Medicine lies at the forefront of human necessity- there is always more to cure and beyond this, always a way to make pre-existing cures more comfortable or efficient. As in the past many would argue our most important medical developments to be the discovery of antibiotics or the vaccine. Harvard Medical School has an excellent list of important past discoveries that you may not know about such as the first public demonstration of anaesthesia in surgery in 1846 or the advent of human blood storage in 1964 [1]. With such a past behind us, what future can we predict in medicine? What advances are being made right now? Let’s have a look.

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The Genome News Network succinctly describes the significance of 1977 as the year “Walter Gilbert (1932-) and Frederick Sanger (1918-2013) [devised] techniques for sequencing DNA” [2], which marked the beginning of specific human intervention with DNA (disregarding the random blasting of plants with radiation and hoping for the best that people killed time with a few years prior [3]). Following this, starting in 1990, The Human Genome Project (HGP) was completed in April 2003, described by Genome.gov as having given us the “ability, for the first time, to read nature’s complete genetic blueprint for building a human being” [4].

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CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats. In extremely simple terms, CRISPR uses a protein known as CAS9 found in bacteria which is generally used as a defence mechanism against viruses. The protein scans any DNA It finds in the bacteria and compares it to an archived copy of a virus made in the bacteria in prior attacks. If a 100% match is found then this DNA is segmented in such a way to make it useless [5]. If that doesn’t make too much sense to you well, it doesn’t have to- the important takeaway is that you recognise the protein can recognise and edit DNA. What makes this relevant though is the fact that it can essentially be ‘programmed’, with the protein being much more precise than other DNA altering proteins. This allows scientists to choose what DNA the protein should alter, working in both living and dead cells in any cell from bacterial to human [6]. With such a precise way to affect DNA, it has been proven in the past that even retroviruses (viruses that hide inside cells) such as HIV can be nullified in the body with clinical trials on mice showing around 40% of subjects to have undetectable levels of HIV 9 weeks after the trials took place according to Nature [7]. It was also pointed out in this study however that “Gene editing was able to eliminate HIV only after the drugs had suppressed the virus”.

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In future, it is expected that human trials of the technique could in future lead to the elimination of certain cancers by removing three genes from cancerous cells. Nicolleta Lanesse of Live Science states that “Two of the genes contain instructions to build structures on the cell surface that had prevented the T cells from binding to tumors properly”, continuing to state that the third of these genes “provided instructions for a protein called PD-1, a kind of ‘off switch’ that cancer cells flip to stop immune cell attacks” [8].

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Russian biologist Denis Rebrikov made headlines in June 2019 with the controversial statement that he intended on using CRISPR to edit the genes in human embryos with the goal of giving the resulting babies a HIV resistance. This has garnered much backlash from the general scientific community on an ethical basis, with prior criticisms of the He Jiankui affair wherein two genetically modified babies were born. This was regarded as irresponsible, with a joint letter from 122 scientists published by Luo Yan of Yicai stating “Any attempt to directly transform human embryos and try to produce babies before they are rigorously further tested is a huge risk” [9].

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The current state of gene editing lives and dies on this aforementioned rigorous testing. Whilst many hurdles, both ethically and practically block the way of progress in this field, the technology exists and provably works. With many advancements (such as the use of other proteins for faster simultaneous gene editing [10]) optimising this technology further, applications, both tested and hypothetical are quickly becoming much more attainable. With many cancers and retrovirus already facing their most formidable foe yet, one can only imagine how much more this technology will be able to accomplish when better understood.