Spliced: Boundary-work and the establishment of human gene therapy
Abstract
Human gene therapy (HGT) aims to cure disease by inserting or editing the DNA of patients with genetic conditions. Since foundational genetic techniques came into use in the 1970s, the field has developed to the point that now three therapies have market approval, and over 1800 clinical trials have been initiated. In this article I present a brief history of HGT, showing how the ethical and practical viability of the field was achieved by key scientific and regulatory actors. These parties carefully articulated gene therapy’s scope, limiting it to therapeutic interventions on somatic cells, and cultivated alliances and divisions that bolstered the field’s legitimacy. At times these measures faltered, and then practitioners and sometimes patients would invoke an ethical imperative, posing gene therapy as the best solution to life and death problems. I suggest that we consider how boundary-work stretches out from science to enlist diverse publics, social formations and the natural world in the pursuit of legitimacy.
Keywords
human gene therapy history biotechnology genomics gene transfer boundary-workNotes
Acknowledgements
This article benefited greatly from feedback offered by Jesper Lassen, Peter Sandøe, Samuel Taylor-Alexander and the Work in Progress group led by Silvia Camporesi at KCL’s Department of Social Science Health and Medicine. This project, as part of the Consortium for Designer Organisms, is funded by the University of Copenhagen’s Excellence Fund for Interdisciplinary Research.
References
- AdSAT Working Group (2002) Assessment of adenoviral vector safety and toxicity: Report of the national institutes of health Recombinant DNA Advisory Committee (NIH Report). Human Gene Therapy 13(1): 3–13.Google Scholar
- Allan, D.S. and Dubé, I.D. (1996) Symposium highlights: Future prospects for gene therapy. Transfusion Science 17(1): 203–205.CrossRefGoogle Scholar
- Amati, M.P. et al (2003) EMEA and gene therapy medicinal products development in the European Union. Journal of Biomedicine and Biotechnology 2003(1): 3–8.CrossRefGoogle Scholar
- Anderson, W.F. and Fletcher, J.C. (1980) Gene therapy in human beings: When is it ethical to begin? New England Journal of Medicine 303(22): 1293–1297.CrossRefGoogle Scholar
- Anderson, W.F. (1982) Human Genetic Engineering: Hearings before the Subcommittee on Investigations and Oversight of the Committee on Science and Technology. (Testimonial) U.S. House of Representatives, 97th Congress, 2nd Session, no. 170, Washington DC.Google Scholar
- Anonymous (1988) Gene therapy in man: Recommendations of the European medical research councils. The Lancet 331(8597): 1271–1272.Google Scholar
- Anonymous (2002) The trials of gene therapy. Nature 420(6912): 107.Google Scholar
- Barber, S. and Border, P. (2015) Mitochondrial donation. (Standard Note SN/SC/6833) House of Commons Library.Google Scholar
- Batshaw, M.L., Wilson, J.M., Raper, S., Yudkoff, M. and Robinson, M.B. (1999) Recombinant adenovirus gene transfer in adults with partial Ornithine Transcarbamylase deficiency (OTCD). Human Gene Therapy 10(14): 2419–2437.CrossRefGoogle Scholar
- Berg, P. et al (1974) Potential biohazards of recombinant DNA molecules. Science 185(4148): 303.CrossRefGoogle Scholar
- Berg, P. and Singer, M.F. (1995) The recombinant DNA controversy: Twenty years later. Proceedings of the National Academy of Sciences 92(20): 9011–9013.CrossRefGoogle Scholar
- Blaese, M.R. et al (1999) T-lymphocyte-directed gene therapy for ADA-SCID: Initial trial results after four years. Science 270(5235): 475–480.CrossRefGoogle Scholar
