How mRNA Could Revolutionize Medicine
In November 2020, messenger RNA catapulted into the public consciousness when the first COVID-19 vaccines were authorized for emergency use. Around the same time, an equally groundbreaking yet relatively unheralded application of mRNA technology was taking place at a London hospital.
Over the past two decades, there's been increasing interest in harnessing mRNA — molecules present in all of our cells that act like digital tape recorders, copying instructions from DNA in the cell nucleus and carrying them to the protein-making structures — to create a whole new class of therapeutics.
Scientists realized that artificial mRNA, designed in the lab, could be used to instruct our cells to produce certain antibodies, turning our bodies into vaccine-making factories, or to recognize and attack tumors. More recently, researchers recognized that mRNA could also be used to make another groundbreaking technology far more accessible to more patients: gene editing. The gene-editing tool CRISPR has generated plenty of hype for its potential to cure inherited diseases. But delivering CRISPR to the body is complicated and costly.
"Most gene editing involves taking cells out of the patient, treating them and then giving them back, which is an extremely expensive process," explains Drew Weissman, professor of medicine at the University of Pennsylvania, who was involved in developing the mRNA technology behind the COVID-19 vaccines.
But last November, a Massachusetts-based biotech company called Intellia Therapeutics showed it was possible to use mRNA to make the CRISPR system inside the body, eliminating the need to extract cells out of the body and edit them in a lab. Just as mRNA can instruct our cells to produce antibodies against a viral infection, it can also teach them to produce one of the two components that make up CRISPR — a cutting protein that snips out a problem gene.
"The pandemic has really shown that not only are mRNA approaches viable, they could in certain circumstances be vastly superior to more traditional technologies."
In Intellia's London-based clinical trial, the company applied this for the first time in a patient with a rare inherited liver disease known as hereditary transthyretin amyloidosis with polyneuropathy. The disease causes a toxic protein to build up in a person's organs and is typically fatal. In a company press release, Intellia's president and CEO John Leonard swiftly declared that its mRNA-based CRISPR therapy could usher in a "new era of potential genome editing cures."
Weissman predicts that turning CRISPR into an affordable therapy will become the next major frontier for mRNA over the coming decade. His lab is currently working on an mRNA-based CRISPR treatment for sickle cell disease. More than 300,000 babies are born with sickle cell every year, mainly in lower income nations.
"There is a FDA-approved cure, but it involves taking the bone marrow out of the person, and then giving it back which is prohibitively expensive," he says. It also requires a patient to have a matched bone marrow done. "We give an intravenous injection of mRNA lipid nanoparticles that target CRISPR to the bone marrow stem cells in the patient, which is easy, and much less expensive."
Cancer Immunotherapy
Meanwhile, the overwhelming success of the COVID-19 vaccines has focused attention on other ways of using mRNA to bolster the immune system against threats ranging from other infectious diseases to cancer.
The practicality of mRNA vaccines – relatively small quantities are required to induce an antibody response – coupled with their adaptable design, mean companies like Moderna are now targeting pathogens like Zika, chikungunya and cytomegalovirus, or CMV, which previously considered commercially unviable for vaccine developers. This is because outbreaks have been relatively sporadic, and these viruses mainly affect people in low-income nations who can't afford to pay premium prices for a vaccine. But mRNA technology means that jabs could be produced on a flexible basis, when required, at relatively low cost.
Other scientists suggest that mRNA could even provide a means of developing a universal influenza vaccine, a goal that's long been the Holy Grail for vaccinologists around the world.
"The mRNA technology allows you to pick out bits of the virus that you want to induce immunity to," says Michael Mulqueen, vice president of business development at eTheRNA, a Belgium-based biotech that's developing mRNA-based vaccines for malaria and HIV, as well as various forms of cancer. "This means you can get the immune system primed to the bits of the virus that don't vary so much between strains. So you could actually have a single vaccine that protects against a whole raft of different variants of the same virus, offering more universal coverage."
Before mRNA became synonymous with vaccines, its biggest potential was for cancer treatments. BioNTech, the German biotech company that collaborated with Pfizer to develop the first authorized COVID-19 vaccine, was initially founded to utilize mRNA for personalized cancer treatments, and the company remains interested in cancers ranging from melanoma to breast cancer.
