Concepts and Principles of Gene Therapy

Main Article Content

Naowarat Suthamnatpong
Aranya Ponpornpisit

Abstract

The concept of gene therapy has been around for over a hundred years. However, the research and development for proving the efficacy and safety of gene therapy is tremendously time-consuming and requires huge investments. Moreover, application of gene therapy depends on management techniques of genetic materials which has advanced rapidly just recently. The history of clinical trials on gene therapy from the past to the present reveals both successes and failures. Correspondingly, a clinical trial on gene therapy has to be approved by scientific review and an ethics committee to check that the benefits outweigh the risk. At present, there are several approved gene therapy products for treatment of some diseases, while many products are currently undergoing late phase of clinical trials or waiting for approval. The development of gene therapy is adapted accordingly to the innovations such as CRISPR/Cas9 gene editing that enables the utilization and modernization of gene therapy. In this review, we describe about concepts and principles of gene therapy, namely, the definition, key events in the history of gene therapy, therapeutic indications, type of gene therapy, strategy of gene therapy, ex vivo and in vivo gene therapy, delivery systems, immune responses and adverse drug reactions, and lastly we address some concerns about ethical issues.

Article Details

Section
Review Article

References

Alshaera, W., H. Zureigat, A. Al-Karaki, A. Al-Kadash, L. Gharaibeh, M. M. Hatmal, A. A. A. Aljabali, and A. Awidi. 2021. siRNA: Mechanism of action, challenges, and therapeutic approaches. Eur. J. Pharmacol. 905: 174178.

Hacein-Bey-Abina S., A. Garrigue, G. P. Wang, J. Soulier, A. Lim, E. Morillon, E. Clappier, L. Caccavelli, E. Delabesse, K. Beldjord, V. Asnafi, E. MacIntyre, L. D. Cortivo, I. Radford, N. Brousse, F. Sigaux, D. Moshous, J. Hauer, A. Borkhardt, B. H. Belohradsky, U. Wintergerst, M. C. Velez, L. Leiva, R. Sorensen, N. Wulffraat, S. Blanche, F. D. Bushman, A. Fischer, and M. Cavazzana-Calvo. 2008. Insertional oncogenesis in 4 patients after retrovirus-mediated gene therapy of SCID-X1. J. Clin. Investig. 118:3132-3142.

Arabi, F., V. Mansouri, and N. Ahmadbeigi. 2022. Gene therapy clinical trials, where do we go? An overview. Biomed. Pharmacother. 153:113324.

Arber, W. and S. Linn. 1969. DNA modification and restriction. Annu. Rev. Biochem. 38:467-500.

Arruda, V., P. Favaro, and J. Finn. 2009. Strategies to modulate immune responses: a new frontier for gene therapy. Mol. Ther. 17:1492–1503.

Battu, R., D. Ratra, and L. Gopal. 2022. Newer therapeutic options for inherited retinal diseases: Gene and cell replacement therapy. Indian J Ophthalmol. 70(7):2316-2325.

Biotechnology Innovation Organization. 2018. Ashanthi DeSilva—Very First Gene Therapy Patient. https://www.youtube.com/watch?v=IgES04-cSr8&t=19s&ab_channel=BiotechnologyInnovationOrganization (Accessed 3 November 2022).

Blaese, R. M., K. W. Culver, A. D. Miller, C. S. Carter, T. Fleisher, M. Clerici, G. Shearer, L. Chang, Y. Chiang, P. Tolstoshev, J. J. Greenblatt, S. A. Rosenberg, H. Klein, M. Berger, C. A. Mullen, W. J. Ramsey, L. Muul, R. A. Morgan, and W. F. Anderson. 1995. T lymphocyte-directed gene therapy for ADA-SCID: initial trial results after 4 years. Science. 270:475-480.

Boye, S. E., S. L. Boye, A. S. Lewin, A. SLewin, and W. W. Hauswirth. 2013. A comprehensive review of retinal gene therapy. Mol. Ther. 21(3):509–519.

Bucher, K., E. Rodríguez-Bocanegra, D. Dauletbekov, and M. D. Fischer. 2021. Immune responses to retinal gene therapy using adeno-associated viral vectors–Implications for treatment success and safety. Prog. Retin. Eye Res. 83:100915.

