1
|
Alex K, Winkler EC. Comparative ethical evaluation of epigenome editing and genome editing in medicine: first steps and future directions. JOURNAL OF MEDICAL ETHICS 2024; 50:398-406. [PMID: 37527926 DOI: 10.1136/jme-2022-108888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
Targeted modifications of the human epigenome, epigenome editing (EE), are around the corner. For EE, techniques similar to genome editing (GE) techniques are used. While in GE the genetic information is changed by directly modifying DNA, intervening in the epigenome requires modifying the configuration of DNA, for example, how it is folded. This does not come with alterations in the base sequence ('genetic code'). To date, there is almost no ethical debate about EE, whereas the discussions about GE are voluminous. Our article introduces EE into bioethics by translating knowledge from science to ethics and by comparing the risks of EE with those of GE. We, first (I), make the case that a broader ethical debate on EE is due, provide scientific background on EE, compile potential use-cases and recap previous debates. We then (II) compare EE and GE and suggest that the severity of risks of novel gene technologies depends on three factors: (i) the choice of an ex vivo versus an in vivo editing approach, (ii) the time of intervention and intervention windows and (iii) the targeted diseases. Moreover, we show why germline EE is not effective and reject the position of strong epigenetic determinism. We conclude that EE is not always ethically preferable to GE in terms of risks, and end with suggestions for next steps in the current ethical debate on EE by briefly introducing ethical challenges of new areas of preventive applications of EE (III).
Collapse
Affiliation(s)
- Karla Alex
- Section Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Eva C Winkler
- Section Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Medical Faculty, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
2
|
Huang X, Li A, Xu P, Yu Y, Li S, Hu L, Feng S. Current and prospective strategies for advancing the targeted delivery of CRISPR/Cas system via extracellular vesicles. J Nanobiotechnology 2023; 21:184. [PMID: 37291577 DOI: 10.1186/s12951-023-01952-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023] Open
Abstract
Extracellular vesicles (EVs) have emerged as a promising platform for gene delivery owing to their natural properties and phenomenal functions, being able to circumvent the significant challenges associated with toxicity, problematic biocompatibility, and immunogenicity of the standard approaches. These features are of particularly interest for targeted delivery of the emerging clustered regularly interspaced short palindromic repeat (CRISPR)/CRISPR-associated (Cas) systems. However, the current efficiency of EV-meditated transport of CRISPR/Cas components remains insufficient due to numerous exogenous and endogenous barriers. Here, we comprehensively reviewed the current status of EV-based CRISPR/Cas delivery systems. In particular, we explored various strategies and methodologies available to potentially improve the loading capacity, safety, stability, targeting, and tracking for EV-based CRISPR/Cas system delivery. Additionally, we hypothesise the future avenues for the development of EV-based delivery systems that could pave the way for novel clinically valuable gene delivery approaches, and may potentially bridge the gap between gene editing technologies and the laboratory/clinical application of gene therapies.
Collapse
Affiliation(s)
- Xiaowen Huang
- Medical College, Henan University of Chinese Medicine, Zhengzhou, 450056, Henan, China
| | - Aifang Li
- Medical College, Henan University of Chinese Medicine, Zhengzhou, 450056, Henan, China
| | - Peng Xu
- Medical College, Henan University of Chinese Medicine, Zhengzhou, 450056, Henan, China
| | - Yangfan Yu
- Medical College, Henan University of Chinese Medicine, Zhengzhou, 450056, Henan, China
| | - Shuxuan Li
- Medical College, Henan University of Chinese Medicine, Zhengzhou, 450056, Henan, China
| | - Lina Hu
- Medical College, Henan University of Chinese Medicine, Zhengzhou, 450056, Henan, China
| | - Shuying Feng
- Medical College, Henan University of Chinese Medicine, Zhengzhou, 450056, Henan, China.
- Department of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450046, Henan, China.
| |
Collapse
|
3
|
Ranisch R, Trettenbach K, Arnason G. Initial heritable genome editing: mapping a responsible pathway from basic research to the clinic. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:21-35. [PMID: 36414813 PMCID: PMC9984515 DOI: 10.1007/s11019-022-10115-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
Following the Second Summit on Human Gene Editing in Hong Kong in 2018, where the birth of two girls with germline genome editing was revealed, the need for a responsible pathway to the clinical application of human germline genome editing has been repeatedly emphasised. This paper aims to contribute to the ongoing discussion on research ethics issues in germline genome editing by exploring key issues related to the initial applications of CRISPR in reproductive medicine. Following an overview of the current discussion on bringing germline genome editing into clinical practice, we outline the specific challenges associated with such interventions and the features that distinguish them from conventional clinical testing of new medical treatments. We then review proposed ethical requirements for initial heritable genome editing, such as the absence of reasonable alternatives, the existence of sufficient and reliable preclinical data, appropriate informed consent, requirements related to safety, and long-term follow-up.
Collapse
Affiliation(s)
- Robert Ranisch
- Junior Professorship for Medical Ethics with a Focus on Digitization, Faculty of Health Sciences Brandenburg, University of Potsdam, Am Mühlberg 9, 14476, Potsdam, Golm, Germany.
- Research Unit "Ethics of Genome Editing", Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, D-72074, Tübingen, Germany.
| | - Katharina Trettenbach
- Junior Professorship for Medical Ethics with a Focus on Digitization, Faculty of Health Sciences Brandenburg, University of Potsdam, Am Mühlberg 9, 14476, Potsdam, Golm, Germany
- Research Unit "Ethics of Genome Editing", Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, D-72074, Tübingen, Germany
| | - Gardar Arnason
- Research Unit "Ethics of Genome Editing", Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, D-72074, Tübingen, Germany
- University of Akureyri, Norðurslóð 2, 600, Akureyri, Iceland
| |
Collapse
|
4
|
Gonzalez-Avila LU, Vega-López JM, Pelcastre-Rodríguez LI, Cabrero-Martínez OA, Hernández-Cortez C, Castro-Escarpulli G. The Challenge of CRISPR-Cas Toward Bioethics. Front Microbiol 2021; 12:657981. [PMID: 34122373 PMCID: PMC8195329 DOI: 10.3389/fmicb.2021.657981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022] Open
Abstract
Since determining the structure of the DNA double helix, the study of genes and genomes has revolutionized contemporary science; with the decoding of the human genome, new findings have been achieved, including the ability that humans have developed to modify genetic sequences in vitro. The discovery of gene modification mechanisms, such as the CRISPR-Cas system (Clustered Regularly Interspaced Short Palindromic Repeats) and Cas (CRISPR associated). Derived from the latest discoveries in genetics, the idea that science has no limits has exploded. However, improvements in genetic engineering allowed access to new possibilities to save lives or generate new treatment options for diseases that are not treatable by using genes and their modification in the genome. With this greater knowledge, the immediate question is who governs the limits of genetic science? The first answer would be the intervention of a legislative branch, with adequate scientific advice, from which the logical answer, bioethics, should result. This term was introduced for the first time by Van Rensselaer Potter, who in 1970 combined the Greek words bios and ethos, Bio-Ethik, which determined the study of the morality of human behavior in science. The approach to this term was introduced to avoid the natural tension that results from the scientific technical development and the ethics of limits. Therefore, associating the use of biotechnology through the CRISPR-Cas system and the regulation through bioethics, aims to monitor the use of techniques and technology, with benefits for humanity, without altering fundamental rights, acting with moral and ethical principles.
