1
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Chin AHB, Nguma JDB, Ahmad MF. Stringent criteria needed for germline genome editing of human IVF embryos. J Assist Reprod Genet 2024; 41:1727-1731. [PMID: 38695986 DOI: 10.1007/s10815-024-03125-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/16/2024] [Indexed: 07/23/2024] Open
Abstract
Germline genome editing of IVF embryos is controversial because it is not directly health or lifesaving but is intended to prevent genetic diseases in yet-unborn future offspring. The following criteria are thus proposed for future clinical trials: (i) Due to medical risks, there should be cautious and judicious application while avoiding any non-essential usage, with rigorous patient counseling. (ii) Genome editing should only be performed on the entire batch of IVF embryos without initial PGT screening if all of them are expected to be affected by genetic disease. (iii) When there is a fair chance that some IVF embryos will not be affected by genetic diseases, initial PGT screening must be performed to identify unaffected embryos for transfer. (iv) IVF embryos with carrier status should not undergo germline genome editing. (v) If patients fail to conceive after the transfer of unaffected embryos, they should undergo another fresh IVF cycle rather than opt for genome editing of their remaining affected embryos. (vi) Only if the patient is unable to produce any more unaffected embryos in a fresh IVF cycle due to advanced maternal age or diminished ovarian reserves, can the genome editing of remaining affected embryos be permitted as a last resort.
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Affiliation(s)
- Alexis Heng Boon Chin
- Singapore Fertility and IVF Consultancy Pvt Ltd, 531A Upper Cross Street, #04-95, Hong Lim Complex, Chinatown, 051531, Singapore.
| | - Jean-Didier Bosenge Nguma
- Department of Obstetrics and Gynecology, Kisangani University Hospital, Kisangani, Democratic Republic of the Congo
| | - Mohd Faizal Ahmad
- Department of Obstetrics & Gynecology, Faculty of Medicine, Advanced Reproductive Centre (ARC), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia.
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2
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Smith KR. Germline genome editing of human IVF embryos should not be subject to overly stringent restrictions. J Assist Reprod Genet 2024; 41:1733-1737. [PMID: 38967708 DOI: 10.1007/s10815-024-03174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/12/2024] [Indexed: 07/06/2024] Open
Abstract
This paper critiques the restrictive criteria for germline genome editing recently proposed by Chin, Nguma, and Ahmad in this journal. While praising the authors for resisting fervent calls for an outright ban on clinical applications of the technology, this paper argues that their approach is nevertheless unduly restrictive, and may thus hinder technological progress. This response advocates for weighing potential benefits against risks without succumbing to excessive caution, proposing that ethical oversight combined with genetic scrutiny at the embryo stage post-editing can enable responsible use of the technology, ultimately reducing the burden of genetic diseases and enhancing human health, akin to how IVF transformed reproductive medicine despite strong initial opposition.
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Affiliation(s)
- Kevin Richard Smith
- Division of Health Science, School of Applied Sciences, Abertay University, Dundee, DD1 1HG, UK.
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3
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Mattar CN, Chew WL, Lai PS. Embryo and fetal gene editing: Technical challenges and progress toward clinical applications. Mol Ther Methods Clin Dev 2024; 32:101229. [PMID: 38533521 PMCID: PMC10963250 DOI: 10.1016/j.omtm.2024.101229] [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] [Indexed: 03/28/2024]
Abstract
Gene modification therapies (GMTs) are slowly but steadily making progress toward clinical application. As the majority of rare diseases have an identified genetic cause, and as rare diseases collectively affect 5% of the global population, it is increasingly important to devise gene correction strategies to address the root causes of the most devastating of these diseases and to provide access to these novel therapies to the most affected populations. The main barriers to providing greater access to GMTs continue to be the prohibitive cost of developing these novel drugs at clinically relevant doses, subtherapeutic effects, and toxicity related to the specific agents or high doses required. In vivo strategy and treating younger patients at an earlier course of their disease could lower these barriers. Although currently regarded as niche specialties, prenatal and preconception GMTs offer a robust solution to some of these barriers. Indeed, treating either the fetus or embryo benefits from economy of scale, targeting pre-pathological tissues in the fetus prior to full pathogenesis, or increasing the likelihood of complete tissue targeting by correcting pluripotent embryonic cells. Here, we review advances in embryo and fetal GMTs and discuss requirements for clinical application.
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Affiliation(s)
- Citra N.Z. Mattar
- Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 12, Singapore, Singapore 119228
- Department of Obstetrics and Gynaecology, National University Health System, Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 12, Singapore, Singapore 119228
| | - Wei Leong Chew
- Genome Institute of Singapore, Agency for Science, Technology and Research (A∗STAR), Singapore, 60 Biopolis St, Singapore, Singapore 138672
| | - Poh San Lai
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 12, Singapore, Singapore 119228
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4
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Geuverink WP, Houtman D, Retel Helmrich IRA, van Baalen S, van Beers BC, van El CG, Henneman L, Kasprzak MD, Arets D, Riedijk SR. The need to set explicit goals for human germline gene editing public dialogues. J Community Genet 2024; 15:259-265. [PMID: 38720104 PMCID: PMC11217238 DOI: 10.1007/s12687-024-00710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/02/2024] [Indexed: 07/02/2024] Open
Abstract
Given the potentially large ethical and societal implications of human germline gene editing (HGGE) the urgent need for public and stakeholder engagement (PSE) has been repeatedly expressed. However, the explicit goals of such PSE efforts often remain poorly defined. In this program report, we outline the goals of our Dutch project called De DNA dialogen (The DNA dialogues). We believe that setting explicit goals in advance is essential to enable meaningful PSE efforts. Moreover, it enables the evaluation of our engagement efforts. The following four goals, which result from intensive consultations among the transdisciplinary projects' consortium members and based on the literature, form the foundation for how we will engage the public and stakeholders in deliberation about HGGE: 1) Enable publics and stakeholders to deliberate on "what if" questions, before considering "whether" and "how" questions regarding HGGE, 2) Investigate agreement and disagreement in values and beliefs regarding HGGE in order to agree and disagree more precisely, 3) Involve diverse publics with various perspectives, with a focus on those that are typically underrepresented in PSE, 4) Enable societally aligned policy making by providing policymakers, health care professionals and legal experts insight into how values are weighed and ascribed meaning in the context of HGGE by various publics, and how these values relate to the principles of democratic rule of law and fundamental rights. The effort to describe our goals in detail may serve as an example and can inform future initiatives striving for open science and open governance in the context of PSE.
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Affiliation(s)
- Wendy P Geuverink
- Department of Human Genetics, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Diewertje Houtman
- Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, the Netherlands
| | | | | | - Britta C van Beers
- Faculty of Law, Department of Legal Philosophy, Vrije Universiteit, Amsterdam, the Netherlands
| | - Carla G van El
- Department of Human Genetics, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Human Genetics, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Michelle D Kasprzak
- Willem de Kooning Academy, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Danielle Arets
- Readership Journalism & Innovation, Fontys University of Applied Sciences, Tilburg, the Netherlands
| | - Sam R Riedijk
- Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, the Netherlands.
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5
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Alex K, Winkler EC. Comparative ethical evaluation of epigenome editing and genome editing in medicine: first steps and future directions. JOURNAL OF MEDICAL ETHICS 2024; 50:398-406. [PMID: 37527926 PMCID: PMC11137457 DOI: 10.1136/jme-2022-108888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
Targeted modifications of the human epigenome, epigenome editing (EE), are around the corner. For EE, techniques similar to genome editing (GE) techniques are used. While in GE the genetic information is changed by directly modifying DNA, intervening in the epigenome requires modifying the configuration of DNA, for example, how it is folded. This does not come with alterations in the base sequence ('genetic code'). To date, there is almost no ethical debate about EE, whereas the discussions about GE are voluminous. Our article introduces EE into bioethics by translating knowledge from science to ethics and by comparing the risks of EE with those of GE. We, first (I), make the case that a broader ethical debate on EE is due, provide scientific background on EE, compile potential use-cases and recap previous debates. We then (II) compare EE and GE and suggest that the severity of risks of novel gene technologies depends on three factors: (i) the choice of an ex vivo versus an in vivo editing approach, (ii) the time of intervention and intervention windows and (iii) the targeted diseases. Moreover, we show why germline EE is not effective and reject the position of strong epigenetic determinism. We conclude that EE is not always ethically preferable to GE in terms of risks, and end with suggestions for next steps in the current ethical debate on EE by briefly introducing ethical challenges of new areas of preventive applications of EE (III).
