Research
Tabrizi is distinguished for her work on mechanisms of cellular neurodegeneration [9] [10] [11] [12] [13] and in particular Huntington's disease mechanistic pathobiology, novel therapeutics, biomarkers, outcome measures and first in human clinical trials. [14] [15] Amongst her achievements, she has identified key pathogenic mechanisms in cellular degeneration in prion disease, [16] [17] [18] identified a key role for the innate immune system in the pathogenesis of Huntington’s disease, [19] published the first assay of the mutant HD protein, [20] and designed and led two major, international, influential research initiatives, TRACK-HD and Track-On HD. To date these studies have yielded fundamental new insights into the preclinical phase of neurodegeneration in Huntington’s disease including identifying predictors of disease onset, [21] [22] [23] [24] [25] [26] [27] progression, evidence of brain compensation and plasticity and neurobiological changes occurring twenty years before predicted disease onset, and her work established a battery of clinical trial outcome measures now being used in global clinical trials. [28] [21] [22] [23] [24] [29] In 2017, her work identified an important new genetic modifier of disease progression in Huntington’s disease (MSH3, a mismatch repair protein), which has opened up new avenues of research into targeting DNA repair pathways as possible therapeutics for Huntington’s disease. [30] [31] [32] A major focus of her research now is to build understanding of how different DNA repair mechanisms are involved in modifying the development of Huntington’s disease. This knowledge to develop novel therapeutic approaches that could stop, slow down or reverse the progression of the disease by targeting the somatic expansion of the CAG repeat tract. [33] [34] [35]
Tabrizi gave a keynote presentation at the 2016 Google Zeitgeist Minds conference about her research, and the prospect of gene silencing for neurodegenerative disease. [36] She was the global lead Clinical Investigator for the first clinical trial of a 'gene silencing' or huntingtin-lowering antisense oligonucleotide (ASO) drug in Huntington's disease patients. The announcement of the ‘top line’ results from the Phase 1b/2a safety trial in December 2017 received widespread national and international media coverage and was covered in features by BBC News, [37] Guardian [38] and Nature. [39] In May 2019 the full results were published in The New England Journal of Medicine. [40] [41]
The potential of antisense oligonucleotides to treat neurodegenerative diseases was reviewed by Tabrizi in Science in 2020. [42] Tabrizi is currently working on several different approaches to treat Huntington’s disease, including testing novel ASOs targeting MSH3 to slow CAG repeat expansion, allele-selective approaches to target mutant HTT only, and new gene therapy approaches targeting the mutant HD gene. [43]
In 2020, Tabrizi published the Huntington’s Disease Young Adult Study (HD-YAS) studying premanifest HD gene carriers approximately 24 years from predicted onset of clinical symptoms using advanced neuroimaging, detailed cognitive testing and biofluid collection. [44] The cohort did not show any clinically meaningful functional impairment, yet there was evidence of elevated levels of neurofilament light protein, suggestive of very early neuronal damage, in those closest to expected symptom onset. HD-YAS will provide critical information on the very earliest signs of neurodegeneration, identifying a time at which a therapy could potentially be introduced to delay or even ultimately prevent the onset of clinical symptoms in HD. [44] This approach has implications beyond HD, providing a model for disease prevention in neurodegeneration and this work continues to be of major interest in the Tabrizi lab. [45]
In 2022, alongside colleagues at the HD Regulatory Science Consortium and CHDI, Tabrizi developed a novel staging framework, the Huntington’s Disease Integrated Staging System (HD-ISS), that assesses the progression of disease from birth. [46] Similar to the cancer staging system, the HD-ISS defines HD in four stages, from 0-3, and also biologically defines the disease as the presence of the HTT CAG repeat mutation. This will allow clinical trials much earlier in course of the disease process, and well in advance of when people show signs and symptoms of the disease, allowing the possibility of disease prevention in the future.
Tabrizi was the subject of profile articles in The Lancet in 2012 and The Lancet Neurology in 2017. [47] [48]
As of May 2024, Tabrizi had authored over 380 publications, with over 39,000 citations for her research. [49]
