Potential genetic enhancements and their implications

From: ⁨cleoabram⁩

CRISPR-Cas9 is a microscopic technology that provides the power to edit genes, offering the potential to cure diseases, prevent others, and possibly “boost what our bodies can do” [00:00:10]. It could even, one day, “give our kids abilities that nobody has ever had before” [00:00:15], effectively putting evolution into human hands [00:00:18]. This is not a future concept but a technology already in use in medicines, plants, and animals [00:00:21]. Deciding how to use this new “superpower” [00:00:41] represents one of humanity’s greatest challenges and opportunities to reduce suffering [00:00:47].

The development of CRISPR-Cas9 by Jennifer Doudna (Nobel Prize winner) and Emmanuelle Charpentier marked a significant leap in gene editing [00:03:29]. While earlier tools like Zinc-finger nucleases and TALEN proteins showed that DNA manipulation was possible, they were “bespoke” (one for every change), expensive, and time-consuming [00:04:29]. CRISPR, inspired by how viruses and bacteria interact in nature, is a “programmable tool” [00:05:35] that allows for quick, precise, and targeted changes to DNA sequences, much like a text editor for the instruction manual of life [00:05:52].

This capability brings “profound implications” [00:06:41], as humans now possess the technology to “change chemically fundamentally who and what we are” [00:06:47].

Types of Genetic Enhancements

The potential uses of genetic editing fall along a spectrum, from treating existing diseases to preventing future ones, and even to what some might call “enhancements” [00:08:42] or “super enhancements” [00:08:58] that move individuals or their descendants “into a new part of what is possible for humans” [00:08:45].

Disease Prevention

Beyond curing active diseases, CRISPR holds promise for preventing future diseases by targeting specific genes that correlate to risk:

• High Cholesterol/Cardiovascular Disease: A clinical trial is running to use CRISPR as a preventative measure by making edits in the liver’s DNA to prevent cholesterol accumulation in susceptible individuals [00:26:42]. This one-time therapy could eliminate the need for daily medication [00:27:15].
• Alzheimer’s Risk: Related to the APOE4 gene [00:26:11].
• Cancer: Related to genes like BRCA [00:26:22].
• Asthma: Research is ongoing to use CRISPR to turn down the production of a molecule in the microbiome correlated with asthma susceptibility in children, potentially preventing the disease [00:45:41].

Physical and Cognitive Enhancements

This category involves moving people “beyond what is possible for anyone right now” [00:36:25], including healing faster, extending life, or giving children “abilities that seem like superpowers” [00:36:25].

• Increased Muscle Mass: The MSTN gene is associated with building larger muscles [00:29:27].
• Reduced Sleep Need: The DEEC2 gene is associated with needing less sleep [00:29:43].
• Pain Tolerance: Natural variations of a gene involved in pain perception exist, allowing some people to be naturally pain tolerant [00:29:53]. Gene manipulation could potentially remove the experience of pain for those with chronic pain conditions [00:30:23].
• Super Athletes: Theoretically, genetic manipulation could create “basketball players that were eight feet tall or you know could jump unreasonably high” [00:36:46] or those with “very well-developed muscles” [00:37:00]. However, this is largely unrealistic at present due to a limited understanding of how manipulating these genes affects overall health [00:37:04].

Implications and Challenges

The discussion around genetic enhancements raises complex ethical implications of genetic modifications and societal considerations.

Somatic vs. Germline Editing

A critical distinction is between editing somatic cells (not involved in reproduction) and germline cells (which would pass changes to future generations) [00:07:13].

• Somatic Cell Editing: Changes affect only the individual being treated. While still having safety and ethical considerations, these are considered less profound than germline changes [00:07:54].
• Germline Editing: Changes made to embryos are permanent and inherited by all future generations [00:08:07]. This raises concerns reminiscent of eugenics and the implications of fundamentally altering humanity [00:07:27]. For example, in 2018, a scientist edited human embryos to prevent HIV transmission, a decision opposed by many scientists due to unproven risks and the existence of safer alternatives [00:18:45]. The edits were also not “clean,” resulting in “chimeras” with a mixture of genetic makeups, the long-term effects of which are unknown [00:21:18].