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Affiliation(s)
- Karla Alex
- Section Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Eva C Winkler
- Section Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Medical Faculty, Heidelberg University, Heidelberg, Germany
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6
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Tręda C, Włodarczyk A, Rieske P. The hope, hype and obstacles surrounding cell therapy. J Cell Mol Med 2024; 28:e18359. [PMID: 38770886 PMCID: PMC11107145 DOI: 10.1111/jcmm.18359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 05/22/2024] Open
Abstract
Cell therapy offers hope, but it also presents challenges, most particularly the limited ability of human organs and tissues to regenerate. Since many diseases are associated with irreversible pathophysiological or traumatic changes, stem cells and their derivatives are unable to secure healing. Although regenerative medicine offers chances for improvements in many diseases, such as type one diabetes and Parkinson's disease, it cannot eliminate the primary cause of many of them. While successes can be expected for diseases such as sickle cell disease, this is not the case for hereditary diseases with varied mutation types or for ciliopathies, which start in embryogenesis. In this complicated medical environment, synthetic biology offers some solutions, but their implementation will take many years. Still, positive examples such as CAR-T therapy offer hope.
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Affiliation(s)
- Cezary Tręda
- Department of Tumor BiologyMedical University of LodzLodzPoland
| | | | - Piotr Rieske
- Department of Tumor BiologyMedical University of LodzLodzPoland
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7
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Asif M, Khan WJ, Aslam S, Aslam A, Chowdhury MA. The Use of CRISPR-Cas9 Genetic Technology in Cardiovascular Disease: A Comprehensive Review of Current Progress and Future Prospective. Cureus 2024; 16:e57869. [PMID: 38725755 PMCID: PMC11078688 DOI: 10.7759/cureus.57869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Over the last century, there have been major landmark developments in the field of medicine, enabling us to control and cure various diseases on a larger scale. A few of these include the discovery of antibiotics, the development of vaccines, and the origin of organ and tissue transplants. The continued quest for innovation in microbiology and medicine has helped humankind save millions of lives and decrease morbidity at the global level. Genetic medicine has grown significantly in the last two decades and appears to be the next frontier of curative therapies for chronic diseases. One important landmark in genetic medicine is the development of CRISPR (clustered, regularly interspaced short palindromic repeats) technology. In this article, we describe the basic structure and function of the CRISPR-Cas9 system, which, simply put, consists of an RNA part and a protein. It works as a molecular scissor that can perform targeted cuts followed by repairs in and around the genes of interest to attain favorable translational outcomes. We focused on summarizing recent studies using CRISPR-Cas9 technology in diagnosing and treating cardiovascular disease. These studies are primarily experimental and limited to animal models. However, their results are promising enough to anticipate that this technology will undoubtedly be available in clinical medicine in the coming years. CRISPR-Cas9-mediated gene editing has been used to study and potentially treat congenital heart disease, hyperlipidemias, arrhythmogenic cardiomyopathies, and the prevention of ischemia-reperfusion injury. Despite the current progress, we recognize the several challenges this technology faces, including funding for research, improving precision and reproducible results for human subjects, and establishing protocols for ethical compliance so that it is acceptable to the scientific community and the general public.
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Affiliation(s)
- Muhammad Asif
- Internal Medicine, University of South Dakota, Sioux Falls, USA
| | - Wahab J Khan
- Internal Medicine, University of South Dakota, Sioux Falls, USA
| | - Sadia Aslam
- Internal Medicine, University of South Dakota, Sioux Falls, USA
| | - Awais Aslam
- Internal Medicine, Essentia Health, Fargo, USA
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8
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Salomonsson SE, Clelland CD. Building CRISPR Gene Therapies for the Central Nervous System: A Review. JAMA Neurol 2024; 81:283-290. [PMID: 38285472 PMCID: PMC11164426 DOI: 10.1001/jamaneurol.2023.4983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Importance Gene editing using clustered regularly interspaced short palindromic repeats (CRISPR) holds the promise to arrest or cure monogenic disease if it can be determined which genetic change to create without inducing unintended cellular dysfunction and how to deliver this technology to the target organ reliably and safely. Clinical trials for blood and liver disorders, for which delivery of CRISPR is not limiting, show promise, yet no trials have begun for central nervous system (CNS) indications. Observations The CNS is arguably the most challenging target given its innate exclusion of large molecules and its defenses against bacterial invasion (from which CRISPR originates). Herein, the types of CRISPR editing (DNA cutting, base editing, and templated repair) and how these are applied to different genetic variants are summarized. The challenges of delivering genome editors to the CNS, including the viral and nonviral delivery vehicles that may ultimately circumvent these challenges, are discussed. Also, ways to minimize the potential in vivo genotoxic effects of genome editors through delivery vehicle design and preclinical off-target testing are considered. The ethical considerations of germline editing, a potential off-target outcome of any gene editing therapy, are explored. The unique regulatory challenges of a human-specific therapy that cannot be derisked solely in animal models are also discussed. Conclusions and Relevance An understanding of both the potential benefits and challenges of CRISPR gene therapy better informs the scientific, clinical, regulatory, and timeline considerations of developing CRISPR gene therapy for neurologic diseases.
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Affiliation(s)
- Sally E Salomonsson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
| | - Claire D Clelland
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Neurology, Memory and Aging Center, University of California, San Francisco
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9
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Nelson JP, Tomblin DC, Barbera A, Smallwood M. The divide so wide: Public perspectives on the role of human genome editing in the US healthcare system. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2024; 33:189-209. [PMID: 37638525 DOI: 10.1177/09636625231189955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
We report findings from two open-framed focus groups eliciting informed public opinion about the rapidly developing technology of human genome editing in the context of the US healthcare system. Results reveal that participants take a dim view of the present healthcare system, articulating extensive concerns about the accessibility and affordability of care. They feel that, unless these problems are resolved, they stand little chance of benefiting from any eventual human genome editing treatments. They prioritize improvement in healthcare access well above human genome editing development, and human genome editing regulation and oversight above human genome editing research. These results reveal substantial divergence between public perspectives and expert discourse on human genome editing. The latter attends primarily to the moral permissibility of technical categories of human genome editing research and how to treat human genome editing within existing regulatory and oversight systems rather than broader political-economic and healthcare access concerns. This divergence illustrates the importance of openly framed public engagement around emerging technologies.
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10
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Kalidasan V, Theva Das K. Advancing Precision Medicine with Gene and Cell Therapy in Malaysia: Ethical, Legal, and Social Implications. Hum Gene Ther 2024; 35:9-25. [PMID: 38047523 DOI: 10.1089/hum.2023.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
A new era of gene and cell therapy for treating human diseases has been envisioned for several decades. However, given that the technology can alter any DNA/cell in human beings, it poses specific ethical, legal, and social difficulties in its application. In Malaysia, current bioethics and medical ethics guidelines tackle clinical trials and biomedical research, medical genetic services, and stem cell research/therapy. However, no comprehensive framework and policy is available to cater to ethical gene and cell therapy in the country. Incorporating ethical, legal, and social implications (ELSI) would be crucial to guide the appropriate use of human gene and cell therapy in conjunction with precision medicine. Policy experts, scientists, bioethicists, and public members must debate the associated ELSI and the professional code of conduct while preserving human rights.
