04 September 2017
ByAppeared in BioNews 916
As a scientist working in a fertility clinic, my normal everyday work routine is occasionally punctuated by the ripple effect that occurs when reports of a new groundbreaking reproductive technology enters the public consciousness. I am soon inundated with questions from inquisitive patients (as well as my nearest and dearest): what exactly has been developed, could this technology help me, is it safe, is this going to result in the end of civilisation as we know it? You know, the standard curiosities of the mind.
The announcement in August that the genome editing technique CRISPR, had been used to correct a disease-causing mutation in human embryos (see BioNews 912) was no exception. I began sifting through scientific articles and media resources in an attempt to work out what this report potentially meant for my fertility patients and to prepare myself for the inevitable onslaught of questions. One resource that may prove to be particularly useful for enquiring minds, and one which I may recommend to interested patients, is an episode of The Guardian’s Science Weekly Podcast that was specifically dedicated to discussing the wider implications of the newly published CRISPR research.
The 30-minute podcast, entitled 'Editing the embryo: removing harmful gene mutations', simplifies the science behind the most recent CRISPR publication in the journal Nature (02 August 2017) and examines some of the social, ethical and legal issues surrounding the potential use of genome editing in clinical treatment. A happy balance between science and bioethics is achieved by Dr Hannah Devlin, the Guardian’s science correspondent, as she interviews Dr Paula Amato, a reproductive endocrinologist and associate professor of obstetrics and gynecology at the Oregon Health and Science University, USA and Professor Karen Yeung, director of the Centre for Technology, Law and Society at King's College London, UK.
While Dr Amato, co-author of the Nature paper, does an expert job at reducing the science into a widely accessible format and explaining the significance and limitations of the research, I found my thoughts lingering on the safety aspects of the technology. Specifically, how sure can you be that the CRISPR system has not induced any off-target DNA changes? I was also curious whether the CRISPR technology would be implemented in situations where the limits of preimplantation genetic diagnosis (PGD) have been reached or whether CRISPR would eventually supersede PGD to increase the yield of genetically normal embryos?
Confirming CRISPR safety is clearly a dominant issue, however, I was struck by the manner in which routine IVF treatment and PGD seemed to be viewed as entirely safe in the podcast. All individuals born from IVF and PGD are still below 40 years of age and while such technologies thankfully appear to be safe, the development of late-onset effects from such treatment is still a possibility. Furthermore, the occurrence of epigenetic changes during routine assisted conception treatment and the resulting outcome is not fully understood. Safety will always be a worry where the possibility of creating life is concerned.
Professor Yeung steers the focus away from pure science and succinctly explains how human embryo research is regulated in the UK, before tackling some of the ethical dilemmas that are associated with introducing new technologies into clinical practice, especially when that technology involves creating genetic changes that will be passed down to from generation to generation.
The podcast thankfully bypasses many of the 'traditional' ethical arguments that can dominate discussions about new reproductive technologies, and research involving human embryos. The research carried out by Dr Amato and her colleagues involved purposefully creating 'healthy' human embryos, using eggs specifically donated to the research programme. There will always be groups and individuals that find experimentation on human embryos to be morally abhorrent as well as many people who would disagree with providing financial compensation to women who donate their eggs to research, however, focusing on these issues can stall the wider debates surrounding the clinical and social implications of using such technology.
There is also only a minor nod to the notion of eugenics and designer babies; Dr Amato concisely explains how the CRISPR system is unlikely to be the starting point of the feared 'slippery slope' that leads to the preferential selection of for example, intelligence or athleticism, simply due to the complex nature of how these traits are encoded and expressed. There are no doomsday proclamations; the podcast simply consists of three well-informed professionals who are carefully considering the implications of using CRISPR technology in a measured and balanced manner – just what you would expect from the Guardian.
This podcast is a great introduction to the reproductive science arena, where science meets ethical judgment. It may hold particular appeal to those working in the assisted conception field, individuals concerned about passing a genetic condition onto their offspring and those who would enjoy wrestling with a new bioethical conundrum.