Covalent linkage of the DNA repair template to the CRISPR-Cas9 nuclease enhances homology-directed repair

Genome editing allows scientists to change an organism’s genetic information by adding, replacing or removing sections of its DNA sequence. The CRISPR-Cas9 system is a genome-editing tool that has had a large impact on biological research in recent years, and also shows promise for the treatment of patients with genetic disorders. The tool works as follows: a small piece of RNA (a close cousin to DNA) is used to guide an enzyme called the Cas9 endonuclease to the desired region of the genome. Then, like a pair of molecular scissors, the enzyme cuts the DNA, breaking both strands of its double helix. The cell naturally starts to repair the damaged DNA, and one way to do this is to use another similar piece of intact DNA as a template. Scientists can exploit this repair mechanism (known as homology-directed repair) by giving the cell extra DNA that carries their desired sequence change, with the hope that the cell will use it as a template and edit its own genome in precisely the same way. However, it turns out that mammalian cells rarely use the template DNA to repair the damage. Instead, mammals tend to fix double-stranded breaks in DNA by simply joining the broken ends together, a method that is prone to errors. To overcome this specific issue, Savic, Ringnalda et al. tested the effect of physically linking the template DNA to the Cas9 enzyme, so that the DNA was already nearby when the enzyme made the cut. Experiments with human cells confirmed that this new approach increased the frequency of homology-directed repair up to 24-fold compared to leaving the enzyme and the template DNA separate. Improving the CRISPR-Cas9 system in this manner makes it more likely that genome editing may one day become a routine treatment for patients with genetic disorders. But first, more preclinical studies are needed to assess the safety of the CRISPR-Cas9 technology for gene editing in patients.