Royal College of Surgeons in Ireland
Browse

Ethics challenge winner 2016/2017. Gene editing

Download (105.78 kB)
journal contribution
posted on 2023-08-09, 08:42 authored by Katie Nolan

The 2016/2017 RCSIsmj Ethics Challenge presents the current state of gene-editing therapies and questions future directions. Gene editing in its current form is very much a double-edged sword – promising a future with endless possibility for medical treatments while at the same time making us question our core beliefs about what is possible and what should be possible. Gene editing came to the fore in the last 20 years as the heralded solution to genetically inherited diseases, and has been making great strides in recent years. Superseding RNA interference techniques, early attempts at targeted gene editing were made with zinc finger nucleases, followed by transcription activator-like effector nucleases (TALENs). More recent and more controversial advances use the CRISPR/CAS9 system. All three techniques utilise endogenous nuclease activity, derived from bacterial immune systems, to direct and excise mutated genes, or insert therapeutic genes, which can ameliorate a disease phenotype. 

Until recently, this work was carried out in somatic cell types or in pluripotent stem cells with a view to implanting augmented cells that could prevent a disease phenotype developing (e.g., medium spiny neurons in Huntington’s disease). This is the forefront of current therapeutic work; however, due to the complexity of the human genome and immune system, these techniques have limitations. Attempting to treat a disease once clinical manifestations are present is more difficult than before signs and symptoms manifest clinically. Hence, some scientists and doctors are calling for germline gene editing in gametes (sperm, ovum) and embryos, to eradicate disease-causing gene mutations before these cells replicate and perpetuate the mutations throughout every cell in the body. A definitive solution to inheritable genetic defects or gene mutations would revolutionise medicine but, hindered by our current level of knowledge, it could do so at a very high price. A topic of this magnitude is therefore a polarising subject in the medical community.

In 1997, the United Nations Educational, Scientific and Cultural Organisation (UNESCO) created the Universal Declaration on the Human Genome and Human Rights, which states that the human genome is the fundamental unit of humanity, and enshrines our human dignity and diversity. UNESCO refers to the genome as the “heritage of humanity”. In particular, UNESCO states that human dignity requires that we are not “reduced to our genetic characteristics”, that we maintain respect for human diversity, and that the human genome does not become a source of “financial gain”. Gene editing of germline cells stands to contravene all of these rights and would require stringent regulation, regulatory enforcement and tightly-controlled research to delineate the procedures and the safety guidelines.

History

Comments

The original article is available at http://www.rcsismj.com/ Part of the RCSIsmj collection: https://doi.org/10.25419/rcsi.c.6781224.v1

Published Citation

Nolan K. Ethics challenge winner 2016/2017. Gene editing. RCSIsmj. 2017;10(1):6-9

Publication Date

2017

Department/Unit

  • Undergraduate Research

Publisher

RCSI University of Medicine and Health Sciences

Version

  • Published Version (Version of Record)