Researchers at the University of Nebraska Medical Center and Temple University say they have eliminated HIV for the first time from the genomes of a small number of humanized mice using a combination of two different therapies. Members of the UNMC research team included: Back row from left: James Hilaire, Brady Sillman, Larisa Poluektova, Santhi Gorantla, Benson Edagwa and Hang Su. Front row from left: R. Lee Mosley, JoEllyn McMillan, Howard Gendelman, Prasanta Dash, Saumi Mathews, Mary Banoub and Zhiyi Lin. Missing from photo are Aditya Bade and Nagsen Gautam.
For the first time since the 1980s AIDS epidemic began, researchers say they’ve taken an important step toward a possible cure for HIV, thanks to technologies developed in labs at the University of Nebraska Medical Center and Temple University.
People living with HIV currently have to take drugs every day for the rest of their lives to keep the virus at bay.
But the virus continues to hide out in some tissues, its DNA tucked into that of its host, ready to flare again if the drugs are stopped.
Now researchers at UNMC and Temple University say they have eliminated HIV for the first time from the genomes of a small number of humanized mice using a combination of two different therapies.
“This is proof of concept that a cure of HIV is possible,” said Dr. Howard Gendelman, chairman of UNMC’s pharmacology and experimental neuroscience department and a senior investigator on the study.
The researchers first used a slow-release, long-lasting formulation of HIV drugs developed at UNMC to suppress the virus in infected mice and then followed with a gene-editing therapy that Temple scientists in Philadelphia created to cut the virus’ DNA from their genomes.
Of the mice that received the treatment, about a third showed no signs of HIV infection for up to five weeks after treatment, according to a report published Tuesday in the journal Nature Communications. The research is receiving international attention.
Both scientists acknowledged that plenty of work lies ahead, starting with more studies in animals. But they said combining the two therapies provides a “clear path to move ahead” in further trials in animals and possibly clinical trials in humans.
“What we’ve done is we’ve showed that HIV can be cured,” Gendelman said.
Kamel Khalili, chairman of the neuroscience department at Temple’s Lewis Katz School of Medicine in Philadelphia, said the fact that no technology since the AIDS epidemic began has been able to eliminate HIV has created the impression that the disease is incurable.
“This is the first time we’ve shown together the disease can be eliminated if we use a combination therapy,” said Khalili, the study’s other senior investigator.
Dr. Robert Gallo, who co-discovered HIV as the cause of AIDS in 1984, offered congratulations.
“In my view, this is the most interesting and important therapy-related research advance I have seen in many, many years,” Gallo said in a statement. He is the co-founder and director of the Institute of Human Virology at the University of Maryland School of Medicine.
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Zandrea Ambrose, an HIV researcher with the University of Pittsburgh Medical Center, called the study promising but said she’s not sure the researchers yet have demonstrated with 100% certainty that they’ve eliminated the virus.
The study followed the mice for a relatively short time. In several human cases in which the virus was believed to have been eliminated, including a Mississippi baby given HIV drugs from an early age, it eventually came back.
Many groups are working toward a cure, said Ambrose, who was not involved in the study. “This is probably one of the most promising studies that have come out, but there’s some work that still needs to be done,” she said.
Given the effectiveness of the HIV drug therapies now available, she added, “We’d want to make sure the system is as safe as possible before we deliver it to humans.”
Gendelman noted that the researchers conducted exhaustive testing in their search for remaining virus. “There was no trace of the virus there,” he said.
According to estimates by the United Nations, more than 36.7 million people worldwide are infected with the virus, about 1.2 million of them in the United States. Some 5,000 people are newly infected every day around the world.
Gendelman and fellow UNMC researchers previously have worked to modify HIV drugs to create the long-acting, slow-release forms. They’ve demonstrated in previous research that their system extends the life of the drugs and helps them reach cells and tissues where the virus hides. The strategy was co-developed by Benson Edagwa, an assistant professor of pharmacology at UNMC.
But Gendelman said that method alone couldn’t eliminate HIV. The Temple group, meantime, had found a way to cut out the virus’ DNA using a modified version of the CRISPR-Cas9 gene editing system. (Think of CRISPR-Cas9 as molecular scissors.) But it wasn’t very effective with a lot of virus present.
Combining the two allowed the researchers to suppress viral activity, which allowed the Temple team’s system to be more effective.
The combination was effective in about one-third of mice treated. Khalili called that a good first step. By comparison, the researchers could readily detect HIV in mice that had received either therapy separately.
“That shows the system works,” he said. “Now you have to optimize the situation to bring it up to 100% of animals. We’re working on it.”
And the CRISPR system stayed on target. Concerns previously have arisen that CRISPR could make cuts in the wrong places.
Gendelman said the researchers went as far as to analyze the genetic sequences of the human cells in the mice and found no harmful effects.
Potential therapies that work in mice often don’t make the jump to humans. Gendelman said that using mice with humanized immune systems partially closed that gap. The humanized mice were developed at UNMC.
The researchers already are proceeding with next steps. The UNMC team has begun moving ahead with research in primates. The Temple team plans to begin testing for toxicity in a small number of humans, using conventional HIV drugs, in 2020.
