Asian Journal of Pediatric Research

Angelman syndrome is a severe neurodevelopmental disorder arising from functional loss of the maternal allele of UBE3A, a gene that sits within a cluster of imprinted loci on the long arm of chromosome 15. Expression across this region is governed by a bipartite imprinting centre associated with the SNRPN gene, made up of two physically separated but functionally interdependent elements: the Prader–Willi syndrome smallest region of deletion overlap and the Angelman syndrome smallest region of deletion overlap. Together these elements establish, in the germline, and maintain, throughout somatic life, the parent-of-origin-specific expression pattern that distinguishes Angelman syndrome from its reciprocal disorder, Prader–Willi syndrome. Because the paternal copy of UBE3A remains structurally intact in most patients with Angelman syndrome, merely silenced by a long non-coding antisense transcript whose own expression is dictated by the imprinting centre, this locus has become the focal point of an unusually concentrated translational effort: rather than replacing a missing gene, contemporary therapeutic strategies aim to reverse an epigenetic mark and thereby unmask a dormant but functional allele. This review draws together the structural biology of the bipartite imprinting centre, the molecular events that establish and maintain its parent-specific epigenotype, the diagnostic and clinical consequences of its disruption, and the rapidly maturing pipeline of antisense oligonucleotides, small molecules, and genome- or epigenome-editing tools designed to exploit this biology therapeutically. Recent clinical trial data, including electroencephalographic and behavioural endpoints from antisense oligonucleotide programmes, are critically appraised alongside preclinical work on CRISPR-based epigenetic editing of the imprinting centre itself, an approach with the conceptual elegance of intervening at the very switch that imprinting biology depends upon. The review concludes that while no disease-modifying therapy is yet approved, the convergence of detailed mechanistic understanding of the SNRPN bipartite imprinting centre with scalable epigenetic editing technologies represents the most plausible route towards a transformative, rather than purely symptomatic, treatment for Angelman syndrome, while candidly addressing the developmental, safety and translational obstacles that remain.