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Affiliation(s)
- V Kalidasan
- Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Malaysia
| | - Kumitaa Theva Das
- Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Malaysia
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11
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Kolanu ND. CRISPR-Cas9 Gene Editing: Curing Genetic Diseases by Inherited Epigenetic Modifications. Glob Med Genet 2024; 11:113-122. [PMID: 38560484 PMCID: PMC10980556 DOI: 10.1055/s-0044-1785234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Introduction CRISPR-Cas9 gene editing, leveraging bacterial defense mechanisms, offers precise DNA modifications, holding promise in curing genetic diseases. This review critically assesses its potential, analyzing evidence on therapeutic applications, challenges, and future prospects. Examining diverse genetic disorders, it evaluates efficacy, safety, and limitations, emphasizing the need for a thorough understanding among medical professionals and researchers. Acknowledging its transformative impact, a systematic review is crucial for informed decision-making, responsible utilization, and guiding future research to unlock CRISPR-Cas9's full potential in realizing the cure for genetic diseases. Methods A comprehensive literature search across PubMed, Scopus, and the Web of Science identified studies applying CRISPR-Cas9 gene editing for genetic diseases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria covered in vitro and in vivo models targeting various genetic diseases with reported outcomes on disease modification or potential cure. Quality assessment revealed a generally moderate to high risk of bias. Heterogeneity prevented quantitative meta-analysis, prompting a narrative synthesis of findings. Discussion CRISPR-Cas9 enables precise gene editing, correcting disease-causing mutations and offering hope for previously incurable genetic conditions. Leveraging inherited epigenetic modifications, it not only fixes mutations but also restores normal gene function and controls gene expression. The transformative potential of CRISPR-Cas9 holds promise for personalized treatments, improving therapeutic outcomes, but ethical considerations and safety concerns must be rigorously addressed to ensure responsible and safe application, especially in germline editing with potential long-term implications.
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12
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Ramos PD, Almeida MS, Olsson IAS. What do people think about genetic engineering? A systematic review of questionnaire surveys before and after the introduction of CRISPR. Front Genome Ed 2023; 5:1284547. [PMID: 38192431 PMCID: PMC10773783 DOI: 10.3389/fgeed.2023.1284547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/27/2023] [Indexed: 01/10/2024] Open
Abstract
The advent of CRISPR-Cas9 in 2012 started revolutionizing the field of genetics by broadening the access to a method for precise modification of the human genome. It also brought renewed attention to the ethical issues of genetic modification and the societal acceptance of technology for this purpose. So far, many surveys assessing public attitudes toward genetic modification have been conducted worldwide. Here, we present the results of a systematic review of primary publications of surveys addressing public attitudes toward genetic modification as well as the awareness and knowledge about the technology required for genetic modification. A total of 53 primary publications (1987-2020) focusing on applications in humans and non-human animals were identified, covering countries in four continents. Of the 53 studies, 30 studies from until and including 2012 (pre-CRISPR) address gene therapy in humans and genetic modification of animals for food production and biomedical research. The remaining 23 studies from after 2013 (CRISPR) address gene editing in humans and animals. Across countries, respondents see gene therapy for disease treatment or prevention in humans as desirable and highly acceptable, whereas enhancement is generally met with opposition. When the study distinguishes between somatic and germline applications, somatic gene editing is generally accepted, whereas germline applications are met with ambivalence. The purpose of the application is also important for assessing attitudes toward genetically modified animals: modification in food production is much less accepted than for biomedical application in pre-CRISPR studies. A relationship between knowledge/awareness and attitude toward genetic modification is often present. A critical appraisal of methodology quality in the primary publications with regards to sampling and questionnaire design, development, and administration shows that there is considerable scope for improvement in the reporting of methodological detail. Lack of information is more common in earlier studies, which probably reflects the changing practice in the field.
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Affiliation(s)
- Pedro Dias Ramos
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- ICBAS–Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Maria Strecht Almeida
- ICBAS–Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Ingrid Anna Sofia Olsson
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- ICBAS–Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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13
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Segers S. Heritable genome editing: ethical aspects of a developing domain. Hum Reprod 2023; 38:2055-2061. [PMID: 37581898 DOI: 10.1093/humrep/dead167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/05/2023] [Indexed: 08/16/2023] Open
Abstract
In the past decade, scientific developments in human germline genome editing (GGE) have reinvigorated questions about research ethics, responsible innovation, and what it means to do good in the field of reproductive biology and medicine. In recent years, it has become part of the ethical debate on GGE whether categorical objections about (un)naturalness, dignity, respect for the gene pool as common heritage, are and should be supplemented by more pragmatic questions about safety, utility, efficacy, and potential 'misuse', which seem to become more dominant in the moral discussion. This mini-review summarizes the morally relevant aspects of the rapidly developing domain of GGE, focusing on reproductive applications and with special attention to the ethical questions pertaining to how this technology may affect the interests of those that come to be by means of it. While vital, this encompasses more than safety considerations. Taking this perspective, it will be crucial to engage with normative questions about how GGE maps on the importance of accommodating future parents' preference to have genetically related children, and how far we should go to facilitate this. Similarly, a comprehensive ethical debate about 'appropriate application' of GGE cannot shake off the more fundamental question about how notions like 'normalcy', 'quality of life', and 'disability' can be conceptualized. This is crucial in view of respecting persons whichever traits they have and in view of acceptable boundaries to parental responsibilities.
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Affiliation(s)
- Seppe Segers
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium
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14
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Kubikova N, Keefe DL, Wells D, Oktay KH, Feinberg EC. Should we use CRISPR gene editing in human embryos? Fertil Steril 2023; 120:737-744. [PMID: 37656090 DOI: 10.1016/j.fertnstert.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Nada Kubikova
- Jesus College, University of Oxford, Oxford, United Kingdom; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - David L Keefe
- NYU Grossman School of Medicine, New York, New York; NYU Langone Fertility Center, New York, New York
| | - Dagan Wells
- John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom; Juno Genetics, Oxford, United Kingdom
| | - Kutluk H Oktay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; Innovation Institute for Fertility Preservation, New York, New York; Innovation Institute for Fertility Preservation, New Haven, Connecticut
| | - Eve C Feinberg
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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15
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Selin C, Lambert L, Morain S, Nelson JP, Barlevy D, Farooque M, Manley H, Scott CT. Researching the future: scenarios to explore the future of human genome editing. BMC Med Ethics 2023; 24:72. [PMID: 37735670 PMCID: PMC10512597 DOI: 10.1186/s12910-023-00951-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Forward-looking, democratically oriented governance is needed to ensure that human genome editing serves rather than undercuts public values. Scientific, policy, and ethics communities have recognized this necessity but have demonstrated limited understanding of how to fulfill it. The field of bioethics has long attempted to grapple with the unintended consequences of emerging technologies, but too often such foresight has lacked adequate scientific grounding, overemphasized regulation to the exclusion of examining underlying values, and failed to adequately engage the public. METHODS This research investigates the application of scenario planning, a tool developed in the high-stakes, uncertainty-ridden world of corporate strategy, for the equally high-stakes and uncertain world of the governance of emerging technologies. The scenario planning methodology is non-predictive, looking instead at a spread of plausible futures which diverge in their implications for different communities' needs, cares, and desires. RESULTS In this article we share how the scenario development process can further understandings of the complex and dynamic systems which generate and shape new biomedical technologies and provide opportunities to re-examine and re-think questions of governance, ethics and values. We detail the results of a year-long scenario planning study that engaged experts from the biological sciences, bioethics, social sciences, law, policy, private industry, and civic organizations to articulate alternative futures of human genome editing. CONCLUSIONS Through sharing and critiquing our methodological approach and results of this study, we advance understandings of anticipatory methods deployed in bioethics, demonstrating how this approach provides unique insights and helps to derive better research questions and policy strategies.
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Affiliation(s)
- Cynthia Selin
- School for the Future of Innovation in Society at Arizona State University, PO Box 876002, 85287-6002, Tempe, AZ, USA.
