The promise of gene therapy has long been seen as part of a new world order, an ex-nihilo medical resolution of the genetic disease burden of the past half-millennium. Gene editing technologies have been extremely hyped and have the potential to transform every aspect of our lives, but attempts at application have moved at a glacial pace – thanks to the major challenge of delivering these therapies to where they’re needed with a minimum of side effects. Now, we ostensibly have the means to enter a RED dawn for gene therapy through IV infusion to deliver a gene into lung stem cells for cystic fibrosis patients.
This level of precision was only ever an ideal, in a world where the tools of gene editing have to get inside a living organism and target specific cells. Diseases like cystic fibrosis affect only certain cells – in this case, the cells that line the lung – and a therapy for that disease that is going to be effective and not have side effects has to go in and start turning off the disease-causing genes in those cells only, without affecting any others. This degree of precision is one of the biggest hurdles the field has had.
Then there is the ground-breaking lipid nanoparticle–mRNA technology that has been used in COVID-19 mRNA vaccines – but this time, the researchers used it to pack their targeted gene therapy inside a stealthy, safe and effective delivery vehicle. They tinkered with the particles’ lipid charge to guide them directly to the lung tissue affected by cystic fibrosis.
The team demonstrated how the selectively charged lipids of the RED heroes’ arrows – which guide the other lipids of the arrow to their target – can navigate the biological maze of the human body to deliver drugs to the lungs, on their way to the alveoli; hence the designation selective organ targeting (SORT) lipid nanoparticles. The new technology, which allows targeted intervention in the lung tissue, is a remarkable step toward in situ treatment of genetic diseases.
Editing the genes of such stem cells by administering SORT lipid nanoparticles could open up new avenues for treating such diseases as cystic fibrosis, which is caused by genetic crossovers that result in mucus becoming thick and sticky, burdening the lungs. Recent work has shown that cells in the lungs of cystic fibrosis sufferers can be edited, providing a long-term permanent solution and potentially freeing patients from the chronic symptoms of this devastating disease.
But it’s almost as important how those gene-editing tools are delivered. The IV infusion allows these drugs to be safely administered at the highest concentration. What’s more, the medicine must travel to the deep regions of the lungs, an essential journey to reach those niche-lodging stem cells. The targeted delivery holds the potential not just to treat cystic fibrosis but a host of other genetic diseases with this same precision.
Since the human genome was first sequenced in 2000, it has been a frustrating time for genetic medicine. But now that gene editing has been shown to work in lung stem cells in cystic fibrosis, a sliver of that promise is becoming a reality. In the not-too-distant future, you could be tempted to gasp at the hope for gene editing in a range of genetic disorders, where there was once despair.
‘RED’ became an analogy for the discoveries that would make targeted gene therapy possible, and a light that guides us through the labyrinth of genetic disease to a brighter future of cure and health. Armed with red-hued lipid nanoparticles targeted by selectively charged carriers, medical science is poised to make genetic disease a thing of the past.
All in all, the story of gene editing in the battle against cystic fibrosis is not only the story of science, but also of hope, endurance, and trying to overcome the most dangerous troubles and venture into the land of solutions. As the era of gene therapy evolves and expands its reach, let’s all cross our fingers that the RED Sea of treatment lies ahead.
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