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IrsiCaixa leads an international research consortium to reproduce the only successful case of a person cured of HIV

26/11/2014

  • European researchers led by the Institute for AIDS Research IrsiCaixa, in Barcelona, jointly funded by “la Caixa” Foundation and the Government of Catalonia Department of Health, and the University Medical Center Utrecht, in the Netherlands, have initiated an ambitious project to try to reproduce the only case of a person cured of HIV, the Berlin patient¬. Experts from the Catalan Institute of Oncology (ICO) and the Gregorio Marañón Hospital, in Spain, will also collaborate in this project.
  • The Berlin patient received a stem cell transplant from a donor naturally resistant to the virus to treat him of leukemia in 2007. However, this is a high-risk procedure, only indicated for patients with life-threatening cancer disease. Doctors around the world have tried to cure other patients with similar conditions, but nobody has managed to cure any other patient of HIV infection so far.
  • The international consortium, named EpiStem, is sponsored by the amfAR Research Consortium on HIV Eradication (ARCHE), a program from the US Foundation for AIDS Research amfAR. The project aims at improving the interventions to cure these patients and to better understand the implication of stem cell transplants in the control and eradication of HIV. The ultimate aim is to continue investigating and exploring potential cure strategies.
  • The project will be presented to the scientific community on November 26 at 5.15pm at the Gesida National Congress, to be hold in the Palacio de Congresos y Ferias in Málaga, Spain. 

 

The only medical intervention that managed to cure a person from the HIV infection is known as the Berlin patient case. Named Timothy Brown, he underwent stem cell transplantation of bone marrow from a donor who had a rare genetic mutation, which conferred him resistance to HIV infection. This mutation is present in approximately 1% of people with European origin. The strategy raised tremendous scientific interest as it opened new prospects of viral eradication. However, this success is not scalable to cure HIV infection, as it is a high-risk procedure only indicated for HIV+ patients with life-threatening hematological disease, as it was the case of Brown.

 

For these patients, many researchers around the world have tried, so far unsuccessfully, to reproduce this approach, and to understand the crucial successful factors of the intervention. The rare genetic mutation of the donor, which confers resistance to HIV, seems to be the main factor for success, but there are other steps in the clinical process that may also have contributed.

 

Improving the strategy to cure HIV infection

A European consortium of researchers co-led by the Institute for AIDS Research IrsiCaixa, jointly funded by “la Caixa” Foundation and the Government of Catalonia Department of Health, and the University Medical Center Utrecht have just initiated an ambitious project to try to improve the interventions to cure these patients with the additional aim to better understand the implication of stem cell transplantation in the control and eradication of HIV infection. The project will be presented to the scientific community on November 26 at 5.15pm at the Gesida National Congress, to be hold in Málaga, Spain.

 

This team, co-led by the ICREA researcher at IrsiCaixa Javier Martínez-Picado, received the largest award in this round of grants of the amfAR Research Consortium on HIV Eradication (ARCHE). The consortium is formed by hematologists, infectious disease specialists, virologists, and immunologists with expertise in the field of HIV, including Gero Hütter, the oncologist credited with the Berlin patient’s cure. Experts from the Catalan Institute of Oncology (ICO) and the Gregorio Marañón Hospital, in Spain, will also collaborate in this project. The Gregorio Marañón Hospital has a great experience in stem cell transplantations in HIV positive patients from all over Spain with blood related cancers.

 

“We need to understand the specific reasons of the HIV cure in the Berlin patient if we want to move forward in the eradication of this infection. We also want to use umbilical cord blood as a source of stem cells to increase the chances of compatibility between donors and patients”, states Martínez-Picado

 

Using stem cells from umbilical cord blood has a clear advantage, as they are far more compatible than the ones extracted from the bone marrow. With this new approach, the chances to find a donor that is compatible and additionally has the rare genetic mutation conferring HIV resistance is raised more than 100 fold.

 

In parallel, also with additional financial support from amfAR, it will be created an inventory that allows to identify which of the 10.000 cord blood units available in the North European cord blood banks contain the rare genetic mutation that confer resistance to HIV. This will allow that these units will be immediately available for transplantation. In Spain, as it was announced earlier this month, the Spanish National Transplant Organization (ONT) leads a project to identify potential high-quality stem cells in the Spanish Cord Blood Banks that may contribute to effective stem cell transplantations

 

Some patients are already being treated with an improved approach

The researchers have already started to implement this strategy in HIV positive people in need of stem cell transplantation with encouraging results, whose latest results are still being evaluated. At present, the team is still enrolling patients in the study, and makes a call for physicians, researchers and citizens to find potential candidates to join the project (contact can be made through epistem@irsicaixa.es).

 

The consortium is undertaking an exhaustive study and follow-up of these patients to collect complete information on the chemotherapy, transplantation procedure, donor selection, HIV variability and treatment, and is also collecting samples to be stored before and after the transplantation. They also measure the size of the HIV reservoirs in Barcelona and Utrecht, using the most cutting edge technologies available in the field.

 

During the first year the experts do not plan to consider antiretroviral treatment interruptions, as it was recently known that two transplanted patients who seemed to be cured had viral rebound after being a few months out of treatment. If at any time it is considered to discontinue antiretroviral treatment, then it will be carefully implemented, and monitoring will be carried out long-term.

 

 

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Project reference: EpiStem: Allogeneic stem cell transplant in HIV-1-infected individuals More information
This project has been given the largest award in this year's round of grants of the amfAR Research Consortium on HIV Eradication (ARCHE). This program is an initiative launched in 2010 to explore potential strategies for eliminating HIV infection. The new grants, totaling nearly $2.4 million, will support the work of seven teams of scientists worlwide irsicaixa.es/epistem