| | - Lauren Lambert
- School of Sustainability at Arizona State University, 4th floor, Walton Center for Planetary Health, 85281, Tempe, AZ, USA
| | - Stephanie Morain
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, 21212, Baltimore, MD, USA
| | - John P Nelson
- School of Public Policy, Georgia Institute of Technology, 685 Cherry St., Suite 107, 30332, Atlanta, GA, USA
| | - Dorit Barlevy
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, 77030, Houston, TX, USA
| | - Mahmud Farooque
- Consortium for Science, Policy and Outcomes, Arizona State University, 1800 I Street, 20006, Washington, DC, USA
| | - Haley Manley
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, 77030, Houston, TX, USA
| | - Christopher T Scott
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, 77030, Houston, TX, USA
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Mahara G, Tian C, Xu X, Wang W. Revolutionising health care: Exploring the latest advances in medical sciences. J Glob Health 2023; 13:03042. [DOI: • doi: 10.7189/jogh.13.03042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Affiliation(s)
- Gehendra Mahara
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Cuihong Tian
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Center for Precision Health, Edith Cowan University, Perth, Australia
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaojia Xu
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Center for Precision Health, Edith Cowan University, Perth, Australia
- Department of Infection Control, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangzhou, China
| | - Wei Wang
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Center for Precision Health, Edith Cowan University, Perth, Australia
- Shantou University Medical College, Shantou, Guangdong, China
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17
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Mahara G, Tian C, Xu X, Wang W. Revolutionising health care: Exploring the latest advances in medical sciences. J Glob Health 2023; 13:03042. [PMID: 37539846 PMCID: PMC10401902 DOI: 10.7189/jogh.13.03042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Affiliation(s)
- Gehendra Mahara
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Cuihong Tian
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Center for Precision Health, Edith Cowan University, Perth, Australia
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaojia Xu
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Center for Precision Health, Edith Cowan University, Perth, Australia
- Department of Infection Control, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangzhou, China
| | - Wei Wang
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Center for Precision Health, Edith Cowan University, Perth, Australia
- Shantou University Medical College, Shantou, Guangdong, China
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18
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Houtman D, Geuverink W, Helmrich IRAR, Vijlbrief B, Cornel M, Riedijk S. "What if" should precede "whether" and "how" in the social conversation around human germline gene editing. J Community Genet 2023; 14:371-375. [PMID: 37326787 PMCID: PMC10444910 DOI: 10.1007/s12687-023-00652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Given the potential large ethical and societal implications of human germline gene editing (HGGE) the urgent need for public and stakeholder engagement (PSE) has been repeatedly expressed. In this short communication, we aim to provide directions for broad and inclusive PSE by emphasizing the importance of futures literacy, which is a skill to imagine diverse and multiple futures and to use these as lenses to look at the present anew. By first addressing "what if" questions in PSE, different futures come into focus and limitations that arise when starting with the "whether" or "how" questions about HGGE can be avoided. Futures literacy can also aid in the goal of societal alignment, as "what if" questions can be answered in many different ways, thereby opening up the conversation to explore a multitude of values and needs of various publics. Broad and inclusive PSE on HGGE starts with asking the right questions.
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Affiliation(s)
- Diewertje Houtman
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wendy Geuverink
- Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | | | - Boy Vijlbrief
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martina Cornel
- Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Sam Riedijk
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands.
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19
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Cutter AD. Guerrilla eugenics: gene drives in heritable human genome editing. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109061. [PMID: 37407027 DOI: 10.1136/jme-2023-109061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023]
Abstract
CRISPR-Cas9 genome editing can and has altered human genomes, bringing bioethical debates about this capability to the forefront of philosophical and policy considerations. Here, I consider the underexplored implications of CRISPR-Cas9 gene drives for heritable human genome editing. Modification gene drives applied to heritable human genome editing would introduce a novel form of involuntary eugenic practice that I term guerrilla eugenics. Once introduced into a genome, stealth genetic editing by a gene drive genetic element would occur each subsequent generation irrespective of whether reproductive partners consent to it and irrespective of whether the genetic change confers any benefit. By overriding the ability to 'opt in' to genome editing, gene drives compromise the autonomy of carrier individuals and their reproductive partners to choose to use or avoid genome editing and impose additional burdens on those who hope to 'opt out' of further genome editing. High incidence of an initially rare gene drive in small human communities could occur within 200 years, with evolutionary fixation globally in a timeframe that is thousands of times sooner than achievable by non-drive germline editing. Following any introduction of heritable gene drives into human genomes, practices intended for surveillance or reversal also create fundamental ethical problems. Current policy guidelines do not comment explicitly on gene drives in humans. These considerations motivate an explicit moratorium as being warranted on gene drive development in heritable human genome editing.
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Affiliation(s)
- Asher D Cutter
- Department of Ecology & Evolutionary Biology, University of Toronto, Toronto, Ontario, Canada
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20
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Neuhausser WM, Fouks Y, Lee SW, Macharia A, Hyun I, Adashi EY, Penzias AS, Hacker MR, Sakkas D, Vaughan D. Acceptance of genetic editing and of whole genome sequencing of human embryos by patients with infertility before and after the onset of the COVID-19 pandemic. Reprod Biomed Online 2023; 47:157-163. [PMID: 37127437 PMCID: PMC10330010 DOI: 10.1016/j.rbmo.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/23/2023] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
Abstract
RESEARCH QUESTION Has acceptance of heritable genome editing (HGE) and whole genome sequencing for preimplantation genetic testing (PGT-WGS) of human embryos changed after the onset of COVID-19 among infertility patients? DESIGN A written survey conducted between April and June 2018 and July and December 2021 among patients at a university-affiliated infertility practice. The questionnaire ascertained the acceptance of HGE for specific therapeutic or genetic 'enhancement' indications and of PGT-WGS to prevent adult disease. RESULTS In 2021 and 2018, 172 patients and 469 patients (response rates: 90% and 91%, respectively) completed the questionnaire. In 2021, significantly more participants reported a positive attitude towards HGE, for therapeutic and enhancement indications. In 2021 compared with 2018, respondents were more likely to use HGE to have healthy children with their own gametes (85% versus 77%), to reduce disease risk for adult-onset polygenic disorders (78% versus 67%), to increase life expectancy (55% versus 40%), intelligence (34% versus 26%) and creativity (33% versus 24%). Fifteen per cent of the 2021 group reported a more positive attitude towards HGE because of COVID-19 and less than 1% a more negative attitude. In contrast, support for PGT-WGS was similar in 2021 and 2018. CONCLUSIONS A significantly increased acceptance of HGE was observed, but not of PGT-WGS, after the onset of COVID-19. Although the pandemic may have contributed to this change, the exact reasons remain unknown and warrant further investigation. Whether increased acceptability of HGE may indicate an increase in acceptability of emerging biomedical technologies in general needs further investigation.
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Affiliation(s)
- Werner M Neuhausser
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Yuval Fouks
- Boston IVF-Eugin Group, 130 2nd Ave, Waltham MA 02451, USA
| | - Si Won Lee
- Boston IVF-Eugin Group, 130 2nd Ave, Waltham MA 02451, USA
| | - Annliz Macharia
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA 02215, USA
| | - Insoo Hyun
- Center for Bioethics, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
| | - Eli Y Adashi
- Department of Medical Science, Brown University School of Medicine, 222 Richmond Street Providence, RI 02903, USA
| | - Alan S Penzias
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Boston IVF-Eugin Group, 130 2nd Ave, Waltham MA 02451, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Denny Sakkas
- Boston IVF-Eugin Group, 130 2nd Ave, Waltham MA 02451, USA
| | - Denis Vaughan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Boston IVF-Eugin Group, 130 2nd Ave, Waltham MA 02451, USA
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21
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Gregg B. Imperfect Methods for Imperfect Democracies: Increasing Public Participation in Gene Editing Debates. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:77-79. [PMID: 37339303 DOI: 10.1080/15265161.2023.2207506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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22
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Lawrence C, Jasanoff S, Evans SW, Raffel K, Mahadevan L. Ethics Inside the Black Box: Integrating Science and Technology Studies into Engineering and Public Policy Curricula. SCIENCE AND ENGINEERING ETHICS 2023; 29:23. [PMID: 37347323 DOI: 10.1007/s11948-023-00440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/21/2023] [Indexed: 06/23/2023]
Abstract
There is growing need for hybrid curricula that integrate constructivist methods from Science and Technology Studies (STS) into both engineering and policy courses at the undergraduate and graduate levels. However, institutional and disciplinary barriers have made implementing such curricula difficult at many institutions. While several programs have recently been launched that mix technical training with consideration of "societal" or "ethical issues," these programs often lack a constructivist element, leaving newly-minted practitioners entering practical fields ill-equipped to unpack the politics of knowledge and technology or engage with skeptical publics. This paper presents a novel format for designing interdisciplinary coursework that combines conceptual content from STS with training in engineering and policy. Courses following this format would ideally be team taught by instructors with advanced training in diverse fields, and hence co-learning between instructors and disciplines is a key element of the format. Several instruments for facilitating both student and instructor collaborative learning are introduced. The format is also designed for versatility: in addition to being adaptable to both technical and policy training environments, topics are modularized around a conceptual core so that issues ranging from biotech to nuclear security can be incorporated to fit programmatic needs and resources.
