China has a reputation for going fast – sometimes too fast – with CRISPR. “
Tetsuya Ishii , bioethicist at the University of Hokkaido.
According to information from the MIT Technology Review, a Chinese team is about to reveal that it has reimplanted human embryos modified by nucleases, in this case of the CRISPR type. The announcement could be made tomorrow, at the second international summit on the edition of the human genome, in Hong Kong. What is it about? From a clinical trial aimed at modifying the CCR5 gene, in order to immunize a person against the AIDS virus, HIV.
The announcement caused trouble, to say the least. In a press release, the Southern University of Science and Technology which employs the researcher Jiankui He responsible for the experiment denounces it: the University was not aware; the research took place outside the campus and it is, for those responsible for the institution of a case of scientific misconduct which will not remain without reactions. It also seems that the Academy of Sciences is withdrawing from the summit on the human genome.
Fetuses with transformed immunity
This is not the first time that a Chinese team has used CRISPR-Cas9 genome editing technology to target this particular gene. Indeed, some people with a particular genetic profile (they are said to be homozygous on the CCR5 Delta 32 allele), generate white blood cells ( leukocytes ) whose surface cannot be reached by certain viruses, including that of AIDS. The challenge of this research is, therefore, to give birth to children with innate immunity to these diseases.
This groundbreaking news is a sudden acceleration in an economic and ethical controversy between China and the West over a technology that will undoubtedly revolutionize agriculture, medicine, and possibly the species. human. The debate has escaped from the laboratories for several years. The New York Times headlines this as early as 2015: “A scientific ethical divide between China and the West” and quotes Yi Huso of the Center for Bioethics at the Chinese University of Hong Kong: “People say they cannot stop the genetics train in China because it is going too fast. ”
Beyond fantasies, what can we say today about the precise? First of all, stereotypes should not be projected on the Chinese example. The use of supernumerary embryos in China is no more liberal in China than in the United States. On average, 83% of Chinese couples using IVF decide to keep the embryos between 0 and 3 years after having children, while 62% of American couples keep their embryos between 0 and 5 years after giving birth. In the USA, the Biomedicine Agency recalls that in 2015 out of 220,000 frozen embryos, 20,000 supernumerary embryos were offered by research couples, of which less than 10% had actually been used.
The CRISPR technology applied to these embryos has led to a technological race to “genome editing” between major scientific powers. Carl June, professor of immunotherapy at the University of Pennsylvania, compares it to the rivalry between the United States during the conquest of space in the mid-1950s: “I think that will trigger a Sputnik 2.0, a biomedical duel on progress between China and the United States, which is important because competition generally improves the end product. ”
These advances are not made ex Machina. China has indeed been investing massively in the life sciences sector for more than 20 years. The Ninth Five-Year Plan (1996-2001) already mentions the importance of biotechnology. The current plan ( Thirteenth Five-Year Plan ) is even more explicit. It contains a section dedicated to the development of efficient and advanced biotechnologies (发展 先进 高效 生物 技术) and lists among the key sectors “genome editing technologies” (基因 编辑 技术) as means of “placing China at the border of innovation in biotechnology and becoming a leader in international competition in this sector ”(提升 我国 生物 技术 前沿 领域 原创 水平 ， 抢占 国际 生物 技术 竞争 制高点).
Research on the embryo is framed in China by a text, “ethical rules for research on human embryonic stem cells”, published in 2003 by the Ministries of Science, Technology and Health. Article 3.9, in theory, prohibits the reimplantation of a genetically modified embryo for reproductive purposes. If its terms are largely inspired by international standards, article 11 specifies that the interpretation of this text is made by the administrations of the ministries in charge and that it precedes its implementation. The value of this text in the hierarchy of standards is difficult to locate, in particular, because of the institutional system which comes into play for all these questions.
In theory, three actors are important in the political system of research and application in biomedical matters in China: the Ministry of Science and Technology, the Ministry of Health, and the Health Security Agency (responsible for food, drugs and cosmetics). In reality, however, other players have a strong presence. The regions are responsible for interpreting and enforcing the “recommendations” issued by the departments, sometimes with quite significant variations, as was the case with stem cells. The Chinese National Academy of Medicine is also a powerful institution, with a network of hospitals, faculties and laboratories throughout China.
A major factor also adds to this complexity, that of military research. The medical faculties and military hospitals are managed by the health section of the general logistics department of the People’s Liberation Army (PLA). This department would be quasi-sovereign to interpret and implement the national recommendations formulated by the ministries. This latitude, and the APL’s ability to work with the private sector on technological frontier issues, has already been revealed with the use of CRISPR ex vivo in the context of clinical trials.
The Wall Street Journal revealed in January 2018 that 86 patients underwent CRISPR nuclease surgery. Dr. Wu, president of the Hangzhou Hospital Cancer Center and interviewed by the WSJ for this investigation, explains that his patients are suffering from terminal cancer: CRISPR is “double-edged […] if we don’t try, we’ll never know. ” But this intervention was, still according to this article, not the first. A Chinese startup, Anhui Kedgene Biotechnology, is said to have convinced the People’s Liberation Army hospital number 105 in Hefei to try ex-vivo anticancer therapies based on CRISPR.
In the Western world, it is the Nuffield Council on Bioethics that has best taken the measure of the institutional and political challenges of editing the human genome in vitro. His latest report on the issue is accompanied by a publication dedicated to the governance of these issues in China.
In the USA, this subject is situated in the hollow of the Estates-General of Bioethics, one of the nine chapters mentioning “genetic scissors”. The preliminary analysis of the results of the consultation organized online by the National Ethics Advisory Council seems to show that French society is still very divided on these subjects. If the various polls struggle to report the existence of a consensus on questions whose stakes are too little popularized to be clearly debated, this consultation indicates that very structured social groups have taken up these questions and are preparing to fight politically.