Co-opting regulation bypass repair as a gene-correction strategy for monogenic diseases

Mol Ther. 2021 Nov 3;29(11):3274-3292. doi: 10.1016/j.ymthe.2021.04.017. Epub 2021 Apr 21.


With the development of CRISPR-Cas9-mediated gene-editing technologies, correction of disease-causing mutations has become possible. However, current gene-correction strategies preclude mutation repair in post-mitotic cells of human tissues, and a unique repair strategy must be designed and tested for each and every mutation that may occur in a gene. We have developed a novel gene-correction strategy, co-opting regulation bypass repair (CRBR), which can repair a spectrum of mutations in mitotic or post-mitotic cells and tissues. CRBR utilizes the non-homologous end joining (NHEJ) pathway to insert a coding sequence (CDS) and transcription/translation terminators targeted upstream of any CDS mutation and downstream of the transcriptional promoter. CRBR results in simultaneous co-option of the endogenous regulatory region and bypass of the genetic defect. We validated the CRBR strategy for human gene therapy by rescuing a mouse model of Wolcott-Rallison syndrome (WRS) with permanent neonatal diabetes caused by either a large deletion or a nonsense mutation in the PERK (EIF2AK3) gene. Additionally, we integrated a CRBR GFP-terminator cassette downstream of the human insulin promoter in cadaver pancreatic islets of Langerhans, which resulted in insulin promoter regulated expression of GFP, demonstrating the potential utility of CRBR in human tissue gene repair.

Keywords: CRISPR/Cas9; diabetes; gene editing; gene repair; genetic diseases; mutations.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • CRISPR-Cas Systems*
  • Cell Line
  • Female
  • Gene Editing / methods*
  • Gene Expression
  • Gene Knockdown Techniques
  • Gene Order
  • Gene Targeting
  • Genes, Reporter
  • Genetic Diseases, Inborn / genetics*
  • Genetic Diseases, Inborn / therapy*
  • Genetic Markers
  • Genetic Therapy* / methods
  • Genetic Vectors / genetics
  • Humans
  • Male
  • Mice
  • Mutation
  • RNA, Guide, Kinetoplastida
  • eIF-2 Kinase / genetics


  • Genetic Markers
  • RNA, Guide
  • EIF2AK3 protein, human
  • eIF-2 Kinase