middle aged woman with leukemia and HIVwho scientists call the “New York patient”, got rid of the human immunodeficiency virus since 2017 after a transplant virus resistant stem cells. noveltyin this case is that mother cells come from the blood umbilical cord not from eligible adult donors.
The preliminary results of the study were presented last year at an international conference, and the final study is published this week in a journal. Cell. The work confirms the long-term effectiveness of this intervention, which is also evidenced by the good health of a woman who identifies herself as a mestizo.
During a press conference that included research and clinical teams associated with the therapeutic procedure, Principal Investigator Yvonne Brysonfrom the University of California, Los Angeles (UCLA), noted “good news”, which means that this woman clinically healthy And “possibly cured“. According to him: “The virus is not detected in the blood with very sensitive tests. Today she free from both diseases“.
The successes of his process, like those of others, were taken into account People who have reached HIV remission in the world are blazing a promising therapeutic path. The previous one, reported less than a month ago, was the “Düsseldorf Patient,” a man who was taken off antiretroviral treatment for HIV under supervision after receiving a stem cell transplant to treat myeloid leukemia. According to an article published in the journal at the time, four years after this intervention, the virus did not reappear. nature medicine. This was the third case of a possible cure for HIV infection on a planetary scale, in which the body’s immune response against the virus was confirmed, despite the termination of specific treatment.
Prior to the Düsseldorf patient, the Berlin patient in 2009 and the London patient in 2020 were confirmed to have cleared the virus.
Three cases known to date refer to stem cell transplantation as part of their cancer treatmentwherein cells donors have consistently come from compatible adults or “related”, carrying two copies of the CCR5-delta32 mutation, one natural mutation conferring resistance HIV, preventing the virus from entering and infecting cells.
With very sensitive tests, the virus is not detected in the blood. Today, she is clinically healthy, free of both diseases, and possibly cured.
Yvonne Bryson
Now an HIV-infected New York patient in remission joins this select group of people who do not have special immunological characteristics that help control HIV infection Spontaneously. In these four casesthe virus was cleared from the body as a result medical intervention and this distinguishes them from eradication by functional cure in the so-called elite controllers or post-treatment (when people have special factors in their own bodies that allow them to stop the virus).
At the moment, scientists refuse to estimate the time (in months or years) that must pass from the moment HIV not detected in the blood until it is declared that the cure is complete, since four patients are still not allowed to develop statistics O.
Stem cell transplantation with CCR5-delta32/32 cells offers a possible cure for HIV and blood cancer at the same time. However, due to invasiveness of the procedure, stem cell transplantation (both with and without the mutation) is considered only for people who need a transplant for other reasons, and not for HIV treatment alone; Before a patient can undergo a stem cell transplant, they need to undergo chemotherapy or radiation therapy to destroy them. the immune system existing.
Cord blood in new methods of treatment
At a press conference to unveil the results, Bryson stressed the value of the treatment, which paves the way for “continuing exploration of this type of technique” more broadly. “We are optimistic that someday stem cells from this particular source (cord blood) could be used to treat diseases other than cancer and even be adapted to different gene therapy“, he stressed.
However, the lead researcher insisted that there were “serious potential opportunities”. complications connected with transplants“, so we are talking about “procedures that they cannot be practiced someone person with HIV“, but only “to those who need a transplant for a coexisting condition as serious as, in this case, leukemia.”
This is the fourth time in the world that the virus has subsided as a result of medical intervention.
Moreover, in the case of the “New York patient” it was almost impossible to find suitable adult donor With mutationso the team transplanted stem cells instead CCR5-delta32/32 carriers cord blood is stored (in cord blood banks) to try and cure his cancer and HIV at the same time. The patient received a transplant in 2017 at Weill Cornell Medicine thanks to a team of transplant specialists led by Jingmei Hsu and Coen van Besien. Her case was part of the International Maternal and Adolescent AIDS Clinical Research Network (IMPAACT).
Cord blood cells were donated along with stem cells from a relative of the patient to increase the chances of the procedure being successful. “With cord blood, there aren’t as many cells available and it takes a little longer for them to repopulate the body after infusion,” Bryson explained in an article presenting the work. And he added that “using a mixture of stem cells from a suitable relative of the patient and cord blood cells gives a boost to the cord blood cells.”
With the help of transplantation, it was possible to save the patient from HIV and leukemia. 37 months after transplantation, the patient was able to stop taking antiviral drugs against HIV. Doctors who continue to monitor her say the virus has not been detected in her blood for more than 30 months since she stopped antiviral treatment.
Donors and racial diversity
Among the findings of the New York City patient’s study, the researchers note a curious fact: the use of cord blood stem cells increases the potential for an HIV cure through stem cell transplantation in people “of all racial origin“. The lead author of the study put it in a presentation: “The HIV epidemic racially diverseand it is extremely rare for African Americans and people of mixed race to find a sufficiently suitable unrelated adult donor.”
The patient has gone more than 30 months without detecting a virus in her blood since she stopped antiviral treatment.
Nails 38 million people people around the world are living with HIV, and antiviral treatment, although effective, must be taken throughout life. Only about 1% white people homozygous (having two identical copies of the gene for that trait) for the CCR5-delta32 mutation, a trait that is still less common in other populations. This rarity limits the possibility of transplantation. mother cells carriers beneficial mutation racial patients, since stem cell transplantation often requires a high match between donor and recipient.
Bryson, who, along with his colleague, led the work pediatrician and infectious disease specialist Deborah Persofrom the Johns Hopkins University School of Medicine, explained: “The use of cord blood cells empowers for people of different backgrounds living with HIV who require transplantation for other conditions to achieve a cure.”
In response to a question from SINC, the UCLA researcher elaborated: “Of course, this case encourages finding more opportunities for racially diverse groups with HIV.” He added that his service has a record of “a significant number of racial children who could be helped by the possibility of using cord blood.” in various therapeutic procedures“. In effect, this means “reaching a wider range of people than can be reached by donations from compatible adults.”
For her part, at the same press conference, Deborah Persaud emphasized the fact that the “New York patient” is Only womanamong the approximately 20 million women living with the virus” in achieving HIV remission after a therapeutic procedure. “It’s very important to give I hope everyone elseespecially given that she is a middle-aged and mixed-race woman,” she said in her statements.
Screening for cells with resistance mutation
“This study points to a really important role for having CCR5-delta32/32 cells in stem cell transplants for HIV patients because all successful cures so far have been linked to it. population of mutated cells, and studies that have transplanted new stem cells without this mutation have failed to cure HIV,” Perso said. Hence the recommendation that when doing a transplant as a cancer treatment for someone with HIV, the priority is to “look for cells that are CCR5-delta32/32” to try to achieve remission for both.
The authors have consistently stressed the need great effort For detect mutation CCR5-delta32 in donors and donations stem cells. “Using our protocol, we have identified 300 units of cord blood with this mutation so that if someone with HIV needs a transplant tomorrow, they will be available,” Bryson said. And stressed that “something needs to be done Constantly look for these mutations, and this will require the support of communities and governments.”
Finally, at a press conference Coen van Bezienfrom the clinical team, pointed out that “there are cord blood bases in more than a dozen countries where mothers can voluntarily donate cord blood”, but this is not enough and that more storage is needed.
Link:
Yvonne Bryson and others. “HIV-1 remission and possible cure in a woman after haplo-cord blood transplantation”. Cell (2023)
Source: Hiper Textual
