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Ann Thorac Surg 2002;73:704-706
© 2002 The Society of Thoracic Surgeons

Editorial

Gene therapy for thoracic disease: practice, promise, and pragmatism

W. Roy Smythe, MD*a

a Section of Thoracic Molecular Oncology, Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

* Address reprint requests to Dr Smythe, Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 445, Houston, TX 77030, USA
e-mail: rsmythe@mdanderson.org

The physician without physiology and chemistry flounders along in an aimless fashion, never able to gain any accurate conception of disease, practicing a sort of popgun pharmacy, hitting now the malady and again the patient, he himself not knowing which. William Osler

In this issue, Kurdow and associates [1] demonstrate improved effectiveness of one of the oldest paradigms in gene therapy ("prodrug" gene therapy utilizing transfer of the herpes simplex thymidine kinase gene followed by ganciclovir administration) for experimental non-small cell carcinoma. Improvements in both the vector (gene therapy transfer vehicle) and transgene (new gene transferred to somatic cell) of this therapeutic system are described [1]. By efforts at the bench, the authors have modified a technique that has thus far not been as clinically useful as anticipated into a paradigm that may have a greater chance of patient benefit. This article is a good example of current progress in experimental practice in gene therapy and reminds us of the future promise of the field. However, the article also illustrates why we should be pragmatic about the work that still needs to be done.

Approximately 7 years ago, a thoracic surgical laboratory published one of the first descriptions of successful adenoviral gene transfer in an orthotopic human model of neoplastic disease (mesothelioma) here in The Annals [2]. An accompanying editorial suggested that, "Thoracic surgeons, thanks to studies like that published in this month’s Annals, are no longer silent witnesses in these exciting developments." [3]. What are the obstacles that we still face for widespread clinical application of gene therapy, how have we fared since this time in regard to the treatment of thoracic diseases utilizing these techniques, and to what degree have the members of our specialty been involved?

The basic problems that we face in the . . . [Full Text of this Article]






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