One of the major hurdles in treating cancer has been the fact that tumors can look very different from one person to the next. It's why conventional approaches, such as chemotherapy or radiation, don't work for every patient. But weaponizing mRNA against cancer primes the immune cells with the tumor's specific genetic sequence, training the patient's body to attack their own unique type of cancer.
"It means you're able to think about personalizing cancer treatments down to specific subgroups of patients," says Mulqueen. "For example, eTheRNA are developing a renal cell carcinoma treatment which will be targeted at around 20% of these patients, who have specific tumor types. We're hoping to take that to human trials next year, but the challenge is trying to identify the right patients for the treatment at an early stage."
Repairing Damaged mRNA
While hopes are high that mRNA could usher in new cancer treatments and make CRISPR more accessible, a growing number of companies are also exploring an alternative to gene editing, known as RNA editing.
In genetic disorders, the mRNA in certain cells is impaired due to a rogue gene defect, and so the body ceases to produce a particular vital protein. Instead of permanently deleting the problem gene with CRISPR, the idea behind RNA editing is to inject small pieces of synthetic mRNA to repair the existing mRNA. Scientists think this approach will allow normal protein production to resume.
Over the past few years, this approach has gathered momentum, as some researchers have recognized that it holds certain key advantages over CRISPR. Companies from Belgium to Japan are now looking at RNA editing to treat all kinds of disorders, from Huntingdon's disease, to amyotrophic lateral sclerosis, or ALS, and certain types of cancer.
"With RNA editing, you don't need to make any changes to the DNA," explains Daniel de Boer, CEO of Dutch biotech ProQR, which is looking to treat rare genetic disorders that cause blindness. "Changes to the DNA are permanent, so if something goes wrong, that may not be desirable. With RNA editing, it's a temporary change, so we dose patients with our drugs once or twice a year."
Last month, ProQR reported a landmark case study, in which a patient with a rare form of blindness called Leber congenital amaurosis, which affects the retina at the back of the eye, recovered vision after three months of treatment.
"We have seen that this RNA therapy restores vision in people that were completely blind for a year or so," says de Boer. "They were able to see again, to read again. We think there are a large number of other genetic diseases we could go after with this technology. There are thousands of different mutations that can lead to blindness, and we think this technology can target approximately 25% of them."
Ultimately, there's likely to be a role for both RNA editing and CRISPR, depending on the disease. "I think CRISPR is ideally suited for illnesses where you would like to permanently correct a genetic defect," says Joshua Rosenthal of the Marine Biology Laboratory in Chicago. "Whereas RNA editing could be used to treat things like pain, where you might want to reset a neural circuit temporarily over a shorter period of time."
Much of this research has been accelerated by the COVID-19 pandemic, which has played a major role in bringing mRNA to the forefront of people's minds as a therapeutic.
"The pandemic has really shown that not only are mRNA approaches viable, they could in certain circumstances be vastly superior to more traditional technologies," says Mulqueen. "In the future, I would not be surprised if many of the top pharma products are mRNA derived."
Democratize the White Coat by Honoring Black, Indigenous, and People of Color in Science
Celebrating BIPOC's achievements in science are a strong first step to make science a guiding force for all.
This article is part of the magazine, "The Future of Science In America: The Election Issue," co-published by LeapsMag, the Aspen Institute Science & Society Program, and GOOD.
Journalists, educators, and curators have responded to Black Lives Matter by highlighting the history and achievements of Black Americans in a variety of fields, including science. The movement has also sparked important demands to address longstanding scientific inequities such as lack of access to quality healthcare and the disproportionate impact of climate change and environmental pollution on neighborhoods of Black, Indigenous, and people of color (BIPOC). Making such improvements requires bringing BIPOC into science and into positions of leadership in laboratories, graduate schools, medical practices, and clinical trials. The moment is right to challenge scientific gatekeepers to respond to Black Lives Matter by widening the pathways that determine who becomes a scientist, a researcher, or a clinician.
The scientific workforce has long lacked diversity, which in turn discourages Black people from pursuing such careers. Causes include a dearth of mentors and role models, preconceived notions that science is exclusive to white males, and subpar STEM education. Across race, gender, class, ability, and all other dimensions that inform how an individual navigates the world, from the familial to the global level, seeing role models who resemble you impacts what you strive for and believe possible. As Marian Wright Edelman stated, "You can't be what you can't see"—a truth with ever-increasing resonance since the U.S. is projected to be minority-white by 2045.
