November 7, 2006 in Nation/World

Gene therapy shows promise against HIV

Marie Mccullough Philadelphia Inquirer
 

PHILADELPHIA – A novel gene therapy that uses a genetic version of a Trojan Horse has shown promise in fighting the AIDS virus, a coup in a field crippled by disappointments and setbacks.

The therapy is being tested at the University of Pennsylvania, where the 1999 death of Arizona teenager Jesse Gelsinger still casts a pall.

His death, the first in a gene therapy experiment, triggered a nationwide halt in human testing of such treatments amid revelations of ethical and regulatory lapses.

Now, seven years after that disaster, a team led by Penn’s Carl June and Bruce Levine has achieved a gene therapy tour de force: They removed some infection-fighting “T cells” from five HIV patients, inserted a gene into the cells to stop the AIDS virus from reproducing, then multiplied the modified T cells and put them back in the patients.

The vehicle, or “vector,” that the researchers used to deliver the protective gene to the cells was a genetically modified HIV virus – also a first.

The five patients, who were no longer responding to conventional HIV drugs, have had no serious side effects during two years of follow-up. Four showed signs that the therapy was working – very unusual in such a preliminary clinical trial.

“In a way, it’s a redemption,” Levine said of the results, published Monday in the Proceedings of the National Academy of Sciences.

Mark. A. Kay, a Stanford University researcher and past president of the American Society of Gene Therapy, said, “The whole technology it took to get this done was cumulatively very strong. It wasn’t clear to me that this was going to work. But I think this is an important step forward. I’m impressed.”

So is “subject 2,” a Philadelphia resident who has had the most dramatic, sustained effects. His HIV viral load fell from 54,100 three years ago to 1,930 this past January. His supply of T cells, which had been so ravaged by HIV that he was on the edge of an AIDS diagnosis, increased slightly. The modified T cells were detectable in his bloodstream for two years. And his immune system grew stronger.

“When I tested positive in 1989, I really didn’t expect to live this long, so I’m very grateful,” said the muscular, 44-year-old public administrator, whose only visible symptom of illness is sunken cheeks, a side effect of HIV drugs. “Now, I don’t expect to be gone anytime soon.”

Gene therapy, still highly experimental after almost 20 years, aims to harness the insidious power of viruses.

On its own, a virus can’t reproduce; it must infect a cell and hijack the host’s machinery to make copies. Some viruses, including HIV, do this by splicing their own genes into the cell’s DNA.

By using these invaders to insert DNA that is helpful to the cell – rather than harmful – gene therapy can theoretically fix the root causes of many diseases.

But the obstacles to this simple-sounding strategy have proved to be enormous.

For one thing, even when researchers deactivate the disease-causing genes in a viral vector, the immune system may spot the invaders and attack. That, investigators concluded, is what killed Jesse Gelsinger: The adenovirus (cold virus) that was supposed to deliver therapy for his rare metabolic disorder sent his immune system into deadly overdrive.

The subsequent suspension of all U.S. gene therapy trials “cost us two years of progress,” recalled June, a professor of pathology and laboratory medicine.

Another obstacle is that the characteristic of viruses that makes them useful as vectors – their constant swapping and shuffling of DNA – also makes them hard to control. In theory, viral vectors can recombine with viruses already in the patient, or insert their genetic payload into the host’s DNA in a way that triggers cancer.

That theory became reality in France. Three of 10 children who underwent gene therapy and were cured of severe combined immune deficiency disease – the so-called Bubble Boy disease – later developed leukemia. One died in 2004.


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