The recent advent of genome and epigenome editing technologies has provided a new paradigm in which the landscape of the human genome and epigenome can be precisely manipulated in their native context. Genome and epigenome editing technologies can be applied to many aspects of aging research and offer the potential to develop novel therapeutics against age-related diseases. Here, we discuss the latest technological advances in the CRISPR-based genome and epigenome editing toolbox, and provide insight into how these synthetic biology tools could facilitate aging research by establishing in vitro cell and in vivo animal models to dissect genetic and epigenetic mechanisms underlying aging and age-related diseases. We discuss recent developments in the field with the aims to precisely modulate gene expression and dynamic epigenetic landscapes in a spatial and temporal manner in cellular and animal models, by complementing the CRISPR-based editing capability with conditional genetic manipulation tools including chemically inducible expression systems, optogenetics, logic gate genetic circuits, tissue-specific promoters, and the serotype-specific adeno-associated virus. We also discuss how the combined use of genome and epigenome editing tools permits investigators to uncover novel molecular pathways involved in the pathophysiology and etiology conferred by risk variants associated with aging and aging-related disease. A better understanding of the genetic and epigenetic regulatory mechanisms underlying human aging and age-related disease will significantly contribute to the developments of new therapeutic interventions for extending health span and life span, ultimately improving the quality of life in the elderly populations.
The recent advent of genome and epigenome editing technologies has allowed precise manipulation of the human genome and epigenome by introducing specific changes in native states. Targeted genome editing tools based on zinc finger nuclease (ZFN), transcription activator-like effector nuclease (TALEN), and CRISPR (clustered regulatory interspaced short palindromic repeat)/Cas9-based RNA-guided DNA endonuclease have become powerful approaches for modeling human disease by creating isogenic cells and transgenic animals (Fig. 1). These efficient, programmable chimeric nucleases provided a breakthrough in generating genetically engineered cells and animals much faster and more economically than via the traditional homologous recombination-based mutagenic approach .
The recent breakthroughs in the CRISPR-based genome editing tool further revolutionize the gene editing technique, due to its simplicity in target design, affordability, high efficiency, versatility, and multiplexing capability . The commonly used CRISPR system can be implemented in mammalian cells by co-expressing Cas9 nuclease along with single guide RNA (sgRNA), which is derived from a synthetic fusion of the CRISPR RNA array (crRNA) and trans-activating crRNA (tracrRNA)  (Fig. 1c). The 20-bp target site sequence of sgRNA immediately needs to be followed by a 3-bp NGG protospacer adjacent motif (PAM) sequence on the 3′ end, and an additional guanine nucleotide on the 5′ end can increase targeting efficiency . The repertoire of CRISPR-mediated tools is expanding fast, and we are now at the dawn of the gene editing age. Substantial improvement of CRISPR's efficiency, specificity, and flexibility following the discovery of CRISPR's variants [3,4,5], of chemical modifications to the sgRNA , and of more efficient delivery methods [5,7] has greatly expanded the CRISPR toolbox. More recently, application of the CRISPR/Cas9 system has expanded beyond genome editing (Fig. 1d) to epigenome engineering (Fig. 1e) to modulate endogenous transcription and epigenetic states . The complement of optogenetics  and multi-input logic gate genetic circuits  with the CRISPR-based targeted epigenome editing capability permits precise modulation of gene expression and of the epigenetic landscape in a spatial and temporal manner in specific tissues and cells. Epigenome engineering has created another wave of excitement across the scientific research community. Biologists are embracing the power of gene editing tools, particularly the CRISPR/Cas9 system, to explore the landscape of genomes and epigenomes in their native context.
The background and development of ZFN-, TALEN-, and CRISPR-based targeted genome and epigenome editing toolboxes have been extensively reviewed elsewhere [1,11]. Here, we discuss the latest major advances in CRISPR-based genome and epigenome editing tools, and the potential application of these programmable chimeric enzymes to aging research. More specifically, we aim to provide insight into how these synthetic biology tools could facilitate aging research by establishing in vitro and in vivo models for dissecting genetic and molecular mechanisms underlying age-related diseases.
