Illustration: Nadia Méndez/WIRED Middle East

When CD Projekt Red, the Polish studio behind Cyberpunk 2077, released the game in 2020, it immersed players in a dystopian yet captivating future where players navigate a high-stakes world of corporate espionage while implanted with advanced body augmentations.

Back then, not many could imagine how close this fictional world could come to mirroring our reality. Today, the gene editing technologies depicted in Cyberpunk 2077 are edging ever closer to implementation with the line between science fiction and science fact continually blurring. The advent of CRISPR-Cas9 gene editing and neuropriming has brought us significantly closer to the possibility of genetically enhancing humans, transforming concepts once confined to imaginative, fictional worlds into tangible realities. Both hold the promise of pushing human performance to unprecedented heights, yet they also ignite fierce debates over ethics, fairness, and the very essence of competition.

Science meets sports

CRISPR-Cas9, a groundbreaking, much-talked-about technology, allows for precise alterations in DNA that could potentially eradicate genetic disorders and enhance physical and cognitive traits. Recent advancements in CRISPR technology are not only theoretical. In 2023, the FDA approved the first CRISPR–based gene–editing therapy for treating sickle cell disease, which has shown remarkable success in clinical trials. This groundbreaking approval is paving the way for further applications of CRISPR in various fields, including sports, where the potential for enhanced muscle recovery and reduced injury times is being actively explored. Researchers are optimistic that similar therapies could soon benefit athletes by providing quicker and more effective healing after injuries. “Mesenchymal stem cells (MSCs) are being used to regenerate tissues like cartilage and tendons,” explains Abbas Berdi, head of pharmaceutical and life sciences at PwC Middle East. “For instance, MSCs can help treat ACL tears, a common sports injury. After intense training or injuries, stem cell therapy could significantly enhance muscle repair, allowing athletes to benefit from quicker and more effective healing.”

Moreover, advancements in neuropriming are complementing these genetic technologies. Neuropriming, which involves stimulating the brain to enhance learning and physical performance, is gaining traction among athletes seeking to maximize their potential. For example, techniques like transcranial direct current stimulation (tDCS) can improve motor skills and cognitive function by enhancing neural plasticity.

Recent studies from the Sleep Foundation have revealed the critical role of sleep in athletic performance. Athletes who get sufficient sleep—typically 8 to 10 hours per night—show significant improvements in reaction times, accuracy, and overall performance. Lack of sleep, on the other hand, can lead to decreased accuracy, slower reaction times, and increased risk of injury. Amy Rantala, M.D., a sports medicine physician at Mayo Clinic Health System, asserts that “when you sleep, your brain processes all the information you’ve taken in during the day. This includes assimilating new skills or techniques you may have learned so they become an intuitive part of your sports performance.”

Neuropriming techniques, such as transcranial magnetic stimulation and vagal nerve stimulation, are known to enhance brain function and stress resilience and have shown promise in enhancing sleep quality, improving focus, motivation, and recovery times. Dr. Dipesh Chaudhury from NYU Abu Dhabi observes how stress impacts physiological responses and how neuropriming can help. “Emotional stress perceived in parts of the brain can lead to elevated stress hormone levels and affect physiological responses like heart rate and respiration,” Dr. Chaudhury shares. “There is accumulating evidence that stress can also negatively impact circadian rhythms of various processes such as body temperature, stress hormones, and melatonin release.”

In their recent study, Dr. Chaudhury and his team discovered that stress-susceptible mice already show signs of fragmented sleep even before being exposed to stress. As Dr. Chaudhury explains, “This is very exciting as it implies that abnormal sleep increases vulnerability to stress.” Translating this to humans, neuropriming, he believes, could help identify individuals vulnerable to stress and improve their sleep patterns, thereby enhancing their overall resilience and performance.

Furthermore, advancements in bioprinting are also emerging, allowing for the creation of custom implants and grafts that improve healing and performance after injuries. “We now have the ability to build constructs that recapitulate key structural, mechanical, and biological properties of native tissues,” says Adam Feinberg, CTO and co-founder of FluidForm, a company that is pioneering the bioprinting of human tissue. Feinberg sees bioprinted tissues significantly enhancing recovery for athletes by providing custom, biologically compatible replacements for damaged tissues.

Advanced healing techniques are further revolutionizing sports medicine. “Exosome therapy is another promising avenue,” says Berdi. “Exosomes, which carry healing factors, can target injured tissues. Using exosomes to deliver regenerative proteins directly to a torn ligament, for instance, can enhance the body’s natural healing processes. Platelet-Rich Plasma (PRP) therapy also plays a vital role. By injecting concentrated platelets from the patient’s blood, PRP therapy accelerates the healing of injuries like torn ligaments or muscles, as the platelets release growth factors that enhance tissue repair.”

