German Doctor Cures an HIV Patient With a Bone Marrow Transplant 639
reporter writes "HIV is the virus that causes Acquired Immune Deficiency Syndrome (AIDS). Until now, HIV has no cure and has led to the deaths of over 25 million people. However, a possible cure has appeared. Dr. Gero Hutter, a brilliant physician in Germany, replaced the bone marrow of an HIV patient with the bone marrow of a donor who has natural immunity to HIV. The new bone marrow in the patient then produced immune-system cells that are immune to HIV. Being unable to hijack any immune cell, the HIV has simply disappeared. The patient has been free of HIV for about 2 years. Some physicians at UCLA have developed a similar therapy and plan to commercialize it."
Is it for real this time? (Score:2, Interesting)
Over the years, I've witnessed probably 640 articles on a cure for HIV either having been discovered, or very near.
So before I get all excited and start fucking everything that moves without a condom, is this for real? Or is this another one of those "cures for a small number (eg, 1) of patients, and cannot be turned into a general cure or vaccine for all?
Peer review (Score:3, Interesting)
Re:Like to see this replicated (Score:5, Interesting)
Re:So you need immune bone marrow? (Score:4, Interesting)
Bone marrow replicates itself. You can keep digging it out of the same person's bone, or out of someone who receives it.
Though I've heard this procedure is quite painful, breaking into bones to dig out (or stuff in) marrow.
Re:So you need immune bone marrow? (Score:3, Interesting)
Re:Like to see this replicated (Score:5, Interesting)
Re:Like to see this replicated (Score:5, Interesting)
Right now, there's a ban on selling organs for donation in this country. However, bone marrow transplants are expensive. If the recipient could later be used as a donor, the ability to pay them for their marrow (thus allowing them to more easily pay for the original transplant) could really help move this thing along. Even if a marrow recipient is reluctant to donate his own marrow, if he had a very large medical bill and was offered money to donate, he would be much more likely to do so.
Of course, given the limited number of naturally HIV-immune people in existence today, it would drive up the price of a transplant in the short term as they demand high prices for their marrow, but in the long run it would even out as we create more HIV-immune people.
Re:Like to see this replicated (Score:5, Interesting)
The advantage of this method is that, since the stem cells are coming from your own body, there is no graft vs host disease (which is essentially like standard organ rejection, but instead the organ rejected is your entire body being rejected by the graft... you can imagine that this is very bad). Of course, you still have the problem of developing leukemia later from the total body irradiation and viral integration into an important gene. You also have a high risk of death upfront when you spend several weeks without a functional immune system when the transplant is taking. But nevertheless, it's exciting.
Comment removed (Score:5, Interesting)
Re:Like to see this replicated (Score:4, Interesting)
Comment removed (Score:3, Interesting)
Survival rates (Score:4, Interesting)
The bad news: about 30% of people who get bone marrow transplants don't survive the procedure,
But the people who currently get bone marrow transplants are already in very bad shape to survive surgery - far worse than a person who has aids. Most bone marrow transplants are done to cure leukemia or some similar disease that damages blood cells. These blood cells includes platelets which are necessary for coagulating blood. If your blood does not coagulate well, you don't have a good chance of surviving surgery.
So the very disease that makes bone marrow transplants necessary often prevents the patient from surviving the surgery to cure it. With AIDS patients, this would not be a problem, so one could expect a better survival rate.
Re:Like to see this replicated (Score:5, Interesting)
AS it was discovered that the very same genes that help immunity from the black death are same for HIV.
if you have none of this gene pair "switched on" then you are gonna get ill quick and die......
if you have one of the pair on then you will go on for a few weeks THEN come down with symptoms.
However with BOTH genes switched on you are immune but carry the black death/HIV virus. Was on the discovery channel....
It was also apparently found that is was only ethnic Europeans who had this gene switched on... this led to some conspiracy theories about HIV/AIDS being created to be targeted at non whites.
NEVER let it be said that a late night spliff to chill out whilst Discovery is on is a waste of your chill time!
Re:Evolution as a problem solver (Score:3, Interesting)
Carrier? (Score:3, Interesting)
Does this or does this not still leave the recipient as an HIV carrier?
Re:I know what bone marrow transplants do to peopl (Score:5, Interesting)
But I just don't know if this is the best way to deal with it once someone is infected.
I'd say it isn't, given the nature of a bone marrow transplant (such things always seems so easy on TV.) Still, there may be other ways to transfer this genetic protection to an individual (a retrovirus maybe) so this qualifies as significant progress.
Re:Like to see this replicated (Score:4, Interesting)
> Because this trait appears to be genetically inheritable, unless well-meaning doctors interfere by transplanting bone marrow, the donors will be replicated. Natural selection will favour those resistant to HIV infections, and within a few generations, people with this survival trait will have produced noticeably more offspring. Of course, this is of little value to those who would develop AIDS or other HIV-related diseases in the mean time...
I don't think so. Selection for the HIV-immunity gene is very weak, since very few people have HIV. Now if we were to stop using drugs against HIV and all have unprotected sex, then natural selection would kick in properly and the gene would spread. Then again, having this gene may not be that great. Maybe having it increases chances of getting some other, even more vicious disease (although it wouldn't be the first time useless genes/organs/bones/whatever are found, so maybe there are no downsides to having the HIV-immunity gene).
