A quantitative comparison of anti-HIV gene therapy delivered to hematopoietic stem cells versus CD4+ T cells

PLoS Comput Biol. 2014 Jun 19;10(6):e1003681. doi: 10.1371/journal.pcbi.1003681. eCollection 2014 Jun.

Abstract

Gene therapy represents an alternative and promising anti-HIV modality to highly active antiretroviral therapy. It involves the introduction of a protective gene into a cell, thereby conferring protection against HIV. While clinical trials to date have delivered gene therapy to CD4+T cells or to CD34+ hematopoietic stem cells (HSC), the relative benefits of each of these two cellular targets have not been conclusively determined. In the present analysis, we investigated the relative merits of delivering a dual construct (CCR5 entry inhibitor + C46 fusion inhibitor) to either CD4+T cells or to CD34+ HSC. Using mathematical modelling, we determined the impact of each scenario in terms of total CD4+T cell counts over a 10 year period, and also in terms of inhibition of CCR5 and CXCR4 tropic virus. Our modelling determined that therapy delivery to CD34+ HSC generally resulted in better outcomes than delivery to CD4+T cells. An early one-off therapy delivery to CD34+ HSC, assuming that 20% of CD34+ HSC in the bone marrow were gene-modified (G+), resulted in total CD4+T cell counts ≥ 180 cells/ µL in peripheral blood after 10 years. If the uninfected G+ CD4+T cells (in addition to exhibiting lower likelihood of becoming productively infected) also exhibited reduced levels of bystander apoptosis (92.5% reduction) over non gene-modified (G-) CD4+T cells, then total CD4+T cell counts of ≥ 350 cells/ µL were observed after 10 years, even if initially only 10% of CD34+ HSC in the bone marrow received the protective gene. Taken together our results indicate that: 1.) therapy delivery to CD34+ HSC will result in better outcomes than delivery to CD4+T cells, and 2.) a greater impact of gene therapy will be observed if G+ CD4+T cells exhibit reduced levels of bystander apoptosis over G- CD4+T cells.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antigens, CD34
  • CD4-Positive T-Lymphocytes / immunology*
  • Computational Biology
  • Computer Simulation*
  • Disease Progression
  • Gene Transfer Techniques
  • Genetic Therapy*
  • HIV Fusion Inhibitors
  • HIV Infections* / therapy
  • HIV Infections* / virology
  • HIV-1 / genetics
  • Hematopoietic Stem Cells / immunology*
  • Humans
  • Models, Biological*
  • Receptors, CCR5
  • Recombinant Fusion Proteins / genetics

Substances

  • Antigens, CD34
  • C46 HIV-1 fusion inhibitory peptide
  • CCR5 protein, human
  • HIV Fusion Inhibitors
  • Receptors, CCR5
  • Recombinant Fusion Proteins

Grants and funding

This work was funded by the Australian Research Council (ARC) and by Calimmune Pty Ltd under an ARC Linkage grant held by GS and JMM (LP100100242). Calimmune participated in this research through the co-authorship of GS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.