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• What is gene therapy?
• How does gene therapy work?
• What is the current status of gene therapy research?
• What factors have kept gene therapy from becoming an effective treatment for genetic disease?
• What are some recent developments in gene therapy research?
• What are some of the ethical considerations for using gene therapy?
• Gene therapy links

What is gene therapy?

Genes, which are carried on chromosomes, are the basic physical and functional units of heredity. Genes are specific sequences of bases that encode instructions on how to make proteins. Although genes get a lot of attention, it’s the proteins that perform most life functions and even make up the majority of cellular structures. When genes are altered so that the encoded proteins are unable to carry out their normal functions, genetic disorders can result.

Gene therapy is a technique for correcting defective genes responsible for disease development. Researchers may use one of several approaches for correcting faulty genes:

• A normal gene may be inserted into a nonspecific location within the genome to replace a nonfunctional gene. This approach is most common.
  
  
• An abnormal gene could be swapped for a normal gene through homologous recombination.
  
  
• The abnormal gene could be repaired through selective reverse mutation, which returns the gene to its normal function.
  
  
• The regulation (the degree to which a gene is turned on or off) of a particular gene could be altered.

How does gene therapy work?

In most gene therapy studies, a "normal" gene is inserted into the genome to replace an "abnormal," disease-causing gene. A carrier molecule called a vector must be used to deliver the therapeutic gene to the patient's target cells. Currently, the most common vector is a virus that has been genetically altered to carry normal human DNA. Viruses have evolved a way of encapsulating and delivering their genes to human cells in a pathogenic manner. Scientists have tried to take advantage of this capability and manipulate the virus genome to remove disease-causing genes and insert therapeutic genes.

Target cells such as the patient's liver or lung cells are infected with the viral vector. The vector then unloads its genetic material containing the therapeutic human gene into the target cell. The generation of a functional protein product from the therapeutic gene restores the target cell to a normal state. See a diagram depicting this process.

Some of the different types of viruses used as gene therapy vectors:

• Retroviruses - A class of viruses that can create double-stranded DNA copies of their RNA genomes. These copies of its genome can be integrated into the chromosomes of host cells. Human immunodeficiency virus (HIV) is a retrovirus.
  
  
• Adenoviruses - A class of viruses with double-stranded DNA genomes that cause respiratory, intestinal, and eye infections in humans. The virus that causes the common cold is an adenovirus.
  
  
• Adeno-associated viruses - A class of small, single-stranded DNA viruses that can insert their genetic material at a specific site on chromosome 19.
  
  
• Herpes simplex viruses - A class of double-stranded DNA viruses that infect a particular cell type, neurons. Herpes simplex virus type 1 is a common human pathogen that causes cold sores.

Besides virus-mediated gene-delivery systems, there are several nonviral options for gene delivery. The simplest method is the direct introduction of therapeutic DNA into target cells. This approach is limited in its application because it can be used only with certain tissues and requires large amounts of DNA.

Another nonviral approach involves the creation of an artificial lipid sphere with an aqueous core. This liposome, which carries the therapeutic DNA, is capable of passing the DNA through the target cell's membrane.

Therapeutic DNA also can get inside target cells by chemically linking the DNA to a molecule that will bind to special cell receptors. Once bound to these receptors, the therapeutic DNA constructs are engulfed by the cell membrane and passed into the interior of the target cell. This delivery system tends to be less effective than other options.

Researchers also are experimenting with introducing a 47th (artificial human) chromosome into target cells. This chromosome would exist autonomously alongside the standard 46 --not affecting their workings or causing any mutations. It would be a large vector capable of carrying substantial amounts of genetic code, and scientists anticipate that, because of its construction and autonomy, the body's immune systems would not attack it. A problem with this potential method is the difficulty in delivering such a large molecule to the nucleus of a target cell.

What is the current status of gene therapy research?

