Abstract
Schistosomiasis is one of the most important and widespread neglected tropical diseases (NTD), with over 200 million people infected in more than 70 countries; the disease has nearly 800 million people at risk in endemic areas. Although mass drug administration is a cost-effective approach to reduce occurrence, extent, and severity of the disease, it does not provide protection to subsequent reinfection. Interventions that target the parasites’ intermediate snail hosts are a crucial part of the integrated strategy required to move toward disease elimination. The recent revolution in gene drive technology naturally leads to questions about whether gene drives could be used to efficiently spread schistosome resistance traits in a population of snails and whether gene drives have the potential to contribute to reduced disease transmission in the long run. Responsible implementation of gene drives will require solutions to complex challenges spanning multiple disciplines, from biology to policy. This Review Article presents collected perspectives from practitioners of global health, genome engineering, epidemiology, and snail/schistosome biology and outlines strategies for responsible gene drive technology development, impact measurements of gene drives for schistosomiasis control, and gene drive governance. Success in this arena is a function of many factors, including gene-editing specificity and efficiency, the level of resistance conferred by the gene drive, how fast gene drives may spread in a metapopulation over a complex landscape, ecological sustainability, social equity, and, ultimately, the reduction of infection prevalence in humans. With combined efforts from across the broad global health community, gene drives for schistosomiasis control could fortify our defenses against this devastating disease in the future.
Highlights
Gene drives, or the purposeful spread of desired alleles throughout a population to control or modify populations of pests [1] or intermediate hosts for disease, are rapidly being developed in research laboratories [2,3,4,5]
Extensive literature exists about the molecular feasibility, ecological ramifications, and bioethics of such approaches [6,7], with most of the research effort focused on arthropods, in particular, mosquitoes that are vectors of important human diseases such as malaria and dengue fever, whereas gene drive application to other intermediate hosts is less widely discussed
We provide supportive evidence suggesting that the development of gene drives for B. glabrata could be technologically feasible in the near future and that gene drives could provide untapped opportunities for the control of the intermediate host of schistosomiasis
Summary
The purposeful spread of desired alleles throughout a population to control or modify populations of pests [1] or intermediate hosts for disease, are rapidly being developed in research laboratories [2,3,4,5]. Mathematical modeling of gene drives and disease dynamics can provide key understanding in the potential for success of gene drive–based intervention to control schistosomiasis. Gene drives have the potential to influence the global schistosomiasis disease burden, allowing for adjustments in future chemotherapeutic needs and alternative elimination efforts.
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