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Affiliation(s)
- Christopher Lawrence
- Science, Technology and International Affairs Program, Walsh School of Foreign Service, Geogetown University, Washington, USA.
| | - Sheila Jasanoff
- Program on Science, Technology and Society, Kennedy School of Government, Harvard University, Cambridge, MA, USA
| | - Sam Weiss Evans
- Program on Science, Technology and Society, Kennedy School of Government, Harvard University, Cambridge, MA, USA
- Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Keith Raffel
- Mather House, Harvard University, Cambridge, MA, USA
| | - L Mahadevan
- Department of Physics, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
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23
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Stapleton P, Torres Yabar A. Playing God? Media coverage of CRISPR in the United States. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2023; 32:504-521. [PMID: 36527362 DOI: 10.1177/09636625221138953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Announcements in 2017 and 2018 that scientists used a gene editing technique called Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) to permanently alter human embryos have highlighted the urgency in regulating the technology's ethical, political, and legal implications. To better understand how a regulatory regime might evolve in response to CRISPR, we must examine how the media covers it. This article reviews online and television news sources in the United States to determine the tone, content, and frequency in media coverage of CRISPR. We find that coverage remained ambiguous and infrequent, as scientific research into CRISPR's clinical potential for treating human disease surged. This infrequent coverage indicates that the media have not yet established the salience of CRISPR to a degree that engages the public or policymakers, though the issue will continue to gain importance as CRISPR transitions from experimental efforts into clinical practice.
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24
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Ranisch R, Trettenbach K, Arnason G. Initial heritable genome editing: mapping a responsible pathway from basic research to the clinic. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:21-35. [PMID: 36414813 PMCID: PMC9984515 DOI: 10.1007/s11019-022-10115-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
Following the Second Summit on Human Gene Editing in Hong Kong in 2018, where the birth of two girls with germline genome editing was revealed, the need for a responsible pathway to the clinical application of human germline genome editing has been repeatedly emphasised. This paper aims to contribute to the ongoing discussion on research ethics issues in germline genome editing by exploring key issues related to the initial applications of CRISPR in reproductive medicine. Following an overview of the current discussion on bringing germline genome editing into clinical practice, we outline the specific challenges associated with such interventions and the features that distinguish them from conventional clinical testing of new medical treatments. We then review proposed ethical requirements for initial heritable genome editing, such as the absence of reasonable alternatives, the existence of sufficient and reliable preclinical data, appropriate informed consent, requirements related to safety, and long-term follow-up.
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Affiliation(s)
- Robert Ranisch
- Junior Professorship for Medical Ethics with a Focus on Digitization, Faculty of Health Sciences Brandenburg, University of Potsdam, Am Mühlberg 9, 14476, Potsdam, Golm, Germany.
- Research Unit "Ethics of Genome Editing", Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, D-72074, Tübingen, Germany.
| | - Katharina Trettenbach
- Junior Professorship for Medical Ethics with a Focus on Digitization, Faculty of Health Sciences Brandenburg, University of Potsdam, Am Mühlberg 9, 14476, Potsdam, Golm, Germany
- Research Unit "Ethics of Genome Editing", Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, D-72074, Tübingen, Germany
| | - Gardar Arnason
- Research Unit "Ethics of Genome Editing", Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, D-72074, Tübingen, Germany
- University of Akureyri, Norðurslóð 2, 600, Akureyri, Iceland
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25
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Brooks PJ, Urv TK, Parisi MA. Gene-targeted therapies: Overview and implications. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:13-18. [PMID: 36864710 DOI: 10.1002/ajmg.c.32033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 03/04/2023]
Abstract
Gene-targeted therapies (GTTs) are therapeutic platforms that are in principle applicable to large numbers of monogenic diseases. The rapid development and implementation of GTTs have profound implications for rare monogenic disease therapy development. This article provides a brief summary of the primary types of GTTs and a brief overview of the current state of the science. It also serves as a primer for the articles in this special issue.
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Affiliation(s)
- P J Brooks
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiina K Urv
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Melissa A Parisi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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26
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Enabling Precision Medicine with CRISPR-Cas Genome Editing Technology: A Translational Perspective. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1396:315-339. [DOI: 10.1007/978-981-19-5642-3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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27
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Vidalis T. Genome Editing in Human Gametes and Embryos: The Legal Dimension in Europe. BIOTECH (BASEL (SWITZERLAND)) 2022; 12:biotech12010001. [PMID: 36648827 PMCID: PMC9844473 DOI: 10.3390/biotech12010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
To date, the legal aspects of the ongoing debate on the application of genome editing in human gametes and early embryos have attracted little attention. In Europe, this seems to have changed with a recent official position that clarifies the meaning of the relevant provision of the common legal instrument on Human Rights and Biomedicine (Oviedo Convention). This provision explicitly prohibits modifications to the genome of future persons and adoptes a precautionary stance with regard to genetic interventions in the human reproductive material. In this article, we examine relevant interpretative options, following the new official clarifications, focusing on the research/clinical application distinctions that characterize their approach. From this viewpoint, we propose an approach that favors basic research activities involving genome editing, even for exploring potential clinical applications under conditions of safety, which may justify a future legislative amendment. Furthermore, we explore the patenting issue, based on the current approach of European case law, and give reasons that may justify patent rights in this ethically sensitive area.
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Affiliation(s)
- Takis Vidalis
- Hellenic National Commission for Bioethics & Technoethics, 10674 Athens, Greece
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28
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Wienmeister A. Rereading Habermas in Times of CRISPR-cas: A Critique of and an Alternative to the Instrumentalist Interpretation of the Human Nature Argument. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:545-556. [PMID: 36149578 PMCID: PMC9908698 DOI: 10.1007/s11673-022-10206-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/06/2022] [Indexed: 06/16/2023]
Abstract
Habermas's argument from human nature, which speaks in favour of holding back the use of human germline editing for purposes of enhancement, has lately received criticism anew. Prominent are objections to its supposedly genetic essentialist and determinist framework, which underestimates social impacts on human development. I argue that this criticism originates from an instrumentalist reading of Habermas's argument, which wrongly focuses on empirical conditions and means-ends-relations. Drawing on Habermas's distinction of a threefold use of practical reason, I show how an alternative-the ethical-reading avoids essentialist and determinist objections by addressing an existential level of sense making. I present three reasons that speak in favour of the ethical reading and I demonstrate how it incorporates social aspects of character formation. Habermas's account therefore offers exactly what the critics claim is missing. The paper concludes with a conceptual challenge that the ethical reading has to face within Habermas's overall approach to genetic engineering.
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Affiliation(s)
- Annett Wienmeister
- Freie Universität Berlin, Institut für Philosophie, Habelschwerdter Allee 30, 14195, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Institut für Geschichte der Medizin und Ethik in der Medizin, Thielallee 71, 14195, Berlin, Germany.
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29
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Moris N, Shahbazi M. Unravelling the mysteries of human embryogenesis. Semin Cell Dev Biol 2022; 131:1-3. [PMID: 35753909 DOI: 10.1016/j.semcdb.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Naomi Moris
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK.
| | - Marta Shahbazi
- MRC Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge CB2 0QH, UK.
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30
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Bekaert B, Boel A, Cosemans G, De Witte L, Menten B, Heindryckx B. CRISPR/Cas gene editing in the human germline. Semin Cell Dev Biol 2022; 131:93-107. [PMID: 35305903 DOI: 10.1016/j.semcdb.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/14/2022]
Abstract
The ease and efficacy of CRISPR/Cas9 germline gene editing in animal models paved the way to human germline gene editing (HGGE), by which permanent changes can be introduced into the embryo. Distinct genes can be knocked out to examine their function during embryonic development. Alternatively, specific sequences can be introduced which can be applied to correct disease-causing mutations. To date, it has been shown that the success of HGGE is dependent on various experimental parameters and that various hurdles (i.e. loss-of-heterozygosity and mosaicism) need to be overcome before clinical applications should be considered. Due to the shortage of human germline material and the ethical constraints concerning HGGE, alternative models such as stem cells have been evaluated as well, in terms of their predictive value on the genetic outcome for HGGE approaches. This review will give an overview of the state of the art of HGGE in oocytes and embryos, and its accompanying challenges.
