Companies: Editas  Excision Bio Therapeutics Prime Medicine. Pairwise. Tome Biosciences. EditCo
See also chimeric antigen receptors (CARs) under Cancer treatment
Programmable nucleases such as CRISPR-Cas9 make double strand DNA breaks (DSBs) that can disrupt genes by inducing mixtures of insertions and deletions (indels) at target sites. DSBs, however, are associated with undersired outcomes including complex mixtures of products, translocations and p53 activaiton. Moreover, the vast majority of pathogenic alleles arise form specific insertions, deletions or base substitutions tha require more precie editing technologies to correct. Homology-directed repair (HDR) stimulateed by DSBs has been used to insall precise DNA changes. HDR, however, relies on exogenous donor DNA repair templates, typically generates an excess of indels form end-joining repair of DSBs, and is inefficient in most therapeutically relevant cell types (T cells and some types of stem cells being important exceptions). (liu, Nature 2019, 576(7785): 149-157).
CRISPR-Cas componetns readily access the gehnome of bacteria as prokaryotes lack a nucleus. However, unmodified CRISPR-Cas components do not readily enter the nucleus of eukaryotic cells, wehre genomic DNA is located, which greatly limits the efficiency of DNA editing. A single nuclear localization signal (NLS) is typically sufficient to facilitate efficient nuclear entry of most prtoeins. However, multiple NLSs are necessary to drive Cas variants to the nucleus in eukaryotic cells, including Sterptococcus pyogenes (Sp) Cas9 and Neisseria meningitidis (Nm) Cas9, as well as base editors, prime editors, Cas12a, and nuclease dead Cas9. This may be because Cas9 is sequenstered in the cytoplams of mammalian cells, inn part, via interaction with the ribosome. Increasing the number of NLSs on Cas9 and/or increasing the amount of cytoplasmic guide RNA has the potential to outcompete ribosomal RNA binding and promote efficient nuclear localization of CRISPR-Cas9 variants. (Zylka, “Exploring the cytoplasmic retention of CRISPR-Cas9 in eukaryotic cells: the role of nuclear localizaiton signals and ribosomal interactions” CRISPR Journal, volume 00, number 00, 2025.)
Classes of CRISPR Nucleases:
In brief, CRISPR based gene editing reagents are generally used as two-component systems: a nuclease protein is complexed with a single-guid RNA (sgRNA) designed to target a specific site in the genome. Much work has gone into engineering both nucleases and guides to optimize function and stabilitiy across an array of cell types. The CRISPR associated nucleases most commonly used for double stranded DNA targeting belong to class II and can be put into two groups, type II and type V, that differ in the position of their protospacer-adjacent motif (PAM) vis-a-vis the spacer region (3′ vs. 5′) and the DNA ends that result from the clevage reaction (blunt vs. overhnag). (Lamothe, “Novel CRISPR-Associated gene-editing systems discovered in metagenomic samples enable efficient and specific genome engeering”, CRISPR Journal, 6(3), 2023)
Type II Nucleases:
The type II CRISPR-Cas system includes three components: (1) a crRNA molecule, which is called a “guide sequence” and “targeter-FNA”, (2) a tracr RNA, also known as an activtor-RNA and (3) a protein called Cas9. To alter a DNA molecule, the ssytem must acheive three intereactions: (1) crRNA binding by specific base pairing to a specific sequence in the dNA of interest (target DNA), (2) crFNA bing by specific base pairing at naother sequence to a tracer RNA, and (3) tracr RNA interacting with a Cas9 protein, which then cuts the target DNA at the specific site.
AÂ CRISPR-Cas9 system is a combination of protein and ribonucleic acid (RNA) that can alter the genetic sequence of an organisms. In their natural environment, CRISPR-Cas systems protect bacterai agaisnt infection by viruses. Te system is now being developed as a powerful tool to modify specific deoxyribonucleic acid (DNA) in the genomes of other organisms, from plants to animals. With CRISP, scientists can create mouse models of human diseases much quicker, study indivdual genes much faster and easily change multiple genes in cells at once to study their interactions.
