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,
Coming up with a cure for a serious diseases is really refreshing, imagine giving hope to the people affected by HIV is really good news, unlike the bad news that I always read from rush essay review which are really devastating.
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