The findings about the lenacapavir to prevent the HIV infection With only two doses a year, the novel brain stimulation technique that has allowed two people with paraplegia walk again, progress in CAR-T cell therapies that have achieved remission of childhood brain cancer in some patients or the promising results in vaccines against breast, lung and pancreatic cancer These are some of the milestones that have marked the year 2024 in the healthcare field.
Doctors from Emory University (United States) published in the ‘New England Journal of Medicine’ the conclusions of a phase III clinical trial, Purpose-2, which showed that an injection of lenacapavir (marketed as ‘Sunlenca’ by Gilead Sciences) twice a year reduces by 96 percent the risk of HIV infection.
In this way, the drug has advantages over daily oral antiretrovirals, commonly called PrEP (pre-exposure prophylaxis), such as ‘Truvada’, which is extremely effective in preventing HIV, but only if taken at daily, as directed.
“What we see over time is that about half of people who start taking daily oral PrEP stop taking it within a year due to several factors,” he said. the lead author of the lenacapavir study, Colleen Kelley. In this way, the new injection would at the same time help to improve adherence to the treatment among HIV patients.
The challenge for next year is to make the medicine “accessible and affordable” for the entire population, in any country in the world, as demanded from the Joint United Nations Program on HIV/AIDS (UNAIDS)whose leaders consider that this innovation can represent a “revolution” to end the HIV pandemic.
“We can usher in a new era by connecting technological innovation with access for all. Let us act boldly together, flatten the curve of new infections and dramatically accelerate the response to HIV,” he said. UNAIDS Executive Director Winnie Byanyima.
The ‘Geneva patient’
In the field of HIV, another important advance has also occurred during 2024. In September it was announced that the ‘Geneva patient’ joined the group of people who have achieved cure after a stem cell transplant, being the first to achieve it without their donor presenting the CCR5(delta)32 mutation, known by confer protection against HIV infection.
At the time of the publication of this success in ‘Nature Medicine’, the ‘Geneva patient’ had been without the presence of the virus in his blood for 32 months, after having interrupted antiretroviral therapy (ART). This milestone was carried out within the framework of the IciStem consortium, co-coordinated by IrsiCaixa -a center promoted by the “la Caixa” Foundation and the Department of Health of the Generalitat of Catalonia- and the University of Utrecht (Netherlands), and was led by the University Hospital of Geneva and the Pasteur Institute.
“Previously, transplants without the CCR5(delta)32 mutation had already been performed in other patients with HIV. However, if the treatment was stopped, a viral regrowth appeared, but slower than that which would be observed in a person with non-HIV. transplanted. The ‘Geneva patient’ has been the first to achieve a prolonged remission over time,” commented the senior researcher at IrsiCaixa and coordinator of IciStem, Maria Salgado.
People with paraplegia walk again
One of the big news of 2024 has been the two people with paraplegia caused by partial spinal cord injuries who have managed to walk again thanks to the application of deep brain stimulation (DBS) in the brain region of the lateral hypothalamus.
Researchers of the Federal Polytechnic School of Lausanne (EPFL, Switzerland) and the Vaud University Hospital Center (CHUV, Switzerland) discovered that this area of the brain had an influence on motor ability that they did not expect. Based on the finding, they decided to apply DBS and managed to improve the patients’ mobility not only during the rehabilitation process but in the long term, even when the stimulation was stopped.
One of the patients who have walked again thanks to this innovative technique is Austrian Wolfgang Jäger, 54, who has been in a wheelchair since 2006 due to a skiing accident. According to him, this innovative technique has allowed him to regain part of his mobility and independence, since he can go down stairs on his own or perform everyday tasks such as reaching for objects in the kitchen cabinets.
CAR-Ts achieve remission of childhood brain cancer
Another of the most anticipated advances in medical research has been in the field of CAR-T cell therapiesinitially developed by immunologist Carl H. June to be applied against blood cancer. This year, a Stanford Medicine clinical trial has managed, thanks to them, to reduce brain tumors in children.
This trial is one of the first successes against solid tumors achieved with this type of modified immune cells and, according to the findings published in ‘Nature’, it achieved benefits in nine of the 11 participants. Specifically, some saw the tumor volume reduced, others achieved functional improvements in the disabilities caused by their illness, or both.
Additionally, one of the four participants whose tumor volume was reduced had a complete response, meaning their tumor disappeared from brain scans. Although researchers preferred to be cautious because it was “too early” to say if he was cured, they were hopeful that he would be.
Cancer vaccines
Furthermore, 2024 has seen several notable advances in cancer vaccine research. In this sense, a trial conducted in patients with triple-negative breast cancer who received an investigational vaccine designed to prevent tumor recurrence showed promising results.
For this test we used the neoantigenic DNA vaccineof which specialists from Washington University in St. Louis (United States) administered three doses to 18 women with non-metastatic triple negative breast cancer, who also received standard care. 14 of them showed immune responses to the vaccine and, after three years, 16 patients remained cancer-free.
Meanwhile, in lung cancer, the Hospital Universitari i Politècnic La Fe and the Castellón Provincial Hospital Consortium administered the BNT116 vaccine to patients with non-small cell lung cancer as part of an international investigation in which 55 centers in Georgia participate, Germany, Republic of Korea, Taiwan, Turkey, United States and Spain.
The objective with this vaccine is to “strengthen the person’s own immune response against the tumor” to eliminate tumor cells through a process similar to what happens with infectious diseases and obtain “long-lasting” and “less toxic” responses than with chemotherapy, as explained by the La Fe oncologist and IIS La Fe researcher, Óscar Juan.
Finally, researchers at Memorial Sloan Kettering Cancer Center (MSK) in New York presented new results for pancreatic cancer from a therapeutic vaccine based on messenger RNA (mRNA), called autogene cevumeran.
A Phase I clinical trial showed that the vaccine activated immune cells that persisted in the body for up to three years after treatment in certain patients. Additionally, a vaccine-induced immune response was correlated with a reduced risk of the cancer coming back.
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