Recent Major Advances in Genome Engineering
CRISPR is transforming biomedical science research and has quickly become the preferred tool for genetic manipulation; it also shows incredible promise as a versatile genome editing platform for interrogating endogenous gene function in vitro and in vivo. One of the major additions to the CRISPR toolbox was the discovery of multiple Cas9 variants with expanded capabilities and minimized molecular weight for genetic manipulation to further advance genome and epigenome engineering (Table 1; Fig. 2). Two smaller-sized Cas9 orthologues, Streptococcus thermophilus Cas9 (St1Cas9) and Staphylococcus aureus Cas9 (SaCas9), could edit the genome with an efficiency and specificity similar to those of the commonly used Streptococcus pyogenes Cas9 (SpCas9) [5,12]. SaCas9 and its sgRNA expression cassette can be packaged into a single adeno-associated virus (AAV) delivery vehicle for efficient and specific in vivo genome editing . Nevertheless, due to exceeding the maximal viral genome packaging capacity, the addition of tag markers such as the commonly used fluorescent reporter downstream of the fused SaCas9 and its sgRNA expression cassette results in no production of functional AAV. To circumvent this issue, the previously reported, similar dual-vector system can be adopted , which uses one vector to express fusion of SaCas9 and fluorescent reporter genes and another to express multiple sgRNAs. In fact, the SpCas9-based dual-vector system was successfully used to interrogate gene function in the mammalian brain by editing multiple genes (Dnmt1, Dnmt3a, and Dnmt3b) in the adult mouse brain in vivo . As illustrated in Figure 2b, the dual-vector system is particularly useful to deliver large fusion transgenes comprising CRISPR and chromatin catalytic domains as well as including tag markers, multiple guide RNA expression cassettes, optogenetics, or doxycycline-inducible elements. To our knowledge, strategies for in vivo administration of CRISPR-based epigenome editing using AAV vectors have yet to be established.
Recent studies have revealed the potential of another 2 distinct class 2 CRISPR/Cas systems, Cpf1  and C2c1  proteins, which could expand, complement, and extend the existing CRISPR/Cas9 genome editing tools. Cpf1 is a single RNA-guided endonuclease of a class 2 CRISPR/Cas system and could mediate robust and efficient genome editing activity with features distinct from those of Cas9 . Cpf1 lacks tracrRNA, utilizes a T-rich PAM for DNA recognition, and requires only 1 RNA molecule to cleave DNA via a staggered DNA double-stranded break . Instead of “blunt” ends as a result of Cas9 cutting both strands in a DNA molecule at the same position, the DNA cleavage activity of Cpf1 could create a “sticky” end . The sticky ends carry information that can direct the insertion of the DNA; hence, it makes the insertion much better controllable, and this distinct advantage could offer researchers more options when selecting a genome site to edit. This feature allows a better, alternative way to precisely introduce DNA in the proper orientation into the genome via non-homology-directed repair (non-HDR) mechanisms, especially in nondividing cells (Fig. 2a). Apart from Cas9 and Cpf1, C2c1 is another distinct class 2 CRISPR/Cas system, which mediates DNA interference in a 5′-PAM-dependent fashion analogous to Cpf1 . Unlike Cpf1, C2c1 depends on both crRNA and tracrRNA for DNA cleavage . Compared to the RNA-guided DNA-targeting enzymes such as Cpf1 and C2c1, C2c2 is a newly discovered RNA-guided RNA-targeting CRISPR effector, which can be programmed to knock down specific mRNAs by cleaving single-stranded RNA targets carrying complementary protospacers .
Engineered CRISPR/Cas9 nucleases with altered PAM specificities eliminate the constraint that only a specific PAM can be recognized by Cas9 . These Cas9 variants with altered PAM specificities allow robust editing of desired endogenous gene sites which are not targetable by wild-type SpCas9 while maintaining the genome-wide specificities comparable to those of wild-type SpCas9 . These Cas9 variants demonstrate the feasibility of engineering a wide range of Cas9s with altered and improved PAM specificities . The SaCas9 PAM sequence for optimal on-target cutting is 5′-NNGRRT-3′, which is longer than the 5′-NGG-3′ PAM recognition sequence of SpCas9. This short PAM has limited the range of sequences that Cas9 orthologues can target . By using molecular evolution to modify the PAM of SaCas9 in order to relax the PAM recognition specificity, the SaCas9 targeting range can be increased while preserving the robustness of genome editing activities at endogenous loci . Recently, Cas9 from Francisella novicida (FnCas9), one of the largest Cas9 orthologues, was successfully microinjected into mouse zygotes to edit endogenous sites with the more relaxed 5′-YG-3′ PAM, thus expanding the target space of the CRISPR/Cas9 toolbox .
