Gene editing is often described as a disruptive technology: an innovation that takes the place of a familiar tech solution and transforms an industry, as defined by TechTarget. The ability to edit our own genome holds endless possibilities and an abundance of controversy.
CRISPR, one of the newest types of gene-editing technology, uses a combination of lab-created RNA and enzymes to selectively trim segments of DNA. In the United States, technologies like CRISPR are currently being used in research only.
The National Institutes of Health states that this type of research focuses primarily on diseases that are caused by a single gene, such as hemophilia or sickle cell anemia. But once we understand this approach better, it may play a role in tackling more complex diseases like cancer. Another potential application of this technology is within the field of IVF.
Gene Editing vs. Preimplantation Genetic Testing
Preimplantation genetic testing (PGT) is used in IVF when aspiring parents have known genetic abnormalities they do not want to pass on, or have risk factors for genetic abnormalities, such as advanced maternal age. PGT does not change an embryo's genes; rather, it screens for chromosomal abnormalities or other defects to help clinicians select the best embryos for implantation.
Gene editing, if it could be accurately used in IVF, could potentially make nearly every embryo available for implantation. If gene editing becomes safe and effective, it could theoretically prevent inherited diseases in an even more reliable way than PGT can. For now, however, questions of its safety remain unanswered, and may remain that way for decades.
Controversy Surrounding Gene Editing
Perhaps the best example of a gene editing controversy comes from China. In 2018, a physician-scientist claimed to have performed gene editing before IVF, which resulted in the birth of twins.
According to Science, He Jiankui removed a receptor found on a white blood cell to reduce the risk of contracting HIV. Although the father was HIV positive, gene editing was not necessary to eliminate the risk of HIV transmission, a step that can be accomplished during the IVF process itself. The end goal was much larger: editing the embryonic genes with the hope of reducing the children's risk of contracting HIV in the future. This gene editing was done so early in embryo development that the germline cells were edited, meaning that the genetic changes in both twins were effectively hereditary.
The international medical community, while shocked by this revelation, was not uniformly opposed to this use of genome editing; some condemned it outright, while others remain curious about its potential effects on participants. Germline genome editing in humans is illegal throughout most of the world, but its ethical implications are something the scientific community will have to reckon with again and again as this technology evolves.
For Now, It Is Unlikely That Gene Editing Will Move Past the Research Stage
The International Commission on the Clinical Use of Human Germline Genome Editing is currently considering guidelines on this approach for the medical community. One of their key considerations is restricting the use of germline gene editing when an alternative treatment or solution is available, as is the case with PGT and IVF.
Genome editing has the potential to benefit both people living today and those who might be born in the future. Yet, the international medical community is undecided about one key question surrounding genome editing: Is this an acceptable use of technology? More research and debate is needed before researchers and providers can decide whether to progress further with gene editing.
