Upload
simon-hodges
View
215
Download
0
Tags:
Embed Size (px)
Citation preview
2013Marek Vácha
Engineering the engineer as well as the engine, we race our train we know not where.
Leon Kass
Gene therapy
Pills Cell therapies
The gene itself becomes the drug
Gene therapy
somatic cells concerns one single individual
germ cells concerns plenty of individuals
LeRoy Walters:
What does it mean to be human? Adding a What does it mean to be human? Adding a occasional gene here and there is not going occasional gene here and there is not going to alter who we are as a human race. But if to alter who we are as a human race. But if we draw no line, if we accept that people we draw no line, if we accept that people have a right to make what they want of their have a right to make what they want of their lives, then we condone the right of humans lives, then we condone the right of humans to manipulate their genomes in the absence to manipulate their genomes in the absence of any real knowledge of what they are of any real knowledge of what they are doing. Might we add a gene here and alter a doing. Might we add a gene here and alter a gene there until we become a society of gene there until we become a society of chimeras, uncertain who wechimeras, uncertain who we are?are?
CONVENTION FOR THE PROTECTION OF HUMAN RIGHTS AND DIGNITY OF THE HUMAN BEING WITH REGARD TO THE APPLICATION OF BIOLOGY AND MEDICINE:
CONVENTION ON HUMAN RIGHTS
AND BIOMEDICINE
Oviedo, 4.IV.1997
Oviedo 1997:CONVENTION ON HUMAN RIGHTS AND BIOMEDICINE
Article 13 – Interventions on the human genome
An intervention seeking to modify the human genome may only be undertaken for preventive, diagnostic or therapeutic purposes and only if its aim is not to introduce any modification in the genome of any descendants.
USA
legally, there is no ban in the United States on germline engineering research
1996: New Jersey: the doctors took a client´s fertilized egg and added 5% of the cytoplasm (including mitochondria) from a donor egg to replace any malfunctioning units in the client´s egg.
Between 1996 and 2001, a reported 16 babies with the genetic makeup of three parents (the client mother and father and the female cytoplasm donor) were born
UNESCO: Universal Declaration on the Human Genome and Human Rights11 November 1997
= nonbinding declaration Article 24
The International Bioethics Committee of UNESCO should contribute to the dissemination of the principles set out in this Declaration and to the further examination of issues raised by their applications and by the evolution of the technologies in question. It should organize appropriate consultations with parties concerned, such as vulnerable groups. It should make recommendations, in accordance with UNESCO’s statutory procedures, addressed to the General Conference and give advice concerning the follow-up of this Declaration, in particular regarding the identification of practices that could be contrary to human dignity, such as germ-line interventions.
This declaration was signed by 186 nations.
Biological background
...not very important for obtaining the credits, but nonetheless very
interesting!
Gene therapy
for gene therapy of somatic cells to be permanent, the cells that receive the normal allele must be ones that multiply throughout the patients´s life.
If the treatment is succesfull, the patient´s bone marrow cells will begin producing the missing protein, and the patient may be cured.
In vivo and Ex vivo gene therapy
The first definite success: a cure for X-linked severe combined immunodeficiency: X-SCID, Paris 2000 nine of 11 treated patients were cured and
enabled to lead a normal life they showed significant, definitive
improvement after two years, the first indisputable success of gene therapy.
The first definite success: a cure for X-linked severe combined immunodeficiency: X-SCID, Paris 2000 however, three of them have subsequently
developed a leukemia almost certainly as a result of insertional activation of the LMO2 oncogene. one of them died
all trials involving retroviral transduction of large pools of lymphocytes were quickly suspended worldwide, pending full understanding of these tragic events.
The first definite success: a cure for X-linked severe combined immunodeficiency: X-SCID, Paris 2000 two factors may have contributed to the
development of leukemia: the insertion of the retroviral vector near a
gene involved in the proliferation of blood cells unknown function of the replacement gene
itself
Contemporary strategies
(A) Loss-of-function conditions. (B) Gain-of-function conditions.
Contemporary strategies
miRNA
miRNA1. An enzyme cuts each hairpin from
the primary miRNA transcript2. A second enzyme, called Dicer, trims
the loop and the single-stranded ends from the hairpin, cutting at the arrows (the fragment has about 20bp).
3. One strand of the double-stranded RNA is degradated; the other strand (miRNA) then forms a complex with one or more proteins.
