Background
Ciliopathies are a class of inherited pleiotropic genetic disorders
in which alterations in cilia assembly, maintenance, and/or function exhibit
penetrance in the multiple organ systems. Olfactory dysfunction is one such
clinical manifestation that has been shown in both patients and model
organisms. Existing therapies for ciliopathies are limited to the treatment
or management of symptoms. The last decade has seen an increase in potential
curative therapeutic options including small molecules and biologics. Recent
work in multiciliated olfactory sensory neurons has demonstrated the
capacity of targeted gene therapy to restore ciliation in terminally
differentiated cells and rescue olfactory function. This review will discuss
the current understanding of the penetrance of ciliopathies in the olfactory
system. Importantly, it will highlight both pharmacological and biological
approaches, and their potential therapeutic value in the olfactory system
and other ciliated tissues.
Methods
We undertook a structured and comprehensive search of peer-reviewed
research literature encompassing in vitro, in vivo, model
organism, and clinical studies. From these publications, we describe the
olfactory system, and discuss the penetrance of ciliopathies and impact of
cilia loss on olfactory function. In addition, we outlined the developing
therapies for ciliopathies across different organ and cell culture systems,
and discussed their potential therapeutic application to the mammalian
olfactory system.
Results
One-hundred sixety-one manuscripts were included in the review,
centering on the understanding of olfactory penetrance of ciliopathies, and
discussing the potential therapeutic options for ciliopathies in the context
of the mammalian olfactory system. Forty-four manuscripts were used to
generate a table listing the known congenital causes of olfactory
dysfunction, with the first ten listed are linked to ciliopathies.
Twenty-three manuscripts were used to outline the potential of small
molecules for the olfactory system. Emphasis was placed on HDAC6 inhibitors
and lithium, both of which were shown to stabilize microtubule structures,
contributing to ciliogenesis and cilia lengthening. Seventy-five manuscripts
were used to describe gene therapy and gene therapeutic strategies. Included
were the implementation of adenoviral, adeno-associated virus (AAV), and
lentiviral vectors to treat ciliopathies across different organ systems and
application toward the olfactory system. Thus far, adenoviral and
AAV-meditated ciliary restoration demonstrated successful proof-of-principle
preclinical studies. In addition, gene editing, ex vivo
gene therapy, and transplantation could serve as alternative therapeutic and
long-term approaches. But for all approaches, additional assessment of
vector immunogenicity, specificity, and efficacy need further investigation.
Currently, ciliopathy treatments are limited to symptomatic management with
no curative options. However, the accessibility and amenability of the
olfactory system t...