“…In this regard, gene therapy offers powerful tools to counteract the progressive degradation of the cartilage in OA as it permits a sustained production of therapeutic factors that otherwise display short pharmacological half‐lives. Therapeutic gene transfer has been successfully tested to either protect the OA joint from cartilage breakdown by applying sequences coding for protective or inhibitory factors (IL‐1 receptor antagonist—IL‐1Ra, soluble IL‐1, and TNF receptors—sIL‐1R and sTNFR, siRNAs/shRNAs against IL‐1 or ADAMTS‐5, NF‐κB inhibitors, kallistatin—KBP, thrombospontin‐1—TSP‐1, Dickkopf‐1—DKK‐1, pro‐opiomelanocortin—POMC, the transcriptional repressor Bagpipe homeobox homolog 1/NK3 homeobox 2—BAPX1/NKX3.2, miRNAs) or enhance anabolic processes by gene transfer of proteoglycan 4, glucuronosyltransferase‐I, the insulin‐like growth factor I (IGF‐I), fibroblast growth factor 2 (FGF‐2), and the bone morphogenetic proteins 4 and 7 (BMP‐4, ‐7) . However, none of such attempts thus far were capable of re‐establishing a natural balance in OA cartilage to restore the full integrity of the damaged tissue, and multiple treatments instead of single options might be necessary to reproduce an original cartilage architecture in OA as already evaluated using dual gene transfer of IL‐1Ra/IGF‐I or/FGF‐2 or of FGF‐2/SOX9 .…”