Barriers to and new approaches for gene therapy and gene delivery in cystic fibrosis.

Abstract:

:Clinical trials of gene therapy for cystic fibrosis suggest that current levels of gene transfer efficiency are probably too low to result in clinical benefit, largely as a result of the barriers faced by gene transfer vectors within the airways. The respiratory epithelium has evolved a complex series of extracellular barriers (mucus, lack of receptors, immune surveillance, etc.) aimed at preventing penetration of lumenally delivered materials, including gene therapy vectors. In addition, once in the cell, further hurdles have to be overcome, including DNA degradation, nuclear import and the ability to maintain long-term transgene expression. Strategies to overcome these barriers will be addressed in this review and include the use of: (i) clinically relevant adjuncts to overcome the extra- and intracellular barriers; (ii) less-conventional delivery routes, such as intravenous or in utero administration; (iii) more efficient non-viral vectors and 'stealth' viruses which can be re-administered; and (iv) new approaches to prolong transgene expression by means of alternative promoters or integrating vectors. These advances have the potential to improve the efficiency of gene delivery to the airway epithelium, thus making gene therapy a more realistic option for cystic fibrosis.

journal_name

Adv Drug Deliv Rev

authors

Ferrari S,Geddes DM,Alton EW

doi

10.1016/s0169-409x(02)00145-x

subject

Has Abstract

pub_date

2002-12-05 00:00:00

pages

1373-93

issue

11

eissn

0169-409X

issn

1872-8294

pii

S0169409X0200145X

journal_volume

54

pub_type

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