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CRISPR is short for “Clusters of Regularly Interspaced Short Palindromic Repeats,” and it’s basically a way to change the DNA of an organism (Vidyasagar). It was discovered by by a scientist Francisco Mojica, from the University of Alicante, Spain, and is found in the defense system of bacteria and archaea (Vidyasagar, “Questions and Answers about CRISPR”). In the defense system of bacteria, CRISPR cuts the DNA of viruses that might otherwise be harmful to the bacteria. However, it has been altered, and scientists have been able to modify gene functions and DNA sequences (Crossley, Vidyasagar). Basically, it’s like a tiny pair of scissors, that cuts out the unwanted gene, and replaces it with the new gene (Crossley, Dobson). CRISPR can also be arranged to target and edit exact parts of DNA (“Questions and Answers about CRISPR.”). With this technology, altering genes permanently in living organisms and cells is doable, and the researchers’ next goal is to be able to treat genetic disorders with it (“Questions and Answers about CRISPR”).

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Cancer is a genetic disease, which is caused by a change in the genes that control cell function, specifically the growth and division of them. Cancer is a general name, that is used to refer a group of related diseases, which can occur almost anywhere in the body, but regardless of location, the cells start to divide uncontrollably, and spread into surrounding tissues. Usually, new cells grow and divide only when they are needed, and when a cell gets old, they die and get replaced by a new cell, but when cancer develops, damaged and old cells survive, and new cells are created even when there is no need. The new cells in turn start to divide non-stop, and depending on where in the body it occurs, might form masses of tissue, called tumors. There are two types of tumors; benign tumors, which might grow big in size, but can’t invade tissues close by, and when removed, don’t grow back. However, tumors caused by cancer are malignant, so they spread to tissues nearby, and they might break off and move elsewhere in the body where they form new tumors. Even if these tumors are removed, there is a possibility, that they might grow back. Cancer cells are simpler than ordinary cells, which allows the malfunctions of excessive division, and staying alive even when damaged. The cancer cells and tumors are sometimes able to hide from, invade, or feed off of the body’s immune system, which keeps the immune system from getting rid of the tumors. (“What Is Cancer?”).

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Cancerous tumors might break off from the original location, and start a new cancerous tumor elsewhere in the body.

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Cancerous tumors might break off from the original location, and start a new cancerous tumor elsewhere in the body.

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Normal cell division vs. Cancer cell division

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Normal cell division vs. Cancer cell division

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Normal cell division vs. Cancer cell division.jpg

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CRISPR is used to improve cancer treatment to “modify human immune cells so that they become expert cancer killers,” and is done by deleting genes from T cell, in order to make the cells more effective in battling against cancer cells (Mullin). PD-1 gene, a gene that is going to be removed, is exploited by cancer cells in their fight against the immune system (Mullin). Additionally, a receptor that immune cells sense danger with, such as sick tissue or germs, will be removed, and replaced by an engineer receptor, that will guide the immune cells toward malignant tumors (Mullin). The genetically altered immune cells could dispose of the malignant, lethal tumors cancer causes (Mullin, “What is Cancer?”). Currently, both U.S. and China are experimenting with CRISPR in cancer treatment. In China, the experiment has already started, and in will be starting in near future in the U.S. In both studies, blood cells are removed from the people, and altered with CRISPR in a laboratory (Mullin, Stein). After the blood cells have been modified, they are infused back into the patients (Mullin, Stein). This ex vivo gene therapy, which basically means, that the gene treatment takes place outside the body, lessens the risks of the CRISPR treatment (Mullin). Directly injecting CRISPR into bloodstream could cause immune reactions (Mullin).

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Cancerous tumors are able to 'deactivate' the body's immune system, thus blocking it from attacking and destroying the malignant tumors.

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Cancerous tumors are able to 'deactivate' the body's immune system, thus blocking it from attacking and destroying the malignant tumors.

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How cancer cell deactivates the immune system.png

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4 - The effect of CRISPR cancer treatment on health

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4 - The effect of CRISPR cancer treatment on health

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Dr. Shixiu Wu’s study, in which CRISPR is tested on cancer patients, is one of many similar studies going on in China, but Wu claims his study to be the most advanced. Since the experiment is still quite new, firm conclusions about the effectiveness of CRISPR treatment, or the side effects of it, can’t be drawn yet. However, Dr. Why says around 40% of the patients treated seem to have responded. One of his patients is alive almost a year after the discovery of the cancer, while usually patients with cancer of the esophagus die in months’ time. According to Wu, no major side effects have presented itself as of yet. Some patients have gotten rash or fever, and one patient had to quit the treatment because a high fever arose, but the rest of the patients are in a stable condition. Several patients have died during the study, but Dr. Wu says, it is due to the cancer, not the treatment. Shaorong Deng, who has the advanced cancer of the esophagus, is a participant in Wu’s study. He was originally treated with radiation and chemotherapy, but the cancer kept spreading regardless. However, after going through only one CRISPR therapy, Deng’s health improved noticeably. Upon arriving the first time, Deng needed a wheelchair, but now he is feeling stable, and considerably better. (Stein).

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5 - Who makes decisions about using CRISPR on humans?

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5 - Who makes decisions about using CRISPR on humans?