Cavazzana-Calvo, M., S. Hacein-Bey, G. de Saint Basile, F. Gross, E. Yvon, P. Nusbaum, F. Selz, C. Hue, S. Certain, J. L. Casanova, P. Bousso, F. L. Deist, and A. Fischer. 2000. Gene therapy of human severe combined immunodeficiency (SCID)-X1 disease. Science. 288:669-672.

Chakraborty, C., A. Sharma, G. Sharma, C. Doss, and S. Lee. 2017. Therapeutic miRNA and siRNA: moving from bench to clinic as next generation medicine. Mol. Ther. Nucleic. Acids. 8:132–143.

Chavez, M., X. Chen, P. Finn, and L. Qi. 2022. Advances in CRISPR therapeutics. Nat. Rev. Nephrol. 24:1-14.

Chen, Y., R. Wen, Z. Yang, and Z. Chen. 2022. Genome editing using CRISPR/Cas9 to treat hereditary hematological disorders. Gene Ther. 29:207–216.

Choi, S. H. and J. F. Engelhardt. 2021. Gene therapy for cystic fibrosis: Lessons learned and paths forward. Mol. Ther. 29(2):428-430.

Cideciyan, A. V., W. W. Hauswirth, T. S. Aleman, S. Kaushal, S. B. Schwartz, S. L. Boye, E. A. M. Windsor, T. J. Conlon, A. Sumaroka, J. J. Pang, A. J. Roman, B. J. Byrne, S. G. Jacobson. 2009. Human RPE65 gene therapy for Leber congenital amaurosis: Persistence of early visual improvements and safety at 1 year. Hum. Gene. Ther. 20(9):999-1004.

Cohen, J. 2022. As creator of ‘CRISPR babies’ nears release from prison, where does embryo editing stand?. https://www.science.org/content/article/creator-crispr-babies-nears-release-prison-where-does-embryo-editing-stand. (Accessed 3 November 2022)

Cyranoski, D. 2018. CRISPR-baby scientist fails to satisfy critics. Nature. 564(7734):13-14.

Davies, K. 2022. 30 years of progress from positional cloning to precision genome editing. Nat. Genet. 54:908–910.

Deng, Y., C. Wang, K. Choy, Q. Du, J. Chen, Q. Wang, L. Li, T. K. H. Chung, and T. Tang. 2014. Therapeutic potentials of gene silencing by RNA interference: Principles, challenges, and new strategies. Gene. 538(2):217-227.

Doxzen, K. 2022. 8 things you should know about gene therapy. https://www.weforum.org/agenda/2022/09/what-is-gene-therapy-things-you-should-know/ (Accessed 3 November 2022)

European Medicines Agency. 2016. Summary of opinion. Strimvelis. Autologous CD34+-enriched cell fraction that contains CD34+ cells transduced with retroviral vector that encodes for the human ADA cDNA sequence. http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/003854/WC500203918.pdf (Accessed 3 November 2022).

Faldu, K. and J. Shah. 2022. Gene therapy for retina and eye diseases. In: Gene Delivery Systems. 1st ed. CRC Press, London. p. 17-36.

Fire, A., S. Xu, M. Montgomery, S. Kostas, S. Driver, and C. Mello. 1998. Potent and specific genetic interference by double-stranded RNA in Caenorhabditis elegans. Nature. 391:806–811.

Frangoul, H., D. Altshuler, M. D. Cappellini, Y. S. Chen, J. Domm, B. K. Eustace, J. Foell, J. de la Fuente, S. Grupp, R. Handgretinger, T. W. Ho, A. Kattamis, A. Kernytsky, J. Lekstrom-Himes, A. M. Li, F. Locatelli, M. Y. Mapara, M. de Montalembert, D. Rondelli, A. Sharma, S. Sheth, S. Soni, M. H. Steinberg, D. Wall, A. Yen, S. Corbacioglu. 2021. CRISPR-Cas9 gene editing for sickle cell disease and beta-thalassemia. N. Engl. J. Med. 384:252-260.

French, A. W. 1990. September 14, 1990: The beginning. Hum. Gene. Ther. 1:371-372.

Friedmann, T. 1992. A brief history of gene therapy. Nat. Genet. 2:93-98.

Friedmann, T. and R. Roblin. 1972. Gene therapy for human genetic disease? Science. 175:949–955.

Gayong, S., K. Dongyoon, L. Quoc-Viet, T. Gyu, K. Taekhyun, and O. Yu-Kyoung. 2018. Nonviral delivery systems for cancer gene therapy: strategies and challenges. Curr. Gene. Ther. 18(1):3-20.

