Santa Claus and his most bureaucratic and boring reindeer—the Food and Drug Administration—bestowed a gift to the Spinal Muscular Atrophy community this past Christmas by approving the first-ever treatment for the genetic condition. The gift comes in the form of a liquid that gets injected into the spine using a really long and pointy needle. While a chewable pill (a la Flintstone’s vitamins) would have been preferable, I suppose crippled beggars can’t be choosers.
It is estimated that only 1 in 10,000 babies born have Spinal Muscular Atrophy (SMA)— including me. It is the #1 genetic killer of children under two years of age. But, there are a minority of us that manage to live well into adulthood, although our physical strength does slowly deteriorate over time and our life expectancy is abbreviated, or truncated— like Trump’s hands.
One in 50 people are genetic carriers of the condition, but since it’s a recessive gene, it takes two copies of the faulty gene to actually cause SMA. Carriers have one bad gene copy and one regular copy. So, to have a kid with SMA, two carriers have to get together. Even then, there’s only a 25% chance their child will end up with SMA (also known as the fuzzy end of the genetic lollipop).
In those of us with the condition, our SMN1 protein coding genes (located on the 5th chromosome) are, in all honesty, kinda fucked up. This protein is essential in muscle development and maintenance. Without it, we must rely on alternate SMN2 genes as our only source of this essential protein. But, these alternate genes are notoriously wonky and unreliable— like the U.S. Congress.
This newly-approved treatment, Spinraza (nusinersen), is an antisense drug that aims to give the alternative SMN2 genes an extreme makeover— turning them from faulty backup genes into fully functioning supergenes. It’s like what would happen if you grab Charlie Sheen, take his drugs and hookers away, and force him into rehab by tying him to a hospital bed. Eventually it’s going to have an effect on him, right?
Well, that’s the idea of Spinraza. In theory, it’s a pretty great concept. And, in clinical trials with small kids, it’s had miraculous results. Kids that should have died, didn’t—and some showed improvement in muscle function and strength— achieving unexpected milestones.
The FDA approved this treatment for all ages and all types of Spinal Muscular Atrophy. Trial research focused on infants and young children, but treatment has been expanded to include teens and adults. This isn’t a cure-all, and it’s important to note that adults won’t see as dramatic results as the kids do. The data is still coming in, but this is a promising beginning.
This week, I head to the Stanford neuromuscular clinic to discuss Spinraza and see if it will be possible and feasible to get the treatment. Given that it must be periodically injected into the spinal fluid like an epidural, it won’t be an easy undertaking and the results are still uncertain.
I have dueling emotions about this whole thing. I’m optimistic and hopeful— but I don’t want to end up like this year’s Atlanta Falcons, who thought they were totally gonna win the Super Bowl until Tom Brady and his hot manliness came and stole it all away.
When you live your entire life with a disability, it becomes a part of you, shaping your identity, your view of the world, and your own place in it. I wouldn’t be “me” without it. Before this bombshell Spinraza news at Christmas, I never thought there would be a treatment for SMA— at least in my lifetime. I never even imagined it. So, it’s hard to fathom that it may be true.
I’m sure folks in 1969 felt the same way about the Moon Landing. You can’t imagine a man on the moon until you see Neil Armstrong awkwardly toddling around on its chalky surface— like an 18-month-old at Chuck E. Cheese.
We will see how things go. I’m quite nervous and anxious about it. But, if it is logistically feasible to pursue Spinraza, and if there is a chance that it can extend or improve my life, I’m going to give it a go.
Wish me luck… And, I’ll keep you posted.