IntroductionPreimplantation Genetic Diagnosis (PGD) was developed in the 1990s and has been used since to diagnose and discard embryos with genetic conditions or chromosomal abnormalities. CRISPR-Cas9 was discovered in 2012 and has been used in research, but has not become clinical practice on humans yet. CRISPR-Cas9 could potentially be applied to treat and prevent genetic disorders.AimThe aim was to investigate the ethical dilemmas of each method through a set of research questions. The ethics of applying PGD according to Swedish guidelines and applying CRISPR-Cas9 on humans was investigated.MethodologyThis was not a systematic literature review. Instead, articles have been selected based on their explanation of each method and uniqueness or volume of ethical arguments surrounding each method, that is of relevance for the discussed issues.ResultsArguments in favour of PGD addressed among other things the somatic and psychological health of future children and parents along with the economical benefits. Arguments against PGD addressed different dilemmas of discarding an embryo and thereby a future individual. Arguments against CRISPR-Cas9 addressed technical limitations, our limited knowledge of genetics and more. Arguments in favour addressed benefits in clinical medicine and research.ConclusionsPGD according to Swedish guidelines was found to be ethically acceptable, since its restrictive use that have not given room for ethically dubious applications. CRISPR-Cas9 was found not to be safe enough for human applications at this moment due to technical limitations. If these were to be solved, caution and restraint must be urged.

京都大学 / 新制・課程博士 / 博士(医科学) / 甲第24885号 / 医科博第152号 / 新制||医科||10(附属図書館) / 京都大学大学院医学研究科医科学専攻 / (主査)教授 河本 宏, 教授 濵﨑 洋子, 教授 上野 英樹 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

T cells modified for expression of Chimeric Antigen Receptors (CARs) were the first genemodified cell products approved for use in cancer immunotherapy. CAR-T cells engineered with gammaretroviral or lentiviral vectors (RVs/LVs) targeting B-cell lymphomas and leukemias have shown excellent clinical efficacy and no malignant transformation due to insertional mutagenesis to date. Large-scale production of RVs/ LVs under good-manufacturing practices for CAR-T cell manufacturing has soared in recent years. However, manufacturing of RVs/LVs remains complex and costly, representing a logistical bottleneck for CAR-T cell production. Emerging gene-editing technologies are fostering a new paradigm in synthetic biology for the engineering and production of CAR-T cells. Firstly, the generation of the modular reagents utilized for gene editing with the CRISPR-Cas systems can be scaled-up with high precision under good manufacturing practices, are interchangeable and can be more sustainable in the long-run through the lower material costs. Secondly, gene editing exploits the precise insertion of CARs into defined genomic loci and allows combinatorial gene knock-ins and knock-outs with exciting and dynamic perspectives for T cell engineering to improve their therapeutic efficacy. Thirdly, allogeneic edited CAR-effector cells could eventually become available as “off-the-shelf” products. This review addresses important points to consider regarding the status quo, pending needs and perspectives for the forthright evolution from the viral towards gene editing developments for CAR-T cells.

The last decades of research in cardiovascular prevention have been characterized by successful bench-to-bedside developments for the treatment of low-density lipoprotein (LDL) hypercholesterolemia. Recent examples include the inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) with monoclonal antibodies, small interfering RNA and antisense RNA drugs. The cumulative effects of LDL cholesterol on atherosclerosis make early, potent, and long-term reductions in LDL cholesterol desirable—ideally without the need of regular intake or application of medication and importantly, without side effects. Current reports show durable LDL cholesterol reductions in primates following one single treatment with PCSK9 gene or base editors. Use of the CRISPR/Cas system enables precise genome editing down to single-nucleotide changes. Provided safety and documentation of a reduction in cardiovascular events, this novel technique has the potential to fundamentally change our current concepts of cardiovascular prevention. In this review, the application of the CRISPR/Cas system is explained and the current state of in vivo approaches of PCSK9 editing is presented.

