Multiplex genome engineering in vivo with CRISPR/Cas9 shows great promise as a potential therapeutic approach. The ability to incorporate multiple single guide RNA (sgRNA) cassettes together with Cas9 gene expression in one AAV vector could greatly enhance the efficiency. In a recent Method article, Mefferd and coworkers indicated that small tRNA promoters could be used to drive sgRNA expression to facilitate the construction of a more effective AAV vector. In contrast, we found that when targeting endogenous genomic loci, CRISPR/Cas9 with tRNA promoter-driven sgRNA expression showed much reduced genome editing activity, compared with significant cleavage with U6 promoter-driven sgRNA expression. Though the underlying mechanisms are still under investigation, our study suggests that the CRISPR/Cas9 system with tRNA promoterdriven sgRNA expression needs to be reevaluated before it can be used for therapeutic genome editing.Keywords: CRISPR/Cas9; genome editing; tRNA promoterThe use of clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated (Cas) systems for in vivo genome editing has emerged as a potential treatment for human diseases (Cox et al. 2015). The high targeting efficiency of CRISPR/Cas systems opens the possibility for multiplex genome engineering in vivo, which could be effective in treating certain diseases that require targeting of multiple genes or deleting a trunk of DNA sequences. Recent studies have demonstrated that in mouse models of Duchenne muscular dystrophy, mutated Dmd exon 23 can be successfully excised with paired flanking single guide RNAs (sgRNAs) in vivo using the smaller Cas9 ortholog form Staphylococcus aureus (SaCas9) delivered by adenoassociated virus (AAV), resulting in partially restored function of dystrophin protein (Long et al. 2016;Nelson et al. 2016;Tabebordbar et al. 2016). However, the use of two different AAVs for separate delivery of Cas9 and two sgRNAs rendered a relatively low efficiency of successful excision. One approach to increase the efficiency would be to have SaCas9 and two or even more different sgRNAs delivered by one AAV vector (Friedland et al. 2015). As AAV vectors have a DNA packaging limit of ∼5 kb, and the standard AAV-SaCRISPR system almost fills the cargo limitation, it would be helpful to further reduce the total length of the SaCRISPR system in order to make extra space for more sgRNA cassettes and to improve the packaging efficiency. Mefferd et al. (2015) reported recently that expression of sgRNAs can be driven by small tRNA promoters (∼70 bp), making it possible to express two full-length sgRNAs using only ∼350 bp of space, about the size of one sgRNA-expressing cassette with a U6 promoter. We tested the potential of this approach by first comparing side-by-side the genome editing efficiency of CRISPR/Cas9 with U6 promoter-and tRNA promoter-driven sgRNA expression, respectively. For efficient delivery of CRISPR materials to cells in vitro, we reconstructed the original lentiCRISPR v2 for Streptococcus pyogen...