Discovered as an adaptive immune mechanism in bacteria – CRISPR, it stands for ‘Clustered Regularly Interspaced Short Palindromic Repeats’. Gene editing was labor intensive and limited to laboratories with advanced molecular biology tools, prior to the development of CRISPR techniques. The technology influences relatively every territory of medicine and also the field of plastic surgery today. In the field of genetic engineering and treatment, CRISPR genome editing technique guarantees to bring a revolution.
According to a paper in the November issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS), CRISPR has potential advances ranging from prevention of craniofacial malformations to therapeutic skin grafts, to new types of rejection-free transplants.
Dr. Liao along with the co-authors of a special regenerative medicine article highlight the potential uses and impact in plastic and reconstructive surgery after reviewing the history and mechanisms of CRISPR genome editing. “CRISPR gene editing is revolutionizing the potential of gene therapy due to its simplicity, specificity, efficiency, low cost, and versatility”, Dr. Liao and co-authors write. “Potential applications of CRISPR are numerous and will certainly impact plastic and reconstructive surgery”. As per the authors,
CRISPR Has Eminent Implications For Plastic Surgery In These Key Areas
- Craniofacial Malformations – Basic science studies using CRISPR techniques have already led to new insights into craniofacial developmental pathways. CRISPR enables quick identification of individual gene mutations, and may one day lead to the ability to correct mutations and prevent the development of cleft lip, cleft palate, and other congenital malformations.
- Wound Healing and Tissue Repair – Gene therapy is a promising approach to enhancing wound and tissue healing. In addition to accelerated healing of skin wounds, CRISPR may lead to new approaches for repair and regeneration of bone, cartilage, nerve, and muscle.
- Cell Therapy and Tissue Engineering – Genetic techniques may enable the creation or modification of the patient’s own (autologous) cells to graft or replace damaged tissues, stimulate cell development, or modulate immune functions. “[Techniques] of creating skin grafts with therapeutic potential would have widespread impact in reconstructive surgery,” Dr. Liao and coauthors write.
- Flap Biology and Transplants – In addition to modifying tissue flaps, gene editing with CRISPR may make it possible to reprogram vascularized composite allotransplants—such as the face or hand transplants—to promote tolerance and prevent rejection by the recipient’s immune system. Similar immune modulation approaches might also promote tolerance of tissues from animal donors (xenotransplantation).
Though many challenges are yet to be seen ensuing further clinical advances with CRISPR gene editing, that includes potential “off-target” effects, FDA regulation and high costs, and ethical issues related to genetic editing of human cells and tissues, as per emphasized by Dr. Liao and colleagues. Furthermore, the authors write, “The ASPS and its members should become stakeholders as well, and participate in future debates on the ethical use of CRISPR for the betterment of our patients.”