Using targeted deep sequencing and unbiased whole-genome off-target analysis, the newly designed “enhanced-specificity” SpCas9 (eSpCas9) variants were shown to reduce off-target effects and maintain robust on-target cleavage in human cells . SpCas9-HF1, another high-fidelity variant of CRISPR/Cas9 nucleases, could significantly reduce unwanted off-target mutations, as shown by genome-wide break capture and targeted sequencing methods . With their exceptional precision and improved specificity, rationally engineered Cas9 nucleases, including SpCas9-HF1 and eSpCas9, could provide an alternative to wild-type SpCas9 for research on and therapeutic applications to numerous inherited disorders [4,17]. A higher genome editing specificity while retaining on-target cleavage efficiency could be achieved by combining a Cas9 nickase mutant with paired guide RNAs to introduce targeted double-strand breaks . In addition, use of truncated guide RNAs could further reduce off-target effects induced by pairs of Cas9 nickases without sacrificing on-target genome editing efficiencies .
For transgene knock-in or DNA replacement, the efficiency of precise sequence replacement by CRISPR-mediated HDR could be significantly increased using asymmetric donor DNA . The utilization of an HDR enhancer, RS-1 (3-[(benzylamino)sulfonyl]-4-bromo-N- [4-bromophenyl]benzamide) was shown to enhance CRISPR/Cas9- and TALEN-mediated knock-in efficiency in rabbit embryos both in vitro and in vivo by stimulating RAD51 . To support this notion, abolished non-homologous end joining (NHEJ) activity by suppressing the NHEJ key molecules (Ku70 or DNA ligase IV) could increase the efficiency of HDR for CRISPR/Cas9-induced, precise gene editing in mammalian cells . Additionally, highly efficient introduction of specific homozygous and heterozygous mutations could be achieved by incorporating silent CRISPR/Cas-blocking mutations along with pathogenic mutations to improve HDR accuracy . Interestingly, a CRISPR/Cas9-induced NHEJ homology-independent knock-in strategy allows more efficient targeted integration of large reporter genes than does HDR-mediated gene targeting knock-in in human cells . In this strategy, the NHEJ pathway was used to promote DNA integration into a genome by rejoining of cleaved genome and donor plasmids following CRISPR/Cas9-induced DNA double-strand breaks . The NHEJ homology-independent knock-in strategy is particularly useful for genome editing in postmitotic or nondividing cells, since HDR does not function in G₀/G1 phase-arrested cells.
More recently, the newly developed base editing approach has permitted programmable editing of a target base in genomic DNA without double-stranded DNA cleavage. This is achieved by directing the irreversible conversion of one target DNA base into another in a programmable manner in the absence of double-stranded DNA backbone cleavage or a donor template . As illustrated in Figure 1d, the base editing strategy involves the use of CRISPR/dCas9 and a cytidine deaminase enzyme fusion for cytidine deamination, followed by DNA replication or base excision DNA repair to mediate conversion of G:C into an A:T base pair . This scarless genome editing strategy can avoid the issue of random insertions and deletions (indels) at the target locus resulting from the cellular DNA repair response to double-stranded DNA breaks. Hence, this base editing approach has greatly expanded the scope and efficiency of genome editing of point mutations while minimizing indel formation to favor desired clean base editing outcomes. Additionally, co-delivering chemically modified sgRNAs  or truncated guide RNAs  along with Cas9 mRNA or protein could enhance genome editing efficiency and retain its high specificity by increasing intracellular stability and minimizing the toxicity associated with DNA delivery.