Gillmore, J., E. Gane, J. Taubel, J. Kao, M. Fontana, M. L. Maitland, J. Seitzer, D. O'Connell, K. R. Walsh, K. Wood, J. Phillips, Y. Xu, A. Amaral, A. P. Boyd, J. E. Cehelsky, M. D. McKee, A. Schiermeier, O. Harari, A. Murphy, C. A. Kyratsous, B. Zambrowicz, R. Soltys, D. E. Gutstein, J. Leonard, L. Sepp-Lorenzino, and D. Lebwohl. 2021. CRISPR-Cas9 in vivo gene editing for transthyretin amyloidosis. N. Engl. J. Med. 385:493-502.

Gruber, K. 2012. Europe gives gene therapy the green light. Lancet. 380:e10.

Hacein-Bey-Abina, S., A. Garrigue, G. P. Wang, J. Soulier, A. Lim, E. Morillon, E. Clappier, L. Caccavelli, E. Delabesse, K. Beldjord, V. Asnafi, E. MacIntyre, L. Dal Cortivo, I. Radford, N. Brousse, F. Sigaux, D. Moshous, J. Hauer, A. Borkhardt, B. H. Belohradsky, U. Wintergerst, M. C. Velez, L. Leiva, R. Sorensen, N. Wulffraat, S. Blanche, F.D. Bushman, A. Fischer, and M. Cavazzana-Calvo. 2008. Insertional oncogenesis in 4 patients after retrovirus-mediated gene therapy of SCID-X1. J. Clin. Investig. 118:3132-3142.

Hacein-Bey-Abina, S., C. von Kalle, M. Schmidt, F. Le Deist, N. Wulffraat, E. McIntyre, I. Radford, J. L. Villeval, C. C. Fraser, M. Cavazzana-Calvo, and A. Fischer. 2003. A serious adverse event after successful gene therapy for X-linked severe combined immunodeficiency. N. Engl. J. Med. 348(3): 255-266.

Hanna, E., C. Rémuzat, P. Auquier, and M. Toumi. 2017. Gene therapies development: slow progress and promising prospect. J. Mark. Access Health Policy. 5(1):1265293.

Hildt, E. 2016. Human germline interventions-think first. Front. Genet. 7:81-98.

Howe, S. J., M. R. Mansour, K. Schwarzwaelder, C. Bartholomae, M. Hubank, H. Kempski, M. H. Brugman, K. Pike-Overzet, S. J. Chatters, D. de Ridder, K. C. Gilmour, S. Adams, S. I. Thornhill, K. L. Parsley, F. J. T. Staal, R. E. Gale, D. C. Linch, J. Bayford, L. Brown, M. Quaye, C. Kinnon, P. Ancliff, D. K. Webb, M. Schmidt, C. von Kalle, H. B. Gaspar, and A. J. Thrasher. 2008. Insertional mutagenesis combined with acquired somatic mutations causes leukemogenesis following gene therapy of SCID-X1 patients. J. Clin. Investig, 118:3143-3150.

Imbert, M., G. Dias-Florencio, and A. Goyenvalle. 2017. Viral vector-mediated antisense therapy for genetic diseases. Genes. 8(2):51-74.

Jablonka, S., L. Hennlein, and M. Sendtner. 2022. Therapy development for spinal muscular atrophy: perspectives for muscular dystrophies and neurodegenerative disorders. Neurol. Res. Pract. 4:Article number 2.

King, N. P. and C. E. Bishop. 2017. New treatments for serious conditions: ethical implications. Gene Ther. 24:534-538.

Landhuis, E. 2021. The definition of gene therapy has changed. https://www.nature.com/articles/d41586-021-02736-8 (Accessed date: 3 November 2022)

Lederberg, J. 1963. Molecular biology, eugenics and euphenics. Nature. 198:428–429.

Ledford, H. 2022. How scientists are trying to make gene therapy safer. Nature. 606:443-444.

Lehman, I. R. 1974. DNA ligase: structure, mechanism, and function. Science 186:790-797.

Li, Y., W. Guo, X. Li, J. Zhang, M. Sun, Z. Tang, W. Ran, K. Yang, G. Huang, and Li, L. (2021). Expert consensus on the clinical application of recombinant adenovirus human p53 for head and neck cancers. Int. J. Oral Sci. 13:38-57.

Liang, M. 2018. Oncorine, the world first oncolytic virus medicine and its update in China. Curr. Cancer Drug Targets. 18:171-176.

