CRISPR-Based Correction of Monogenic Disease in Patient-Derived Induced Pluripotent Stem Cells
DOI:
https://doi.org/10.5281/zenodo.22274817Keywords:
Induced pluripotent stem cells; Genome editing; Isogenic controls; Loss of heterozygosity; Monogenic diseaseAbstract
Background: Isogenic pairs anchor monogenic disease modelling in induced pluripotent stem cells, and CRISPR correction has
made them routine across the monogenic disease spectrum.
Objective: To reassess where the residual risk in generating corrected isogenic pairs now lies, given that correction efficiency is no
longer the limiting obstacle.
Methods: Narrative review of gene editing studies, clone screening reports and early clinical applications.
Findings: Templated correction in human induced pluripotent stem cells ran at 1.0%, whereas prime editing reached 4.3-24.8% in
human embryonic stem cells. Large on-target lesions appeared in 33% of 27 edited clones and in up to 40% of edited clones, all
passing standard PCR and Sanger checks; copy-neutral loss of heterozygosity occurred in 7 of 648 clones.
Conclusions: The evidence supports treating on-target structural damage, not efficiency, as the main threat to isogenic validity; it
does not show that amplicon sequencing alone validates a corrected pair.
References
Soldner, F., Laganiere, J., Cheng, A.W., Hockemeyer, D., Gao, Q., Alagappan, R., et al. (2011) Generation of isogenic pluripotent stem cells differing exclusively at two early onset Parkinson point mutations. Cell, 146(2): 318-331.
Yusa, K., Rashid, S.T., Strick-Marchand, H., Varela, I., Liu, P.-Q., Paschon, D.E., et al. (2011) Targeted gene correction of alpha1-antitrypsin deficiency in induced pluripotent stem cells. Nature, 478(7369): 391-394.
Kilpinen, H., Goncalves, A., Leha, A., Afzal, V., Alasoo, K., Ashford, S., et al. (2017) Common genetic variation drives molecular heterogeneity in human iPSCs. Nature, 546(7658): 370-375.
An, M.C., Zhang, N., Scott, G., Montoro, D., Wittkop, T., Mooney, S., et al. (2012) Genetic correction of Huntington's disease phenotypes in induced pluripotent stem cells. Cell Stem Cell, 11(2): 253-263.
Li, H.L., Fujimoto, N., Sasakawa, N., Shirai, S., Ohkame, T., Sakuma, T., et al. (2015) Precise correction of the dystrophin gene in Duchenne muscular dystrophy patient induced pluripotent stem cells by TALEN and CRISPR-Cas9. Stem Cell Reports, 4(1): 143-154.
Wang, Y., Liang, P., Lan, F., Wu, H., Lisowski, L., Gu, M., et al. (2014) Genome editing of isogenic human induced pluripotent stem cells recapitulates long QT phenotype for drug testing. Journal of the American College of Cardiology, 64(5): 451-459.
Lin, S., Staahl, B.T., Alla, R.K., Doudna, J.A. (2014) Enhanced homology-directed human genome engineering by controlled timing of CRISPR/Cas9 delivery. eLife, 3: e04766.
Yang, L., Guell, M., Byrne, S., Yang, J.L., De Los Angeles, A., Mali, P., et al. (2013) Optimization of scarless human stem cell genome editing. Nucleic Acids Research, 41(19): 9049-9061.
Byrne, S.M., Ortiz, L., Mali, P., Aach, J., Church, G.M. (2015) Multi-kilobase homozygous targeted gene replacement in human induced pluripotent stem cells. Nucleic Acids Research, 43(3): e21.
Surun, D., Schneider, A., Mircetic, J., Neumann, K., Lansing, F., Paszkowski-Rogacz, M., et al. (2020) Efficient generation and correction of mutations in human iPS cells utilizing mRNAs of CRISPR base editors and prime editors. Genes, 11(5): 511.
Ihry, R.J., Worringer, K.A., Salick, M.R., Frias, E., Ho, D., Theriault, K., et al. (2018) p53 inhibits CRISPR-Cas9 engineering in human pluripotent stem cells. Nature Medicine, 24(7): 939-946.
Kim, S., Kim, D., Cho, S.W., Kim, J., Kim, J.-S. (2014) Highly efficient RNA-guided genome editing in human cells via delivery of purified Cas9 ribonucleoproteins. Genome Research, 24(6): 1012-1019.
Steyer, B., Bu, Q., Cory, E., Jiang, K., Duong, S., Sinha, D., et al. (2018) Scarless genome editing of human pluripotent stem cells via transient puromycin selection. Stem Cell Reports, 10(2): 642-654.
Paquet, D., Kwart, D., Chen, A., Sproul, A., Jacob, S., Teo, S., et al. (2016) Efficient introduction of specific homozygous and heterozygous mutations using CRISPR/Cas9. Nature, 533(7601): 125-129.