- Bordignon, C. et al (1993) Clinical protocol: Transfer of the ADA gene into bone marrow cells and peripheral blood lymphocytes for the treatment of patients affected by ADA-deficient SCID. Human Gene Therapy 4(4): 513–520.CrossRefGoogle Scholar
- Bordignon, C. et al (1995) Gene therapy in peripheral blood lymphocytes and bone marrow for ADA immunodeficient patients. Science 270(5235): 470–475.CrossRefGoogle Scholar
- Bowker, G.C. and Star, S.L. (1999) Sorting Things Out: Classification and its Consequences. Cambridge, MA: MIT Press.Google Scholar
- Bryant, L.M. et al (2013) Lessons learned from the clinical development and market authorization of Glybera. Human Gene Therapy Clinical Development 24(2): 55–64.CrossRefGoogle Scholar
- Büning, H. (2013) Gene therapy enters the pharma market: The short story of a long journey. EMBO Molecular Medicine 5(1): 1–3.CrossRefGoogle Scholar
- Butler, D. (1994) Call for risk/benefit study of gene therapy. Nature 372(6508): 716.CrossRefGoogle Scholar
- Campbell, P., Maranto, G., Cantor, C.R., Glantz, L.H. and Miller, F.H. (1998) Gene therapy: Legal, financial and ethical issues. Boston University Journal of Science and Technology Law 4(3): 110.Google Scholar
- Cavazzana-Calvo, M. et al (2000) Gene therapy of human severe combined immunodeficiency (SCID)-X1 disease. Science 288(5466): 669.CrossRefGoogle Scholar
- Cavazzana-Calvo, M.A., Thrasher, A. and Mavilio, F. (2004) The future of gene therapy: Balancing the risks and benefits of clinical trials. Nature 427(6977): 779–781.CrossRefGoogle Scholar
- Check, E. (2003) Harmful potential of viral vectors fuels doubt over gene therapy. Nature 423(6940): 573–574.Google Scholar
- Churchill, L.R., Collins, M.L., King, N.M.P., Pemberton, S.G. and Wailoo, K.A. (1998) Genetic research as ‘therapy’: Implications of ‘gene therapy’ for informed consent. Journal of Law, Medicine and Ethics 26(1): 38–47.CrossRefGoogle Scholar
- Clothier Committee (1992) Report of the committee on the ethics of gene therapy. Human Gene Therapy 3(5): 519–523.Google Scholar
- Cohen-Haguenauer, O. (1992) Gene therapy in Europe. Transfusion Science 17(1): 185–190.CrossRefGoogle Scholar
- Comfort, N. (2013) The Science of Human Perfection: How Genes became the Heart of American Medicine. New Haven, CT, London: Yale University Press.Google Scholar
- Committee on Government Reforms (2000) Human Subject Research Protections. Hearing before the Subcommittee on Criminal Justice, Drug Policy and Human Resources of the Committee on Government Reforms. Washington DC: US Government Printing Office.Google Scholar
- Couzin, J. and Kaiser, J. (2005) As Gelsinger case ends, gene therapy suffers another blow. Science 307(5712): 1028.CrossRefGoogle Scholar
- Culver, K.W. et al (1991) Correction of ADA deficiency in human T-lymphoctyes using retroviral-mediated gene transfer. Transplantation Proceedings. 23(1): 170–171.Google Scholar
- Curnutte, M. and Testa, G. (2010) Consuming genomes: Scientific and social innovation in direct-to-consumer genetic testing. New Genetics and Society 31(2): 159–181.CrossRefGoogle Scholar
- Deakin, C.T., Alexander, I.E. and Kerridge, I. (2009) Accepting risk in clinical research: Is the gene therapy field becoming too risk averse? Molecular Therapy 17(11): 1842–1848.CrossRefGoogle Scholar
- Devlin, H. (2015) Britain’s House of Lords approves conception of three-parent babies. The Guardian, 24 February, http://www.theguardian.com/politics/2015/feb/24/uk-house-of-lords-approves-conception-of-three-person-babies.
