Noti hf2/8/2024 Research groups have also used ex vivo approaches for certain cancers, harvesting patient T-cells and targeting with CRISPR-Cas before re-introducing the edited population back into the patient 22. A similar strategy is being used for CRISPR-directed gene editing of solid tumors 21. An innovative approach being undertaken for Hereditary Transthyretin Amyloidosis (hATTR) avoids correction, but rather aims to disable gene expression, so that patients fail to produce the faulty protein altogether 20. For SCD, clever workaround strategies for the reactivation of fetal hemoglobin (HbF) expression to counteract the effects of this disease, are becoming prevalent 17, 18, 19. Significant improvement in efficiency and precision has not yet been sufficiently realized which could explain, in part, why many clinical trials are not aiming to repair point mutations within the context of the chromosome. To address these challenges, many laboratories focus on improving the precision and activity of the CRISPR-Cas system through genetically reengineering the Cas protein 10, 11, 12, 13 or exploring the possibility of altering the chemical composition and molecular features of the DNA repair templates 14, 15, 16. We have also confirmed other laboratories initial observations that unintended genetic changes were prevalent after CRISPR-Cas gene editing in CD34 + cells 4, 8, 9. While successful single base mutation correction was observed, unintended on-site changes were also found at an alarmingly high rate. We were among many laboratories that analyzed the effectiveness of gene editing at the beta globin locus in somatic cells and clearly demonstrated single base conversion at the targeted site. Our laboratory has previously worked to investigate precise point mutation correction of the single base mutation responsible for SCD using a CRISPR-Cas9 ribonucleoprotein (RNP) complex and a single-stranded oligonucleotide (ssODN) donor repair template 2. Our work 2, 3, 4 and others 5, 6, 7 have revealed that while successful point mutation repair can be achieved, it is almost always associated with a significant amount of imprecise editing, particularly at the targeted sites where the CRISPR-Cas complex was designed to act, i.e., on-site mutagenesis. The most prominent challenge centers on the diversity of genetic outcomes that have resulted from sophisticated attempts to correct a single base mutation using CRISPR-based gene editing. While the “surgical” form of gene repair is clearly a direct path to treatment and cure, the current landscape of scientific work within the field, with respect to precise gene correction, remains unclear and full of significant barriers. The straightforward therapeutic vision of direct gene repair is to resolve genetic disorders caused by point mutations, such as Sickle Cell Disease (SCD). While foundational work began years ago 1, the breakthrough CRISPR-Cas technology has increased optimism that genetic repair of point mutations might finally become a clinical reality. This extension of the cell-free gene editing system to model point mutation repair may provide insight for understanding the factors influencing precise point mutation correction.Ī major goal of gene therapy is to edit and correct a genetic mutation within the context of the human chromosome. ![]() We successfully direct correction of four unique point mutations which include two unique nucleotide mutations at two separate targeted sites and visualize the repair profiles resulting from these reactions. To do this, we modified an in vitro gene editing system which utilizes a cell-free extract, CRISPR-Cas RNP and donor DNA template to catalyze point mutation repair. Here, we introduce a pathway model for Homology Directed Correction, specifically point mutation repair, which enables a foundational analysis of genetic tools and factors influencing precise gene editing. One of the most prominent challenges to precise CRISPR-directed point mutation repair centers on the prevalence of on-site mutagenesis, wherein insertions and deletions appear at the targeted site following correction. Gene correction is often referred to as the gold standard for precise gene editing and while CRISPR-Cas systems continue to expand the toolbox for clinically relevant genetic repair, mechanistic hurdles still hinder widespread implementation.
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