The Food and Drug Administration (FDA) has not yet approved any human gene therapy product for sale. Current gene therapy is experimental and has not proven very successful in clinical trials. Little progress has been made since the first gene therapy clinical trial began in 1990. In 1999, gene therapy suffered a major setback with the death of 18-year-old Jesse Gelsinger. Jesse was participating in a gene therapy trial for ornithine transcarboxylase deficiency (OTCD). He died from multiple organ failures 4 days after starting the treatment. His death is believed to have been triggered by a severe immune response to the adenovirus carrier.

Another major blow came in January 2003, when the FDA placed a temporary halt on all gene therapy trials using retroviral vectors in blood stem cells. FDA took this action after it learned that a second child treated in a French gene therapy trial had developed a leukemia-like condition. Both this child and another who had developed a similar condition in August 2002 had been successfully treated by gene therapy for X-linked severe combined immunodeficiency disease (X-SCID), also known as "bubble baby syndrome."

FDA's Biological Response Modifiers Advisory Committee (BRMAC) met at the end of February 2003 to discuss possible measures that could allow a number of retroviral gene therapy trials for treatment of life-threatening diseases to proceed with appropriate safeguards. In April of 2003 the FDA eased the ban on gene therapy trials using retroviral vectors in blood stem cells.

What factors have kept gene therapy from becoming an effective treatment for genetic disease?

• Short-lived nature of gene therapy - Before gene therapy can become a permanent cure for any condition, the therapeutic DNA introduced into target cells must remain functional and the cells containing the therapeutic DNA must be long-lived and stable. Problems with integrating therapeutic DNA into the genome and the rapidly dividing nature of many cells prevent gene therapy from achieving any long-term benefits. Patients will have to undergo multiple rounds of gene therapy.
  
  
• Immune response - Anytime a foreign object is introduced into human tissues, the immune system is designed to attack the invader. The risk of stimulating the immune system in a way that reduces gene therapy effectiveness is always a potential risk. Furthermore, the immune system's enhanced response to invaders it has seen before makes it difficult for gene therapy to be repeated in patients.
  
  
• Problems with viral vectors - Viruses, while the carrier of choice in most gene therapy studies, present a variety of potential problems to the patient --toxicity, immune and inflammatory responses, and gene control and targeting issues. In addition, there is always the fear that the viral vector, once inside the patient, may recover its ability to cause disease.
  
  
• Multigene disorders - Conditions or disorders that arise from mutations in a single gene are the best candidates for gene therapy. Unfortunately, some the most commonly occurring disorders, such as heart disease, high blood pressure, Alzheimer's disease, arthritis, and diabetes, are caused by the combined effects of variations in many genes. Multigene or multifactorial disorders such as these would be especially difficult to treat effectively using gene therapy. For more information on different types of genetic disease, see Genetic Disease Information.
  

What are some recent developments in gene therapy research?

• Nanotechnology + gene therapy yields treatment to torpedo cancer. March, 2009. The School of Pharmacy in London is testing a treatment in mice, which delivers genes wrapped in nanoparticles to cancer cells to target and destroy hard-to-reach cancer cells. Read BBC article.

• Results of world's first gene therapy for inherited blindness show sight improvement. 28 April 2008. UK researchers from the UCL Institute of Ophthalmology and Moorfields Eye Hospital NIHR Biomedical Research Centre have announced results from the world’s first clinical trial to test a revolutionary gene therapy treatment for a type of inherited blindness. The results, published today in the New England Journal of Medicine, show that the experimental treatment is safe and can improve sight. The findings are a landmark for gene therapy technology and could have a significant impact on future treatments for eye disease. Read Press Release.

  Previous information on this trial (May 1, 2007): A team of British doctors from Moorfields Eye Hospital and University College in London conduct first human gene therapy trials to treat Leber's congenital amaurosis, a type of inherited childhood blindness caused by a single abnormal gene. The procedure has already been successful at restoring vision for dogs. This is the first trial to use gene therapy in an operation to treat blindness in humans. See Doctors Test Gene Therapy to Treat Blindness at www.reuters.com.
  