Black Americans have paved the way for the nation to lead in science and technology, despite marginalization and exclusion from textbooks. Physicist Dr. Shirley Ann Jackson invented the technology behind Caller I.D. and Call Waiting. Otis Boykin's patents made televisions and radios what they are today. Thanks to the 2017 movie Hidden Figures, millions of Americans know about Katherine Johnson, the NASA mathematician whose calculations were essential to the successful trajectory of the Apollo 11 mission.
However, highlighting past role models who were Black achievers is not enough and paints too static a picture—especially when examples of transformative work by contemporary BIPOC scientists serving BIPOC communities abound. Cognitive neuroscientist Dr. Jonathan Jackson founded the Community Access, Recruitment, & Engagement (CARE) Research Center with the goal to break down barriers so that people of color participate in clinical trials. Geneticist Dr. Nanibaa' Garrison's research creates ethical frameworks to overcome genomic injustices so Indigenous populations can benefit from genetic research. Computer scientists Joy Buolamwini and Dr. Timnit Gebru's research drew attention to reinforced racial bias in artificial intelligence, leading Microsoft, Amazon, and IBM this summer to halt use of their facial recognition software.
"Integration does not mean equality if the space being integrated isn't exuberantly down for the cause."
In order to honor concretely the ubiquitous public statements and commitments to justice and equity that flooded everyone's inboxes in early June, we must include traditionally underrepresented voices in all phases of science and its applications. For guidance, we would benefit from listening to activists leading, for example, climate marches and protests over toxic water. Indeed, science is at the core of the issues for which young BIPOC are mobilizing. We need to sit down with these individuals to gain their input on how the narratives, practices, and opportunities in science should change. As Zeena Abdulkarim, a youth climate change organizer working with Zero Hour, explains: "Minority communities are exposed to what the privileged and people in power are not; therefore these communities know the right steps to take in the change we need for the kickstart of true social and environmental justice."
Two other Black youth, for example, used the platform of the laboratory while in high school to mobilize for change. Elle Lanair Lett, now specializing in epidemiology as an M.D.-Ph.D. student in Philadelphia, was prompted by family prevalence of diabetes to research the genetics of pancreatic cells. Dr. Otana Jakpor, now an ophthalmology resident in Michigan, was motivated by the pollution in her hometown of Riverside, California, to research the pulmonary effects of indoor air purifiers, with findings that influenced California ozone regulations. Both became finalists in a national science fair, propelling them on paths toward science careers. These young scientists demonstrate how people's communities and lived experiences can shape trajectories of science research, which, in turn, determines which visions for society are materialized and popularized.
We can also gain insight from another childhood science fair veteran, self-proclaimed "Black STEMinist" Augusta Uwamanzu-Nna, who graduated from college in May and works as a bioengineer. In her view, "we need to shift the burden away from Black people and onto individuals who have contributed to our current reality—fundamentally requiring understanding, open-mindedness, a lack of bias, cultural competency, anti-racism, anti-homophobia, and many, many other things."
Celebrating BIPOC's accomplishments in science and cultivating new leadership today are strong first steps to make science a guiding force for all. Ms. Uwamanzu-Nna keenly reminds us, "Integration does not mean equality if the space being integrated isn't exuberantly down for the cause." Indeed, educational institutions, scientific companies, and medical centers must acknowledge and embrace their role in democratizing science in order for society to realize racial and scientific justice.
[Editor's Note: To read other articles in this special magazine issue, visit the beautifully designed e-reader version.]
Artificial avatars for hire and sophisticated video manipulation carry profound implications for society.
This article is part of the magazine, "The Future of Science In America: The Election Issue," co-published by LeapsMag, the Aspen Institute Science & Society Program, and GOOD.
Alethea.ai sports a grid of faces smiling, blinking and looking about. Some are beautiful, some are oddly familiar, but all share one thing in common—they are fake.
