Gene therapy in inflammatory diseases – are we there yet?: Gene therapy in inflammatory diseases edited by C.H. Evans and P.D. Robins

Abstract

Birkhauser Verlag, 2000. Hardback DM 218 (272 pages)ISBN 3 7643 5855 6Gene therapy of human disease is endowed with perfect rationale – to replace whatever gene is missing or malfunctioning – and, indeed, represents the golden hope for the relief of humanity from life-taxing inflammatory disorders. From this point of view, concepts and difficulties that are associated with its full development should be part of every physician’s training and wealth of knowledge.Concepts of gene therapy were first entertained in the treatment of simple, monogenic disorders for obvious reasons. The possibility of using gene therapy in the treatment of inflammatory diseases, including rheumatic and allergic disorders, draws more attention because as many as 10–20% of the population is afflicted. It is true that the current approaches on gene therapy may resemble the flying machines of the Wright brothers, as Sergei Makarov, one of the authors of the book suggest, and there is no doubt that we need to reach the equivalent of a jet fighter. Yet, even if we need more than half a century to get there, we should invest properly to reach that point. Quality books, such as this one, will help brilliant physicians and investigators to successfully enter this field.There are many instructive books on the library shelves that describe the currently used gene-therapy vectors and techniques, but Evans and Robins, two talented investigators, have put together a book that is also exciting to read. Despite the fact that this is the first edition, the included chapters display sufficient homogeneity to capture the reader’s interest from cover to cover.Evans and Robins have selected a dozen or so pioneers in the field of gene therapy who have composed informative, easy-to-read chapters. Three chapters are devoted to rheumatoid arthritis and single chapters discuss gene therapy approaches in Sjogren’s syndrome, systemic lupus erythematosus, multiple sclerosis and diabetes mellitus. The remaining chapters discuss issues that pertain to organ transplantation, the use of naked DNA and the development of animal inflammatory models using gene transfer. Each chapter discusses briefly the underlying pathology, the possible gene candidates and progress so far.The chapter on clinical trials discusses the regulatory issues that relate to the introduction of gene therapy in humans. The use of gene therapy in humans presents enormous substantive issues that may be even larger than the scientific and technical problems and are rightly addressed in this chapter. A chapter dedicated to the systematic discussion of human use issues that pertain to the performance of gene therapy clinical trials would also have appealed to this reader. The chapters on ‘Gene therapy of allergic airways inflammation’ and on ‘Gene therapy as an anti-inflammatory strategy’ would have benefited from additional editing. The chapter on the use of naked DNA is poorly presented and it could have been eliminated. Instead, a chapter discussing gene delivery methods in use, placed after the first chapter, would have helped the reader.Overall, Gene Therapy in Inflammatory Diseases is an excellent read and it is recommended to investigators and physicians alike. Teachers should recommend this book to fellows and residents. The practicing physician will also find it very useful in addressing concerns of patients who might have become misinformed through the mass media.