> Transplanting bone marrow to a HIV-infected individual should, IMO, be followed by a mandatory sterilisation. Else, we will be working against natural selection, and will in the long run assist HIV in surviving by increasing the number of non-resistant individuals in future populations.
Ah, but where to stop? I guess we should also sterilise blind people, deaf people, people with diabetes, etc. While removing people with bad genes from the gene pool would fix many genetic defects for generations to come (obviously), most people would agree it may not be the right thing to do.
You know one kind of method for one kind of illnes (Score:5, Interesting)
I have had a bone marrow transplant. No radiation, minimal chemo-like drugs. In the hospital a week or a week and a half, 6 months of outpatient monitoring and I was cured.
For the AIDS treatment to work, they would most likely use something closer to my transplant protocol than the full oblation that they use with cancer patients.
Note to those interested: They dont have to go in with needles or drills to "dig out" the bone marrow from the donor. They give you a drug call the "G" that causes your bone marrow to percolate into your bloodstream. Then they filter it out with a dialysis-type procedure. Its fairly painless. I had it done to save my own marrow in case something went wrong with the transplant.
Re:Like to see this replicated (Score:5, Interesting)
or you could do a little [hrw.org] research [hhs.gov] yourself before running your mouth off.
in the U.S. there are also conscience clauses in several states that allow pharmacists to refuse to fill a patent's prescription based on religious grounds. this was primarily introduced to to deny women emergency contraceptive pills, but it also opens the door for denying patients other types of medical treatment based on religious prejudices.
Re:Like to see this replicated (Score:4, Interesting)
Why bother wiping out the existing bone marrow?
This isn't like leukemia, where we want to kill all the abnormal cells. The patient's existing marrow is perfectly healthy, and its presence or absence will have no effect on the ability of the donor cells to colonized the liver or where-ever it is that they typically wind up.
So the patient shouldn't need any radiation at all. Their unmodified marrow will still produce T cells that are susceptible to the virus, but that's no big deal because the T cells from the modified marrow will be able to handle it.
Maybe I'm missing something, but it seems at least possible that one could do this with a "marrow plant" rather than a "marrow transplant".
Re:natural immunity problem (Score:2, Interesting)
Re:Like to see this replicated (Score:3, Interesting)
Re:Like to see this replicated (Score:4, Interesting)
With the severely limited number of people with known immunity to HIV, and the pain of removing bone marrow, I'm wondering if more than a mere handful of people can be treated via this method.
It says in TFA there is a 30% mortality for bone marrow transplants, so it will never be the therapy of choice. This case is just one more piece of data indicating that the CCR5 receptor is *the* Achilles heel that makes us vulnerable to HIV, so disabling it may be the cure.
Re:Like to see this replicated (Score:3, Interesting)
From Wikipedia:
Preventing this receptor from functioning does not appear to disable the immune system, though it may raise the risk of contracting certain specific diseases. This is probably an acceptable tradeoff for the limited period of time a patient with HIV would be required to take such a drug. If you're going to be a jerk, at least make sure you get your information right before you flame.
Re:Yeah great and all (Score:3, Interesting)
I'm pretty sure that mortality rate is due to the fact that they are already in bad shape (advanced leukemia, auto-immune, etc.) prior to the transplant, in addition to the fact that you need to wipe out their immune system (via radiation or some other method) prior to the transplant which results in them having no immune system until the donor marrow takes hold, which means that pretty much any kind of infection will kill them and creating and maintaining a completely sterile environment for that length of time is difficult. AFAICT, the wiping out is not needed in this case, as the virus is already suppressing the immune system, allowing a more graceful transition to the new marrow.
Re:Like to see this replicated (Score:4, Interesting)
The immune 'response' is generated in another animal, in this case antibodies in a rabbit, to a protein resembling CCR5 receptor. This antibody is only injected back into the patient after numerous purification steps, to ensure as little cross reactivity as possible. The idea is that an antibody will bind very tightly to the exact molecule it's raised against, thereby blocking the entry of HIV. Any response to this new 'drug' antibody by the normal immune mechanisms is both unnecessary and unwanted.
The study looks promising but since they don't know exactly what CCR5 actually looks like, they are still trying to find out what the best blocker will be. Again I have very little experience with these matters, but once this is discovered I don't see why a monoclonal antibody could be grown that would be extremely specific and likely eliminate cross reactivity.
Any immunologists please feel free to correct me if I'm wrong.
Re:Like to see this replicated (Score:3, Interesting)
Re:Like to see this replicated (Score:5, Interesting)
>>Black Death is not a virus. It is a bacterium. Yersinia pestis.
Maybe.
Yersina is actually just our best guess, but the modern version of it doesn't match symptoms of the black death from back in the day, so it could be something else entirely.
neat but is it really a "cure?" (Score:3, Interesting)
Re:Like to see this replicated (Score:3, Interesting)
No. Bone marrow stem cells are very difficult to keep in culture, never mind amplify to a great degree. There's some promising research, but bone marrow transplants are generally pretty straight shots from donor to recipient.
How about patients that refuse to be treated? (Score:2, Interesting)
Re:Like to see this replicated (Score:3, Interesting)
I met a really nice woman in my favorite bar, and we really hit it off. I asked her out to dinner, we have a date for Friday.
I found out a day or two ago that this woman has AIDS. Is there a test to see if you're immune to this disease? Because if not the date Friday will be as far as it goes; I can't be more than "just friends" with a woman with AIDS unless I find out I'm immune.
AFAIK all my anscestors were European.