Heart attack is the leading natural killer worldwide, with up to one in two men and one in three women past the age of 40 having heart attacks in their lifetimes. What if one shot, similar to a vaccine, could prevent that?
Writing in Circulation Research, researchers show they have developed a “genome-editing” approach for permanently reducing cholesterol levels in mice through a single injection, a development that could reduce the risk of heart attacks in humans by 40 to 90 percent.
Don't start drinking bacon smoothies just yet, it will be at least a decade before this even gets to a phase I clinical trials in humans. But “for the first iteration of an experiment, this was pretty remarkable,” said co-author Kiran Musunuru, a cardiologist at Brigham and Women’s Hospital.
In 2003, a group of researchers in France studying families with very high cholesterol levels and very early heart attacks discovered that PCSK9 was a cholesterol regulator, because they found that mutations in this gene seemed to be responsible for the high cholesterol levels and the heart attacks. These mutations are extremely rare and are limited to a few families.
But a research group in Texas discovered that about 3 percent of the population have mutations in PCSK9 that have the opposite effect. Those with the mutations have low-density lipoprotein (LDL, or bad) cholesterol levels about 15 to 28 percent lower than the average level. And the people with that “good” defect have heart attack risks that range from about 47 to 88 percent below average.
“Our reasoning was that nature has already done the experiment; you have people who have won the genetic lottery,” said Musunuru. “They are protected from heart attack, and there are no known adverse consequences. So that led us to reason that if we could find a way to replicate this, we could significantly protect people from heart attack.”
The project to turn normal PCSK9 genes into those with the “good” defect came at an inflection point in genome editing, the refinement early last year of a technology called CRISPR/Cas9, first discovered in 2007. “The biological sciences as a field got really excited by this new technology, because it makes it far easier to edit the genome in every species you can think of, from fruit flies to fish, to mice, to monkeys, to human cells,” said Musunuru, whose group was among the first to use it in stem cells.
“Cas9 is a protein that will create a break in DNA, and the CRISPR is an RNA component that will bind to a matching sequence and directs the Cas9 to that sequence in the DNA in which you are interested,” he said. “This creates a break where you want it. The cell can then repair itself, though often with errors, which is useful if you want to disrupt a gene to create a ‘knockout’ of the gene,” which is precisely what Musunuru’s team did with PCSK9.
“The PCSK9 gene is expressed primarily in the liver,” explained Musunuru, “and produces a protein that is active in the bloodstream and prevents the removal of cholesterol from the blood. Several drug companies have been developing antibodies” to it, he said, but “the problem with antibody-based drugs is they don’t last forever; you’d need an injection every few weeks. The main option for reducing cholesterol is statin drugs, such as Lipitor, but many people taking statin drugs every day still have heart attacks. So there is still a great need for other approaches,” said the scientist.
“What we were thinking was that, with this genome-editing technology, we can do something we couldn’t do before: make permanent changes in the genome at the level of the DNA. We can actually go to the source. So the question was whether we can use genome editing to make normal people like people born with the ‘good’ mutations.” The answer, in mice, was yes.
“The first question was whether we could get CRISPR/Cas9 into the liver, and once we got it into the liver, would it function properly?” Musunuru asked. “And it did. It could have had no effect, but it turned out to have a dramatic effect. Within three to four days of delivering the system into the liver, the majority of the PCSK9 gene copies in all of the liver cells were disrupted, knocked out. And what we hoped to see was much less of the protein product in the bloodstream, which is what we saw.
“The other consequence that we saw was a 35 to 40 percent reduction in cholesterol levels in these mice,” which would translate in humans to a heart attack risk-reduction of as high as 90 percent. If you had a therapy that targeted the liver, changed the genome, if you could do that, and if it were totally safe, then at least in theory you could think of this therapy as something like a vaccination. It could be a onetime treatment, a permanent alteration. If you used this in a population, you could reduce the occurrence of heart attack by 30 percent, 50 percent, 90 percent.
“As a cardiologist, what I find most tragic is when a 55-year-old person, with a family, in the prime of life, still working, out of the blue has a heart attack and drops dead. The public health implications are not trivial. Heart attack is a killer of the elderly, but there are many 50-, 60-, 70-year-old men and women dying of heart attacks.”
Citation: Qiurong Ding, Alanna Strong, Kevin M Patel, Sze-Ling Ng, Bridget S Gosis, Stephanie N Regan, Daniel J Rader, and Kiran Musunuru , 'Permanent Alteration of PCSK9 With In Vivo CRISPR-Cas9 Genome Editing', Circulation Research, June 10 2014, doi:10.1161/CIRCRESAHA.115.304351. Source: A shot against heart attacks? by BD Colen, Harvard University staff
- PHYSICAL SCIENCES
- EARTH SCIENCES
- LIFE SCIENCES
- SOCIAL SCIENCES
Subscribe to the newsletter
Stay in touch with the scientific world!
Know Science And Want To Write?
- Is That A Real Patient Or A Junkie? Now There's An App For That
- How Wild Rabbits Genetically Became Tame Ones
- Coastal Regions Need To Worry About Non-Climate Change Sea Level Rise Now
- Junk Food Rats Ditch Balanced Diet To Eat Just Like Obese People
- Will We Meet ET Microbes On Mars? Why We Should Care Deeply About Them - Like Tigers
- Anger Face Is Universal, And It Evolved Because Of Psychology
- Meet BPA-Free, The New BPA
- "from TOLSTOY AND THE CULT OF SIMPLICITY..."
- "If we don't have animal studies, we are left with anecdotes as evidence. I agree organic foods..."
- "Am I the only one who is concerned about the usage of the animals for such experiments? I'm really..."
- "No Hank, You put words in my mouth. The environment of domestication that the rabbit was thrust..."
- Medication shows mixed results in reducing complications from cardiac surgery
- Transvenous lead extraction clinically successful in 98 percent of cases
- First multidisciplinary recommendations on management of arrhythmias in ACS patients
- First expert consensus on ventricular arrhythmias published
- First comprehensive ESC Guidelines on aortic diseases published