4. The miRNA in the complex can bind to any target mRNA that contains at least 6 bases of complementary sequence.
5. If miRNA and mRNA bases are complementary all along their length
1..
2.
3.
4.
5.
siRNAs
RISC = RNA-induced silencing complex
miRNAs and siRNAs
the same cellular machinery generates miRNAs and siRNAs and both can associate with the same proteins, producing similar results
the distinction between miRNAs and siRNAs is based on the nature of the precursor molecule for each while an miRNA is usually formed from single hairpin in
a precursor RNA, siRNAs are formed from much longer double-stranded RNA molecules, each of which gives rise to many siRNAs
it has been estimated that expression of up to one-third of all human genes may be regulated by miRNAs
Contemporary strategies
Somatic Cell Gene Therapy
most scientists agree that treating a disease by inserting a corrected gene into a patient is not ethically different from using medicines to treat the disease.
most of the concerns: the safety of the procedures
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 200)
Treatment or Enhancement?
the boundary between treatment (for disease) and enhancement (for cosmetic or athletic purposes) can be indistinct is short stature a disease? is infertility a disease? is baldness a disease?
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 200)
Myostatin„Schwarzenegger mice“
studies in mice showed that if the gene for myostatin is absent, the mice grow into muscular rodents who are stronger and faster than their non-mutant littermates
Myostatin„Schwazenegger mice“
individual muscles from myostatin mutants mice weighed 2-3 times more than muscles taken from normal mice
the increased muscle mass resulted from both an increased number of muscle fibers and an increased size of individual fibers
Myostatin„Schwazenegger mice“
a human child has been found who is deficient in this gene
he has an exceptional musculature and is much stronger than other boys of his age
although he is healthy, physicians are watching him closely because the same gene is active in heart muscle, where such enlargement can be dangerous
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 201)
Somatic gene therapy
A notable example is the trials conducted on patients suffering from cystic fibrosis, who inhale an aerosol spray of liposomes containing the gene that patients lack. if they were more promising, such therapies
might appear to be ethically unproblematical, because any changes induced would be limited to the patient and not passed on to their children
(Mepham, B., (2008) Bioethics. An Introduction for the Biosciences. Oxford University Press, Oxford, p. 139)
squirrel monkeys have two opsin genes the opsin encoded by one gene is
sensitive to blue light the other opsine is sensitive to either
red or green light, depending on the allele
because the red/green opsin gene is X-linked, all males have only the red sensitive or green sensitive versions and are red-green color blind
in a gene therapy experiment, researched injected a virus containing the gene for the missing version into the retina of adult male monkeys.
After 20 weeks, the new opsin allele was being expressed in cones and the monkeys had begun to distinguiosh red from green in a field color dots.
Gene therapy has already been used to treat Leber´s congenital amaurosis (LCA), an inherited retinal degenerative disease that dauses severe oss of vision at birth.
After using gene therapy to restore vision in dogs and mice with LCA, researchers succesfully treated the disease in humans by injecting the functioanl LCA gene in a viral vector.
(Reece, J.B., Urry, L.A., (2011) Campbell Biology. 9th. ed. Pearson Publication, Inc. , New York. p. 1146)
Germline Gene Therapy
Germ-line genetic modification
A therapeutic effect of a somatic-cell gene therapy would be limited to the treated patient a would not affect progeny
animals carrying foreign genes in their germ line (transgenic animals) have been produced using mice, rats, rabbits and some others.
Germline Gene Therapy
= IGM = Inheritable Genetic Modification in laboratory animals, IGM has been
accomplished in two ways: by modifing the parental germ cells or the fertilized egg
such that a new genome is in every cell of the person´s body and is therefore transferred to the next generation through the germ cells
by modifying embryonic stem cells so that the adult body contains a high percentage of cells derived from these genetically altered blastomere
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 196)
Germline Gene Therapy
Gregory Stock: the question is not if, but when.
given that IGM might be able to eradicate inhereited genetic diseases and enable us to expand our genetic repertoire, why should anyone be against it?
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 196)
Some Comments.Ethics
there is no fundamental difference between the transplantation of genes into somatic cells and the transplantations of organs
Gene therapy
Most human disease results from interaction of a born genetic factors with environmental influences.
Therapy only modifies the symptoms of disease, thereby giving the body an opportunity to heal itself
gene therapy: effective treatment should correct the underlying genetic defect itself and not just a symptoms
Gene Therapy
is it true that… the natural is good and the unnatural is
bad?
