Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
Sci Transl Med. 2015 Dec 23;7(319):319ra206. doi: 10.1126/scitranslmed.aad5752.
Passive immunization with HIV-1-neutralizing monoclonal antibodies (mAbs) is being considered for prevention and treatment of HIV-1 infection. As therapeutic agents, mAbs could be used to suppress active virus replication, maintain suppression induced by antiretroviral therapy (ART), and/or decrease the size of the persistent virus reservoir. We assessed the impact of VRC01, a potent human mAb targeting the HIV-1 CD4 binding site, on ART-treated and untreated HIV-1-infected subjects. Among six ART-treated individuals with undetectable plasma viremia, two infusions of VRC01 did not reduce the peripheral blood cell-associated virus reservoir measured 4 weeks after the second infusion. In contrast, six of eight ART-untreated, viremic subjects infused with a single dose of VRC01 experienced a 1.1 to 1.8 log10 reduction in plasma viremia. The two subjects with minimal responses to VRC01 were found to have predominantly VRC01-resistant virus before treatment. Notably, two subjects with plasma virus load <1000 copies/ml demonstrated virus suppression to undetectable levels for over 20 days until VRC01 levels declined. Among the remaining four subjects with baseline virus loads between 3000 and 30,000 copies, viremia was only partially suppressed by mAb infusion, and we observed strong selection pressure for the outgrowth of less neutralization-sensitive viruses. In summary, a single infusion of mAb VRC01 significantly decreased plasma viremia and preferentially suppressed neutralization-sensitive virus strains. These data demonstrate the virological effect of this neutralizing antibody and highlight the need for combination strategies to maintain virus suppression.
被动免疫接种 HIV-1 中和单克隆抗体(mAbs)正在被考虑用于预防和治疗 HIV-1 感染。作为治疗药物,mAbs 可用于抑制活跃的病毒复制,维持抗逆转录病毒治疗(ART)诱导的抑制,和/或减少持续病毒库的大小。我们评估了靶向 HIV-1 CD4 结合位点的强效人源 mAb VRC01 对接受和未接受 ART 治疗的 HIV-1 感染者的影响。在六位血浆病毒载量不可检测的接受 ART 治疗的个体中,两次输注 VRC01 并未降低第二次输注后 4 周时测量的外周血细胞相关病毒库。相比之下,八位接受 ART 治疗但病毒血症的个体单次输注 VRC01 后,血浆病毒载量降低了 1.1 至 1.8 log10。对 VRC01 反应最小的两名个体在治疗前被发现主要存在 VRC01 耐药病毒。值得注意的是,两名病毒载量 <1000 拷贝/ml 的个体在 VRC01 水平下降之前,病毒抑制持续了超过 20 天,直至达到无法检测的水平。在其余四名基线病毒载量在 3000 至 30000 拷贝之间的个体中,mAb 输注仅部分抑制了病毒血症,我们观察到对生长为中和敏感性较低的病毒的强烈选择压力。总之,单次输注 mAb VRC01 显著降低了血浆病毒载量,并优先抑制了中和敏感性病毒株。这些数据表明了这种中和抗体的病毒学作用,并强调了需要联合策略来维持病毒抑制。