Biotech: Designer Babies

There are more than two million couples that are infertile just in the USA. Worldwide, there are tens of millions. The most common procedure for these couples to have a baby is "in-vitro fertilization" (IVF). The first "test-tube baby" was born in 1978 in Britain: Louise Brown. There are now thousands of "test-tube babies". But IVF is an unreliable procedure, successful for about 20% of couples, and it is a painful procedure for the woman. PGD (preimplantation genetic diagnosis) is a procedure that combines IVF and genetic screening. The procedure is IVF (eggs are taken from a woman's ovaries and fertilized in the laboratory with the man's sperm), but PGD includes the genomic testing: after three days the embryos already contain all the genetic information that the scientists need to determine the future health of that baby. PGD immediately tells the scientist if the embryo has any genetic defect. PGD was the result of research by Mark Hughes at Baylor College of Medicine in Texas, Robert Winston at Imperial College London, and Alan Handyside at the University of London. Originally, PGD was conceived to help couples who carry genetic disorders: the risk that their children will have a horrible disease is high, and PGD is a way to make sure that their babies will be healthy. Another important use of this technique is to help parents who have a child with a disease that can be cured only with a transplant from a healthy donor. This procedure can be used to "design" a baby who will be a healthy sibling of the child: that's the best possible donor. Handyside is the one who in 1989 carried out the PGD procedure that led to the birth of the first PGD baby in 1990 (in that first case PGD was simply used to pick the sex of the baby because the parents needed a daughter to avoid a disease that only affects boys). In 2014 there were already 3,000 PGD babies, i.e. 3,000 humans who have been "designed" in the laboratory. Mark Hughes now heads the Genesis Genetics Institute in Detroit, the leading provider of PGD.

The ethical problem with these procedures is that the laboratory creates a number of embryos and then only one is kept. In other words, all the other embryos are killed. The scientists pick the healthiest one. Of course, this means that the parents too could pick an embryo and kill all the others. Using IVF and PGD the parents can create dozens of embryos and then pick the ones that (who?) will become tall, or blonde, or more similar to granpa; or someday, when we know more about the relationship between genes and intelligence, they could pick the ones who are more likely to become a scientist, or a painter, or a business man. CRISPR makes it easier and easier to edit genes out. So you can "design" the baby that you want. But it also means that you kill all the embryos that you don't want. All of this because we invented a way to create embryonic stem cells via in vitro fertilization. In fact, someday it will be possible to do all of this without in vitro fertilization. At the end of 2015 a new technique called "in vitro gametogenesis" (IVG) has been tested in mice in Japan by Katsuhiko Hayashi of Kyushu University. This technique allows scientists to create both eggs and sperm in the laboratory. They took skin cells from the mice and created eggs and sperm, then fertilized the eggs to create hundreds of embryos and finally implanted the eggs into a female mouse, and several healthy pups were born. In 2012 Hayashi, working in the team of Mitinori Saitou at Kyoto University, had already discovered how to reprogram skin cells to behave like the cells that generate eggs, and earlier in 2016 Yayoi Obata's team at Tokyo University of Agriculture found out how to turn these cells into eggs without placing them into a female body. A few weeks later Hayashi combined the two procedures and obtained the embryos.

You can use either Shinya Yamanaka's technique or Shoukhrat Mitalipov's technique to reprogram adult cells, such as skin cells, to behave like embryonic stem cells. Then you can use Hayashi's procedure to program these stem cells so they will become eggs or sperm. Then you can fertilize the egg and you get an embryo. In fact, usually the scientists produce many embryos, even hundreds. The goal is to select the "best" one.

This has been done only in mice, but in 2014 Jacob Hanna in Israel has already created the primordial human cells needed to generate human eggs. The next step (to generate the eggs, fertilize them and obtain the embryos) is not far away. Hanna is working with Azim Surani at Cambridge University to complete the cycle.

As Hank Greely has written in his book "The End of Sex and the Future of Human Reproduction" (2016), procedures like IVG will complete the process of separating sexual intercourse and reproduction. In the future a doctor will only need a few cells from a woman's skin and a few cells from a man's skin to create as many embryos as desired. Then these parents will be told the "features" of each embryo and pick their favorite. IVG can even create eggs from the skin cells of a man, and sperm from the skin cells of a woman. IVG will allow lesbians to have babies. It will even allow a woman to be both the father and the mother of a baby, a uniparent (although this presents the same genetic problems of incest).

Imagine a computer program that allows the parents to play with 100 different embryos: the parents can see a simulation of how each embryo will look like at the ages of 5, 10, 15 ,20... 80. The parents can simulate the life of each embryo and then decide which one they want to be. All the other embryos get thrown in the garbage.

That day is not far away. In 2013 the first "designer baby" was born, a baby boy named Connor: his parents carefully selected one embryo out of seven grown in the laboratory of Dagan Wells at the University of Oxford. All the other embryos were thrown in the garbage.

I personally don't blame the scientists for "playing God": every doctor plays God when s/he saves the life of someone who is dying of a disease. But society will be truly disrupted when it becomes possible to "design" babies, and it is not clear what the rights and the duties are. Should the parents have the right to choose which embryo will live and kill all the others? And nobody can ask a baby if she wants to be a genetic experiment. someone could take a paper coffee cup that you casually tossed in the trash and turn you into a parent without your knowledge or consent. I am not sure that i would like to be the product of parents who wanted to program my beauty, my intelligence, my skills and maybe even my hobbies.

In 2015 Junjiu Huang's team at Sun Yat-sen University in Guangzhou used CRISPR to edit the genes of a human embryo but failed to produce a working embryo: some of the cells did not have the edited gene and some cells had damaged DNA ("CRISPR/Cas9-mediated Gene Editing in Human Tripronuclear Zygotes", 2015). In 2017 Shoukhrat Mitalipov's team succeeded: they removed a gene that causes a hereditary heart defect (hypertrophic cardiomyopathy) from a number of embryos without damaging the rest of the DNA. We are not too far from the day when scientists will implant gene-edited embryos in women.

Greely argues that the "killer app" of synthetic biology will be the procedure to avoid rare diseases in babies (there are 6,000 rare diseases, with a chance of about 1% that your child will have one). He then argues that the same killer app will be used to treat infertility, and to give children to lesbian parents. Once it is approved, the social benefits of having healthy babies will become obvious: babies with fewer diseases mean lower costs for health care (especially later in life) and fewer epidemics. Greely thinks that states will provide something like IVG for free because of its public health benefits (exactly like vaccines are mandatory). Imagine a society in which there are no more disabilities. George Church, in his book "Regenesis" (2012), envisioned a factory-style process to produce humans who will be immune to all viruses.

But what willl happen to the others? Will these superhumans, equipped with a superpowerful immune system and with the perfect genes, be willing to live among regular humans who get sick and spread diseases, or with humans who are born phisically handicapped and are a financial burden on the healthy ones? Will these perfect humans be willing to pay taxes that help cure the illnesses of regular humans?