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Affiliation(s)
- B Bekaert
- Ghent-Fertility And Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - A Boel
- Ghent-Fertility And Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - G Cosemans
- Ghent-Fertility And Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - L De Witte
- Center for Medical Genetics Ghent, Ghent University, Department of Biomolecular Medicine, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - B Menten
- Center for Medical Genetics Ghent, Ghent University, Department of Biomolecular Medicine, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - B Heindryckx
- Ghent-Fertility And Stem cell Team (G-FaST), Department for Reproductive Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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31
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Kirillova A, Mazunin I. Operation "mitochondrial wipeout" - clearing recipient mitochondria DNA during the cytoplasmic replacement therapy. J Assist Reprod Genet 2022; 39:2205-2207. [PMID: 35852730 PMCID: PMC9596630 DOI: 10.1007/s10815-022-02561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022] Open
Affiliation(s)
- Anastasia Kirillova
- Center of Life Sciences, Skolkovo Institute of Science and Technology (Skoltech), Skolkovo, Russia.
- Fomin Clinic, Moscow, Russia.
| | - Ilya Mazunin
- Center of Life Sciences, Skolkovo Institute of Science and Technology (Skoltech), Skolkovo, Russia.
- Fomin Clinic, Moscow, Russia.
- Medical Genomics LLC, Moscow, Russia.
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32
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Huang C, Li Q, Li J. Site-specific genome editing in treatment of inherited diseases: possibility, progress, and perspectives. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:471-500. [PMID: 37724161 PMCID: PMC10388762 DOI: 10.1515/mr-2022-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/11/2022] [Indexed: 09/20/2023]
Abstract
Advancements in genome editing enable permanent changes of DNA sequences in a site-specific manner, providing promising approaches for treating human genetic disorders caused by gene mutations. Recently, genome editing has been applied and achieved significant progress in treating inherited genetic disorders that remain incurable by conventional therapy. Here, we present a review of various programmable genome editing systems with their principles, advantages, and limitations. We introduce their recent applications for treating inherited diseases in the clinic, including sickle cell disease (SCD), β-thalassemia, Leber congenital amaurosis (LCA), heterozygous familial hypercholesterolemia (HeFH), etc. We also discuss the paradigm of ex vivo and in vivo editing and highlight the promise of somatic editing and the challenge of germline editing. Finally, we propose future directions in delivery, cutting, and repairing to improve the scope of clinical applications.
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Affiliation(s)
- Chao Huang
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Qing Li
- State Key Laboratory of Cell Biology, Shanghai Key Laboratory of Molecular Andrology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Jinsong Li
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China
- State Key Laboratory of Cell Biology, Shanghai Key Laboratory of Molecular Andrology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
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Alkuraya FS. Consanguineous families with unusually high recurrence risk: A voice to be heard in the germline gene-editing debate. Clin Genet 2022; 102:560-561. [PMID: 35971820 DOI: 10.1111/cge.14209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
A hypothetical pedigree that illustrates the 100% recurrence risk scenario in a consanguineous family.
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Affiliation(s)
- Fowzan S Alkuraya
- Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Abstract
Abstract
Discovery of the CRISPR/Cas system revolutionized biology and biomedicine in the 21st century. Here we discuss the milestones in the development of CRISPR/Cas genome editing technology, from the history of discovery to current developments, including medical applications. Technical and ethical problems associated with the use of CRISPR/Cas for editing human embryonic genomes are also discussed.
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35
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Raguram A, Banskota S, Liu DR. Therapeutic in vivo delivery of gene editing agents. Cell 2022; 185:2806-2827. [PMID: 35798006 DOI: 10.1016/j.cell.2022.03.045] [Citation(s) in RCA: 134] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 12/18/2022]
Abstract
In vivo gene editing therapies offer the potential to treat the root causes of many genetic diseases. Realizing the promise of therapeutic in vivo gene editing requires the ability to safely and efficiently deliver gene editing agents to relevant organs and tissues in vivo. Here, we review current delivery technologies that have been used to enable therapeutic in vivo gene editing, including viral vectors, lipid nanoparticles, and virus-like particles. Since no single delivery modality is likely to be appropriate for every possible application, we compare the benefits and drawbacks of each method and highlight opportunities for future improvements.
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Affiliation(s)
- Aditya Raguram
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA; Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
| | - Samagya Banskota
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA; Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
| | - David R Liu
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA; Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA.
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Discovering the Landscape and Evolution of Responsible Research and Innovation (RRI): Science Mapping Based on Bibliometric Analysis. SUSTAINABILITY 2022. [DOI: 10.3390/su14148944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The growing number of papers on Responsible Innovation (RI) and Responsible Research and Innovation (RRI) have shaped the popularity and usefulness of RI and RRI as a technology governance concept. This study reviews and assesses the development of RRI research through a bibliometric analysis of 702 RRI-focused papers and 26,471 secondary references published in the Web of Science Core Collection database between 2006 and 2020. Firstly, the paper provides a broad outline of the field based on annual growth trends, journal distribution, and disciplinary distribution for RRI publications. Secondly, this study reveals the current state of RRI research by identifying influential literature, journals, authors, countries, and institutions. Thirdly, a phased keyword analysis is conducted to determine the stage characteristics of the RRI field. Finally, based on the bibliometric analyses, this study summarises the evolutionary trajectory of RRI and makes recommendations for future research directions. As a complement to the previous qualitative literature review, the paper provides a systematic and dynamic understanding of RRI research.
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Velasquez-Vasconez PA. Reflections about the Molecular Tool That Could Change the Course of Human History: Genome Editing. PERSONA Y BIOÉTICA 2022. [DOI: 10.5294/pebi.2022.26.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Genetic editing has many applications in almost all areas of society, but may also lead to unpredictable consequences. Genome editing to modify the human germline is at the center of global discussion. Owing to the increasing number of unanswered scientific, ethical, and policy questions, the scientific community agrees that it would be inappropriate to genetically modify embryos. A serious and open debate is necessary to decide whether such research should be suspended or encouraged. Here we show some bold arguments in favor of deleting deleterious genes from the human genome and the risks liberal eugenism poses.
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van Dijke I, van El CG, Lakeman P, Goddijn M, Rigter T, Cornel MC, Henneman L. Dynamics of reproductive genetic technologies: Perspectives of professional stakeholders. PLoS One 2022; 17:e0269719. [PMID: 35727796 PMCID: PMC9212161 DOI: 10.1371/journal.pone.0269719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/26/2022] [Indexed: 11/19/2022] Open
Abstract
Reproductive and genetic medicine are evolving rapidly, and new technologies are already impacting current practices. This includes technologies that can identify a couples' risk of having a child with a genetic disorder. Responsible implementation of new technologies requires evaluation of safety and ethics. Valuable insights for shaping governance processes are provided by various stakeholders involved, including healthcare professionals. Their willingness to adopt these technologies and guide the necessary systemic changes is required for the successful implementation of these technologies. In this study, twenty-one semi-structured interviews were conducted with professionals from different disciplines in the field of reproductive and genetic healthcare in the Netherlands. Three emerging technologies were discussed: expanded carrier screening (ECS), non-invasive prenatal diagnosis (NIPD) and germline genome editing (GGE). By probing stakeholders' views, we explored how culture, structure and practice in healthcare is being shaped by innovations and changing dynamics in genetic and reproductive medicine. The general consensus was that the implementation of reproductive genetic technologies nationwide is a slow process in Dutch healthcare. A "typical Dutch approach" emerged that is characterized by restrictive legislation, broad support for people living with disabilities, values of an egalitarian society and limited commercialisation. Different scenarios for embedding ECS in future practice were envisioned, while implementation of NIPD in clinical practice was considered obvious. Views on GGE varied among stakeholders. Previous implementation examples in the Netherlands suggest introduction of new technology involves an organized collective learning process, with pilot studies and stepwise implementation. In addition, introducing and scaling up new technologies is complex due to perceived barriers from the legislative framework and the complex relationship between the government and stakeholders in this area. This paper describes how the international trends and advances of technologies are expected to manifest itself in a national setting.