Although Streptococcus pyrogenes Cas9 is a highly active gene editing enzyme, its use is complicated by a low editing specificity. Furthermore, Cas9 is derived from a Streptococcus bacterium, a very commonly pathogenic genus. As a result, between one third and half of people have a preexisting immune response to the Cas9 enzyme and thus are less than optimal candidates for a Cas9 based gene editing therapy. (Lamothe, “Novel CRISPR-Associated gene-editing systems discovered in metagenomic samples enable efficient and specific genome engeering”, CRISPR Journal, 6(3), 2023)
Base Editors:
Base editors generate targeted base conversions without requiring DSBs. Cystosine base editors and adenine base editors for example comine deaminases with CRISPR systems to produce C:G-to T:A and A:T to G:C base transcritions, respectively. (Liu, “The CRISPR-Cas toolbox and gene editing technologies” Molecualr Cell 82, 2022)
Prime Editors (Prime editing):
Prime editing relies on Cas9 and a reverse transcriptase.
Prime editors are powerful tools for installing base substitutions and precise DNA insertions and deletions. They are composed of two components: an engineered Cas9 nickase (H840A) reverse transcriptase (RT) fusion protein and a prime editing guide RNA (pegRNA). The pegRNA contains an RT template (RTT) encoding the desired edits and a primer binding site (PBS) for hybridization of the 3′ end of the nicked DNA strand to initiate reverse transcription. After reverse transcription, the RT template is reverse transcribed, forming a 3′ DNA flap followed by a 5′ DNA flap, and this enables the desired edit to be integrated into the target site. (Liu, “The CRISPR-Cas toolbox and gene editing technologies” Molecualr Cell 82, 2022)
liu, (Nature 2019, 576(7785): 149-157) discloses a search-and-replace genome editing technology called “prime editing” that mediates targeted insertions, deletions, all 12 possible base to base conversions and combinations thereof in human cells without requiring DSBs or donor DNA templates. Prime editiors (PEs) use a reverse transcriptase (RT) fused to an RNA programmable nickage and a prime editing guide RNA (pegRNA) to direclty copy genetic informaiton from an extension on the pegRNA into the target genomic locus. The DNA nicked at the target site to expose a 3′-hydroxyl group can be used to prime the reverse transcription of an edit-encoding extension of the engineered guide RNA (prime editing guid RNA, or “pegRNA) directly into the target site. These initial steps result in a branched intermedaite with two redundant single-stranded DNA falps: a 5′ flap that contains the uneditind DNA sequence and a 3′ flap that contains the edited sequence opied form the pegRNA. %’ flaps are hte preferred substrate for structure-specific endonucleases such as FEN1 which excises 5′ flaps engenerated during lagging-strand DNA syntehsis and long-patch base excision repair. Alternativley, the reduncant uneidted DNA may be removed by 5′ exonucleases such as EXO1. 5′ flap excision and 3′ flap ligation can drive the incorproation of the edited DNA strand, creating heteroduplex DNA containing one edited strand and one unedited strand. DNA repair to resolved the hteroduplex by copying the informaiton in the edited strand to the complementary strand will permanently install the edit.
DNA-Dependent Polymerase (DDP) Editing (DPE):
DNA-dependent polymerase (DDP) editing presents adnvatages over prime editing by allowing researchers to cale materials up for clinical use. DPE benefits fro the highly processive and accurate synthesis abilities of DNA polyemrases. The approach avoids a range of problems associated with prime editing: fewer erros, less reliance on a cell cycle due to higher dNTP affinity, and easier template synthesis.
–Click Editing:
An even newer form of genome eidint that relies on a DDP, a nickase Cas9 (nCas9) and a histidine-hyrophogic histidine (HUH) endonuclease to alter the geneome allows for mass screening of DNA templates and futher refines DDNA polymerase editing (DPE). Click editing adds HUH edonucleases to DPE. HUH endonucleases are smalle (10-40 kDa) proteins common across all domains of life and which are often found playing a role in replication. HUH enzymes are guided by 8-40 nucleotide ssDNA regoniction sequences. Click editors eploy HUH endonculeases for teplate recruitment to teh target site, which covalently and sequence specifically bind ssDNA. Click editing invovles 5 components: nCas9, a single guid RNA (sgRNA), an HUH endonuclease, a DDP and a click DNA (clkDNA). clkDNA guides the DDP and contains the edit of itnerest, which an sgRNA directs nCas9. In this way, clkDNA mimics the role of DPETs. Click editing follows a methodical set of steps to alter the geome. Frist, the click editor binds and nicks the genome at the target site. The, HUH tethers or “clicks” -clkDNA to the target site. The primer binding sequence of the clkDNA subsequently binds to the flap created by the nickase, allowing clkDNA to serve as a tplate for polymerization. After the primer has synthesized the new sequence, the click editor dissociates and leaes the edited flap behind. Finally the new sequence is integrated into the gebome. Using a DNA based template has a range of benefits over prime editing, which uses a long pegRNA to direct and initate its reverse trasncriptase appraoch. Click editing extends these benefits by removing RNA form teh template to facilitate easier synthesis. (Seren hough, “Polymerase editing ‘clicks’ together in trailbalzing study’ Tides Global, Oct 25, 2024.)
