Turkiye Klinikleri Journal of Medical Ethics-Law and History

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We are Able to Edit the Genome of Human Embryos with CRISPR/Cas9 Technology, But are We Allowed to Do so?
İnsan Embriyosunun Genomunu CRISPR/Cas9 Tekniği ile Değiştirebiliriz; Ancak Bunu Yapmaya İznimiz Var mı?
Esra BİLİRa, Gülsüm ÖNALb, Emine Elif VATANOĞLU LUTZc
aKoç University Faculty of Medicine, İstanbul, TURKEY
bDepartment of Medical History and Ethics, Trakya University Faculty of Medicine, Edirne, TURKEY
cDepartment of Medical History and Ethics, İstanbul University İstanbul Faculty of Medicine, İstanbul, TURKEY
Turkiye Klinikleri J Med Ethics. 2021;29(1):111-8
doi: 10.5336/mdethic.2020-76393
Article Language: EN
Full Text
ABSTRACT
 In 2018, a Chinese scientist claimed the birth of the two girls whose C-C chemokine receptor type 5 (CCR5) gene(s) were deleted by CRISPR/Cas9 [clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPRassociated (Cas)] technology. The reason for this experimental procedure was the father being infected with human immunodeficiency virus (HIV). The national and international authorities heavily criticized the scientist in terms of scientific pitfalls of the technique used and ethics and showed condemnation against him. Two of the greatly criticized issues were that the implanting the genetically edited embryos to a woman with, and fabrication of the Institutional Review Board approval. Eventually, the Chinese Government sentenced him to three-year prison and fine. In this review, we aim to present the case, introduce the history of in vitro fertilization, its current implications, history of HIV, advocate reproductive rights of the individuals infected with HIV, and present CRISPR/Cas9 technique and its pitfalls. Finally, we critically evaluate the case based on the international and Turkish National Ethical Codes, including the Declaration of Helsinki, Nuremberg Code, and the Convention on Human Rights and Biomedicine. It is certain that we need stricter institutional, national, and international guidelines for gene editing of the human embryos. We also made several suggestions for updates in the curriculums of medicine and biological sciences regarding the CRISPR/Cas9 use in human subjects. We conclude that although it was an unethical human experiment conducted with inadequate scientific grounds, the CRISPR/Cas9 is a very promising technique for the cure of many human diseases. Therefore, more animal experiments with CRISPR/Cas9 should be encouraged and funded to achieve our goal of being healthier humans.

Keywords: Bioethics; CRISPR/Cas9; human genome; HIV; IVF; embryo; gene editing
ÖZET
 2018 yılında Çinli bir bilim insanı, C-C kemokin reseptörü tip 5 (CCR5) genini, CRISPR/Cas9 [düzenli aralıklarla bölünmüş kısa palindromik tekrar kümeleri (CRISPR)/CRISPR ilişkili nükleaz 9 (Cas9)] teknolojisi ile sildiğini ve de bunun sonucunda ikiz kız bebek doğumu gerçekleştiğini iddia etti. Bu deneysel çalışmanın nedeni olarak ileri sürülen babanın insan bağışıklık yetmezliği virüsü [human immunodeficiency virus (HIV)] pozitif olduğu, ulusal ve uluslararası otoriteler tarafından yoğun olarak tartışılmış ve etik açıdan eleştirilmiştir. En fazla eleştirilen konulardan ikisi ise genetiği değiştirilmiş embriyoların bir kadına implante edilmesi ve de etik kurul onayının uydurma oluşudur. Çin Hükümeti'nin bu çalışmadaki araştırmacıyı, 3 yıl hapis ve aynı zamanda ağır bir tazminat ile cezalandırmasının ardından konu ile ilgili tartışmalar farklı bir boyut kazandı. Bu derlemede; olguyu sunmayı, in vitro fertilizasyon tarihini, onun mevcut sonuçlarını, HIV tarihini, HIV ile enfekte kişilerin üreme haklarını savunmayı ve CRISPR/Cas9 tekniğini ve tehlikelerini sunmayı amaçladık. Son olarak ise bu vakayı Helsinki Deklarasyonu, Nürnberg Kodu ve İnsan Hakları ve Biyotıp Sözleşmesi dâhil olmak üzere uluslararası ve Türk Ulusal Etik Kurallarına göre eleştirel olarak değerlendiriyoruz. İnsan embriyolarının gen düzenlemesi hususunda daha sıkı kurumsal, ulusal ve uluslararası yönergelere ihtiyacımız olduğu kesindir. Ayrıca tıbbi ve biyolojik bilimlerin müfredatlarında, insan araştırmalarında CRISPR/Cas9 kullanımına dair güncellemeler için çeşitli önerilerde bulunduk. Bilimsel dayanağı yetersiz olan ve etik olmayan bir insan deneyi olmasına rağmen CRISPR/Cas9'un birçok insan hastalığının tedavisi için çok umut verici bir teknik olduğu sonucuna vardık. Bu nedenle, sağlıklı insanlar olma hedefimize ulaşmak için CRISPR/ Cas9 tekniği ile daha fazla hayvan deneyi teşvik edilmeli ve finanse edilmelidir.

Anahtar Kelimeler: Biyoetik; CRISPR/Cas9; insan genomu; HIV; IVF; embriyo; gen değiştirme
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