Collapse
Affiliation(s)
- Luis Uriel Gonzalez-Avila
- Laboratorio de Investigación Clínica y Ambiental, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de Mexico, Mexico
| | - Juan Manuel Vega-López
- Laboratorio de Investigación Clínica y Ambiental, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de Mexico, Mexico
| | - Leda Ivonne Pelcastre-Rodríguez
- Laboratorio de Investigación Clínica y Ambiental, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de Mexico, Mexico
| | - Omar Alejandro Cabrero-Martínez
- Laboratorio de Investigación Clínica y Ambiental, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de Mexico, Mexico
| | - Cecilia Hernández-Cortez
- Laboratorio de Bioquímica Microbiana, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de Mexico, Mexico
| | - Graciela Castro-Escarpulli
- Laboratorio de Investigación Clínica y Ambiental, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de Mexico, Mexico
| |
Collapse
|
5
|
Alon I, Urbanos-Garrido R, Guimón J. Regulating reproductive genetic services: dealing with spiral-shaped processes and techno-scientific imaginaries. J Assist Reprod Genet 2021; 38:305-317. [PMID: 33405005 PMCID: PMC7884509 DOI: 10.1007/s10815-020-02017-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE We have been inquiring into the diffusion process of reproductive genetic services (RGS) and the viability of geneticization in human reproduction. METHOD A 2-round modified-Delphi survey was applied amongst Israeli and Spanish experts to analyze regulatory attitudes and expectations about the future applications of RGS. We argue that an explanation of RGS diffusion based on a 'technology-push' impulse should be complemented by a 'demandpull' approach, which underscores the importance of regulatory frameworks and demand-inducing policies. The diffusion of RGS is advancing in a 'spiralshaped' process where technology acts as a cause and effect simultaneously, modulating social acceptance and redefining the notions of health and responsibility along the way. RESULTS We suggest that there is a 'grey-zone' of RGS regulations regarding four procedures: the use of germline genome modification (GGM) for severe monogenic disorders, preimplantation genetic testing (PGT) for detection of chromosomal abnormalities, PGT for multifactorial diseases, and PGT with whole-exome screening. CONCLUSIONS Although far from the geneticization of human reproduction, our findings suggest that, since techno-scientific imaginaries tend to shape regulations and thus favor the diffusion of RGS, policymakers should pay attention to those procedures by focusing on good practices and equity while providing sound information on potential risks and expected success rates. A broad and inclusive societal debate is critical for overcoming the difficulty of drawing a clear line between medical and non-medical uses of genetic selection and engineering while searching for the right balance between allowing reproductive autonomy and protecting the public interest.
Collapse
Affiliation(s)
- Ido Alon
- Department of Development Economics, Research Group on Economics and Management of Innovation, Autonomous University of Madrid, Madrid, Spain
| | - Rosa Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, Complutense University of Madrid, Madrid, Spain
| | - José Guimón
- Department of Development Economics, Research Group on Economics and Management of Innovation, Autonomous University of Madrid, Madrid, Spain
| |
Collapse
|
6
|
Gene Editing by Extracellular Vesicles. Int J Mol Sci 2020; 21:ijms21197362. [PMID: 33028045 PMCID: PMC7582630 DOI: 10.3390/ijms21197362] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/23/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022] Open
Abstract
CRISPR/Cas technologies have advanced dramatically in recent years. Many different systems with new properties have been characterized and a plethora of hybrid CRISPR/Cas systems able to modify the epigenome, regulate transcription, and correct mutations in DNA and RNA have been devised. However, practical application of CRISPR/Cas systems is severely limited by the lack of effective delivery tools. In this review, recent advances in developing vehicles for the delivery of CRISPR/Cas in the form of ribonucleoprotein complexes are outlined. Most importantly, we emphasize the use of extracellular vesicles (EVs) for CRISPR/Cas delivery and describe their unique properties: biocompatibility, safety, capacity for rational design, and ability to cross biological barriers. Available molecular tools that enable loading of desired protein and/or RNA cargo into the vesicles in a controllable manner and shape the surface of EVs for targeted delivery into specific tissues (e.g., using targeting ligands, peptides, or nanobodies) are discussed. Opportunities for both endogenous (intracellular production of CRISPR/Cas) and exogenous (post-production) loading of EVs are presented.
Collapse
|
7
|
Abstract
Purpose of Review Continued development of gene editing techniques has raised the real possibility of clinical application of germline gene editing. These results, as well as reports of an unethical experiment which resulted in the birth of at least two children from edited embryos in 2018, have highlighted the urgency and importance of ethical issues about translational pathways for editing of human germline cells. Charting responsible translational pathways for germline gene editing requires tackling some significant and complex ethical issues. Recent Findings A literature on development of clinical applications of germline gene editing is emerging, and several key ethical issues are coming into focus as major challenges for responsible translational pathways. Summary Potential clinical utility, clinical justification, and human subjects research for germline gene editing raise outstanding ethical questions. Work on these questions will help provide guidance to researchers and clinicians and direct translational projects toward justifiable applications.