Neuropriming: Enter, the super-athlete

Photograph: KEITH CHAMBERS, Getty Images

This emerging field of neuropriming is already starting to show significant promise in sports science. “We think of ourselves like fertilizer. The technology helps athletes absorb skills faster by putting the brain into a state of hyperplasticity, making their training more effective,” says Dr. Daniel Chao, CEO of Halo Neuroscience.

In practical terms, neuropriming devices such as the Halo Sport headphones have been used by elite sports teams, including those in the NBA and NFL, to improve performance. These devices stimulate the brain’s motor cortex to enhance muscle coordination and learning. Athletes have reported improvements in sprint times and endurance, demonstrating the tangible benefits of this technology.

“Priming brain regions, or rather modulating neural activity to alter stress responses, is not typically used in the clinical setting,” says Dr. Chaudhury. “However, in theory, it may be possible to use transcranial stimulation over selected cortical regions to modulate activity that perceives or encodes stress. This could potentially ‘reset’ some pathways upstream of stress response circuits in the brain that would typically activate the HPA-axis.”

Recent developments further highlight the potential of these technologies. For instance, the University of California’s Innovative Genomics Institute has announced a new project to explore in vivo CRISPR editing techniques that could be directly applied to muscle tissues. This approach could offer more efficient and targeted enhancements, enabling precise genetic modifications that enhance muscle strength, endurance, and recovery times. By editing genes in vivo, the process becomes less invasive and more effective, potentially transforming athletes into “super-athletes” with optimized physical capabilities and faster recovery from injuries. Additionally, bioprinting advancements have led to the development of custom implants that replicate the mechanical and biological properties of native tissues, providing personalized recovery solutions for injured athletes.

A report from biology-focused media company SynBioBeta notes, “The latest innovation in the push to ever-better results in sports is the use of bioengineering,” which could include CRISPR to enhance an athlete’s abilities at the cellular level. As these technologies advance, the future of sports may see athletes benefiting from neuropriming and genetic enhancements, creating a new era of optimized performance and recovery.

Ensuring fair play

The use of CRISPR in sports has time and again raised significant ethical concerns. The World Anti-Doping Agency (WADA) has banned gene editing as a form of “gene doping.” Dr. Mario Thevis and his team are developing methods to detect CRISPR modifications in athletes, which could be crucial for maintaining fair competition. Their research focuses on identifying CRISPR-Cas9 enzymes in human plasma, a key step towards detecting genetic modifications in athletes.

“The ethical implications of genome editing are profound, and developing clear regulations is essential to guide its application in medicine and beyond,” states Dr. Eric Topol, a renowned expert in digital medicine.

A 2023 study by the World Health Organization (WHO) highlighted the need for international collaboration to establish guidelines that prevent misuse of genetic technologies while promoting their benefits. The study emphasized that regulatory frameworks must evolve to keep pace with scientific advancements and ensure public trust.

“Preventing gene doping is essential for fair sports competition,” says Berdi. “Advanced methods for detecting gene doping, such as specific tests for CRISPR modifications, are being developed. Additionally, research into epigenetic modulation is underway. This involves drugs that modify gene expression to enhance athletic performance without altering DNA, such as developing endurance-enhancing drugs that reduce fatigue.”

Incorporating genetic technologies into existing legal systems poses significant challenges that necessitate a balance of innovation with stringent oversight to prevent ethical breaches. “Legislation needs to be adaptive and forward-thinking to manage the rapid developments in biotechnology,” notes Dr. Jennifer Doudna, co-inventor of CRISPR.

The pharmaceutical and life sciences sectors can greatly impact the shape of policies on genetic editing technologies in sports through various mechanisms. “These sectors collaborate with regulatory bodies to establish guidelines,” says Berdi. For example, companies like Editas Medicine work with regulators to ensure the safe and ethical use of CRISPR technology. “Ethical standards are also set by companies that participate in bioethics committees, influencing policy development,” adds Berdi. “Organizations like BIO and ISSCR develop position papers that guide industry practices.”

According to the Global Gene Editing Regulation Tracker, as of 2023, only 30 percent of countries worldwide have comprehensive legal frameworks for genome editing, spotlighting the dire need for legislative action. “I guess the challenges are similar to doping,” says Dr. Chaudhury. “If the logic is that drugs that give athletes an unfair advantage by changing biochemical processes, such as extra muscle growth or better efficiency for oxygen uptake, are illegal, then it could be argued that neuropriming, which could potentially upregulate neural activity leading to better muscle activity or activate biochemical processes that make athletes better, could also be regulated similarly to pharmacological doping.”

Bioethicists argue that the potential for CRISPR to enhance athletic performance brings forth significant ethical questions about fairness and the nature of sport. “The possibility of creating genetically modified athletes challenges the fundamental principles of equal competition,” observes Henry Greely, a bioethicist at Stanford University, weighing in on the ethical complexities.

