Of course, only after intense chemotherapy and a risky bone marrow stem cell transplant using special marrow from a guy with a rare genetic mutation, but this is still pretty awesome.
This certainly isn’t going to work for everyone but it’s not too often we discover a plague like this is definitively curable.
Well, it’s obvious what we do next: Create a way to grow those marrow cells in bulk, either in vats or in genetically modified organisms, and make those marrow transplants as safe and cheap as possible. (That second part may well be an insuperable barrier.)
Am I the only person who immediately thought of the Omega Man?
In all seriousness, are all us Northern European types going to be encouraged to be tested for the CCR5-delta32 mutation? And do we get cookies after we give?
Very interesting. I remember a million years ago (about 15) when I was a volunteer in an NIH AIDS vaccine study. Of all the people in the study, throughout the country, I had the strongest immune response to the vaccine. I won a bag of mini Snickers at the summer picnic held for the volunteers. I often thought that should generate some study - why my response was so strong.
This is hopeful news. I wonder how hard it will be to synthesize the marrow?
This guy got insanely lucky. his donor match happened to have the rare mutation where his immune cells lacked the HIV receptor. These cells could only be used for transplant in people for whom they are a donor match - not a large proportion of people.
Add to that the fact that this wasn’t just a bone marrow transplant - it was a marrow replacement. They first use high dosage radiation or drugs to kill all of the original bone marrow - a procedure that has a pretty high death rate. if it doesn’t kill you, then the transplant the new marrow in.
Finally, this guy has traded a lifetime of anti-retroviral drugs for a lifetime of immune suppression drugs (so that he doesn’t reject the new marrow). His lifespan is probably not greatly improved- he probably has a couple decades either way.
An interesting case study, but that’s it - it won’t lead to any new cures in the future.
mozchron: If he’s so lucky he got a good bone marrow match, and matches are so rare, and so on, why does he still need the immunosuppressive drugs? Isn’t the whole point of looking high and low for a match to get something your body won’t reject?
It’s a match in that it has a chance of being accepted at all, rather than killing him quickly in a massive immune system attack on the strange tissue.
And a nitpick; when talking about bone marrow rejection, since your immune system is part of what has been replaced, it’s as it is in Soviet Russia: transplant rejects YOU!
Unfortunately this really won’t be able to be a good “cure.” There are several things that went “just right”:
The man had the correct strain of HIV
The donor was a match and had the mutation
The process of killing/destroying the man’s marrow didn’t kill him
The marrow (so far) hasn’t been rejected
That first past is pretty key…not all strains of HIV use that receptor, so even if you have the right mutation, don’t go around thinking you’re immune to HIV or anything crazy like that.
It had a one in a large number shot of working, and so far it has. I do hope some sort of treatment can be given to others who may be able to match like this donor/recipient has.
My father-in-law was diagnosed with Leukemia in 93. He had a conventional bone marrow transplant in 94 and got to the five year mark and was declared “cured”. In 2003, the leukemia came back. This time he had a stem cell transplant. It grafted and became determined to do a number on him and he developed Graft v Host. They used photopheresis to treat his GVH. He still has lingering symptoms, especially when his body is stressed.
Transplants and the lot of “stuff” that comes with it can be very taxing on a body.
This is where I could see stem cell and gene therapy really stepping up to the plate.
Maybe some day, we could harvest stem cells from an HIV patient, use gene therapy to replace the regular HIV-vulnerable gene with the resistant one, and then replicate and grow the stem cells into a full bone marrow replacement. Since it comes from the original patient, there’d be no fear of graft-versus-host disease, and with the resistant gene, there’d be no more HIV.
I’ll also bet it’s about a kajillion times more complicated than I made it sound.
Seriously. One of my best friends is 12-years post transplant for leukemia, and at the ripe old age of 29 she’s menopausal, infertile, has ridiculously high blood pressure (and can’t take hormone treatments for the menopause because they raise her blood pressure), is down to about 50% kidney function after an infection, manages to get pneumonia a couple of times a year, is dealing with uveitis and related vision problems and has a 35% chance of getting another form of cancer within the next 10 years.
And her marrow donor was a perfect match.
On the other hand, she had about 2 months to live when she was first diagnosed, so really, it’s worth it. I’m grateful every day that she’s still around, but it really isn’t easy for her!
The patient in the news story may be HIV-free, but I’m not sure how healthy he’ll be for the rest of his life!
Yes except children attack the nervous system but leave the body intact.
The problem with AIDS is that it’s a virus and as such medical science has not really made much of a dent. Even if this treatment works it will be expensive and not really advance the science of fighting viruses directly.
For anyone who’s interested, the article points you this wiki entry for the delta 32 variant of the CCR5 protein. As it was explained to me, this protein is part of a receptor that the virus uses to gain entry to the cell. In the d32 version, there are fewer CCR5 proteins for the virus to latch on to. This seems to be the main method used by HIV but probably isn’t the only one.
And it’s not that rare. Between 5 and 14% of N. Europeans have it. I assume that means at least one allele. Of course to be “immune” you would need both so if we assume 10% have at least one, that means that at least 1% should have both - probably a lot more though.