, SONG XQ, et al. Breast cancer organoids from a patient with giant papillary carcinoma as a high-fidelity model[J]. Cancer Cell Int, 2020, 20(1): 86.
[84] ZHI W, LIU ML, YANG D, et al. Analysis of marketed orphan drugs in China[J]. Intractable Rare Dis Res, 2023, 12(3): 132-140.
[85] 曹永芳, 唐湘燕, 武铮, 等. 我国罕见病药品审评审批现状分析[J]. 中国新药杂志, 2024, 33(13): 1316-1320.
[86] ZHU XY, CHEN Y. Bridging the new drug access gap between China and the United States and its related policies[J]. Front Pharmacol, 2024, 14: 1296737.
[87] 杨润锋, 王乾, 田侃. 孤儿药注册审评制度的国际现状及对我国的启示[J]. 中国新药杂志, 2025, 34(9): 911-917.
[88] 凌星, 范冰冰, 郭文. 《鼓励研发申报儿童药品清单》实施现状与成效[J]. 中国医药工业杂志, 2025, 56(5): 694-701.
[89] 张晓敏, 刘晓溪, 黄哲. 真实世界证据用于罕见病监管决策的思考[J]. 中国新药杂志, 2024, 33(22): 2314-2317.

基金资助

中国工程院咨询项目“‘十五五’时期我国生物医药发展的前沿技术突破和战略工程布局研究”(2025-JZ-09)

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