The ability to generate multiplexed genomic modifications using CRISPR-based gene editing has fundamentally changed the scope of possible reverse genetic screening approaches that can be executed in human cells. A diversity of Cas effector proteins lies at the center of pooled CRISPR screens. Working in unison with targeting gRNAs, CRISPR-Cas effector complexes can produce a range of alterations at user specified genomic sites. The type of alteration, ranging from double-strand break (DSB) formation to precise single nucleotide substitutions, is dictated by the Cas protein. Initially, pooled CRISPR screens were conducted using the Cas9 endonuclease to generate loss of function mutations in single genes through the formation of DSBs. As CRISPR technologies matured, the discovery and engineering of novel Cas proteins has allowed for increasingly complex sets of genomic alterations to be studied in a high-throughput manner. In Chapter 1, I introduce a variety of CRISPR-based functional genomic technologies that have been used in high-throughput screening approaches. Here, I also describe discoveries that have been made in the human DNA damage response (DDR) using these approaches. In Chapter 2, I present my work using Cas12a to interrogate the genetic interaction landscape of the DDR. This work leverages the ability of Cas12a to generate several DSBs from a single gRNA array to investigate ~27,000 genetic interactions between 233 DDR genes. In these screens, novel synthetic lethal interactions were identified, with three sets of synthetic lethal interactions between gene complexes being highlighted. In Chapter 3, I present a published manuscript that demonstrates the utility of precision base editing screens. This study uses BE3-dependent base editing to induce mutational tiling of 86 human DDR genes and analyze the effects of these mutations in response to DNA damaging agents. In total, the work presented here highlights the utility of novel CRISPR screening platforms through the interrogation of the human DDR.

Genome editing technologies have advanced from methods that rely on nucleases to catalyze programmed double-strand breaks (DSBs), which are known to cause deleterious side effects, to next-generation reagents that perform more controlled chemistry using DSB-independent approaches. Base editing and prime editing are ideally suited for small-scale modifications, but methods to achieve large-payload gene insertion have been lacking. Recent technology development efforts have advanced strategies that employ eukaryotic transposases, bacterial recombinases/transposases, and retroelements, yet these enzymes broadly suffer from either inflexibility of target site requirements or non-specific, genome-wide insertion profiles. The ability to precisely and safely insert kilobase-scale DNA cargos at user-defined loci remained challenging due to a dearth of programmable transposase tools. CRISPR-associated transposon (CAST) systems represent a unique opportunity to solve this longstanding challenge. CASTs are diverse (types I-B, I-D, I-F, and V-K) heteromeric, macromolecular machineries that require multivalent protein-protein interactions, each of which represents a potential kinetic bottleneck, inefficiency, or failure point when porting from bacteria to mammalian cells. Through meticulous, step-by-step engineering involving functional assays, bioinformatic mining, homolog screening, structure-guided engineering, and directed evolution, we have iteratively improved overall editing efficiencies of type I-F CASTs, identified an essential bacterial co-factor, and reached editing efficiencies that approach therapeutic relevance. Together, this work represents a critical advancement towards a broad platform for targeted genomic integration of large DNA payloads.

Yes / CRISPR (clustered regularly interspaced short palindromic repeats) gene editing technologies appear to be a game-changer and suggest great potential for genome manipulation and for developments in next-generation therapeutics. Ethical, legal and social concerns have been raised in light of recent applications in humans. Concern also arises in relation to the potential of such developments for misuse. In addressing the post-COVID19 challenges raised by responsible research innovation and in confronting what to do about the vexed question of “dual-use”, we contend that awareness-raising and education concerning the ethical, legal and social implications of scientific research innovation represents a welcome and empowering alternative to top down regulatory responses that may serve to stifle innovation. The design and subsequent implementation of a novel transformative pedagogy combining Team-Based Learning and Threshold Concepts yields both empirical evidence-based metrics for real-time learning. As well as generating novel empirical data-sets for the identification of subject-specific threshold concepts across discrete specialisms in the life sciences, we argue that this hybrid methodology can be used to engage science professionals and students alike in meaningful and much-needed dialogue about developments relating to genome manipulation. We demonstrate how evidence-based threshold concepts can inform the design of bespoke subject-specific training as we suggest was the case from our deployment of team-based learning and threshold concepts during our proof of concept application, prior to the pandemic, during the course of two European Union Human Brain Project training programmes undertaken in 2017 and 2018, with experts in neuroscience research at the Karonlinska Institutet, Stockholm, Sweden.