- Dworkin, R.B. (1990) Science, society, and the expert town meeting: Some comments on Asilomar. Southern California Law Review 51(6): 1471–1482.Google Scholar
- Edelstein, M.L., Abedi, M.R. and Wixon, J. (2007) Gene therapy clinical trials worldwide to 2007 – An update. The Journal of Gene Medicine 9(10): 833–842.CrossRefGoogle Scholar
- Ehrich, K., Williams, C., Scott, R., Sandall, J. and Farsides, B. (2006) Social welfare, genetic welfare? Boundary work in the IVF-PGD clinic. Social Science and Medicine 63(5): 1213–1224.CrossRefGoogle Scholar
- EMA (European Medicines Agency) (2012) Glybera, alipogene tiparvovec. EPAR summary for the public, pp. 1–3.Google Scholar
- Emery, D.W. (2004) Gene therapy for genetic disease: On the horizon. Clinical and Applied Immunology Reviews 4(6): 411–422.CrossRefGoogle Scholar
- Epstein, S. (1995) Impure Science: AIDS, Activism and the Politics of Knowledge. Berkeley, CA: University of California Press.Google Scholar
- European Parliament and the Council of the European Union (2001) Directive 2001/20/EC.Google Scholar
- Finkler, K. (2000) Experiencing the New Genetics: Family and Kinship on the Medical Frontier. Philadelphia, PA: University of Pennsylvania Press.CrossRefGoogle Scholar
- Fischer, M.M.J. (2004) Emergent Forms of Life and the Anthropological Voice. Durham, NC: Duke University Press.Google Scholar
- Fletcher, J.C. (1990) Evolution of ethical debate about human gene therapy. Human Gene Therapy 1(1): 55–68.CrossRefGoogle Scholar
- Fortun, M. (2008) Promising Genomics: Iceland and deCODE Genetics in a World of Speculation. Berkeley, CA: University of California Press.Google Scholar
- Franklin, S. and Roberts, C. (2006) Born and Made: An Ethnography of Pre-Implantation Genetic Diagnosis. Princeton, NJ; Oxford: Princeton University Press.CrossRefGoogle Scholar
- Frederikson, D.S. (1991) Asilomar and recombinant DNA: The end of the beginning. In: K.E. Hanna (ed.) Biomedical Politics. Washington DC: National Academies Press, pp. 258–298.Google Scholar
- Friedman, T. (1992) A brief history of human gene therapy. Nature Genetics 2(2): 93–98.CrossRefGoogle Scholar
- Frist, B. (2002) Protecting Human Subjects in Research: Are Current Safeguards Accurate? Hearing before the Subcommittee on Public Health of the Committee of Health, Education, Labour and Pensions United States Senate. Washington DC: US Government Printing Office.Google Scholar
- Frith, L., Jacoby, A. and Gabbay, M. (2011) Ethical boundary work in the infertility clinic. Sociology of Health and Illness 33(4): 570–585.CrossRefGoogle Scholar
- Gaspar, H.B. et al (2011) Long-term persistence of polyclonal T cell repertoire after gene therapy for X-linked severe combined immunodeficiency. Science Translational Medicine 3(97): 97–99.Google Scholar
- Gibbon, S. (2002) Re-examining geneticization: Family trees in breast cancer genetics. Science as Culture 11(4): 429–457.CrossRefGoogle Scholar
- Gieryn, T. (1983) Boundary-work and the demarcation of science from non-science: Strains and interests in the professional ideologies of scientists. American Sociological Review 48(6): 781–795.CrossRefGoogle Scholar
- Gieryn, T. (1991) Cultural Boundaries of Science: Credibility on the Line. Chicago, IL: University of Chicago Press.Google Scholar
- Ginn, S.L., Alexander, I.E., Edelstein, M.L., Abedi, M.R. and Wixon, J. (2013) Gene therapy clinical trials worldwide to 2012 – An update. Journal of Gene Medicine 15(2): 65–77.CrossRefGoogle Scholar
- Genetic Alliance UK (2014) Avoiding mitochondrial disease. Response to the Nuffield Council of Bioethics, pp. 1–3.Google Scholar
- Gershon, D. (1990) Clinical trials next step. Nature 344(6261): 2.CrossRefGoogle Scholar
- Gore, A. (1982) Human Genetic Engineering: Hearings before the Subcommittee on Investigations and Oversight of the Committee on Science and Technology. Opening address, U.S. House of Representatives, 97th Congress, 2nd Session, no. 170, Washington DC.Google Scholar
