
Crispr Gene-Editing May Offer Path to Cure for HIV, First Published Report Shows - pseudolus
https://www.npr.org/sections/health-shots/2019/09/11/759369190/crispr-gene-editing-may-offer-path-to-cure-for-hiv-first-published-report-shows
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Yuval_Halevi
Many times when I see this kind of articles about cure for HIV and cancer I do
some research, get to the page of the project that work on the cure and
understand that we are still really far from getting to a point wherer there
is a cure and it's just a marketing tricks they do to raise funds for their
research

I support this kind of innovation and understand that the marketing buzz is
necessary for the projects to raise funds

just keep in mind that those titles sometimes are pretty far from reality

~~~
dogma1138
Unlike cancer we do know the mutation which protects against HIV and about
2-4% of the population has it so it’s somewhat much simpler if you can
actually use it.

That particular receptor which the mutation affects is also what some HIV
drugs especially the post exposure ones target.

Edit: looks like 2-4% of Europeans have the mutation world wide population is
closer to 1%

[https://en.m.wikipedia.org/wiki/Innate_resistance_to_HIV](https://en.m.wikipedia.org/wiki/Innate_resistance_to_HIV)

~~~
esturk
Exactly. A Chinese doctor was ostracized for effectively programming a zygote
to be immune to HIV. Theoretically this should work for human adults. And not
everyone need it too once a community achieve herd immunity.

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DrScientist
Three challenges with CRISPR:

\- find right change to make

\- make that change in target cell without any off-target changes to other
genes.

\- efficiency - being able to change enough of the cells to have the desired
effect.

The last one is probably the hardest if the cell type isn't something you can
easily take out of the body, change, grow up and put back.

~~~
The_rationalist
What are the "high score" for efficiency? Did researchers tried and were
successful at modifying a whole organ, a whole body?

~~~
DrScientist
The human body contains 35-40 _trillion_ cells.

By far the best way to make a whole body change would be to change one cell (
the embyro/egg/sperm ) and let nature take it's course - however that has the
'playing god with human evolution' concern.

Delivery mechanisms are key - you have to get your therapeutic _inside_ each
cell - this is hard and even harder to do in a cell type specific way.

It's much easier to do ex-vivo than in-vivo: ( see the diagram on this page )
[http://www.crisprtx.com/gene-editing/therapeutic-
approach](http://www.crisprtx.com/gene-editing/therapeutic-approach)

How many cells you need all depends on the biology of what you are trying to
do - there is no universal answer.

So you might need a small number cells if you are changing the messages the
changed cells send to other cells through control networks.

In other cases, where the change only changes that cell - you might need to
change a large number to see an effect.

~~~
airstrike
> 'playing god with human evolution' concern

Don't mean to derail this entire thread, but even as someone who believes in
God, I find it increasingly harder to understand what _objectively_ is wrong
about these purported ethical dilemmas (e.g. cloning)

~~~
judah
> I find it increasingly harder to understand what objectively is wrong about
> these purported ethical dilemmas (e.g. cloning)

Believer in God here, and, like you, I find these "playing God" concerns to be
largely unfounded, and often based in fear-of-the-unknown more than
objectivity.

In the 18th and 19th centuries, some religious groups opposed surgery because
it was playing god; "disfiguring the divine image." But today, we religious
people almost invariably welcome such medical advances: the good they do far
outweighs any theoretical fear-based concerns. I think the same will happen
with modern medical advances.

And, theologically in the Jewish and Christian Bible, God has given humans
dominion over nature. I see medical advances -- including surgery, blood
transfusions, vaccines, and yes, gene editing -- as exercising that dominion
to help heal people and reduce suffering.

~~~
DrScientist
Gene editing on an embryo involves making a choice for an unborn person
without possibility of consent - and their children, and their children etc.

That assumption of knowing better than the person affected is 'playing god' in
a way that doing a surgical procedure on a consenting person isn't.

Obviously that stuff is already done today - abortion or medical intervention
at an early stage where the parent acts on behalf of the person.

One of the things that's different is the scope and power of these techniques.

Look at the diversity of domestic dogs, from great danes to toy dog breeds -
that all came through selective breeding from the same wolf ancestor in a few
thousand years.

Also remember that humans are 99% the same as chimps at the DNA level and
about 85% with mice.

Direct, untrammeled genetic modification of humans could unleash huge changes
in a very short time.

Until we are clear about how we want to manage that, it's easier to have a
moratorium.

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criddell
Since HIV is a virus, does that mean the same tools could be used for other
viruses? Is there any hope of wiping out influenza or the common cold?

