process is also limited in the length of DNA it can carry, and it may cause an immune response. And precisely where
the new DNA integrates into the cell's DNA has been a largely uncontrollable process.
32
Physical injection (microinjection) of DNA into cells is possible but prohibitively expensive.
Exciting advances
have recently been made, however, in other means of transfer. For example, liposomes—fatty spheres with a watery
core—can be used as a "molecular Trojan horse" to deliver genes to brain cells, thereby opening
the door to treatment
of disorders such as Parkinson's and epilepsy.
33
Electric pulses can also be employed to deliver a range of molecules
(including drug proteins, RNA, and DNA) to cells.
34
Yet another option is to pack DNA into ultratiny "nanoballs" for
maximum impact.
35
The major hurdle that must be overcome for gene therapy to be applied in humans is proper positioning of a gene
on a DNA strand and monitoring of the gene's expression. One possible solution is to deliver an imaging reporter gene
along with the therapeutic gene. The image signals would allow for close supervision of both
placement and level of
expression.
36
Even faced with these obstacles gene therapy is starting to work in human applications. A team led by University
of Glasgow research doctor Andrew H. Baker has successfully used adenoviruses to "infect" specific organs and even
specific regions within organs. For example, the group was able to direct gene therapy precisely at the endothelial
cells, which line the inside of blood vessels. Another approach is being
developed by Celera Genomics, a company
founded by Craig Venter (the head of the private effort to transcribe the human genome). Celera has already
demonstrated the ability to create synthetic viruses from genetic information and plans to apply these biodesigned
viruses to gene therapy.
37
One of the companies I help to direct, United Therapeutics, has begun human trials of delivering
DNA into cells
through the novel mechanism of autologous (the patient's own) stem cells, which are captured from a few vials of their
blood. DNA that directs the growth of new pulmonary blood vessels is inserted into the stem cell genes, and the cells
are reinjected into the patient. When the genetically engineered stem cells reach the tiny pulmonary blood vessels near
the lung's alveoli, they begin to express growth factors for new blood vessels. In animal studies
this has safely reversed
pulmonary hypertension, a fatal and presently incurable disease. Based on the success and safety of these studies, the
Canadian government gave permission for human tests to commence in early 2005.
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