With the recent conclusion of the Biotechnology Innovation Organization’s BIO 2019 event, we thought we’d talk to some of the pioneers and fascinating individuals who were present to showcase their innovative ideas or technologies. Dr. Eric Kmiec, Director of the Gene Editing Institute at Christiana Care Health System, spoke at BIO 2019 about meeting unmet medical needs with gene editing. We spoke to him about his work at Christiana Care Health System and CRISPR’s role in promoting better social equality in life science.

FLG: You Have the Important Role of Director of the Gene Editing Institute at Christina Care Health System. What are You Currently Working On?

EK: I’ve worked in the gene editing area for a very long time, first supported by NIH to study the mechanisms of cells. When CRISPR came along, we began to pair our studies with that technology.

For the last five or six years, we’ve been focused on CRISPR, understanding how it works and some of the challenges of it, without being driven by shareholders. We operate on two tracks: first, what is CRISPR doing in the cell, in its entirety? There’s no current way to look at it quantitatively, so we developed in vitro gene editing, called gene editing on a chip. With this, we can follow all outcomes and measure them to see how truly effective CRISPR is.

The second track is to do with populations. We’ve found that CRISPR works quite differently between populations, even when targeting the same gene. So this led me to wonder what we’re developing these tools for, or more importantly who.

The current answer in the field is, of course, those who are already being treated or who can afford it. There’s been no discussion about social responsibility when using CRISPR.

FLG: You Recently Spoke at BIO 2019 on Genome Editing Meeting These Unmet Medical Needs. Could You Tell Us More About the Talk, and its Outcomes?

EK: The main concern of the session was that breakthrough technology almost never reaches under-represented minority populations. New advances are being made in minority diseases such as sickle-cell anemia, but how do you engage people in those communities to join a clinical trial?

People of all socio-economic levels come to Christiana Care to be treated, so that task of engagement has been embedded here for a long time. One of our first thoughts on moving to our new building was: how can CRISPR be used to serve all types of patients. It’s a challenge! The GWAS information from 1995 or 1999 still has around 70% individuals from European descent, and today’s information is largely the same. So we discussed how to engage these minority communities, and how you translate that to clinical care.

I don’t think there’s an answer for that yet. But CRISPR gives us an opportunity to do this correctly. At Christiana Care we’ve been working on a gene editing process for lung cancer and realised that 85% of all Americans get cared for in places like this. It’s like seeing your family doctor: we need to be sure that these populations trust us to help them.

FLG: Do You Think We’ll See an Improvement on Diversity in Patient Populations and Precision Medicine in the Next Ten Years?

EK: It’s a good question. At Christiana Care I don’t think we have that problem, since we’re already engaged in that population. It’s about reputation, what you’ve done, outside of gene editing. I think we’re uniquely positioned: people are racing towards this topic now, but Christiana Care has had the lead for a long time.

Other organisations in this field are doing great work, but I think some try to buy the sort of diversity we see. I don’t think it can be bought like that.

FLG: What’s Next for the Technical and Design Side of Your Work?

EK: The research side of the lab will always continue to focus on the basic mechanisms and regulatory circuitry that surrounds gene editing. I think there are a lot more things to know there. It’s not as precise as some people think, but it’s still more precise than anything we’ve had before. When you’re in a life-threatening situation, if it gives you some hope it’s probably worth moving forward. We’ll always continue studying the cell and molecular base of gene editing.

We’re also dedicated now to developing gene editing for solid tumors – most of the work in the field has been primarily on T-cells and Car-T cells, and we support that hugely. But we’re looking primarily here at the low-hanging fruit: while there are certainly delivery issues, CRISPR could be used to reduce a tumor to make it operable. Many are wrapped around nerves or things like that, and we may soon be able to use CRISPR inside a virus as it is implanted to make an inoperable tumor operable again.

Our other big use of CRISPR is to augment standards of care, whether in immunotherapy or chemotherapy. I think the goals of using putative CRISPR for any sort of oxygenic is pie in the sky, I don’t think that’s going to work. But direct injection into a tumor will make the process much less onerous for the patient.

Stay tuned for more from BIO 2019, coming soon.