Cuestionamientos éticos relacionados con la terapia génica para el tratamiento de enfermedades hereditarias

Abstract

ABSTRACT

The introduction of exogenous genetic sequences named transgenes is known as gene therapy and has the purpose of correcting genotypic and phenotypic alterations in the human organism. This therapy can be carried out in somatic cells or in germinal cells. The ethical questioning related to somatic gene therapy has to do basically with the potential risks for health and the informed consent while germ-line gene therapy has the potential to affect permanently future generations. Since genic therapy involves much more than the simple alteration of genetic sequences, this revision presents the main ethical problems associated with gene therapy for inherited disease.

Keywords:

Terapia génica

consideraciones éticas

enfermedades hereditarias

gene therapy

ethical issues

inherited diseases

References

 Alemany, R. (2007). “Cancer selective adenoviruses”. Mol Aspects Med, 28(1), 42-58.

 Ali, M.; Lemoine, N.R. & Ring, C. J. (1994). “The use of DNA viruses as vectors for gene therapy”. Gene Ther, 1(6), 367-384.

 Anderson, W. F.; Blaese, R. M. & Culver, K. (1990). “The ADA human gene therapy clinical protocol: Points to Consider response with clinical protocol”. Hum Gene Ther, 1(3), 331-362.

 Ariga, T.; Oda, N.; Yamaguchi, K.; Kawamura, N.; Kikuta, H.; Taniuchi, S. et al. (2001). “Tcell lines from 2 patients with adenosine deaminase (ADA) deficiency showed the restoration of ADA activity resulted from the reversion of an inherited mutation”. Blood,97(9):2896-2899.

 Ashorn, M.; Pitkänen, S.; Salo, M. K. & Heikinheimo, M. (2006). “Current strategies for the treatment of hereditary tyrosinemia type I”. Paediatr Drugs, 8(1), 47-54.

 Braas, G.; Searle, P. F.; Slater, N. K. H. & Lyddiatt, A. (1996). “Strategies for the isolation and purification of retroviral vectors for gene therapy”. Bioseparation, 6(4), 211-228.

 Brody, S.L. & Crystal, R. G. (1994). “Adenovirus-mediated in vivo gene transfer”. Ann N Y Acad Sci, 716, 90-101.

 Cabrera-Salazar, M. A.; Novelli, E. & Barranger, J. A. (2002). “Gene therapy for the lysosomal storage disorders”. Curr Opin Mol Ther, 4, 1464-8431.

 Cavazzana-Calvo, M.; Lagresle, C.; Hacein-Bey-Abina, S.; Fischer, A. (2005). “Gene therapy for severe combined immunodeficiency”. Annu Rev Med, 56, 585-602.

 Cavazzana-Calvo, M.; Hacein-Bey, S.; De Saint Basile, G.; Gross, F.; Yvon, E.; Nusbaum, P.et al. (2000). “Gene therapy of human severe combined immunodeficiency (SCID)-X1 disease”. Science, 288, 669-672.

 Cheng, S. H. & Smith, A. E. (2003). “Gene therapy progress and prospects: gene therapy of lysosomal storage disorders”. Gene Ther, 10, 1275-1281.

 Cheng, S. H.; Ziegler, R.; Barbon, S.; Disnick, R.; Schuchman, E. (2004). “Efficacy of AAVmediated expression of ASM in Niemann-Pick B mice”. J Inherit Metab Dis, 27(suppl 1),162.

 Department of health and human services. Part 46.“Protection of human subjects”.http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm.

 Dettweiler, U. & Simon, P. (2001). “Points to consider for ethics committees in human gene therapy trials”. Bioethics, 15(5-6), 491-500.

 Escors, D. & Breckpot, K. (2010). “Lentiviral vectors in gene therapy: their current status and future potential”. Arch Immunol Ther Exp (Warsz), 58(2), 107-119.

 “Gen therapy clinical trials world wide”. (2010). J Gene Med.http://www.wiley.co.uk/genmed/clinical/

 Griesenbach, U.; Ferrari, S.; Geddes, D. M. & Alton, E.W.F.W. (2002). “Gene therapy progress and prospects: cystic fibrosis”. Gene Ther, 9,1344-1350.

