Dr. He, hero or goat?
Recently Dr. He Jiankui, from the Southern University of Science and Technology in Shenzhen, used CRISPR-Cas9 technology to perform, what he calls, “gene surgery” on the DNA of embryos, naturally produced by a man and a women.
Dr. He’s “gene surgery “eliminated the CCR5 gene, used by Human Immunodeficiency Virus (HIV) to enter and infect host cells and cause HIV to occur in children resulting from the maturing embryos. The father was already afflicted with HIV and so the parents had avoided conception to avoid their children being afflicted with the virus.
Most of today’s commentary characterizes the work of Dr. He as “producing” “genome-edited babies” by altering their DNA but Dr. He didn’t “produce” any babies. Rather he edited the DNA of embryos that had already been produced through a natural conception process or as he described it, he performed gene surgery on existing embryos.
Almost concurrently, in what is being billed as a medical first, scientists in London, with little to no criticism, used a genome-editing technology called TALEN, to cure a child with otherwise untreatable leukemia. The British scientists “edited genes” in immune cells to make them hunt down and destroy the malignant blood cells that threatened the year-old girl’s life.
Sangamo therapeutics is becomming the leader in zinc finger nuclease (ZFN) technology which. allows it to make a double stranded break in the DNA in a precise location in the albumin gene, where the transgene is permanently integrated using the cell’s natural repair mechanism.
So in one case a gene, causing the disease was removed and in the other cases a gene was edited to behave therapeutically.
Apparently the difference is that in Dr. He’s case the genome was “reengineered” and in the other it was “modified”? In both cases, however the human genome was changed through human intervention for the purpose of treating disease. Going forward Both children will have DNA different than that provided by their parents. In one case the procedure was preventative care ( before the disease existed) . In the other case the procedure was therapeutic care ( after the disease existed) but regardless the genes of the children they became different from what their parents would have provided without medical intervention, prentative or therapeutic.
Now famed ethicist Arthur Caplan has weighed-in on Dr. He’s work calling it “Monstrous’ Immorality”. Dr. Caplan, for whom I have great respect, makes it sound as if Dr. He’s intent was to “create genetically engineered human beings. “he had created the world’s first genetically engineered babies” when in fact Dr He’s objective was to remove the gene that could cause the children to become afflicted by AIDS because of their father’s affliction, not “create” genetically modified humans. I’m very surprised and disturbed with Dr Caplan’s fear-mongering when he writes
“Altering the inherited properties of our children strikes many as manufacturing people. Add a bit of 20th century eugenics à la Nazi Germany into the mix and fear turns rapidly into prohibition.”
Dr. Caplan’s five specific objections to Dr. He’s work are
- CRISPR is not yet ready for germline use
- A recent paper published by Dr He called “Draft Ethical Principles for Therapeutic Assisted Reproductive Technologies should be withdrawn as fraudulent
- Dr. He’s experiments have been announced by “press conference” or videos posted online.
- No one should be the sole evaluator of their own potentially lucrative work.
- nothing appears to have been done to prepare for possible failure.
However, none of these objections speak to fact that Dr. He did anything to jeopardize his patient other than perhaps number 5 regarding preparations for possible failure but the trade-off is the risk of failure vs. the child becoming afflicted with AIDS. We know nothing of the risks of the failure of removing the CCR5 gene but we do know there are risks of it’s presence in the offspring of parents with HIV.
Dr. Caplan would have sounded less hyperbolic if his commentary stuck to the AMA’s Code of Medical Ethics:
This is what the AMA Code of Medical Ethics Opinion 7.3.6 says about Gene therapy and Genetic Engineering”
“Physicians should not engage in research involving gene therapy or genetic engineering with human participants unless the following conditions are met:
(a) Experience with animal studies is sufficient to assure that the experimental intervention will be safe and effective and its results predictable.
(b) No other suitable, effective therapies are available.
( c ) Gene therapy is restricted to somatic cell interventions, in light of the far-reaching implications of germ-line interventions.
(d) Evaluation of the effectiveness of the intervention includes determination of the natural history of the disease or condition under study and follow-up examination of the participants’ descendants.
(e) The research minimizes risks to participants, including those from any viral vectors used.
(f ) Special attention is paid to the informed consent process to ensure that the prospective participant (or legally authorized representative) is fully informed about the distinctive risks of the research, including use of viral vectors to deliver the modified genetic material, possible implications for the participant’s descendants, and the need for follow-up assessments.
Most children who have HIV got it from their mother when she was pregnant, during the birth process, or from breastfeeding so, to the degree Dr. He’s work reduces this risk to unborn children you would think it would be celebrated not criticized.
Charles Darwin knew that once he announced his findings, he would become the center of a debate between religion and science. He knew he would shake everything that people had believed for so long. Darwin waited 23 years to present his work to the public. Perhaps Dr. He could have followed Darwin’s example but to the harm of how many?
Dr. He’s status as a hero or goat in the medical community is yet to be determined but to one little girl who’ll live a life free of AIDS, he’s likely to be a hero.
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Notes:
1 https://www.statnews.com/2015/11/05/doctors-report-first-use-gene-editing-technology-patient/
2 https://www.geneticsandsociety.org/internal-content/about-human-germline-gene-editing
4 https://www.ama-assn.org/delivering-care/ethics/genome-editing-and-ama-code-medical-ethics
5 https://biography.yourdictionary.com/articles/why-darwin-wait-long-publish-his-theory.html