From Genome Engineering to Epigenome Editing
DNA methylation, histone posttranslational modification, ATP-dependent chromatin remodeling, histone subunit exchange, genomic imprinting, RNA-associated silencing, 3-dimensional (3D) nuclear architecture, and higher-order chromatin organization can contribute to epigenetic alterations and modulate the activities of cis- and trans-acting regulatory DNA elements. Epigenetic changes can switch genes on or off and determine which genes are transcribed. The epigenetic marks can be influenced by several factors including age, the environment/lifestyle, and the disease state. Furthermore, the vast majority of genetic variants associated with the risk of common diseases detected by genome-wide association studies (GWAS) lies in the noncoding regions of the genome , suggesting that gene-regulatory changes contribute to interindividual differences in genetic susceptibility to disease. Thus, epigenetic editing tools would be in demand to understand the causal effects of epigenetic variation and ultimately to counteract the epigenetic changes that functionally contribute to disease risk.
Until recently, traditional approaches such as pharmacological inhibition or genetic perturbation have been used to characterize the functional role of cis-/trans-acting DNA regulatory elements and chromatin regulation. These include pharmacological inhibitors of histone-modifying enzymes or epigenetic modifiers such as 50-AzaC and valproic acid and ectopic overexpression or knockdown of these factors followed by genome-wide profiling of gene expression and chromatin states. Obviously, these approaches have limitations in resolving the complex interactions in the native genetic context at the target locus due to the genome-wide changes in chromatin state and gene expression induced by the general, nontargeted manipulation . For many specific histone modifications and for chromatin remodeling, it remains unclear whether these epigenetic states are the cause or the consequence, and these methods do not directly assess causal functional roles for chromatin regulators at specific loci due to the potential pleiotropic effects. Targeted epigenetic editing tools address these issues, allowing investigation of the precise roles played by specific epigenetic modulators on the cell type-specific chromatin state and gene activity in their native contexts.
Cas9 protein has been repurposed by site-specific mutations (D10A; H840A) in the nuclease domain to make nuclease-deficient Cas9, known as “dCas9.” CRISPR/dCas9 has revolutionized the ability to modulate the genomic regulatory elements and epigenetic marks when fused with minimal catalytic domains of chromatin-modifying enzymes to generate synthetic sequence-specific activators and repressors [8,27]. The nuclease-based fusions of chromatin-modifying enzymes such as p300 (histone acetyltransferase) , LSD1 (histone demethylase or enhancer repressor by removing H3K4 methylation) , KRAB (transcriptional repressor) , VP64 (transcriptional activator) , and TET1 (DNA demethylation)  were successfully used to achieve targeted DNA methylation or hydroxymethylation, histone methylation or demethylation, or histone acetylation or deacetylation in mammalian cells (Table 2). A similar strategy could also be adopted for other nucleosome-modulating factors, chromatin remodelers, and histone chaperones to modulate the chromatin structure of genomic functional elements in order to affect the activity of downstream target genes. Hence, targeting histone-modifying activities to specific loci with dCas9 has been a powerful epigenome editing tool for testing the functions of genomic elements and associated chromatin states in their endogenous context . The advances in these nuclease-based site-specific epigenome editing tools have recently been extensively reviewed elsewhere .
The establishment and maintenance of the newly introduced epigenetic marks depend on the intrinsic amenability of the target genes, the levels of transcription, the local chromatin context, and the dynamic interplay between chromatin writers, readers, and erasers . A possible approach to maintain heritability of the edited epigenetic marks in the nuclei is by adopting light-inducible CRISPR/dCas9-mediated targeted epigenome engineering. AAV-mediated expression of photoactivatable CRISPR/dCas9 vectors can exist long term as concatemers in nondividing cells; however, this will be lost in replicating cells. To establish conditional knock-in permanent cell lines stably expressing a CRISPR/dCas9-based photoactivatable transcription system, a copy of sgRNA-dCas9-CIB1 and transactivation domain-CRY2 (cryptochrome 2) fusion vectors can be inserted into a safe harbor gene knock-in locus such as human AAV integration site 1 and mouse Rosa26 by using a CRISPR/Cas9-mediated homologous recombination approach. In postmitotic cells such as primary neuronal cells in the mammalian brain, there is no need to introduce these optogenetic vectors into the genome, since episomal stability permits long-term transgene expression in nondividing cells. In fact, the nonintegrating and replication-defective nature of AAV is effectively used in optogenetics-based neuroscience experiments to stably express an optogenetic construct in a brain region without the need to integrate these vectors into the host cell genome. As illustrated in Figure 2c, in the presence of blue light, a transactivation domain would colocalize with the catalytically inactive dCas9 following the fusion of the light-sensitive heterodimerizing proteins CRY2 and CIB1 to modulate transcription . Gene activation is reversible through simple removal of illumination. Increasing the number of chromatin-modifying domains localized to the targeted promoter or enhancer sequence could synergistically enhance gene activation . Thus, the CRISPR/dCas9-based photoactivatable transcription system allows rapid and reversible targeted gene activation by light . Since lighting or extinguishing the blue light irradiation is sufficient to switch on or off the epigenomic modulation, this system could be used for precise control of the epigenome editing activity in a spatially and temporally dependent manner for better understanding of the complex gene regulatory networks and chromatin dynamics. Light activation of CRISPR/dCas9 allows for the study of the epigenetic regulatory mechanisms underlying specific gene functions with high precision, and can reduce toxicity from off-target epigenetic modulation by restricting the function of dCas9 to certain locations or time points .
