Gene Therapy against Necrotic Neurological Insults
Robert M. Sapolsky, Ph.D., Stanford University
Abstract:
The last decade has seen tremendous progress in our understanding of the cellular events that mediate neuron death following seizure, hypoxia-ischemia and hypoglycemia. With this insight regarding necrotic neuronal injury has come the potential for therapeutic interventions in which a neuroprotective gene is overexpressed. In this talk, I will review the progress in gene therapy against necrotic neurological insults. Some of the findings are quite encouraging. For example, a number of groups, working independently and using quite different gene delivery systems, have shown the neuroprotective potential of more than half a dozen different genes against a variety of models of insults. A particularly detailed case of such protection, involving overexpression of the rat Glut-1 glucose transporter, will be reviewed. As another bit of good news, there are many reasons why inducible vector systems will be particularly advantageous for therapy against acute necrotic insults, and data from two such inducible systems will be shown. Despite this good news, there are also some major issues troubling this nascent field. As one problem to be reviewed, expression driven by many of these vectors declines dramatically shortly after introduction into neurons; as will be shown, this greatly curtails the usefulness of inducible vectors (in which much of the potential inducibility declines during their period of quiescence prior to activation). A second and disquieting problem will be reviewed, revolving around recent evidence that some gene therapy interventions, while saving neurons from death, fail to save them from dysfunction. Collectively, this generates a picture of an emerging field.