Gene therapy is a rapidly advancing field that aims to treat illnesses by modifying or replacing genes. In the Philippines, gene therapy has gained attention due to the growing number of patients with genetic disorders and promising results from international trials. Research institutions and hospitals are pursuing gene therapy using viral vectors and CRISPR/Cas9. This article discusses current trends, challenges, and potential impacts on the country's healthcare system.

 

What is Gene Therapy?

First of all, let us define genes. Genes are sections in our DNA, found in our chromosomes, that contain the instructions for our characteristics, such as how our bodies work, look, and even think. However, disorders may arise affecting the genes. Gene therapy is a medical approach that treats or prevents genetic disorders. With gene therapy, the gene itself is altered to address the genetic disease or disorder.

 

Applications in the Philippines

The Institute of Human Genetics at the National Institutes of Health (IHG-NIH) is the largest provider of genetic services in the Philippines. Services range from specific services such as clinical diagnosis, genetic counseling, and newborn screening to large-scale services such as population genetics and family genetic disorder diagnosis.

 

Here are some examples and services of gene therapy in the Philippines:

 

Clinical Genetics

Clinical genetics provides a comprehensive diagnosis for individuals and families currently suffering from genetic disorders and those at risk of inherited disorders. Clinical genetics renders three services: diagnosis, management, and genetic counseling.

 

Cytogenetics

If clinical genetics offers general services, cytogenetics, on the other hand, offers specialized services such as routine karyotyping. Karyotyping allows geneticists to directly examine your set of chromosomes. Particularly, peripheral blood cells, cord blood, solid tissues, and bone marrow are examined, and diseases such as multiple birth defects, mental retardation, abnormal sexual development, infertility or multiple miscarriages, malignancies, and hematologic disorders can be diagnosed.

 

Molecular Genetics

In this field, local and international researchers collaborate to determine the genetic disorders of the Filipino population. Furthermore, this service utilizes molecular genetic techniques and tools to treat genetic disorders. You can think of molecular genetics as the engineer of gene therapy.

 

Biochemical Genetics

This field works in collaboration with medical practitioners to offer the best and most appropriate services to patients with genetic disorders. Biochemical genetics is also responsible for conducting tests on urine, amino acids, lysosomal storage disease, mitochondrial, and peroxisomal disorders.

 

Newborn Screening

This service offers genetic disorder diagnosis to newborn infants and is considered the most successful population-based genetic screening program in the Philippines. Now, there are five newborn screening centers in the Philippines, namely: NSC-NIH, NSC-Central Luzon, NSC-Visayas, NSC-Southern Luzon, and NSC-Mindanao.

 

Public Perception, Ethics, and Laws 

The use of gene therapy is hindered by societal, economic, and moral considerations. One reason that gene therapy as a service is frowned upon is the public's lack of knowledge about it; most people still avoid the treatment, demanding a comprehensive breakdown from their medical providers.

 

Another issue with gene therapy is the ethics of the treatment and how it impacts the human body. Because gene therapy mostly entails tampering with DNA to "fix" broken or malfunctioning genes, the following question arises: "Who gets to decide whether the traits are normal or a disability?" and "What constitutes ‘good’ or ‘bad’ gene therapy applications?". In the economic sector, most people feel that because gene therapy is so expensive, it will only be available to the wealthy. And in terms of social acceptance, "Will widespread use of gene therapy make society less accepting of those who are different?". 

 

Two pieces of legislation have been passed in the Philippines with the assistance of the IHG-NIH. One of these is the Newborn Screening Act of 2004, Republic Act No. 9228, which ensures that every newborn has the right to receive newborn screening in the future. This statute also assures that parents are completely aware of their obligations when subjecting their children to therapy in order to prevent preventable deaths and disabilities from impeding their children's health and development. The second law, Republic Act 10747, requires that people with rare diseases be offered and receive comprehensive medical care, as well as a collaborative effort from the state's medical agencies.

 

Future Outlooks 

The sole service covered by government health insurance is newborn screening. The use of NBS is an excellent technique to introduce the concept of gene therapy. However, gene therapy treatments remain inaccessible due to budgetary constraints, as services are still carried by the patient, and there is still a lack of community knowledge. There is also a shortage of geneticists and genetic counselors, prompting the necessity for geneticist training. The advancement of gene therapy will be dependent on both the government's implementation and the community's desire to use such services.