Rare diseases, when considered as a whole, affect up to 7% of the population, which would represent 3.5 million individuals in the United Kingdom alone. However, while 'personalised medicine' is now yielding remarkable results using recent sequencing technologies in terms of diagnosing genetic conditions, we have made much less headway in translating this patient information into therapies and effective treatments. Even with recent calls for greater research into personalised treatments for those affected by a rare disease, progress in this area is still severely lacking, in part due to the astronomical cost and time involved in bringing treatments to the clinic. Gene correction using the recently-described genome editing technology CRISPR/Cas9, which allows precise editing of DNA, offers an exciting new avenue of treatment, if not cure, for rare diseases; up to 80% of which have a genetic component. This system allows the researcher to target any locus in the genome for cleavage with a short guide-RNA, as long as it precedes a highly ubiquitous NGG sequence motif. If a repair sequence is then also provided, such as a wild-type copy of the mutated gene, it can be incorporated by homology-directed repair (HDR), leading to gene correction. As both guide-RNA and repair template are easily generated, whilst the machinery for editing and delivery remain the same, this system could usher in the era of 'personalised medicine' and offer hope to those with rare genetic diseases. However, currently it is difficult to test the efficacy of CRISPR/Cas9 for gene correction, especially in vivo. Therefore, in my PhD I have developed a novel fluorescent reporter system which provides a rapid, visual read-out of both non-homologous end joining (NHEJ) and homology-directed repair (HDR) driven by CRISPR/Cas9. This system is built upon a cassette which is stably and heterozygously integrated into a ubiquitously expressed locus in the mouse genome. This cassette contains a strong hybrid promoter driving expression of membrane-tagged tdTomato, followed by a strong stop sequence, and then membrane-tagged EGFP. Unedited, this system drives strong expression of membrane-tdTomato in all cell types in the embryo and adult mouse. However, following the addition of CRISPR/Cas9 components, and upon cleavage, the tdTomato is rapidly excised, resulting via NHEJ either in cells without fluorescence (due to imperfect deletions) or with membrane-EGFP. If a repair template containing nuclear tagged-EGFP is also supplied, the editing machinery may then use the precise HDR pathway, which results in a rapid transition from membrane-tdTomato to nuclear- EGFP. Thereby this system allows the kinetics of editing to be visualised in real time and allows simple scoring of the proportion of cells which have been edited by NHEJ or corrected by HDR. It therefore provides a simple, fast and scalable manner to optimise reagents and protocols for gene correction by CRISPR/Cas9, especially compared to sequencing approaches, and will prove broadly useful to many researchers in the field. Further to this, I have shown that methods which lead to gene correction in our reporter system are also able to partially repair mutations found in the disease-causing gene, Zmynd10; which is implicated in the respiratory disorder primary ciliary dyskinesia (PCD), for which there is no effective treatment. PCD is an autosomal-recessive rare disorder affecting motile cilia (MIM:244400), which results in impaired mucociliary clearance leading to neonatal respiratory distress and recurrent airway infections, often progressing to lung failure. Clinically, PCD is a chronic airway disease, similar to CF, with progressive deterioration of lung function and lower airway bacterial colonization. However, unlike CF which is monogenic, over 40 genes are known to cause PCD. The high genetic heterogeneity of this rare disease makes it well suited to such a genome editing strategy, which can be tailored for the correction of any mutated locus.