Brave new world? CRISPR gene editing controversy

Jan. 23, 2019 / By Camille Ruiz, RHIA

I was sidetracked recently by an article regarding CRISPR biotechnology and the controversy surrounding its use. CRISPR is an abbreviation for Clustered Regularly Interspaced Short Palindromic Repeats. You can Google CRISPR and CRISPR-associated 9 (Cas9) if you want a very technical scientific explanation. A basic explanation for CRISPR/Cas9: It is a gene editing biotechnology used to modify or “cut out” specific portions of DNA. In theory, the cells will replicate with the edited DNA. Some trials have been successful while others have failed. It reminds me of the Microsoft Find & Replace Function. The function is great if you’re reviewing your finished document, but it’s not so great if you run it in the middle of editing your document. 

Historically, the process of gene editing modified, replaced or deleted the DNA of a living organism by introducing genetic DNA material to specific site locations. CRISPR’s germline technique would edit sperm, eggs or single-celled embryos, thus allowing the possibility for edits to be passed on to future generations. The germline technique is controversial in the scientific community and against the law in some countries. The U.S. National Academy of Science and the National Academy of Medicine urge caution and advocate the use of “scientific” and “ethical” standards.   

Currently a few clinical trials on animals and human cells have begun to test some possible medical applications. If successful, CRISPR could potentially eliminate genetic disorders such as hemophilia, Down syndrome, sickle cell anemia and cystic fibrosis, not to mention other genetic disorders and cancers (The cynical “middle revenue cycle” part of me envisions a decrease in hospital Case Mix Index and reduction in patient revenue days).  

This biotechnology has been applied to agriculture, including edits to corn to make it less susceptible to mold infestations. Today, this biotechnology is used on food products, but it is not the same as Genetically Modified Organisms (GMO). The GMO process takes the genetic material from the DNA of one species and transfers it to another. Hope that makes you feel better about your non-GMO groceries. 

On a more serious note, the topic of human gene editing biotechnology ignites the fear of Huxley’s Brave New World society. There is potential for unethical practices or misuse, such as the creation of “designer babies,” mutant species or biological weapons. These fears of “designer babies” were amplified in November 2018 after scientists Jiankui He and Michael Deem disclosed the use of CRISPR to genetically alter human embryos, claiming that twin girls had been brought to term successfully using CRISPR. A married couple provided their embryos and the scientists used CRISPR on the gene affected by the HIV infection carried by one of the parents. China has since put a halt to this genetic editing research and charged He. Recently the world learned of a second woman who is pregnant with a gene-edited baby as part of He’s research. 

These ethical issues raise a number of questions: Should we fool with nature? Is it safe? If you “fix” one DNA section, will another section be adversely altered? Is it possible for unexpected mutations to be passed to future generations? Should we direct resources to new biotechnologies when we have current patient populations facing barriers to basic healthcare, such as rural and low income communities? Would insurance companies cover gene editing biotechnology for genetic disorders?  Would patients with genetic disorders who refuse biotechnology interventions face legal action passing their genetic disorders to their children? But that’s jumping way ahead… I think even if the germline technique is not an option, gene editing applications should still be considered in global terms for use against diseases. Is it more reasonable that CRISPR biotechnology would be used to prevent or cure diseases? Shouldn’t it at least be part of the discussion? 

 In 2015, British geneticist Austin Burt successfully used CRISPR on a certain mosquito population in Panama that carried Dengue-fever, reducing it by 93 percent. Science Daily discussed the CRISPR trials on mosquitos to eliminate the transmission of malaria, which kills one million people annually. If you’re thinking the U.S. isn’t affected with many cases of malaria or Dengue-fever, we thought the same about the Zika virus or West Nile virus until recently. 

In 2016, the United States Food and Drug Administration (FDA) approved human clinical trials in which CRISPR would be used to alter the T cells of people with specific types of cancer. This year, CRISPR Therapeutics company received FDA human clinical trial approval on the blood disorder beta-thalassemia. There are still concerns about effectiveness and safety, but, love it or hate it, CRISPR biotechnology is here to stay. You can go down the rabbit hole researching advocates and opponents of CRISPR. Thinking back over the last decade of new healthcare technology, devices and pharmaceuticals advancements I am hopeful for CRISPR and its applications. There will always be fear of the unknown, but we must bravely continue to move forward. 

Camille Ruiz is an outpatient CDI consultant at 3M Health Information Systems.

Resources

Welcome Trust Sanger Institute. (2018, July 19). Genome damage from CRISPR/Cas9 gene editing higher than thought: Caution required for using CRISPR/Cas9 in potential gene therapies. ScienceDaily. Retrieved October 16, 2018.

Normille, Dennis. CRISPR bombshell: Chinese researcher claims to have created gene-edited twins. Science. Nov. 26, 2018.