La réponse courte
Editing does a small number of fundamentally different things. A knockout breaks a gene so it stops working. A deletion removes a stretch of DNA, sometimes to skip over a fault. An insertion adds new sequence. And a correction changes a wrong letter back to the right one. They differ enormously in difficulty: knockouts are routine, corrections are hard, and large insertions are hardest of all.
Knockout is achieved by frameshifting indels from end joining, and is the most reliable outcome. Targeted deletion uses paired guides flanking a region — the basis of exon skipping. Insertion requires either homology-directed repair with a donor template, or integrase and transposase systems for kilobase-scale cargo. Correction of a point mutation is best served by base or prime editing rather than nuclease editing.
Difficulty, in order
| Goal | Difficulty | Typical approach |
|---|---|---|
| Switch a gene off | Routine | Cas9 cut, end joining does the rest |
| Remove a specific region | Moderate | Two guides flanking the region |
| Change one letter | Harder | Base editing where possible; prime editing otherwise |
| Insert a short sequence | Hard | Prime editing, or homology-directed repair |
| Insert a whole gene | Hardest | Integrases and transposases — mostly preclinical |
This ordering explains why the approved therapy works by switching a gene off rather than repairing the mutation that causes the disease.
Sources
- National Human Genome Research Institute
Talking Glossary of Genomic Terms ↗