I have worked in genetics or done genetic research for the last 6 or so years. Admittedly while I have certainly read sparingly about siRNAs I only have heard about them in real life as a research tool. Their clinical utility has not really come to fruition. When I moved over to the clinical world in genetics 3 years ago I have not heard a peep about siRNAs. On the other hand I'm able to attend weekly talks on research clinicians getting super excited about CRISPR. I have never seen this level of excitement for a gene editing tool.
To further dig into your question I think this paper does a good job. They state the following "Many of the genetic diseases will benefit from gene therapy through stable gene editing. As RNAi is unable to either stably introduce gene segments/mutations or induce activation of genes, CRISPR/Cas9 system will be the method of choice for such gene therapy applications. Because CRISPR based gene editing is heritable, technically, one will have to introduce the genomic changes into host cells only a single time, and the physiological effect might last as long as the targeted cells are viable, or will be inherited to daughter cells in the case of dividing cells. In contrast to CRISPR/Cas9,
in vivo application of RNAi is limited only to the instances in which the expression of genes has to be suppressed post-transcriptionally."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4813155/
I think the dividing cells part here is big. . We know that dermal papilla (DP) cells not only regulate hair follicle development and growth, but they are also thought to be a reservoir of multi-potent stem cells. One change to your DP androgen receptors and bam, it's permanent for the rest of your life.
Good question. This is much easier to answer for monogenic diseases such as duchenne muscular dystorphy (DMD) where there is a protein disruption event due to a mutation. When this broken gene has been fixed in mice and dogs via CRISPR, they have seen a reversal of symptoms. I believe this reversal will happen with many monogenic diseases but this is of course very dependent on what damage has been done and what proteins were affected. In mice with Huntington's Disease which can cause a build up of nasty proteins in the brain, they even saw the proteins disappear and the mice showed signs of improvement (
https://www.jci.org/articles/view/92087).
Now onto these f*****g polygenic diseases like hair loss. As you had previously mentioned there are MANY small affect alleles that are contributing to baldness but the hardest part about this is that many of these do not correlate to protein changes directly. Many of these are in non-coding regions and while they may have some effect on promoters or splice sites, it's REALLY hard to tell.
But say we find you have some larger effect allele like (rs9282858;
P=8.9 × 10−18 in
https://www.nature.com/articles/ncomms14694) which causes a missense variant (c.145G>A; p.Ala49Thr) in
SRD5A2. This modified 5-alpha reductase gene causes WAY more 5 alpha reductase, which may be a main player in YOUR baldness. So f*** that, let's CRISPR that right out.
This might happen for a few more large effect alleles as well, we'll ignore all those small 1.02 OR affect alleles because we'd be here all day and that may be insanity.
Will this reverse hair loss? Hard to say. Maybe. One thing that does give me hope is very strong anti-androgenic treatments reversing hair loss, but I suppose that isn't really the case here. It does give me hope that the DP stem cells can be rejuvenated though.