Is three-parent IVF a new breakthrough in genetic disease treatment and ethical debate?

Three-parent IVF is a method of producing healthy children using the eggs of two women and the sperm of one man to prevent inherited diseases. While this technique can prevent inherited diseases, it comes with the controversy of genetic manipulation. Safety and ethics need to be discussed.

 

On April 6, 2016, Abrahim Hassan, the world’s first three-parent baby with two mothers and one father, was born in Mexico. Normally, a child inherits the DNA of the egg, the DNA of the sperm, and the DNA of the mitochondria in the egg when the sperm invades the mother’s egg and fertilizes it, but Shaban’s biological mother, Shaban, had a gene mutation in her mitochondria that caused her child to develop Leigh syndrome, an inherited neurometabolic disorder that slowly deteriorates the central nervous system, including the brain and spinal cord. After her two previous children died at 8 months and 6 years of age due to a genetic mutation in her mitochondrial DNA, which makes up just 0.1% of her total DNA, she traveled to Mexico, where there were no genetic laws, and had a healthy baby using three-parent IVF. This method is gaining more attention because it can prevent hereditary diseases, a previously impregnable territory. But for those with mitochondrial genetic disorders who dare not bear children, the technology is seen by some as a drought in the life sciences and a precursor to genetically engineered, customized babies. Last year, the United Kingdom became the first country in the world to pass legislation allowing three-parent IVF. The country decided that the treatment of genetic diseases outweighed the ethical imperative. It’s estimated that 2,500 couples in the UK alone will be able to take advantage of the technology. Nevertheless, the three-parent procedure is technically genetically modified and is still banned in more than 40 countries due to its potential for abuse. But we shouldn’t judge this technology by its appearance. In this article, we’re going to break down the basics of three-parent IVF, which is still a hotly debated topic in the scientific community.
Before we get into that, let’s take a closer look at mitochondria. Mitochondria are independent and essential organelles that are responsible for the production of energy for cellular activities. They even have their own DNA, in addition to the DNA in the cell nucleus, and it’s in this DNA that 1 in 6,500 women are born with a genetic abnormality. These mitochondrial gene abnormalities cause diseases primarily related to cellular energy production, including heart disease, Parkinson’s disease, and Huntington’s disease, as well as diabetes, deafness, muscle weakness, progressive visual impairment, liver dysfunction, and dementia. The disease can lead to death or, if you survive, to a lifetime of related illnesses. Mitochondrial DNA, which accounts for only 33 out of more than 20,000 bits of DNA, is passed down 100% intact from the mother, which has caused untold suffering for children. This is where the three-parent child procedure comes to the rescue. It involves extracting the nucleus from a healthy woman’s egg, replacing it with a nucleus from the mother’s egg, and fertilizing it with the father’s sperm. With this method, a simple nuclear swap can result in a child with healthy mitochondria. The implications of this procedure, which involves changing only 0.1% of all DNA, which is responsible for energy production, are illustrated by the following quote from medical ethicist Dr. Gillian Lockwood “Three-parent IVF is about getting a broken biological battery working properly, not about a child’s height, eye color, intelligence, etc. The genes you receive from the third woman are only one-thousandth of your DNA, so it should be called a two-parent procedure, not a three-parent procedure.”
Among the various criticisms that naysayers throw around, the biggest one is that the technology has the potential to lead to genetically engineered, customized babies. Three-parent IVF is a small but obvious change to DNA that could be abused in the future, and if it is, it could lead to a huge ethical debate. However, this common criticism of genetic engineering is actually liberating when you look at it closely. These views are basically based on the premise that some genes are better than others (so-called eugenics), and mitochondria are only there to help cells generate energy in the first place. You can only replace them with other healthy mitochondria, but you can’t intend to or have the ability to express other traits, so it’s not like a “designed baby” where parents can pick and choose the traits they want. While there is always the potential for abuse of any technology, this technology can be described as liberating because there is no way to utilize the mitochondrial DNA for any other purpose. This is only a therapeutic approach, not a way to order genes at will for parents. More importantly, it does not erase the child with the genetic disorder, only the disease.
Another criticism is that this procedure assumes that the child is born. How will a three-parent child born from this procedure accept the fact that they have another parent? I think this is a fallacy of intent that comes from the exaggerated nomenclature. Sure, the child receives about 0.2% of its DNA from the other woman, but the role of the DNA in the mitochondria is limited to energy production and does not contribute to the formation of organs, so it is hardly a parent. The child will look just like any other child, and it is more important that society does not perceive them differently. In this regard, bioethicists have taken the position that the child’s right to know should be respected, and the fact that the child received assisted reproduction should be kept secret until the child reaches the age of majority. In addition to this, having a professional counselor on hand to provide ongoing care after the child reaches the age of majority will help address any psychological issues that may arise. No parent wants their child to be born with an illness. This is a problem that can be solved if the parents’ desires are well communicated to the child and if there is institutional support at the national level.
In fact, the main concern with this technology is the safety of the technology. Of course, Time reported that the researchers looked at the chances of the three-parent child, Abraham Hassan, developing Leigh syndrome, a genetic disorder, and found that there was less than a 1% chance that the mitochondrial DNA mutation would occur. But it’s not always a safe bet. In fact, when the nucleus is extracted from the egg, it’s done by squeezing, and some of the maternal mitochondria are mixed in. When the nucleus is injected into another egg, the DNA from the two maternal mitochondria competes for space in the egg, and each mitochondrion has a different rate of competition. Because of these uncertainties, the U.K. government legalized mitochondrial replacement therapy last year, but authorities in the U.K. have not yet approved it for clinical use. Legislation only allows the licensing process to begin, but only when scientific evidence is clear that there is little risk. In the U.S., a committee led by the National Academies of Sciences, Engineering, and Medicine recommended this year that “clinical trials should not be allowed unless preclinical data confirm safety.” So it’s true that we’re all still cautious and cautious. However, this is just an early symptom of all technologies. We’ve seen the benefits of IVF, and now we’re just learning the risks. This is where the right laws and regulations come in. We must actively encourage the development of these diamonds in the rough into beautiful jewelry with wise management.
Three-parent child technology is different from traditional genetic engineering and should be utilized. Of course, it is not yet theoretically perfect, but it is clear that it must be achieved over time, and studies are constantly being conducted and published to prove its safety in other countries. However, Article 21, Paragraph 2, Article 4 of Korea’s Bioethics and Safety Act prohibits human genetic modification. Under the current law, the procedure cannot be performed, research cannot be conducted, and there is no discussion about it. Parents who are desperate to save their baby’s life may end up traveling to unregulated countries to undergo three-parent IVF. We need to have a democratic debate about this technology and institutionalize it within the context of scientific oversight and transparent disclosure. Advances in science have always started with new challenges. In a deadly disease with no cure, conducting research for therapeutic purposes is a new challenge and a new hope. We have no reason to refuse to even discuss it in the name of ethics. I fervently dream of the day when a three-parent child will be a normal part of our society without being labeled as a three-parent child, without prejudice.