Gene therapy is scientifically flawed, high risk, will never get to the clinic
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Transcript of Gene therapy is scientifically flawed, high risk, will never get to the clinic
Are we most likely to cure HIV with gene therapy?
Sharon R LewinDirector, Infectious Disease Unit, Alfred HospitalProfessor, Department of Medicine, Monash UniversityCo-head, Centre for Virology, Burnet Institute, Melbourne, Australia
Amfar-IAS Satellite Meeting, 5th IAS Conference, Rome
Gene therapy is scientifically flawed,high risk,will never get to the clinic
The problem: 1 in a million cells are latently infected
Nucleases chop up DNA – lets hope they get it 100% right!
Naldini et al., Nature Genetics 2011; 12:301
Pharmacotherapy is rational, short term,toxicities that are mild and reversible,available now to test, scalable
Licensed drugs that also …..eliminate latently infected cells
HDACi
Vorinostat YesRomidepsin YesPanabinostat Entinostat GivinostatBelinostat
2
5-azacytidine
Others (9)
1Disulfiram Yes 1
Minocycline ` Yes
Auranofin Yes
Phase I
PhaseII
PhaseIII
Licensed Latency trials
Methylation inhibitor
Cytokine
Anti-alcoholic
Antibiotic
Anti-rheumatic
Interleukin-7
* Total number of trials listed on http://clinicaltrials.gov (July 2011)
# Trials*
17632942028
7>26
52
20
Latent HIV activity
Latency activators
Immune modulators
MDX-1106 Anti PD-1
++++++
+++
-
+
++9
BryostatinPKC modulators
+22Others Yes (1) +
Combination strategies enhance potency
SAHA
+ Pro
Vira
l RN
A (c
opie
s/m
l)
50000
0
20000
30000
40000
10000
NI
VPA
SAHA
VPA
+ Pro
Pro
60000 WHS 22
Pro = prostratin; VPA = valproic acid; SAHA = vorinostat Reuse et al., Plos One 2009
Latency activators(combination)
Immune modulators+
New possibilities to enhance specificity
AIDS 2009; 23(14):1799-806
Plos One 2011; 6: e18270
We need a cure that is scalable, deliverable and cheap
http://www.afripol.org/africa-newspapers/3-africa/2-newshour-with-jim-lehrer-africa-coverage-pbs.html