The NIH "Points to Consider" and the limits of human gene therapy

Advanced gene nanocarriers/scaffolds in nonviral-mediated delivery system for tissue regeneration and repair

Tissue regeneration technology has been rapidly developed and widely applied in tissue engineering and repair. Compared with traditional approaches like surgical treatment, the rising gene therapy is able to have a durable effect on tissue regeneration, such as impaired bone regeneration, articular cartilage repair and cancer-resected tissue repair. Gene therapy can also facilitate the production of in situ therapeutic factors, thus minimizing the diffusion or loss of gene complexes and enabling spatiotemporally controlled release of gene products for tissue regeneration. Among different gene delivery vectors and supportive gene-activated matrices, advanced gene/drug nanocarriers attract exceptional attraction due to their tunable physiochemical properties, as well as excellent adaptive performance in gene therapy for tissue regeneration, such as bone, cartilage, blood vessel, nerve and cancer-resected tissue repair. This paper reviews the recent advances on nonviral-mediated gene delivery systems with an emphasis on the important role of advanced nanocarriers in gene therapy and tissue regeneration.

Breakthroughs in cancer gene therapy

OBJECTIVES

To give oncology nurses an overview on the vectors and selected approaches used in the current clinical trials involving gene transfer to cancer patients.

DATA SOURCES

Peer-reviewed scientific papers, review articles, and book chapters.

CONCLUSION

Significant progress has been made in the field of cancer gene therapy. Different phases of clinical protocols derived from new generations of vectors and novel approaches are being tested for use in the treatment of patients with cancer.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses need to be familiar with current advances in the field of cancer gene therapy to expand their role as health care professional, patient educator, and advocate for the treatment of patients with cancer.

The ethics of somatic and germline gene therapy

Somatic gene therapy research in humans is still searching for appropriate vector systems and remains experimental. Germline therapy is a major technical challenge and can be considered only for the future.

Gene therapy: current and future implications for oncology nursing practice

OBJECTIVES

To provide oncology nurses with the basic concepts of gene therapy related to cancer and to outline their practice roles.

DATA SOURCE

Published professional articles, clinical protocols, and textbooks.

CONCLUSION

Oncology nurses will need to become knowledgeable about the methods and applications of gene therapy for cancer to participate in clinical trials and to develop relevant nursing development plans.

IMPLICATIONS FOR NURSING PRACTICE

Advances in genetic testing and gene therapies will extend oncology nursing roles in direct patient care, education, advocacy, provision of genetic services, and nursing research. Oncology nurses will also participate in dialogue and development of social policies with regard to the safety, ethical, and social issues related to cancer gene therapy.

Human fetal gene therapy: moral and ethical questions

This two-part paper discusses moral and ethical questions raised by future trials of human fetal gene therapy. The first part examines broad moral issues to explore whether fetal gene therapy is a morally praiseworthy goal. Ought it be done at all? These issues include (i) how the concept of fetal gene therapy originally arose as a goal envisioned at the beginning of prenatal diagnosis, (ii) preimplantation genetic diagnosis as a better preconceptual alternative for parents at higher genetic risk, (iii) alternatives to genetic abortions, (iv) the social and economic priority of fetal gene therapy, and (v) whether fetal gene therapy is a "slippery slope" that will end in germ-line gene therapy. This part concludes that far more reasons exist to commend fetal gene therapy than to reject it, given its limits and modest social and economic priority. The second part responds to specific ethical questions that must be raised about any protocol for human gene therapy. These questions and issues are adapted to the prenatal situation: (i) how the previable fetus becomes a "patient," (ii) concern for clinical benefit and minimizing risks to the fetus and pregnant woman, (iii) concern for the voluntary and informed participation of the pregnant woman, the father, and for protection of their privacy, (iv) concern for fair selection of subjects, (v) considerations of harm to germ line cells, and (vi) the role of public oversight of fetal gene therapy. The article concludes by recommending a continuation of the consolidated Recombinant Advisory Committee (RAC) for the near future.

Designer genes and critical care nursing: the future is now

Discoveries about the human genetic code and innovations to manipulate genes are rapidly advancing. Laboratory strategies used for recombinant deoxyribonucleic acid techniques have revolutionized medication production and have led to experimental protocols for gene therapy. The implications for critical care nursing practice are profound. To keep pace with new discoveries, critical care nurses now need to consider the impact of advances in genetic engineering on their practice. Nurses assisting with gene therapy protocols will need to not only update their knowledge of genetics but also learn the fundamentals of recombinant technology. Administration of genetically engineered medications almost certainly will lead to new clusters of side effects and new routes for delivery. A multitude of ethical considerations such as biosafety and patient selection raises a realm of clinical practice implications. To provide the care that critically ill patients require, practitioners will need to update their knowledge constantly about the rapidly changing discipline of genetics and how advances in genetics relate to nursing and medical practice.

Ethical and policy issues in human embryo twinning

In 1993, investigators from George Washington University (GWU) Medical Center separated the cells of 17 human embryos and produced 48 embryos, an average of three embryos for each original. The method, variously called twinning, cloning, embryo splitting, and blastomere separation, demonstrated that human embryos could be split to create genetically identical entities during conception. When publicized, however, the experiment brought to mind a different view of cloning repeated since the beginning of the new reproductive technologies. In the early 1970s, when research onin vitrofertilization (IVF) was in its infancy, commentators worried that cloning–defined as the duplication of persons–would be next, leading to a scenario of “boys genetically exactly like the father, girls like the mother, or individuals like some true or false hero of art, science, or sports, or like some demagogue or some saint.”

Human gene therapy: a biopolitical overview and analysis

The benefits, risks, and social consequences arising from human gene therapy have received substantial citation in the literatures of medical, biological, ethical, and legal commentary. I argue that the question of what "public policy garb" best fits the parameters of human gene therapy in the United States and around the world is a quintessential political question, best understood under the microscope of political science analytic inquiry. I describe the nature of that inquiry, apply its insights to the various ends and means of human gene therapy, and posit empirical models of "political success" for the salient purposes of the craft. I focus particularly on the tract record of the National Institutes of Health's Recombinant DNA Advisory Committee (RAC) in orchestrating the process by which human gene therapy protocols achieve official sanction.

Human gene therapy: ethics and public policy

The first three human gene transfer/therapy clinical protocols are now underway after having been subjected to an extensive review process by the Recombinant DNA Advisory Committee (RAC) and its Human Gene Therapy Subcommittee. The "Points to Consider" document developed by the RAC established the framework for evaluating genetic intervention protocols. This review process is taking place in a broader social context. Public attitude surveys in this country have indicated a general lack of knowledge in the area of genetic engineering but an acceptance of somatic-cell gene therapy as treatment for disease. Internationally, numerous policy statements on human genetic intervention have been published, all of which support the moral legitimacy of somatic-cell gene therapy for the cure of disease. The debate over the ethical issues related to somatic-cell gene therapy has evolved over a ten-year-period. The time has now come to begin a formal public process for the ethical assessment of germ-line genetic intervention.