Six years ago, Chinese researcher He Jiankui stunned the world by announcing the birth of the first two babies whose genes were edited as embryos. An ethical red line was crossed and condemnation from his peers was swift.
Nature
reportedly
rejected
a paper describing his work. Top scientists called for a
moratorium
on embryo editing. And with many other ways to alter genes in adults and children, tampering with the earliest stage of life seemed unnecessary.
So imagine the surprise when Nature, one of the world’s top scientific journals, this week published an article suggesting that embryo editing
could
play a role in preventing society’s most burdensome diseases, including diabetes, heart disease and schizophrenia.
“It’s kicking a sleeping dog,” bioethicist and Stanford law professor Hank Greely told me when I asked him about the work.
The
paper
, led by Peter Visscher, a geneticist at the University of Queensland in Australia, builds on nearly two decades of genome-wide association studies that have pinpointed thousands of unique genetic variants that raise or lower the risk of disease — so-called polygenic traits. On their own, the impact of most of these variants is modest, but the new study models how the cumulative effect of key variants could “theoretically yield extreme reductions in disease susceptibility.”
The argument is tantalizing. Visscher and his colleagues suggest that editing 10 tidbits of DNA could reduce the prevalence of Alzheimer’s disease or schizophrenia by nearly 10-fold. Another 10 edits could diminish coronary artery disease by more than 30-fold, and 10 more edits could cut type 2 diabetes by roughly 60-fold.
But doing so is also certain to be controversial, both at a scientific and moral level.
Embryo editing, let alone polygenic editing, is nowhere close to ready. Every additional edit is another chance for something to go wrong, and the genome can only handle so much abuse at once. While the
Nature
authors acknowledge that making tens or hundreds of edits in one fell swoop is not technically feasible today, they believe it might be within 30 years.
In other words, today’s infants will be tomorrow’s parents, so the time to start seriously debating the possibility is now.
Nature
published its own
editorial
that aims to justify the article with a similar argument, saying the prospect of polygenic embryo editing “is not a hypothetical issue” and that we “need to consider relevant benefits and risks before that day comes.”
Not everyone agrees.
“The article, as published, has a greater likelihood of doing harm than doing good,” Greely told me. “There are arguments for it and arguments against it. I don’t think it’s a crazy idea if it was proven to be safe and effective, but it’s so far from being proven safe and effective that it’s not worth talking about now.”
Last summer, as
Nature
considered Visscher’s article, it asked Greely, who wrote a book on the CRISPR babies scandal in China, to pen a
commentary
in response. Greely and two biologists who brought a technical perspective scrambled to write it in a few weeks. But Greely said
Nature
kept pushing back publication of the two articles until they finally appeared online last week.
It’s not hard to imagine a debate amongst
Nature’
s editors about whether to publish. The journal appears to have been deliberating for some time — the paper notes that Visscher submitted it in June 2022, and that it underwent at least three rounds of extensive peer review. The reviewers’ comments, documented across a
48-page supplement
, reveal that an early draft broached the thorniest of all topics: using gene editing to enhance intelligence. (The IQ discussion was removed from the final publication.)
Greely’s commentary highlights some of the assumptions underpinning Visscher’s model, including that CRISPR gene editing always works perfectly (it doesn’t) and that the benefits of protective genetic variants are additive (which we don’t know for sure). Likewise, Visscher’s final paper is also stuffed with technical caveats and ethical considerations. The authors acknowledge that embryo editing “may deepen inequalities and raise the spectre of eugenics,” but they quickly pivot to say that it’s also important to consider the risk of not undertaking polygenic embryo editing — noting that potentially preventable common diseases will continue to burden individuals and societies.
The obvious counter-argument is that many of these diseases can be treated with existing drugs or future ones. In fact, some CRISPR companies are already developing therapies for adults inspired by rare mutations in the ANGPTL3 and PCSK9 genes that
lower cholesterol
and reduce the risk of heart disease.
Fyodor Urnov, a gene editing scientist at the University of California, Berkeley, who peer-reviewed Visscher’s paper, told me he recommended the authors discuss non-heritable therapies “as an ethical and realistic alternative.” The final paper admitted that such therapies “may be a superior option,” so long as they are cheap (not yet) and safe and effective (to be determined).
Visscher argues that embryo editing will always have one advantage over traditional therapies. Its benefits would persist not only for an individual’s life, they would become part of the human gene pool. In a world where everyone could be born with a drastically reduced risk of common conditions, what would that mean for public health, individual patients, and drugmakers?
Of course, any unintended harms from embryo editing would be just as permanent. The procedure, if it becomes feasible, would be on top of
in vitro
fertilization, meaning it’s unlikely to be cheap or widely accessible. The pharmaceutical industry can rest assured that designer babies are unlikely to chip away at their business any time soon. Yet with biotechs trying to justify $3 million price tags for gene therapies and then struggling to sell them, the one-and-done cures business is in need of disruption.
Is embryo editing the answer? Many geneticists still steer clear of the question, which reeks of science fiction and career-ending headlines. But every year more and more medicines that sound like science fiction become real — think
CAR-T cell therapies for cancer
, the
CRISPR therapy for sickle cell disease
, and
lab-grown blood vessels
.
After He Jiankui’s reckless experiment, the utility of embryo editing was so thoroughly castigated that few scientists have dared to publicly entertain the idea in the years following.
But the genie is out of the bottle. Following his apparent imprisonment for a few years, He is back in the lab and continues to post on X about his dreams of an embryo-edited future. It’s easy to dismiss him as a quack or a cowboy, but Visscher’s paper shows that at least a few serious scientists are grappling with the fact that one of the great tropes of science fiction could soon see the “fiction” part could drop away. They’re probably not the only ones.
—Ryan
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