Barcelona – Research using man-made, blood-forming stem
cells has shown great promise in animal experiments in
suppressing HIV.
But now a grant from the California Institute for
Regenerative Medicine (CIRM) has funded a clinical trial
using those bio-engineered stem cells to treat HIV patients
who have lymphoma, a deadly cancer that eventually kills
people with AIDS.
Timothy Brown was the first patient to ever be cured of
HIV after a bone marrow transplant to treat his leukemia
received. He is known as the ‘Berlin patient’.
By using blood transplants from the umbilical cords of
individuals with a genetic resistance to HIV, Spanish medical
professionals believe they can treat the virus, having
proven the procedure successful with one patient.
Now, a 37-year-old man from Barcelona, who had been
infected with the HIV virus in 2009, was cured of the
condition after receiving a transplant of blood.
While unfortunately the man later died from cancer just
three years later, having developed lymphoma, the Spanish
medical team is still hugely encouraged by what it considers
to be a breakthrough in the fight against HIV and related
conditions, according to the Spanish news source El Mundo.
Doctors in Barcelona initially attempted the technique using
the precedent of Timothy Brown, an HIV patient who
developed leukemia before receiving experimental treatment
in Berlin, the Spanish news site The Local reported.
Brown was given bone marrow from a donor who carried
the resistance mutation from HIV. After the cancer
treatment, the HIV virus had also disappeared.
According to The Local, the CCR5 Delta 35 mutation
affects a protein in white blood cells and provides an
estimated one percent of the human population with high
resistance to
infection from HIV.
Spanish doctors attempted to treat the lymphoma of the
so-called “Barcelona patient” with chemotherapy and an
auto-transplant of the cells, but were unable to find him a
suitable bone marrow.
“We suggested a transplant of blood from an umbilical cord
but from someone who had the mutation because we knew
from ‘the Berlin patient’ that as well as [ending] the
cancer, we could also eradicate HIV,” Rafael Duarte, the
director of the Haematopoietic Transplant Programme at
the Catalan Oncology Institute in Barcelona, told The Local.
Prior to the transplant, a patient’s blood cells are
destroyed
with chemotherapy before they are replaced with new
cells,
incorporating the mutation which means the HIV virus can
no longer attach itself to them. For the Barcelona patient,
stem cells from another donor were used in order to
accelerate the regeneration process.
Eleven days after the transplant, the patient in Barcelona
experienced recovery. Three months later, it was found
that
he was clear of the HIV virus.
Despite the unfortunate death of the patient from cancer,
the procedure has led to the development of an ambitious
project that is backed by Spain’s National Transplant
Organization.
March 2015 marked the world’s first clinical trials of
umbilical cord transplants for HIV patients with blood
cancers.
Javier Martinez, a virologist from the research foundation
Irsicaixa, stressed that the process is primarily designed to
assist HIV patients suffering from cancer, but “this
therapy
does allow us to speculate about a cure for HIV,” he added.
Despite the joy and ululation, those who think its time to
celebrate may have not done their research. The process of
curing HIV referred to by the doctors is called Stem Cell
Transplant. Whilst it has worked on this one patient, there
is a lot more information about its viability and use as a
cure for all people affected with HIV / AIDS.
To begin with, getting a Stem Cell Transplant is much more
dangerous than living with HIV.
To successfully complete an SCT you have to completely
destroy the stem cells in your bone marrow using intense
conditioning resulting in:
1. Low/No white blood cells – [no ability to fight off
infection, meaning even something as small as flu could kill
you]
2. Low Platelets – [heavy risk of uncontrollable bleeding- a
nosebleed would most likely result in death)
3. Low hemoglobin – [you will need many, many blood
transfusions]
4. Graft vs Host disease – [which can cause really poor
quality of life or kill you]
5. A long time spent in hospital – [weeks to months, if not
a year plus].
Stem Cell Transplants do save lives, but judging by the
risks state above, they only make sense for people who
have specific life threatening conditions such as acute
leukemia. These conditions would imply that loss of life is
almost guaranteed, and certain, leaving SCT as the last
hope or only option.
From a sensible perspective, HIV is now a manageable
chronic condition in most cases. This “CURE” is certainly
interesting but probably not applicable for almost all HIV
positive people.
HIV is a minor inconvenience in the world of modern
medicine. It is easily controlled with 1 pill (ARVs) taken
once a day, typically with no complications or side effects.
