Evidence base. The review synthesizes ~179 primary sources across cell culture (HEK293, iPSCs), zebrafish, mice, pigs, rabbits, non-human primates, Drosophila, plants and yeast, framing the central problem: NHEJ-driven indels can exceed 90% efficiency in vivo, while precise genome editing (PGE) via HDR/SSTR is typically an order of magnitude lower . Key quantitative claims include BE4 reaching ~70% base conversion in HEK293T cells, PE3 averaging 36Β±8.7% point-mutation efficiency with 8.6Β±2.0% indels, and zebrafish base editing at 9-28% in early work rising toward 50-100% of larvae showing some editing in later studies .
Strengths. The paper correctly distinguishes Rad51-dependent HDR (dsDNA donors) from Rad52-dependent SSTR (ssODN donors) and usefully flags that interventions discordant with donor type can backfire, e.g. Rad51 overexpression being detrimental with ssODNs . It candidly reports inter-study inconsistencies (RS-1/SCR7 variable outcomes; conflicting homology-arm optima of 30-60 bp vs 600 bp) rather than forcing false consensus, and its high-fidelity Cas9 discussion is supported by SpCas9-HF1, which showed genome-wide undetectable off-targets while maintaining on-target activity .
Weaknesses and blind spots. As a narrative (not systematic) review, it risks selective emphasis on positive results; the authors themselves acknowledge locus- and organism-specific variability that hinders cross-study comparison. No new data or meta-analytic synthesis is offered. Chemical modulators are presented optimistically despite acknowledged inconsistencies, and several mechanistic claims (e.g. RS-1 acting via Rad51-like proteins) remain speculative. Prime-editing in vivo limitations are only partially covered: Aida et al.'s preprint finding that prime editing primarily induces undesired outcomes in mice is cited but not deeply integrated (unreviewed preprint β uncertain strength).
Falsification of the review's thesis would require demonstrating that pathway modulation and donor design changes do not reproducibly improve PGE across independent labs, or that reported gains reflect confounders (cell type, locus chromatin state, delivery) rather than mechanism .
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