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Noushin rajaeie What is Gene Therapy A technique for correcting defective genes that are responsible for disease development.There are four approaches: 1. A normal gene inserted to compensate for a nonfunctional gene. 2. An abnormal gene traded for a normal gene 3. An abnormal gene repaired through selective reverse mutation 4. Change the regulation of gene pairs Gene therapy requires three things: the identification of thedefect at the molecular level a correcting gene a way tointroduce the gene into appropriate host cells (i.e., a vector). Choices of Vectors For Gene therapy: Viral vectors: Non-viral vectors: • • • • Retrovirus adenovirus Adeno-associated virus Herpes Simplex Virus • Liposome • DNA–polymer conjugates • Naked DNA The ideal vector system for gene therapy: (1) an adequate carrying capacity (2) to be undetectable by the immune system (3) to be non-inflammatory (4) to be safe to the patients with pre-existing lung inflammation. (5) to have an efficiency sufficient to correct the cystic fibrosis phenotype. (6) to have long duration of expression and/or the ability to be safely re-administered. The history of gene thropy: In the 1980:Scientists began to look into gene therapy. In the 1990:The first gene therapy was performed for treatment of SCID. In the1993 : Trials using liposome-mediated CFTR gene transfer In the1995:The first cystic fibrosis gene therapy clinical trials used an adenovirus vector In the 1998:Trials using adeno-associated virus to deliver gene. How Gene Therapy With Virus Works: A vector delivers the therapeutic gene into a patient’s target cell. 2) The target cells become infected with the viral vector. 3) The vector’s genetic material is inserted into the target cell. 4) The therapeutic gene causing the cell to return to a normal state. 1) B C A a beneficial gene A virus modified virus A virus insert its genes into the host cell's genome. This virus has three genes - A, B and C: 1)Gene A encodes a protein which allows this virus to insert itself into the host's genome. 2)Genes B and C actually cause the disease this virus is associated with. 3)Replace B and C with a beneficial gene. Thus, the modified virus could introduce your 'good gene' into the host cell's genome without causing any disease. Adeno-associated virus (AAV) A small virus which infects humans and some other primate species. AAV dose not cause disease AAV causes a very mild immune response. AAV is a candidate for gene therapy. AAV belongs to the genus Dependovirus,turn belongs to the family Parvoviridae. The virus is a small (20 nm). AAV is a replication-defective, non envelopevirus. AAV life cycle: AAV undergoes productive infection in the presence of adenovirus co infection. characterized by: genome replication viral gene expression virion production In the absence of helper virus infection: AAV binds to its receptor, traffics to the nucleus, and integrates into the distal end of chromosome 19. In the presence of an Ad coinfection:the AAV genome is replicated as replicative form monomers and dimers (RFM, RFD) yielding progeny virus. AAV’s life regulated by: 1)complex interactions between the AAV genome and AAV 2) adenoviral 3)host protein (AAV) vectors: Adeno-associated viral (AAV) vectors are based on a non- pathogenic, replication deficient member of the parvovirus family with a 4.7 kb single-stranded DNA genome. AAV-mediated gene transfer is under investigation for treatment of a large number of diseases. Producing recombinant AAV vectors The advantages of (AAV)vectors: AAV is non-pathogenic and safe for use as a vector. All viral genes can be deleted from recombinant AAV (rAAV) vectors. AAV can efficiently infect both dividing and nondividing cells in muscle liver, brain, retina , heart , and pancreas. Vector administration does not elicit a strong cellular immune reaction. The disadvantages with AAV vectors: limited tissue tropism for serotypes targetedgene delivery to specific cell populations. preexisting immunity due to prior exposure of the majority of the human population with multiple AAV serotypes and a limited transgene carrying capacity. AAV CLINICAL TRIALS: AAV vectors have been used in over 38 clinical trials worldwide Including: retinal diseases Hemophilia congestive heart failure lipoprotein lipase deficiency Parkinson's disease Cystic fibrosis Gene Therapy for Cystic Fibrosis: CF, a lethal, autosomal recessive disease in CF the CF transmembrane regulator (CFTR) is inactivated by mutation This mutation leads to the accumulation of thick secretions in the lung CF is an autosomal recessive disease and is the most common lethal genetic disease among whites. Cystic fibrosis as an ideal candidate for gene therapy: 1. it is a single gene defect 2. it is a recessive condition, with heterozygotes being phenotypically normal 3. the main pathology is in the lung, which is accessible for treatment 4. it is a progressive disease with a virtually normal phenotype at birth Hemophilia Two of the required enzymes are factors VIII and IX; a lack of the former results in hemophilia A, and a lack of the latter results in hemophilia B. A factor IX AAV vector could be used to “cure” mice with hemophilia B. Parkinson’s disease • It is a chronic neurodegenerative disease • In Parkinson’s disease, a loss of dopaminergic neurons leads to the loss of inhibitory gamma aminobutyric acid-sensitive input to the subthalamic nucleus. • a study in which 12 patients with advanced Parkinson’s disease had an AAV vector carrying a transgene encoding glutamic acid decarboxylase injected into the subthalamic nucleus on one side References: 1. 2. 3. 4. Berns,K.Daya,sh.(2008) Gene Therapy Using Adeno-Associated Virus Vectors, Clinical Microbiology Reviews, Vol. 21, No. 4:583–593 Collaco,R.F.Tremp,J.P(2000) A Method for Helper Virus-Free Production of Adeno-Associated Virus Vectors. Kenneth,H. Roland,W.Warrington,J.r (2006)Treatment of human disease by adeno-associated viral gene transfer, Hum Genet ,119: 571–603. Kwon,I.Schaffer,D(2008) Designer Gene Delivery Vectors: Molecular Engineering and Evolutionof Adeno-Associated Viral Vectors for Enhanced Gene Transfer, Pharmaceutical Research, Vol. 25, No. 3