BASE EDITING AS A POTENTIAL CURE FOR FANCONI ANEMIA – PUBLISHED IN NATURE COMMUNICATIONS
Cas-mediated genome editing technology holds great promise as a curative treatment for a number of genetic diseases. Conventional CRISPR-Cas genome editing...
Cas-mediated genome editing technology holds great promise as a curative treatment for a number of genetic diseases. Conventional CRISPR-Cas genome editing induces DNA damage (double stranded DNA breaks) and relies on the cellular DNA repair system to yield the desired repair outcome. This works quite well in cells with a fully operational DNA repair machinery. However, in Fanconi Anemia (FA), a genetic disorder associated with bone marrow failure and cancer predisposition, DNA repair is defective due to the gene mutat
In this proof-of-concept study, we find that base editing can indeed restore the function of FA bone marrow stem cells. First, the team went through cycles of optimization for the conditions (base editor construct, vector type, guide RNA format, delivery) in cell lines from multiple FA patients. The developed approach effectively corrected FA mutations in both patient-derived cell lines and bone marrow stem cells from FA patients, leading to restored FANCA expression and functional FA pathway and phenotypic resistance to crosslinking agents.
An obvious question that comes up: how safe is this editing approach? To answer this question, the team predicted possible off-targets and measured the editing outcomes in > 60 sites across multiple base editors. Unintended modifications were detected at a single site with one guide RNA, but a guide RNA targeting the most prevalent FA mutation had no detected off-targets. Nevertheless, un-biased off- target identification using genome or RNA-sequencing will be the next step in the preclinical validation of base editing as an approach to cure FA.
Altogether, this work highlights base editors as a feasible editing strategy in FA and brings us one step closer to the future clinical implementation of base editing not only in FA, but also in other genetic diseases.
Check out our paper, now out in Nature Communications!

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Alan took an unbiased approach to figure out what was removing Cas9 from DNA. He fused recombinant Cas9 with a promiscuous biotin ligase, bound purified Cas9-ligase to a plasmid, and used mass spectrometry to figure out what pushed the Cas9 off the plasmid. We were pleasantly surprised to find that both subunits of a dimeric histone chaperone called FACT were top mass spec hits! Follow-up experiments showed that FACT was necessary and sufficient for displacing Cas9 from DNA substrates. FACT was responsible for turning Cas9 from a multi-turnover “classic” nuclease enzyme into a single-turnover sticky enzyme!
The first set of hits are known homologous recombination factors, such as BRCA1. This gives high confidence that the screen worked as expected. Surprisingly, the same Fanconi Anemia complexes that are required for single stranded oligo HDR are required for plasmid HDR. The FA pathway is thus a core regulator of all forms of HDR!
Our favorite CDC7 inhibitor is XL413, which is non-toxic and quite reversible. This distinguishes it from some other HDR-improving compounds that lead big genomic messes, including polyploidy. Delving into mechanism, CDC7 inhibition leads to loss of MCM2 phosphorylation. Because MCM2 phosphorylation is required for S phase progression, XL413 leads to a longer S phase. This is a magical phase of the cell cycle for HDR, and so our model is that XL413 increases HDR by increasing the amount of time cells are able to do HDR. We tested this with a timing experiment. Hitting cells with Cas9 and then immediately putting them in XL413 leads to increased HDR, because the cells are piling up in S phase at the same time they are repairing the Cas9 damage. But putting cells in XL413 first and then taking them out during editing leads to decreased HDR. This is because the cells all pile up S phase before editing, and then exit into HDR non-permissive cell cycle while Cas9 is doing its thing.
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