Bone-marrow transplants as a ‘cure’ for AIDS? II

Posted by ERV on December 15, 2010
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You still need to file this under “Whoa thats cool! But its not really a realistic solution for the AIDS pandemic”.

The HIV+ fellow they treated for cancer with bone marrow from a deltaCCR5 donor is still alive and kicking 3.5 years later, and for all intents and purposes, ‘cured’ of HIV/AIDS.

Evidence for the cure of HIV infection by CCR5delat32/delta32 stem cell transplantation

They went through and immunologically characterized ‘The Berlin Patient’ and hes pretty much normal now. HIV+ patients lose the CD4+ T-cells in their gut mucosa pretty much right after acute infection. This guy has had his gut mucosa repopulated with T-cells from the transplant.

They cant find HIV-1 anywhere.

Anti-HIV-1 antibodies are decreasing (indicating a lack of current infection). Antibodies to Gag are totally gone (though they would pop up again, should infection rev up again. theyre pointless, non-neutralizing antibodies, but your body doesnt know that).

So, pop news is freaking out:

Doctors Claim HIV-Positive Man Cured by Stem Cell Transplant

In the magazine, Hutter said he was a scientist “in the right place at the right time,” and “for me, it is important to have overthrown the dogma that HIV can never be cured.”

:-/ Well, I agree that Dr. Hutter was at the right place at the right time, I dont think it was dogma preventing anyone from doing what he did. It was him being at the right place at the right time…

Even though Brown’s procedure proved to be successful, Quinn warns this was a rare case and a bone marrow transplant is not a cure-all for other HIV patients.

“It is a near fatal procedure that he had to have done because of the leukemia, but this procedure is very expensive and you have to be transplanted with a donor who is shown to be already resistant to HIV,” Quinn said. “You’re asking for a tall order to replicate this in the future.”

Yup. Pretty much.

So, Ive got to conclude with the same thing I said two years ago:

Oh well. Its still cool. Appreciate it for being cool. But right now, with todays technologies, its not a solution to the worlds HIV-1 pandemic.

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Comments

  1. #1 cynical1
    December 15, 2010

    What about a transplant in the presence of high doses of a CCR antagonist or the antibody that was under development at one time?

  2. #2 Dr. Matthew
    December 15, 2010

    Have you blogged about/followed the new study that plans to give maraviroc and isentris for 6 months, followed by a round of administration of a chemotherapy agent found to “force” the virus into replication and out of dormancy? The idea being you might flush it out and prevent replication/re-entry to cells in this way.

  3. #3 Jay-El
    December 16, 2010

    The implication that the article suggests Hutter was prevented from carrying out this experiment by dogma does not exist.

    You implied the article implied that, the article does not imply it by itself.

  4. #4 Knightly
    December 16, 2010

    OK, this is likely a stupid question but it’s the best I can muster: what happens when we transplant just the T-cells? Is it possible that the T-cell die-off is merely a phase of the disease and it’s just a matter of repairing the damage after the storm? Seems like it’d be easier to move the cells instead of doing a marrow transplant. Or do you need the new marrow to keep producing the cells?

  5. #5 Poodle Stomper
    December 16, 2010

    You probably would not want to do that. Maturing T-cells are selected in the thymus first to survive if they bind weakly to self MHC and then to die off if they react strongly with MHC+self peptides from the host. Transplanting these mature T-cells cannot guarantee that the T-cells will react well with recipient MHC and will not react with the MHC+self peptides from the recipient.

    Also, the mature T-cells at this point already have their variable domains set. I would think that you’d want to transplant cells that have not yet matured so that they can provide the full breadth of variability. I’m sure there are other reasons, too. Just my opinion, though.

  6. #6 ERV
    December 16, 2010

    cynical1– Maybe! I think with drugs its always a matter of ‘Is it at the right place at the right time?’ If the drug isnt where the new susceptible cells are at the right concentration… ehhh. But if CCR5 isnt on any cells at all, its like a perfect anti-CCR5 therapy.

    Dr. M– Ive heard about that, but havent read much about it. I can look into it!

    Knightly– T-cells need to develop and mature in the body of the person they are going to be inhabiting. They are ‘educated‘ throughout their development as to what their host ‘looks like’, so they know what ‘somethin aint right’ looks like. So with these cells we really have to start from scratch (the bone marrow) rather than just ‘transplanting’ the cells :)

  7. #7 Poodle Stomper
    December 16, 2010

    Don’t quote me on this but I believe the administration of excess CCR5-binding chemokines have been tried and failed (obviously a well designed drug may have a better chance). I’d have to go back through find the papers unless you know it off the top of your head, ERV?

  8. #8 Alan Kellogg
    December 16, 2010

    An Alternate Progression of Progress

    First: Neat, but not really practical, and possibly even dangerous.

    Second: Useful under close supervision, and don’t expect anything spectacular out of it.

    Third: Yes, it is damn useful, but don’t expect miracles.

    Fourth: Used as a matter of course, but there’s always something new on the horizon.

  9. #9 Neil
    December 18, 2010

    There’s been a lot of reportage on this cure but like you say its not a “cure” for anyone except the incredibly sick. However it does appear to demonstrate that if we could get modified CD4 cells into positives by other means than the hellish and dangerous bone-marrow transplant, there may be hope. Fair comment ?