To achieve more precise spatial control of transcriptional gene activities, CRISPR/dCas9-based logic gate genetic circuits could be considered. As illustrated in Figure 2d, CRISPR/dCas9-based AND gate circuits can integrate cellular information from 2 promoters as inputs (tissue- and disease-specific promoters) and activate the output (target gene expression) only when both inputs are active in the tested cells. Using this chimeric system, the gene of interest can be manipulated to be expressed only in diseased cells of specific tissue origin, but to remain silenced in normal cells or diseased cells of other tissue origin. As a proof of principle, synthesizing AND gate genetic circuits based on CRISPR/Cas9 has been successfully used to specifically identify and control bladder cancer cells in vitro . Theoretically, dCas9 and designed sgRNAs can be used to build any type of transcriptional logic gate and connect them to on-target epigenetic manipulation in living cells and computational analysis of the gene regulatory network. For example, combined use of the elementary logic gates such as AND, OR, NOT, NAND, NOR, XOR, and XNOR (universal symbols for logic gates in electronic fields) allows epigenome manipulation of desired transcriptional regulations at targeted loci. Each of this logic gate uses only 2 inputs (e.g., cell type-dependent and tissue-specific cis-/trans-acting chromatin regulation) to give a distinct output (e.g., epigenetic state and gene expression level). Hence, CRISPR/dCas9-based logic gate genetic circuits could be used to selectively and robustly correct transcriptional misregulation or to restore normal epigenetic patterning in disease-relevant cell types.
Recently, nuclear-localized RNA-targeting nuclease-inactive Cas9 (RCas9) has been developed to track endogenous RNA in living cells in a programmable manner without relying on the incorporation of genetically encoded, exogenous tags . Subsequently, an in vivo genome editing technique called SLENDR (single-cell labeling of endogenous proteins by CRISPR/Cas9-mediated HDR) has been developed to allow high-throughput, high-resolution mapping of protein localization in the mammalian brain . Additionally, an integrated approach using CRISPR genome editing and single-molecule imaging has been used to track the dynamics of telomerase recruitment to telomeres in nuclei of living human cells . These 3 modified CRISPR-based strategies permit real-time tracking of mRNAs and proteins in a specific cellular compartment and live-cell dynamic monitoring of gene and pathway activities.
To understand the dynamic 3D organization and interactions of genomic elements that are critical for the spatial and temporal regulation of gene expression, a series of CRISPR-based imaging techniques has recently been developed (Fig. 2e). These include multicolor CRISPR  and CRISPRainbow , and they are used to determine genomic DNA localization, dynamics, and interlocus interactions in living cells in space and time. In combined use with superresolution microscopy such as structured illumination microscopy or spectral precision distance/position determination microscopy, a CRISPRainbow system allows simultaneous imaging and tracking of multiple genomic loci in living cells to interrogate the intranuclear dynamics and chromatin architecture . As illustrated in Figure 2e, using pairs of differently fluorescent-tagged dCas9-sgRNAs (red, green, and blue), the intranuclear distance between loci on different chromosomes could be determined [34,35]. CRISPRainbow and multicolor CRISPR also allow tracking the dynamic interaction between cis-/trans-acting regulatory elements and a promoter to rewire transcriptional activity under a specific experimental condition. By correlating the linear intrachromosomal distance and the spatial fluorescence resolution between 2 loci on the same chromosome, the DNA compaction in the region of interest could be assessed in a live cell [34,35]. This combination of nanoscale imaging and a CRISPR system opens a new avenue to study the 3D nuclear topography of active and inactive regulatory sequences directly on the individual cell level at a single-molecule resolution.