Collapse
Affiliation(s)
- Bryan Cwik
- Philosophy and University Studies, Portland State University, Fourth Ave Building Suite 175, 1900 SW 4th Ave, Portland, OR 97201 USA
| |
Collapse
|
8
|
Rewriting the Future: Promises and Limits of Germline Gene Editing in Craniofacial Surgery. J Craniofac Surg 2020; 31:1517-1520. [PMID: 32796298 DOI: 10.1097/scs.0000000000006602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
9
|
Al-Balas QAE, Dajani R, Al-Delaimy WK. The Ethics of Gene Editing from an Islamic Perspective: A Focus on the Recent Gene Editing of the Chinese Twins. SCIENCE AND ENGINEERING ETHICS 2020; 26:1851-1860. [PMID: 32125604 DOI: 10.1007/s11948-020-00205-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 02/25/2020] [Indexed: 06/10/2023]
Abstract
In light of the development of "CRISPR" technology, new promising advances in therapeutic and preventive approaches have become a reality. However, with it came many ethical challenges. The most recent worldwide condemnation of the first use of CRISPR to genetically modify a human embryo is the latest example of ethically questionable use of this new and emerging field. Monotheistic religions are very conservative about such changes to the human genome and can be considered an interference with God's creation. Moreover, these changes could cause perpetual changes to future generations. The Muslim scholars establish their decisions by addressing five foundations of Islamic law i.e. "maqāṣid al sharı̄`a"; the purposes of the law. These are dın̄ (religion), nafs (life), nasl (progeny), `aql (intellect) and māl (wealth). To achieve this, the five principles should all be met before approval of an experiment like the Chinese embryo modifications; Qaṣd (intention) which is achieved in this case as it aims to protect the embryo from HIV. Yaqın̄ (certainty) and Ḍarar (injury) were not satisfied as they require strong scientific certainty of the procedures, and evidence of safety. Ḍarūra (necessity) by which the alternatives being compared; in this case more established and proven safe alternatives to protect the HIV transmission from the father are available, so this principle is not met. The final principle is `Urf (custom), by which the social context of using any contemporary technology should be taken in consideration, and clearly this was not achieved. Collectively, germline changes are rejected from an Islamic perspective until the five principles are fulfilled. In the Chinese Twins gene editing case, there was clearly no justification or support for it according to the Muslim Jurisprudence laws. These laws and approaches can serve as an ethical checklist for such controversial research, especially in early stages of the research.
Collapse
Affiliation(s)
- Qosay A E Al-Balas
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Rana Dajani
- Biology Department, Hashemite University, Zarqa, 13115, Jordan
| | - Wael K Al-Delaimy
- University of California San Diego, 9500 Gilman Dr. MC 0628, La Jolla, CA, 92093 0628, USA
| |
Collapse
|
10
|
Editorial. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2020. [DOI: 10.1108/ijhg-03-2020-081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
11
|
Cwik B. Intergenerational monitoring in clinical trials of germline gene editing. JOURNAL OF MEDICAL ETHICS 2020; 46:183-187. [PMID: 31473657 PMCID: PMC7036322 DOI: 10.1136/medethics-2019-105620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 05/08/2023]
Abstract
Design of clinical trials for germline gene editing stretches current accepted standards for human subjects research. Among the challenges involved is a set of issues concerning intergenerational monitoring-long-term follow-up study of subjects and their descendants. Because changes made at the germline would be heritable, germline gene editing could have adverse effects on individuals' health that can be passed on to future generations. Determining whether germline gene editing is safe and effective for clinical use thus may require intergenerational monitoring. The aim of this paper is to identify and argue for the significance of a set of ethical issues raised by intergenerational monitoring in future clinical trials of germline gene editing. Though long-term, multigenerational follow-up study of this kind is not without precedent, intergenerational monitoring in this context raises unique ethical challenges, challenges that go beyond existing protocols and standards for human subjects research. These challenges will need to be addressed if clinical trials of germline gene editing are ever pursued.
Collapse
Affiliation(s)
- Bryan Cwik
- Philosophy and University Studies, Portland State University, Portland, Oregon, USA
| |
Collapse
|
12
|
Ranisch R. Germline genome editing versus preimplantation genetic diagnosis: Is there a case in favour of germline interventions? BIOETHICS 2020; 34:60-69. [PMID: 31448423 PMCID: PMC6973094 DOI: 10.1111/bioe.12635] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 06/05/2023]
Abstract
CRISPR is widely considered to be a disruptive technology. However, when it comes to the most controversial topic, germline genome editing (GGE), there is no consensus on whether this technology has any substantial advantages over existing procedures such as embryo selection after in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD). Answering this question, however, is crucial for evaluating whether the pursuit of further research and development on GGE is justified. This paper explores the question from both a clinical and a moral viewpoint, namely whether GGE has any advantages over existing technologies of selective reproduction and whether GGE could complement or even replace them. In a first step, I review an argument of extended applicability. The paper confirms that there are some scenarios in which only germline intervention allows couples to have (biologically related) healthy offspring, because selection will not avoid disease. In a second step, I examine possible moral arguments in favour of genetic modification, namely that GGE could save some embryos and that GGE would provide certain benefits for a future person that PGD does not. Both arguments for GGE have limitations. With regard to the extended applicability of GGE, however, a weak case in favour of GGE should still be made.
Collapse
Affiliation(s)
- Robert Ranisch
- Institute of Ethics and History of Medicine, University of TübingenGermany
| |
Collapse
|
13
|
Nordgren A. Designing Preclinical Studies in Germline Gene Editing: Scientific and Ethical Aspects. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:559-570. [PMID: 31755017 PMCID: PMC6937224 DOI: 10.1007/s11673-019-09947-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
Human germline gene editing is often debated in hypothetical terms: if it were safe and efficient, on what further conditions would it then be ethically acceptable? This paper takes another course. The key question is: how can scientists reduce uncertainty about safety and efficiency to a level that may justify initiation of first-time clinical trials? The only way to proceed is by well-designed preclinical studies. However, what kinds of investigation should preclinical studies include and what specific conditions should they satisfy in order to be considered well-designed? It is argued that multispecies and multigenerational animal studies are needed as well as human embryo editing without implantation. In order to be possible to translate to first-time clinical trials, animal studies need to satisfy strict conditions of validity. Moreover, embryo studies intended for translation to first-time clinical trials need to correspond to the animal studies in experimental design (with exception of implantation). Only in this way can uncertainty about risk for harm (safety) and prospect of benefit (efficiency) in first-time clinical trials be reduced to a modest level. If uncertainty is not reduced to such a level, first-time clinical trials in germline gene editing should not be initiated.
