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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 Lewin Director, Infectious Disease Unit, Alfred Hospital Professor, Department of Medicine, Monash University Co-head, Centre for Virology, Burnet Institute, Melbourne, Australia Amfar-IAS Satellite Meeting, 5 th IAS Conference, Rome.

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Gene therapy is scientifically flawed, high risk, will never get to the clinic

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  1. 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, AustraliaAmfar-IAS Satellite Meeting, 5th IAS Conference, Rome

  2. Gene therapy is scientifically flawed,high risk,will never get to the clinic

  3. The problem: 1 in a million cells are latently infected

  4. Nucleases chop up DNA – lets hope they get it 100% right! Naldini et al., Nature Genetics 2011; 12:301

  5. Pharmacotherapy is rational, short term,toxicities that are mild and reversible,available now to test, scalable

  6. Licensed drugs that also …..eliminate latently infected cells Phase I Phase II Phase III Licensed # Trials* Latency trials Latent HIV activity Latency activators 2 + 176 Vorinostat Yes + 32 Romidepsin Yes + 94 Panabinostat HDACi + 20 Entinostat + 28 Belinostat + 7 Givinostat - >26 Others (9) Methylation inhibitor 52 + 5-azacytidine 1 + Cytokine 20 Interleukin-7 1 + Anti-alcoholic Disulfiram Yes Immune modulators + Antibiotic Minocycline ` Yes + Anti-rheumatic Auranofin Yes + 9 Anti PD-1 MDX-1106 + 22 PKC modulators Bryostatin + Others Yes (1) * Total number of trials listed on http://clinicaltrials.gov (July 2011)

  7. 60000 WHS 22 50000 40000 Viral RNA (copies/ml) + 30000 20000 Immune modulators 10000 0 NI Pro VPA SAHA VPA + Pro SAHA + Pro Combination strategies enhance potency Latency activators (combination) Pro = prostratin; VPA = valproic acid; SAHA = vorinostat Reuse et al., Plos One 2009

  8. AIDS 2009; 23(14):1799-806 Plos One 2011; 6: e18270 New possibilities to enhance specificity

  9. 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

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