Gene therapy and genome-editing for schwannoma in NF2-related schwannomatosis: current understanding and future directions

NF2-related schwannomatosis (NF2-SWN) is a rare genetic disorder characterized by bilateral vestibular schwannomas. NF2-SWN represents a difficult management problem with most patients facing substantial morbidity and reduced life expectancy. Gene therapy involves replacing a faulty gene or adding a new gene in an attempt to cure disease or improve the patient's condition. Several studies of gene therapy for NF2-SWN have utilized adeno-associated viral vector serotype-1 (AAV1) to deliver apoptosis-inducing enzyme, the pore-forming protein gasdermin-d, apoptosis-associated speck-like protein containing a caspase recruitment domain, and functional merlin causing schwannoma regression in a xenograft mouse model. These studies support the potential therapeutic efficacy of gene therapy against NF2-SWN. Currently, gene therapy approaches primarily include bystander-killing effect by inducing immune responses, gene replacement or augmentation therapy, and gene knockdown and replacement combination approach through genome-editing technology. Although these gene therapeutic strategies have shown potential in preclinical animal model studies, they still face many specific challenges apart from the traditional challenges in gene therapy, such as immunogenicity, delivery vector, manufacturing, and long-term effects of treatments. In this article, we discuss the current understanding and future directions of gene therapy and genome-editing for schwannoma in NF2-SWN.