- Gore, A. (1984) Human Gene Therapy: A Background Paper. Washington DC: U.S. Congree, Office of Technology Assessment.Google Scholar
- Grobhans, H. (2000) Gene therapy – When a simple concept meets a complex reality. Functional Integrative Genomics 1(2): 142–145.CrossRefGoogle Scholar
- Hacein-Bay-Abina, S. et al (2008) Insertional oncogenesis in 4 patients after retrovirus-mediated gene therapy of SCID-X1. Journal of Clinical Investigation 118(9): 3132–3142.CrossRefGoogle Scholar
- Hacein-Bay-Abina, S., von Kalle, C. and Schmidt, M. (2003a) A serious adverse event after successful gene therapy for X-Linked severe combined immunodeficiency. New England Journal of Medicine 348(3): 255–256.CrossRefGoogle Scholar
- Hacein-Bay-Abina, S. et al (2003b) LMO2-associated clonal T-cell proliferation in two patients after gene therapy for SCID-X1. Science 302(5644): 415–419.CrossRefGoogle Scholar
- Hedgecoe, A. (2001) Schitzophrenia and the narrative of enlightened geneticisation. Social Studies of Science 31(6): 875–911.CrossRefGoogle Scholar
- Horst, M. (2007) Public expectations of gene therapy: Scientific futures and their performative effects on scientific citizenship. Science, Technology and Human Values 32(2): 150–171.CrossRefGoogle Scholar
- House of Commons Science and Technology Committee (2014) Mitochondrial donation. Correspondence relating to evidence hearing, 22 October.Google Scholar
- Human Fertilisation and Embryo Authority (2014) Mitochondrial donation: An introductory briefing note, http://www.hfea.gov.uk/6896.html.
- Inhorn, M.C. and Birenbaum-Carmeli, D. (2008) Assisted reproductive technologies and culture change. Annual Review of Anthropology 37: 177–196.CrossRefGoogle Scholar
- Isasi, R.M., Nguyen, T.M. and Knoppers, B.M. (2006) National Regulatory Frameworks Regarding Human Genetic Modification Technologies. A report for the Genetics and Public Policy Centre, Montreal.Google Scholar
- Kaiser, J. (2005) Panel urges limits on X-SCID trials. Science 307(5715): 1544–1545.CrossRefGoogle Scholar
- Kay, L.E. (2000) Who Wrote the Book of Life? A History of the Genetic Code. Stanford, CA: Stanford University Press.Google Scholar
- Keller, E.F. (2000) The Century of the Gene. Cambridge, MA: Harvard University Press.Google Scholar
- Kerr, A., Cunningham-Burley, S. and Amos, A. (1998) Eugenics and the new genetics in Britain: Examining contemporary professionals accounts. Science, Technology and Human Values 23(2): 175–198.CrossRefGoogle Scholar
- Kerr, A. and Shakespeare, T. (2002) Genetic Politics: From Genetics to Genome. Cheltenham, UK: New Clarion Press.Google Scholar
- Kimmelman, J. (2009) Gene Transfer and the Ethics of First-in-Human Research: Lost in Translation. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
- Kim, S., Peng, Z. and Kaneda, Y. (2007) Current status of gene therapy in Asia. Molecular Therapy 16(2): 237–243.CrossRefGoogle Scholar
- Klug, B., Celis, P., Carr, M. and Reinhardt, J. (2012) Regulatory structures for gene therapy medicinal products in the European Union. Methods in Enzymology 507: 337–354.CrossRefGoogle Scholar
- Knorr-Cetina, K. (1999) Epistemic Cultures: How the Sciences Make Knowledge. Cambridge, MA: Harvard University Press.Google Scholar
- Koenig, B. (1988) The technological imperative in medical practice: The social creation of a ‘routine’ treatment. In: M. Lock and R. Gordon (eds.) Biomedicine Examined. Dordrecht, The Netherlands: Kluwer Academic Publishers.Google Scholar
- Kohn, D.B. and Gänsbacher, D. (2003) Letter to the editors of Nature from the American Society of Gene Therapy and the European Society of Gene Therapy. Journal of Gene Medicine 5(7): 641.CrossRefGoogle Scholar
- Landecker, H. (2007) Culturing Life: How Cells Became Technologies. Cambridge, MA: Harvard University Press.CrossRefGoogle Scholar
- Latour, B. (1987) Science in Action. Cambridge, MA: Harvard University Press.Google Scholar