Collapse
Affiliation(s)
- Anders Nordgren
- Centre for Applied Ethics, Linköping University, 58183, Linköping, Sweden.
| |
Collapse
|
14
|
Ishii T, Beriain IDM. Safety of Germline Genome Editing for Genetically Related "Future" Children as Perceived by Parents. CRISPR J 2019; 2:370-375. [PMID: 31746634 PMCID: PMC6919246 DOI: 10.1089/crispr.2019.0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The social acceptability of germline genome editing (GGE) depends on its perceived safety, as well as respect for reproductive autonomy. However, it is doubtful that prospective parents sufficiently understand the risks of GGE. In the future, the use of GGE in specific situations seems plausible, as it offers couples potential means to safeguard genetically related future children from a serious disease and overcome infertility due to a gene mutation. Should GGE fail, however, some couples may be obliged to abort affected fetuses, or give birth to adversely affected children, which would be a tragedy. Some children might develop diseases later in life due to overlooked off-target mutations. Compounding this, some parents are unlikely to inform their offspring about the details of conception, hampering necessary follow-up. Prospective parents, scientists and policy makers should carefully discuss the safety implications of GGE for genetically related future children.
Collapse
Affiliation(s)
- Tetsuya Ishii
- Office of Health and Safety, Hokkaido University, Sapporo, Japan
| | - Iñigo de Miguel Beriain
- Law and the Human Genome RG, University of the Basque Country UPV/EHU, Faculty of Law, Leioa, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| |
Collapse
|
15
|
Abstract
The ethical issues associated with germline gene modification and embryo research are some of the most contentious in current international science policy debates. In this paper, we argue that new genetic techniques, such as CRISPR, demonstrate that there is an urgent need for China to develop its own regulatory and ethical framework governing new developments in genetic and embryo research. While China has in place a regulatory framework, it needs to be strengthened to include better compliance oversight and explicit criteria for how different types of research should be reviewed by regulatory authorities. We also document a variety of opinions about the new technologies among the public, scholars, and policy makers. China needs to develop its own regulations in coordination with other countries; but it is unlikely that an international consensus will be achieved in this area, given the existing differences in regulations between countries. We should aim at harmonization, not necessarily complete consensus, and the perspective from China is vital when international norms are developed and harmonized. Chinese policy makers and researchers need to be aware of the international discussions, at the same time as the international community is aware of, and accommodates, Chinese positions on important policy options.
Collapse
Affiliation(s)
- Di Zhang
- Department of Social Sciences and Humanities/Center for Bioethics, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao #5, Dongcheng District, Beijing, 100730, China
| | - Reidar K Lie
- Department of Philosophy, University of Bergen, Sydnesplassen 12-13, 5020, Bergen, Norway.
| |
Collapse
|
16
|
The Potential Use of the CRISPR-Cas System for HIV-1 Gene Therapy. Int J Genomics 2019; 2019:8458263. [PMID: 31531340 PMCID: PMC6721108 DOI: 10.1155/2019/8458263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/14/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023] Open
Abstract
The HIV-1 virus (human immunodeficiency virus) affects 36.9 million people worldwide, with approximately 900000 deaths in 2017. The virus carrier can develop severe immunodeficiency since CD4+ T lymphocytes are the main target, leading to acquired immunodeficiency syndrome (AIDS). Despite advances in pharmacological treatment, it is still difficult to eliminate latent reservoirs, becoming one of the main obstacles for viral eradication. The CRISPR- (clustered regularly interspaced short palindromic repeat-) Cas system is a genome-editing method which uses a guide RNA, a complementary sequence to the interested site, recruiting a nuclease that can break the viral or the host cell genetic material. From this double-stranded break, cellular repair mechanisms are activated being able to generate deletions, insertions, or substitutions, in order to inactivate specific gene loci, leading to loss of function. The objective of this minireview is to synthesize the current knowledge on the application of CRISPR-Cas-based gene therapy for HIV-1. The strategies encompass all steps of the viral infection cycle, from inhibition of cell invasion, through viral replication and integration inhibition, to excision of the latent provirus. Off-target effects and ethical implications were also discussed to evaluate the safety of the approach and viability of its application in humans, respectively. Although preclinical and clinical tests are still needed, the recent results establish an exciting possibility of applying this technology for prophylaxis and treatment of HIV-1.
Collapse
|
17
|
Macpherson I, Roqué MV, Segarra I. Ethical Challenges of Germline Genetic Enhancement. Front Genet 2019; 10:767. [PMID: 31552088 PMCID: PMC6733984 DOI: 10.3389/fgene.2019.00767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/19/2019] [Indexed: 11/22/2022] Open
Abstract
The new reproductive technologies have opened the door to different processes of germline genetic enhancement by which the characteristics of an individual according to the interests of the agents involved could be selected during its gestation. Although the initiative is apparently oriented towards developing individuals that would excel in society, critical voices raise the concerns about that this approach would generate and need for a reflection on the ethical, social and legal implications of these techniques and their implementation in society. We reviewed the literature about these issues throughout their historical records to date, focusing on the moral arguments and non-clinical aspects that affect the legal and social environment. We have observed various trends of thought with divergent positions (proactive, preventive, and regulatory) as well as a large number of articles that try to reconcile the different approaches. This review illustrates a series of concepts from the ethics and philosophy fields which are frequently used in studies that evaluate the ethical implications of germline genetic enhancement, such as dignity, benefit, autonomy, and identity. In addition, amongst the many unresolved controversies surrounding genetic enhancement, we identify procreative beneficence, genetic disassociation, gender selection, the value of disability, embryo chimerization, and the psychosocial inequality of potentially enhanced individuals as crucial. We also develop possible scenarios for future debate. We consider especially important the definition and specification of three aspects which are essential for the deployment of new reproductive technologies: the moral status of the embryo undergoing enhancement, the legal status of the enhanced individual, and the responsibility of the agents executing the enhancement. Finally, we propose the precautionary principle as a means to navigate ethical uncertainties.
