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Siristatidis C, Mantzavinos T, Vlahos N. Maternal spindle transfer for mitochondrial disease: lessons to be learnt before extending the method to other conditions? HUM FERTIL 2022; 25:838-847. [PMID: 33993847 DOI: 10.1080/14647273.2021.1925168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Mitochondrial diseases are a group of conditions attributed to mutations of specific genes that regulate mitochondrial function. Maternal spindle transfer (MST) has been proposed as a method to prevent the transmission of these diseases and utilisation of the technique resulted in the birth of a baby free of disease in 2017 in Mexico. Potential flaws in research governance and the associated criticism emerged from the expansion of MST to provide a potentially new assisted reproductive technique to overcome infertility problems characterised by repeated in vitro embryo development arrest caused by mitochondrial dysfunction and cytoplasmic deficiencies of the oocyte. This applied technique represents a good example of the need to strike "a balance between taking appropriate precautions and hampering innovation". The purpose of this article is to explore, through a comprehensive literature search, whether and how this process can evolve from an experimental method to treat a medical condition to a standard of care solution for certain types of infertility. We argue that a number of key issues should be considered before applying the technique more broadly. These include regulatory oversight, safety and efficacy, cost, implications for research, essential laboratory skills and oversight, as well as the care needs of patients and egg donors.
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Affiliation(s)
- Charalampos Siristatidis
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Aretaieio" University Hospital, Athens, Greece
| | - Themis Mantzavinos
- Scientific director of "Institute of Life" IVF Center, Iaso Maternity Hospital, Athens, Greece
| | - Nikos Vlahos
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Aretaieio" University Hospital, Athens, Greece
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Borg AM, Baker JE. Contemporary biomedical engineering perspective on volitional evolution for human radiotolerance enhancement beyond low-earth orbit. Synth Biol (Oxf) 2021; 6:ysab023. [PMID: 34522784 PMCID: PMC8434797 DOI: 10.1093/synbio/ysab023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/15/2021] [Accepted: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
A primary objective of the National Aeronautics and Space Administration (NASA) is expansion of humankind's presence outside low-Earth orbit, culminating in permanent interplanetary travel and habitation. Having no inherent means of physiological detection or protection against ionizing radiation, humans incur capricious risk when journeying beyond low-Earth orbit for long periods. NASA has made large investments to analyze pathologies from space radiation exposure, emphasizing the importance of characterizing radiation's physiological effects. Because natural evolution would require many generations to confer resistance against space radiation, immediately pragmatic approaches should be considered. Volitional evolution, defined as humans steering their own heredity, may inevitably retrofit the genome to mitigate resultant pathologies from space radiation exposure. Recently, uniquely radioprotective genes have been identified, conferring local or systemic radiotolerance when overexpressed in vitro and in vivo. Aiding in this process, the CRISPR/Cas9 technique is an inexpensive and reproducible instrument capable of making limited additions and deletions to the genome. Although cohorts can be identified and engineered to protect against radiation, alternative and supplemental strategies should be seriously considered. Advanced propulsion and mild synthetic torpor are perhaps the most likely to be integrated. Interfacing artificial intelligence with genetic engineering using predefined boundary conditions may enable the computational modeling of otherwise overly complex biological networks. The ethical context and boundaries of introducing genetically pioneered humans are considered.
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Affiliation(s)
- Alexander M Borg
- Departments of Biomedical Engineering and Radiation Oncology, Wake Forest University, Winston-Salem, NC, USA
| | - John E Baker
- Radiation Biosciences Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA
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Noohi F, Li M, Joly Y. Clinical translation of mitochondrial replacement therapy in Canada: a qualitative study of stakeholders’ attitudes. Facets (Ott) 2021. [DOI: 10.1139/facets-2020-0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mitochondrial replacement therapy (MRT) in Canada is considered a criminal offense according to article 5(1)(f) of the Assisted Human Reproduction Act (AHRA) (2004). The Act prohibits any practice that modifies the genome of “a human being or in vitro embryo such that the alteration is capable of being transmitted to descendants.” We carried out 32 semi-structured interviews with clinicians, researchers, patient groups, egg donors, and members of the public to explore their attitudes toward the clinical implementation of MRT in Canada. Our interview guide was informed by the socio-ethical, legal, and scientific literature of MRT. We used a thematic analysis to identify and analyze emerging themes and sub-themes. Our findings were divided into five broad themes: ( i) an outdated criminal ban, ( ii) motives for using MRT, ( iii) terminology, ( iv) practical and theoretical risks and benefits, and ( v) the feasibility of clinical translation in Canada. Although the public and stakeholders’ views on the feasibility of foreseeable translation of MRT in Canadian clinics varied, there was consensus on conducting an overdue review of the current AHRA ban on MRT.
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Affiliation(s)
- Forough Noohi
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montreal, QC H3A 0G1, Canada
| | - Miranda Li
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON M5S 3G5, Canada
| | - Yann Joly
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montreal, QC H3A 0G1, Canada
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Sharma H, Singh D, Mahant A, Sohal SK, Kesavan AK, Samiksha. Development of mitochondrial replacement therapy: A review. Heliyon 2020; 6:e04643. [PMID: 32984570 PMCID: PMC7492815 DOI: 10.1016/j.heliyon.2020.e04643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/10/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
Mitochondrial replacement therapy (MRT) is a new form of reproductive invitro fertilization (IVF) which works on the principle of replacing a women's abnormal mitochondrial DNA (mt-DNA) with the donor's healthy one. MRT include different techniques like spindles transfer (ST), pronuclear transfer (PNT) or polar body transfer (PBT). Transmission of defective mitochondrial DNA to the next generation can also be prevented by using these approaches. The development of healthy baby free from genetic disorders and to terminate the lethal mitochondrial disorders are the chief motive of this technique. In aged individuals, through in vitro fertilization, MRT provides the substitution of defective cytoplasm with cured one to enhance the expectation of pregnancy rates. However, moral, social, and cultural objections have restricted its exploration. Therefore, this review summarizes the various methods involved in MRT, its global status, its exaggerated censure over the years which depicts a strong emphasis for social acceptance and clinical application in the world of medical science.
