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Le NHEJ consiste en une ligation directe des extrémités de la coupure pouvant induire de petites insertions ou délétions avant la ligation. Ces mutations, si elles sont introduites dans un exon, vont modifier le cadre de lecture et pouvoir inactiver le gène cible (Knock Out). La RH permet la réparation de la cassure en recopiant les informations présentes sur la chromatide soeur. Si un ADN exogène comportant des homologies avec la séquence à réparer est inséré avec les nucléases artificielles, la cellule peut le prendre comme matrice de réparation, il est ainsi possible d'insérer n'importe quelle mutation ou transgène de manière précise (Knock In). Ici, différentes stratégies ont été développées pour optimiser ces approches d'édition du génome. Le couplage du domaine Nter de la protéine CtIP à la nucléase Cas9 permet d'augmenter le taux d'insertion par homologie d'un transgène au site de coupure. Le couplage de l'exonucléase Trex2 à la nucléase Cas9 nickase permet quant à lui d'augmenter le taux de mutation après coupure. Ces nouvelles approches peuvent être largement utilisées et permettent de faciliter l, et sur les différents systèmes de réparation que la cellule va mettre en place pour réparer ces dommages. Les deux systèmes de réparation principaux sont le NHEJ (Non Homologous End Joining) et la RH (Recombinaison Homologue) ,