Liu, Z., Z. Li, and B. Li. 2022. Nonviral delivery of CRISPR/Cas systems in mRNA format. Adv. NanoBiomed. Res. 2200082:1-16.

Lu, J. and G. Jiang. 2022. The journey of CAR-T therapy in hematological malignancies. Mol. Cancer. 21:194-202.

Ma, C., Z. Wang, T. Xu, Z. He, and Y. Wei. 2020. The approved gene therapy drugs worldwide: from 1998 to 2019. Biotechnol. Adv. 40:107502.

Mahajan, R. 2019. Onasemnogene abeparvovec for spinal muscular atrophy: the costlier drug ever. Int. J. Appl. Basic Med. Res. 9:127-128.

Merrouche, Y., S. Negrier, C. Bain, V. Combaret, A. Mercatello, B. Coronel, J. F. Moskovtchenko, P. Tolstoshev, R. Moen, and T. Philip. 1995. Clinical application of retroviral gene transfer in oncology: Results of a French study with tumor-infiltrating lymphocytes transduced with the gene of resistance to neomycin. J. Clin. Oncol. 13(2):410-418.

Misaki, Y., I. Ezaki, T. Ariga, N. Kawamura, Y. Sakiyama, and K. Yamamoto. 2001. Gene-transferred oligoclonal T cells predominantly persist in peripheral blood from an adenosine deaminase-deficient patient during gene therapy. Mol. Ther. 3(1):24-27.

Mulligan, R. C. 1993. The basic science of gene therapy. Science. 260:926-932.

Murphy, K. and C. Weaver. 2022. Janeway's Immunobiology. 9th ed. Garland Science, New York.

Nashimoto, M. 2022. True gene silencing. Int. J. Mol. Sci. 23(10):5387.

National Academies of Sciences, Engineering, & Medicine. 2017. Human genome editing, science, ethics, and governance. The National Academies Press. Washington DC.

Nelson, J. P., C. L. Selin, and C. T. Scott. 2021. Toward anticipatory governance of human genome editing: A critical review of scholarly governance discourse. J. Responsible Innov. 8(3):382-420.

Nóbrega, C., L. Mendonça, and C. A. Matos. 2020. Gene and cell therapy. In: A handbook of gene and cell therapy. Springer Cham, Switzerland, AG. p. 1-22.

Nuijten, M. 2022. Pricing Zolgensma-the world’s most expensive drug. J. Mark. Access Health Policy. 10(1):2022353.

Onodera, M., D. M. Nelson, Y. Sakiyama, F. Candotti, and R. M. Blaese. 1999. Gene therapy for severe combined immunodeficiency caused by adenosine deaminase deficiency: improved retroviral vectors for clinical trials. Acta. Haematol. 101:89-96.

Padhy, S., B. Takkar, R. Narayanan, P. Venkatesh, and S. Jalali. 2020. Voretigene, neparvovec and gene therapy for leber’s congenital amaurosis: review of evidence to date. Appl. Clin. Genet. 13:179-208.

Philippidis, A. 2022. Novartis confirms deaths of two patients treated with gene therapy Zolgensma. Hum. Gene Ther. 33(17-18):842-844.

Portin, P. and A. Wilkins. 2017. The evolving definition of the term “gene”. Genetics. 205:1353-1364.

Prado, D. A., M. Acosta-Acero, and R. S. Maldonado. 2020. Gene therapy beyond luxturna: a new horizon of the treatment for inherited retinal disease. Curr. Opin. Ophthalmol. 31(3):147-154.

Raper, S. E., N. Chirmule, F. S. Lee, N. A. Wivel, A. Bagg, G. P. Gao, J. M. Wilson, M. L. Batshaw. 2003. Fatal systemic inflammatory response syndrome in a ornithine transcarbamylase deficient patient following adenoviral gene transfer. Mol. Genet. Metab. 80:148-158.

Reilly, A., L. Chehade, and R. Kothary. 2022. Curing SMA: Are we there yet? Gene Ther. https://doi.org/10.1038/s41434-022-00349-y.

Rosenberg, S. A., P. Aebersold, K. Cornetta, A. Kasid, R. A. Morgan, R. Moen, E. M. Karson, M. T. Lotze, J. C. Yang, S. L. Topalian, M. J. Merino, K. Culver, A. D. Miller, R. M. Blaese, and W. F. Anderson. 1990. Gene transfer into humans—immunotherapy of patients with advanced melanoma, using tumor-infiltrating lymphocytes modified by retroviral gene transduction. N. Engl. J. Med. 323:570–578.

