To CRISPR or not to CRISPR?

CRISPR has been the star of synthetic biology and gene-editing for the last few years. The technology presents a method for editing genes in mammals simpler, safer and with higher precision than any of its predecessors, and has brought new hope to the idea of eliminating genetic disease for good. CRISPR can (hypothetically) snip out the faulty genes that cause Huntingtons or Cystic Fibrosis, but it can also be used to target non-genetic disorders like HIV by editing the patient’s immune cells.

Although CRISPR comes with an immense potential in human medicine, it also comes with immense ethical issues. Although CRISPR is safer than previous gene-editing methods, is it safe enough to use in humans? Is it ethical to edit the genes of an embryo, changing the genes of a person for ever, without them being able to consent? And one of the most discussed issues; does editing out disease lead us down a slippery slope to editing genes responsible for looks, IQ, or athleticism?

There are many questions that need to be discussed in depth before we decide whether to use CRISPR in humans or not. Tomorrow (27th Nov 2018), there is a conference in China on exactly this topic, the Second International Summit on Human Genome Editing, where scientists from all over the world will discuss these pressing queries.

Only, it seems, they are all too late.

Pandora’s box is already open

Researchers at the Southern University of Science and Technology, in Shenzhen China, have reported that a pair of twins have been born, both of whom have been edited with CRISPR. The edit in question is the deletion of the CCR5 gene. Some people are naturally born without CCR5, and have been found to be immune to HIV infection, since CCR5 is a receptor on immune-cells that the virus binds to in order to infect them.

On one hand, this is an amazing scientific achievement; the first ever gene-edited, potentially HIV-immune babies. On the other hand, this is a Pandora’s box flipped wide open. The wider scientific community are in general consensus that human gene-editing with CRISPR must be properly understood, both scientifically and ethically before it is attempted. It needs to be deemed both ethically defensible, and medically safe. It has not been deemed either yet. Using it anyway is not amazing; it is reckless and irresponsible, and puts human lives at an unnecessary risk.

Salvation for an HIV-epidemic?

There are always ways to try and justify recklessness in science. The attempt at creating HIV-resistance comes in the midst of an HIV epidemic in China. In the last year alone there has been a 14% increase in HIV-infected patients in China, most of which spread through unprotected sex. Though there are highly effective one-pill treatments for HIV, it can be problematic reaching a vast population, many of whom still rely mostly on traditional medicine. However, traditional Chinese medicine is quickly losing ground to western medicine, and the Chinese government has put huge efforts into making treatment available to anyone who needs it. 99% of Chinas HIV-prevention programmes are domestically funded. Regardless, the main issue is not to get treatment to affected patients, it’s to prevent the spread of the disease. Wouldn’t editing the population to make them HIV-resistant be perfect then? Considering that CRISPR is carried out in parallel with in vitro fertilization, and costs a minor fortune, it is not exactly a procedure that could easily be made accessible to an entire population. In fact it’d be nearly impossible. One would also have to eliminate natural conception, which again; nearly impossible.

In short, genetically modifying the Chinese population is not the answer to its HIV-epidemic. It’s an expensive luxury product which would only be afforded by a select few, who would not be at high risk for the disease to begin with. The HIV-epidemic needs to be tackled with prevention efforts, like mandatory sensible sex education, which historically has not been readily available in China. To date, only 44% of university students receive any sexual health education at all prior to University. That right there is a tried and tested method for combating HIV without poking around in science we have yet to evaluate.

What’s the real harm though?

History repeats itself. Genetic editing and gene-therapy was a very hot topic back in the 90s as well. Back then it was through non-pathogenic viruses which had been modified to be able to edit the human genome. It too was considered safe, and it was used to treat a severe genetic immune-deficiency disease called SCID. There were limited treatment options for children born with scid, and a 1 in 4 mortality rate. Magically, through viral gene-therapy, 15 young boys were cured. Completely.

Five of these young boys also developed leukemia as a direct result of the gene-therapy.

Not only were lives lost, but the field itself was destroyed. No one dared touch any gene-therapy research for decades. Now we have a potentially much safer option, and if we use it recklessly we risk repeating the same mistakes, sending the field back into oblivion, and risking innocent lives while we do it.

The scientists presumably wanted nothing more than to be the first ever to put into this world the gene-edited HIV resistant human. The science behind it is amazing. But the scientist strikes me as an irresponsible person chasing glory, rather than a scientific benefactor looking to cure disease. Let the science take its time, and let us properly discuss what we’re doing, before we actually do it. Let’s not repeat history.

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