Do you think we should allow genetic modification of the germline in ?the US? Consider if you, your child, or a family member carried a ?devastating genetic disease that could potential

2015 was the year it became OK to genetically engineer babies

Written by

Akshat Rathi

December 22, 2015

In April of this year, researchers in China published the results of an experiment in  modifying the DNA of human embryos . Though the embryos they worked on were damaged ones that could not have grown into living babies, it sent a tremor through the scientific establishment.

Just a month earlier, a group of leading geneticists had  called for a moratorium  on gene-editing in embryos. Since any genetic changes would get passed on to future generations, they argued, the risk of unintended consequences was too great. And in November, at a summit in Washington DC, scientists from across the world agreed that, while  research should continue , it’s still too risky to allow any altered embryos to grow into full human beings.

And, yet, when historians of science look back decades from now, they may well mark 2015 as the year genetically engineering humans became acceptable. That’s because, while the world was paying attention to the gene-editing summit, a more momentous decision had been made just a month earlier in the UK. There, a governmental body got ready to hand out licenses for creating a particular kind of genetically engineered human—using a technique the US tried and then banned 13 years ago.

This technique won’t create the fabled “designer babies” just yet. But the changes made to an embryo will be hereditary, and thus alter the genetic makeup of all the offspring to follow. The story of how we got here, and what will come next, is why 2015 will be remembered as a turning-point.

Just getting better

Our ability to do some form of genetic engineering  goes back 40,000 years . Selective breeding created a tamer and more likable version of a wolf, the common ancestor of all today’s dogs.

Our desire to design better humans is also old. In Plato’s  Republic, Socrates calls for a state-run program to get the  best citizens to mate  so that the population could be improved.

By the 19th century, the ideology of eugenics—a word not invented by Plato, but  coined much later  from the Greek for “good breeding”—had taken such a hold that countries were passing laws for such programs. Before World War II, 30 states in the US had passed  some form of eugenics laws  that mandated sexual sterilization of those deemed unfit (typically the mentally ill).

Only after the horror of Hitler’s genocide did the world recoil from eugenics. Most geneticists never returned to the idea that biological intervention would build a better society than social intervention. As Nathaniel Comfort, a professor of history of medicine,  writes in Aeon , eugenics survived only in the form of “preventive medicine for genetic diseases”—such as screening people for them and, occasionally, treating them with gene therapy.

Not everyone stopped trying. Taking inspiration from Aldous Huxley’s  Brave New World, eugenicist Robert Graham created the Repository for Germinal Choice, a sperm bank for the super-intelligent. The bank  existed from 1980 to 1999  and had some 19 high-IQ donors, including at least one Nobel laureate (William Shockley).

The resulting “Genius Babies ”—some 200 of them—are no different from normal people. One of those conceived through Graham’s sperm bank  told CNN , “There’s only so much you can control when it comes to genetics. It all has to do with what you give to your family.”

Beyond our control

That comment defines the limits of science today. In the 1970s, we  finally understood  how to tweak the genes of microbes, plants and animals to achieve certain traits. But in humans, with the  exception of a few things  such as color blindness or tasting certain foods, “designer baby” traits, such as greater intelligence, taller stature, stronger muscles, or better memory, are controlled by hundreds of genes, each of which also perform many other critical functions. Tools that can deal with such complexity are still a long way off.

For now, then, the only foreseeable use for gene-editing is to prevent disease. And the goal is to make genetic tools good enough to do that without any unintended consequences.

Since 1989, thousands of people have received experimental gene therapies. Typically these involve the use of a “vector”—a biological vehicle, such as a virus, that can deliver the correct copy of a faulty gene to the specific cells in the body affected by the genetic disorder, such as cancer cells or faulty cells in the eye.

While most of these treatments have been safe, only a few have been effective. China approved the world’s first gene therapy in 2003 to  treat certain kinds of cancers . Europe got its first in 2012 that  treats a rare inherited disorder  (pdf) affecting the pancreas. The US is likely to get its first gene therapy approved in 2016 to  treat a form of blindness .

None of these therapies, however, have used the latest advance in gene-editing:  CRISPR-Cas9 , a highly precise copy-and-paste tool that allows for the removal and replacement of individual genes. Since its development in 2012, it has become an instant favorite among scientists.

CRISPR-Cas9’s immediate potential lies in curing single-gene disorders in embryos. Changes made at that stage would affect every cell in the body and could cure many diseases. We know  some 4,000 such disorders , and, though each is rare, put together they could change the lives of millions in the next generation, and keep many more free from those diseases for all the generations to follow.