Sack, B. and R. Herzog. 2009. Evading the immune response upon in vivo gene therapy with viral vectors. Curr. Opin. Mol. Ther. 11:493–503.

Sandor, J. 2022. Genome editing: Learning from its past and envisioning its future. Eur. J. Health Law, 29(3-5):341–358.

Sarvari, R., M. Nouri, S. Agbolaghi, L. Roshangar, A. Sadrhaghighi, A. Seifalian, and P. Keyhanvar. 2022. A summary on non-viral systems for gene delivery based on natural and synthetic polymers. Int. J. Polym. Mater. Polym. Biomater. 71(4):246-265.

Sayed, N., P. Allawadhi, A. Khurana, V. Singh, U. Navik, S. K. Pasumarthi, I. Khurana, A. K. Banothu, R. Weiskirchen, and K. K. Bharani. (2022). Gene therapy: Comprehensive overview and therapeutic applications. Life. Sci. 294:120375.

Secord, E. and N. L. Hartog. 2022. Review of treatment for adenosine deaminase deficiency (ADA) severe combined immunodeficiency (SCID). Ther. Clin. Risk. Manag. 18:939–944.

Seimetz, D., K. Heller, and J. Richter. 2019. Approval of first CAR-Ts: Have we solved all hurdles for ATMPs? Cell. Med. 11:2155179018822781.

Shahryari, A., M. S. Jazi, S. Mohammadi, H. R. Nikoo, Z. Nazari, E. S. Hosseini, I. Burtscher, S. J. Mowla, and H. Lickert. 2019. Development and clinical translation of approved gene therapy products for genetic disorders. Front. Genet. 10:868-881.

Shmakova, A. A., O. P. Shmakova, A. A. Karpukhina, and Y. S. Vassetzky. 2022. CRISPR/Cas: History and Perspectives. Russ. J. Dev. Biol. 53:272–282.

Sung, Y. and S. Kim. 2019. Recent advances in the development of gene delivery systems. Biomater. Res. 23:8.

US FDA. 2017. FDA approval brings first gene therapy to the United States. https://www.fda.gov/news-events/press-announcements/fda-approval-brings-first-gene-therapy-united-states. (Accessed 3 November 2022).

US FDA. 2018. What is gene therapy. https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/what-gene-therapy#:~:text=Gene%20therapy%20is%20a%20technique,that%20is%20not%20functioning%20properly. (Accessed 3 November 2022).

Wang, S., C. Gao, Y.-M. Zheng, L. Yi, J. Lu, X. Huang, J-B. Cai, P-F. Zhang, Y-H. Cui, A.W. Ke. 2022. Current applications and future perspective of CRISPR/Cas9 gene editing in cancer. Mol. Cancer. 21:57-84.

Watson, J. D. and F. H. Crick. 1953. Molecular structure of nucleic acids; a structure for deoxyribose nucleic acid. Nature. 171:737-738.

Williams, D. A., I. R. Lemischka, D. G. Nathan, and R. C. Mulligan. 1984. Introduction of new genetic material into pluripotent haematopoietic stem cells of the mouse. Nature. 310:476-480.

Wolff, J. A. and J. Lederberg. 1994. An early history of gene transfer and therapy. Hum. Gene Ther. 5:469-480.

Yahya, E. and A. Alqadhi. 2021. Recent trends in cancer therapy: A review on the current state of gene delivery. Life Sci. 269:119087.

Zhang, H., C. Zhang, J. Wang, Y. Yang, Y. Wei, Z. Zhang, and Y. Wang. 2021. Governance of Emerging Biotechnologies: Lessons from Two Chinese Cases. Am. J. Bioeth. 22(1):56-58.

Zhang, W. W., L. Li, D. Li, J. Liu, X. Li, W. Li, X. Xu, M. J. Zhang, L. A. Chandler, H. Lin, A. Hu, W. Xu, and D. M-K. Lam. (2018). The first approved gene therapy product for cancer Ad-p53 (gendicine): 12 years in the clinic. Hum. Gene Ther. 29:160-179.

Zhao, Z., A. C. Anselmo, and S. Mitragotri. 2022. Viral vector-based gene therapies in the clinic. Bioeng. Transl. Med. 7(1):e10258