  
• A combination of two tumor suppressing genes delivered in lipid-based nanoparticles drastically reduces the number and size of human lung cancer tumors in mice during trials conducted by researchers from The University of Texas M. D. Anderson Cancer Center and the University of Texas Southwestern Medical Center. See Dual Gene Therapy Suppresses Lung Cancer in Preclinical Test at www.newswise.com (January 11, 2007).
  
  
• Researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, successfully reengineer immune cells, called lymphocytes, to target and attack cancer cells in patients with advanced metastatic melanoma. This is the first time that gene therapy is used to successfully treat cancer in humans. See New Method of Gene Therapy Alters Immune Cells for Treatment of Advanced Melanoma at www.cancer.gov (August 30, 2006).
  
  
• Gene therapy is effectively used to treat two adult patients for a disease affecting nonlymphocytic white blood cells called myeloid cells. Myeloid disorders are common and include a variety of bone marrow failure syndromes, such as acute myeloid leukemia. The study is the first to show that gene therapy can cure diseases of the myeloid system. See Gene Therapy Appears to Cure Myeloid Blood Diseases In Groundbreaking International Study at www.cincinnatichildrens.org (March 31, 2006).
  
  
• Gene Therapy cures deafness in guinea pigs. Each animal had been deafened by destruction of the hair cells in the cochlea that translate sound vibrations into nerve signals. A gene, called Atoh1, which stimulates the hair cells' growth, was delivered to the cochlea by an adenovirus. The genes triggered re-growth of the hair cells and many of the animals regained up to 80% of their original hearing thresholds. This study, which many pave the way to human trials of the gene, is the first to show that gene therapy can repair deafness in animals. See Gene Therapy is First Deafness 'Cure' at NewScientist.com (February 11, 2005).
  
  
• University of California, Los Angeles, research team gets genes into the brain using liposomes coated in a polymer call polyethylene glycol (PEG). The transfer of genes into the brain is a significant achievement because viral vectors are too big to get across the "blood-brain barrier." This method has potential for treating Parkinson's disease. See Undercover Genes Slip into the Brain at NewScientist.com (March 20, 2003).
  
  
• RNA interference or gene silencing may be a new way to treat Huntington's. Short pieces of double-stranded RNA (short, interfering RNAs or siRNAs) are used by cells to degrade RNA of a particular sequence. If a siRNA is designed to match the RNA copied from a faulty gene, then the abnormal protein product of that gene will not be produced. See Gene Therapy May Switch off Huntington's at NewScientist.com (March 13, 2003).
  
  
• New gene therapy approach repairs errors in messenger RNA derived from defective genes. Technique has potential to treat the blood disorder thalassaemia, cystic fibrosis, and some cancers. See Subtle Gene Therapy Tackles Blood Disorder at NewScientist.com (October 11, 2002).
  
  
• Gene therapy for treating children with X-SCID (sever combined immunodeficiency) or the "bubble boy" disease is stopped in France when the treatment causes leukemia in one of the patients. See 'Miracle' Gene Therapy Trial Halted at NewScientist.com (October 3, 2002).
  
  
• Researchers at Case Western Reserve University and Copernicus Therapeutics are able to create tiny liposomes 25 nanometers across that can carry therapeutic DNA through pores in the nuclear membrane. See DNA Nanoballs Boost Gene Therapy at NewScientist.com (May 12, 2002).
  
  
• Sickle cell is successfully treated in mice. See Murine Gene Therapy Corrects Symptoms of Sickle Cell Disease from March 18, 2002, issue of The Scientist.

What are some of the ethical considerations for using gene therapy?

 --Some Questions to Consider...

• What is normal and what is a disability or disorder, and who decides?
  
  
• Are disabilities diseases? Do they need to be cured or prevented?
  
  
• Does searching for a cure demean the lives of individuals presently affected by disabilities?
  
  
• Is somatic gene therapy (which is done in the adult cells of persons known to have the disease) more or less ethical than germline gene therapy (which is done in egg and sperm cells and prevents the trait from being passed on to further generations)? In cases of somatic gene therapy, the procedure may have to be repeated in future generations.
  
