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Targeting Genes for Treatment in Idiopathic Pulmonary Fibrosis

Challenges and Opportunities, Promises and Pitfalls

Department of Pathology and Molecular Medicine, Center for Gene Therapeutics; and Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada

Correspondence and requests for reprints should be addressed to Jack Gauldie, Ph.D., Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada L8N 3Z5. E-mail: gauldie{at}mcmaster.ca

ABSTRACT

The currently accepted approach to treatment of idiopathic pulmonary fibrosis (IPF) is based on the assumption that it is a chronic inflammatory disease, and most available antiinflammatory drugs target numerous biological processes involving multiple genes, but are not often beneficial. More novel therapeutic strategies take recent findings about the underlying molecular mechanisms of fibrogenesis into account, and ongoing and as yet unpublished clinical trials in IPF aim to block single gene targets believed to play major roles in disease progression. Characterization of the mechanisms involved in the pathogenesis of IPF has largely come from the use of animal disease models in rodents. Most data suggest, from among the different factors, a prominent role for the transforming growth factor (TGF)–ß1 and platelet-derived growth factor pathways. Inflammation is a critical element of the initiation of fibrosis and data indicate that the Smad pathway is a necessary link to fibrosis through TGF-ß and Smad3 signaling, which introduces matrix regulation as a new target for therapeutic intervention. Regardless, gene targeted therapy has numerous pitfalls that have to be addressed before we see a real therapeutic advance.

Key Words: pulmonary fibrosis • targeting genes • therapeutics review

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