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Novel approaches for HIV cure
Breach Symposium
Guido Vanham
27 November 2015
Can HIV be eliminated or controlled without ART? C
ircula
ting v
irus
Time
HIV persists during ART
ART
26/10/2015 2
In untreated subjects: new viruses are produced by CD4 T cell activation
In subjects under cART: cycle interrupted, but integrated provirus persists
= source of rebound upon cART interruption!
HIV persists as a latent provirus under cART
26/10/2015 3
In untreated subjects: new viruses are produced by CD4 T cell activation
In subjects under cART: cycle interrupted, but integrated provirus persists
If deeply latent → no transcription
→ no viral proteins/peptides
= invisible to CD8 T cells
HIV persists as a latent provirus under cART
26/10/2015 4
EC/ES: low plasma viral load without treatment → no or slow disease progression i.e. long-term non-progression (LTNP) Correlates?
Natural HIV control (Elite Controller or Elite Suppressor)
26/10/2015 5
EC/ES: low plasma viral load without treatment → no or slow disease progression i.e. long-term non-progression (LTNP) Correlates?
- Low amount of proviral (integrated) DNA - High activity of CD8 T cells against infected CD4 T cells
HIV-infected CD4 T cells
HIV specific CD8 T cells
HIV progressor Elite controller
Natural HIV control (Elite Controller or Elite Suppressor)
26/10/2015 6
What? Induce “Elite Controller” status in patients with chronic infection
How?
- Improve CD8 T cell function = therapeutic vaccination
- Render target cells resistant to HIV = gene therapy
- Purge the latent proviral reservoir = anti-latency therapy
New concept of “Functional Cure”
26/10/2015 7
In non-treated HIV infected subjects:
• CD8 T against Gag associated with lower viral load • CD8 T against Env associated with higher viral load
→ broadening and “deepening” of Gag responses could be beneficial
Kiepiela et al Nat Med 2007
HIV protective CD8 T cell responses?
26/10/2015 8
WBC
Apheresis
Monocytes
Electroporation with HIV-1 gag mRNA
Differentiation
Gag-expressing DC = vaccine
Injection 4X
Dendritic cells (DC)
HIV + subjects under cART
Van Gulck et al. AIDS 2012
DIVA trial: DC therapeutic vaccination
26/10/2015 9
Suppression of vaccine-related HIV is induced in 3/5 patients
V2 T2 V3 T3 V1 V4
w 4
T4 T1
w -3 w 5 w 8 w 12 w 13 w 18 w 0
DIVA trial: induction of CD8 T cells against autologous infected CD4 T cells
26/10/2015 10
Van Gulck et al. AIDS 2012
CD4+ Th
CD40L
CD40
CD4 0 L m RNA
caTLR4 m RNA TLR4
LPS
CD70 CD27
CD8+ CTL
support ac vated T cell survival and prolifera on
induc on of DC matura on
1.
2.
CD7 0 m RNA
3.
Activation signals: TriMix
Gag Pol Vif Nef
Antigen: HIVACAT
In situ loading of DC with antigenic and adjuvant mRNA
! "#$%$&!"!!# $!%&' &() *+' !
IN mRNA
HIV-1 specific CD8 T-cell responses
iHIVARNA principle: Intranodal vaccination with mRNA encoding TriMix and HIVACAT in cART patients
26/10/2015 11
1) Therapeutic vaccine: improve CD8 T cell function to suppress virus
2) Gene therapy: render target cells resistant to HIV infection OR excise integrated HIV from infected cells
3) Anti-Latency therapy: rescue AND PURGE the latent reservoir
Possible strategies for Cure
26/10/2015 12
The facts:
Timothy Brown, HIV-infected with acute myeloid leukemia, treated with
• Total body irradiation: destruction of his own immune system
• Transplantation with hematopoietic stem cell (HSC), homozygous for the Δ32 mutation: no functional CCR5
26/10/2015 13
The Berlin patient
The facts:
Timothy Brown, HIV-infected with acute myeloid leukemia, treated with
• Total body irradiation: destruction of his own immune system
• Transplantation with hematopoietic stem cell (HSC) with the Δ32 mutation: no functional CCR5
After this treatment cART was not restarted and yet:
• No viral rebound
• High CD4 T cells
• Good health
26/10/2015 14
The Berlin patient
CCR5
Principle: Cell line can be transfected with so called Zinc finger nucleases, TALEN or CRISPR/Cas9 to delete CCR5 and render the cells resistant to HIV infection
Genetic therapy deleting CCR5
26/10/2015 15
Future therapy: Deletion CCR5 in haematopoietic stem cells (HSC) ?
