terapi gen kelainan genetik genetic disorders treatment
DESCRIPTION
sekilas pengenalan secara umum mengenai terapi untuk kelainan genetik. genetic disorders therapy, terapi kelainan bawaan, terapi penyakit autoimun, rekayasa genetikTRANSCRIPT
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OVERVIEW THERAPY OF GENETIC
DISORDERSHendrik Sutopo
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Current Therapy of Genetic Disorders
Preventive Metabolic Manipulation Gene Product Replacement Cell or Organ Transplantation Somatic Gene Therapy
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Therapy of Genetic Disorders Preventive Therapy
Prenatal diagnosis Preimplantation diagnosisPreventive screening for disease onset
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Therapy of Genetic Disorders
Metabolic ManipulationDietary restriction
○ Lactose restriction for Lactase deficiency; phenylalanine restriction for PKU
Dietary Supplementation ○ Vitamin C for Scurvy, Biotin for Biotinidase deficiency, Starch for G-
6-P deficiency
Chelation and enhanced excretion○ copper chelation for Wilson Disease
Metabolic inhibitors○ allopurinol for gout, Statins for hypercholesterolemia
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Therapy of Genetic Disorders Gene Product Therapy
Hormone, protein or enzyme replacement○ Hormone supplementation:
Hypothyroidism: thyroid Congenital adrenal hyperplasia: cortisolGrowth hormone
○ Hemophilia; clotting factors ○ Diabetes: insulin ○ Enzyme replacement
Beta glucosidase : GauchersAlpha glucosidase: PompeAdenosine deaminase (PEG): ADA- SCID
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Somatic Gene TherapyIntroduction of recombinant genes into somatic cells
to treat genetic or acquired disease• applicable to any disease with molecular basis of
pathogenesis
• currently does not involve removal, repair or site-specific replacement of mutant genes
• need repetitive therapy
• All gene therapy so far in people has been directed at somatic cells
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The Beginning… In the 1980s, Scientists began to look into gene
therapy.
They inserted human genes into a bacteria cell.
Then the bacteria cell would transcribe and translate the information into a protein
Then they would introduce the protein into human cells
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The First Case The first gene therapy was performed on
September 14th, 1990Ashanti DeSilva was treated for SCID
○ Sever combined immunodeficiency
Doctors removed her WBC○ inserted the missing gene into the WBC, then○ put them back into her blood stream.
This strengthened her immune systemworked for a few months
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Real treatments performed with retroviral system
Severe Combined Immunodoficiency (SCID)
Mutation on Chromosome 20 is often to blame
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10http://encarta.msn.com/media_461561269/Gene_Therapy.html
How It Works
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Real treatments performed with retroviral system
Problems:• not cure of the disease• maintenance of venous access to administer the therapy• shortage• cost• requirement of frequent, repeated administrations• allergic, inflammatory and immune responses to the
infused materials• • …
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Future Treatments
Stem Cells
Therapeutic Cloning
Advanced IVF Techniques
Gene Therapies
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“If your ship doesn’t come in, swim out to it”
Jonathan Winters
The future is here
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..Adult Stem Cells
•Stem cell collected from adult can be harvested from many area including the bone marrow.
•Alternative to Embryonic Stem cells
•Potential to reverse and cure Diabetes
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..Embryonic Stem Cells•Use undifferentiated cell from embryos and cultures them to grow into need cells
•Neurons Grown from Embryonic Stem Cells Restore Function in Paralyzed Rats
•Hold potential cures for 1000s of diseases many genetic disorders.
•Many ethical and social concerns surrounding this research
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..Therapeutic Cloning
•Using stem cells to replace or create tissues and organs
•Currently heart tissues and full bladders are being grow in lab
Fig. Stem cell treatments and tissues recreated in the heart of a child
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Advanced IVF Techniques
•This treatment is aimed at women who would pass on a genetic defect to the child.
•Also helps women who suffer with mitochondria disease.
•Faulty genes are removed from the embryo, and replaced by healthy genes from the additional woman.
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Ethical Issues
Who decides what diseases to cure?
Who will have access to therapy?
Is it interfering with God’s plan?
Is it alright to use the therapy in the prenatal stage of development in babies?
Courtesy of www.cbs.dtu.dk
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all Inherited and acquired disorders
cancer
AIDS/HIV
Goal of gene therapy
Management and correction of human diseases
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The Bubble Boy In 2002, then 18-month-
old Rhys Evans received one of the first successful gene therapy treatments for a genetic disorder, which cured his severe combined immunodeficiency (SCID).
Courtesy of news.bbc.co.uk
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Major Advancements
2002- Scientists are able cure children of SCID. 2003- Researchers are able to insert genes to
the brain, opening up a wider variety of diseases that could be cured.
2006- Successfully treat two cancer patients.
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Gene therapy could be very different for different diseases• Gene transplantation (to patient with gene deletion)
• Gene correction (To revert specific mutation in the gene of interest)
• Gene augmentation (to enhance expression of gene of interest)
• Change the regulation of gene repairs
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Target sites for gene therapy
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Gene Transfer
Transcription(nucleases)
Exogenous DNA+ vector (viral)
Cytosol
Endosome
Lysosome
Protein expression
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Vectors in gene transfer: Viruses
Retroviruses
Adenoviruses
Adeno-associated viruses
Envelope protein pseudotyping of viral vectors
Non-viral methods
Naked DNA
Oligonucleotides
Lipoplexes and polyplexes
Hybrid methods
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Retrovirus Engineering
From: Alberts et al. Molecular Biology of the Cell
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The Gene Therapy Process
1. A desired gene is selected and inserted into a genome to replace an “abnormal”, disease-causing gene.
2. The genome is then transferred into a vector, most commonly an adenovirus, which will transport the gene into the patient.
3. The vector is sent to a target cell in the patient’s genome and then “unloads” the genetic material in the virus.
4. Once the genetic material has been inserted into the target cell, the cell will continue its reproductive cycle with the new therapeutic gene . This will cause new generations of cells with the integral therapeutic gene which will cure the desired disease in the patient.
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Non viral vectors
Un complexed plasmid DNA
DNA coated gold particles
Liposomes
DNA – protein conjugates
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Injections of naked DNA
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Gene Transfer techniques
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Problems with Gene Therapy
Difficult to integrate desired DNA into a genome. Effects are usually temporary Immune system automatically attacks foreign objects reduce
effects of gene therapy. The possibility of the modified adenovirus to revert back to its
harmful state. In rare cases therapy has induced tumors leukemia (if integrated
in a tumor suppressor gene because insertional mutagenesis)
Multigene Disorders Heart disease, Hypertension, Alzheimer’s, arthritis, diabetes : hard to treat
Until today : Efficacy in any gene therapy protocol not definitive.
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Problems with Gene Therapy
Economic : Funding for therapy fluctuates with
rise and fall of success. Most funding in government
research, + $400 million a year. Difficult to afford and can’t be
covered by insurance. Economic market : something new?
Ethic? Law?
Courtesy of dir.nichd.nih.gov
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Current Status FDA hasn’t approved any human gene therapy productsamples: 18-year-old Jesse Gelsinger died from multiple organ
failure 4 days after treatment Death was triggered by severe immune response to adenovirus carrier
January 2003, halt to using retrovirus vectors in blood stem cells because children developed leukemia-like condition after successful treatment for X-linked SCID
Inadequate understanding of biological interactions of vector and host.
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The Future treatment for genetic disorders is Experimental (incld. Gene Therapy)
It is not currently available outside a clinical trials
Current Status
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Thank You
QUESTIONS ??