Genome and Epigenome Engineering to Investigate the Molecular Mechanisms Underlying Aging and Aging-Related Diseases in Humans
Aging is characterized by a decline in the maintenance of homeostatic processes over time that increases the risk for many common chronic diseases and degenerative conditions, ultimately resulting in death. As aging affects multiple organs and systems in humans, the complexity in animal modeling has been a major obstacle to elucidating the mechanisms by which genetic factors - as seen in hereditary longevity and the high recurrence of the same age-related disease within a family - impact the differential progression of aging. Compared to invertebrate models, vertebrate models (e.g., mice or rats) can recapitulate many more important pathological features of human aging and disease phenotypes. However, modeling aging and age-related diseases in the laboratory is challenging, because classic vertebrate models have relatively long life spans and high costs of maintenance. Luckily, the emerging CRISPR-based genome and epigenome editing technologies have shortened the lengthy steps in generating multiple transgenic animal models. By enabling the introduction of desired genetic modifications in many genes encompassing the hallmarks of aging, the CRISPR/Cas9 technology permits a rapid exploration of their roles in health span and life span in a high-throughput manner as well as a functional characterization of genetic variants mapped by human GWAS  (Fig. 3).
The importance of epigenetic dysregulation in the etiology of human disease and the aging process is increasingly recognized. Diverse epigenetic mechanisms have been implicated in human diseases, where it can affect disease etiology and progression. Incorporation of epigenetic variation into genetic studies may help to explain the late onset and progressive nature of most of the common diseases, the severity of their symptoms, the quantitative nature of their complex traits, and the role of the environment in disease development, which a purely sequence-based approach might not be able to do. Even monozygotic twins may succumb to the same disease, albeit often the severity of their symptoms is different and the age at onset is years apart, and this phenotypic discordance has become more noticeable with age; hence, environmental exposure-driven heritable changes in the epigenome play a critical role in the modulation of human aging and aging-related diseases. Cross-sectional and longitudinal data on monozygotic twin pairs have shown that sustained epigenetic differences emerging during the adult life span could contribute to an increasing discordance between monozygotic twins during aging . Apart from genetic defects in genome maintenance and mitochondrial function, epigenetic dysregulation has recently been highlighted as an important biological hallmark of aging and longevity, because transcriptional misregulation as a result of an aberrant epigenetic landscape causes a shorter life span and premature aging in humans and mice [38,39,40]. Genome-wide DNA methylation profiles of centenarians and centenarians' offspring revealed a contribution of epigenetic factors to human aging and longevity .
From a clinical point of view, targeted editing of aging-related genes offers novel therapeutic avenues for multiple diseases. The feasibility of creating specific genetic variants in human induced pluripotent stem cells (iPSCs) derived from patients or engineered de novo has been demonstrated . An iPSC-derived 3D organoid culture system, termed “cerebral organoids” (miniature 3D brain tissue), closely mimics the endogenous developmental program and can serve as a good in vitro model for studying human brain development and a wide range of complex brain diseases . Cerebral organoids can be used in combination with CRISPR/Cas9-based genome and epigenome editing to unravel genetic and epigenetic mechanisms that cause neurodevelopmental and neurodegenerative disorders. Additionally, human primary intestinal stem cells derived from cystic fibrosis patients can be expanded in culture as genetically and phenotypically stable epithelial organoids for restoring the functional activity of CFTR (cystic fibrosis transmembrane conductance regulator) by CRISPR-mediated homologous recombination . CFTR encodes an anion channel essential for fluid and electrolyte homeostasis of epithelia, and a hereditary defect of this gene causes cystic fibrosis . Since the intestine is an organ with a high turnover and cystic fibrosis is a single-gene hereditary defect disorder, in conjunction with the facts that primary intestinal stem cells can be expanded as cultured organoids and that genetically corrected intestinal organoids can be reimplanted in the intestine of a patient, the precise correction of point mutations linked to cystic fibrosis in patient-derived organoids might permit effective adult stem cell-based gene therapy of this disease in the near future. The combined use of a CRISPR/Cas9-based gene correction approach with the organoid culture technology allows clonal expansion of single adult patient stem cells and the selection of genetically modified clonal organoid cultures harboring the precise gene correction (Fig. 3).
