Existing approaches to gene editing are all-or-nothing: gene sequences are altered, removed or added. However, some diseases manifest through inadequate gene expression that is dialled too far up or down rather than turned on or off. This means that, in some cases, techniques such as editing the epigenome may be a better option.⁴⁵

Future Horizons:

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5-yearhorizon

Disease spread is monitored through metagenomics

Metagenomics advances make it possible to monitor the emergence (or re-emergence) of viral diseases with the goal of containing their spread. Epigenome editors alter epigenetic state at precise locations within the genome, lowering the chance of immune response, and are fine-tuned for first use on disease genes and tissues, and tested in vivo. New sequencing methods identify epigenetic modifications while preserving the accuracy of genome sequencing. Insights are gained into how interventions like diet and exercise alter gut microbiome.

10-yearhorizon

Epigenome editors are fine-tuned

Metagenomics becomes a standard tool for microbial ecology laboratories, using methods similar to gene fingerprinting to profile microbial communities. Electrogenetics tools are put to work in editing eukaryotic systems, using redox-sensing transcription factors that have been identified in plants, and animals. Epigenome editing becomes titratable.

25-yearhorizon

Cosmetic gene editing becomes possible

Delivery methods of enzymes and editors — whether gene or epigenome — become straightforward and open to dynamic control. Epigenome editing and electrogenetics helps people temporarily mute some genes or express others, making for temporary alterations including night vision and resistance to radiation, viruses and chemical weapons. Cosmetic mutations, such as temporary eye-colour changes, are popular in body-hacking subcultures. Fundamental alterations to the microbiome make humans capable of digesting cellulose or extracting nutrition from plastic.

Simply adding or removing the chemical tags that adorn DNA, for instance, could dial down or up expression of certain genes or variants without the risk of dangerous mutations. Epigenetic mechanisms include histone modifications and DNA methylation; manipulating the factors that control these can be both tuneable and reversible, and could be especially useful for controlling more than one gene.⁴⁶ Once considered a dark art, epigenome editing is now rapidly advancing.⁴⁷

Another approach, editing RNA, could open up much more common diseases like chronic pain. Some drugs are already in clinical trials.

Alternatives to direct gene editing - Anticipation Scores

The Anticipation Potential of a research field is determined by the capacity for impactful action in the present, considering possible future transformative breakthroughs in a field over a 25-year outlook. A field with a high Anticipation Potential, therefore, combines the potential range of future transformative possibilities engendered by a research area with a wide field of opportunities for action in the present. We asked researchers in the field to anticipate:

The uncertainty related to future science breakthroughs in the field
The transformative effect anticipated breakthroughs may have on research and society
The scope for action in the present in relation to anticipated breakthroughs.

This chart represents a summary of their responses to each of these elements, which when combined, provide the Anticipation Potential for the topic. See methodology for more information.