Meantime, UNMC’s tech transfer office, UNeMed, is working to commercialize the long-lasting drugs, said Michael Dixon, its president and CEO.
The benefits of the drugs, known by the acronym LASER ART, are significant on their own, he said. Gendelman’s previous research suggests that they can be taken less often than the current daily routines.
Dixon cautioned that bringing a drug to market is not a fast process. It took five to 10 years to commercialize current HIV drugs, which essentially have changed the virus from a death sentence to a chronic illness.
Both Gendelman and Khalili hailed the collaborative nature of the project — the report lists more than 30 authors. Prasanta Dash, an instructor in UNMC’s pharmacology and experimental neuroscience department, was the paper’s lead author.
Khalili said he doesn’t believe the work would have been possible in a single laboratory because of the expertise required at each.
Said Gendelman: “It’s the first time anyone has eliminated HIV from an animal with the prospect of moving to humans.”
17 rare and unusual health stories out of Omaha
One rare disease left an Omaha doctor eating a shakelike formula to supplement her diet. A friend said it tasted like cat food. An Omaha man woke up after his family took him off life support. And a Lincoln teen is allergic to almost everything.
Check out the stories on their unusual ailments and sometimes equally unusual treatment plans.
Matthew Eledge and husband Elliot Dougherty plan to explain her out-of-the-ordinary birth to their daughter in terms she can understand: that her grandmother furnished the garden where she grew, and that her aunt, Lea Yribe, generously supplied the seeds.
One pothole did a passenger a favor when the ambulance he was in struck it, according to first responders. Gretna firefighters were taking a man suffering chest pain and a high heart rate to the hospital. While en route to Lakeside Hospital, the ambulance hit a pothole. The jolt returned the patient’s heart rate to normal.
Thought to be brain dead, doctors took former Creighton Bluejays play-by-play announcer T. Scott Marr off life support. Before his family settled on a funeral home, they decided to see their dad one more time. When they got there, he was awake and speaking.
Karla Perez was 22 weeks pregnant when she suffered a catastrophic brain bleed and was declared brain dead. Her unborn child was alive, but wouldn't survive delivery. So family and doctors kept her on life support. Angel was born eight weeks later.
Darnisha Ladd never imagined Snapchat would help save her life after she suffered a stroke. But needing a precise timeline of events, doctors and family relied on a post on the phone app and were able to give her a needed medication in time.
Lindsey and Derek Teten's triplets are one in a million. Literally. The Nebraska City couple's three daughters, born in late June 2017, are identical and were conceived without fertility treatments. The girls were the second set of spontaneous triplets born at Methodist Women's Hospital. The first set, also girls, was born in 2015.
What makes Jamey Dougall's health story unusual is his treatment plan. Dougall, who's legally blind, uses a special pair of glasses to see. He's seen his wife Kandice, his two daughters, and now, his favorite college football team — the Huskers.
Doctors diagnosed the paralysis that was creeping up Justin Chenier's legs as Guillain-Barre syndrome. It would become so serious that the Omaha man would nearly lose consciousness while screaming because of the pain. The syndrome was triggered by West Nile virus.
Kenze Messman's been diagnosed with several chronic illnesses. Sometimes her heart rate climbs, seizures send her to the floor and migraines leave her in the dark. And one of the ailments causes the 17-year-old to have allergic reactions to almost everything.
The skin on Sharan Bryson's leg was black from lack of circulation. She felt nothing but a sharp, stabbing pain. The leg was dead, and her best option was amputation. Bryson bounced back and put her hard work to the test by running a 5K.
Chase Tiemann has had numerous surgeries in his young life, including the amputation of his left arm. The Omaha boy has a condition that causes tumors — sometimes benign, sometimes cancerous — to form on his body. To boost his spirits after amputation, the Papillion Fire Department named Chase an honorary firefighter.
Wesley Woods battled heart disease for 20 years. He'd racked up nine heart attacks, multiple surgeries and one heart transplant. He was tired of hospitals. Tired of chest pain. Tired of feeling tired. Woods was lucky — he received a second transplant.
Urmi Basu was set to walk across the stage to receive her doctorate. But five days before the ceremony, the then-30-year-old suffered a major stroke. It left her paralyzed on her right side and struggling to speak. After three years of intense rehab, she returned the the University of Nebraska Medical Center for graduation.
Amber Kudrna wasn't sure she'd be able to have a child of her own. After two kidney transplants, doctors gave the Omaha woman a laundry list of potential pregnancy complications. Kudrna and husband Adam weighed their options and, in September 2018, welcomed a baby boy.
Sue Venteicher started what would be the largest single-hospital living-donor kidney transplant chain in Nebraska history. Nine living donors gave kidneys to nine recipients at the Nebraska Medical Center.
Joe Nolan couldn't take his son James' pain away. But he could find a way to share it. Nolan got a tattoo that arched across his head, just like his son's scar. James was born with a handful of ailments, including one that regularly requires his skull to be reshaped.
Dr. Jennifer Harney used to eat pizza sans meat or cheese. She couldn't add milk to her coffee. She had to choke down a shakelike formula to supplement her diet. She was diagnosed with a rare, genetic condition after birth. But thanks to a new therapy, she's been able to eat things she never thought possible.
julie.anderson@owh.com, 402-444-1066