Surgical synovectomy for rheumatoid arthritis: a comprehensive literature review

Ali, Mohammed; Khalid, Mozafar

doi:10.18203/2349-2902.isj20162863

Cited by 2 publications

(1 citation statement)

References 41 publications

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“…They become hyperplastic and express an array of cytokines, chemokines and growth factors, as well as playing an active role in cartilage degradation [78]. Accordingly, the synovium of an inflamed joint can be surgically, chemically or radiologically removed to alleviate pain and inflammation [79]. However, this is an invasive procedure and therefore, the delivery of cytocidal genes, which requires only transient expression of the transgene, to reduce the hyperplastic synovium has been considered as an alternative.…”

Section: Genetic Synovectomymentioning

confidence: 99%

Toward gene therapy in rheumatoid arthritis

Young

Gould

Hart

2020

Expert Review of Precision Medicine and Drug Development

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Introduction: Rheumatoid arthritis (RA) is an autoimmune disease of the joint, affecting 0.24% of the global population. Many patients only respond partially, do not respond or develop resistance to current treatments, and the severe systemic complications, including immunosuppression, are unacceptable. Genetic therapies for RA have the potential to improve treatments by targeting delivery to the disease site, enhancing efficacy and avoiding adverse effects.Areas covered: The route of administration, delivery vector, nucleic acid type and target gene must be carefully selected to develop an effective gene therapy for RA. Drawing from examples of RA gene therapies investigated in animal models and clinical trials, this review discusses how these strategies may be used to translate RA gene therapy into the clinic. Expert opinion:Existing RA treatments lack specificity to the joint. Genetic delivery systems can include targeting properties, such as disease-responsive promoters or cell-targeting moieties, to overcome this. Non-viral vectors in particular can be engineered easily to possess these properties and, unlike viral vectors, display low immunogenicity. Contrary to current drugs, gene therapy can be delivered intra-articularly, providing sustained levels of the therapeutic. Targeted vectors may also achieve this, but with a single systemic injection, simultaneously delivering the therapeutic to all affected joints. Article Highlights• Gene therapy for RA can provide high and prolonged therapeutic gene expression at the disease site, whilst avoiding systemic side effect.• Intra-articular delivery is possible, but arthritis is polyarticular, so multiple injections would be required. Alternatively, systemic delivery could target all joints with one injection.• Viral vectors provide adequate efficacy, but safety and immunogenicity are of concern. Nonviral vectors are safer and new formulations may provide the desired efficacy in vivo.• Including cell-targeting properties or inducible promoters into gene delivery vectors may improve potency of the gene therapy, prevent off-target effects and make systemic delivery feasible.

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Section: Genetic Synovectomymentioning

confidence: 99%