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Although the real science is fascinating, doctors didn't "inject HIV into a dying child"

We’ve recently noticed an inspiring short film circulating on the internet about how doctors in the US have apparently cured a child of leukaemia by “injecting her with HIV”.

But while the actual science behind this story is fascinating, the treatment is still at an extremely experimental stage and has only been tested in a handful of patients.

And while we’re always keen to welcome exciting experimental cancer treatments, we also want to clear up a few misconceptions about what the research actually involved.

To be absolutely clear, the doctors in the video did NOT inject HIV – nor a “deadly disease” – into a child.

So who are these people, and what did they actually do?

[Note – the headline of the Upworthy page hosting the video has now been changed to reflect that it was a modified form of HIV. KA 13/05/14]

Turning the immune system on cancer

The research comes from Professor Carl H. June and his team in Philadelphia in the US. He’s a highly-respected scientist working on cancer, HIV and the immune system, and has published his work in hundreds of papers in many leading scientific journals over several decades.

The immune system is an incredibly hot topic in cancer research. Cancer is an illness that starts from our own cells going rogue within us. Our immune system is pretty good at recognising and attacking foreign invaders – such as bacteria or viruses – but it doesn’t do so well at tackling tumours.

A huge amount of research effort around the world is focused on trying to understand why the immune system doesn’t recognise and fight off the disease. And there’s also a lot of work aimed at harnessing this powerful force for treating cancer, and this is leading to new ways to treat the disease.

Professor June and his team are taking an interesting approach to this challenge. In particular, they’re developing new ways to turn the power of the immune system on leukaemia – a cancer caused by white blood cells (usually B cells, also part of the immune system themselves) growing out of control.

They’ve developed a technique in which they collect special ‘killer’ immune cells, called T cells, from a cancer patient. These are then ‘reprogrammed’ in the lab using a modified virus, which is very good at smuggling genes into the T cells.

In this case, the researchers added genes carrying instructions that tell the T cells to make a new protein called a “chimeric antigen receptor” – this lets them lock on to molecules found on the surface of cancer cells, killing them in the process.

These reprogrammed T cells are then injected back into the patient, where they grow and multiply, creating an army of killer cells to fight the disease.

At least, that’s the theory.

From the lab to the clinic

The Philadelphia team has been working on this technique for many years, developing it first in the lab then testing it in animals with promising results.  They’re now taking this a step forward, into clinical trials with cancer patients.

The situation described in the video, where a little girl called Emily Whitehead (referred to as Emma in the film) undergoes modified T cell treatment, isn’t the first time this approach has been tested in people. There’s more than a decade’s worth of data looking at the safety and effectiveness of virus-modified T cells in clinical trials for treating people with HIV as well as cancer.

In 2011, Professor June’s team treated three adults with chronic lymphocytic leukaemia (CLL) with virus-modified immune cells as part of a small, early-stage clinical trial. All three had undergone several rounds of chemotherapy, yet their cancer kept coming back.  For two of them, their cancer completely went away after the T cell therapy – something known as “complete remission”. This was an important and impressive result, although one that was probably over-hyped in the media at the time.

Further results from the trial – totalling 10 adult patients with CLL and two children with a different type of leukaemia (acute lymphoblastic leukaemia, or ALL) were announced at a scientific conference at the end of 2012.  The researchers claimed that nine out of the twelve patients had been treated successfully – presumably three of the adult patients are from the 2011 paper, while the two children are likely to be from the paper we’ll discuss shortly.

And in March this year, a team at Memorial Sloan-Kettering Cancer Centre in New York published results testing a similar approach in five adults with ALL. In all five, the cancer vanished, although four of them went on to have further treatment so it’s hard to say whether this therapy was solely responsible for curing them. And for the final patient, the cancer came back once the reprogrammed T cells had died off in their body.

From what we can tell, the girl in the video – Emily/Emma – is being treated as part of another small-scale, early-stage clinical trial for children with leukaemia and lymphoma, testing the virus-modified T cell treatment. This is primarily a trial to find out whether the treatment is safe, rather than how well it works.

