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Gene therapy: pursuing restoration of dermal adhesion in recessive dystrophic epidermolysis bullosa.
[dystrophic epidermolysis bullosa]
The
replacement
of
a
defective
gene
with
a
fully
functional
copy
is
the
goal
of
the
most
basic
gene
therapy
.
Recessive
dystrophic
epidermolysis
bullosa
(
RDEB
)
is
characterised
by
a
lack
of
adhesion
of
the
epidermis
to
the
dermis
.
It
is
an
ideal
target
for
gene
therapy
as
all
variants
of
hereditary
RDEB
are
caused
by
mutations
in
a
single
gene
,
COL
7
A
1
,
coding
for
type
VII
collagen
,
a
key
component
of
anchoring
fibrils
that
secure
attachment
of
the
epidermis
to
the
dermis
.
RDEB
is
one
of
the
most
severe
variants
in
the
epidermolysis
bullosa
(
EB
)
group
of
heritable
skin
diseases
.
Epidermolysis
bullosa
is
defined
by
chronic
fragility
and
blistering
of
the
skin
and
mucous
membranes
due
to
mutations
in
the
genes
responsible
for
production
of
the
basement
membrane
proteins
.
This
condition
has
a
high
personal
,
medical
and
socio-economic
impact
.
People
with
RDEB
require
a
broad
spectrum
of
medications
and
specialised
care
.
Due
to
this
being
a
systemic
condition
,
most
research
focus
is
in
the
area
of
gene
therapy
.
Recently
,
preclinical
works
have
begun
to
show
promise
.
They
focus
on
the
virally
mediated
ex
vivo
correction
of
autologous
epithelium
.
These
corrected
cells
are
then
to
be
expanded
and
grafted
onto
the
patient
following
the
lead
of
the
first
successful
gene
therapy
in
dermatology
being
a
grafting
of
corrected
tissue
for
junctional
EB
treatment
.
Current
progress
,
outstanding
challenges
and
future
directions
in
translating
these
approaches
in
clinics
are
reviewed
in
this
article
.
Diseases
Validation
Diseases presenting
"lack of adhesion of the epidermis"
symptom
dystrophic epidermolysis bullosa
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