Current Gene Therapy - Volume 5, Issue 1, 2005

Androgen ablation is the choice of treatment for patients with advanced prostate cancer. Although untreated tumors are mostly androgen-dependent, hormone withdrawal is only palliative. The major problem in prostate cancer treatment represents the progression to androgen-independent growth during therapy, rendering current strategies inefficient. Thus, there is an urgent need to develop novel treatments to combat therapy-resistant prostate cancer. Intensive research strongly improved the knowledge about the molecular changes, which are believed to occur during prostate carcinogenesis and progression to androgen-independence. This in turn led to the identification of several interesting genes, which may be useful as targets for prostate cancer gene therapy. In fact, there is a broad range of different gene therapy approaches in the field of prostate cancer, some of which have already progressed to clinical evaluation in patients. Promising data and best benefit for patients currently provide studies where gene therapy strategies are combined with conventional treatments like chemotherapy or radiation. In this review we will give an overview of several interesting gene therapy concepts and delivery systems in prostate cancer and discuss their usefulness in the clinic.

Ribozymes are RNA molecules that have the ability to catalyse the cleavage and formation of covalent bonds in RNA strands at specific sites. The “hammerhead” motif, approximately 30-nucleotide long, is the smallest endonucleolytic cis-acting ribozyme structure found in natural circular RNAs of some plant viroids. Hammerhead ribozymes became appealing when it was shown that it is possible to produce trans-acting ribozymes directed against RNA sequences of interest. Since then, gene-tailored ribozymes have been designed, produced and given to cells to knock down the expression of specific genes. At present, this technology has advanced so much that many hammerhead ribozymes are being used in clinical trials. With this work we would provide some guidelines to design efficient trans-acting hammerhead ribozymes as well as review the recent results obtained with them as gene therapy tools.

The recent incidents of leukemia development in X-SCID patients after a successful treatment of the disease with retroviral gene therapy raised concerns regarding the safety of the use of retroviral vectors in clinical gene therapy. In this review, we have tried to re-evaluate the safety issues related to the use of retroviral vectors in human clinical trials and to suggest possible appropriate solutions to the issues. As revealed by the X-SCID incident, oncogenesis caused by retroviral insertional activation of host genes is one of the most prominent risks. An ultimate solution to this problem will be in re-engineering retroviral vectors so that the retroviral insertion takes place only at the desired specific sites of the host cell chromosome. This is, however, a technically demanding tasks, and it will take years to develop retroviral vectors with targeted insertion capability. In the mean time, the use of chromatin insulators can reduce chances for retrovirus-mediated oncogenesis by inhibiting non-specific activation of nearby cellular proto-oncogenes. Co-transduction of a suicidal gene under the control of an inducible promoter could also be one of the important safety features, since destruction of transduced cells can be triggered if abnormal growth is observed. Additionally, conditional expression of the transgene only in appropriate target cells via the combination of targeted transduction, cell type-specific expression, and targeted local administration will increase the overall safety of the retroviral systems. Finally, splitting of the viral genome, use of self-inactivating (SIN) retroviral vectors, or complete removal of the coding sequences for gag, pol, and env genes is desirable to virtually eliminate the possibility of generation of replication competent retroviruses (RCR).

Current treatment modalities for musculoskeletal injuries due to disease or trauma often implement the use of tissue grafts, cell transplantations, and artificial scaffolding. These approaches may be augmented with the use of specific biological factors, which accelerate healthy tissue regeneration. Unfortunately, the short half-life and inherent instability of proteins requires the delivery of high doses or multiple doses of these molecules, neither of which is ideal for the patient or clinician. Gene therapy, as an alternative approach, has the potential to circumvent the existing limitations associated with protein delivery by producing a sustained release of the biologic agent at therapeutic levels. This is achieved by the direct transfer of the gene encoding the therapeutic agent to the cells of the afflicted tissue or by implanting cells that have been previously genetically modified in vitro. Using these methods, several laboratories have demonstrated the ability to deliver genes in vitro and in vivo resulting in accelerated and enhanced musculoskeletal tissue regeneration or inhibited disease progression. Many of these investigations, which involved bone, ligament, tendon, and cartilage, are covered in this review. Specifically, musculoskeletal tissue anatomy, factors relevant to musculoskeletal tissue regeneration, target cells, and in vivo and ex vivo gene therapy approaches for musculoskeletal regeneration are discussed. The experience and knowledge gained from these studies have affirmed gene therapy is a promising therapeutic strategy to combat musculoskeletal tissue repair and regeneration following disease or injury.

Solid tumours present numerous obstacles for efficient systemic delivery of therapeutic agents. This goal has to face specific problems related to the nature of each targeting element, but also the physical barriers posed by tumours, such as heterogeneous blood supply and elevated interstitial pressure. These barriers impair the delivery to tumours of antibodies or viral particles. Immune cells are supposed to be endowed with the ability to target tumours, but in general, tumour cells themselves provide poor targets for immunological responses. A key challenge of tumour gene therapy (cell carrier- and / or viral vector-mediated) is to control the site at which genes are expressed by instructing cells or virus or to distinguish between target and non-target tissue. Thus, antibody-directed targeting of virus or cells could potentially improve both the safety and the efficacy of therapeutic gene delivery to tumours. Furthermore, virus production can rely on carrier cells under the transcriptional control of a factor activated after specific triggering of a tumour-specific receptor. Given that any of these anti-tumour strategies by themselves have fulfilled their therapeutic potential, we propose here their combination for developing more effective anti-cancer therapies.