Applications:
See FDA Approved Cellular Therapies
Gene editing has been applied to cell therapy with many types of primary immune cells –especially T cells –via electroporation of Cas9 ribonucleoprotein particles (RNPs). Such engineering has been used to knockout the T cell receptor (TCR), checkpoint inhibitors, and ot knock in chimeric antigen receptors (CARs), among many examples. Gene editing systems (type II and type V) have also been used to edit B cells, NK cells, indicued pluripotent stem cells (iPSCs), and hematopoietic stem cells (HSCs). Lamothe, “Novel CRISPR-Associated gene-editing systems discovered in metagenomic samples enable efficient and specific genome engeering”, CRISPR Journal, 6(3), 2023)
HIV Gene Editing:
Manucuso et al. (“CRISPR based gene editing of SIV proviral DNA in ART treated non-human primates; Nature Communications 2020) discloses creating an adeno-associated virus mediated plasmid DNA vector that allows for simultaneous expression of Cas9 endonuclease and multiple guide RNA. The Cas9 endonucleas and gRNAs specifically recognize LTR and Gag region of the HIV-like simian immunodeficiency virus genome. Excision of large segments of the integrated proviral DNA spanning from cleavage site mitgates the chance of the replication -competent virus’s emergence.
Based on these promising results, Excision Bio Therapeutics has started clinical trials to evaluate the construct, termed EBT-101 as a potential cure of HIV infection.
Colesterol lowering/PCSK9:
Musunuro (“In vivo CRISPR base editing of PCSK9 durably lowers cholesterol in primates”  Nature, 2021) demonstrates durable editing in target organs of nonhuman primates is a key step before in vivo administration of gene editors to patients in clinical trials. Here we demonstrate that CRISPR base editors that are delivered in vivo using lipid nanoparticles can efficiently and precisely modify disease-related genes in living cynomolgus monkeys (Macaca fascicularis). We observed a near-complete knockdown of PCSK9 in the liver after a single infusion of lipid nanoparticles, with concomitant reductions in blood levels of PCSK9 and low-density lipoprotein cholesterol of approximately 90% and about 60%, respectively; all of these changes remained stable for at least 8 months after a single-dose treatment.
Deafness (Hearing Loss):
–Autosomal dominant deafness-50 (DFNA50) is a form of progressive hearing loss which starts with mild symptoms before getting significantly worse later in life. The condition is caused by a variant in the microRNA gene MIR96. A new CRISPR-Cas9 based treatment for FFNA50 has been desmontrated in an artile published in Science Translational Medicin (Zheng-Yi). The study showed that hearing loss was restored in mice after targeting and disrupting the DFNA50 causing version of MIR96. Chen’s team used an adeno-associated virsu (AAV) system to deliver Cas9 and a single guid RNA (sgRNA) specifically to teh cochlea in the inner ear, the region responsbiel for hearing. AAV has become a popualr choice for delivery becasue it is less likely to interate into the target cell. Moreover, different serotypes of AAV can be used to target specific parts of the body. On the other hand, the small cargo size of AAV prohibits the delivery of a large gene like traditional Cas9. To get around this limitation, the team used a specific kind of Cas9 derived form Staphylococcus aureus bacteria. This ortholog is smaller than the typical streptococcus pyogenes Cas9-making it an idea match for AAV delivery.
Sickle Cell Disease and beta-thalassemia:
–Casgevy (CRISPR Therapeutics & Vertex Pharmaceuticals): is a one time treatment for people age 12 and over for sickle-cell diesease as well as beta-thalassemia. Vertex recieved the FDA first approval for a CRIP based gene edited therapy, Casgevy for sickle cell disease. The following month, the FDA approved Casgevy to treat tranfusion dependent beta-thalassemia.
Beam Therapeutics also expects to conduct Phase I/II trails to asess its lead candicate BEAM-101 in severe sickle cell diseas.