By CCR5 deletion
26/10/2015 16
1) Therapeutic vaccine: improve CD8 T cell function to suppress virus
2) Gene therapy: render target cells resistant to HIV infection or excise integrated HIV
1) Anti-Latency therapy: rescue and PURGE the latent reservoir
Possible strategies for Cure
26/10/2015 17
Principle: Some drugs (e.g. HDAC inhibitors) can activate the latent provirus → virus production may kill infected cells
Anti-Latency treatment
26/10/2015 18
Principle: Some drugs (e.g. HDAC inhibitors) can activate the latent provirus → virus production may kills infected cells Or render them sensitive to CD8 T cells?
Anti-Latency treatment
26/10/2015 19
Principle: Some drugs (e.g. HDAC inhibitors) can activate the latent provirus → virus production may kill infected cells Or render them sensitive to CD8 T cells? → Uninfected cells protected by cART
Anti-Latency treatment
26/10/2015 20
Courtesy of O. Søgaard, Aarhus University
Clinical trail of HDACi Romidepsin (under cART protection)
26/10/2015 21
Principle: Some drugs (e.g. HDAC inhibitors) can activate the latent provirus → virus production may kill infected cells Or render them sensitive to CD8 T cells? → uninfected cells protected by cART Problems: Non-specific activation of other genes → how to make drugs more specific for HIV activation?
Anti-Latency treatment
26/10/2015 22
1. Gene therapy: resistant “HIV targets”: CD4 T cells, DC, macrophages
2. Anti-latency: induces expression of viral epitopes for CD8 T cells
3. Therapeutic vaccination: improves CD8 T cell responses
Together could be enough to stop cART without viral rebound?
23 1/12/2015
Integration of various “Cure” approaches
Acknowledgment
KUL: Jan Ceuppens , Eric Stevens, Jos Bloemmen, Lieve Mariën, Roger Bouillon, Johan Févery ITM: all HIV(+) particpants of our studies + Virology Lab: Kevin Ariën, Derek Atkinson; Sunita Ballah; Ivan Best; Lotte Bracke; Sandra Coppens, Tessa Dieltjens; Winni De Haes; Youssef Gali; Katrijn Grupping; Leo Heyndrickx, Sabelle Jallow; Jordan Kyongo; Céline Merlin, Jo Michiels; Harr Njai, Pieter Pannus; Charlotte Pollard; Philippe Selhorst; Michael Talledo; Katty Terrazas, Rafaël van den Bergh, Guido van der Groen, Ellen Van Gulck; Yven Van Herrewege, Tine Verdonck, Katleen Vereecken, Johan Vingerhoets, Betty Willems. HIV Immunology: Luc Boel, Luc Kestens, Lieve Penne, Chris Vereecken AIDS Reference Lab: Annelies VD Heuvel, Tine Vermoesen, Katrien Fransen HIV Clinic: Marc Vekemens, Erica Vlieghe, Liesbeth Mertens, Bob Colebunders, Eric Florence EXTERNAL : J Balzarini, D Schols, P Augustyns, A Van Damme (KUL); ); K Thielemans, J Aerts (VUB); N Cools, V Van Tendeloo, Z Berneman, J Joossens, K Augustyns, P Lewi, J Heeres, L Van Laer, G Van Camp (UA); B Verhasselt, M. Praet, W De Spiegelaere, L Vande Kerckhove (U Gent); M Moutschen (U Liège); B Berkhout, A Pasternak (AMC); R Gruters, C Boucher (EMC); T Verrips, N Strokappe, L Rutten (UU); D Corti (Bolzano), R Weiss (London); J Binley (San Diego); E Rich, J Ellner (Cleveland); E Gotuzzo (Lima); M Kizza (Kampala); F Garcia (IDIBAPS); L Martin (CEA Saclay); A Hosmalin (Cochin); B Verrier (Lyon); T Bourlet, O Delézay, B Pozzetto (St Etienne);); F Baleux (Pasteur Paris); H Lortat (Grenoble); R Legrand, N Bosquet, D Desjardin (CEA Paris) …
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