AIDS "cured" after stem cell transplantation, the third case in the world may appear!

In 2013, a middle-aged woman from New York was diagnosed with HIV infection when she was still in the early stages of infection

But fate presented her with another problem

On February 15, local time, at the CROI (Conference on Retroviruses and Opportunistic Infections) 2022 annual meeting, Dr.

This means that, after the "Berlin patient" and the "London patient", this "New York patient" will be the third lucky person to achieve AIDS "cure" through stem cell transplantation if he can continue to stop taking the drug and has no signs of HIV infection.

The research team pointed out in the report of the CROI meeting that it is worth noting that, unlike the first two cures, the "New York patient" was the first female transplant cure, and was also a minority (CCR5 mutation carriers were mostly white), and adopted umbilical cord blood transplant

The same critical CCR5 gene

HIV specifically attacks CD4-positive lymphocytes in the human body, proliferates in the lymphocytes, and then destroys the lymphocytes, resulting in cell lysis, thereby continuing to infect and destroy other lymphocytes

Some people are born with the CCR5Δ32/Δ32 mutation (homozygous carriers), which makes them almost immune to HIV

In 2007, HIV-infected "Berlin patient" Timothy Ray Brown received a bone marrow transplant for AML from a CCR5Δ32/Δ32 mutation

At the 2008 International AIDS Conference, researchers reported on the case of Timsey, who became the world's first cured AIDS patient

Nearly a decade later, a "London patient" with a similar fate has come into the spotlight

Adam is believed to be the second AIDS patient in the world to be cured

The emergence of the "New York patient" provides further insights into curing HIV infection

The "New York Patient" Difference: Bone Marrow Transplant + Cord Blood Transplant

The "New York patient" received a "combined gift" of stem cells from her relatives' bone marrow and umbilical cord blood from a blood bank

In other words, doctors performed both a bone marrow transplant and an umbilical cord blood transplant for her

Previously, stem cells from the "Berlin Patient" and "London Patient" came from bone marrow transplants

After the transplant, the patient's immune system began to rebuild using stem cells derived from the bone marrow transplant, and she did not develop "graft-versus-host disease" (GVH), a common side effect of stem cell transplants

The proportion of cells derived from cord blood transplants gradually increased over time
.
After 100 days, stem cells from the cord blood had "taken over" her immune system
.
More than a year after the transplant, her CD4 immune cells returned to normal levels
.

At 27 months, she decided to stop all HIV treatment to see if a transplant would work for HIV immunity
.

The time for the real test has come
.

Over time, apart from a brief detection of HIV DNA at 12 weeks, the researchers never detected HIV viral loads in the patients, including in CD4+ T cells and bone marrow
.
"It's been 14 months now and she hasn't rebounded
," noted Dr.
Yvonne Bryson
.

Also, her antibody test was negative
.
The research team even grew another 75 million cells in the lab based on her cells, again finding no trace of HIV infection
.

more to explore

Of course, the researchers also looked at this case with caution
.

For example, after receiving stem cell transplantation, this woman not only carried a CCR5 mutation, but also accidentally carried a CXCR4 mutation, and the CXCR4 receptor is also one of the "side doors" that HIV can walk when infecting cells
.

For example, except that HIV was not detected in the blood, what was the test result in the tissue? There is a lack of information on this issue
.

For another example, why did this patient not develop common GVH after transplantation? "There has long been a hypothesis that at some point the body may need GVH to help clear CD4+ T cells, whether or not those cells carry replication-competent viruses
.
"

.
.
.

In addition, how to move from a single case to providing a cure for more AIDS patients is also a follow-up challenge
.
Luis Montaner, director of the Laboratory of Immunopathology at the Wistar Institute in Philadelphia, said the case "supports a therapeutic strategy for editing CCR5 through CRISPR Cas9 technology
.
"

Looking forward to the enlightenment from the cases of these lucky people, which can bring hope for more HIV-infected people to be cured
.

References

[1] Bryson Y et al.
HIV-1 remission with CCR5∆32/∆32 haplo-cord transplant in a US woman.
CROI 2022, Oral abstract 65.
https://ww2.
aievolution.
com/cro2201/index.
cfm ?do=abs.
viewAbs&abs=3310

[2] A Third Person Living With HIV Has Been Cured by Transplant.
Retrieved February 16, 2022 from https:// CROI 2022: Potential HIV cure case in a US woman using donor cord stem cells.
Retrieved February 16, 2022 from https://i-base.
info/htb/42182

[4] Gupta RK, et al.
, (2020).
Evidence for HIV-1 cure after CCR5Δ32/Δ32 allogeneic haemopoietic stem-cell transplantation 30 months post analytical treatment interruption: a case report.
Lancet HIV, DOI: 10.
1016/S2352- 3018(20)30069-2.

[5] HIV Resistant Mutation, Retrieved February 16, 2022 from https:// abridged)