Cure for HIV found? Stem Cell transplant eliminates all traces of virus...

[RollWithIt]

http://www.cnn.com/2009/HEALTH/02/11/health.hiv.stemcell/index.html?eref=rss_latest

A 42-year-old HIV patient with leukemia appears to have no detectable HIV in his blood and no symptoms after a stem cell transplant from a donor carrying a gene mutation that confers natural resistance to the virus that causes AIDS, according to a report published Wednesday in the New England Journal of Medicine.
The patient underwent a stem cell transplant and since, has not tested positive for HIV in his blood.

The patient underwent a stem cell transplant and since, has not tested positive for HIV in his blood.

"The patient is fine," said Dr. Gero Hutter of Charite Universitatsmedizin Berlin in Germany. "Today, two years after his transplantation, he is still without any signs of HIV disease and without antiretroviral medication."

The case was first reported in November, and the new report is the first official publication of the case in a medical journal. Hutter and a team of medical professionals performed the stem cell transplant on the patient, an American living in Germany, to treat the man's leukemia, not the HIV itself.

However, the team deliberately chose a compatible donor who has a naturally occurring gene mutation that confers resistance to HIV. The mutation cripples a receptor known as CCR5, which is normally found on the surface of T cells, the type of immune system cells attacked by HIV.

[cosmicone]

1. While interesting as an anecdote,

it is not practical as a cure for most poeople. Few people would want to undergo chemo/radiation to destroy their immune systems and then would be lucky to find a compatible donor to provide CCR5 deficient stem cells!

Furthermore, it will cost $175,000 per patient to administer.

[msongs]

4. and how much does a decade of current treatments cost then? nt

[ingac70]

11. Meds cost about 6k a year.. n/t

[cosmicone]

19. Would you uindergo chemo and radiation and then what if a homologus

transplant is not available?

Also, the procedure would have a 5-10% mortality risk.

[thereismore]

31. You'd first find a donor, THEN destroy your own bone marrow. That's a given. nt

[RollWithIt]

8. Question, how much would the US Government currently pay for longterm treatment vs shortterm cure?

Also, it would be worth it to find out if the "cured" individuals can still infect the disease free. Unfortunately, that means animal testing and that sucks but I'm sure they've already started considering it.

[ljm2002]

30. Apart from the cost and the compatible donor issue...

...I believe your statement that "Few people would want to undergo chemo/radiation to destroy their immune systems" is patently false, given the realities of HIV.

Cost of course is an issue, and finding a compatible donor is an issue. But if using stem cells from a donor with HIV resistance actually cures HIV -- that is a real breakthrough. Here's hoping someone can build on this, maybe cultivate a cell line with HIV resistance for more general usage.

Sounds pretty exciting to me.

[HiFructosePronSyrup]

2. Am I reading this right?

Is it now possible to create a knock-out in an adult organism?

[RollWithIt]

5. Esssentially, they would call it "Gene Modification"

Basically adding a superior gene to the bloodstream. The possibilities are limitless if you think about it. Hypothetically you could transplant any disease immune gene at some point. Maybe even eliminate cancer. Not to mention the implications of actual cell growth to heal severe damage such as paralysis.

[HiFructosePronSyrup]

7. You're not following me.

It's one thing to add a gene.

It's a different matter to knock out a gene.

[RollWithIt]

9. HIV isn't a gene... it's a virus...

Two different principles. Essentially this procedure adds a gene to the blood that is HIV resistant. Most blood types don't contain this gene, hence the dynamic spread of the virus.

[HiFructosePronSyrup]

10. Yeah, forget it.

Anybody else want to take a stab at my question?

[mopinko]

16. there was a similar story last week about ms

at the feinberg school of medicine here in chicago.
they took bone marrow, knocked out the entire immune system, they replaced the bone marrow. the stem cells rebuilt the immune system from scratch, and not only stopped attacking the myelin, it repaired it.
if i read the above story correctly, this was the same thing, except that it was donated cells.
seems to me we are opening the door here to cures for a lot of things.
not sure if i answered your question, exactly, but it sounds to me like a yes we can.

[HiFructosePronSyrup]

17. OK.

[mopinko]

18. yeah! 11!

turn it up!

[DCKit]

28. The CCR5 gene evolved among 15% of Northern Eruopeans...

and provides immunity/resistance against the Plague. Happily, it also seems to provide the same against HIV.

This was a standard 'chemo to destroy bone marrow' (the leukeimic cells) followed by a transplant from a compatible doner who also possessed the CCR5 gene.

[HiFructosePronSyrup]

29. The CCR5 mutation evolved among 15% of Northern Europeans.

Everybody has the CCR5 gene, the thing is that a deletion in some northern europeans lead to the CCR5 delta 32 gene, essentially inactivating it and conferring resistance.

That's all been known for 20 years or so.

The problem is, it's "easy" to add a gene. It's another thing entirely to knock out a gene.