 Hacein-Bey-Abina, S.; Fischer, A. & Cavazzana-Calvo, M. (2002). “Gene therapy of X-linked severe combined immunodeficiency”. Int J Hematol, 76(4), 295-298.

 Hacein-Bey-Abina, S.; Von Kalle, C.; Schmidt, M.; Le Deist, F.; Wulffraat, N.; McIntyre, E. et al. (2003a). “A serious adverse event after successful gene therapy for X-linked severe combined immunodeficiency”. N Engl J Med, 348(3), 255-256.

 Hacein-Bey-Abina, S.; Von Kalle, C.; Schmidt, M.; McCormack, M. P.; Wulffraat, N.; Leboulch, P. et al. (2003b). “LMO2-associated clonal T cell proliferation in two patients after gene therapy for SCID-X1”. Science, 302(5644), 415-419.

 Hart, S. L. (2010). “Multifunctional nanocomplexes for gene transfer and gene therapy”. Cell Biol Toxicol, 26(1), 69-81.

 Heilbronn, R. & Weger, S. (2010). “Viral vectors for gene transfer: current status of gene therapeutics”.Handb Exp Pharmacol, 197, 143-170.

 Hoatlin, M. E.; Kozak, S. L.; Spiro, C. & Kabat, D. (1995). “Amplified and tissue directed expression of retroviral vectors using ping-pong techniques”. J Mol Med, 73(3), 113-120.

 Katz, R. V.; Green, B. L.; Kressin, N. R.; Kegeles, S. S.; Wang, M. Q.; James, S. A. et al. (2008). “The legacy of the Tuskegee Syphilis Study: assessing its impact on willingness to participate in biomedical studies”. J Health Care Poor Underserved, 19(4):1168-1180.

 Kay, M. A.; Manno, C. S.; Ragni, M. V.; Larson, P. J.; Couto, L. B.; McClelland, A. et al.(2000). “Evidence for gene transfer and expression of factor IX in haemophilia B patients treated with an AAV vector”. Nat Genet, 24(3), 257-261.

 Lander, E.S.; Linton, L.M.; Birren, B.; Nusbaum, C.; Zody, M.C.; Baldwin, J. et al. (2001). “Initial sequencing and analysis of the human genome”. Nature, 409, 860-921.

 Laufs, S.; Gentner, B.; Nagy, K. Z.; Jauch, A.; Benner, A.; Naundorf, S. et al. (2003).“Retroviral vector integration occurs in preferred genomic targets of human bone marrowrepopulating cells”. Blood, 101(6), 2191-2198.

 Lazo, P. A. & Tsichlis, P. N. (1990). “Biology and pathogenesis of retroviruses”. Semin Oncol, 17(3), 269-294.

 Manno, C. S. (2002). “Gene therapy for bleeding disorders”. Curr Opin Hematol, 9(6), 511-515.

 Manno, C. S.; Chew, A. J.; Hutchison, S.; Larson, P. J.; Herzog, R. W.; Arruda, V. R. et al. (2003). “AAV-mediated factor IX gene transfer to skeletal muscle in patients with severe hemophilia B”. Blood, 101(8), 2963-2972.

 Manno, C. S.; Pierce, G. F.; Arruda, V. R.; Glader, B.; Ragni, M.; Rasko, J. J. et al. (2006).“Successful transduction of liver in hemophilia by AAV-Factor IX and limitations imposed by the host immune response”. Nat Med, 12(3), 342-347.

 Mitani, K.; Clemens, P. R.; Moseley, A. B. & Caskey, C. T. (1993). “Gene transfer therapy for heritable disease: cell and expression targeting”. Philos Trans R Soc Lond B Biol Sci, 339(1288), 217-224.

 Mir, L. M.; Moller, P. H.; André, F. & Gehl, J. (2005). “Electric pulse-mediated gene delivery to various animal tissues”. Adv Genet, 54, 83-114.

 Morgan, R. A. & Anderson, W. F. (1993). “Human gene therapy”. Annu Rev Biochem 62,191–217.

 Morsy, M. A.; Mitani, K.; Clemens, P. & Caskey, C. T. (1993). “Progress toward human gene therapy”. JAMA, 270(19), 2338-2345.

 NIH Report. (2002). “Assesment of adenoviral vector safety an toxicity: report of the National Institutes of Health Recombinant DNA Advisory Committee”. Hum Gene Ther, 13, 3-13.

