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Stem Cell Transplant can pave the Way for an Efficient HIV Cure

The recent buzz about the discovery of the HIV cure has drawn out everyone’s attention towards the 2nd patient who had remained anonymous, dubbed as the ‘London Patient.’ He is the new patient, who had been diagnosed to be infected with the retrovirus back in 2003, and appears to be or may have been HIV-free after a special bone-marrow transplant surgery, according to the headlining report of the CROI 2019 (Conference on Retroviruses and Opportunistic Infections 2019). The researchers who have carried out this particular study under the leadership of Dr. Ravindra Gupta, are strictly claiming the case not yet to be a definite cure for HIV but the patient is found to have remission from the viral infection for a long period without the intake of the antiretroviral medications for 18 months.HIV is a virus that infects through a particular set of body fluids in humans and other Primates, and it tends to hamper the human immune system by disintegrating the immune cells, CD4 cells (T cells), such that the body becomes unable to maintain the required immunity level to fight off the pathogens.

The patients with HIV are treated with antiretroviral therapy (ART) which reduces the viral load or the amount of HIV in the bloodstream. An HIV diagnosed patient when undergoes the ART, he/she can live as long as one not infected by HIV. Opportunistic infections or cancers take advantage of the impaired immune system when infected by HIV, and that signifies the onset of AIDS or Acquired Immune Deficiency Syndrome.

The individual male patient in the latest study appeared to have been cured of HIV. The HIV cure news emanates nearly 12 years post the day when the first patient was found to be cured, “Berlin Patient” had come forward, a feat that academics and investigators have attempted and failed to replicate. The surprise success of the London patient now opens up several doorways for determining the proper ‘cure’ for deflecting HIV infection, although figuring out such ways can be difficult according to some of the researchers.

The Berlin patient, Timothy Ray Brown had been diagnosed to be HIV positive back in 1995 and was prescribed to take the antiviral drugs, protease inhibitors, which functions by preventing viral maturation. This treatment continued for the next decade, and afterward, he was diagnosed with Acute Myeloid Leukemia, a type of cancer that required him to go for four rounds of chemotherapy treatments. By the end of it, his oncologist, Dr. Gero Hütter had sent Brown’s bone marrow sample for a tissue type match to carry out the Stem Cell transplant surgery.

As soon as they found his tissue match, Tim Brown was given a treatment that disintegrated nearly all his immune cells through radiotherapy or drugs and then were replaced with cells from a donor who was naturally resistant to HIV because of a rare but naturally occurring mutation in a gene called CCR5. This gene codes for a protein bound to the peripheral surface of the immune cells or CD4 cells, which function as the doorway for HIV to enter into the cell. Upon its absence from the cell membrane, the CD4 cell does not get infected by HIV, and the person becomes immune to the virus. This is how the procedure pans out to cure HIV until now: The procedure is a form of stem cell transplantation (SCT) surgery, where the patient receives blood forming cells or stem cells to replace their own. SCT has gained much popularity as a viable alternative reconstructive option in recent years and the growth rate for the global stem cell market according to Inkwood Research is estimated to be around 9.73% from 2018-2026.According to recent studies, approximately 1% of the European descent have two copies of the CCR5 mutation and are thus, resistant to HIV infection.

Currently, the latest news as per Andrew Freedman, a clinical infectious-disease physician from the Cardiff University, the UK, who was not involved in the study stated that the patient to receive the Stem Cell transplant treatment had been showing a response similar to Brown’s. Analogous to Brown, the latest patient whose identity had not been disclosed yet, known as the “London Patient” had been diagnosed with a form of blood cancer that wasn’t responding to chemotherapy. So, they needed him to undergo a bone-marrow transplant to replenish the infected immune cells with the CCR5 mutant ones from the transplanted stem cells of the healthy donor.

The study being supervised by Dr. Ravindra Gupta, a professor in the Division of Infection and Immunity at University College London had explicitly described the study in a paper to be published in Nature. The report states that the transplant had been successful in substituting the patient’s immune cells with the HIV-resistant variant. The WBCs circulating within the patient’s bloodstream have shown an expression inhibition of the CCR5 doorway, and in the in vitro studies, the group had been unable to re-infect the viral-resistant immune cells with the patient’s version of HIV. The London patient had shown zero levels of the viral load after he stopped his AR medications by 18 months and he had undergone less aggressive treatment for the transplant than Brown.

The study as per Gupta, clearly indicates that Brown’s case hadn’t been a one-off. Gero Hütter, who at present is the medical director of the stem-cell company, Cellex based in Dresden, Germany, believes that Brown’s aggressive kind of treatment could only ever be used for a small set of patients, but if carried out under certain conditions with multiple modifications as per the new study can stimulate the application of gene therapy to a much broader group of people. He says, “The real breakthrough, we are still waiting for.”

Inkwood Research

Author: Inkwood Research

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