721 karma · joined January 20, 2019
> if there are other genes between the ends that are cut
I think what you're saying is that if two sites on the same chromosome are cut, then everything in between is deleted. However, this isn't going to happen in practice. DNA repair systems will rejoin the cut DNA ends rapidly, just erroneously (with maybe a few dozen missing/incorrect bases typically). If the cut site is in the protein coding region, it will usually disrupt the sequence to make the protein nonfunctional. Sometimes this is the desired effect, but for most gene therapies you'll probably use base or prime editing, which don't create double strand breaks.
> we'd need to sequence the patient's genes...to make sure that any patterns don't appear anywhere else
While sequencing an individual patient's genome isn't going to happen in practice, the FDA does require gene editing companies to do in silico off-target prediction, where you scan the genome for sites that have similar sequences to the target. You then have to show that none of the off-targets are in dangerous regions (e.g. DNA repair genes), and also show experimentally whether those sites are cut at all (they usually aren't, fortunately, as there are thousands within reasonable thresholds).
The reason you don't need to sequence individual patients is because you just assume that any patient could have any variant that has ever been catalogued (there are databases with thousands of individuals and the differences between them and the reference genome). You then have to show that none of those variants could induce a new target in a dangerous region.
> then come up with an iterative process, probably using AI, to catalog and repair all major genetic disorders.
I don't know what AI would do for you here. Figuring out the change you need to make to revert a genetic disorder is trivial. The hard part is making it safe and effective, and proving to regulators that it's safe and effective.
> Then it's probably 5-10 years before gene editing is a solved problem.
Not even close. Ironically, while the technologies are pretty good in general, every edit requires a ton of engineering work. CRISPR systems are notoriously idiosyncratic - they might edit one target in 80% of cells, and 0% at another target, for no apparent reason. There are definitely open problems with base and prime editing, and those will probably get more-or-less solved in 5-10 years, but I'm reasonably sure there will be genetic disorders for which there is no treatment for decades.
It doesn't help that the one approved therapy isn't really making much money: https://www.biopharmadive.com/news/sickle-cell-gene-therapy-...
See also: https://blog.genesmindsmachines.com/p/we-still-cant-predict-...
What they should have done was eat a pizza before the treatment, gotten sick, then taken the treatment and shown that the same pizza had no effect afterwards.
I agree with the broader point of the article that color is underused, but the state of the art has moved way past what the author’s tools are currently configured to provide.
But I can’t use this at all at work (a pharma company) because it would leak confidential information. So anything they learn from usage data is systematically excluding (the vast majority of?) people working on therapeutics.
I think the problem is that you're viewing things as either "cures for cancer", or "not cures for cancer". I would suggest instead framing things as, "how on Earth could we possibly cure cancer when human bodies have trillions of moving parts and we only understand half of them?" It's like trying to fix a broken car and not even knowing what internal combustion is.
Your instincts are good - if we could simulate people in silico we could basically understand and cure every disease - but the scale of such a simulation is literally (not figuratively!) astronomical. Biological systems are way, way, way more complex than they appear and our computers are (currently) hopelessly inadequate.
How do I justify spending all this money? I need some theory of why this search is going to give me anything other than incremental improvements in activity or whatever metric I care about, but rational design can only take me so far. Generative models aren't going to give me a step change in activity. Why am I confident that the set of proteins I'm testing have megabucks of potential?
So sure, limitations in automation are an obstacle to bigger scale, but we often can't use the scale that's already achievable. There's certainly room for improvement in the automation space, but unlocking scale is not the only problem you need to solve.