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The International Commission on the Clinical Use of Human Germline Genome Editing was tasked with developing a framework for scientists, clinicians, and regulatory authorities to consider when assessing potential clinical uses of human germline genome editing, should society conclude that heritable human genome editing (HHGE) applications are acceptable.

COMMISSION COMPOSITION

The U.S. National Academy of Medicine, the U.S. National Academy of Sciences, and the U.K.’s Royal Society appointed a Commission of 18 experts to undertake the Statement of Task. The Commission’s membership spans 10 nations and 4 continents and includes experts in science, medicine, genetics, ethics, psychology, regulation, and law. Appendix B provides biographical information for each Commissioner.

In addition, an International Oversight Board (IOB) of leaders from national academies of sciences and international institutions was charged with ensuring that the Commission followed due processes, including approving the Statement of Task and membership of the Commission and ensuring that the Commission’s report underwent rigorous external review prior to publication.

MEETINGS AND INFORMATION-GATHERING ACTIVITIES

The Commission deliberated from approximately June 2019 through March 2020 to conduct its assessment and prepare its final report. To

address its task, the Commission analyzed information obtained from current literature and other publicly available resources and undertook information-gathering activities such as inviting stakeholders to share perspectives at public meetings, holding webinars, and soliciting public input online and in person.

Public Meetings and Webinars

Sessions at meetings and webinars held over the course of the study enabled Commissioners to obtain input from a range of stakeholders and members of the public.

The Commission’s first meeting was held in August 2019 in Washington, DC. Public sessions provided an opportunity for the Commission to discuss its Statement of Task with the co-chairs of IOB and sponsoring organizations and to hear presentations on the state of understanding of genetics and genetic manipulation; on somatic genome editing translational pathways from scientists, developers, and regulatory bodies; and on the views of genetic disease patient communities.

In November 2019, the Commission held a second meeting and workshop in London, United Kingdom. The Commission heard from invited experts on topics such as the medical ethics of HHGE, how clinical use of HHGE would intersect with the use of assisted reproductive technologies, and technologies that might enable HHGE, including making and validating edits in embryos and germ cells, and what we can learn from animal models. In addition, the Commission hosted a session on governance developed in consultation with two members of the WHO Advisory Committee.

At a third meeting in January 2020, Commission members developed the conclusions and recommendations presented in this report.

In October 2019, the Commission also held a series of four public webinars on the state of research in relevant areas. These webinars covered (1) informed consent in the context of HHGE, (2) the impact of genome editing on embryo viability and the state of the science on editing spermatogonial stem cells, (3) homology directed repair and single cell genomics, and (4) validating on-target and off-target edits.

The list of speakers who provided input to the Commission in these meeting and webinar sessions is below.

Public Comments

The Commission’s data-gathering meetings provided opportunities for the Commission to interact with a variety of stakeholders. Each public meeting included a public comment period, in which the Commission

invited input from any interested party. The Commission also worked to make its activities as transparent and accessible as possible.

The study websites hosted by the U.S. National Academies and the U.K.’s Royal Society were updated regularly to reflect recent and planned Commission activities. Study outreach included a study-specific email address for comments and questions. A subscription to email updates was available to share further information and solicit additional comments and input to the Commission.

Live video streams with closed captioning were provided throughout the course of the study to allow the opportunity for input from those unable to attend public meetings in person. Information provided to the Commission from outside sources or through online comment is available by request through the National Academies’ Public Access Records Office.

Call for Evidence

To inform its deliberations, the Commission invited responses to a public call for evidence during fall 2019. Several of the questions invited broad input on considerations associated with HHGE, while others asked for technical input in areas such as preclinical safety and efficacy and the use of genome editing in human embryos. Still other questions asked about considerations for informed consent, long-term monitoring, and oversight of HHGE.

There were 83 responses received. Respondents came from every continent and included academic leaders, lawyers, social scientists, philosophers, and representatives from disability advocacy groups, journals, national ethics councils, industry, and scientific societies.

Consulted Experts

The following individuals were invited speakers at data-gathering sessions of the Commission or provided other expert input.

Sonia Abdelhak

Institut Pasteur de Tunis, Tunisia

Britt Adamson

Princeton University, USA

Fabiana Arzuaga

Ministry of Science, Technology and Productive Innovation, Argentina

Richard Ashcroft

City University of London, U.K.

Christina Bergh

University of Gothenburg, Sweden

Peter Braude

King’s College London, U.K.

Annelien Bredenoord

University Medical Centre Utrecht, Netherlands

Aravinda Chakravarti

New York University School of Medicine

Sarah Chan

University of Edinburgh, U.K.

Ellen Clayton

Vanderbilt University, USA

Chad Cowan

Harvard Stem Cell Institute, USA

James Lawford Davies

Hill Dickinson LLP, U.K.

Tarek El-Toukhy

Guy’s and St Thomas’ Hospital NHS Foundation Trust, U.K.

Frances Flinter

King’s College London, U.K.

Denise Gavin

Food and Drug Administration, USA

Melissa Goldstein

George Washington University, USA

Margaret Hamburg

U.S. National Academy of Medicine and Co-chair of WHO Expert Advisory Committee, USA

Muntaser Ibrahim

University of Khartoum, Sudan

Pierre Jouannet

Paris Descartes University, France

Jin-Soo Kim

Seoul National University, South Korea

Robert Klitzman

Columbia University, USA

Bruce Levine

University of Pennsylvania, USA

Robin Lovell-Badge

Francis Crick Institute, U.K.

Sandy Macrae

Sangamo Therapeutics, USA

Julie Makani

Muhimbili University of Health and Allied Sciences, Tanzania

Nick Meade

Genetic Alliance U.K.

Shoukhrat Mitalipov

Oregon Health & Science University, USA

Vic Myer

Editas Medicine, USA

Kathy Niakan

Francis Crick Institute, U.K.

Sarah Norcross

Progress Educational Trust, U.K.

Helen O’Neill

University College London, U.K.

Kyle Orwig

Magee-Womens Research Institute, USA

Matthew Porteus

Stanford University, USA

Adam Pearson

Actor, Presenter, and Campaigner, U.K.

Catherine Racowsky

Brigham and Women’s Hospital, USA

Jackie Leach Scully

University of New South Wales, Australia and Newcastle University, U.K.

Azim Surani

University of Cambridge, U.K.

Sarah Teichmann

Wellcome Sanger Institute, U.K.

Sharon Terry

Genetic Alliance, USA

Peter Thompson

Human Fertilisation and Embryology Authority, U.K.

Carrie Wolinetz

National Institutes of Health, USA

Xiaoliang Sunney Xie

Peking University, China

Hui Yang

Institute of Neuroscience, Chinese Academy of Sciences, China

Mohammed Zahir

Muhimbili University of Health and Allied Sciences, Tanzania