[Gene therapy in rheumatoid polyarthritis: perspectives].

THE CONCEPT OF GENE THERAPY

Gene therapy is applicable in diseases involving several genes such as rheumatoid arthritis. Gene transfer is the insertion in vivo of genetic material necessary to produce a molecule with therapeutic action. This strategy is currently in experimental stages; feasibility studies in humans are in the preliminary stage. SEVERAL TARGETS: In experimental models of rheumatoid arthritis, the most widely studied target genes are those which code for inflammation inhibitors such as IL-1 receptor antagonists or anti-inflammatory cytokines (IL-4, IL-10, IL-13). Another interesting target would concern genes coding for molecules inhibiting joint destruction (for example metalloprotease inhibitors). VECTORS: The development of high-performance vectors (both viral and nonviral vectors) will greatly improve the expected benefit/risk potential of gene therapy in general. IN RHEUMATOID ARTHRITIS: The particular problem in rheumatoid arthritis is the choice of the transfection site. An articular site would require multiple injections in the different affected joints. A systemic approach would take into account the general disseminated nature of the disease.