...not particularly important for obtaining the credits, but interesting enough
Genetic Engineering
= a proceess of inserting new genetic information into a cell with the intention of changing that cell´s function and ultimately modifying the phenotype of the organism.
Gene therapy = specific apllication of genetic engineering techniques with the primary objective of correcting defective genes to treat a genetic disorder.
The General Nature of Biological Engineering engineering = designing and constructing
of complex material artifacts for human use
up to the present, all technology has been concerned with lifeless material (most typically metals), shaping them into human artifacts for human use
man was the subject, „nature“ the object of technological mastery
Biological engineering: man becomes the direct object as well as the subject of the engineering art.
(Jonas, H., (1974) Philosophical essays: from ancient creed to technological man. Prentice-Hall)
Engineering:
man nature (metal)
Biological engineering:
man man
ENGINEERING from first element to final
product designing
maker is the sole agent vis-à-vis the passive material building
predictability is 100 % the engineer can accurately
predict the properties of his product
BIOLOGICAL ENGINEERING work on pregiven structure;
rather improvement than making de novo design alteration
modifier is a co-agent with the self active material intervention
number of unknown is immense prediction is reduced to
guessing, planning – to gambling
ENGINEERING experiments are performed
with substitute models which can be altered, tested and retested
everything in mechanical construction is reverisble
conventional engineering can always correct its mistakes in the planning and testing stages, even inthe finishing product automobiles f.e.) can be recalled to the factory for correcting of faults
BIOLOGICAL ENGINEERING the intended redesigning or
modification or improvement is in fact an experiment
for valid experiment, it must operate with the original itself the experiment is the real
deed modifications are
irreversible what is done is done (the
baby is born f.e.)
History
Gene therapy
The first approved gene-therapy protocol began on September 14, 1990, in NIH, Maryland
ADA
within a few weeks after gene therapy began, her immune system showed improvement, and after several months she began living a relatively normal life
a four-year-old girl suffering from adenosin deaminase (ADA) deficiency was given back her own immune cells (specifically her blood T lymphocytes) that had been corrected by inserting a normal copy of ADA gene
W. French Anderson, 1990
In the treated children, a sample of their own (ADA-deficient) immature lymphocyte stem cells was cultured. The functioning ADA gene was inserted into the genome of a harmless virus, which was then allowed to „infect“ the cultured precursor cells. These cells incorporated the corrected gene and were injected back into the patient. The treatment has been successful in several cases; the patients´immune system function was restored, although they undergo continual medical treatment
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 192)
The first definite success: a cure for X-linked severe combined immunodeficiency: X-SCID
later other patients received similar treatment, with up to 10-12 treatments per patients
several patients reported dramatic clinical improvements however, all the patients continued also to
receive treatment with an enzyme preparation, making it uncertain how much of their improvement was due to the gene therapy
The first definite success: a cure for X-linked severe combined immunodeficiency: X-SCID
X-linked SCID was the first unambigous success
the treatment was ex vivo, using a retroviral vector encoding the γc chain of cytokine receptor gene IL2R
bone marrow cells expressing CD34, a marker of hematopoietic stem cells, were incubated for 3 days with the retroviral vector…
…and then returned to the patient
Angelina Jolie underwent a preventive double mastectomy
MY MOTHER fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.
¶We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.
¶My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.
¶Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.
¶Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.
¶On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.
¶But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.
¶My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple.
¶Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.
¶Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.
¶I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.
¶It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.
¶I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.
¶For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.
¶I acknowledge that there are many wonderful holistic doctors working on alternatives to surgery. My own regimen will be posted in due course on the Web site of the Pink Lotus Breast Center. I hope that this will be helpful to other women.
¶Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.
¶I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.
¶Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of. ¶Angelina Jolie is an actress and director.
„The Bubble Boy“
David Phillip Vetter (September 21, 1971 – February 22, 1984)
he suffered SCID at the age of 12, he died
after hematopoietic stem cell transplantation
„The Bubble Boy“
What was wrong?
pros cons
effort to save the life doing everything is
possible
career of the researchers publications popularity for the
researches
giving too much hope to the parents
Celý životopis JG sepsaný jeho otcem Paulem Gelsingerem je na http://www.jesse-gelsinger.com/
Jesse Gelsinger
Jesse Gelsinger, 18 yrs old, was the first person publicly identified as having died in a clinical trial for gene therapy. He suffered from ornithine transcarbamylase deficiency, an X-lomked genetic disease of the liver which include an inability to metabolize ammonia - a byproduct of protein breakdown. The disease is usually fatal at birth, but Gelsinger’s disease was not inherited but rather, the result of a genetic mutation and as such was not as severe - some of his cells were normal which enabled him to survive on a restricted diet and special medications.