Alethea creates "synthetic media"— including digital faces customers can license saying anything they choose with any voice they choose. Companies can hire these photorealistic avatars to appear in explainer videos, advertisements, multimedia projects or any other applications they might dream up without running auditions or paying talent agents or actor fees. Licenses begin at a mere $99. Companies may also license digital avatars of real celebrities or hire mashups created from real celebrities including "Don Exotic" (a mashup of Donald Trump and Joe Exotic) or "Baby Obama" (a large-eared toddler that looks remarkably similar to a former U.S. President).
Naturally, in the midst of the COVID pandemic, the appeal is understandable. Rather than flying to a remote location to film a beer commercial, an actor can simply license their avatar to do the work for them. The question is—where and when this tech will cross the line between legitimately licensed and authorized synthetic media to deep fakes—synthetic videos designed to deceive the public for financial and political gain.
Deep fakes are not new. From written quotes that are manipulated and taken out of context to audio quotes that are spliced together to mean something other than originally intended, misrepresentation has been around for centuries. What is new is the technology that allows this sort of seamless and sophisticated deception to be brought to the world of video.
"At one point, video content was considered more reliable, and had a higher threshold of trust," said Alethea CEO and co-founder, Arif Khan. "We think video is harder to fake and we aren't yet as sensitive to detecting those fakes. But the technology is definitely there."
"In the future, each of us will only trust about 15 people and that's it," said Phil Lelyveld, who serves as Immersive Media Program Lead at the Entertainment Technology Center at the University of Southern California. "It's already very difficult to tell true footage from fake. In the future, I expect this will only become more difficult."
How do we know what's true in a world where original videos created with avatars of celebrities and politicians can be manipulated to say virtually anything?
As the U.S. 2020 Presidential Election nears, the potential moral and ethical implications of this technology are startling. A number of cases of truth tampering have recently been widely publicized. On August 5, President Donald Trump's campaign released an ad featuring several photos of Joe Biden that were altered to make it seem like was hiding all alone in his basement. In one photo, at least ten people who had been sitting with Biden in the original shot were cut out. In other photos, Biden's image was removed from a nature preserve and praying in church to make it appear Biden was in that same basement. Recently several videos of Speaker of the House Nancy Pelosi were slowed down by 75 percent to make her sound as if her speech was slurred.
During a campaign event in Florida on September 15 of this year, former Vice President Joe Biden was introduced by Puerto Rican singer-songwriter Luis Fonsi. After he was introduced, Biden paid tribute to the singer-songwriter—he held up his cell phone and played the hit song "Despecito". Shortly afterward, a doctored version of this video appeared on self-described parody site the United Spot replacing the Despicito with N.W.A.'s "F—- Tha Police". By September 16, Donald Trump retweeted the video, twice—first with the line "What is this all about" and second with the line "China is drooling. They can't believe this!" Twitter was quick to mark the video in these tweets as manipulated media.
Twitter had previously addressed several of Donald Trump's tweets—flagging a video shared in June as manipulated media and removing altogether a video shared by Trump in July showing a group promoting the hydroxychloroquine as an effective cure for COVID-19. Many of these manipulated videos are ultimately flagged or taken down, but not before they are seen and shared by millions of online viewers.
These faked videos were exposed rather quickly, as they could be compared with the original, publicly available source material. But what happens when there is no original source material? How do we know what's true in a world where original videos created with avatars of celebrities and politicians can be manipulated to say virtually anything?
"This type of fake media is a profound threat to our democracy," said Reid Blackman, the CEO of VIRTUE--an ethics consultancy for AI leaders. "Democracy depends on well-informed citizens. When citizens can't or won't discern between real and fake news, the implications are huge."
In light of the importance of reliable information in the political system, there's a clear and present need to verify that the images and news we consume is authentic. So how can anyone ever know that the content they are viewing is real?
"This will not be a simple technological solution," said Blackman. "There is no 'truth' button to push to verify authenticity. There's plenty of blame and condemnation to go around. Purveyors of information have a responsibility to vet the reliability of their sources. And consumers also have a responsibility to vet their sources."
Yet the process of verifying sources has never been more challenging. More and more citizens are choosing to live in a "media bubble"—gathering and sharing news only from and with people who share their political leanings and opinions. At one time, United States broadcasters were bound by the Fairness Doctrine—requiring them to present controversial issues important to the public in a way that the FCC deemed honest, equitable and balanced. The repeal of this doctrine in 1987 paved the way for new forms of cable news channels such as Fox News and MSNBC that appealed to viewers with a particular point of view. The Internet has only exacerbated these tendencies. Social media algorithms are designed to keep people clicking within their comfort zones by presenting members with only the thoughts and opinions they want to hear.
