13.1 Unit Overview
Learning Objectives
- Identify current and emerging gene therapies
- Explore ethical issues involving gene therapy and regulatory oversight
- Compare somatic-cell and germ-line gene therapy
- Examine additional biotechnologies that can contribute to health and wellness
- Envision the future of genomics nursing in the context of Canada’s readiness for genomics integration
Outline
Topics covered in this chapter include:
- Gene editing
- Other genomic technologies
- Health system readiness for the genomic era
Competencies Nurses will Develop in this Chapter
ANA (2023):
Identification:
- Identifies credible, accurate, appropriate, and current genomic information, resources, services, and technologies specific to given clients.
- Identifies ethical, ethnic or ancestral, cultural, religious, legal, fiscal, and societal issues related to genomic information and technologies.
NHS (2023):
Identify individuals who might benefit from genomic services and/or information as part of assessing needs and planning care:
- recognizing the key indicators of a potential genetic condition, or clinical situation where genomics-informed healthcare would be appropriate; and
- recognizing the importance of family history in assessing predisposition to a genetic condition.
Demonstrate a knowledge and understanding of genomics in human development, variation and health to underpin effective practice:
- relating it to the maintenance of health and manifestation of conditions;
- relating it to the prevention and management of a genomic condition or response to treatment; and
- underpinned by core genomic concepts that form a sufficient knowledge base for understanding the implications of different conditions and clinical situations that may be encountered.
Apply knowledge, understanding and context of genomic testing and information to underpin care and support for individuals and families prior to, during and following decision-making:
- incorporating awareness of the ethical, legal and social issues related to testing, recording, sharing and storage of genomic information and data.
Examine your own competency of practice on a regular basis:
- recognizing areas where professional development related to genomics would be beneficial;
- maintaining awareness of clinical developments in genomics that are likely to be of most relevance to your area of practice, seeking further information on a case-by-case basis; and
- based on an understanding of the boundaries of your professional role in delivering genomic healthcare including the referral, provision or follow-up to genomic services.
Obtain and communicate reliable, current information about genomics, for self, patients, families and colleagues:
- using information technologies and other information sources effectively to do so;
- applying critical appraisal skills to assess the quality of information accessed; and
- ensuring the information is appropriate for the intended audience.
Key terminology
Bio-hacking
A movement in which people are experimenting with biotechnology research and development methods outside of traditional research institutions (Parker et al., 2016).
CRISPR
CRISPR (short for “clustered regularly interspaced short palindromic repeats”) is a technology that research scientists use to selectively modify the DNA of living organisms. CRISPR was adapted for use in the laboratory from naturally occurring genome editing systems found in bacteria.
Gene drives
A natural phenomenon whereby the inheritance of a particular gene or set of genes is favorably biased, resulting in the increase in its frequency in the population. Gene drives can arise through a variety of mechanisms, and scientists have proposed using gene editing to engineer gene drives for specific purposes (Parker et al., 2016).
Gene therapy
Gene therapy is a technique that uses a gene(s) to treat, prevent or cure a disease or medical disorder. Often, gene therapy works by adding new copies of a gene that is broken, or by replacing a defective or missing gene in a patient’s cells with a healthy version of that gene. Both inherited genetic diseases (e.g., hemophilia and sickle cell disease) and acquired disorders (e.g., leukemia) have been treated with gene therapy.
Genetically modified organisms
GMO (short for “genetically modified organism”) is a plant, animal or microbe in which one or more changes have been made to the genome, typically using high-tech genetic engineering, in an attempt to alter the characteristics of an organism. Genes can be introduced, enhanced or deleted within a species, across species or even across kingdoms. GMOs may be used for a variety of purposes, such as making human insulin, producing fermented beverages and developing pesticide resistance in crop plants.
Germline gene therapy
Alteration of a germline cells using gene therapy. These changes can be passed on to offspring, leading to unintended consequences for future generations (Parker et al., 2016).
Off-target effects
Potential alterations induced by CRISPR that are unintended, such as changing a beneficial gene, altering its product (Parker et al., 2016).
Recombinant DNA technology
Recombinant DNA technology involves using enzymes and various laboratory techniques to manipulate and isolate DNA segments of interest. This method can be used to combine (or splice) DNA from different species or to create genes with new functions. The resulting copies are often referred to as recombinant DNA. Such work typically involves propagating the recombinant DNA in a bacterial or yeast cell, whose cellular machinery copies the engineered DNA along with its own.
Transgenic
Transgenic refers to an organism or cell whose genome has been altered by the introduction of one or more foreign DNA sequences from another species by artificial means. Transgenic organisms are generated in the laboratory for research purposes.
Attribution & References
ANA (2023) Nursing Competencies are © American Nurses Association. Reprinted with permission. All rights reserved. Seek permission before reusing this portion of the page.
Except where otherwise noted, this page is adapted from:
- Talking Glossary of Genomic and Genetic Terms, Courtesy of: National Human Genome Research institute (NGHRI), Public Domain with attribution.
- 12.4 Gene Therapy In Microbiology by Nina Parker, Mark Schneegurt, Anh-Hue Thi Tu, Philip Lister and Brian M. Forster, CC BY 4.0. Access for free at Microbiology (OpenStax)
Definitions adapted from the two sources and combined.
References
American Nurses Association (ANA). (2023). Essentials of genomic nursing: Competencies and outcome indicators (3rd ed.). https://www.nursingworld.org/nurses-books/ana-books/ebook-essentials-of-genomic-nursing-competencies-/
National Health Service (NHS). (2023). The 2023 genomic competency framework for UK nurses. https://www.genomicseducation.hee.nhs.uk/wp-content/uploads/2023/12/2023-Genomic-Competency-Framework-for-UK-Nurses.pdf
National Human Genome Research Institute (NHGRI). (n.d.). Talking glossary of genetic and genomic terms. https://www.genome.gov/genetics-glossary
Parker, N., Schneegurt, M., Tu, A. T., Lister, P., & Forster, B. M. (2016, November 1). 12.4 Gene therapy – Microbiology. OpenStax. https://openstax.org/books/microbiology/pages/12-4-gene-therapy