Duchenne Mascular Dystrophy:
–ELEVIDYS (Sarepta Therapeutics): is a prescription gene therapy used to treat ambulatory children aged 4 through 5 years old with Duchenne muscular dystrophy (DMD) who have a confirmed mutation in the dystrophin gene. ELEVIDYS was approved under accelerated approval.
Animal Genetics:
Genus, a British animal genetics company with research facilites in Wisconsin and Tennessee, has developed a new generation of CISPR edited pigds that are resistant to procine reproductive and respiratory syndrome (PRRS) virus, a disease that has had a widespread impact on porcine populations around the world for decades. Several genes are invovled in viral infection, including CD163, which encoes the entry receptor for teh virus. In pigs, this particular protein is expressed on teh surface of macrophage and monocytes and mediates inflammation among other functions. A single modified CD163 allele was introduced into four geentically diverse, elete porcine lines. Genus scientifits injected CRISPR-Cas9 editing reagents into the genomes of pig zygotes. Their goal was to make a preice deletion in CD163 that removed a single expon encoding the domain that directly interacts with the virus. Importantly, the edit did not impact CD163’s function in the new population. The work produced healthy pigs that resisted PRRS virus infections. The company is now seeking regulatory approval in the US which is the only country which regulated intentional genetic alterations including single base pair deletions as an animal drug and reqires a new animal drug approval for commercialization. This regulatory path is very hard for small companies. Until the pigs are approved, they are considered unsalable.
Gene Editing in Plants:
Classical genome editing in plants involves a sgRnA guided Cas dsDNA nuclease with subsequent induction of the non-homologous end-joing (NHEJ) DNA repair pathway, frequently resulting in loss of function (LOF) mutaitons. Modulation or gain of function may be obtained through the use of sgRNA wity subsequent induction of the base excision repair pathway or by prime editor RNA (pegRNA) guided prime editors with subsequent induction of the NHEJ or the homology directed repair pathway, depending on cell type. Petersen “Strategies and Protocols for optimized genome editing in potato” CRISPR Journal, volume 00, number 00, 2024).
Diagnostics:
–Zika Detection:
Collins (“Rapid, low-cost detection of Zika virus using programmable biomolecular components” Cell 165, 1255-1266, 2016) demonstrate the rapid development of a diagnostic workflow for sequence-specific detection of Zika virus that can be employed in low-resource settings. Discriminatio of different viral strains at single-base resolution was achieved using a CRISPR-based tool. By simply boiling (95C) virsu samples for 2 min, sufficient quantities of RNA for amplication and detection were generated. NASBA is an extremely sensitive and has a proven track record in the field-based diagnostic applications. The amplificaiton process betgins with reverse transcription of a target RNA that is mediated by a sequence-specific reverse primer to create an RNA/DNA duplex. RNase H then degrades the RNA template, allowing a forward primer containing the T7 promoter to bind and initiate elongation of the complementary. strand, generating a double-stranded DNA product. T6-mediated transcription of the DNA template then creates copies of the target RNA sequence. Importantly, each new target RNA can be detected by a towhold switch sensors and also serve as starting material for futher amplication cycles. NASBA requires an initial heating step (65C), followed by isothermal amplication at 41 C. NASBA was performed on trigger RNA corresponding to Zika genomic regions for sensors 27B and 32B. Toehold switch sensors are programmable syntehtic riboregulators that control the translation of a gene via the binding of a trans-acting trigger RNA. The switches contain a hairpin structure that blocks gene translation in cis by sequestration of the ribosome binding stie (RBS) and start condon. Upon a switch binding to a complementary trigger RNA, sequenstraiton of the RBS and start condon is relieved, activating gene translation. To allow for colrimetric detection of trigger RNA sequencs, the sensors can be desigend to regulate translation of the enzyme LacA, which mediates a color change by converting a yellow substrate to a purpose product. Toehold switch sensors for sequence based detectin of Zika virus were generated using a modified version of a developed in silico design algorithm. The modifed algorithm screened the genome of the Zika strain prevalent in the American (Genbank: KU312312) for regions compatible with RNA amplication and toehold switch activation. The slected Zika genome regions were then computationally filtered to eliminate potential homology to the human transcriptome and to a panel of related virsues, incuding Dengue and Chikungunya. A total of 24 unique regions of the Zika genome compatible with downstream sensing efforts were identified. The presence of a train-sepcific PAm leads to the production of either truncated or full lenght trigger RNA, which differentially activate a towhold switch. The probability that a non-biased single nucleotide polymorphism (SNP) between two strains can be discriminated by CRISPR/Cas9 is 48%.