"I sometimes laugh when I hear people tell me they can back a particular opinion they hold with research," said Blackman. "Having conducted a fair bit of true scientific research, I am aware that clicking on one article on the Internet hardly qualifies. But a surprising number of people believe that finding any source online that states the fact they choose to believe is the same as proving it true."
Back to the fundamental challenge: How do we as a society root out what's false online? Lelyveld suggests that it will begin by verifying things that are known to be true rather than trying to call out everything that is fake. "The EU called me in to talk about how to deal with fake news coming out of Russia," said Lelyveld. "I told them Hollywood has spent 100 years developing special effects technology to make things that are wholly fictional indistinguishable from the truth. I told them that you'll never chase down every source of fake news. You're better off focusing on what can be proved true."
Arif Khan agrees. "There are probably 100 accounts attributed to Elon Musk on Twitter, but only one has the blue checkmark," said Khan. "That means Twitter has verified that an account of public interest is real. That's what we're trying to do with our platform. Allow celebrities to verify that specific videos were licensed and authorized directly by them."
Alethea will use another key technology called blockchain to mark all authentic authorized videos with celebrity avatars. Blockchain uses a distributed ledger technology to make sure that no undetected changes have been made to the content. Think of the difference between editing a document in a traditional word processing program and editing in a distributed online editing system like Google Docs. In a traditional word processing program, you can edit and copy a document without revealing any changes. In a shared editing system like Google Docs, every person who shares the document can see a record of every edit, addition and copy made of any portion of the document. In a similar way, blockchain helps Alethea ensure that approved videos have not been copied or altered inappropriately.
While AI companies like Alethea are moving to ensure that avatars based on real individuals aren't wrongly identified, the situation becomes a bit murkier when it comes to the question of representing groups, races, creeds, and other forms of identity. Alethea is rightly proud that the completely artificial avatars visually represent a variety of ages, races and sexes. However, companies could conceivably license an avatar to represent a marginalized group without actually hiring a person within that group to decide what the avatar will do or say.
"I don't know if I would call this tokenism, as that is difficult to identify without understanding the hiring company's intent," said Blackman. "Where this becomes deeply troubling is when avatars are used to represent a marginalized group without clearly pointing out the actor is an avatar. It's one thing for an African American woman avatar to say, 'I like ice cream.' It's entirely different thing for an African American woman avatar to say she supports a particular political candidate. In the second case, the avatar is being used as social proof that real people of a certain type back a certain political idea. And there the deception is far more problematic."
"It always comes down to unintended consequences of technology," said Lelyveld. "Technology is neutral—it's only the implementation that has the power to be good or bad. Without a thoughtful approach to the cultural, moral and political implications of technology, it often drifts towards the bad. We need to make a conscious decision as we release new technology to ensure it moves towards the good."
When presented with the idea that his avatars might be used to misrepresent marginalized groups, Khan was thoughtful. "Yes, I can see that is an unintended consequence of our technology. We would like to encourage people to license the avatars of real people, who would have final approval over what their avatars say or do. As to what people do with our completely artificial avatars, we will have to consider that moving forward."
Lelyveld frankly sees the ability for advertisers to create avatars that are our assistants or even our friends as a greater moral concern. "Once our digital assistant or avatar becomes an integral part of our life—even a friend as it were, what's to stop marketers from having those digital friends make suggestions about what drink we buy, which shirt we wear or even which candidate we elect? The possibilities for bad actors to reach us through our digital circle is mind-boggling."
Ultimately, Blackman suggests, we as a society will need to make decisions about what matters to us. "We will need to build policies and write laws—tackling the biggest problems like political deep fakes first. And then we have to figure out how to make the penalties stiff enough to matter. Fining a multibillion-dollar company a few million for a major offense isn't likely to move the needle. The punishment will need to fit the crime."
Until then, media consumers will need to do their own due diligence—to do the difficult work of uncovering the often messy and deeply uncomfortable news that's the truth.
[Editor's Note: To read other articles in this special magazine issue, visit the beautifully designed e-reader version.]