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Affiliation(s)
- Ivy van Dijke
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine and Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Carla G. van El
- Department of Human Genetics and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Phillis Lakeman
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariëtte Goddijn
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine and Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Tessel Rigter
- Department of Human Genetics and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martina C. Cornel
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Governance of Heritable Human Gene Editing World-Wide and Beyond. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116739. [PMID: 35682323 PMCID: PMC9180052 DOI: 10.3390/ijerph19116739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023]
Abstract
To date, the controversy surrounding the unknown risks and consequences of heritable genome editing has grown, with such work raising biosafety and ethical concerns for future generations. However, the current guideline of global governance is limited. In the context of the new framework for the governance of human genome editing developed by the World Health Organization (WHO) committee, this paper presents further analysis by highlighting predicaments of governance on germline engineering that merit the most attention: (1) building a scientific culture informed by a broader set of values and considerations in the internal scientific community at large, such as codes of ethics, and education, in addition to awareness-raising measures; and (2) reflecting on and institutionalizing policies in grassroots practice according to local conditions in external governance, such as the experimentalist governance, which is a multi-layered model of governance that establishes an open-ended framework from the top and offers stakeholders the freedom of discussion. The key to achieving these goals is more democratic deliberation between the public and the inclusive engagement of the global scientific community, which has been extensively used in the Biological and Toxin Weapons Convention (BTWC). On a global scale, we believe that practicing heritable human genome editing in accordance with the WHO and BTWC appears to be a good choice.
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Küchenhoff S, Doerflinger J, Heinzelmann N. The genetic technologies questionnaire: lay judgments about genetic technologies align with ethical theory, are coherent, and predict behaviour. BMC Med Ethics 2022; 23:54. [PMID: 35614491 PMCID: PMC9134650 DOI: 10.1186/s12910-022-00792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 05/12/2022] [Indexed: 11/11/2022] Open
Abstract
Background Policy regulations of ethically controversial genetic technologies should, on the one hand, be based on ethical principles. On the other hand, they should be socially acceptable to ensure implementation. In addition, they should align with ethical theory. Yet to date we lack a reliable and valid scale to measure the relevant ethical judgements in laypeople. We target this lacuna.
Methods We developed a scale based on ethical principles to elicit lay judgments: the Genetic Technologies Questionnaire (GTQ). In two pilot studies and a pre-registered main study, we validated the scale in a representative sample of the US population. Results The final version of the scale contains 20 items but remains highly reliable even when reduced to five. It also predicts behaviour; for example, ethical judgments as measured by the GTQ predicted hypothetical donations and grocery shopping. In addition, the GTQ may be of interest to policymakers and ethicists because it reveals coherent and ethically justified judgments in laypeople. For instance, the GTQ indicates that ethical judgments are sensitive to possible benefits and harms (in line with utilitarian ethics), but also to ethical principles such as the value of consent-autonomy. Conclusions The GTQ can be recommended for research in both experimental psychology and applied ethics, as well as a tool for ethically and empirically informed policymaking. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00792-x.
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Affiliation(s)
- Svenja Küchenhoff
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany.,Otto Hahn Research Group for Cognitive Neurogenetics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Nora Heinzelmann
- Institute of Philosophy, University of Erlangen-Nuremberg, Erlangen, Germany.
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Houtman D, Vijlbrief B, Polak M, Pot J, Verhoef P, Cornel M, Riedijk S. Changes in opinions about human germline gene editing as a result of the Dutch DNA-dialogue project. Eur J Hum Genet 2022; 31:409-416. [PMID: 35551502 PMCID: PMC9095815 DOI: 10.1038/s41431-022-01114-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/03/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022] Open
Abstract
Public engagement for Human Germline Genome Editing (HGGE) has often been called for, for example by the WHO. However, the impact of public engagement remains largely unknown. This study reports on public engagement outcomes in the context of a public dialogue project about HGGE in the Netherlands; the DNA-dialogue. The aim was to inquire opinions and opinion change regarding HGGE. A questionnaire was distributed on a national level (n = 2381) and a dialogue level (n = 414). The results indicate that the majority of the Dutch population agrees with the use of HGGE to prevent severe genetic diseases (68.6%), unlike the use to protect against infectious diseases (39.7%), or for enhancement (8.5%). No indications of change in these acceptance rates as a result of dialogue participation were found. The results did provide a tentative indication that participation in dialogue may lead to less negative opinions about HGGE (χ2(1) = 5.14, p = 0.023, OR = 0.56, 95% CI [0.34, 0.93]). While it was not a goal of the project to make people more accepting towards HGGE, this might be the effect of exposure to opinions that are less often heard in the global debate. We conclude that dialogue may lead to different outcomes for different people, depending on their characteristics and their entrance attitude, but does not appear to systematically direct people towards a certain opinion. The self-reported, impacts of dialogue participation included no impact, strengthening of opinion, enabling of forming a first opinion, more insight into the potential implications of HGGE, and a better understanding of other people's perspectives.
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Affiliation(s)
- Diewertje Houtman
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Boy Vijlbrief
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marike Polak
- Department of Psychology, Education and Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | - Martina Cornel
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sam Riedijk
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands.
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42
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Jurić D, Zlatin M, Marušić A. Inadequate reporting quality of registered genome editing trials: an observational study. BMC Med Res Methodol 2022; 22:131. [PMID: 35501706 PMCID: PMC9063127 DOI: 10.1186/s12874-022-01574-0] [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: 09/21/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background To assess registration completeness and safety data of trials on human genome editing (HGE) reported in primary registries and published in journals, as HGE has safety and ethical problems, including the risk of undesirable and unpredictable outcomes. Registration transparency has not been evaluated for clinical trials using these novel and revolutionary techniques in human participants. Methods Observational study of trials involving engineered site-specific nucleases and long-term follow-up observations, identified from the WHO ICTRP HGE Registry in November 2020 and two comprehensive reviews published in the same year. Registration and adverse events (AEs) information were collected from public registries and matching publications. Published data were extracted in May 2021. Results Among 81 eligible trials, most were recruiting (51.9%) phase 1 trials (45.7%). Five trials were withdrawn. Most trials investigated CAR T cells therapies (45.7%) and used CRISPR/Cas9 (35.8%) ex vivo (88.9%). Among 12 trials with protocols both registered and published, eligibility criteria, sample size, and secondary outcome measures were consistently reported for less than a half. Three trials posted results in ClinicalTrials.gov, and one reported serious AEs. Conclusions Incomplete registration and published data give emphasis to the need to increase the transparency of HGE trials. Further improvements in registration requirements, including phase 1 trials, and a more controlled publication procedure, are needed to augment the implementation of this promising technology. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01574-0.
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Affiliation(s)
- Diana Jurić
- Department of Pharmacology, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia.
| | - Michael Zlatin
- School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine and Health, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
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Christian A. Addressing Conflicts of Interest and Conflicts of Commitment in Public Advocacy and Policy Making on CRISPR/Cas-Based Human Genome Editing. Front Res Metr Anal 2022; 7:775336. [PMID: 35572153 PMCID: PMC9094628 DOI: 10.3389/frma.2022.775336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
Leading experts on CRISPR/Cas-based genome editing—such as 2020 Nobel laureates Jennifer Doudna and Emmanuelle Charpentier—are not only renowned specialists in their fields, but also public advocates for upcoming regulatory frameworks on CRISPR/Cas. These frameworks will affect large portions of biomedical research on human genome editing. In advocating for particular ways of handling the risks and prospects of this technology, high-profile scientists not only serve as scientific experts, but also as moral advisers. The majority of them currently intend to bring about a “responsible pathway” toward human genome interventions in clinical therapy. Engaging in advocacy for such a pathway, they issue moral judgments on the risks and benefits of this new technology. They declare that there actually is a responsible pathway, they draft resolutions on temporary moratoria, they make judgments on which groups and individuals are credible and should participate in public and semi-public debates, so they also set the standards for deciding who counts as well-informed, as well as the standards of evidence for adopting or rejecting research policies. This degree of influence on public debates and policy making is, at the very least, noteworthy. This contribution sounds a note of caution with regard to the endeavor of a responsible pathway to human genome editing and in particular scrutinizes the legitimacy of expert-driven research policies given commercial conflicts of interest and conflicts of commitment among first-rank scholars.