Jesse Gelsinger
Gelsinger joined a clinical trial run by the University of Pennsylvania that aimed to correct the mutation. On Monday, September 13 1999, Gelsinger was injected with adenoviruses carrying a corrected gene in the hope that it would manufacture the needed enzyme. He died four days later, apparently having suffered a massive immune response triggered by the use of the viral vector used to transport the gene into his cells.
Jesse Gelsinger
Treatment for JG: low-protein diet and cca 32 pills per day
the day he turned eighteen he left to Pennsylvania and gave the informed consent with the gene therapy
Jesse Gelsinger
he was pronounced dead on September 17, 1999 His death was the first reported death ever directly
attributable to a gene therapy experiment There were questions about the quality of informed
consent at University of Pennsylvania and accusations that the university had failed to report toxic side effects earlier that could have shut down the study.
Jesse Gelsinger
the announcement of Jesse´s death made for headlines, shocked the public and terryfied the scientific community
gradually, increasing numbers of articles suggested, that his death had been avoidable
there were 18 participants in this OTC gene therapy trial, JG was the youngest why JG did die when others who received the same
treatment did not is not known in the aftermath of this tragedy, the gene therapy
institute in Pennsylvania has stopped working with human subjects and returned to work on animal model system
Gene TherapyArguments for
Gene TherapyArguments FOR
Isolating a disease-inducing aberrant gene looks fairly continuous with isolating a disease-inducing intracellular virus
Suppllying diabetics with normal genes for producing insulin has the same medical goal as supplying them with insulin for injection
Gene Therapy of Germ CellsArguments FOR
it solves the problem once and for all. Why leave the patient´s descendants at risk of a disease if you could equally well eliminate the risk?
Germinal Choice Technology (GCT)
GCT could be accomplished by adding auxiliary human chromosomes (numbers 47 and 48), which will carry artificial genes for characteristics promoting attributes like increasing intelligence and longevity
each successive generation could have a genetic update, rather as you currently update your computer!
If we could make our baby smarter, more attractive, a better athlete or musician, or keep him of being overweight, why shouldn´t we? (Gregory Stock)
(Mepham, B., (2008) Bioethics. An Introduction for the Biosciences. Oxford University Press, Oxford, p. 150)
Gene TherapyArguments against
Germ cells gene therapyobjections
present men have the power over the future men, who are the defenseless objects of antecedent choices by the planners of today
there is no right to existence for hypothetical individuals not yet conceived
but though not the right of merely imagined offspring, the right to offspring of the hindered progenitor is involved.
Germ cells gene therapyobjections
it could lead to people being viewed as products capable of being manufactured, with the result that people could be „made to measure“.
our actions might come to be viewed as genetically determined rather than a matter of free will
Germ cells gene therapyobjections
germ line therapy is not necessary. Candidate couples would most likely have dominant or recessive Mendelian disorders (recurrence risk 50 % and 25 % respectively). Given a dish containing half a dozen IVF embryos from the couple, it would seem crazy to select the affected ones and subject them to an uncertain procedure, rather than simply to select the 50 % or 75 %of unaffected ones for re-implantation
Germ-line TherapyObjections
there are several alternative procedures prenatal genetic diagnosis gamete donation embryo selection adoption
...these are currently available and would not evoke the issues involved in germline manipulation
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 201)
Germ-line TherapyObjections
it is not safe when altered genes are inserted into the genome,
they may disrupt presently functional genes this has certainly been encountered in laboratory
mice. In one case, the disruption of single gene resulted in mice who were born without eyes, semicircular ear canals, or a sense of smell
some effects may take several generations to manifeste themselves - and any mistakes made will be permanent
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 202)
Germ-line TherapyObjections
it is not safe IGM is not a drug that can be discontinued if
the side effects are disastrous ...but we may one day use artificial
chromosomes to add genes that could be induced to lose their centromeres by a signal from exogenous factor. Once the signal was administered, such chromosomes would not survive meiosis or mitosis and would not be passed on to the next generation.
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 202)
Germ-line TherapyObjections
we know that there are genes that affects height and muscle mass, so we could conceivably make our offspring taller and stronger
if genes involving intelligence were found, those who could afford this procedure might enhance themselves in the hopes of producing highly intelligent offspring
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 202)
Germ-line TherapyObjections
Lee Silver (1998) envisions a world where, due to such economic inequality, the genetic haves and have-nots are far apart in their abilities: genetic engineering would convert economic differences into inherited biological differences.
