Posted on November 16, 2017 at 11:46 PM
To my post of last week, add the case of a 44 year-old man who has received gene therapy for an inherited metabolic disease called Hunter’s syndrome. This is another example of a form of gene editing as true therapy. That is, an existing individual is given a construct intended to edit his genes to introduce a gene that makes an enzyme that is lacking in the disease, and that causes terrible problems. In this case, as part of a clinical trial, the construct, using a so-called “zinc finger” technique, is intended to introduce the gene into only about 1% of the patient’s liver cells. Â If successful, the damage already done by the disease won’t be affected, but it’s progress may be arrested, with the potential to avoid having to have repeated, costly treatment with the missing enzyme protein itself.
Cool idea–and well within the current regulatory ethical regime. The edit would not be inherited, and unborn humans don’t have to be sacrificed to develop the technique. The adult patients are capable of giving informed consent. Trials in children would come later, controlled by accepted ethical experimentation on children in clinical trials.
In a separate note, on a separate topic, Nature Biotechnology is editorializing that inherited gene editing is way behind mitochondrial replacement therapy (MRT), the “3-parent baby” approach to treating genetic problems, and will likely have limited use in the future. Why? Because it is likely that preimplantation genetic diagnosis (PGD) after in vitro fertilization (IVF) will be preferred to identify and give birth to babies unaffected by serious genetic disorders. The journal editors argue that gene editing would be preferred only in those few cases where PGD cannot avoid passing on a disease–for example, in cases where it is known that all embryos from a fertilizing couple would be affected. Otherwise, the gene editing would not be worth the trouble.
MRT, on the other hand, has been studied more and is closer to being used to treat unborn humans who have diseases that MRT could treat. Thing is, those diseases are also rare, on the order of 1000 cases per year in the US, and technically, gene editing would probably not be too useful for those.
There is a lot of talk about using a mix of gene editing and PGD to eliminate certain genetic disease from the human prospect. I recently wrote about the Chinese government working on this. To achieve the goal absolutely, every born human would have to be a product of IVF.
And the risk of some of the disorders is low enough that the absolute risk in any one “natural” pregnancy would be low. So why go to the trouble of trying to eliminate the risks utterly? (I think that’s a rhetorical question.)
The title of the editorial in question is “Humans 2.0.” Indeed.