Most genetic medicines are built to treat one gene, one mutation, one disease at a time. That's true even for the newest modalities — gene therapy, gene editing, mRNA — each still has to be engineered disease by disease. Alltrna is testing a different idea: that the real target isn't the gene, but the process of translation itself, where genetic instructions become protein. The company's lead approach focuses on nonsense mutations, a shared error responsible for roughly a tenth of all genetic disease diagnoses, and asks whether a single engineered molecule could address it across many conditions at once.

My guest today is Dr. Nerissa Kreher, Chief Medical Officer of Alltrna. Nerissa brings two decades of rare disease drug development experience, including CMO roles at Entrada Therapeutics, Tiburio Therapeutics, and AVROBIO, to the task of turning that platform thesis into an actual clinical program. We'll talk translation, trial design, and what it takes to bring the first engineered tRNA therapy into the clinic.

• 02:45 Meet Nerissa Kreher and Alltrna's tRNA platform
• 07:29 Gene-by-gene versus mutation-by-mutation drug development
• 12:08 What nonsense mutations are and why they matter
• 15:55 Phase 1 trial approval in Australia
• 19:49 What basket trials are and FDA receptiveness
• 27:27 Where Alltrna could be in five years

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To dive deeper into the topic: 

• Beyond Biotech - Episode 66: treating rare diseases with tRNA
• Will tRNA therapy be the next big thing in genetic disease treatment?
• Pharma giants pull back on AAV research: what’s next for the gene therapy space?