|
1. It’s the Virus, Stupid
By now most people know HIV causes AIDS. But this is actually inaccurate. To understand why this is inaccurate helps explain why there are two different ways scientists are trying to figure out how to treat AIDS.
2. What Causes AIDS
AIDS is a condition in which a person is not able to fight off many illnesses that the body generally can get rid of or can learn to live with. The illnesses that kill people with AIDS get are called “opportunistic infections” because they take advantage of a problem HIV sets in motion—the slaughter of many different types of t helper cells. Before turning attention to how the t helper cells are killed off, let’s look at how these t helper cells protect us in the first place.
3. How t cells protect us
The immune system is our protection against disease, and it has many parts.
The simplest parts are barriers stopping germs from getting into important parts of our body, for example, our skin. Another part is cells that are pre-programmed to kill off certain illness causing germs the body already knows about.
Then there is a third part that is much more creative and adaptable. This is the part of the immune system that can recognize a new enemy germ, raise an army of fighter cells that are taught what the enemy looks like and gun down the enemy, attacking it either directly with chemical weapons like ‘neutralizing antibody’ (stuff that sticks to the germ like glue and kills it or stops it from working), or indirectly by killing cells that hide it or help make more of it. In other words - by killing off infected cells that have been hijacked by the virus.
Infected cells hijacked by the virus are reprogrammed by the virus to manufacture more of itself. To get rid of that kind of infection we have to kill off those infected cells. The body does this with T helper cells.
T helper cells are the part of the immune system that recognize the new kinds of intruders, train the army, and hunt down the infected cells. After ‘learning’ that a virus is an enemy, the T helper cells send out messages that get a different group of killer cells to do an investigation and terminate anything infected. This in most cases eventually can cure us of the illness or at least hold it in check.
4. How do t helper cells learn that some virus is an enemy?
It turns out that all living things are made up of chemicals that we understand pretty well. The same set of chemicals which, when you break them down, form long chains of simple things called peptides. T helper cells can tell which peptides are parts of you and which belong to something that should not be inside of you. When they ‘recognize’ a peptide or bunch of peptides that don’t belong in you, they mobilize the immune system in a lot of different ways to get rid of the virus that the foreign peptide(s) are part of.
T helper cells are all born different, recognizing different specific peptides. They form a kind of alphabet, so that the ‘z’ T helper cells would know right away that a virus spelled ‘zebra’ was a bad guy because they would recognize ‘z’ and know that you don’t have a ‘z’. They would alert everyone in the immune system that you have been attacked by zebra and hence kill off the cells that are making more zebra grow inside of you.
But in the case of late stage HIV progressing to AIDS, your cells lose this ability—why?
5. How do the t helper cells lose this ability to tell ‘zebra virus’ attacked you?
If something is killing off T cells, and if there are only a limited number of T cells that can recognize ‘zebra’ then when there are none of those cells left, if zebra attacks you, it will be very hard for you to fight zebra. For one thing it will take you a long time to realize that zebra is even there doing damage.
So when enough cells are killed off so that the ‘z’ T helper cells are gone from your repertoire, your alphabet of T cells is missing an important one that makes you vulnerable to zebra if it attacks. One letter after another disappears, as more and more T cells disappear, you become less and less able to fight more and more illnesses and this condition is called “AIDS”.
Importantly the virus HIV is not directly making the T helper cells vanish— the disappearing act is being caused by something else.
6. What is killing off the t helper cells?
It has been known for a long time that a killer cell (whose job it is to kill off infected cells) also kills off uninfected cells that look a lot like the infected ones— we might call them ‘bystander’ T cells. The killer cell is called a ‘CD8+cytotoxic lymphocyte’ and they get hyperactive when HIV is around. So much so that for every cell actually infected with HIV they kill hundreds or thousands of uninfected T helper cells and they slowly reduce your total healthy T cell repertoire lower and lower and lower. This overkill from hyperactive killer cells (CD8's) is what causes you to get AIDS, not the actual virus.
[A technical note: In the early 1990s, Joyce Zarling, Leonard Adelman and Allen D. Allen, working independently, proved to a scientific certainty that it was the cytotoxic CD8 T cells that were indiscriminately killing off CD4 T cells. This was published in prominent journals, such as Journal of Immunology, AIDS, etc. and led Allen to invent Cytolin. ]
7. How could we stop this from happening?
Well the killing cells would calm down if we got rid of HIV, which is what antiretrovirals (the medicines that stop HIV from making more HIV) accomplish. However there are several problems with this approach that has worked wonderfully keeping millions of people alive for many, many years.
The problems are: the medicines are expensive, have side effects and the virus can sometimes get resistant to them.
For this reason it would be useful to have a medicine or a group of medicines which the virus does not get resistant to, which are not too expensive and which would help calm down the killer cells a little. Acting like a brake on their hyperactivity, this would help the body keep healthy T cells around to do their work preventing opportunistic infections, and therefore avoiding AIDS.
We have known for some time that this approach would work because we have had medicines that calm down or slow down the immune system, like cyclosporine A for example. When you use these types of drugs on people with HIV you can show that T cells are no longer being killed off and actually the amount of virus goes down. However these early immune tranquilizers were just as over reactive as the CD8’s we are trying to calm down, and made the immune system unable to protect us from many illnesses.
But now there are some ‘immune modulators’ (or for analogy ‘brakes’) that make the killing cells less hyperactive, but allow them to still kill off the already infected cells, and allow them to still protect against other infections as the body gets attacked.
One of these immune modulators, called “Cytolin”, is what scientists call a ‘monoclonal antibody’ and it makes the killer cells less crazy. During the height of the AIDS pandemic before the antiviral cocktails were available, activist doctors used Cytolin to rescue a few hundred patients. Data from 188 patients treated with Cytolin for 18 months were reported to the FDA]. A Phase I(b)/II(a) study of Cytolin was reported at a CROI national conference by Donald W. Northfeld, MD.
This drug is being developed by a west coast company called CytoDyn and is being studied by Eric Rosenberg, M.D. who is a scientist at the Massachusetts General Hospital, and we are hoping that within a year we can get more information on how the medicine works on people with HIV.
8. Why would we think this drug might work?
Because before 1996 when viral cocktails were invented, many doctors used this drug on many patients (188 of them) and we know from the records of those patients that the drug seemed to help them.
In general, using the antibody showed some return in the ability to fight illnesses, an increased number of T cells, and a drop in the amount of virus. The way scientists measured this was to use a test of the body’s ability to recognize enemy germs, a skin test and it was clear that people who were not able to fight some illnesses got this ability back after using the antibody. Some of the well known scientists who worked with this antibody years ago were contacted by the non-profit organization Search For A Cure and interviewed. All of them indicated that they would like to see Cytolin studied because they felt it had potential.
9. What is happening now?
Search For A Cure researched this drug and helped get a clear strategy for studying it underway. The testing will first happen in vitro (in the test tube) and later in people.
There are several ways studying the drug might be helpful:
1. To protect the antivirals from resistant strains of HIV emerging as the virus cannot get resistant to Cytolin
2. To see exactly how Cytolin protects T cells and through this to better understand the errors made by the immune system that leads to AIDS
3. To see if some version or amount of Cytolin might be able to help people avoid needing the use of antivirals for long periods of time
The research will take a good deal of time, but many specialized scientists are convinced that the monoclonal antibody is a good way to help the body fight against its own over reaction to HIV and protect its immune system. This would make Cytolin the first Immune Based Therapy (IBT) in existence for HIV. There are others like Interferon alpha for Hepatitis C for example, but none for HIV.
12. How can I get more information?
For more information:
|