 Nguyen, T. H. & Ferry, N. (2007). “Gene therapy for liver enzyme deficiencies: what have we learned from models for Crigler-Najjar and tyrosinemia?”. Expert Rev Gastroenterol Hepatol, 1(1), 155-171.

 O'Neal, W.K. & Beaudet, A. L. (1994). “Somatic gene therapy for cystic fibrosis”. Hum Mol Genet, 3 Spec No.,1497-1502.

 Porteus, M. H. (2006). “Mammalian gene targeting with designed zinc finger nucleases”. Mol Ther, 13(2), 438-446.

 Porteus, M. H. & Carroll, D. (2005). “Gene targeting using zinc finger nucleases”. Nat Biotechnol, 23(8), 967-973.

 Porteus, M. H.; Connelly, J. P. & Pruett, S. M. (2006). “A look to future directions in gene therapy research for monogenic diseases”. PLoS Genet, 2(9), e133.

 Raper, S. E.; Wilson, J. M.; Yudkoff, M.; Robinson, M. B.; Ye, X. & Batshaw, M. L. (1998).“Developing adenoviral-mediated in vivo gene therapy for ornithine transcarbamylase deficiency”. J Inherit Metab Dis, 21(Suppl 1), 119-137.

 Raper, S. E. & McClane, S. J. (2002). “Gene transfer strategies for metabolic diseases”. World J Surg, 26(7), 838-842.

 Raper, S.E.; Yudkoff, M.; Chirmule, N.; Gao, G. P.; Nunes, F.; Haskal, Z. J. et al. (2002). “A pilot study of in vivo liver-directed gene transfer with an adenoviral vector in partial ornithine transcarbamylase deficiency”. Hum Gene Ther, 13(1), 163-175.

 Raper, S. E.; Chirmule, N.; Lee, F. S.; Wivel, N. A.; Bagg, A.; Gao, G. P. et al. (2003). “Fatal systemic inflammatory response syndrome in a ornithine transcarbamylase deficient patient following adenoviral gene transfer”. Mol Genet Metab, 80(1-2), 148-58.

 Räty, J. K.; Pikkarainen, J. T.; Wirth, T. & Ylä-Herttuala, S. (2008). “Gene therapy: the first approved gene-based medicines, molecular mechanisms and clinical indications”. Curr Mol Pharmacol, 1(1), 13-23.

 Reich, D.E. & Lander, E. S. (2001). “On the allelic spectrum of human disease”. Trends Genet, 17(9), 502-510.

 Roberts, D. M.; Nanda, A.; Havenga, M. J.; Abbink, P.; Lynch, D. M.; Ewald, B.A. et al. (2006). “Hexon-chimaeric adenovirus serotype 5 vectors circumvent pre-existing anti-vectorimmunity”. Nature, 441(7090), 239-243.

 Savulescu, J. (2001). “Harm, ethics comities and gene therapy death”. J Med Ethics, 27,148-150.

 Shi, J. & Zheng, D. (2009). “An update on gene therapy in China”. Curr Opin Mol Ther, 11(5),547-553.

 Solly, S. K.; Trajcevski, S.; Frisen, C.; Holzer, G. W.; Nelson, E.; Clerc, A. et al. (2003).“Replicative retroviral vectors for cancer gene therapy”. Cancer Gene Ther 10(1), 30-39.

 Venter, J.C.; Adams, M.D.; Myers, E.W.; Li, P.W.; Mural, R.J.; Sutton G.G. et al. (2001). “The sequence of the human genome”. Science, 291,1304-1351.

 Walsh, C. E. (2003). “Gene therapy progress and prospects: gene therapy for the hemophilias”. Gene Ther, 10, 999-1003.

 White, R. M. (2008). “Challenges in a narrative about the Tuskegee Study of Untreated Syphilis”. J Transcult Nurs, 19(2):105-106.

 Yang, Z. X.; Wang, D.; Wang, G.; Zhang, Q.H.; Liu, J. M.; Peng, P. et al. (2010). “Clinical study of recombinant adenovirus-p53 combined with fractionated stereotactic radiotherapy for hepatocellular carcinoma”. J Cancer Res Clin Oncol, 136(4), 625-630.