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Medicine Science

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."
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German Doctor Cures an HIV Patient With a Bone Marrow Transplant

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  • by Junior J. Junior III ( 192702 ) on Sunday November 09, 2008 @12:56PM (#25695029) Homepage

    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)

    by FeatureBug ( 158235 ) on Sunday November 09, 2008 @12:58PM (#25695051)
    The Wall Street Journal is a fine newspaper, but it is not a scientifically peer-reviewed journal. I'd wait and see what the peer review process decides about this proposed treatment. It would not be the first time that a "revolutionary" treatment has failed to prove itself in peer review.
  • by MSTCrow5429 ( 642744 ) on Sunday November 09, 2008 @01:03PM (#25695103)
    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.
  • by v1 ( 525388 ) on Sunday November 09, 2008 @01:03PM (#25695109) Homepage Journal

    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.

  • by Tubal-Cain ( 1289912 ) on Sunday November 09, 2008 @01:05PM (#25695125) Journal
    Any hope of putting the marrow into a petri dish and growing more?
  • by Chaos Incarnate ( 772793 ) on Sunday November 09, 2008 @01:11PM (#25695189) Homepage
    Couldn't the recipients, who will generate the new bone marrow, then be used as donors?
  • by eln ( 21727 ) on Sunday November 09, 2008 @01:19PM (#25695249)

    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.

  • by DebateG ( 1001165 ) on Sunday November 09, 2008 @01:24PM (#25695287)
    I think the end goal is to use this method for autologous stem cell transplant (when the donor is the same as the recipient) rather than allogeneic (when the donor is different). Currently, there are technologies such as small interfering RNA (siRNA) that let you suppress a specific gene through genetic engineering. They are widely used in research, although there are many hurdles before they make the transition to clinical use. It would go something like this:
    1. Draw out someone's own stem cells
    2. Permanently express the CCR5 siRNA in their stem cells by culturing them with a virus
    3. Wipe the person's bone marrow out by total body irradiation
    4. Reinfuse the altered stem cells

    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.

  • by jcr ( 53032 ) < .ta. .rcj.> on Sunday November 09, 2008 @01:32PM (#25695353) Journal

    One thing I've been wondering about is whether it would be possible to fight infection just by making a protein that binds to CCR5 and does nothing else. I'm presuming that HIV can't attach to the receptor if there's something in the way.

    Would any molecular biologist reading this please tell me if this works or not?


  • by geckipede ( 1261408 ) on Sunday November 09, 2008 @01:42PM (#25695405)
    That's how some of the new drug treatments for HIV work. The article mentions them. Are you suggesting a form of genetic treatment where you don't remove the surface protein from existing cells but add more cells that produce blocking drugs?
  • by jcr ( 53032 ) < .ta. .rcj.> on Sunday November 09, 2008 @01:44PM (#25695425) Journal

    I wasn't suggesting any particular way of administering the blocking proteins, just wondering whether it was a viable strategy.


  • Survival rates (Score:4, Interesting)

    by Harmonious Botch ( 921977 ) * on Sunday November 09, 2008 @01:44PM (#25695427) Homepage Journal

    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.

  • by Pax681 ( 1002592 ) on Sunday November 09, 2008 @01:52PM (#25695485)
    IIRC i watched a TV doc about HIV immunity and how it was found. there is a link to the black death here too.

    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!
  • by st0rmshad0w ( 412661 ) on Sunday November 09, 2008 @01:53PM (#25695493)
    Actually, the natural immunity can largely be traced back to small populations in europe that had very large survival rates during the Black Death in the middle ages. The immunity was likely present prior to HIV's emergence.
  • Carrier? (Score:3, Interesting)

    by wonkavader ( 605434 ) on Sunday November 09, 2008 @01:53PM (#25695495)

    Does this or does this not still leave the recipient as an HIV carrier?

  • by ScrewMaster ( 602015 ) * on Sunday November 09, 2008 @02:06PM (#25695593)

    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.

  • by Thiez ( 1281866 ) on Sunday November 09, 2008 @02:37PM (#25695819)

    > 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.