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 202)
some question a consequence if a trait chosen in one generation falls out of fashion in the next or becomes particulary ill-suited to a change in the environment one genration preffering a certain hair color, height
or organ endowment if parents were to select genes for height and
body musculature, they might then pressure their child to succeed at sports, regardless of whether the chilod wants to play the game
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 204)
a genetic engineering could convert a child into a commercial product with expected parameters of normality and function
...and people who fell short of some technically achievable ideal would be seen as "damaged goods", increasing prejudices and discrimination
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 204)
Gene TherapyArguments AGAINST
"Still harder will it be for most people to live easily and wisely with less certain information - say, where multigenic traits are involved or where the predictions are purely statistical, with no clear implication for any partictlar "predisposed" individual
The recent case of a father who insisted that ovariectomy and mastectomy be performed on his ten-year-old daughter because she happened to carry the BRCA-1 gene for breast cancer dramatically shows the toxic effect of genetic knowledge"
(Kass, L.R., (2002) Life, Liberty and the Defense of Dignity. Encounter Books. New York, London. p. 125)
Gene TherapyArguments AGAINST
Hans Jonas: "knowledge of the future, especially one´s
own, has always been excepted /from the injunction to "Know thyself"/ and the attempt to gain it by whatever means (astrology is one) disparaged - as futile superstition by the enlightened, but as sin by theologians; and in the latter case with reasons that are also philosophically sound"
(Kass, L.R., (2002) Life, Liberty and the Defense of Dignity. Encounter Books. New York, London. p. 125)
Gene TherapyArguments AGAINST
C.S.Lewis: "In reality (...) if any one age really attains, by
eugenics and scientitfic education, the power to make its descendants what it pleases, all men who live after it are the patients of that power. They are weaker, not stronger „for though we may have put wonderful machines in their hands we have pre-ordained how they are to use them..."
(Kass, L.R., (2002) Life, Liberty and the Defense of Dignity. Encounter Books. New York, London. p. 127)
Germ-line TherapyObjections
because the technology is imprecise, any errors in the therapy (e.g. involving the insertion of a gene in the middle of another gene, disrupting its
expression) would also be inherited outcomes are unpredictable, for examle eradicating
the gene for sickle cell anaemia might increase the susceptibility of some carriers of the gene (e.g. in tropical Africa) to malaria, against which the gene confers resistance
manipulating of the embryo is seen as intrinsically ethically objecionable
Germ cells gene therapyobjections
germ line therapy is not necessary. Candidate couples would most likely have dominant or recessive Mendelian disorders (recurrence risk 50 % and 25 % respectively). Given a dish containing half a dozen IVF embryos from the couple, it would seem crazy to select the affected ones and subject them to an uncertain procedure, rather than simply to select the 50 % or 75 %of unaffected ones for re-implantation
Genetic Enhancement
Beacause memory is good, can we say how much more memory would be better?
If sexual desire is good, how much more will be better?
Life is good, but how much extension of the lifespan would be good for us?
Only simplistic thinkers believe they can easily answer such question
Kass, R.L., (2002) Life, Liberty and the Defense of Dignity. Encounter Books, New York, London. p. 132
Religions
Judaism
The jewish posture should be, in the briefest formula: education - yes; genetic manipulation - no. (...)
We have not been authorized, so Jewish piety would say, to be makers of a new image (...)
The protest should always be against turning men into things
Jonas, H., (2001) Contemporary Problems in Ethics from a Jewish Perspective in Yaffe, M.D., (ed.) Judaisms and Environmental Ethics. Lexington Books. Lanham. p. 259)
Judaism
The older and comforting belief that human nature remains the same and that the image of God in it will assert itself against all defacements by man-made conditions, become untrue if we "engineer" this nature genetically and be the sorcerers (or sorcerer´s apprentice) that make the future race of Golems
Jonas, H., (2001) Contemporary Problems in Ethics from a Jewish Perspective in Yaffe, M.D., (ed.) Judaisms and Environmental Ethics. Lexington Books. Lanham. p. 259)
Judaism
The jewish posture should be, in the briefest formula: education - yes; genetic manipulation - no. (...)
We have not been authorized, so Jewish piety would say, to be makers of a new image (...)
