The future of medicine (and of the human) is in genetics

In an article published this past Sunday, the website SingularityHub highlights “why editing our own biology will be the next wave in medicine”. In other words, beyond just thinking about treatments or disease prevention, the proposal for the future of medicine and human health (or the human being itself) is to edit our biology and be able to modify what is not right—from a health perspective. Jane Metcalf, co-founder of Wired magazine and founder of the company Neo.Life, mentioned in her talk at the Exponential Medicine event at Singularity University that, however, what we observe is how the history of innovation is incredible, until we reach the 20th century.

What Metcalf means is that, at the beginning of the last century, doctors began performing blood transfusions and complex surgeries, and started eradicating infectious diseases with sterilization, antibiotics, vaccines, and painkillers. However, by the middle of the century, scientists began to gain a deeper new understanding of the human body, knowledge which is being used today to manipulate the fundamental processes of living beings.

As Jason Dorrier describes in his article, “this is a familiar story, but it is one that suggests something radical. Just as physics and chemistry gave humans power over the inanimate world, biology is giving us the ability to modify living systems, from viruses to bacteria, animals, and people.” And that is why Metcalf thinks design is the next great innovation in medicine.

“We will fight disease and improve human health by designing biological systems from scratch. ‘We can design embryos. We can edit genes in humans. We have synthetic biology. So we are really looking at the design of the human future,’ said Metcalf.”

To this end, one of the best-known tools is the CRISPR gene-editing technique. Scientists are increasingly able to manipulate genes using this technique, and as it is refined, ways are also being found to create genetic treatments for people, for example, who suffer from cancer.

On the other hand, another issue inevitably raised by Metcalf during her talk was the case of the Chinese scientist Dr. He Jiankui, who used CRISPR to edit human embryos to make them immune to HIV and potentially other traits that were not, however, intentional. These children were born last year, and as the scientific community learned of this incident, Jiankui’s work was universally condemned by the scientific community for its recklessness and lack of ethics. However, there was also another case in Russia of a scientist publicly declaring his intention to use CRISPR to edit human embryos.

From an ethical standpoint, therefore, we are not talking about the technical or technological possibility of doing something, but rather about the consequences, and whether the tools are truly ready and refined enough to be used on human beings. And this was a question already anticipated by George Church, considered by Metcalf to be one of the most prolific bioengineers of our time. According to the speaker, the researcher is investigating fifty types of alleles that are beneficial to humans, especially for preventing cardiovascular disease and Alzheimer’s. Other types may even improve memory and learning, as well as extend telomeres—which means an improvement in longevity, for example.

However, Metcalf does not believe that these edits and designs will be reserved only for existing genes. In reality, there are biological systems created synthetically from scratch that could have a new impact on society and on the very conception of what it means to be human. For Andrew Hessel, CEO of Humane Genomics and a professor of nanotechnology and biotechnology at Singularity University, this type of work is being increasingly refined.

Hessel cited the company Twist Bioscience, which has been using synthetic biology to manufacture custom DNA sequences on a large scale. Customers can create and purchase their own sequences and have them delivered by mail. “With tools like this, synthetic biologists have begun to create synthetic enzymes and proteins, which have proven functional—like their natural counterparts—in bacteria,” writes Dorrier.

As for Craig Venter, who became known precisely for his work on human genome sequencing, there have been announcements since 2010 that they are reproducing synthetic bacteria, something that anticipated his 2016 work with “minimal” synthetic cells—that is, improvements on the smallest known genomes, which have no natural counterpart. In 2019, however, Venter surprised everyone with a new achievement: the researcher was able to create E. coli bacteria synthetically from a base of four million genomic pairs, which is four times larger than his 2010 feat, and using only 61 codons instead of 64. The next step, already underway, is the creation of synthetic eukaryotic cells, thus anticipating the ultimate goal: the possibility of creating human genomes from scratch, hence the project co-founded by Hessel and titled Genome Project-write (GP-write). According to him:

“Literally, in ten years, we have advanced from the synthetic creation of proteins to the creation of eukaryotic cells. Once we can make complete chromosomes and, well, there are only 23 of them. It won’t be long before we run into the human genome.”

But although this type of achievement will take some time, it is important that the conversation be started today, both to attract more minds to the research and for critics and thinkers to consider these technological inventions and achievements from an ethical point of view. In science fiction, we have examples from Brave New World to Gattaca that have brought us extreme points of view on tangible possibilities arising from technological achievements like those envisioned by bioengineering and synthetic biology. In other words, it is better to be surprised today to think about tomorrow and not be threatened in the future.