Rolling F
Laboratoire de Thérapie Génique, INSERM U649, CHU-Hotel DIEU, Nantes Cedex, France.
Gene Ther. 2004 Oct;11 Suppl 1:S26-32. doi: 10.1038/sj.gt.3302366.
Retinal degenerative diseases such as retinal macular degeneration and retinitis pigmentosa constitute a broad group of diseases that all share one critical feature, the progressive apoptotic loss of cells in the retina. There is currently no effective treatment available by which the course of these disorders can be modified, and visual dysfunction often progresses to total blindness. Gene therapy represents an attractive approach to treating retinal degeneration because the eye is easily accessible and allows local application of therapeutic vectors with reduced risk of systemic effects. Furthermore, transgene expression within the retina and effects of treatments may be monitored by a variety of noninvasive examinations. An increasing number of strategies for molecular treatment of retinal disease rely on recombinant adeno-associated virus (rAAV) as a therapeutic gene delivery vector. Before rAAV-mediated gene therapy for retinal degeneration becomes a reality, there are a number of important requirements that include: (1) evaluation of different rAAV serotypes, (2) screening of vectors in large animals in order to ensure that they mediate safe and long-term gene expression, (3) appropriate regulation of therapeutic gene expression, (4) evaluation of vectors carrying a therapeutic gene in relevant animal models, (5) identification of suitable patients, and finally (6) manufacture of clinical grade vector. All these steps towards gene therapy are still being explored. Outcomes of these studies will be discussed in the order in which they occur, from vector studies to preclinical assessment of the therapeutic potential of rAAV in animal models of retinal degeneration.
视网膜退行性疾病,如视网膜黄斑变性和色素性视网膜炎,构成了一大类疾病,它们都有一个关键特征,即视网膜中的细胞逐渐发生凋亡性损失。目前尚无有效的治疗方法可以改变这些疾病的病程,视觉功能障碍往往会发展为完全失明。基因治疗是一种有吸引力的治疗视网膜退行性变的方法,因为眼睛易于接近,且允许局部应用治疗载体,从而降低全身效应的风险。此外,视网膜内的转基因表达和治疗效果可以通过多种非侵入性检查进行监测。越来越多的视网膜疾病分子治疗策略依赖于重组腺相关病毒(rAAV)作为治疗性基因递送载体。在rAAV介导的视网膜退行性变基因治疗成为现实之前,有许多重要要求,包括:(1)评估不同的rAAV血清型;(2)在大型动物中筛选载体,以确保它们介导安全且长期的基因表达;(3)适当调控治疗性基因的表达;(4)在相关动物模型中评估携带治疗性基因的载体;(5)识别合适的患者,最后(6)生产临床级载体。基因治疗的所有这些步骤仍在探索中。这些研究的结果将按照其发生顺序进行讨论,从载体研究到rAAV在视网膜退行性变动物模型中的治疗潜力的临床前评估。