March 25, 2013
Patrick Younan from the Fred Hutchinson Cancer Research Center delivered an interesting talk about transplantation of gene-modified stem cells in pigtailed macaques (abstract, webcast -- third in session). The experiment used lentiviral vectors to deliver the gene for a virus entry inhibitor, C46 (also known as M87o, it has a similar mechanism of action to the approved antiretroviral Fuzeon), into stem cells along with a green fluorescent protein (GFP) marker to make the modified cells identifiable. Four macaques underwent stem cell transplantation, with two given C46-modified cells and two controls given cells with only the GFP marker. All were subsequently challenged with the dual-tropic SIV/HIV hybrid virus SHIV89.6P. The two controls displayed typical rapid CD4 T-cell loss, and one was euthanized at week 32 due to the onset of simian AIDS. In contrast, recipients of the modified cells recovered CD4 T-cell counts after an initial dip and showed significantly lower viral loads. Levels of gene-modified CD4 T cells peaked at around 90% during acute infection, but subsequently declined to pre-challenge levels (around 20% in one animal, 55% in the other) during follow-up. Despite the decline in modified CD4 T cells, levels of unmodified cells improved over time, suggesting a protective effect of the intervention on the overall CD4 T-cell pool.
Further studies revealed that superior SHIV-specific CD4 T-cell and antibody responses were associated with the salutary outcome. SHIV-specific CD4 T cells were not detectable in either of the controls. Younan found that a striking 85% of the SHIV-specific CD4 T cells in treated animals were gene-modified, suggesting that protection of these cells had allowed them to better perform their role of providing help to B cells and CD8 T cells. One potentially encouraging implication of this work is that gene therapy approaches might not have to protect all susceptible cells from HIV infection in order to offer benefit; if sufficient numbers of HIV-specific CD4 T cells can be protected, it is possible that these cells will do a better job of coordinating the immune response against HIV, leading to improved control of viral replication. This possibility is being investigated in ongoing trials of Sangamo BioSciences SB-728-T gene therapy, which aims to protect CD4 T cells by abrogating expression of the CCR5 coreceptor.
Richard Jefferys is the coordinator of the Michael Palm HIV Basic Science, Vaccines & Prevention Project Weblog at the Treatment Action Group (TAG). The original blog post may be viewed here.