Collapse
Affiliation(s)
- Ignacio Macpherson
- Department of Humanities, International University of Catalonia, Barcelona, Spain
- Pharmacokinetics, Patient Care and Translational Bioethics Research Group, Catholic University of Murcia (UCAM), Murcia, Spain
| | - María Victoria Roqué
- Department of Humanities, International University of Catalonia, Barcelona, Spain
- Pharmacokinetics, Patient Care and Translational Bioethics Research Group, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Ignacio Segarra
- Pharmacokinetics, Patient Care and Translational Bioethics Research Group, Catholic University of Murcia (UCAM), Murcia, Spain
- Department of Pharmacy, Faculty of Health Sciences, Catholic University of Murcia (UCAM), Murcia, Spain
| |
Collapse
|
18
|
Wang W, Hou J, Zheng N, Wang X, Zhang J. Keeping our eyes on CRISPR: the "Atlas" of gene editing. Cell Biol Toxicol 2019; 35:285-288. [PMID: 31165372 DOI: 10.1007/s10565-019-09480-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/16/2019] [Indexed: 12/22/2022]
Affiliation(s)
- William Wang
- Zhongshan Hospital Institute for Clinical Science, Shanghai Institute of Clinical Bioinformatics, Shanghai Engineering Research for AI Technology for Cardiopulmonary Diseases, Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiayuan Hou
- Zhongshan Hospital Institute for Clinical Science, Shanghai Institute of Clinical Bioinformatics, Shanghai Engineering Research for AI Technology for Cardiopulmonary Diseases, Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Nannan Zheng
- Zhongshan Hospital Institute for Clinical Science, Shanghai Institute of Clinical Bioinformatics, Shanghai Engineering Research for AI Technology for Cardiopulmonary Diseases, Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiangdong Wang
- Zhongshan Hospital Institute for Clinical Science, Shanghai Institute of Clinical Bioinformatics, Shanghai Engineering Research for AI Technology for Cardiopulmonary Diseases, Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Jiaqiang Zhang
- Department of Anaesthesiology, Centre for Clinical Single Cell Biomedicine, Henan provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
19
|
Padela AI, Aparicio MK. Genethics and Human Reproduction: Religious Perspectives in the Academic Bioethics Literature. New Bioeth 2019; 25:153-171. [PMID: 31130111 DOI: 10.1080/20502877.2019.1606154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The successes of the human genome project and genomics research programs portend great potential to improve upon health and enhance life. As scientific advancements continue, bioethicists and policy makers deliberate over the social and ethical implications of genetic and genomic technologies and information (ggT/I). The application of ggT/I to human reproduction raises conceptual and moral questions about being human and the links between offspring, parents, and society. Given ggT/I's ability to significantly affect the biological constitution of humans and future human generations thinking through such issues is fundamental to ethical and policy analysis. By means of a systematic literature review and accompanying content analysis, this paper highlights the dominant ethical concerns raised within recent bioethics discourse over the use of ggT/I for human reproduction. Based on these findings it aso offers a framework through which, and demarcates where, religious perspectives can add value to genethics debates and policy deliberation.
Collapse
Affiliation(s)
- Aasim I Padela
- a Initiative on Islam & Medicine, Program on Medicine and Religion , The University of Chicago , Chicago , IL , USA.,b Section of Emergency Medicine, Department of Medicine , The University of Chicago , Chicago , IL , USA.,c MacLean Center for Clinical Medical Ethics , The University of Chicago , Chicago , IL , USA.,d Divinity School , The University of Chicago , Chicago , IL , USA
| | - Mariel K Aparicio
- e Universidad Anáhuac , Facultad de Bioética México City , México.,f Bioética Clínica y Neuroética Anáhuac , Cátedra de Bioética Clínica Gerardo del Valle Toca , Mexico city , Mexico
| |
Collapse
|
20
|
Abstract
There is a role for regulatory oversight over new genetic technologies. Research must ensure the rights of human subjects, and all medical products and techniques should be ensured to be safe and effective. In the United States, these forms of regulation are largely the purview of the National Institutes of Health and the Food and Drug Administration. Some have argued, however, that human genetic therapies require new regulatory agencies empowered to enforce cultural norms, protect against hypothetical social harms, or ensure that the human genome remains unchanged. Focusing on the United States, this essay will briefly review these arguments and argue that the current limited regulatory role over human gene therapies is sufficient to protect public health, bodily autonomy, and reproductive freedom.
Collapse
|
21
|
van Dijke I, Bosch L, Bredenoord AL, Cornel M, Repping S, Hendriks S. The ethics of clinical applications of germline genome modification: a systematic review of reasons. Hum Reprod 2018; 33:1777-1796. [PMID: 30085071 PMCID: PMC6454467 DOI: 10.1093/humrep/dey257] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/07/2018] [Accepted: 07/20/2018] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION What are the reasons for or against the future clinical application of germline genome modification (GGM)? SUMMARY ANSWER A total of 169 reasons were identified, including 90 reasons for and 79 reasons against future clinical application of GGM. WHAT IS KNOWN ALREADY GGM is still unsafe and insufficiently effective for clinical purposes. However, the progress made using Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)- CRISPR-associated system (Cas) has led scientists to expect to overcome the technical hurdles in the foreseeable future. This has invited a debate on the socio-ethical and legal implications and acceptability of clinical applications of GGM. However, an overview of the reasons presented in this debate is missing. STUDY DESIGN, SIZE, DURATION MEDLINE was systematically searched for articles published between January 2011 and June 2016. Articles covering reasons for or against clinical application of intentional modification of the nuclear DNA of the germline were included. PARTICIPANTS/MATERIALS, SETTING, METHODS Two researchers independently extracted the reported reasons from the articles and grouped them into categories through content analysis. MAIN RESULTS AND THE ROLE OF CHANCE The systematic search yielded 1179 articles and 180 articles were included. Most papers were written by professionals in ethics, (science) journalism and biomedical sciences. Overall, 169 reasons were identified, including 90 reasons for, and 79 reasons against future clinical application of GGM. None of the included articles mentioned more than 60/169 reasons. The reasons could be categorized into: (i) quality of life of affected individuals; (ii) safety; (iii) effectiveness; (iv) existence of a clinical need or alternative; (v) costs; (vi) homo sapiens as a species (i.e. relating to effects on our species); (vii) social justice; (viii) potential for misuse; (ix) special interests exercising influence; (x) parental rights and duties; (xi) comparability to acceptable processes; (xii) rights of the unborn child; and (xiii) human life and dignity. Considerations relating to the implementation processes and regulation were reported. LIMITATIONS, REASONS FOR CAUTION We cannot ensure completeness as reasons may have been omitted in the reviewed literature and our search was limited to MEDLINE and a 5-year time period. WIDER IMPLICATIONS OF THE FINDINGS Besides needing (pre)clinical studies on safety and effectiveness, authors call for a sound pre-implementation process. This overview of reasons may assist a thorough evaluation of the responsible introduction of GGM. STUDY FUNDING/COMPETING INTEREST(S) University of Amsterdam, Alliance Grant of the Amsterdam Reproduction and Development Research Institute (I.D.), and Clinical Center, Department of Bioethics, National Institutes of Health Intramural Research Program (S.H.). There are no competing interests.
