The medical industry has always been a rapidly shifting, with new technologies and breakthroughs being made regularly. One of the more recent and high-profile breakthroughs is the gene-editing technology, CRISPR. As a technology, CRISPR is very flexible and has tremendous implications for a number of medical practices. There’s currently extensive research and development looking to leverage CRISPR to edit human genes for disease prevention, create more precise diagnostic tests, or even modify human embryos to get rid of undesirable traits. This article will focus on one of the avenues that CRISPR research that may become present in the near future – the creation of a “CRISPR pill” that looks to replace antibiotics.
To help us understand the implications of the CRISPR pill, Dr. Imran Haque will be lending his expertise. He is an internist and general practitioner based out of North Carolina who has been managing his own practice for over a decade. With his expertise, Dr. Imran Haque will outline the benefits of a CRISPR pill and the diminishing returns that antibiotics provide over time.
What is CRISPR?
At a high level, CRISPR is a technique that allows editing DNA of living cells, something that can be utilized in nearly all fields of medicine. When it comes to the CRISPR pill, the focus is on editing snippets of DNA in bacteriophages (viruses that infect bacteria) that govern how specific bacteria may react to them.
Bacteria vs. Bacteriophages
Bacteria can become sick too – they can be infected by something called bacteriophages. In order to combat against bacteriophages, bacteria store memories of past viruses they have suffered from in their DNA known as “clustered regularly interspersed short palindromic repeats,” otherwise known as CRISPRs. Whenever a bacteria encounters bacteriophages, it relies on CRISPR to identify whether or not it is at risk – much like a person relies on past memories to identify threats. If their CRISPR flags the bacteriophage, then the bacteria will trigger an enzyme that chops the bacteriophage into pieces.
The CRISPR Pill
The idea behind the CRISPR pill is to create a bacteriophage that sends a false message to the bacteria’s CRISPR that results in the attack enzyme chopping up the bacteria itself. In other words, the manufactured bacteriophage will cause the bacteria to destroy itself. One of the difficulties in this approach is delivering the custom bacteriophages intact to the diseased area – so they need to be delivered into the body via a pill or needle.
Jan-Peter Van Pijkeren of the University of Wisconsin-Madison, is currently pursing development of a CRISPR pill to fight Clostridium difficile. Clostridium difficile is a germ that proliferates in the gut of victims and is resistant to antibiotics, which devastates patients in hospitals. In his research, Van Pijkeren looks to create an means to deliver the bacteriophage into a patient’s gut, and he is looking to pursue the treatment in the form of a pill. The idea is to create a “mothership” that hosts all the bacteriophages (aka: the pill) that will protect the treatment from stomach acid and will later break open in the gut, allowing the bacteriophage to spread out inside a person’s gut to cause Clostridium difficile to destroy itself.
Dr. Imran Haque is excited about this solution because it is ultra-precise. Since the bacteriophage is inherently harmless to people and causes only one strain of bacteria to destroy itself, it should theoretically leave all the beneficial flora in a person’s intestines unharmed. This is in direct contrast to antibiotics, which employ more of a carpet bombing approach and can often has a number of side effects associated with each dose – which can destroy a portion of a person’s beneficial bacteria, which can cause some long-term side effects.
Another reason Dr. Imran Haque is looking forward to a future with CRISPR pills is due to the diminishing returns of antibiotics. When antibiotics were first introduced in the past, they were deemed a miracle drug capable of curing nearly any infection. As time progressed, it became clear that the effectiveness of antibiotics was diminishing, forcing researchers to tweak existing formulas or find new ways to affect the same type of bacteria. Dr. Imran Haque points that that the decline of antibiotics is due to bacteria building up resistance – as bacteria with less resistance to antibiotics are killed off, the remaining bacteria proliferate. Over time, this will eventually cause bacteria to develop strong resistance or even outright immunity to certain kinds of antibiotics, effectively creating “super bugs.” The carpet bombing approach antibiotics does not help either – it means that antibiotic intake will expedite the mutation of multiple bacteria at once.
Antibiotics are a fantastic short-term solution. Being able to find new ways to kill off bacteria means the development of new antibiotics, but it also signals an arms race where bacteria are constantly developing new immunities in retaliation to the new types of antibiotics created by people. CIRSPR pills offer an exciting way around this – as it will target only one type of bacteria with absolute effectiveness, giving no chance to develop any sort of resistance.
The Future of Medicine – CRISPR
Dr. Imran Haque is excited for all the possibilities associated with CRISPR, but especially with the potential replacement for antibiotics. As a general care practitioner, he has experienced a number of illnesses that have mutated to become resistant to antibiotics – such as the annual common cold. The lure of a future where diseases can be eliminated with a single solution without need to iterate and adapt for mutations is exciting – it hints towards a future with more effective, ultra-precise solutions with significantly fewer side effects.