Clinical and ethical impact of CRISPR genome engineering

13 November 2013

Concerns over the potential implications of a ground-breaking new technique for genetic engineering have provoked calls for more public debate on ethical, legal, social and policy issues.
The CRISPR technique published last year (see previous news) is a novel form of artificial genome editing that could allow much more precise and reliable genetic manipulation, including for gene therapeutic purposes.
Prominent scientists have raised the question of what this could mean not only for research and clinical genetic applications, but potentially also for broader genetic engineering of human IVF embryos if manipulation of the human germline becomes a feasible possibility. This is illegal in the UK and many other countries, but if there is genuine scope to cure inherited diseases there may be pressure for change; the UK is already moving towards permitting mitochondrial replacement, a form of germline (heritable) genetic modification, albeit of a very specific and modest nature (see previous news).
Professor George Church of Harvard University, the first to use the technique successfully in human cells and mouse embryos (see original Science paper) and founder of the international Personal Genomes Project (now operating in the UK; see previous news) told the Independent newspaper that it was important to have public discussion of the ethical and social implications, adding: “Talking about the future is better than letting it sneak up on us.  We need to do more of this or we will be left with very limited vocabulary in the space between positive and negative hype”.
Professor Robin Lovell-Badge of the National Institute for Medical Research, whilst warning that there was a long way to go before CRISPR or any other methods could be considered suitable for manipulation of IVF embryos, irrespective of legal barriers, agreed, saying that such techniques: “deserve proper consideration and debate, and not just either hype or condemnation, so that the wonderful opportunities they present can be applied sensibly and with public support”.

Comment: It is certainly important to start considering the implications of scientific possibility well in advance of actual clinical utility for effective policy development and implementation planning. Public acceptability is an important early criterion for success. In this instance, if the CRISPR technique were shown to be useful and reliable in humans then it would eliminate many of the technical barriers to the safe manipulation of human genomes and could revolutionise treatment for inherited diseases. This would also highlight attendant ethical issues for public consideration. Often, ethical concerns and safety concerns are closely linked; wider separation of the two can sharpen (and indeed polarise) debate around an issue.  

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