Collapse
Affiliation(s)
- Ivy van Dijke
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Women’s and Children’s Hospital, Meibergdreef 9, AZ Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Genetics, Amsterdam Public Health Research Institute, van der Boechorsstraat 7, BT Amsterdam, The Netherlands
| | - Lance Bosch
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Women’s and Children’s Hospital, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Annelien L Bredenoord
- Julius Center, Medical Humanities, University Medical Center Utrecht, Universiteitsweg 100, CG Utrecht, The Netherlands
| | - Martina Cornel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Genetics, Amsterdam Public Health Research Institute, van der Boechorsstraat 7, BT Amsterdam, The Netherlands
| | - Sjoerd Repping
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Women’s and Children’s Hospital, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Saskia Hendriks
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Women’s and Children’s Hospital, Meibergdreef 9, AZ Amsterdam, The Netherlands
- Department of Bioethics, Clinical Center, National Institutes of Health, 10 Center Dr, Bethesda, MD, USA
| |
Collapse
|
22
|
The advances in CRISPR technology and 3D genome. Semin Cell Dev Biol 2018; 90:54-61. [PMID: 30004018 DOI: 10.1016/j.semcdb.2018.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 07/08/2018] [Indexed: 12/26/2022]
Abstract
The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein (Cas) system is a prokaryotic immune system that used to resist foreign genetic factors. It rapidly becomes the hot technology in life sciences and is applies for genome editing to solve the problem of genome-derived diseases. Using CRISPR/Cas technique, the biological DNA sequence can be repaired, cut, replaced, or added. It can effectively change the human stem cells and is expected to achieve results in the treatment. Compared with ZFN and TALEN genome editing techniques, CRISPR is more effective, accurate, and convenient. The application of CRISPR technique in three dimensional (3D) genome structure makes us understand the relationship between linear DNA sequence and 3D chromatin structure. Utilizing CRISPR/Cas9 genome editing to reverse or delete CTCF binding sites, to recognize changes of topological isomerism of the genome and interactions between chromatin loops. The purpose of this review is to introduce the characteristics and classification of the current CRISPR/Cas system, multiple functions, and potential therapeutic uses, as well as to outline the effect of the technique on chromatin loops by changing CTCF sites in 3D genomes. We will also briefly describe the importance of ethical dilemmas to be faced in CRISPR applications and provide a perspective for potential CRISPR considerations.
Collapse
|
23
|
Tan ZY, Huang T, Ngeow J. 65 YEARS OF THE DOUBLE HELIX: The advancements of gene editing and potential application to hereditary cancer. Endocr Relat Cancer 2018; 25:T141-T158. [PMID: 29980644 DOI: 10.1530/erc-18-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 12/26/2022]
Abstract
Hereditary cancer predisposition syndromes are associated with germline mutations that lead to increased vulnerability for an individual to develop cancers. Such germline mutations in tumour suppressor genes, oncogenes and genes encoding for proteins essential in DNA repair pathways and cell cycle control can cause overall chromosomal instability in the genome and increase risk in developing cancers. Gene correction of these germline mutations to restore normal protein functions is anticipated as a new therapeutic option. This can be achieved through disruption of gain-of-function pathogenic mutation, restoration of loss-of-function mutation, addition of a transgene essential for cell function and single nucleotide changes. Genome editing tools are applicable to precise gene correction. Development of genome editing tools comes in two waves. The first wave focuses on improving targeting specificity and editing efficiency of nucleases, and the second wave of gene editing draws on innovative engineering of fusion proteins combining deactivated nucleases and other enzymes that are able to create limitless functional molecular tools. This gene editing advancement is going to impact medicine, particularly in hereditary cancers. In this review, we discuss the application of gene editing as an early intervention and possible treatment for hereditary cancers, by highlighting a selection of highly penetrant cancer syndromes as examples of how this may be achieved in clinical practice.
Collapse
Affiliation(s)
- Zi Ying Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Institute of Molecular and Cell Biology, Singapore
| | - Taosheng Huang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joanne Ngeow
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Institute of Molecular and Cell Biology, Singapore
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School Singapore, Singapore
| |
Collapse
|
24
|
Chakraborty S. Inconclusive studies on possible CRISPR-Cas off-targets should moderate expectations about enzymes that have evolved to be non-specific. J Biosci 2018; 43:225-228. [PMID: 29872009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Sandeep Chakraborty
- R-44/1, Celia Engineers, T. T. C Industrial Area, Rabale, Navi Mumbai 400701, India,
| |
Collapse
|
25
|
Inconclusive studies on possible CRISPR-Cas off-targets should moderate expectations about enzymes that have evolved to be non-specific. J Biosci 2018. [DOI: 10.1007/s12038-018-9761-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
26
|
Harper JC, Aittomäki K, Borry P, Cornel MC, de Wert G, Dondorp W, Geraedts J, Gianaroli L, Ketterson K, Liebaers I, Lundin K, Mertes H, Morris M, Pennings G, Sermon K, Spits C, Soini S, van Montfoort APA, Veiga A, Vermeesch JR, Viville S, Macek M. Recent developments in genetics and medically assisted reproduction: from research to clinical applications. Eur J Hum Genet 2018; 26:12-33. [PMID: 29199274 PMCID: PMC5839000 DOI: 10.1038/s41431-017-0016-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 09/14/2017] [Indexed: 12/15/2022] Open
Abstract
Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.