Therapy for Parkinson's disease (PD), a common neurological disorder characterized by pathological degeneration of the nigrostriatal dopaminergic system, remains unsatisfactory. Gene therapy is considered one of the most promising approaches to developing a novel effective treatment for PD. Among the numerous candidate genes that have been tested as therapeutic agents, those encoding tyrosine hydroxylase, guanosine triphosphate cyclohydrolase I and aromatic L-amino acid decarboxylase all boost dopamine production, while glial cell line-derived neurotrophic factor promotes the survival of dopaminergic neurons and is generally believed to possess the greatest potential for successful restoration of the dopaminergic system. The genes encoding vesicular monoamine transporter-2 and glutamic acid decarboxylase have also produced therapeutic effects in animal models of PD. Both viral and non-viral vectors, each with its particular advantages and disadvantages, have been used to deliver these genes into the brain. Whether or not regulatable expression systems are essential to successful gene therapy for PD remains a critical issue in the clinical application of this emerging treatment. Here we review the current status of gene therapy for PD, including the application of control systems for transgene expression in the brain.

Gene therapy has been investigated in many aspects of plastic and reconstructive surgery. These areas ultimately involve various forms of tissue healing and the manipulation of bony and soft tissues to reconstruct defects secondary to neoplastic and congenital disorders and trauma. Most research has been limited to animal studies with the exception of clinical trials on the use of gene therapy in lower leg ulcer healing and as an adjunct to advanced recurrent squamous cell carcinoma of the head and neck. Overall, these preliminary studies have produced optimistic results. With the development of more efficient and safer delivery systems, the application of gene therapy in plastic surgery could become more widespread, especially in combination with tissue engineering technology.

Introduction of gene therapy into molecular medicine has been gaining increasing interest. Although treatment of various diseases e.g. monogenetic defects or cancer by using gene transfer technologies has been extensively probed, the clinical success has been limited. However, recent experimental data suggest that gene therapy may represent an attractive and powerful approach in preventing ischemia / reperfusion injury as well as organ rejection in transplant recipients. Easy and selective access to the donor organ facilitates the reduction of potentially harmful systemic side effects of gene therapy vectors. By introducing anti-apoptotic or cytoprotective genes, these studies focused on the protection of the transplant from the apoptotic cell death. In addition, down-regulation of adhesion molecules and / or blockade of gene expression in the graft itself also ameliorated ischemia / reperfusion injury. This review summarizes the current progress on gene therapy application in combating ischemia-reperfusion injury in organ transplantation. Although the use of viral vectors is emphasized, non-viral gene transfer techniques are also discussed. Future development of novel, low-immunogenic vectors should further contribute to the minimization of ischemia / reperfusion injury, and thus to the overall success of organ transplantation.

The incidence of prostate cancer has dramatically increased worldwide in the past decade, with mortality rates also increasing in many countries. Once prostate cancer is diagnosed, it is important to rapidly begin a treatment regimen that is either potentially curative or impedes disease progression. When the disease is confined to the prostate, it can be cured by radical prostatectomy or irradiation therapy. However, there are no curative therapies for locally advanced, recurrent, or metastatic diseases. Clearly, new therapies are needed for these patients. Gene therapy may provide additional therapeutic options with the potential to affect both localized and metastatic disease. Virus-mediated transduction of the herpes simplex virus thymidine kinase (HSV-tk) gene transfer, followed by a course of the prodrug ganciclovir (GCV), so-called suicide gene therapy, has been demonstrated by several investigators. The present in situ gene therapy clinical trial for human prostate cancer demonstrated safety, clinical efficacy, and biological effects of antitumor activity. HSV-tk clinical trials for prostate cancer are also ongoing in Japan, the Netherlands, and Mexico. Currently, numerous preclinical studies have reported immunomodulatory cytokine gene therapy, such as interleukin-2, interleukin-12, B7-1 (CD80), B7-2 (CD86) and granulocyte-macrophage colony-stimulating factor. Several clinical studies have been approved that potentially will show that these immunomodulatory gene therapies may generate an effective local and systemic antitumor activity and that should provide options for patients with prostate cancer. We review the multiple issues involved in current in situ gene therapy (gene / immunotherapy), its outcome, and future directions for patients with prostate cancer.

Graft versus host disease (GVHD) is a T cell mediated phenomenon that arises following allogeneic haematopoietic stem cell transplantation, and may be particularly severe in the context of human leukocyte antigen (HLA) mismatched procedures. Although GVHD can be largely abrogated through T cell depletion, such measures result in loss of graft potency and reduced anti-viral and anti-leukaemic effects. The genetic modification of T cells to carry a suicide gene mechanism has been advocated as means of allowing T cells to be harnessed for their beneficial effects, and safely eliminated in the event of significant GVHD. The feasibility of the strategy has been demonstrated in clinical studies using T cells modified by retroviral transduction to encode the herpes simplex thymidine kinase (HSVTK) gene to treat patients with haematological malignancies. However, a number of limitations associated with current protocols have become apparent. Most notably, the process of retroviral transduction, which requires pre-activation of T cells, appears to impair subsequent functional potential. Efforts are now directed towards circumventing the pre-activation requirements of retroviral vectors by using alternative lentiviral systems, in association with improved suicide gene / prodrug combinations.

Cancer gene therapy is the most promising and active field in gene therapy treatment. Although previous experimental and clinical trials have brought forward some exciting cases, in general, the clinical benefits have been limited. A major difference between virus-mediated gene therapy and other therapies is the poor physical diffusibility of viral vectors, which is also one of the major obstacles in cancer gene therapy. As safety is a prerequisite to enhanced viral dissemination, tumor-specific targeting becomes crucial. The present review focuses on questions related to efficient viral dissemination in tumor masses and how to sustain a high level of oncolytic virus targeting of tumor cells only. We will first consider two common reasons for limited virus spread in tumor masses and then discuss strategies for improving the tumor-specific oncolysis of currently used viral vectors and to comment on their advantages and potential problems.