The protest should always be against turning men into things
Jonas, H., (2001) Contemporary Problems in Ethics from a Jewish Perspective in Yaffe, M.D., (ed.) Judaisms and Environmental Ethics. Lexington Books. Lanham. p. 259)
Catholic Church
in the present state of research, it is not morally permissible to act in a way that may cause possible harm to the resulting progeny. In the hypothesis of gene therapy on the embryo, it needs to be added that this only takes place in the context of in vitro fertilization and thus runs up against all the ethical objections to such procedures. For these reasons, therefore, it must be stated that, in its current state, germ line cell therapy in all its forms is morally illicit.
Enhancement
Nontherapeutical gene modifications
Nontherapeutic genetic modificationethical issues Issue of eugenic - are we allowed to
make hereditary „improvements“? Slippery slope - might we slide into a new
age of eugenic thinking by starting with small genetic improvements?
Nontherapeutic genetic modificationethical issues since more and more scientists believe
that all traits of personality have at least a partial biological basis, how will we distinguish the biological "defect" that yields "disease" from the biological condition that yields shyness or melancholy or irascibility?
Neterapeutické genetické modifikaceetické problémy everyone would welcome a gene therapy
to alleviate muscular dystrophy and to reverse the debilitating muscle loss that comes with old age.
But what if the same therapy were used to improve athletic performance?
Nontherapeutic genetic modificationethical issues researches have developed a synthetic gene
that, when injected into the muscle cells of mice, prevents and even reverses natural muscle deterioration. The gene not only repaires wasted or injured muscles but also strenghtens healthy ones
suppose that muscle-enhancing gene therapy turned out to be safe - or at least no riskier than a rigorous weight-training regimen. Would there be a reason to ban its use in sports?
Nontherapeutic genetic modificationethical issues it might be argued that a genetically
enhanced athlete, like a drug-enhanced athlete, would have an unfair advantage over his unenhanced competitors...
...but it has always been the case that some athletes are better endowed than others, and yet we do not consider this to undermine the fairness of competitive sports
(Sandel, M.J., The Case Against Perfection. The Atlantic Monthly (April 2004): 51-62 in (Pierce, J., Randels, G., (2010) Contemporary Bioethics. Oxford University Press, NY, Oxford. p.599)
Runners
Nontherapeutic genetic modificationethical issues researches have produced smart mice by
inserting extra copies of a memory-related gene into mouse embryo. The altered mice learn more quickly and remeber things longer than normal mice.
The extra copies were programmed to remain active even in old age, and the improvement was passed on to offspring.
.. we are now looking for "a Viagra for the brain"
Nontherapeutic genetic modificationethical issues there are 81 million Americans over fifty, who
are beginning to encounter the memory loss that comes naturally with age
such use would straddle the line between remedy and enhancement
unlike the treatment for Alzheimer´s , it would cure no disease...
...but insofar as it restored capacities a person once posessed, it would have a remedial aspect
Neterapeutické genetické modifikaceetické problémy IGF - 1
IGF-1 shows great promise in animal studies to increase muscle mass, and would be very difficult to detect by current monitoring systems. Most would consider this just as unacceptable as steroids in the atletic setting
but IGF-1 appears potentially able also to slow down the aging process
If that turns out to be true, would this use alo be immoral? (Collins, F., (2006) The Language of God. Free Presss, New York, p. 266)
Nontherapeutic genetic modificationethical issues What distinguishes a serious disease from
a“minor“ disease or from genetic variation? Should an adolescent whose parents are both 150 cm tall be provided with a growth hormone gene on result?
If the gene transfer extends one day to allowing a normal individual to acquire, for example, a memory-enhancing gene?
since more and more scientists believe that all traits of personality have at least a partial biological basis, how will we distinguish the biological "defect" that yields "disease" from the biological condition that yields shyness or melancholy or irascibility?
everyone would welcome a gene therapy to alleviate muscular dystrophy and to reverse the debilitating muscle loss that comes with old age.
But what if the same therapy were used to improve athletic performance?
Finasteride and Propecia
there is a very fine line between treatment and enhancement the drug finasteride stops the prostate from enlarging and is
medically prescribed to men with this serious condition in smaller doses, the same drug will retard male pattern
baldness both prostate growth and pattern baldness result from the
metabolizing of testosterone to a more potent steroid hormone, and finasteride blocks that metabolism
those men who can afford the drug can impede baldness by using it, and it is widely marketed for this purpose under the brand name Propecia
(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 195)