Scholarly Article Summary

Article Link:

http://search.proquest.com/docview/218673183?accountid=12073

Summary:

Chase Kilmer

Dr. Kyburz

Colle Writing 2 (1:00pm-1:50pm)

19 October 2017

Scholarly Article Summary

            The scholarly article “On the scientific and ethical issues of fetal somatic gene therapy” by C. Coutelle and C. Rodeck from 2002, discusses not only the technological advancements in the field, but the risks that coincide. Coutelle and Rodeck acknowledge that there are no doubt possible consequences to what some may call ‘mad science,’ but they also inform that many people who lack information  on the topic are quick to jumping to conclusions.

            Coutelle and Rodeck begin by expressing that it is quite unfortunate that “many of the adverse reactions to this approach [fetal gene therapy] such as accusations of wanting to play god, to manipulate the germ-line, to create designer babies or tamper with evolution are based on misunderstanding, confusion, and sometimes just sheer emotion” (Coutelle, Rodeck). Coutelle and Rodeck then continue by bringing up a few common questions about gene therapy, such as “should fetal gene therapy be preferred over preimplantation selection or abortion?” and “what are the risks to the fetus and the mother?” and several other questions concerning risk and legal issues Coutelle, Rodeck).

            Coutelle and Rodeck progress by stating that before answering any questions, they “would like to emphasize that fetal or in utero somatic gene therapy is still an experimental concept for the treatment and hopefully the prevention of genetic disease” (Coutelle, Rodeck). That statement is also tagged by mentioning that studies are exclusively working with animals at this point. Closing the introduction, it is explained that if their goals are achieved, fetal gene therapy “may be able to provide prenatal prevention and permanent correction of disease manifestation” (Coutelle, Rodeck).

            Coutelle and Rodeck move directly into a series of answering the several questions posed in their introduction. The first question to be discussed is “should fetal gene therapy be preferred over postnatal gene therapy?” Coutelle and Rodeck answer this question by giving certain circumstances where one option would be more appropriate. Coutelle and Rodeck explain that postnatal gene therapy is the better option for less sever genetic diseases, but “in utero gene therapy would be particularly relevant for diseases presenting early in life for which no curative postnatal treatment is available and in those that cause irreversible to the brain before birth” (Coutelle, Rodeck).

            The second question, “should fetal gene therapy be preferred over pre-implantation or abortion?” is then addressed. Coutelle and Rodeck testify that provided it is “effective and safe, there should be no question that it would be preferable to abortion and certainly much less demanding and expensive than preimplantation selection” (Coutelle, Rodeck).

The third question about scientific justification is then answered. What this argument mainly boils down to is that “effectiveness and safety are certainly the main criteria that will determine if and when fetal gene therapy can be considered as a scientifically sound and ethically acceptable approach to dealing with a genetic condition” (Coutelle, Rodeck). It is then reassured that fetal gene therapy studies are still only in experimentation involving animals as models as a prerequisite for safety and efficiency before human application is even considered.

            The fourth question, “what are the risks of inadvertent germ-line gene transfer?” is discussed. Coutelle and Rodeck explain that fetal gene therapy “does not attempt to modify the genetic content of the germ-line, however, inadvertent germ-line gene transfer is a frequently voiced concern in connection with in utero gene therapy’ (Coutelle, Rodeck). This argument is counteracted but explaining that it seems unlikely that this would be transgene would cause problems other than possibly “through the circulation” which essentially “fetal gene therapy would carry the same risk for inadvertent germ-line transmission as postnatal gene therapy” (Coutelle, Rodeck). This also supports the argument that fetal gene therapy is a better option since it has the same risk as postnatal gene therapy but with greater benefits.

            The major question is then addressed. “What are the risks to fetus and mother?” Coutelle and Rodeck state the in utero gene therapy does involve some risk that postnatal gene therapy otherwise does not. These risks include “infection, fetal loss and preterm labor as a consequence of intervention” (Coutelle, Rodeck). Another concern addressed is that the possibility that “a certain gene product, which is required later in life […] may be particularly harmful to the fetus or that the insertion of vector sequences into the genome may cause developmental aberrations” (Coutelle, Rodeck). With these risk discussed, Coutelle and Rodeck explain that these risks will be “carefully monitored for any sign of birth defects after in utero manipulation” (Coutelle, Rodeck). As another reassurance, Coutelle and Rodeck mentioned that in theory, gene therapy is relatively safe and can be highly reliable in preventing genetic disease.

            The final question that is addressed is as follows: “Does fetal gene therapy infringe the right to abortion or legal status of the fetus and does fetal gene therapy conform with informed consent?” Coutelle and Rodeck thus far have described fetal gene therapy as the opposite of abortion. With that said, in utero gene therapy neither extinguishes a person’s right to decide to have an abortion of a perfectly normal fetus, nor takes away the possibility to have an abortion and a fetus effected by a genetic disease. Coutelle and Rodeck explain that fetal gene therapy only offers a third option when deciding how to act upon the knowledge of a fetus with a genetic disease. Coutelle and Rodeck then present the remainder that fetal gene therapy is still only in the stage of experimentation with animals, but assuming that it is proven to be safe and reliable, “considerations such as cost-effectiveness and equal accessibility as well as relation to genetic screening, and in particular prenatal screening, will have to be addressed” (Coutelle, Rodeck).

            Coutelle and Rodeck close by presenting the fact that for fetal gene therapy to “become truly preventative it will require the broad support and ethical acceptance of the majority of the population” (Coutelle, Rodeck). For fetal gene therapy to be widely accepted, Coutelle and Rodeck express that it will take extensive experimentation and in-depth research, and that their studies will continue on in order to do so.

Works Cited

Coutelle, C. and Rodeck, C. “On the scientific and ethical issues of fetal somatic gene therapy.” Nature Publishing Group. 2002. www.nature.com/gt