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In China, there are multiple studies going on about CRISPR as a form of cancer treatment, whereas only one study has been approved in the U.S. On the whole, medical research is much more controlled in the America and Europe than it is in China. The fear of an experiment being taken over the top is much greater in the West, where the starting point is, that the experiment might be dangerous, and we should be extremely careful, whereas in China, the starting point is, that it might benefit China. However, the studies still need to be approved before beginning. Wu’s study gained approval of the hospital committee containing a lawyer, a bioethicist, nurses, doctors, a journalist, a representative of cancer patients and a representative of the public, in two months’ time, after which he was allowed to stat. According to Wu, patients are eager to be cured, and therefore aren’t skeptical about trying new cures. This laid-back attitude towards gene-editing is raising concerns amongst doctors and scientists from other countries. They worry, that some studies and doctors might be rushing too much, and possibly putting patients at risk. A bioethicist at the University of Chicago, Lainie Ross, bases her concerns on the fact, that CRISPR is still extremely new technology, and there still are a lot of things we don’t know or understand about it, and we might actually be doing more harm than good . Doctor Wu on the other hand believes, that improvements should be made and new technologies tried in order to provide better treatment to the patients. Wu’s patients are explained all possible risks considering this new technology, before their treatment starts, and they understand the “experimental nature” of CRISPR treatment. (Stein).

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CRISPR technology has huge potential to improve the healthcare and well-being of humans, which is why so much research about CRISPR as a form of treatment for multiple different diseases, cancer being one of them, is going on (Meštrović). However, even though the potential benefits are significant, the risks for misuse, or unexpected consequences, are huge as well, and sometimes, “the risk cannot be justified by the potential benefit” (Meštrović, Rodriguez, “What Are the Ethical Concerns about Genome Editing?”). CRISPR, when used on humans, arises numerous serious concerns about ethics, and it’s crucial to address those worries before proceeding to clinical applications (Meštrović). Most concerns regarding ethics of CRISPR relate to editing sperm, or egg cells, and the reason for this is because those changes would be passed on to future generations (Shinwari, “What Are the Ethical Concerns about Genome Editing?”). People are most concerned about the safety and morality issues of this, because we don’t know enough to accurately predict the risks, or the side-effects of it (Rodriguez, Shinwari). On the other side, however, this could be the method to cure genetic diseases (Kataria, PhD Hewings-Martin). However, even though CRISPR could be extremely beneficial to those who suffer from genetic diseases, the ability to precisely edit GNA is a huge power, and easy to take to extremes. Even if it was used only for therapeutic purposes at first, the technology could be applied for example to improving the performance of an athlete, or even “designing our future children” (PhD Hewings-Martin, Rodriguez, “What Are the Ethical Concerns about Genome Editing?”).

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Altogether, CRISPR and gene-editing technology has huge potential to completely change the world we currently live in. It could be the key player in helping and curing those, who suffer from genetic diseases and illnesses, but it could also lead to the world, where even humans are being ‘programmed’ before their birth. There are a lot of discussion revolving around CRISPR, such as when should we use it, or even if we should use it at all, and they are all very tricky questions, because this type of technology is very new, and we don’t know much about it. Many are concerned how ethical it is to scientifically change the DNA of an organism, which is essentially what makes us us. Others believe we should research, develop, and use this technology to improve our lives. Since the knowledge regarding CRISPR is so limited, there is no one to make the last decision about the usage of gene-editing, we can only proceed with precaution, and see what happens.

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Crossley, Merlin. “What is CRISPR Gene Editing and How Does It Work?” The Conversation, The Conversation, http://theconversation.com/what-is-crispr-gene-editing-and-how-does-it-work-84591.

Dobson, Marin. Science G10, 16 May 2018 – 18 May 2018.

Kataria, Meghna. “Embryo gene-editing is unsafe and unethical, say gene-editing scientists.” Bio News, Progress Educational Trust, 23 Mar. 2015, https://www.bionews.org.uk/page_94968.

Meštrović, Tomislav. “CRISPR: Ethical and Safety Concerns.” News-Medical.net, News-Medical.net, 14 Jan. 2016, https://www.news-medical.net/life-sciences/CRISPR-Ethical-and-Safety-Concerns.aspx.

Mullin, Emily. “U.S. Doctors Plan to Treat Cancer Patients Using CRISPR.” MIT Technology Review, MIT Technology Review, 22 Jan. 2018, https://www.technologyreview.com/s/609999/us-doctors-plan-to-treat-cancer-patients-using-crispr/.

PhD Hewings-Martin, Yella. “The Ethics of Gene Editing.” Medical News Today, MediLexicon International, 20 Oct. 2017, https://www.medicalnewstoday.com/articles/319817.php.

“Questions and Answers about CRISPR.” Broad Institute, Broad Institute, 20 Mar. 2018, https://www.broadinstitute.org/what-broad/areas-focus/project-spotlight/questions-and-answers-about-crispr.

Rodriguez, E. “Ethical Issues in Genome Editing Using Crispr/Cas9 System.” OMICS International, OMICS International, 24 Mar. 2016, https://www.omicsonline.org/open-access/ethical-issues-in-genome-editing-using-crisprcas9-system-2155-9627-1000266.php?aid=70914.

Shinwari, Z K, et al. “Ethical Issues Regarding CRISPR Mediated Genome Editing.” Advances in Pediatrics., I.S. National Library of Medicine, 7 Sept. 2017, https://www.ncbi.nlm.nih.gov/pubmed/28879860.

Stein, Rob. “Doctors In China Lead Race To Treat Cancer By Editing Genes.” NPR, NPR, 21 Feb. 2018, https://www.npr.org/sections/health-shots/2018/02/21/585336506/doctors-in-china-lead-race-to-treat-cancer-by-editing-genes.

Vidyasagar, Aparna. “What is CRISPR?” LiveScience, Purch, 20 Apr. 2018, https://www.livescience.com/58790-crispr-explained.html.

“What Are the Ethical Concerns about Genome Editing?” National Human Genome Research Institute (NHGRI), The Forefront of Genomics, https://www.genome.gov/27569225/what-are-the-ethical-concerns-about-genome-editing/.

“What Is Cancer?” National Cancer Institute, National Institutes of Health, https://www.cancer.gov/about-cancer/understanding/what-is-cancer.