ConspectusThe discovery of CRISPR/Cas has revolutionized
the field of genome
editing. CRIPSR/Cas components are part of the bacterial immune system
and are able to induce double-strand DNA breaks in the genome, which
are resolved by endogenous DNA repair mechanisms. The most relevant
of these are the error-prone nonhomologous end joining and homology
directed repair pathways. The former can lead to gene knockout by
introduction of insertions and deletions at the cut site, while the
latter can be used for gene correction based on a provided repair
template. In this Account, we focus on the delivery aspects of CRISPR/Cas
for therapeutic applications in vivo. Safe and effective delivery
of the CRISPR/Cas components into the nucleus of affected cells is
essential for therapeutic gene editing. These components can be delivered
in several formats, such as pDNA, viral vectors, or ribonuclear complexes.
In the ideal case, the delivery system should address the current
limitations of CRISPR gene editing, which are (1) lack of targeting
specific tissues or cells, (2) the inability to enter cells, (3) activation
of the immune system, and (4) off-target events.To circumvent
most of these problems, initial therapeutic applications
of CRISPR/Cas were performed on cells ex vivo via classical methods
(e.g., microinjection or electroporation) and novel methods (e.g.,
TRIAMF and iTOP). Ideal candidates for such methods are, for example,
hematopoietic cells, but not all tissue types are suited for ex vivo
manipulation. For direct in vivo application, however, delivery systems
are needed that can target the CRISPR/Cas components to specific tissues
or cells in the human body, without causing immune activation or causing
high frequencies of off-target effects.Viral systems have been
used as a first resort to transduce cells
in vivo. These systems suffer from problems related to packaging constraints,
immunogenicity, and longevity of Cas expression, which favors off-target
events. Viral vectors are as such not the best choice for direct in
vivo delivery of CRISPR/Cas. Synthetic vectors can deliver nucleic
acids as well, without the innate disadvantages of viral vectors.
They can be classed into lipid, polymeric, and inorganic particles,
all of which have been reported in the literature. The advantage of
synthetic systems is that they can deliver the CRISPR/Cas system also
as a preformed ribonucleoprotein complex. The transient nature of
this approach favors low frequencies of off-target events and minimizes
the window of immune activation. Moreover, from a pharmaceutical perspective,
synthetic delivery systems are much easier to scale up for clinical
use compared to viral vectors and can be chemically functionalized
with ligands to obtain target cell specificity. The first preclinical
results with lipid nanoparticles delivering CRISPR/Cas either as mRNA
or ribonucleoproteins are very promising. The goal is translating
these CRISPR/Cas therapeutics to a clinical setting as well. Taken
together, these current trends seem to favor the use...