[Xithras]

34. It does have negative implications though.

CCR5 evolved to fight specific types of infections, and while the absence of that gene does block HIV, it also impairs immunity to the types of diseases CCR5 would help fight in other people. People with a CCR5 knockout are at a much higher risk of death from West Nile, as an example.

That said, I'd bet that most HIV patients would gladly trade a known killer for one that simply poses a "statistically significant" chance of killing them.

By the way, the link between the CCR5 mutation and the Plague has been largely disproven. The mutation has been detected in examinations of European remains predating the Black Death, and is probably a holdover from another disease that happened in prehistoric times (plagues have been around as long as we have).

[mike_c]

33. my sense is that it's not really a knock-out because the stem cell population...

...is replaced with the donor cells, i.e. the recipient's gene is not knocked out all-- at least not in that particular cell population-- it's replaced with a different allele that codes for an HIV resistant version of the protein it expresses. The original allele is not turned off at all-- the entire cell population that would express it is destroyed and replaced by the transplant.

Of course, that doesn't affect the original allele in the rest of the body's cells, but since they either don't express that gene or their gene product doesn't end up ornamenting T-cells, it doesn't matter.

on edit-- there appears to be some confusion about the terms "gene" and "allele" in the discussion above. As you say, everyone has the CCR5 gene-- the prize is the δ 32 allele.

[thereismore]

32. They replace your own bone marrow stem cells with CCR5 negative ones. They

in turn replenish your own T cells with the mutated ones, permanently. Your body will be the same, but the bone marrow and T cells will be somebody else's.

[HiFructosePronSyrup]

35. What prevents the growrth of CCR5 positive marrow?

[thereismore]

36. The new stem cells lack part of the CCR5 gene. They are CCR5-, so they cannot

produce a CCR5+ T cells, only CCR5- cells. Remember, the guy's own CCR5+ cells were killed by radiation, so that once the new bone marrow stem cells are put in, the old T cells in circulation will gradually die and be replaced by CCR5- cells, therefore, the HIV virus has no calls left to invade and is cleared from the body (HIV-1 only enters CCR5+ T cells. The rest of your body is impervious to them). So HIV basically runs out of cells to invade and is flushed out, digested, whatever.

[kenny blankenship]

3. Well you know this is going to make the Fundies go completely apeshit

Science AGAIN nullifying the Will of God - and their favorite part too!

[mistertrickster]

24. I was thinking the same thing. Killing fetuses to save gays. Wow. Their heads will blow up. nt

[tammywammy]

27. It was stem cells from an adult n/t

[Catshrink]

6. 6 years too late for my dear friend

:cry:

But I am very happy for those it may help now.

[Barack_America]

12. Awesome. My fiance is CCR5 negative.

That's pretty freaking exciting.

[xchrom]

13. i'm going to recommend this -- though obviously it isn't

a panacea of any sort.

it's going to help -- very few people.

but the science is very interesting.

[Barack_America]

15. Yeah, you have to get pretty well irradiated before you can have a transplant...

So there's no way that this is going to be available to everyone with HIV. Too risky, especially with the antivirals we have now.

But hopefully it will encourage the testing of bone marrow donors for their CCR5 status so more patients like this one (with an illness requiring transplant + HIV) can be hooked up with CCR5(-) donors.

[xchrom]

22. hey -- the science on this is fascinating.

may not benefit hiv patients -- but somebody will gain benefit -- the immune system has a lot of mysteries to give up.

it just gave up one.

[QueenOfCalifornia]

14. Even though

several people are shooting this down as "too expensive" I am very happy to see that there is some new hope on the horizon.

All new technology, at first, is "too expensive." There is an evolution in medicine and technology - as more is learned, more leaps forward and then price begins to drop.

This will give hope to millions who have HIV.

:applause:

K&R - :)

[Fire_Medic_Dave]

20. No one is shooting anything down, they are pointing at the real problems with the therapy.

Everyone is hopeful that those problems can be overcome, but that doesn't make them less real.

David

[girl gone mad]

21. Yes.....

I can see it evolving into something that doesn't require a full marrow transplant with chemo.

[Spangle]

23. Me too!

At least now they know something works. And have a little direction. I can see something coming of it.

I've always figured that if something was found to work/help, it would be in a country that has health care for it's people. It would be cheaper to nip this, then to do long term care.

[Wildewolfe]

25. Bone marrow transplants

aren't really a viable cure. By themselves they have a 5 to 10% mortality rate just from the procedure itself (as was mentioned above) and that's just in the first few weeks to months after the procedure is done. It's a last ditch everything else has failed procedure.

Having said that, what they learn from this might lead to other therapies that would provide the same benefit without the same risks and hopefully costs associated with the bone marrow transplant.

[trotsky]

26. Not to mention the difficulty of matching up donors and recipients.

Tons of leukemia sufferers die without finding a match. And now you're further restricting the potential donors by screening for the anti-HIV gene. But still, any gain is a gain, and hopefully this will lead to more breakthroughs.