Collapse
Affiliation(s)
- J C Harper
- Institute for Women's Health, University College London, London, UK
| | - K Aittomäki
- Laboratory of Genetics, Helsinki University Hospital, Helsinki, Finland
| | - P Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - M C Cornel
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - G de Wert
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - W Dondorp
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - J Geraedts
- Department Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Gianaroli
- S.I.S.Me.R. Reproductive Medicine Unit, Bologna, Italy
| | | | - I Liebaers
- Center for Medical Genetics, UZ Brussels, Brussels, Belgium
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - K Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - H Mertes
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Ghent, Belgium
| | - M Morris
- Synlab Genetics, Lausanne, Switzerland
| | - G Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Ghent, Belgium
| | - K Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Spits
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Soini
- Helsinki Biobank, Helsinki University Central Hospital, Helsinki, Finland
| | - A P A van Montfoort
- IVF Laboratory, Department of Obstetrics & Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Veiga
- Barcelona Stem Cell Bank, Centre of Regenerative Medicine in Barcelona, Hospital Duran i Reynals, Barcelona, Spain
- Reproductive Medicine Service of Dexeus Woman Health, Barcelona, Spain
| | - J R Vermeesch
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - S Viville
- Institute of Parasitology and Pathology, University of Strasbourg, Strasbourg, France
- Laboratory of Genetic Diagnostics, UF3472-Genetics of Infertility, Nouvel Hôpital Civil, Strasbourg, France
| | - M Macek
- Department of Biology and Medical Genetics, Charles University-2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
| |
Collapse
|
27
|
Harper JC, Aittomäki K, Borry P, Cornel MC, de Wert G, Dondorp W, Geraedts J, Gianaroli L, Ketterson K, Liebaers I, Lundin K, Mertes H, Morris M, Pennings G, Sermon K, Spits C, Soini S, van Montfoort APA, Veiga A, Vermeesch JR, Viville S, Macek M. Recent developments in genetics and medically-assisted reproduction: from research to clinical applications †‡. Hum Reprod Open 2017; 2017:hox015. [PMID: 31486804 PMCID: PMC6276693 DOI: 10.1093/hropen/hox015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/14/2017] [Indexed: 12/13/2022] Open
Abstract
Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively-parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.
Collapse
Affiliation(s)
- J C Harper
- Institute for Women's Health, University College London, 86-96 Chenies Mews, London WC1E 6HX, UK
| | - K Aittomäki
- Laboratory of Genetics, Helsinki University Hospital, PO Box 720, FI-00029, Helsinki, Finland
| | - P Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 - Box 7001. B-3000, Leuven Belgium
| | - M C Cornel
- Department of Clinical Genetics, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - G de Wert
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, De Byeplein 1, 6229 HA Maastricht, The Netherlands
| | - W Dondorp
- Department of Health, Ethics and Society, Research Schools CAPHRI and GROW, Maastricht University, De Byeplein 1, 6229 HA Maastricht, The Netherlands
| | - J Geraedts
- Department Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - L Gianaroli
- S.I.S.Me.R. Reproductive Medicine Unit, Via Mazzini 12, 40138 Bologna, Italy
| | - K Ketterson
- Althea Science, Inc., 3 Regent St #301, Livingston, NJ 07039, USA
| | - I Liebaers
- Centre for Medical Genetics, UZ Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - K Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Blå Stråket 6, 413 45, Göteborg, Sweden
| | - H Mertes
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Belgium
| | - M Morris
- Synlab Genetics, chemin d'Entre-Bois 21, CH-1018, Lausanne, Switzerland
| | - G Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Belgium
| | - K Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - C Spits
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - S Soini
- Helsinki Biobank, Helsinki University Central Hospital, Haartmaninkatu 3, PO Box 400, 00029 HUS, Helsinki, Finland
| | - A P A van Montfoort
- IVF laboratory, Department of Obstetrics and Gynaecology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - A Veiga
- Barcelona Stem Cell Bank, Centre of Regenerative Medicine in Barcelona, Hospital Duran i Reynals, Gran Via de l' Hospitalet 199, 08908, Hospitalet de Llobregat, Barcelona, Spain
- Reproductive Medicine Service of Dexeus Woman Health, Gran Via Carles III, 71-75 - 08028 Barcelona, Spain
| | - J R Vermeesch
- Department of Human Genetics, KU Leuven, O&N I Herestraat 49 - Box 602, B-3000 Leuven, Belgium
| | - S Viville
- Institute of Parasitology and Pathology, University of Strasbourg, 3 rue Koberlé, 67000 Strasbourg, France
- Laboratory of Genetic Diagnostics, UF3472-Genetics of Infertility, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67091 Strasbourg cedex, France
| | - M Macek
- Department of Biology and Medical Genetics, Charles University 2nd Faculty of Medicine and Motol University Hospital, V Úvalu 84, Prague CZ-15006, Czech Republic
| |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW To review the recent ethical, legal, and social issues surrounding human reproduction involving germline genome editing. RECENT FINDINGS Genome editing techniques, such as CRISPR/Cas9, have facilitated genetic modification in human embryos. The most likely purpose of germline genome editing is the prevention of serious genetic disease in offspring. However, complex issues still remain, including irremediable risks to fetuses and future generations, the role of women, the availability of alternatives, long-term follow-up, health insurance coverage, misuse for human enhancement, and the potential effects on adoption. Further discussions, a broad consensus, and appropriate regulations are required before human germline genome editing is introduced into the global society. SUMMARY Before germline genome editing is used for disease prevention, a broad consensus must be formed by carefully discussing its ethical, legal, and social issues.
Collapse
Affiliation(s)
- Tetsuya Ishii
- Office of Health and Safety, Hokkaido University, Sapporo 060-0808, Japan
| |
Collapse
|
29
|
Ranisch R. Germline Genome Editing and the Functions of Consent. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:27-29. [PMID: 29148947 DOI: 10.1080/15265161.2017.1388875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
30
|
Miller LF. Transplanting the Body: Preliminary Ethical Considerations. New Bioeth 2017; 23:219-235. [PMID: 29058535 DOI: 10.1080/20502877.2017.1385919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A dissociated area of medical research warrants bioethical consideration: a proposed transplantation of a donor's entire body, except head, to a patient with a fatal degenerative disease. The seeming improbability of such an operation can only underscore the need for thorough bioethical assessment: Not assessing a case of such potential ethical import, by showing neglect instead of facing the issue, can only compound the ethical predicament, perhaps eroding public trust in ethical medicine. This article discusses the historical background of full-body transplantation, documents the seriousness of its current pursuit, and builds an argument for why prima facie this type of transplant is bioethically distinct. Certainly, this examination can only be preliminary, indicating what should be a wide and vigorous discussion among practitioners and ethicists. It concludes with practical suggestions for how the medical and bioethics community may proceed with ethical assessment.