Komor, A.C., Kim, Y.B., Packer, M.S., Zuris, J.A., Liu, D.R. (2016) Programmable editing of a target base in genomic DNA without double-stranded DNA cleavage. Nature, 533(7603): 420-424.
Gaudelli, N.M., Komor, A.C., Rees, H.A., Packer, M.S., Badran, A.H., Bryson, D.I., et al. (2017) Programmable base editing of A-T to G-C in genomic DNA without DNA cleavage. Nature, 551(7681): 464-471.
Anzalone, A.V., Randolph, P.B., Davis, J.R., Sousa, A.A., Koblan, L.W., Levy, J.M., et al. (2019) Search-and-replace genome editing without double-strand breaks or donor DNA. Nature, 576(7785): 149-157.
Habib, O., Habib, G., Hwang, G.-H., Bae, S. (2022) Comprehensive analysis of prime editing outcomes in human embryonic stem cells. Nucleic Acids Research, 50(2): 1187-1197.
Chen, P.J., Hussmann, J.A., Yan, J., Knipping, F., Ravisankar, P., Chen, P.-F., et al. (2021) Enhanced prime editing systems by manipulating cellular determinants of editing outcomes. Cell, 184(22): 5635-5652.e29.
Cullot, G., Boutin, J., Toutain, J., Prat, F., Pennamen, P., Rooryck, C., et al. (2019) CRISPR-Cas9 genome editing induces megabase-scale chromosomal truncations. Nature Communications, 10(1): 1136.
Simkin, D., Papakis, V., Bustos, B.I., Ambrosi, C.M., Ryan, S.J., Baru, V., et al. (2022) Homozygous might be hemizygous: CRISPR/Cas9 editing in iPSCs results in detrimental on-target defects that escape standard quality controls. Stem Cell Reports, 17(4): 993-1008.
Weisheit, I., Kroeger, J.A., Malik, R., Klimmt, J., Crusius, D., Dannert, A., et al. (2020) Detection of deleterious on-target effects after HDR-mediated CRISPR editing. Cell Reports, 31(8): 107689.
Boutin, J., Rosier, J., Cappellen, D., Prat, F., Toutain, J., Pennamen, P., et al. (2021) CRISPR-Cas9 globin editing can induce megabase-scale copy-neutral losses of heterozygosity in hematopoietic cells. Nature Communications, 12(1): 4922.
Kosicki, M., Tomberg, K., Bradley, A. (2018) Repair of double-strand breaks induced by CRISPR-Cas9 leads to large deletions and complex rearrangements. Nature Biotechnology, 36(8): 765-771.
Leibowitz, M.L., Papathanasiou, S., Doerfler, P.A., Blaine, L.J., Sun, L., Yao, Y., et al. (2021) Chromothripsis as an on-target consequence of CRISPR-Cas9 genome editing. Nature Genetics, 53(6): 895-905.
Hwang, G.H., Lee, S.H., Oh, M., Kim, S., Habib, O., Jang, H.K., et al. (2025) Large DNA deletions occur during DNA repair at 20-fold lower frequency for base editors and prime editors than for Cas9 nucleases. Nature Biomedical Engineering, 9(1): 79-92.
Haapaniemi, E., Botla, S., Persson, J., Schmierer, B., Taipale, J. (2018) CRISPR-Cas9 genome editing induces a p53-mediated DNA damage response. Nature Medicine, 24(7): 927-930.
Enache, O.M., Rendo, V., Abdusamad, M., Lam, D., Davison, D., Pal, S., et al. (2020) Cas9 activates the p53 pathway and selects for p53-inactivating mutations. Nature Genetics, 52(7): 662-668.
Merkle, F.T., Ghosh, S., Kamitaki, N., Mitchell, J., Avior, Y., Mello, C., et al. (2017) Human pluripotent stem cells recurrently acquire and expand dominant negative P53 mutations. Nature, 545(7653): 229-233.
Tsai, S.Q., Zheng, Z., Nguyen, N.T., Liebers, M., Topkar, V.V., Thapar, V., et al. (2015) GUIDE-seq enables genome-wide profiling of off-target cleavage by CRISPR-Cas nucleases. Nature Biotechnology, 33(2): 187-197.
Volpato, V., Webber, C. (2020) Addressing variability in iPSC-derived models of human disease: guidelines to promote reproducibility. Disease Models & Mechanisms, 13(1): dmm042317.
Frangoul, H., Altshuler, D., Cappellini, M.D., Chen, Y.-S., Domm, J., Eustace, B.K., et al. (2021) CRISPR-Cas9 gene editing for sickle cell disease and beta-thalassemia. New England Journal of Medicine, 384(3): 252-260.
Vaidyanathan, S., Salahudeen, A.A., Sellers, Z.M., Bravo, D.T., Choi, S.S., Batish, A., et al. (2020) High-efficiency, selection-free gene repair in airway stem cells from cystic fibrosis patients rescues CFTR function in differentiated epithelia. Cell Stem Cell, 26(2): 161-171.e4.