  • by Marrow ( 195242 ) on Sunday November 09, 2008 @03:46PM (#25696411)

    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.

  • by lysergic.acid ( 845423 ) on Sunday November 09, 2008 @04:02PM (#25696565) Homepage

    or you could do a little [] research [] 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.

  • by radtea ( 464814 ) on Sunday November 09, 2008 @04:17PM (#25696697)

    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".

  • by cleojo42 ( 573624 ) on Sunday November 09, 2008 @04:30PM (#25696819)
    What you are thinking about is called long-term non-progressers. If the virus can't actually get into the cell, which is what we are talking about here, means that while there might be some HIV in the blood (floating around in the liquid part), it can't actually infect any of the cells. No infection, no disease.
  • by tsotha ( 720379 ) on Sunday November 09, 2008 @04:54PM (#25697001)
    I'm not sure a form to submit complaints really buttresses your argument. I've never heard of an instance in the US where someone was denied medication for HIV for any reason. Not even money. I'm sure it's happened, just because with a large enough sample group you'll get any behavior you can imagine. But it's a small enough chance as to be functionally zero. In most places a pharmacist who refused to provide a lifesaving drug for pretty much anything would be run out of town even before the government started in on him.
  • by rrohbeck ( 944847 ) on Sunday November 09, 2008 @05:54PM (#25697503)

    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.

  • by Metasquares ( 555685 ) <> on Sunday November 09, 2008 @05:56PM (#25697515) Homepage

    From Wikipedia:

    Individuals with the Delta 32 allele of CCR5 are healthy, suggesting that CCR5 is largely dispensable. However, CCR5 apparently plays a role in mediating resistance to West Nile virus infection in humans, as CCR5-Delta 32 individuals have shown to be disproportionately at higher risk of West Nile virus in studies,[5] indicating that not all of the functions of CCR5 may be compensated by other receptors.

    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.

  • by compro01 ( 777531 ) on Sunday November 09, 2008 @05:58PM (#25697531)

    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.

  • by teklob ( 650327 ) on Sunday November 09, 2008 @07:31PM (#25698223)
    I'm only an undergrad heading towards immunology, but from what I can tell from that paper you posted, the idea is not so much to stimulate an immune response in the patient, per se.

    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.

  • by AmonTheMetalhead ( 1277044 ) on Sunday November 09, 2008 @08:06PM (#25698489)
    Why do you people tolerate laws like that?!
  • by ShakaUVM ( 157947 ) on Sunday November 09, 2008 @08:51PM (#25698827) Homepage Journal

    >>Black Death is not a virus. It is a bacterium. Yersinia pestis.


    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.

  • by seeker_1us ( 1203072 ) on Sunday November 09, 2008 @10:00PM (#25699245)
    Will the newly "immune" people be carriers of HIV?
  • by ceoyoyo ( 59147 ) on Monday November 10, 2008 @03:46AM (#25701023)

    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.

  • by Zerelli ( 579376 ) on Monday November 10, 2008 @12:00PM (#25705119)
    I see a lot of talk about people who are refused treatment and such, but I have seen no mention of the people who refuse to get treated or to stop spreading the disease. My wife worked as a case management RN and set up an AIDS/HIV clinic intended to supply free treatment to those who could not afford it. The issue they had was that a lot of these people do not want to be bothered by treatment. They seem to either not give a shit because their lives are already hell or they assume that because they have it they are going to die so they do not want to be bothered. To me the biggest problem with HIV/AIDS are the people who still go out there sharing needles and engaging in unsafe sex. I think that needs to be prosecuted a lot more vigorously. I have seen spouses who were dying because their significant other was going out on the DL and brought home a nice case of HIV/AIDS (I used to be a MLT/phlebot). The guy that did that should be prosecuted for murder.
  • by mcgrew ( 92797 ) * on Monday November 10, 2008 @12:40PM (#25705863) Homepage Journal

    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.

Houston, Tranquillity Base here. The Eagle has landed. -- Neil Armstrong