From the battleground of bacteria and archaea against virus and plasmid DNA (pDNA), the discovery of the clustered regularly interspaced short palindromic repeat (CRISPR)/CRISPRassociated (Cas) gene system gives an efficient and promising toolbox for genetic engineering. [1][2][3][4][5] Compared with other genome editing technologies, such as transcription activator-like effector nucleases (TALEN) and zinc-finger nucleases (ZFN), the CRISPR/Cas system lowers the bar of conducting genome editing experiments because it does not require redesign of nucleases to recognize distinct target gene. [6] With only one decade of development, the CRISPR/Cas systems have emerged as a revolutionary engineering tool for sequence-specific genome modifications and have brought significant advances in gene therapy, developmental biology, cancer research, etc. [7] Currently, dozens of CRISPR/Cas-based therapeutics have entered clinical trials, paving the way for precision medicine. [8][9][10] The CRISPR/Cas systems can be classified into two categories (class 1 and class 2) according to the number of Cas proteins involved. [11] The class 1 systems contain multiple Cas subunits, while class 2 systems only contain a single Cas effector protein. [11] The simplicity and flexibility of type II (CRISPR/Cas9) and V (CRISPR/Cas12) systems from class 2 make them more suitable for genetic engineering. [12] Both CRISPR/Cas9 and CRISPR/Cas12 utilize their own single-guide RNAs (sgRNAs) and protospacer adjacent motifs (PAM) to recognize and bind the target gene. [2,13,14] After the formation of the R-loop, the RNA-bounded Cas protein undergoes conformational rearrangement, and induces DNA double-strand break (DSB). [15,16] Eventually, the DNA repair system in eukaryotic cells is activated to repair the cleaved DNA primarily by either nonhomologous end joining (NHEJ) or homology-directed repair (HDR) pathways (Figure 1). NHEJ is usually considered as a highly effective but error-prone mechanism due to the direct ligation of the broken DNA. The ligation process is easy to introduce random insertions or deletions (indels) at the target loci. [17] Thus, NHEJ repair is widely employed in treating diseases caused by the overexpression of abnormal proteins, for instance, transthyretin amyloidosis. [6] The HDR pathway uses homologous DNA templates to repair DNA lesions. [18] As a result, diseases caused by loss-of-function mutations, such as hemophilia, phenylketonuria, and X-linked retinitis pigmentosa, can benefit from CRISPR/Cas-mediated HDR. [10,19] In addition to NHEJ and HDR, alternative mechanisms for DSB repair including homology-mediated end joining (HMEJ), microhomology-mediated end joining (MMEJ), and homology-independent targeted integration (HITI) were also developed to broaden the scope of CRISPR/Cas system. [20][21][22][23] Although CRISPR/Cas systems hold great potential for therapeutic applications, there are two major challenges that need to be addressed. [24] The first challenge is to minimize off-target effects. [25] The second one i...