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-01-08T14:33:50Z No. of bitstreams: 1 gustavotorresdesouza.pdf: 5085443 bytes, checksum: eada917698a8738ea1947743e940692c (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-01-23T11:05:29Z (GMT) No. of bitstreams: 1 gustavotorresdesouza.pdf: 5085443 bytes, checksum: eada917698a8738ea1947743e940692c (MD5) / Made available in DSpace on 2018-01-23T11:05:29Z (GMT). No. of bitstreams: 1 gustavotorresdesouza.pdf: 5085443 bytes, checksum: eada917698a8738ea1947743e940692c (MD5) Previous issue date: 2017-08-08 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O advento sistema CRISPR/Cas9 tornou o processo de edição gênica consideravelmente mais fácil e direto, uma vez que retirou empecilhos técnicos relacionados aos sistemas já disponíveis. Desta forma, foram permitidos diversos avanços no entendimento da função de elementos genômicos, assim como a produção de embriões geneticamente modificados com diversas finalidades. O atual trabalho objetivou a edição gênica no gene da beta-lactoglobulina em células somáticas bovinas objetivando a produção futura de embriões da espécie geneticamente modificados. Considerando-se que a hipersensibilidade a essa proteína responde pela maior parte das alergias ao leite bovino, a produção de animais cujo leite não contenha essa molécula é de grande interesse para a indústria de laticínios. Durante os experimentos, foi possível obter uma linhagem de células bovinas MDBK expressando a enzima Cas9 (MDBK-Cas). Usando células MDBK e as células MBDK-Cas foi possível se obter com sucesso edições gênicas no locus beta-lactoglobulina utilizando-se os componentes do sistema CRISPR/Cas9 na forma de mRNA da proteína Cas9 e sgRNAs. Conclui-se que o sistema CRISPR/Cas9 pode ser usado com os sgRNA desenhados neste estudo para editar o gene da betalactoglobulina em células MDBK. Assim, células MDBK podem ser utilizadas como alvo o locus em estudo. Modelos de estudos para edição do genoma bovino. Em vista da escassa literatura constando de trabalhos em que tenha sido feita a edição gênica em embriões bovinos, os dados gerados por esse trabalho colaborarão para o avanço do estado da arte no que diz respeito a engenharia gênica de bovinos e no conhecimento do funcionamento do sistema CRISPR/Cas9. / The advent of the CRISPR / Cas9 system made the process of gene editing considerably easier and more straightforward, since it removed technical impediments related to the systems already available. In this way, several advances were made in the understanding of the function of genomic elements, as well as the production of genetically modified embryos for various purposes. The present work aimed at the genetic editing of the beta-lactoglobulin gene in bovine somatic cells aiming at the future production of genetically modified embryos of the species. Considering that hypersensitivity to this protein accounts for most of the allergies to bovine milk, the production of animals whose milk does not contain this molecule is of great interest to the dairy industry. During the experiments, it was possible to obtain a lineage of bovine MDBK cells expressing the Cas9 enzyme (MDBK-Cas). Using MDBK cells and MBDKCas cells it was possible to successfully obtain gene editions at the beta-lactoglobulin locus using the components of the CRISPR / Cas9 system as mRNA of the Cas9 protein and sgRNAs. It is concluded that the CRISPR / Cas9 system can be used with the sgRNAs designed in this study to edit the beta-lactoglobulin gene in MDBK cells. Thus, MDBK cells can be targeted as the locus under study. Models of studies for editing the bovine genome. In view of the scarce literature consisting of studies in which bovine embryos have been genetically engineered, the data generated by this work will contribute to the advancement of the state of the art regarding the genetic engineering of cattle and the knowledge of the functioning of the system CRISPR / Cas9.

The causative role of the huntingtin (HTT) gene in Huntington's disease (HD) has been identified more than 25 years ago. The extension of CAG repeat stretch over 39 repeats in exon 1 of one HTT allele results in full penetrance of this neurodegenerative disorder. While the identification of the causative mutation raised hopes that development of the therapeutic compound will be easily achievable, the patients and their families are still waiting for treatment until now. The main reason for that might be the complex cellular function HTT that makes the determination of the pathologic mechanism difficult and the development of treatments even more challenging. Although a lot of different animal models have been generated until now, establishing a suitable model has still not been achieved yet. Due to its anatomy, physiology, and genetics, the minipig seems to be a suitable candidate for neurodegenerative disease models. Indeed, the existing Transgenic (Tg) Libechov minipig model manifests signs typical for HD in patients, but on the other hand significant inconsistencies have also been observed. The finding of malformation that partially shows the situation in human patients is true for both, the male reproductive tract as well as for the brain. The reason for this might be the fact the genetic...