However, the Chinese study earlier this year showed that we might need something even more precise than CRISPR-Cas9 currently is. Only in one-third of the 86 embryos was the faulty gene erased as predicted, and even in those cases, CRISPR-Cas9 had also modified things it wasn’t meant to—the unintended consequences scientists worry about.

There is, however, another form of genetic engineering of human embryos. This is the one that the US tried and then banned, and that the British government recently opened licensing applications for. And what’s probably more important for the future of the debate is how Britain decided the technology works and is safe.

Three-parent child

Alana Saarinen was born in the US with three biological parents. Two of them contribute more than 99% of her genetic material and the third provides the rest. She is one of only  30 or so people  in the world who grew from a genetically engineered embryo into a healthy adult.

Sharon and Paul Saarinen had attempted in-vitro fertilization (IVF) four times, but without success. A likely reason was that Sharon’s egg cells had faulty mitochondria. These are like biological batteries within a cell—they play an essential role in converting your food into the energy that powers your body. Uniquely, they also have their own DNA (though it’s only some  37 of the 20,000  or so genes that make up the human genome).

During reproduction, when an egg cell fuses with a sperm cell, creating the first cell of an embryo, it’s only the DNA in its nucleus that is a mix of both parents’ DNA. Mitochondria and their DNA are passed on directly from mother to offspring. Because Sharon Saarinen’s mitochondria were faulty, she basically needed a mitochondria transplant in order to conceive.

That was where the third parent came in. A donor provided an egg cell, whose nucleus was removed and healthy mitochondria along with other bits of the cell were transferred to Sharon’s egg. The egg cell was then mixed with Paul’s sperm cells in a normal IVF procedure, and the resulting embryo would become Alana Saarinen.

This technique won’t only help women like Sharon conceive. In a lot of cases with faulty mitochondria, pregnancies proceed normally, but the child then turns out to have one of several mitochondrial diseases, which can lead to  all sorts of problems , from poor growth to autism to diabetes. One in every 5,000 children suffers from one of them.

Mitochondrial replacement therapy like the Saarinens had is currently the only known way of preventing mitochondrial diseases. But since they conceived Alana in 2000, only some 30 or so children have been born using the technique. In 2002, the US Food and Drug Administration (FDA) banned its use. Apart from ethical concerns about scientists “playing God,” there was a scientific worry too. We had never attempted to edit the “germ line”—the DNA that is transferred from one generation to another—and the risks were unknown. (About 10% of the pregnancies that resulted from this treatment had complications, but it wasn’t clear whether the procedure was to blame.)

Selfish genes

The FDA ban meant that US women with faulty mitochondria were left  with difficult choices  (pdf). They could choose not to have children, or undergo IVF and pick the fertilized embryo with the fewest defective mitochondria—taking a gamble on whether their child would develop mitochondrial disease.

But nearly a decade later the UK government’s Human Fertilization and Embryology Agency (HFEA) took up the case. In 2012, after taking a detailed look at the results of studies on animals and humans, it deemed that mitochondrial replacement therapy was “not unsafe”—meaning that the benefits of curing mitochondrial disease would outweigh the risks of the procedure.

The interesting thing was what the HFEA did next. In Sept. 2012, it launched a  public consultation,  creating a website that explained both the risks and benefits, and holding public events to do the same. Then it conducted a survey and asked people to send in their comments online. After the public had shown broad support for the therapy—and despite  stiff opposition  from scholarly groups and religious groups alike—the HFEA spent two years taking the necessary steps to get the regulations discussed in parliament. In February, MPs agreed to allow the use of the therapy under strict guidelines. In October, the process for handing out licenses began.

We already use genetic engineering to create climate-resistant crops and drug-producing bacteria. Now one of the world’s most scientifically advanced countries—and, fittingly, the birthplace of IVF—has agreed that genetically modified humans, too, are sometimes not just OK, but desirable. This is what makes 2015 an historic year.

Based on past progress, it is likely that genetic enhancements to humans will become a reality step by step. Just like mitochondrial replacement therapy, they will first appear for a very narrow purpose, such as curing single-gene disorders, and then, likely over many decades, we might reach the stage of creating those fabled designer babies.

That gives us enough time to deliberate the implications of each step. When our decisions will affect generations of humans to come, it is important we use that time well. The process that HFEA designed to win public and political support is a model worth emulating. If each step were to get the same scrutiny that mitochondrial replacement therapy got, genetically modified humans could become as normal as genetically modified crops and bacteria are today—and, barring the occasional controversy, as widely accepted.