However, dying from a bone marrow transplant because of
the risks mentioned before is, by comparison, a major
inconvenience.
There is great reason to be excited however, discoveries
like these are a major breakthrough and can allow medical
personnel to build on them for a more constructive and less
intensive cure.
Trials are already underway to gather more information.
They started in March 2015.
To decide if it could be done or not a trial, it was
necessary
first to note that Spanish banks umbilical cord had samples
that will carry a key mutation that is responsible for
transferring protection against HIV. This is the genetic
mutation CCR5 Delta 3 , a variation that acts as
a shield against the AIDS virus. Cells carrying this variant
areimpermeable to the pathogen.
That’s what was discovered, almost by chance, with the
Berlin patient, ie, if a person receives bone (or cord blood)
from another subject that carries this positive change, will
renew your blood cells they are immune to HIV, the body
that will end disappearing.
“We knew that Spain is a world power in number of cords
and cellularity, because the collection protocol makes us
samples with many cells needed for transplants in adults.
So we decided to analyze those cells rich laces, 25,000 .
To
this end, we agreed with all the autonomous communities
and cord banks, “he told WORLD Rafael Matesanz, director
of the National Transplant Organization, which has funded
the search with about 100,000 euros.
After one year evaluating cord by cord to see which of
them carried the mutation , said Rafael Duarte, who was
director of Hematopoietic Transplant Program at the
Catalan Institute of Oncology (ICO) and is now head of
Hematopoietic Transplantation Oncohematology and the
Hospital Puerta Iron, “we have managed to identify this
feature 157 units, representing 0.6% of the Spanish
population.”
That elite cords, and a solution for those offers that
require
a transplant for hematologic problem, an option to cure
HIV
to those who, besides being HIV positive, develop a cancer
of the blood. “This is not a therapy for any patient with
HIV. Only is intended for those who in addition to the virus
develop leukemia, lymphoma, etc,” explains Matesanz.
With antiretroviral treatments available, a general therapy
umbilical cord blood is not viable. First, because there are
few units worldwide who carry the mutation makes the
infallible cells against the virus, and secondly because this
type of transplantation is not without risks. According to
overall figures in Europe the expected mortality from
complications of transplant is between 20% and 25%.
This is only acceptable in patients with very serious blood
disease , which if not treat them in a short time, to death.
Furthermore, according a study of over 100 patients, those
with HIV who have undergone a bone marrow transplant
have a higher risk of complications than for people without
HIV. Therefore, there is a therapy for all HIV-positive
people
but to very specific cases, “says Duarte.
For all this is important to test this treatment in the
context of a clinical trial, said the hematologist, because
the protocols are the same in the various hospitals where it
is made, monitoring will be equal and once the results are
available, allow you to learn from experience experts
worldwide.
The trial, which will involve the Puerta de Hierro Hospital,
the Gregorio Maranon (both in Madrid), the Catalan
Institute of Oncology (ICO), and the Hospital La Fe de
Valencia, along with cord blood banks and the ONT, It aims
to recruit patients in two to five years. “The first patient
is
already in. It is discussed in Madrid not until later this year
or early next, because previously required to go through a
chemotherapy [to kill tumor cells in their bone] and a
conditioner that take several weeks. This is a person with a
type of lymphoma and HIV we do not want to give more
information, “said Duarte, who is the principal investigator
of this trial.
157 cords mutation CCR5 Delta 3 identified in Spain
continue to be part of the international registration,
REDMO,
but is an advisory committee (formed by doctors in
hospitals, banks cord and ONT) through a protocol
established to decide what to do with them if they are
claimed by researchers from another country well for an
HIV-positive patient with a hematologic or problem for a
person without carrying HIV, consistent with the cord and
requires a medical problem as a leukemia or lymphoma.
The trial, scheduled for three years and with a budget of
150,000 euros provided by the Mutua Madrileña
Foundation, is within an experimental framework. “It is
looking for a high amount of healing but the proof of the
hypothesis that this transplant can make HIV disappear.
The implications are qualitative rather than quantitative.”
The same view Josep Maria Gatell, co-director of the XV
European AIDS Conference being held these days in
Barcelona, is shown “is interesting in terms of research, no
practical way for the current treatment of patients with
HIV.”
Online With Additional Reporting From Health
Correspondent, El Mundo ES,
