A 53-year-old man from Düsseldorf, Germany, has become the third person in the world to be completely cured of HIV by stem cell transplant using donor cells with specific genetic mutations.
Like the “Berlin patient” and the “London patient” before him, the “Düsseldorf patient” was treated for an acute hematologic disease and in the process contracted infection with the human immunodeficiency virus type 1 (HIV-1). Healed. According to a recent study published by Düsseldorf University Hospital.
HIV is divided into two main types, HIV-1 and HIV-2. When we refer to HIV, we are generally referring to HIV-1, which is more prevalent worldwide. HIV-2 is of low pathogenicity and transmission by viruses of its subtypes is primarily restricted to West Africa. References to HIV in this article are references to HIV-1.
HIV can remain in the body despite antiretroviral therapy (ART), but this is a treatment, not a cure. However, allogeneic hematopoietic stem cell transplantation (HSCT), the scientific term for bone marrow transplantation, has been shown to significantly reduce viral reservoirs of dormant HIV in cells that can be reactivated if ART is discontinued. . The term “allogeneic” means that the transplanted stem cells are genetically different. from someone other than the recipient.
The patient was diagnosed as HIV-positive in January 2008. In 2011, six months after he started his HIV treatment at a university hospital, he had acute myeloid leukemia (AML), a life-threatening type of blood cancer. was diagnosed. In 2013, he underwent a stem cell transplant primarily as a treatment for his AML.
Transplanted stem cells were selected against specific mutations found in the CCR5 gene. Her CCR5 co-receptor on the body’s immune cells plays a key role in HIV infection, acting as a “docking site” for HIV to enter cells.
A homozygous mutation in the CCR5 gene, the CR5Δ32/Δ32 mutation, removes the docking site for both copies (maternal and paternal) of the gene, preventing virus entry into cells and leading to widespread HIV resistance.
Stem cells with the same genetic mutation were used to treat patients in Berlin and London.As in the previous case, cells with CR5Δ32/Δ32
Mutations have been used to treat both AML and HIV.
“From the beginning, the goal of the transplant was to control both the leukemia and the HI virus,” said Professor Guido Cobbe, who carried out the transplant surgery and co-author of the study.
After following the Düsseldorf patient for many years, doctors found that almost ten years after the transplant and four years after stopping ART, he showed sustained HIV suppression. The patient is in complete remission from both his AML and HIV.
“After intensive research, we have confirmed that it is fundamentally possible to stop HI virus replication in the long term by combining two key strategies. One is to largely deplete the cell’s viral reservoirs, and the other is to transfer the HIV resistance of the donor’s immune system to the recipient.”
This study represents an important advance in the fight against HIV.
The development of gene-editing techniques such as CRISPR could mean that the types of stem cells transplanted to patients in Düsseldorf could be made in the lab rather than harvested from donors.
The study was published in a journal natural medicine.
Source: Düsseldorf University Hospital/Dusseldorf Heinrich Heine University
