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DebRA International Current Genetic Research Projects  
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GENETIC RESEARCH

Epidermolysis Bullosa (EB) is a genetic condition affecting approximately 1:17,000 live births. In the UK there are an estimated 4-5,000 people with the condition, with around 300,000 worldwide. The condition is always painful, frequently very disabling and life threatening and, in its most severe forms, babies die within the first two years of life.

There are three distinct types of the condition, all with several sub groups, which vary greatly in appearance and prognosis. Some forms are inherited dominantly, i.e. where one parent has the condition and passes it on, and others have a recessive pattern of inheritance, i.e. both parents are unaffected carriers of the condition.


Despite the complexity of the condition, there has been an explosion of knowledge about the genetics of EB over the past 5-10 years. The genes that are responsible for all of the main forms of EB are now known and genetic material has been successfully altered in the laboratory to correct the defect in vitro. Much of the work that has accomplished this has been funded by DebRA as a result of collaborations with the leading research groups in Europe and, to a lesser extent, in the USA. As a result, EB is in the front rank of genetic conditions where there are realistic expectations of treatments being developed.


The challenge now facing EB research is to move towards the time when the defect can be altered in humans to alleviate or eliminate their symptoms. The challenge is different in the recessive and dominant forms. In the case of recessive EB, it is known that an increase in correctly functioning protein over a certain threshold will correct the symptoms. In dominantly inherited types of EB it has generally been believed to be necessary to knock out the defective gene since it will “overpower” any correctly functioning gene. However, recent data suggests that, if the defective protein can be suppressed sufficiently, symptoms can be eliminated.

Delivery of the modified gene is also a major challenge. Any delivery mechanism, known as a vector, must be safe, effective and targeted. Various different types of vector are being investigated and comparisons are planned.

Whilst these are significant challenges there is considerable optimism that they can be overcome. The first ever consensus meeting on EB was held in late 1999 as a result of a joint initiative between DebRA Europe and DebRA of America, involving the leading researchers from Europe, the USA and Japan. This conference determined the key issues to be addressed in EB genetic research and encouraged the development of multi-national collaborations between research groups with a strong emphasis on the needs of the patient. The principles agreed at the meeting, which have been updated at two subsequent conferences, guide DebRA’s current genetic research programme. A further meeting is to be held in Ireland in October 2005.

CURRENT RESEARCH FUNDED OR ASSISTED

Programme grants

EB Simplex

Identification of genes and mutations in unsolved cases of EBS.
Profs. B Lane & WHI McLean, University of Dundee

RNA therapeutics for EB Simplex. Profs. Irwin McLean & Birgit Lane, University of Dundee.

Recessive dystrophic EB

Preclinical gene therapy of recessive dystrophic EB and the development of a gene therapy approach for dominant dystrophic EB.  Dr G Meneguzzi, INSERM U 385, Nice

A mouse model for non-Hallopeau-Siemens recessive dystrophic EB: testing cell and protein therapies in vivo.      Prof. L Bruckner-Tuderman, University of Freiburg

Therapeuskin.  Prof Alain Hovnanian, INSERM U563, Toulouse et al

Skintherapy. Dr Guerrino Meneguzzi, INSERM 634, Nice et al.

DebRA funds in full the grant to Profs. McLean and Lane to work on the development of gene therapy for EBS. Therapeuskin and Skintherapy are both programmes funded under the European Union Sixth Framework Programme to work on gene therapy for RDEB; DebRA is a partner in both programmes.

All of these programmes have the objective of finalising preclinical work on gene therapy for different forms of EB, prior to Phase I/II clinical trials.

Project grants

EB Simplex

Small molecule-based therapy approaches for EBS.  Prof. Thomas Magin, University of Bonn, Germany

Identification of genes and mutations in unsolved cases of EBS Prof Irwin McLean, Prof Birgit Lane

Investigation of fever-associated improvement in EBS. Prof. Birgit Lane, University of Dundee.

Study of the mechanism behind the cell fragility of EBS.
Prof. Birgit Lane, University of Dundee.

Identification of mutations and mechanisms in EBS.
Prof. Birgit Lane, University of Dundee.

Generation of a mouse model for EBS-MD.
Prof. Arnoud Sonnenberg, Netherlands Cancer Institute, Amsterdam.

Developing spliceosome mediated RNA trans-splicing (SMaRT) for gene therapy in EB patients.
Prof. Johann Bauer, Paracelsus Medical University, Salzburg.

K15 keratin to the rescue of basal keratinocytes in EBS: use of thyroid hormones and interferon-gamma to increase specifically K15 gene transcription.
Dr Miroslav Blumenberg, New York University School of Medicine.

Inducible deletion of plectin in basal keratinocytes.
Prof. Gerhard Wiche, Max F Perutz Laboratories, Vienna.

Recessive dystrophic EB

Preclinical research project for ex vivo gene therapy for RDEB using COL7A1 expressing retroviral vectors. Prof. Alain Hovnanian, INSERM U563, Toulouse

The influence of allogeneic fibroblasts on basement membrane zone composition in RDEB.
Prof. John McGrath, St John’s Institute of Dermatology, London and Prof. Irene Leigh & Dr Harry Navsaria, Centre for Cutaneous Research, Barts & London School of Medicine & Dentistry.

Preclinical gene therapy of RDEB.
Dr Guerrino Meneguzzi, INSERM 634, Nice.

Exploration of therapeutic approaches for EB.
Dr Jane Farrar, Prof. Peter Humphries and Mr D Allen, Trinity College Dublin. DEBRA Ireland project

Junctional EB

Imbalance of protease activity in JEB patients: implications in skin blistering.   Dr l Gagnoux-Palacios, INSERM U 634, Nice

A new model for junctional EB. Dr John Sundberg, The Jackson Laboratory, Bar Harbor, Maine, USA

Gene therapy of mild junctional EB. Dr Guerrino Meneguzzi, INSERM 634, Nice.

Generic

Identification of novel genes involved in maintaining structural integrity of the cutaneous basement membrane zone.
Dr Mahendra Sonawane, Max-Planck Institut fur Entwicklungsbiologie, Tuebingen.

Kindler Syndrome: an inducible mouse model for gene therapy development.
Prof. Irwin McLean, University of Dundee.

         


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