Gene transfer to human joints: Progress toward a gene therapy of arthritis

doi:10.1073/pnas.0502854102

Gene transfer to human joints: Progress toward a gene therapy of arthritis

Departments of ^*Orthopaedic Surgery and ^†Molecular Genetics and Biochemistry, ^∥Division of Rheumatology and Immunology, Department of Medicine, ^††Immunologic Monitoring and Cellular Products Laboratory, Department of Pathology, and ^‡‡Center for Biologic Imaging, Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261

Communicated by Darwin J. Prockop, Tulane University, New Orleans, LA, April 8, 2005 (received for review January 4, 2005)

Abstract

This article describes the clinical application of gene therapy to a nonlethal disease, rheumatoid arthritis (RA). Intraarticular transfer of IL-1 receptor antagonist (IL-1Ra) cDNA reduces disease in animal models of RA. Whether this procedure is safe and feasible in humans was addressed in a phase I clinical study involving nine postmenopausal women with advanced RA who required unilateral sialastic implant arthroplasty of the 2nd-5th metacarpophalangeal (MCP) joints. Cultures of autologous synovial fibroblasts were established and divided into two. One was transduced with a retrovirus carrying IL-1Ra cDNA; the other provided untransduced, control cells. In a dose escalation, double-blinded fashion, two MCP joints were injected with transduced cells, and two MCP joints received control cells. One week later, injected joints were resected and examined for evidence of successful gene transfer and expression by using RT-PCR, ex vivo production of IL-1Ra, in situ hybridization, and immunohistochemistry. All subjects tolerated the protocol well, without adverse events. Unlike control joints, those receiving transduced cells gave positive RT-PCR signals. Synovia that were recovered from the MCP joints of intermediate and high dose subjects produced elevated amounts of IL-1Ra (P = 0.01). Clusters of cells expressing high levels of IL-1Ra were present on synovia of transduced joints. No adverse events occurred. Thus, it is possible to transfer a potentially therapeutic gene safely to human rheumatoid joints and to obtain intraarticular, transgene expression. This conclusion justifies additional efficacy studies and encourages further development of genetic approaches to the treatment of arthritis and related disorders.

Footnotes

↵ § To whom correspondence should be addressed at the ‡ address. E-mail: cevans{at}rics.bwh.harvard.edu.
↵ ‡ Present address: Center for Molecular Orthopaedics, Harvard Medical School, Boston, MA 02115.
↵ ¶ Present address: Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL 32610.
↵ ** Present address: Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY 14642.
Author contributions: C.H.E. and P.D.R. designed research; C.H.E. and M.V. analyzed data; P.D.R. contributed new reagents/analytic tools; S.C.G., E.M.E., T.L.W., and S.C.W. performed research; M.C.W. supervised patient care/evaluation (rheumatology); M.M.T. obtained consent of subjects for study and follow-up; R.K. and T.A.M. supervised patient recruitment/care/evaluation; J.H.H. performed intraarticular injections and joint replacement surgery; and C.H.E. wrote the paper.
Abbreviations: RA, rheumatoid arthritis; IL-1Ra, IL-1 receptor antagonist; MCP, metacarpophalangeal; RCR, replication-competent retrovirus; DMARD, disease-modifying antirheumatic drug; NSAID, nonsteroidal antiinflammatory drug.