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August 1996
Volume 60 |
Number 8
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| Molecular Biology,
Molecular Genetics and Anesthesiology |
Paula M. Bokesch, M.D.
Henry Rosenberg, M.D.
Molecular genetic technology has changed the way that biomedical
researchers approach clinical problems. The ultimate goal of molecular
biology is to identify genes that contribute to diseases and pathologic
processes. Genes function by being expressed in the form of proteins.
Once a disease gene has been identified, its expressed protein
can be studied and the molecular mechanism of pathogenesis determined.
Therefore, human molecular genetics results in the diagnosis of
disease processes, prevention strategies and potential molecular-based
therapies. In a broad sense, the term "molecular therapeutics"
encompasses any attempts at treating diseases or pathologic processes
by influencing the expression of normally functioning genes or
introducing missing genes using recombinant DNA technologies.
Molecular genetics and molecular biology also provide insights
into how drugs affect organ system function and explanations of
physiologic differences between individuals in health and disease.
These advances have already led to the development of pharmacologic
agents with more specific sites of action and fewer side effects
and have begun to clarify sites and mechanisms of action of anesthetic
agents and the many other drugs in the anesthesiologist's armamentarium.
For example, in this issue of the NEWSLETTER, Gudarz
Davar, M.D., reviews the molecular mechanisms behind pain
and potential interventions. Paula M. Bokesch,
M.D., describes "excitotoxicity" in the brain and
novel therapeutics to protect the brain from ischemia and hypofusion.
Developments in two inherited disorders that are of special interest
to anesthesiologists are also highlighted in this issue. Jeffrey
E. Fletcher, Ph.D., reviews the progress being made in the
understanding of the pathopsychology of the potentially fatal
syndrome of malignant hyperthermia (MH). He also describes the
obstacles to defining a simple test for MH based on the molecular
genetics of this disorder. Bert N. La Du,
Jr., M.D., Ph.D., and Sérgio L. Primo-Parmo, Ph.D.,
demonstrate how molecular genetics techniques may explain and
clarify the metabolism of the commonly used drug succinylcholine
and why the traditional tests for "pseudocholinesterase"
abnormality do not explain all the phenotypic variations of expression
of this enzyme.
It is hoped that these several articles will provide readers of
the NEWSLETTER with a glimpse into the many changes yet
to come based on the application of molecular genetics and molecular
biology to clinical medicine in general and to anesthesiology
in particular.
Paula M. Bokesch, M.D., is Staff Anesthesiologist,
Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation,
Cleveland, Ohio.
E-mail the author.
Henry Rosenberg, M.D., is Professor
and Chair, Department of Anesthesiology, Allegheny University
of the Health Sciences, and Chief of Anesthesiology at Allegheny
University Hospitals, Center City Campus, Philadelphia, Pennsylvania.
He is Vice-President of the Malignant Hyperthermia Association
of the United States.
E-mail the author.
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