Collapse
|
31
|
|
32
|
Mulvihill JJ, Capps B, Joly Y, Lysaght T, Zwart HAE, Chadwick R. Ethical issues of CRISPR technology and gene editing through the lens of solidarity. Br Med Bull 2017; 122:17-29. [PMID: 28334154 DOI: 10.1093/bmb/ldx002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 01/30/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The avalanche of commentaries on CRISPR-Cas9 technology, a bacterial immune system modified to recognize any short DNA sequence, cut it out, and insert a new one, has rekindled hopes for gene therapy and other applications and raised criticisms of engineering genes in future generations. SOURCES OF DATA This discussion draws on articles that emphasize ethics, identified partly through PubMed and Google, 2014-2016. AREAS OF AGREEMENT CRISPR-Cas9 has taken the pace and prospects for genetic discovery and applications to a high level, stoking anticipation for somatic gene engineering to help patients. We support a moratorium on germ line manipulation. AREAS OF CONTROVERSY We place increased emphasis on the principle of solidarity and the public good. The genetic bases of some diseases are not thoroughly addressable with CRISPR-Cas9. We see no new ethical issues, compared with gene therapy and genetic engineering in general, apart from the explosive rate of findings. Other controversies include eugenics, patentability and unrealistic expectations of professionals and the public. GROWING POINTS Biggest issues are the void of research on human germ cell biology, the appropriate routes for oversight and transparency, and the scientific and ethical areas of reproductive medicine. AREAS TIMELY FOR DEVELOPING RESEARCH The principle of genomic solidarity and priority on public good should be a lens for bringing clarity to CRISPR debates. The valid claim of genetic exceptionalism supports restraint on experimentation in human germ cells, given the trans-generational dangers and the knowledge gap in germ cell biology.
Collapse
Affiliation(s)
- John J Mulvihill
- Section of Genetics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Suite 12100, 1200 Children's Avenue, Oklahoma City, OK 73104, USA
| | - Benjamin Capps
- Department of Bioethics, Dalhousie University, 5849 University Avenue, Room C-312, CRC Bldg, PO Box 15000, Halifax, Nova Scotia, Canada B3H 4R2
| | - Yann Joly
- Department of Human Genetics, Centre of Genomics and Policy, McGill University, 740 Avenue Dr. Penfield, Suite 5200, Montreal (Quebec), Canada H3A 0G1
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Level 2 Block MD11, Clinical Research Centre, 10 Medical Drive, Singapore 117576, Singapore
| | - Hub A E Zwart
- Faculty of Science, Department of Philosophy and Science Studies, Radboud UniversityNijmegen, P.O. Box 9010, NL-6500 GL Nijmegen, The Netherlands
| | - Ruth Chadwick
- School of Law, University of Manchester, Williamson Building-2.13, Manchester M13 9PL, UK
| | | |
Collapse
|
33
|
Wykes RC, Lignani G. Gene therapy and editing: Novel potential treatments for neuronal channelopathies. Neuropharmacology 2017; 132:108-117. [PMID: 28564577 DOI: 10.1016/j.neuropharm.2017.05.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 01/14/2023]
Abstract
Pharmaceutical treatment can be inadequate, non-effective, or intolerable for many people suffering from a neuronal channelopathy. Development of novel treatment options, particularly those with the potential to be curative is warranted. Gene therapy approaches can permit cell-specific modification of neuronal and circuit excitability and have been investigated experimentally as a therapy for numerous neurological disorders, with clinical trials for several neurodegenerative diseases ongoing. Channelopathies can arise from a wide array of gene mutations; however they usually result in periods of aberrant network excitability. Therefore gene therapy strategies based on up or downregulation of genes that modulate neuronal excitability may be effective therapy for a wide range of neuronal channelopathies. As many channelopathies are paroxysmal in nature, optogenetic or chemogenetic approaches may be well suited to treat the symptoms of these diseases. Recent advances in gene-editing technologies such as the CRISPR-Cas9 system could in the future result in entirely novel treatment for a channelopathy by repairing disease-causing channel mutations at the germline level. As the brain may develop and wire abnormally as a consequence of an inherited or de novo channelopathy, the choice of optimal gene therapy or gene editing strategy will depend on the time of intervention (germline, neonatal or adult). This article is part of the Special Issue entitled 'Channelopathies.'
Collapse
Affiliation(s)
- R C Wykes
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, London, UK.
| | - G Lignani
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, London, UK.
| |
Collapse
|
34
|
Evitt NH, Mascharak S, Altman RB. Response to Open Peer Commentaries on "Human Germline CRISPR-Cas Modification: Toward a Regulatory Framework". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:W1-W2. [PMID: 27653416 DOI: 10.1080/15265161.2016.1214308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
35
|
Ethical and regulatory aspects of genome editing. Blood 2016; 127:2553-60. [PMID: 27053531 DOI: 10.1182/blood-2016-01-678136] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/18/2016] [Indexed: 12/26/2022] Open
Abstract
Gene editing is a rapidly developing area of biotechnology in which the nucleotide sequence of the genome of living cells is precisely changed. The use of genome-editing technologies to modify various types of blood cells, including hematopoietic stem cells, has emerged as an important field of therapeutic development for hematopoietic disease. Although these technologies offer the potential for generation of transformative therapies for patients suffering from myriad disorders of hematopoiesis, their application for therapeutic modification of primary human cells is still in its infancy. Consequently, development of ethical and regulatory frameworks that ensure their safe and effective use is an increasingly important consideration. Here, we review a number of issues that have the potential to impact the clinical implementation of genome-editing technologies, and suggest paths forward for resolving them such that new therapies can be safely and rapidly translated to the clinic.
Collapse
|
36
|
Mertes H, Pennings G. Modification of the Embryo's Genome: More Useful in Research Than in the Clinic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:52-53. [PMID: 26632365 DOI: 10.1080/15265161.2015.1103813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
37
|
Allyse M, Michie M, Mozersky J, Rapp R. Cherchez la Femme: Reproductive CRISPR and Women's Choices. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:47-9. [PMID: 26632363 DOI: 10.1080/15265161.2015.1103808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
|