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The pros and cons of genetically engineering your children

Written by

Akshat Rathi

December 03, 2015

From time to time, science troubles philosophers with difficult ethical questions. But none has been as difficult as considering permanently altering the genetic code of future generations. At a meeting that began on Dec. 1 in Washington DC, the world’s leading gene-editing experts met with ethicists, lawyers, and interested members of the public to decide whether it should be done.

Gene-editing tools have existed since 1975, when a meeting of a similar kind was held to discuss the future of genetic technology. But recent developments have made the technology safe enough to consider turning science fiction into reality. In fact, in April,  Chinese researchers announced  that they had conducted experiments to remove genes of an inheritable disease in human embryos (embryos that were alive but damaged, so they could not have become babies).

So the stakes are high. By eliminating “bad” genes from sperm and egg cells—called the “germline”—these tools have the potential to permanently wipe out diseases caused by single mutations in genes, such as cystic fibrosis, Huntington’s disease, or Tay-Sachs.

At the same time, there is huge uncertainty about what could go wrong if seemingly troubling genes are eliminated.

One of the key researchers in the field is Jennifer Doudna at the University of California, Berkeley. She has been touted for a Nobel Prize for the development of CRISPR-Cas9, a highly precise copy-paste genetic tool. In the build-up to the meeting, Doudna made her  concerns clear in Nature :

“Human-germline editing for the purposes of creating genome-modified humans should not proceed at this time, partly because of the unknown social consequences, but also because the technology and our knowledge of the human genome are simply not ready to do so safely.”

Her sentiments were  echoed in a report  released before the meeting by the Center for Genetics and Society. They believe that research in genetic tools must advance, but only through therapy for adults (where genetic modifications are targeted at some cells in the body but not passed on to kids, such as in  curing a form of inherited blindness ). The report continues:

“But using the same techniques to modify embryos in order to make permanent, irreversible changes to future generations and to our common genetic heritage—the human germline, as it is known—is far more problematic.”

Consider sickle-cell anemia, an occasionally fatal genetic disorder. Its genes, though clearly harmful, have persisted and spread because, while having two copies of the sickle-cell gene causes anemia, having just one copy happens to provide protection against malaria, one of the most deadly diseases in human history. Had we not known about their benefits, eliminating sickle-cell genes would have proved to be a bad idea.

More importantly, there is a worry that once you allow for designer babies you go down a slippery slope. Emily Smith Beitiks, disability researcher at the University of California, San Francisco,  said recently :

“These proposed applications raise social justice questions and put us at risk of reviving eugenics—controlled breeding to increase the occurrence of ‘desirable’ heritable characteristics. Who gets to decide what diversity looks like and who is valued?”

But the history of science shows that it is hard to keep such a cat in the bag. Once developed, technologies have a way of finding their way into the hands of those who desire to use them. That worries George Church, a geneticist at Harvard Medical School, who has been a strong voice in this debate since the beginning.  In Nature , he writes:

“Banning human-germlined editing could put a damper on the best medical research and instead drive the practice underground to black markets and uncontrolled medical tourism, which are fraught with much greater risk and misapplication.”

And many believe that the risks of gene-editing are not that high anyway. Nathaniel Comfort, a historian of medicine at Johns Hopkins University in Baltimore,  writes in Aeon :

“The dishes do not come à la carte. If you believe that made-to-order babies are possible, you oversimplify how genes work.”

That is because abilities, such as intelligence, height, or personality traits, involve thousands of genes. So there may be some things that you cannot genetically enhance much, and certainly not safely. And even knowingly changing the human genome is not as big a deal as some make it out to be, Church notes:

“Offspring do not consent to their parents’ intentional exposure to mutagenic sources that alter the germ line, including chemotherapy, high altitude, and alcohol—nor to decisions that reduce the prospects for future generations, such as misdirected economic investment and environmental mismanagement.”

The meeting ended on Dec. 3, and the committee of organizers—10 scientists and two bioethicists— came to a conclusion  on the debate. They believe that the promises of germline editing are too great to scupper future developments. They endorse that research should continue in non-human embryos and “if, in the process of research, early human embryos … undergo gene editing, the modified cells should not be used to establish a pregnancy.” That is because the committee believes that we neither know enough about safety issues to allow any clinical application, nor enough about how society will respond to the use of this technology in humans.

And, yet, perhaps the last word on the debate should go to a woman in the audience at the meeting. Her child died only six days old after torturous seizures caused by a genetic ailment. She  implored the research community , “If you have the skills and the knowledge to eliminate these diseases, then freakin’ do it!”

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