Ethical and Societal Concerns

• Defining the Line: It is challenging to draw a clear line between treating a disease and making an enhancement, as there is a “continuum” [00:31:00]. What one person calls an enhancement, another might call health-related. The question arises: “who decides?” [00:31:10]
• Accessibility and “Gene Gap”: There’s a concern that genetic enhancements could create a “gene gap” [00:31:36], leading to a divide based on wealth, similar to the movie Gattaca [00:31:24]. However, new technologies often start expensive and become more accessible over time, suggesting that withholding development due to initial exclusivity might be counterproductive to long-term benefit [00:31:44].
• In Vitro Fertilization (IVF) and Embryo Selection: Enhancements could potentially be achieved through IVF and preimplantation genetic diagnosis (PGD), which allows for embryo selection based on desired traits or the avoidance of certain mutations [00:33:55]. CRISPR could go a step further by actively editing traits that might be present in all embryos from a couple, rather than just selecting existing ones [00:34:46]. IVF itself is a difficult, time-consuming, and expensive process [00:35:05], highlighting the existing barriers to advanced reproductive technologies. Future developments in gametes (eggs and sperm) could further change the landscape of what is possible in human reproduction over decades [00:35:30].
• Balancing Risks and Benefits: Any therapy requires assessing whether risks outweigh benefits [00:19:27]. When not dealing with life-threatening illnesses, the demand for safety in a preventative or enhancement therapy becomes extremely high [00:27:32]. The argument that “it would almost be unethical not to use it” [00:18:02] for devastating diseases like Huntington’s contrasts with the caution needed for untested enhancements.

Scientific Challenges

Despite the rapid technological advancements and future potential of CRISPR, significant scientific challenges remain:

• Delivery Mechanisms: A major hurdle is safely and effectively delivering CRISPR molecules into specific cells or tissues in the body, especially for organs like the lungs, liver, or brain [00:13:01]. The body’s immune system can attack foreign molecules, and targeting specific cell types within complex organs is tricky due to the need for “chemical mechanisms of distinguishing one cell type from another” [00:15:15]. Scientists are studying how viruses and bacteria naturally achieve this precise delivery for inspiration [00:15:48].
• Understanding Gene Interconnectedness: Genes are interconnected, meaning “when you tweak one thing you’re probably not just changing one effect you’re you’re changing lots of other things” [00:37:21]. This complexity requires extensive research before sophisticated manipulations can be safely performed [00:37:32].
• Multi-gene Disorders: CRISPR is currently best suited for disorders resulting from a single gene mutation, like sickle cell disease or Huntington’s [00:12:11]. Treating complex diseases like schizophrenia, which may involve hundreds of mutations, is far more challenging [00:12:28].

Applications Beyond Humans

CRISPR is expected to have an “extraordinary global impact” [00:38:24] first in plant and animal manipulations, as testing can be done more rapidly and less restrictively than in humans [00:38:36].

• Agriculture: CRISPR allows for “targeted precise changes that only alter one trait” [00:40:05] in plants, unlike traditional breeding methods that involve random changes and take decades [00:39:09]. It can increase crop yields and nutritional value [00:38:00]. Examples include non-browning mushrooms [00:41:34] and higher-yielding tomatoes already approved in Japan [00:41:06].
• Climate Change: CRISPR could address environmental issues, such as making cows “fart less methane” [00:42:52] by altering the metabolism of methane-producing bacteria in their gut [00:43:21]. This is an example of ethical and ecological implications of using genetically modified organisms for climate intervention.
• Animal Health: Editing the microorganisms within animals, rather than the animals themselves, offers a new category of assistance [00:45:07]. This approach can also be applied to humans by editing the human microbiome to impact health [00:45:18].

Conclusion

“Few technologies are inherently good or bad. What matters is how we use them” [00:52:35]. While the possibilities of CRISPR are immense, both for good and potential harm, careful determination from individuals and society is required [00:52:46]. Controlling the species’ genetic future is both “awesome and terrifying” [00:53:02], and deciding how to handle it may be the biggest challenge humanity has ever faced [00:53:07]. Challenges and opportunities in CRISPR development and implementation remain, but the ongoing scientific curiosity will continue to drive progress [00:49:18].