Over the last decade, as DNA-sequencing technology has grown    ever faster and cheaper, our understanding of the human genome    has increased accordingly. Yet scientists have until recently    remained largely ham-fisted when theyve tried to directly    modify genes in a living cell. Take sickle-cell anemia, for    example. A debilitating and often deadly disease, it is caused    by a mutation in just one of a patients three billion DNA base    pairs. Even though this genetic error is simple and well    studied, researchers are helpless to correct it and halt its    devastating effects.  
    Now there is hope in the form of new genome-engineering tools,    particularly one called CRISPR. This technology could allow    researchers to perform microsurgery on genes, precisely and    easily changing a DNA sequence at exact locations on a    chromosome. Along with a technique called TALENs, invented    several years ago, and a slightly older predecessor based on    molecules called zinc finger nucleases, CRISPR could make gene    therapies more broadly applicable, providing remedies for    simple genetic disorders like sickle-cell anemia and eventually    even leading to cures for more complex diseases involving    multiple genes. Most conventional gene therapies crudely place    new genetic material at a random location in the cell and can    only add a gene. In contrast, CRISPR and the other new tools    also give scientists a precise way to delete and edit specific    bits of DNAeven by changing a single base pair. This means    they can rewrite the human genome at will.  
    It is likely to be at least several years before such efforts    can be developed into human therapeutics, but a growing number    of academic researchers have seen some preliminary success with    experiments involving sickle-cell anemia, HIV, and cystic    fibrosis (see table below). One is Gang Bao, a bioengineering    researcher at the Georgia Institute of Technology, who has    already used CRISPR to correct the sickle-cell mutation in    human cells grown in a dish. Bao and his team started the work    in 2008 using zinc finger nucleases. When TALENs came out, his    group switched quickly, says Bao, and then it began using    CRISPR when that tool became available. While he has ambitions    to eventually work on a variety of diseases, Bao says it makes    sense to start with sickle-cell anemia. If we pick a disease    to treat using genome editing, we should start with something    relatively simple, he says. A disease caused by a single    mutation, in a single gene, that involves only a single cell    type.  
      In little more than a year, CRISPR has begun reinventing      genetic research.    
    Bao has an idea of how such a treatment would work. Currently,    physicians are able to cure a small percentage of sickle-cell    patients by finding a human donor whose bone marrow is an    immunological match; surgeons can then replace some of the    patients bone marrow stem cells with donated ones. But such    donors must be precisely matched with the patient, and even    then, immune rejectiona potentially deadly problemis a    serious risk. Baos cure would avoid all this. After harvesting    blood cell precursors called hematopoietic stem cells from the    bone marrow of a sickle-cell patient, scientists would use    CRISPR to correct the defective gene. Then the gene-corrected    stem cells would be returned to the patient, producing healthy    red blood cells to replace the sickle cells. Even if we can    replace 50 percent, a patient will feel much better, says Bao.    If we replace 70 percent, the patient will be cured.  
    Though genome editing with CRISPR is just a little over a year    old, it is already reinventing genetic research. In particular,    it gives scientists the ability to quickly and simultaneously    make multiple genetic changes to a cell. Many human illnesses,    including heart disease, diabetes, and assorted neurological    conditions, are affected by numerous variants in both disease    genes and normal genes. Teasing out this complexity with animal    models has been a slow and tedious process. For many questions    in biology, we want to know how different genes interact, and    for this we need to introduce mutations into multiple genes,    says Rudolf Jaenisch, a biologist at the Whitehead Institute    in Cambridge Massachusetts. But, says Jaenisch, using    conventional tools to create a mouse with a single mutation can    take up to a year. If a scientist wants an animal with multiple    mutations, the genetic changes must be made sequentially, and    the timeline for one experiment can extend into years. In    contrast, Jaenisch and his colleagues, including MIT    researcher Feng Zhang (a 2013 member of our list of 35 innovators under    35), reported last spring that CRISPR had allowed them to    create a strain of mice with multiple mutations in three weeks.  
    
    Genome GPS  
    The biotechnology industry was born in 1973, when Herbert Boyer    and Stanley Cohen inserted foreign DNA that they had    manipulated in the lab into bacteria. Within a few years, Boyer    had cofounded Genentech, and the company had begun using E.    coli modified with a human gene to manufacture insulin for    diabetics. In 1974, Jaenisch, then at the Salk Institute for    Biological Studies in San Diego, created the first transgenic    mouse by using viruses to spike the animals genome with a bit    of DNA from another species. In these and other early examples    of genetic engineering, however, researchers were limited to    techniques that inserted the foreign DNA into the cell at    random. All they could do was hope for the best.  
    It took more than two decades before molecular biologists    became adept at efficiently changing specific genes in animal    genomes. Dana Carroll of the University of Utah recognized that    zinc finger nucleases, engineered proteins reported by    colleagues at Johns Hopkins University in 1996, could be used    as a programmable gene-targeting tool. One end of the protein    can be designed to recognize a particular DNA sequence; the    other end cuts DNA. When a cell then naturally repairs those    cuts, it can patch its genome by copying from supplied foreign    DNA. While the technology finally enabled scientists to    confidently make changes where they want to on a chromosome,    its difficult to use. Every modification requires the    researcher to engineer a new protein tailored to the targeted    sequencea difficult, time-consuming task that, because the    proteins are finicky, doesnt always work.  
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Genome Surgery