Results from two children with ALL were recently published in a paper in the New England Journal of Medicine. Of the two kids, one seems to have had a complete remission – we can only assume this might be Emily, though she isn’t mentioned by name in the paper. Sadly, the other child didn’t do so well. The cancer came back just two months after the T cell treatment.

Obviously, for Emily and her family this experimental therapy has been nothing short of a miracle. But from the handful of cancer patients treated so far, it’s clear that it doesn’t work for everyone – something that’s rightly pointed out in the film.

The therapy also causes significant side effects, dramatically described in the video. Several of the patients who receive the modified T cells seem to experience what’s known as a “cytokine storm” – a potentially fatal immune reaction. Subjecting weakened cancer patients to such a barrage is highly risky, so researchers need to proceed with great caution as the clinical trials continue recruiting patients.

How does HIV fit into the picture?

Promoting the video, the Upworthy website boldly states that the doctors are injecting “HIV into a dying girl”, and that she received a “deadly disease”. This is a serious bending of scientific truth, and very misleading.

In fact, the researchers are using a type of virus called a lentivirus to reprogramme the T cells. This family of viruses – of which HIV is a member – are particularly skilled at sneaking into cells and embedding their genetic code within the cell’s DNA. Unsurprisingly, this makes them a good vehicle for smuggling in the genetic instruction telling T cells to attack the cancer.

According to the video, Professor June says that the virus used in these experiments was originally derived from HIV, and we hear the film-maker asking off-camera “So you’re taking the HIV virus and infecting healthy cells with it to help kill cancer?” However, the virus has undergone significant genetic tinkering, meaning that it is no longer harmful (as June does go on to explain). And it’s arguable whether it should even be referred to as HIV at all, given how much it has been altered.

And the researchers didn’t inject any virus into anyone. As we’ve explained, they took immune cells out of the patient, treated them with the virus in the lab, then injected the modified cells back in.

To sum up

Broadly speaking, we feel that this film is inspiring, and we’re always happy to see the fruits of promising new therapies for cancer. But to promote “injecting HIV” as a treatment is misleading.

One child surviving ‘incurable’ cancer is an amazing event, but there is a lot more work to be done to find out how best to use this new technology. At the moment it’s still highly experimental and expensive. It’s only being trialled in a very small number of patients, primarily to make sure it is safe, and so far we’ve seen that it doesn’t work for everyone.

In the case of the child whose cancer came back after treatment, the researchers found that her cancer cells had somehow stopped carrying the T cells’ target molecule. So it’s likely that other targets will need to be identified, to make the treatment more effective for more patients in the future.

On a positive note, there’s no reason why this type of treatment should be restricted to cancers affecting the immune system (namely leukaemia and lymphoma), although they’re much more accessible to the killer T cells. Researchers elsewhere are investigating how to target a range of different types of cancer with this approach.

There are several similar therapies being tested in the lab and in clinical trials around the world, including in the UK. And Cancer Research UK scientists are finding out whether harmless genetically-engineered viruses could be used as therapeutic vaccines, training the immune system to seek and destroy cancer cells.

It’s still early days for these exciting new approaches and there are many hurdles to jump, but we’re looking forward to the day when they can be used to treat patients on a wider scale.

Kat

Reference:

Grupp S.A. et al (2013). Chimeric antigen receptor-modified T cells for acute lymphoid leukemia., The New England journal of medicine, PMID:

Comments

Wanda December 4, 2013

Get over it! Who cares what the title is that little girl is alive and that is what counts!

Heather Arey December 3, 2013

I agree that the headline was used to catch your eye, I know that I probably would not have watched it if the title wasn’t so ‘crazy’. I watched my little sister go through hell as a child battling leukemia and i’m just happy that they are doing such awesome research so that someone may be saved from such a terrifying fate.

Lee Ingram December 3, 2013

Thanks for clearing up, I knew it was “too good to be true”! Great strides indeed, but the facts are incredibly important, and the sensationalised video and the sites that host it do no justice to the truth. Science deserves much more than that.

Lisa December 2, 2013

Thank you for catching this article/ slash discussion. I am a Pediatric nurse and this topic just came up at work. We all want to feel good but it’s important to get the facts. Not sure if the person initiating the discussion had seen a video or only read a headline.