- Lehrman, S. (1995) … but seeks ‘practical’ gene therapy deals. Nature 378(6552): 7.CrossRefGoogle Scholar
- Liang, P. et al (2015) CRISPR/Cas9-mediated gene editing in human tripronuclear zygotes. Protein and Cell 6(5): 363–372.CrossRefGoogle Scholar
- Lindee, S. (2005) Moments of Truth in Genetic Medicine. Baltimore, MD: John Hopkins University Press.Google Scholar
- Lippman, A. (1992) Led astray by genetic maps: The cartography of the human genome project and healthcare. Social Science and Medicine 39(12): 1469–1476.CrossRefGoogle Scholar
- Lu, D.R. et al (1993) Stage 1 clinical trial of gene therapy for haemophilia B. Science in China 36(11): 1342–1351.Google Scholar
- Lock, M. (2005) Eclipse of the gene and the return of divination. Current Anthropology 46(S48): S47–S70.CrossRefGoogle Scholar
- Lock, M. (2008) Biomedical technologies, cultural horizons and contested boundaries. In: E.J. Hackett, O. Amsterdamska, M. Lynch and J. Wajcman (eds.) Handbook of Science and Technology Studies, Third Edition. Cambridge, MA; London: MIT Press.Google Scholar
- Lock, M. (2015) Comprehending the body in the era of the epigenome. Current Anthropology 56(2): 151–177.CrossRefGoogle Scholar
- Marshall, E. (1996) Gene therapy’s growing pains. Science 269(5227): 1050–1055.CrossRefGoogle Scholar
- Martin, P. (1999) Genes as drugs: The social shaping of gene therapy and the reconstruction of genetic disease. Sociology of Health and Illness 21(5): 517–538.CrossRefGoogle Scholar
- Miller, H. (1995) Overregulation is an unnecessary hindrance to human gene therapy. Human Gene Therapy 6(11): 1361–1362.CrossRefGoogle Scholar
- Miller, D.A. (1992) Human gene therapy comes of age. Nature 357(6368): 455–460.CrossRefGoogle Scholar
- Mitchell, R. and Waldby, C. (2010) National biobanks: Clinical labour, risk production, and the creation of biovalue. Science, Technology and Human Values 35(3): 330–355.CrossRefGoogle Scholar
- Nelkin, D. and Lindee, S. (1995) The DNA Mystique: The Gene as Cultural Icon. New York: W. H. Freeman.Google Scholar
- NIH (2013) NIH guidelines for research involving recombinant or synthetic nucleic acid molecules, http://oba.od.nih.gov, accessed November 2013.
- Novas, C. and Rose, N. (2000) Genetic risk and the birth of the somatic individual. Economy and Society 29(4): 485–513.CrossRefGoogle Scholar
- O’Reilly, M. et al (2013) NIH oversight of human gene transfer research involving retroviral, lentiviral, and adeno-associated virus vectors and the role of the NIH Recombinant DNA Advisory Committee. Methods in Enzymology 507: 313–335.CrossRefGoogle Scholar
- Orkin, S. and Motulsky, A. (1995) Report and recommendations of the panel to assess the NIH investment in research on gene therapy. Bulletin of Medical Ethics 116: 10–11.Google Scholar
- President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1982) Splicing Life: A. Report on the Social and Ethical Issues of Genetic Engineering with Human Beings. Washington DC: U.S. Government Printing Office.Google Scholar
- Rabeharisoa, V. and Callon, M. (2002) The Involvement of Patients’ Associations in Research. UNESCO report, Oxford, UK and Malden, MA.Google Scholar
- Rabinow, P. (1996) Making PCR: A Story of Biotechnology. Chicago, IL; London: The University of Chicago Press.Google Scholar
- Randall, C., Mandelbaum, B. and Kelly, T. (1980) Letter from three general secretaries. Letter to congress, Washington, DC.Google Scholar
- Raper, S.E. et al (2003) Fatal systemic inflammatory response syndrome in a ornithine transcarbamylase deficient patient following adenoviral gene transfer. Molecular Genetics and Metabolism 80(1–2): 148–158.CrossRefGoogle Scholar
- Rapp, R. (1999) Testing Women, Testing the Fetus: Women and Prenatal Diagnosis. New York: Routledge.Google Scholar
- Schmek, H.M. (1981) U.S. agency disciplines gene therapy researcher. The New York Times, http://www.nytimes.com/1981/05/29/us/us-agency-disciplines-gene-splicing-researcher.html.