Disease modeling in cell lines does not recapitulate the complex interactions between tissues and complex responses to the environment or to drugs. An increasing number of studies have utilized the CRISPR/Cas9 system for in vivo gene editing. Epigenetic studies of longevity and aging based on diverse animal models have recently been comprehensively reviewed . Of special interest is life span extension in various animal models that strongly support an epigenetic role in modulating aging and longevity pathways . Thus far, the majority of evidence suggests histone loss coupled with chromatin remodeling, an imbalance of activating and repressive histone modifications, transcriptional change, global and local change in DNA methylation, site-specific loss of and gain in heterochromatin, and significant nuclear reorganization as a general mechanism of aging in mammalians . For example, to mimic the autism condition in humans, researchers have engineered monkeys to have the MECP2 duplication syndrome . The protein of MECP2 (methyl CpG-binding protein 2) is essential for normal brain function and transcriptional repression through chromatin modification. Severe neurodevelopmental disorders associated with MECP2 include Rett syndrome and X-linked mental retardation . Additionally, many of the symptoms of autism are found in people who have extra copies of the MECP2 gene being expressed in the brain . To examine the impact on autism-like symptoms in monkeys, researchers plan to use the CRISPR system to knock out the extra MECP2 copies in specific brain regions . Depletion of DNA methyltransferase MeCP2 led to lethality and caused a neuronal phenotype, but postnatally, neuron-specific activation of MeCP2 could significantly prolong the life span of mutant mice and delayed the onset of neurologic symptoms . On the other hand, depleting the histone methyltransferase SUV39H1 was shown to improve DNA repair capacity, delay senescence, and extend the life span in a progeria mouse model, providing a potential strategy for aging intervention by targeting SUV39H1-mediated heterochromatin remodeling .
The transgenic animal model is useful to recapitulate the premature aging features of the human segmental progeroid syndromes, including Werner syndrome and Hutchinson-Gilford progeria syndrome, which are characterized by defective DNA helicases (WRN) and aberrant processing of the nuclear envelope protein lamin A (LMNA), respectively . Aberrant DNA methylation profiles in WRN and LMNA mutant patients can also impact these premature aging diseases . By generating human iPSCs from fibroblasts obtained from patients with Hutchinson-Gilford progeria syndrome, in vitro iPSC-based models could recapitulate laminopathy phenotypes such as lack of the nuclear envelope and epigenetic alterations normally associated with premature aging . The CRISPR/Cas9 technology will accelerate the progress in dissecting the contributions of genetic and epigenetic components to life span and longevity in animal models. This gene editing technology allows us to uncover principles that determine the spatial organization of chromosomes, to reveal novel layers of chromatin structure, and to relate these aberrant structures to the gene dysregulation underlying human aging. Modulating chromatin states and cis-/trans-acting DNA regulatory elements may be prime targets for therapeutic intervention to help improve health spans and life spans by correcting transcriptional dysregulation or restore normal epigenetic patterning during aging. Owing to the fact that epigenome editing does not involve genetic changes and the reversible nature of epigenetic mechanisms, it may be less risky with respect to unwanted off-target effects as well as side effects upon healthy cells and tissues.
