Advances in the treatment of familial dysautonomia: what does the future hold?

Abstract

Introduction: Familial Dysautonomia (FD) is a rare autosomal recessive genetic disease caused by a single point mutation in the ELP1 gene, leading to a deficiency in the Elongator Protein 1. Management has traditionally focused on symptomatic supportive care and prevention of complications. However, promising disease-modifying treatments are now being developed to correct the underlying splicing defect in ELP1.

Areas covered: The authors searched PubMed, GoogleScholar, and clinicaltrials.gov for all types of studies regarding the genetic basis of FD and recent advances in the development of disease-modifying therapies, including publications available through November 2025.

Expert opinion: Experimental evidence indicates that boosting ELP1 protein levels could halt disease progression. Several small molecules and genetic therapies have shown the ability to enhance wild-type ELP1 mRNA and protein expression in animal models. An ongoing N-of-1 clinical trial is evaluating the intrathecal administration of an antisense oligonucleotide (ASO) designed to correct the splicing defect in an individual with FD. Combining small molecules, such as optimized potent oral kinetin derivatives, with intrathecal antisense oligonucleotides (ASOs) and intravitreal gene therapy using viral vectors presents a synergistic therapeutic approach to elevate ELP1 levels. Assessing the efficacy and safety of these targeted strategies will require innovative, well-designed clinical trials.