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Type I SMA is the most common genetic cause of death in infancy and accounts for about 50% of all patients with SMA. Most forms of SMA are caused by mutations of the survival motor neuron (<jats:italic>SMN1<\/jats:italic>) gene. A second gene that is 99% identical to <jats:italic>SMN1<\/jats:italic> (<jats:italic>SMN2<\/jats:italic>) is located in the same region. The only functionally relevant difference between the two genes identified to date is a C\u2009\u2192\u2009T transition in exon 7 of <jats:italic>SMN2<\/jats:italic>, which determines an alternative spliced isoform that predominantly excludes exon 7. Thus, <jats:italic>SMN2<\/jats:italic> genes do not produce sufficient full length SMN protein to prevent the onset of the disease. Since the identification of the causative mutation, biomedical research of SMA has progressed by leaps and bounds: from clues on the function of SMN protein, to the development of different models of the disease, to the identification of potential treatments, some of which are currently in human trials. The aim of this review is to elucidate the current state of knowledge, emphasizing how close we are to the solution of the puzzle that is SMA, and, more importantly, to highlight the missing pieces of this puzzle. Filling in these gaps in our knowledge will likely accelerate the development and delivery of efficient treatments for SMA patients and be a prerequisite towards achieving our final goal, the cure of SMA. \u00a9 2013 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajmg.a.36251","type":"journal-article","created":{"date-parts":[[2013,10,12]],"date-time":"2013-10-12T02:36:56Z","timestamp":1381545416000},"page":"2836-2845","source":"Crossref","is-referenced-by-count":21,"title":["Solving the puzzle of spinal muscular atrophy: What are the missing pieces?"],"prefix":"10.1002","volume":"161","author":[{"given":"Francesco Danilo","family":"Tiziano","sequence":"first","affiliation":[{"name":"Istituto di Genetica Medica Universit\u00e0 Cattolica del Sacro Cuore Roma Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Melki","sequence":"additional","affiliation":[{"name":"UMR 788 Inserm et Universit\u00e9 Paris 11, H\u00f4pital Bicetre le 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