There have been a number of human clinical trials using alternative gene editing techniques, but none so far has used CRISPR. The application of ZFN technology for gene therapy has been completed, and 6 early-phase clinical trials are currently underway (ClinicalTrials.gov identifiers). Excitingly, the first human trial of CRISPR will start later this year for cancer immunotherapy . A team of researchers from China has announced plans to begin the very first clinical trial with CRISPR-edited immune cells as early as August 2016 to treat patients with lung cancer . Other CRISPR trials may not be far behind. In June 2016, an advisory panel of the US National Institutes of Health (NIH) approved a similar CRISPR-based study to create genetically altered immune cells, which are infused back into a patient with melanoma, sarcoma, or myeloma to target and eradicate cancer cells . However, the US proposal has yet to be given the green light from the US Food and Drug Administration (FDA) and a university review board . Although chimeric antigen receptor T-cell therapy was successfully used to treat patients with leukemia  and multiple myelomas , it did not work for solid tumors such as sarcomas and melanomas. Therefore, CRISPR-edited immune cells can be used to overcome the limitation of chimeric antigen receptor-modified T cells to treat patients with solid malignancies.
As the higher-order chromatin structure and heritable epigenetic marks can directly influence gene transcriptional activity, site-specific epigenome editing provides an opportunity to study the contributions of epigenetic regulation to aging and aging-related disease. The CRISPR/Cas9 system can be used to identify and characterize super-enhancers, which are large clusters of transcriptional enhancers with unusually high levels of mediator binding (e.g., cofactors and chromatin regulators) that drive the expression of cell identity genes and, when dysregulated, play a key role in disease . Disease-associated variation was shown to be especially enriched in the super-enhancers of disease-relevant cell types . Insulators and silencers are another 2 important cis-/trans-acting DNA regulatory elements that may act in concert with enhancers, but with opposing roles in regulating gene transcriptional activity. Chromatin insulators can block the action of transcriptional enhancers by forming chromatin loop domains to affect enhancer-promoter interactions. A recent study revealed that CRISPR-mediated disruption of the CTCF (CCCTC-binding motif) in human IDH wild-type gliomas was able to induce a loss of insulation between topological domains and led to aberrant oncogene activation by permitting a constitutive enhancer to interact aberrantly with a prominent glioma oncogene . Additionally, CRISPR/Cas9 nuclease can be used to disrupt topologically associating domains or chromatin domain clusters - and the boundary regions separating them - to study the consequences of genomic rearrangements in gene dysregulation and disease. Disruption of topologically associating domains was shown to lead to de novo enhancer-promoter interactions and to rewiring of the long-range regulatory genome architecture, thereby affecting the pathogenicity of human structural variants, particularly in noncoding regions of the human genome .
Conclusions and Perspective
Genome editing and epigenome editing have revolutionized biomedical research and offer an unprecedented opportunity to study the molecular mechanisms underlying aging and aging-related diseases in humans. CRISPR expressed by tissue-specific promoters and serotype-specific AAV permits highly precise editing of a genome and an epigenome in a specific tissue. Multi-input logic gate genetic circuits can be integrated with optogenetics-based targeted epigenome engineering to precisely modulate gene expression and the epigenetic landscape in a spatially and temporally specific manner. Light activation of CRISPR could allow gene functional studies with high precision and may reduce toxicity from off-target effects by restricting the function of CRISPR to certain locations (e.g., tissues/cells) and time points (e.g., turn on/off the transcriptional activity). While an increasing number of experimental studies have demonstrated the potential and promises of these techniques, methodological and conceptual advances will be needed before genome and epigenome editing can be effectively and routinely applied as a research tool and in clinical settings. Furthermore, strategies for in vivo delivery of CRISPR/dCas9-based epigenome editing tools have yet to be established. The small packaging capacity of AAVs has hindered their application for delivering large fusion transgenes comprising CRISPR/dCas9-based epigenetic modulators.
Together with the genome editing toolbox, site-specific recruitment of engineered chromatin regulators to modulate epigenetic marks and associated chromatin states at proximal promoters or distal DNA regulatory elements will allow us to gain molecular insight into the function of epigenetic marks underlying human aging and aging-related diseases. Combined use of genome and epigenome editing tools will help uncover novel molecular pathways that account for associations detected with global analyses including GWAS by elucidating genotype-epigenotype interactions. A better understanding of the genetic and epigenetic regulatory mechanisms underlying human aging and age-related diseases will significantly contribute to the development of new therapeutic interventions for extending health span and life span, ultimately improving the quality of life of elderly populations.
This work was funded by NIH grants AG017242, GM104459, and CA180126.
The authors declare no competing interests.