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Ravendran S, Hernández SS, König S, Bak RO. CRISPR/Cas-Based Gene Editing Strategies for DOCK8 Immunodeficiency Syndrome. Front Genome Ed 2022; 4:793010. [PMID: 35373187 PMCID: PMC8969908 DOI: 10.3389/fgeed.2022.793010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/14/2022] [Indexed: 12/17/2022] Open
Abstract
Defects in the DOCK8 gene causes combined immunodeficiency termed DOCK8 immunodeficiency syndrome (DIDS). DIDS previously belonged to the disease category of autosomal recessive hyper IgE syndrome (AR-HIES) but is now classified as a combined immunodeficiency (CID). This genetic disorder induces early onset of susceptibility to severe recurrent viral and bacterial infections, atopic diseases and malignancy resulting in high morbidity and mortality. This pathological state arises from impairment of actin polymerization and cytoskeletal rearrangement, which induces improper immune cell migration-, survival-, and effector functions. Owing to the severity of the disease, early allogenic hematopoietic stem cell transplantation is recommended even though it is associated with risk of unintended adverse effects, the need for compatible donors, and high expenses. So far, no alternative therapies have been developed, but the monogenic recessive nature of the disease suggests that gene therapy may be applied. The advent of the CRISPR/Cas gene editing system heralds a new era of possibilities in precision gene therapy, and positive results from clinical trials have already suggested that the tool may provide definitive cures for several genetic disorders. Here, we discuss the potential application of different CRISPR/Cas-mediated genetic therapies to correct the DOCK8 gene. Our findings encourage the pursuit of CRISPR/Cas-based gene editing approaches, which may constitute more precise, affordable, and low-risk definitive treatment options for DOCK8 deficiency.
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45
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Salas SP. Edición genética humana: análisis de algunos desafíos éticos. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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46
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Shozi B, Kamwendo T, Kinderlerer J, Thaldar DW, Townsend B, Botes M. Future of global regulation of human genome editing: a South African perspective on the WHO Draft Governance Framework on Human Genome Editing. JOURNAL OF MEDICAL ETHICS 2022; 48:165-168. [PMID: 33762299 PMCID: PMC8899489 DOI: 10.1136/medethics-2020-106863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
WHO in 2019 established the Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing, which has recently published a Draft Governance Framework on Human Genome Editing. Although the Draft Framework is a good point of departure, there are four areas of concern: first, it does not sufficiently address issues related to establishing safety and efficacy. Second, issues that are a source of tension between global standard setting and state sovereignty need to be addressed in a more nuanced fashion. Third, it fails to meaningfully engage with the extent to which the conceptualisation of human dignity may justifiably vary between jurisdictions. Fourth, the meaning of harm to the interests of a future person requires clarity. Provided these four areas of concern can be addressed, the future of the global governance of human genome editing may hold promise.
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Affiliation(s)
- Bonginkosi Shozi
- School of Law, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Tamanda Kamwendo
- School of Law, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Julian Kinderlerer
- School of Law, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Donrich W Thaldar
- School of Law, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Beverley Townsend
- School of Law, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Marietjie Botes
- School of Law, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Stephan T, Burgess SM, Cheng H, Danko CG, Gill CA, Jarvis ED, Koepfli KP, Koltes JE, Lyons E, Ronald P, Ryder OA, Schriml LM, Soltis P, VandeWoude S, Zhou H, Ostrander EA, Karlsson EK. Darwinian genomics and diversity in the tree of life. Proc Natl Acad Sci U S A 2022; 119:e2115644119. [PMID: 35042807 PMCID: PMC8795533 DOI: 10.1073/pnas.2115644119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Genomics encompasses the entire tree of life, both extinct and extant, and the evolutionary processes that shape this diversity. To date, genomic research has focused on humans, a small number of agricultural species, and established laboratory models. Fewer than 18,000 of ∼2,000,000 eukaryotic species (<1%) have a representative genome sequence in GenBank, and only a fraction of these have ancillary information on genome structure, genetic variation, gene expression, epigenetic modifications, and population diversity. This imbalance reflects a perception that human studies are paramount in disease research. Yet understanding how genomes work, and how genetic variation shapes phenotypes, requires a broad view that embraces the vast diversity of life. We have the technology to collect massive and exquisitely detailed datasets about the world, but expertise is siloed into distinct fields. A new approach, integrating comparative genomics with cell and evolutionary biology, ecology, archaeology, anthropology, and conservation biology, is essential for understanding and protecting ourselves and our world. Here, we describe potential for scientific discovery when comparative genomics works in close collaboration with a broad range of fields as well as the technical, scientific, and social constraints that must be addressed.
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Affiliation(s)
- Taylorlyn Stephan
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20817
| | - Shawn M Burgess
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20817
| | - Hans Cheng
- Avian Disease and Oncology Laboratory, Agricultural Research Service, US Department of Agriculture, East Lansing, MI 48823
| | - Charles G Danko
- Department of Biomedical Sciences, Baker Institute for Animal Health, Cornell University, Ithaca, NY 14850
| | - Clare A Gill
- Department of Animal Science, Texas A&M University, College Station, TX 77843
| | - Erich D Jarvis
- Laboratory of Neurogenetics of Language, The Rockefeller University, New York, NY 10065
- HHMI, Chevy Chase, MD 20815
| | - Klaus-Peter Koepfli
- Smithsonian-Mason School of Conservation, George Mason University, Front Royal, VA 22630
- Smithsonian Conservation Biology Institute, National Zoological Park, Washington, DC 20008
| | - James E Koltes
- Department of Animal Science, Iowa State University, Ames, IA 50011
| | - Eric Lyons
- School of Plant Sciences, BIO5 Institute, University of Arizona, Tucson, AZ 85721
| | - Pamela Ronald
- Department of Plant Pathology, University of California, Davis, CA 95616
- The Genome Center, University of California, Davis, CA 95616
- The Innovative Genomics Institute, University of California, Berkeley, CA 94720
- Grass Genetics, Joint Bioenergy Institute, Emeryville, CA 94608
| | - Oliver A Ryder
- San Diego Zoo Wildlife Alliance, Escondido, CA 92027
- Department of Evolution, Behavior, and Ecology, University of California San Diego, La Jolla, CA 92093
| | - Lynn M Schriml
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Pamela Soltis
- Florida Museum of Natural History, University of Florida, Gainesville, FL 32611
| | - Sue VandeWoude
- Department of Micro-, Immuno-, and Pathology, Colorado State University, Fort Collins, CO 80532
| | - Huaijun Zhou
- Department of Animal Science, University of California, Davis, CA 95616
| | - Elaine A Ostrander
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20817
| | - Elinor K Karlsson
- Bioinformatics and Integrative Biology, University of Massachusetts Medical School, Worcester, MA 01655;
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01655
- Broad Institute of MIT and Harvard, Cambridge, MA 02142
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48
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Lange V, Kappel K. CRISPR Gene-Therapy: A Critical Review of Ethical Concerns and a Proposal for Public Decision-Making. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1089787ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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49
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Liscum M, Garcia ML. You can't keep a bad idea down: Dark history, death, and potential rebirth of eugenics. Anat Rec (Hoboken) 2021; 305:902-937. [PMID: 34919789 DOI: 10.1002/ar.24849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022]
Abstract
"Be careful what you wish for": This adage guides both how this project came to life, and how the topic covered in this review continues to unfold. What began as talks between two friends on shared interests in military history led to a 4-year discussion about how our science curriculum does little to introduce our students to societal and ethical impacts of the science they are taught. What emerged was a curricular idea centered on how "good intentions" of some were developed and twisted by others to result in disastrous consequences of state-sanctioned eugenics. In this article, we take the reader (as we did our students) through the long and soiled history of eugenic thought, from its genesis to the present. Though our focus is on European and American eugenics, we will show how the interfaces and interactions between science and society have evolved over time but have remained ever constant. Four critical 'case studies' will also be employed here for deep, thoughtful exploration on a particular eugenic issue. The goal of the review, as it is with our course, is not to paint humanity with a single evil brush. Instead, our ambition is to introduce our students/readers to the potential for harm through the misapplication and misappropriation of science and scientific technology, and to provide them with the tools to ask the appropriate questions of their scientists, physicians, and politicians.
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Affiliation(s)
- Mannie Liscum
- Division of Biological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Michael L Garcia
- Division of Biological Sciences, University of Missouri, Columbia, Missouri, USA
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50
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Opinion: Toward inclusive global governance of human genome editing. Proc Natl Acad Sci U S A 2021; 118:2118540118. [PMID: 34789569 DOI: 10.1073/pnas.2118540118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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