~~~
bitwize
CRISPR is used against a wide range of viruses all the time -- by bacteria.

There isn't a reason why it couldn't be used against other viruses, although
it may be more economical to sip chicken soup for a cold and keep your flu
shots up to date.

~~~
criddell
I remember reading something one time where people were discussing if the cold
could be eradicated by having everybody on the planet stay home for 2 weeks. I
don't remember what the answer was though...

~~~
schoen
It looks like there are some old Reddit and Quora threads where people discuss
this. Some answers there seem to be

* no because of non-human animal hosts for some viruses

* no because everyone would die if everyone actually stayed home for 2 weeks

* no because some people might be long-term carriers of some viral strains (maybe because of compromised immune systems?)

* no because people's homes aren't properly isolated from one another (e.g. within an apartment building)

* no because a virus could slowly spread between unlucky members of a single household and thereby persist within the household for many weeks at a time

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reportgunner
Scientists were not sure if it's safe to use Crispr on people, the chinese
tried it and now we know that someone has tried it. - that's about all of the
info in the article

~~~
hansjorg
> the chinese tried it

"The chinese", really? That was one single rogue Chinese scientist.

~~~
tomasato
> The first trial of CRISPR in humans took place in China in 2016, when Lu
> You, a physician at Sichuan University, put gene-edited cells into a lung
> cancer patient. Since then, other Chinese trials have moved forward, though
> not much is known about them.

> Last year Chinese researcher He Jiankui caused a global outcry ...

Ethics aside, it’s definitely more than one Chinese scientist working in this
area.

[https://www.scientificamerican.com/article/despite-
controver...](https://www.scientificamerican.com/article/despite-controversy-
human-studies-of-crispr-move-forward-in-the-u-s/)

------
vagab0nd
I know this question might not apply to the article, but in general, how does
Crispr work on adults? Does it change the DNA of all the cells in the body?

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chriswwweb
Oh wow this reminds me so much about that article I read some time ago about a
chinese scientist who had edited genes of babies (he actually altered a gene
in IVF embryos): [https://www.sciencemag.org/news/2019/08/untold-story-
circle-...](https://www.sciencemag.org/news/2019/08/untold-story-circle-trust-
behind-world-s-first-gene-edited-babies)

So editing genes of adults is ok but babies is not? This article sounds so
positive and supportive of the act ... I'm a bit confused.

~~~
mrob
>So editing genes of adults is ok but babies is not?

Adults can consent.

~~~
chriswwweb
true, that makes sense ... I'm not a gene or biology specialist, but if you
change the gene of a human and he has kids, the kids will inherit the
modification, right? so my problem with all these gene manipulations is that
the more we do and the more it will impact future generations and who knows
what the impact on those will be? So for me having the adult consent is not
enough as the impact is not just on him but potentially much greater.

~~~
tcbawo
Gene manipulation of an adult likely would target a subset of overall tissue.
Although, ethics of modifying reproductive tissue could be an issue.

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eternalny1
So the headline talks about HIV but the article states it cured cancer and
didn't do anything to HIV.

~~~
apendleton
Crispr didn't cure the cancer, the bone marrow transplant did; bone marrow
transplants (without Crispr) are the standard of care for treating this
cancer. The fact that the bone marrow transplant was necessary for the cancer
gave the researchers an opportunity to also try out this HIV treatment, which
requires a bone marrow transplant that would ordinarily be too high-risk to be
justifiable on its own. This was a very early-stage trial, probably not
expected to be curative; they were just seeing if the method in general was
safe, and did _anything._ It apparently was safe, and successfully conferred
the desired mutation to at least some of the patient's immune cells (so it did
something), but not enough of them to be curative. It sounds like future
trials will focus on improving efficacy.