Govindaraj December 1, 2013

Titles matter. The title of this shortfilm is misleading. The article has explained very clearly the facts. Just by looking at the title, people may get the impression that getting HIV may help in preventing cancer. On the contrary, HIV infected persons are more prone for getting cancer. The principle of adoptive cell transfer used by the researchers is really promising. This principle was very well explained by this article. Great!

Shane Jones December 1, 2013

I think it’s shitty that because of this ignorant statement “experimental” in this and other studies will preclude insurance carriers from allowing their patrons to take part in this because most insurance carriers do not allow or pay for “experimental” treatments. So we should thank them for their bureaucratic statements. Conspiracy theorist…right? Well let’s think, aren’t there extreme dangers and risks involved with chemo and radiation therapy? Yet we as American’s will be denied the option to choose a risky treatment because it’s “experimental” and “expensive”. It’s simple…isn’t it? If someone chooses to have a treatment that has “cured” cancer in any patients but has potential side effects, knowing all the details and facts…shouldn’t they be allowed to choose? No you say? Then how is it that we can get vaccines and various other treatments and medicines that pose risk and sometimes cause illnesses greatly then the one originally sought to be treated?

Tom Kovacs November 30, 2013

Would the science be there without the AIDs virus? The point of the video is to show 85% of the world a scientific process that has found some good in a long history of sad.

Pedro Franco November 29, 2013

Important and enlightening article. Thank you for clearing this up.

Kat Arney November 28, 2013

Hi everyone,
Thanks for your comments. Just to reiterate what we’ve said in the post, our concern is with the specific headline used by Upworthy to promote the video (“Doctors inject HIV into a dying girl”) and not with the content of the film itself, which accurately explains what the researchers have done.

In a world where headlines can be seen by thousands of people around the world in a few minutes thanks to Twitter and Facebook, we wanted to clear up any confusion about the research and explain a bit more about why it’s so exciting but still early days, and provide links to the fascinating scientific research behind the story.

This isn’t just arguing about semantics. We have seen many comments responding to the coverage of this video on various social media channels revealing that people think the doctors *are* injecting HIV to cure cancer, rather than using an engineered version of the virus to modify the patient’s T cells. There is a huge amount of misinformation on the internet about cancer and its treatment, which can mislead patients and their families. We feel it is important to play a small part in tackling it.

Kat
Cancer Research UK Science Information Manager

Regan November 28, 2013

I agree with Alun. The film was designed to get more attention for research and bring light to the subject. Anyone who took a basic high school bio class understands the virus was genetically manipulated. June tells us how it is done, and it explains it in an honest manner that my grandma would understand. The film was short, sweet,and honest. This article is good because it clears up confusion one may have with out making a mockery of this new research.

Alun November 28, 2013

Actually, I think the film was a pretty fair description considering A: it was only a few minutes long, B: was clearly aimed at the layperson, and C: did clarify the virus was highly modified before use!

Normally I’m the first to call bull**** on sensationalist rubbish in the internet, but as far as I’m concerned, yesterday was a much better day for watching that film!

Imran November 27, 2013

Very informative thanks

starkly November 27, 2013

THANK YOU. I had to go through a couple of pages of Google results to find a truly rational take on this video. The first page was littered with hype and Christian results. Pocketed and sharing. Thanks.

izzy November 27, 2013

Well the video I saw on upworthy clearly stated it was NOT HIV, but something that turned on the Tcells.

Coco November 26, 2013

Great article, well done!

Ugur November 26, 2013

Really very informative article. Thank you.

StayAtHomeVet November 26, 2013

excellent follow up

Matt Brooks November 25, 2013

Thanks for clarifying. This was fascinating reading and in no way does it diminish (or make less interesting) the work these physicians are doing. SEMANTICS MATTER.

Clervis November 25, 2013

This article is misleading. Writing about medical science is difficult, but this article’s title leads you to believe that the mentioned video is incorrect, taken out of context, or misleading. The scientists used a virus that was derived from HIV to reprogram a girl’s T-cells which went on to cure her cancer. And, as the article admits, the video explains all of this. Thanks for the explanation, Kat, but this article is more poorly delivered than the video.

Kevin November 24, 2013

So, you’re just playing semantics over their semantics. /eyeroll