Powering up partnerships

To ensure genetic technology advancements are accessible and ethical in the MENA region, industry players opine that several strategies can be implemented. “Subsidies and public-private partnerships can make genetic technologies affordable,” says Berdi. “For example, Saudi Arabia’s Vision 2030 initiative includes funding for genetic research.”

Biotechnology advancements are set to transform the region’s sports and healthcare sectors. “Government initiatives, such as Saudi Arabia’s Vision 2030, prioritize advancements in medical and genetic research,” says Berdi. “The establishment of the King Abdullah International Medical Research Center (KAIMRC) focuses on cutting-edge biomedical research, including genetics.”

Doudna asserts that international collaborations are crucial for advancing genetic research. “Establishing partnerships across borders can accelerate innovation and ensure the ethical use of genetic technologies,” she says.

Cultural sensitivity is vital in implementing these advancements. “Policies and practices must be sensitive to the cultural and religious contexts of the MENA region,” says Berdi. “Engaging religious and community leaders in discussions about the ethical use of genetic technologies can help ensure broader acceptance. Emphasizing patient autonomy and privacy is crucial, particularly in conservative societies where genetic information might be sensitive.”

Enhancing healthcare infrastructure too is imperative or supporting these advancements. “Establishing centers of excellence for genetic research and clinical applications is crucial,” Berdi notes. Notably, the Qatar Genome Programme has sequenced over 40,000 genomes, significantly contributing to the field of precision medicine. This initiative has helped reduce hospital stay lengths and improve treatment outcomes by tailoring drug treatments to individual genetic profiles. The program’s efforts in pharmacogenomics are particularly impactful, identifying genetic traits that influence drug responses, which enhances personalized medicine approaches

“The Qatar Genome Programme continues to advance genetic research and has developed comprehensive training programs for local healthcare professionals,” Berdi adds. “Leveraging telemedicine and digital health platforms expands access to genetic counseling and testing services. For example, the Abu Dhabi Telemedicine Centre has been pivotal in providing remote healthcare services, including genetic consultations.”

The MENA region seems to be actively partaking in this revolution, with several countries launching pilot projects and clinical trials aimed at integrating these technologies into their healthcare systems. For instance, the King Faisal Specialist Hospital & Research Centre in Saudi Arabia is conducting cutting-edge research on gene therapy applications, including those aimed at treating genetic disorders prevalent in the region.

“Developing local expertise and infrastructure is key to integrating biotechnology effectively. Investing in education and training for healthcare professionals ensures sustainable progress,” Nobel laureate Dr. Frances Arnold highlights.

Regional biotechnology parks are also supporting biotech startups and research. The UAE is developing Dubai Science Park and Abu Dhabi’s Masdar City as biotech hubs, aiming to attract global biotech companies and foster local startups.“Countries like Egypt are developing biotechnology parks, such as the Smart Village in Cairo, to support biotech innovation,” Berdi adds. “In 2023, Egypt announced plans to expand the Smart Village to include a dedicated biotech research and innovation zone.”

The future of the augmented athlete

“The power to control our species’ genetic future is awesome and terrifying. Deciding how to handle it may be the biggest challenge we have ever faced,” Doudna states.

Biotechnological advances benefit significantly from strong public-private partnerships (PPPs), particularly in the sports industry. “Funding and grants from governments and NGOs support biotech research,” says Berdi. “For instance, the NIH in the USA and Horizon Europe in the EU offer significant funding for biotech innovations. Tax incentives, like Canada’s SR&ED program, encourage companies to invest in R&D, making biotech advancements more feasible.”

Educational and training programs also play a vital role. “Institutions like NSF in the USA and DFG in Germany provide training programs to develop skilled biotech researchers,” Berdi notes. “These programs are crucial for sustaining innovation and maintaining a pipeline of qualified professionals in the field.”

As for the neuropriming arena, Dr. Chaudhury states that further work is needed to better understand the biology connecting stress responses and circadian changes. “Transcranial magnetic stimulation could be used to activate brain regions associated with motivation. However, we don’t yet know the detailed firing properties of all these neurons over the course of a day/night cycle in humans,” he explains. “More work in the space could potentially lead to the development of better tools, such as neuropriming, to optimize performance and recovery.”

According to experts, robust discussions about the implications of these technologies is the way forward. “We need to think about what are the potential applications, taking therapeutic as well as enhancement, and breaking it down to think about what is it that we do want and particularly what do we have question marks over,” says Diana Bowman, a professor at Arizona State University.

Others warn that gene editing isn’t a technology on its own, and that the thing that’s going to make it really have a profound impact is how it merges with other technologies.“The ethical risk of this promotional role is that scientists may contribute to unrealistic expectations about the timeline to curing diseases,” notes Jodi Halpern from UC Berkeley.

As the MENA region continues to innovate and integrate these advancements, it stands at the forefront of a new era in sports and healthcare, where science and technology push human capabilities to new heights. The challenge will be to maintain ethical standards and accessibility for all. 

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