  
• Preliminary attempts at gene therapy are exorbitantly expensive. Who will have access to these therapies? Who will pay for their use?

Gene Therapy Links

General Information

• MEDLINEplus: Genes and Gene Therapy - Access news, information from the National Institutes of Health, clinical trials information, research, and more.
• Recombinant DNA and Gene Transfer - National Institutes of Health Guidelines
• Questions and Answers about Gene Therapy - A fact sheet from the National Cancer Institute.
• Introduction to Gene Therapy - An overview by Access Excellence.
• Gene Therapy and Children - From KidsHealth for Parents.
• Pioneering gene treatment gives frail toddler a new lease of life
• Genetic modification - An overview of gene therapy
• How to Turn on a Gene - An article from Wired Magazine.
• How Viruses Are Used in Gene Therapy - From The DNA Files, a series of radio programs from SoundVision Productions.
• Human Gene Therapy: Present and Future - A Human Genome News article.
• Ethical Issues in Human Gene Therapy - A Human Genome News article.
• Virtual Library on Genetics: Gene Therapy
• Gene Therapy - A NewsHour with Jim Lehrer transcript covering the death of gene therapy patient, Jesse Gelsinger (February 2, 2000).
• Animations from the Tokyo Medical University Department of Pediatrics Genetics Study Group
  • Animations of Induction of Genes (Gene Therapy)
  • Animations of Problems in Gene Therapy

FDA Information

• FDA Cellular and Gene Therapy --details about and links to all FDA gene therapy information
• FDA Advisory Committee Discusses Steps for Potentially Continuing Certain Gene Therapy Trials That Were Recently Placed on Hold - 2/28/2003
• FDA Places Temporary Halt On Gene Therapy Trials Using Retroviral Vectors In Blood Stem Cells - 1/14/2003
• New Initiatives to Protect Participants in Gene Therapy Trials - 3/7/2000
• Human Gene Therapy and The Role of the Food and Drug Administration - An overview from the Center for Biologics Evaluations and Research of the U.S. Food and Drug Administration.
• Human Gene Therapy Harsh Lessons, High Hopes - An article published in the September-October 2000 issue of FDA Consumer magazine.
• The Last Word: Researchers React to Gene Therapy's Pitfalls and Promises - An article published in the September-October 2000 issue of FDA Consumer magazine.
• Fundamentals of Gene Therapy - Diagrams and basic description of gene therapy from the FDA.

Gene Therapy Clinical Trials

• Gene therapy studies in ClinicalTrials.gov - The U.S. National Institutes of Health resource for public access to information on clinical research studies.
• Gene Therapy Clinical Trials - Access to a worldwide database of gene therapy clinical trials at this Web site from the publishers of The Journal of Gene Medicine. To search the database, click on "Interactive Database" at the top of the page. Access to charts, statistics, and abstracts from clinical trials results also provided.

Professional Associations

• American Society of Gene Therapy
• Australasian Gene Therapy Society (AGTS)
• European Society of Gene and Cell Therapy (ESGCT)
• Gene therapy societies' listing from Gene Therapy Net

Gene Therapy Journals
(Scientific, peer-reviewed publications targeted to clinicians and researchers. Access to full-text articles in these journals typically requires a subscription.)

• Cancer Gene Therapy - From the publishers of Nature.
• Current Gene Therapy - From Bentham Science Publishers.
• Gene Therapy - From the publishers of Nature.
• Human Gene Therapy - Journal published by Mary Anne Liebert, Inc.
• The Journal of Gene Medicine - Official journal of the European Society of Gene Therapy (ESGT), Japan Society of Gene Therapy (JSGT), and the Australasian Gene Therapy Society (AGTS).
• Molecular Therapy - A monthly journal published by the American Society of Gene Therapy (ASGT).

Other Publications

• Vector - Magazine of the Gene Therapy Center at the University of Alabama at Birmingham. Issues available for download as PDF.