The Nuffield Council on Bioethics has published an ethical review of
new techniques which aim to prevent the transmission of faulty mtDNA
from mother to child. The report concludes that such techniques are
ethically permissible, provided that further research establishes their
safety.
The Council said the benefits of children being born free of mitochondrial
disorders outweigh the ethical concerns raised over the potential use
of the techniques. It also highlighted the benefits of women carrying mutated mtDNA being able to have children who are genetically related to them, and ensuring that subsequent generations are also free from mitochondrial disorders.
Dr Geoff Watts, chair of the Council's working group, said: 'If
further research shows these techniques to be sufficiently safe and
effective, we think it would be ethical for families to use them if they
wished to, provided they receive an appropriate level of information
and support. They could offer significant health and social benefits to
individuals and families, who could potentially live their lives free
from what can be very severe and debilitating disorders'.
Errors in mtDNA which are inherited down the maternal line can lead to serious health disorders (reported in BioNews 641) in both men and women. There are currently no cures for such disorders.
The new techniques, which are not currently permitted for use in
treatment under UK law, aim to prevent only the transmission of
mitochondrial disorders caused by mutated mtDNA (as distinct from
mitochondrial disorders caused by nuclear DNA). There are two techniques - pronuclear transfer and maternal spindle
transfer - which both involve using healthy mitochondria from a donated
egg, thereby creating children with a genetic connection to three people.
The Council examined ethical concerns that the techniques may constitute germline
therapy. It also considered whether children born with genetic
contributions from three people may have confused perceptions of their
identity, and whether the use of the techniques could create the
potential for harm to future generations. The report concludes that the
proposed treatments do indeed constitute germline genetic modification,
albeit a circumscribed form of modification where DNA molecules are
left completely intact, thereby avoiding risks posed by intervening in
the gene sequence within the DNA molecule.
'We understand that some people concerned about the idea of germline
therapies may fear that if such treatments for mitochondrial gene disorders were approved, a ''slippery slope'' would be created towards comparable alterations to the nuclear genome',
said Dr Watts. 'However, we are only talking about the use of these
techniques in the clearly-defined situation of otherwise incurable
mitochondrial disorders, under strict regulation', he added.
The report also rejects the notion of the mitochondrial donor
representing a 'third parent', either in legal or in ethical terms, and
finds no evidence that mitochondrial inheritance is an element of
personal identity. The report concludes that mitochondrial donors should
not have the same status in law as reproductive egg donors.
Clinical geneticist and member of the working group, Professor
Frances Flinter, said: 'As far as we know, mitochondrial genes alone
create no unique identifiable genetic link between the child and donor.
The child's recognisable likeness to family members would come from
their parents' nuclear DNA. Given these, and other reasons, we think it
is both legally and biologically inaccurate to refer to a mitochondrial
donor as a ''second mother'' or ''third parent'' to the child'.
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