Background
Cancer is a significant threat not only to the health care system of individual states but to humanity as a whole. In terms of mortality, cancer ranks second after cardiovascular diseases, but malignant tumors inspire patients much more fear (“Cancer,” 2018). Today, a great many researchers around the world are trying to understand the causes of cancer and, more importantly, to find ways to prevent and treat it. Dozens of institutions and hundreds of scientific laboratories around the world are working on this problem, ensuring success in understanding it and slow but steady progress in medicine.
The importance of urgently seeking innovative and effective solutions for tumor control is driven by statistical data. According to the World Health Organization 2018, one in six deaths worldwide is due to cancer (“Cancer,” 2018). Also, researchers note that not all countries can afford to finance cancer research (“Cancer,” 2018). For global health, this means that a universal solution is delayed due to financial factors. It is well known that the leading cause of the abnormal development of tumors inside the human body is the genetic breakdown of DNA. Further research on this issue has led to the conclusion that the cancer problem can be overcome by changing the broken sequences of the DNA molecule in human cancer cells.
Genetic Engineering
Approaches to cancer treatment that are used by modern clinics demonstrate effectiveness only at an early stage of the disease. If the disease is detected early enough, chemotherapy and radiation therapy helps to cure patients fully. However, with the current health system in low- and middle-income countries, most cancer patients seek help at a late stage when they are significantly less likely to survive (“Cancer,” 2018). Therefore, healthcare professionals were tasked with developing a technology solution that would show results. This is how the field of genetic engineering, called CRISPR/Cas-9 technology, emerged.
The innovative gene-editing technology CRISPR-Cas9 can be used to treat cancer. It is known that the abnormal proliferation of cell mass, which occurs in cancer diseases, is caused by a failure in the genes responsible for containing countless cell divisions (Kennedy & Henderson, 2019). As a result, a cell without Heiflik’s limit is randomly divided, creating a local tumor that is not recognized by the human immune system.
The cancer is spreading in the body because the human defenses do not recognize the dividing cells as foreign and do not destroy them in time. CRISPR-Cas9 technology is based on an element of the protective system of bacteria, which biologists have adapted to modify the DNA of plants, animals, and even humans (Zhan, Rindtorff, Betge, Ebert, & Boutros, 2019). Prokaryotes produce special enzymes: every time a bacterium succeeds in killing a virus, it cuts through the remains of its genetic material and stores them inside sequences of clustered regularly interspersed short palindromic repeats (CRISPR) (Zhan et al., 2019).
This information is then used in case of a new virus attack. In an attack, the bacterium produces Cas9 proteins that carry a fragment of the virus’s genetic material. If this section and the DNA of the attacking virus match, Cas9 cuts the genetic material of the latter and neutralizes the threat. The same works with human immune cells that have been genetically modified (Zhan et al., 2019). Patients are taken away from the T cells and edited by the genome: scientists remove two genes from the DNA cells. The first gene is responsible for the protein PD-1, which blocks lymphocyte activity (Zhan et al., 2019).
The second is a common receptor, through which lymphocytes recognize their target. Then, a gene from another receptor is injected into the cells through a viral vector that binds only to specific proteins on the tumor surface (Kennedy & Henderson, 2019). After such triple editing, the T-lymphocyte can selectively recognize a cancer cell, and at the same time, it becomes resistant to its overwhelming action (Kennedy & Henderson, 2019).
Benefits of CRISPR/Cas9
Compared to traditional cancer control tools, gene-editing technology has several advantages. Standard chemotherapy and radiation therapy procedures have a negative effect not only on cancer cells but also on neighboring healthy cells (Zhan et al., 2019). Gene editing allows bypassing this because CRISPR/Cas9 only targets and modifies the necessary DNA fragment. Also, unlike other gene-editing techniques such as restriction systems, CRISPR/Cas9 has faster execution speeds and is easier to use (Kennedy & Henderson, 2019).
The ease of programming of the CRISPR-Cas9, the unique DNA cutting mechanism, the ability to recognize targets in multiple ways, and the existence of many natural variants of the CRISPR-Cas system provide a tremendous boost to the use of this technology solution in the fight against cancer.
Ethical Issues
The changes that genetic engineering entails can be considered from both sides. On the one hand, these changes will significantly help us in the fight against serious genetic diseases and will significantly improve people’s quality of life at the moment. On the other hand, these changes have a direct impact on human evolution (Baumann, 2016). The practical use and development of CRISPR-Cas9 technology are complicated by the ethical difficulties that arise when researchers edit the human genome.
As early as 1997, UNESCO issued the Universal Declaration on the Human Genome and Human Rights, recommending a moratorium on genetic modification of the human germline (Baumann, 2016). Thus, the legal systems of most countries in the world have banned genetic modification until a final decision is taken on the ethics of procedures (Baumann, 2016). However, in the future, there will be even more ethical issues related to new technologies in genetics and reproduction, as bioethics becomes an increasingly important discipline.
An essential ethical challenge in research is that the benefits of technology must be greater than the risks. The application of CRISPR/Cas9 is still risky at the moment, as it can cause mutations that can be harmful. The problem is that large genomes may contain multiple DNA sequences identical to or highly homologous to the intended DNA target sequence (Baumann, 2016). CRISPR/Cas9 may also split these unintentional sequences, causing mutations that may cause cell death or transformation. Scientists are currently working to reduce the mutations, but further improvement is needed, especially for the precise modifications required for therapeutic interventions.
Role of Nurses
Modern genome editing is a rather complicated process, the responsibility for which is assumed by the attending physicians. However, it is possible that as the technology develops, the procedure of changing the genetic material of human immune cells will become fast and straightforward enough for nurses of clinics to cope with it. It is likely that this process will not be time-consuming and will most likely be carried out by injecting DNA-changing enzymes or vector viruses.
In this case, the process of genetic editing for cancer control will be comparable to an insulin injection to a diabetic patient or an adrenaline injection, which is part of the nurses’ primary duties. In addition, an alternative biomedical development scenario may change the nurse’s concept. Included in the list of qualifications of future medical personnel may be knowledge of information technology required to create vectors of altered DNA (Kennedy & Henderson, 2019). All of the above will affect the role of the future nurse in one way or another, making her more universal and certainly more important in clinical practice.
References
Baumann, M. (2016). CRISPR/Cas9 genome editing–new and old ethical issues arising from a revolutionary technology. NanoEthics, 10(2), 139-159.
Cancer. (2018). Web.
Kennedy, A. J., & Henderson, J. O. (2019). The use of CRISPR-Cas9 technology to study and create cancer therapeutics. Journal of Student Research, 8(1), 62-70.
Zhan, T., Rindtorff, N., Betge, J., Ebert, M. P., & Boutros, M. (2019). CRISPR/Cas9 for cancer research and therapy. Seminars in Cancer Biology, 55(1), 106-119.