الفهرس | Only 14 pages are availabe for public view |
Abstract lbroughout the past 20 yr, molecular biolo] ’ has expanded the horizons of clinical medicine in both diagnosi, and treatment. A background on a variety of molecular biology tl zhniques and their application in genetic engineering and medicine hould facilitate an understanding of the application of genetic techi iques in the daily practice of clinical medicine . Our enhanced understanding of the neurobie], ~y of pain and great progress in molecular biologic technology, particul rly in gene therapy, render a gene therapeutic approach to pain mal igement a realistic possibility. Gene therapy offers the tantalizing possibi ty of specific and selective targeting of a single point in the synthesis of proteins. Current gene therapy tools are promising but still require sigr ficant improvement before routine human clinical application becomes a rality, CNS delivery of antisense oligonucleotides as a means for reducir ~ the target protein level is a technology on the verge of human clinical tri Is, and viral vectors clearly will improve as the entire field of human ge re therapy evolves. Animal work with state-of-the-art viral vectors conch lively demonstrates the feasibility of tissue-specific and regulatable expre sion of transgenes. Application of the tools and strategies of gene therapj to the field of pain medicine may yield valuable therapies for the m nagement of pain resistant to conventional pharmacotherapeutic options. The process ofnociception involves intricate i ueractions between a large number of cellular and molecular targets and i eludes many classes of potential targets for gene therapy. We have pres’ ated only a selected subset of targets that may be amenable to a gene the ipeutic approach for attenuation of nociception; however, the strategies ; rd methods of gene therapy may be applied to other current or future noci eptive targets. Many gaps in our understanding of the roles 0 receptors and other potential targets for gene therapy for pain exist. How ver, much is known about the physiology, pharmacology, and molecular iiology of potential therapeutic targets. Subsequent elucidation of the neur ibiology of pain and progress in the tools available for gene therapy will ac ’ance the possibility and reality of gene therapy for the management of lain. Strategies and methods currently available for implementing ge e therapy for the management of pain are not ideal but sufficiently elu idated for an initial clinical trial. Anesthesiologists, by the virtue of au understanding and intimate familiarity with the clinical problems of pa 1 management, are situated particularly well to become the leaders in trar ilating the dramatic • developments in the neurobiology of pain to clinic I gene therapy for chronic pain management. |