three-parent baby

three-parent baby, human offspring produced from the genetic material of one man and two women through the use of assisted reproductive technologies, specifically mitochondrial replacement therapy (MRT) and three-person in vitro fertilization (IVF). In general, the reproductive technologies used to produce three-parent babies focus on replacing or otherwise reducing the effects of mutations that occur in the DNA of cellular organelles known as mitochondria, which reside in the cell cytoplasm. The various approaches could help women overcome infertility and could prevent the transmission to their offspring of potentially debilitating mitochondrial diseases.

The first three-parent babies were born in the 1990s and early 2000s, the products of a then-novel IVF-based technique known as ooplasmic transfer (cytoplasmic transfer). The success of the technique was seen as miraculous, but its use was controversial. It prompted scientists to develop improved techniques and caused regulatory agencies to restrict the use of three-parent IVF. In 2015, following extensive review, MRT was legalized in the United Kingdom for the purpose of preventing genetic disease. The following year a medical scientist in the United States reported the birth of the first three-parent baby produced using MRT; the procedure was carried out in Mexico in order to bypass U.S. regulations. The development was again greeted with excitement and controversy. Much was unknown about the safety of various three-parent IVF techniques, and their use to generate human babies raised ethical and social concerns, among them the possible impacts on health and heredity.

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Characteristics of the Human Body

Mitochondrial replacement therapy

Ooplasmic transfer entails the injection of a small amount of cytoplasm from an egg cell (ovum) donated by a healthy woman into the mother’s egg, which is then fertilized by the father’s sperm and implanted into the mother’s uterus using IVF. Because ooplasmic transfer involves the mixing of cytoplasm from maternal and donor eggs—the health and hereditary risks of which could be significant—interest in its potential use to overcome infertility or mitochondrial disease has declined. Furthermore, other techniques have supplanted ooplasmic transfer, the two most significant of which are maternal spindle transfer and pronuclear transfer.

In maternal spindle transfer, the nucleus is removed from a donor egg, leaving behind the cytoplasm. The nucleus from the mother’s egg cell is then inserted into the donor egg. The egg is fertilized with the father’s sperm and then transferred to the mother’s uterus for normal gestation, similar to other IVF procedures.

In pronuclear transfer, the mother’s egg is first fertilized with the father’s sperm, producing a zygote. The pronuclei of the egg and sperm are then removed from the zygote and inserted into a donor egg that has been fertilized and has had its own nucleus removed (a pronucleus is the nucleus of the egg or sperm at the stage of fertilization prior to nucleus fusion). The zygote derived from the donor egg is then implanted into the mother’s uterus.

The biological basis of mitochondrial replacement

Normally, a zygote possesses a nucleus that houses a genome comprising nuclear DNA from both the father and the mother and mitochondria that house a distinct genome, which is solely composed of mitochondrial DNA (mtDNA) from the mother (paternal mitochondria in the sperm are destroyed by the egg). Maternally inherited mtDNA accounts for only a very small percentage of the total DNA in cells (less than 1 percent in mammals, by most estimates), yet the ability of an egg to be fertilized successfully is thought to be associated with the health of a woman’s mitochondria and in particular her mtDNA. Correlations have been identified, for example, between reduced mtDNA quantity and infertility, as well as between mtDNA mutations and fertilization rates.

Mutations in mtDNA are a cause of mitochondrial disease, a heterogeneous group of diseases that can lead to premature death, sometimes in infancy or childhood. Most mitochondrial diseases lack specific treatments, and women who carry the causative mutations are at high risk of transmitting the diseases to their offspring. Risk of transmission is greatest for women with high heteroplasmy—women whose total mtDNA content in affected cells or tissues is made up of between 60 and 90 percent mutated mtDNA, the threshold at which mitochondrial disease becomes apparent clinically. However, even women with low heteroplasmy and who are therefore asymptomatic are at risk of passing on mitochondrial disease to their offspring. In such women, heteroplasmy levels can be increased by phenomena such as selective replication of mtDNA and mitochondrial bottleneck, in which only a select number of mtDNA molecules are transferred to eggs at the time of egg maturation.

Both maternal spindle transfer and pronuclear transfer attempt to minimize heteroplasmy by replacing the mother’s mitochondria with healthy donor mitochondria. Ooplasmic transfer, on the other hand, may contribute to heteroplasmy, thereby possibly diluting the effects of mutations in maternal mtDNA and enabling embryo survival. The precise mechanisms by which any of the three techniques could potentially treat infertility or prevent inherited mitochondrial disease are not fully known.

Safety and ethical considerations

Ooplasmic transfer was introduced in the mid-1990s at a reproductive medical centre in the United States to treat infertility in women over age 35 who had failed to conceive despite repeated attempts with traditional IVF techniques. At the time, however, data on the long-term safety of the technique was lacking, and testing in animal models had not been carried out. The health implications of heteroplasmy involving donor mtDNA also were unknown. In the early 2000s, studies of mitochondrial replacement in animals yielded conflicting results; for example, some animals suffered accelerated aging or declines in cognitive function in adulthood, whereas others were apparently healthy and able to breed. Whereas ooplasmic transfer initially was intended for the treatment of infertility, techniques developed later were aimed primarily at preventing the transmission of mitochondrial disease. However, as with ooplasmic transfer, little was known about their safety. It also was uncertain to what degree they could prevent the inheritance of mitochondrial disease.

The impact of mitochondrial manipulation on heredity remains unknown. However, because mtDNA is passed along to offspring, crossing the germ line, reproductive techniques that involve donor mtDNA have the potential to alter the course of family ancestry. Critics of three-person IVF claimed that the techniques would lead to the generation of “designer” babies, though many scientists consider that possibility to be exceedingly remote. Little is known about the legal, psychological, and social ramifications for the child of three genetic parents.

Because of the many unforeseeable risks, the use of three-parent IVF is restricted. In 2001 the U.S. Food and Drug Administration (FDA) introduced a special-permissions requirement for the use of mitochondrial manipulation technologies, which essentially banned their use by requiring reproductive clinics to seek explicit authorization from the FDA. The agency revisited scientific issues related to three-person IVF in 2014, taking into consideration the development of improved technologies with the potential to prevent mitochondrial disease, as well as new data from animal testing.

Debate around three-parent IVF was prominent in the United Kingdom, where researchers were leading the effort to test mitochondrial manipulation technologies in clinical trials. A panel in 2012 in the United Kingdom concluded that the use of the technologies was ethical. Laws in the United Kingdom prevented germ-line alteration, but a proposal was introduced in 2014 that raised the possibility of legalizing the generation of three-parent babies. In early 2015, members of Parliament in the United Kingdom voted in favour of allowing three-parent babies; the country was poised to become the first to introduce laws to guide the use of three-person IVF.

In 2017, the year following the birth of the first baby born using MRT, medical scientists in Ukraine reported the birth of two babies from MRT. The technique has since been applied to treat infertility and genetic diseases in other countries, including Greece. Long-term studies to assess the health of three-parent babies born using MRT are ongoing.