目錄 總論 1 基因組編輯應(yīng)用和政策問(wèn)題概述 2 人類(lèi)基因組編輯的應(yīng)用 4 監(jiān)管人類(lèi)基因組編輯的原則 10 建議 12 1 概述 14 研究現(xiàn)況 16 研究背景 19 研究方法 25 報(bào)告概要 25 2 人類(lèi)基因組編輯監(jiān)管的總體原則 27 人類(lèi)基因組編輯的監(jiān)管原則 27 美國(guó)基因治療技術(shù)的監(jiān)管 32 其他國(guó)家的監(jiān)管細(xì)節(jié) 53 總結(jié)和建議 53 3 基因組編輯技術(shù)的基礎(chǔ)研究應(yīng)用 57 基因組編輯基本方法 57 基因組編輯技術(shù)的飛速發(fā)展 63 人類(lèi)細(xì)胞和組織基礎(chǔ)實(shí)驗(yàn)研究進(jìn)展 65 哺乳動(dòng)物繁殖與發(fā)育基礎(chǔ)實(shí)驗(yàn)研究進(jìn)展 66 基礎(chǔ)研究中的倫理和監(jiān)管問(wèn)題 75 總結(jié)和建議 76 4 體細(xì)胞基因組編輯 78 研究背景 79 基因編輯較傳統(tǒng)基因治療和早期方案的優(yōu)勢(shì) 81 基于核酸酶的同源與非同源重組編輯修復(fù)技術(shù) 85 人類(lèi)體細(xì)胞基因編輯技術(shù)的潛在應(yīng)用 86 基因編輯的設(shè)計(jì)和應(yīng)用涉及的科技考量 88 體細(xì)胞基因編輯產(chǎn)生的倫理和監(jiān)管問(wèn)題 97 總結(jié)和建議 103 5 可遺傳性基因組編輯 105 潛在應(yīng)用方向和替代方法 107 相關(guān)的科學(xué)和技術(shù)問(wèn)題 110 以糾正引發(fā)疾病性狀為目的的種系編輯帶來(lái)的倫理監(jiān)管問(wèn)題 112 規(guī)則制定 123 總結(jié)和建議 126 6 基因強(qiáng)化 130 人類(lèi)遺傳多樣性及“正?!焙汀白匀弧钡亩x 131 了解公眾對(duì)基因強(qiáng)化的態(tài)度 132 如何區(qū)分基因治療和基因強(qiáng)化 137 種系( 遺傳) 基因組的編輯和強(qiáng)化 147 總結(jié)和建議 154 7 公眾參與 155 公眾參與:廣義概念 157 美國(guó)的實(shí)踐 160 國(guó)際上的實(shí)踐 164 公眾參與性研討活動(dòng)的經(jīng)驗(yàn) 166 更進(jìn)一步 167 總結(jié)和建議 168 8 原則和建議概要 171 人類(lèi)基因組編輯監(jiān)管原則 171 美國(guó)監(jiān)督人類(lèi)基因組編輯的現(xiàn)有機(jī)制 173 參考文獻(xiàn) 183 附錄A 基因組編輯的基礎(chǔ)科學(xué) 199 附錄B 國(guó)際研究監(jiān)管法規(guī) 236 附錄C 資料來(lái)源及方法 246 附錄D 組委會(huì)成員簡(jiǎn)介 251 附錄E 術(shù)語(yǔ)表 264 Contents Summary 1 OVERVIEW OF GENOME-EDITING APPLICATIONS AND POLICY ISSUES 2 APPLICATIONS OF HUMAN GENOME EDITING 4 PRINCIPLES TO GUIDE THE GOVERNANCE OF HUMAN GENOME EDITING 10 RECOMMENDATIONS 12 1 Introduction 14 STUDY CONTEXT 16 BACKGROUND 19 STUDY APPROACH 25 ORGANIZATION OF THE REPORT 26 2 Oversight of Human Genome Editing and Overarching Principles for Governance 27 PRINCIPLES FOR GOVERNANCE OF HUMAN GENOME EDITING 27 REGULATION OF GENE THERAPY IN THE UNITED STATES 32 GOVERNANCE IN OTHER NATIONS 55 CONCLUSIONS AND RECOMMENDATION 56 3 Basic Research Using Genome Editing 57 THE BASIC TOOLS OF GENOME EDITING 57 RAPID ADVANCES IN GENOME-EDITING TECHNOLOGY 63 BASIC LABORATORY RESEARCH TO ADVANCE UNDERSTANDING OF HUMAN CELLS AND TISSUES 65 BASIC LABORATORY RESARCH TO ADVANCE UNDERSTANDING OF MAMMALIAN REPRODUCTION AND DEVELOPMENT 66 ETHICAL AND REGULATORY ISSUES IN BASIC RESEARCH 76 CONCLUSIONS AND RECOMMENDATION 77 4 Somatic Genome Editing 78 BACKGROUND 79 ADVANTAGES OF GENOME EDITING OVER TRADITIONAL GENE THERAPY AND EARLIER APPROACHES 81 HOMOLOGOUS AND NONHOMOLOGOUS REPAIR METHODS USED FOR NUCLEASE-BASED GENOME EDITING 85 POTENTIAL HUMAN APPLICATIONS OF SOMATIC CELL GENOME EDITING 86 SCIENTIFIC AND TECHNICAL CONSIDERATIONS ASSOCIATED WITH THE DESIGN AND APPLICATION OF GENOME-EDITING STRATEGIES 88 ETHICAL AND REGULATORY ISSUES POSED BY SOMATIC CELL GENOME EDITING 97 CONCLUSIONS AND RECOMMENDATIONS 103 5 Heritable Genome Editing 105 POTENTIAL APPLICATIONS AND ALTERNATIVES 107 SCIENTIFIC AND TECHNICAL ISSUES 110 ETHICS AND REGULATION OF EDITING THE GERMLINE TO CORRECT DISEASE-CAUSING TRAITS 112 REGULATION 123 CONCLUSIONS AND RECOMMENDATION 127 6 Enhancement 130 HUMAN GENETIC VARIATION AND DEFINING “NORMAL” AND “NATURAL” 131 UNDERSTANDING PUBLIC ATTITUDES TOWARD ENHANCEMENT 132 DRAWING LINES: THERAPY VERSUS ENHANCEMENT 137 GERMLINE (HERITABLE) GENOME EDITING AND ENHANCEMENT 147 CONCLUSIONS AND RECOMMENDATIONS 154 7 Public Engagement 155 PUBLIC ENGAGEMENT: BROAD CONCEPTS 157 U.S. PRACTICES 160 INTERNATIONAL PRACTICES 164 LESSONS LEARNED FROM PUBLIC ENGAGEMENT ACTIVITIES 166 MOVING FORWARD 168 CONCLUSIONS AND RECOMMENDATIONS 169 8 Summary of Principles and Recommendations 171 OVERARCHING PRINCIPLES FOR GOVERNANCE OF HUMAN GENOME EDITING 171 EXISTING U.S. OVERSIGHT MECHANISMS FOR HUMAN GENOME EDITING 173 References 183 Appendix A The Basic Science of Genome Editing 199 Appendix B International Research Oversight and Regulations 236 Appendix C Data Sources and Methods 246 Appendix D Committee Member Biographies 251 Appendix E Glossary 264