- Sheridan, C. (2011) Gene therapy finds its niche. Nature Biotechnology 29(2): 121–128.CrossRefGoogle Scholar
- Stockdale, A. (1999) Waiting for the cure: Mapping the social relations of human gene therapy research. Sociology of Health and Illness 21(5): 579–596.CrossRefGoogle Scholar
- Stolberg, S.G. (1999) The biotech death of Jesse Gelsinger. The New York Times Magazine, 28 November, http://www.nytimes.com/1999/11/28/magazine/the-biotech-death-of-jesse-gelsinger.html?pagewanted=all.
- Taussig, K.-S. (2009) Ordinary Genomes: Science, Citizenship, and Genetic Identities?. Durham, NC: Duke University Press.CrossRefGoogle Scholar
- Thompson, C. (2005) Making Parents: The Ontological Choreography of Reproductive Technologies. Cambridge, MA: MIT Press.Google Scholar
- Uniqure (2012) uniQure’s Glybera® first gene therapy approved by European Commission. Press release. Amsterdam, The Netherlands.Google Scholar
- Wade, N. (1981) Gene therapy caught in more entanglements. Science 212(4490): 24–25.CrossRefGoogle Scholar
- Wadman, M. (1995) Hyping results ‘could damage’ gene therapy. Nature 378(6558): 655.CrossRefGoogle Scholar
- Wailoo, K. and Pemberton, S. (2006) The Troubled Dream of Genetic Medicine: Ethnicity and Innovation in Tay-Sachs, Cystic Fibrosis, and Sickle Cell Disease. Baltimore, MD: John Hopkins University Press.Google Scholar
- Wainwright, S.P., Williams, C., Michael, M., Farsides, B. and Cribb, A. (2006) Ethical boundary work in the embryonic stem cell laboratory. Sociology of Health and Illness 28(6): 732–748.CrossRefGoogle Scholar
- Wilson, J. (2005) Gendicine: The first commercial gene therapy product. Human Gene Therapy 16(9): 1014.CrossRefGoogle Scholar
- Wilson, J.M. (2009) Lessons learned from the gene therapy trial for ornithine transcarbamylase deficiency. Molecular Genetics and Metabolism 96(4): 151–157.CrossRefGoogle Scholar
- Wilson, J.M. (2013) Bulls, bubbles, and biotech. Human Gene Therapy 24(7): 715–716.CrossRefGoogle Scholar
- Wolff, J.A. and Lederberg, J. (1994) An early history of gene transfer and therapy. Human Gene Therapy 5(4): 469–480.CrossRefGoogle Scholar
- Yarborough, M. and Sharp, R.R. (2009) Public trust and research a decade later: What have we learned since Jesse Gelsinger’s death? Molecular Genetics and Metabolism 97(1): 4–5.CrossRefGoogle Scholar
- Ylä-Herttuala, S. (2012) Endgame: Glybera finally recommended for approval as the first gene therapy drug in the European Union. Molecular Therapy 20(10): 1831–1832.CrossRefGoogle Scholar
- Zallen, D.T. (2000) U.S. gene therapy in crisis. Genetics and Society 16(6): 272–275.Google Scholar