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Affiliation(s)
- Hitika Sharma
- Department of Zoology, Khalsa College Amritsar, Punjab, 143005, India
| | - Drishtant Singh
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | | | - Satwinder Kaur Sohal
- Department of Zoology, Guru Nanak Dev University Amritsar, Punjab, 143005, India
| | - Anup Kumar Kesavan
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Samiksha
- Department of Zoology, Guru Nanak Dev University Amritsar, Punjab, 143005, India
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Two Women One Baby: Mitochondrial Replacement Therapy with Medical, Ethical and Legal Aspects. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.673832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cohen IG, Adashi EY, Gerke S, Palacios-González C, Ravitsky V. The Regulation of Mitochondrial Replacement Techniques Around the World. Annu Rev Genomics Hum Genet 2020; 21:565-586. [PMID: 31961722 DOI: 10.1146/annurev-genom-111119-101815] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mitochondrial replacement techniques (MRTs, also referred to as mitochondrial replacement therapies) have given hope to many women who wish to have genetically related children but have mitochondrial DNA mutations in their eggs. MRTs have also spurred deep ethical disagreements and led to different regulatory approaches worldwide. In this review, we discuss the current regulation of MRTs across several countries. After discussing the basics of the science, we describe the current law and policy directions in seven countries: the United Kingdom, the United States, Canada, Australia, Germany, Israel, and Singapore. We also discuss the emerging phenomenon of medical tourism (also called medical travel) for MRTs to places like Greece, Spain, Mexico, and Ukraine. We then pull out some key findings regarding similarities and differences in regulatory approaches around the world.
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Affiliation(s)
- I Glenn Cohen
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts 02138, USA; ,
| | - Eli Y Adashi
- Warren Alpert Medical School, Brown University, Providence, Rhode Island 02912, USA;
| | - Sara Gerke
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts 02138, USA; ,
| | - César Palacios-González
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford OX1 1PT, United Kingdom;
| | - Vardit Ravitsky
- Bioethics Programs, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec H3C 3J7, Canada;
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Overcoming bioethical, legal, and hereditary barriers to mitochondrial replacement therapy in the USA. J Assist Reprod Genet 2018; 36:383-393. [PMID: 30554395 PMCID: PMC6439114 DOI: 10.1007/s10815-018-1370-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 11/07/2018] [Indexed: 01/06/2023] Open
Abstract
The purpose of the paper is to explore novel means to overcome the controversial ban in the USA against mitochondrial replacement therapy, a form of IVF, with the added step of replacing a woman’s diseased mutated mitochondria with a donor’s healthy mitochondria to prevent debilitating and often fatal mitochondrial diseases. Long proven effective in non-human species, MRT recently performed in Mexico resulted in the birth of a healthy baby boy. We explore the ethics of the ban, the concerns over hereditability of mitochondrial disease and its mathematical basis, the overlooked role of Mitochondrial Eve, the financial burden of mitochondrial diseases for taxpayers, and a woman’s reproductive rights. We examine applicable court cases, particularly protection of autonomy within the reproductive rights assured by Roe v Wade. We examine the consequences of misinterpreting MRT as genetic engineering in the congressional funding prohibitions causing the MRT ban by the FDA. Allowing MRT to take place in the USA would ensure a high standard of reproductive medicine and safety for afflicted women wishing to have genetically related children, concurrently alleviating the significant financial burden of mitochondrial diseases on its taxpayers. Since MRT does not modify any genome, it falls outside the “heritable genetic modification” terminology of concern to Congress and the FDA. Correcting this terminology, the IOM’s conclusion that MRT is ethical, the continuing normalcy of the first MRT recipient, and increasing public awareness of the promising benefits might be all that is required to modify the FDA’s position on MRT.
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Cavaliere G, Palacios-González C. Lesbian motherhood and mitochondrial replacement techniques: reproductive freedom and genetic kinship. JOURNAL OF MEDICAL ETHICS 2018; 44:835-842. [PMID: 29491042 PMCID: PMC6288697 DOI: 10.1136/medethics-2017-104450] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 01/12/2018] [Accepted: 02/05/2018] [Indexed: 05/17/2023]
Abstract
In this paper, we argue that lesbian couples who wish to have children who are genetically related to both of them should be allowed access to mitochondrial replacement techniques (MRTs). First, we provide a brief explanation of mitochondrial diseases and MRTs. We then present the reasons why MRTs are not, by nature, therapeutic. The upshot of the view that MRTs are non-therapeutic techniques is that their therapeutic potential cannot be invoked for restricting their use only to those cases where a mitochondrial DNA disease could be 'cured'. We then argue that a positive case for MRTs is justified by an appeal to reproductive freedom, and that the criteria to access these techniques should hence be extended to include lesbian couples who wish to share genetic parenthood. Finally, we consider a potential objection to our argument: that the desire to have genetically related kin is not a morally sufficient reason to allow lesbian couples to access MRTs.
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Affiliation(s)
- Giulia Cavaliere
- Department of Global Health and Social Medicine, King’s College London, London, UK
| | - César Palacios-González
- Centre of Medical Law and Ethics, The Dickson Poon School of Law, King’s College London, London, UK
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Joseph Millum, The Moral Foundations of Parenthood. Asian Bioeth Rev 2018. [DOI: 10.1007/s41649-018-0063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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