Maternal spindle transfer for mitochondrial disease: lessons to be learnt before extending the method to other conditions?

Abstract

Mitochondrial diseases are a group of conditions attributed to mutations of specific genes that regulate mitochondrial function. Maternal spindle transfer (MST) has been proposed as a method to prevent the transmission of these diseases and utilisation of the technique resulted in the birth of a baby free of disease in 2017 in Mexico. Potential flaws in research governance and the associated criticism emerged from the expansion of MST to provide a potentially new assisted reproductive technique to overcome infertility problems characterised by repeated in vitro embryo development arrest caused by mitochondrial dysfunction and cytoplasmic deficiencies of the oocyte. This applied technique represents a good example of the need to strike “a balance between taking appropriate precautions and hampering innovation”. The purpose of this article is to explore, through a comprehensive literature search, whether and how this process can evolve from an experimental method to treat a medical condition to a standard of care solution for certain types of infertility. We argue that a number of key issues should be considered before applying the technique more broadly. These include regulatory oversight, safety and efficacy, cost, implications for research, essential laboratory skills and oversight, as well as the care needs of patients and egg donors.

Keywords:

• Mitochondrial disease
• gene editing
• ethics
• maternal spindle transfer
• three parent IVF
• infertility

Acknowledgments

Authors would like to thank Dr Mark Hamilton, MD, FRCOG, Consultant Gynaecologist from Aberdeen Maternity Hospital for his suggestions in improving the final draft of the paper.

Author contributions

CS conceived the idea and drafted the paper. NV co-drafted the paper.

Disclosure statement

Authors have no competing interest.