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(Adnkronos Salute) - L'inizio di tutto è stato il caso di Timothy Ray Brown, passato alla storia come il 'paziente di Berlino': la prima persona al mondo a essere guarita dall'Hiv, dopo un trapianto di cellule staminali. Da allora altre 5 sono finite sotto i riflettori per lo stesso motivo (l'ultima della lista ha però un follow-up ancora breve). E adesso la Charité - Universitätsmedizin Berlin, lo stesso ospedale tedesco che trattò Brown, poi morto negli Stati Uniti nel 2020 all'età di 54 anni a seguito di una recidiva della sua leucemia, annuncia di aver curato un secondo paziente, affetto sia da leucemia mieloide acuta che da Hiv: il team che lo ha trattato sembra essere riuscito di nuovo a eliminare, all'apparenza completamente, il virus dell'Hiv dal suo organismo. Sarebbe dunque il settimo caso al mondo. Questo paziente, spiegano gli esperti della struttura in una nota, non ha avuto alcun virus rilevabile per più di 5 anni, nonostante non stia assumendo farmaci antivirali, avendoli interrotti autonomamente nel 2018. Quello che rende questo caso speciale, evidenziano dal centro, è che il team ha utilizzato un metodo di trattamento diverso dai precedenti. Il trapianto di staminali è un'opzione solo per i pazienti che, oltre a convivere con l'Hiv, sviluppano anche alcune forme di leucemia o linfoma che non rispondono a radiazioni o chemio. In questa procedura, le staminali di una persona sana vengono trasferite al paziente, sostituendone il sistema immunitario. Ciò rende possibile combattere non solo il cancro, ma anche l'Hiv.Ma in precedenza, gli scienziati avevano ritenuto fosse necessario trovare un donatore di cellule staminali con caratteristiche genetiche molto specifiche. Questo perché, per moltiplicarsi, l'Hiv entra in varie cellule immunitarie e per farlo ha bisogno di un certo tipo di recettore, Ccr5. Circa l'1% della popolazione europea ha un recettore Ccr5 con una mutazione nota come mutazione delta 32, che impedisce al virus di entrare, rendendo queste persone naturalmente immuni all'Hiv. Serve dunque trovare un donatore con la mutazione, quindi immune, e compatibile con il paziente ricevente. Per il secondo paziente di Berlino, però, questo non è stato necessario. "Non siamo riusciti a trovare un donatore di cellule staminali compatibile che fosse immune all'Hiv, ma siamo riusciti a trovarne uno le cui cellule hanno due versioni del recettore Ccr5: quella normale e poi una in più, mutata", riferisce Olaf Penack, medico senior del reparto che ha in cura il paziente. "Questo accade quando una persona eredita la mutazione delta 32 da un solo genitore - continua Penack - Tuttavia, avere entrambe le versioni del recettore non conferisce immunità all'Hiv".Il paziente trattato con questa strategia è un 60enne, positivo all'Hiv dal 2009, che ha ricevuto la diagnosi di leucemia nel 2015. Il caso verrà presentato al mondo medico alla Conferenza internazionale sull'Aids a Monaco il 24 luglio. Sebbene la donatrice non fosse immune, dunque, è diventato evidente che il trapianto di cellule staminali aveva avuto successo nel curare il paziente dall'Hiv dopo l'interruzione degli antivirali. Il paziente è stato monitorato molto attentamente e, fino a oggi, il team che lo segue non è stato in grado di trovare alcuna indicazione che il virus persista. Il sistema immunitario del paziente è funzionante e non ci sono cellule tumorali rilevabili. "Siamo molto contenti che il paziente sia in buona salute e stia bene", afferma Penack. "Il fatto che sia stato sotto osservazione per più di 5 anni e che sia stato privo di virus per tutto il tempo indica che siamo effettivamente riusciti a eradicare completamente l'Hiv dal suo organismo. Quindi lo consideriamo guarito". E' "estremamente sorprendente che il paziente sia guarito nonostante il donatore di cellule staminali non fosse immune all'Hiv", afferma Christian Gaebler, esperto di Hiv e responsabile del gruppo di ricerca presso il Dipartimento di malattie infettive e medicina intensiva della Charité e Berlin Institute of Health. "In precedenti casi di trapianto di cellule staminali che coinvolgevano donatori non immuni, il virus ha ripreso a replicarsi dopo alcuni mesi".Il secondo paziente di Berlino dimostra che è possibile curare l'Hiv anche se esiste un recettore funzionale che il virus può usare. "Ciò significa che il fatto che il virus sia stato curato è apparentemente attribuibile al fatto che le cellule immunitarie trapiantate hanno eliminato tutte le cellule infette da Hiv del paziente", spiega Gaebler. "Sostituendo il suo sistema immunitario, abbiamo apparentemente distrutto tutti i posti in cui il virus si nascondeva".Non è ancora chiaro perché il trapianto di cellule staminali abbia portato alla guarigione del paziente in questo caso, mentre il virus ha ripreso a replicarsi in casi simili. I ricercatori stanno prendendo in considerazione molteplici potenziali fattori. "La velocità con cui il nuovo sistema immunitario sostituisce quello vecchio potrebbe svolgere un ruolo", afferma Gaebler. "Nel secondo paziente di Berlino, ciò è avvenuto relativamente in fretta, in meno di 30 giorni. Ma il sistema immunitario del donatore potrebbe anche avere caratteristiche speciali, come cellule natural killer altamente attive". Gli esperti continueranno a indagare. "Il nostro obiettivo rimane quello di curare l'Hiv non solo nei singoli pazienti, ma su una base più ampia in futuro", prospetta Gaebler.Prima di sottoporsi al trapianto, il secondo paziente di Berlino, esattamente come la sua donatrice, faceva parte del circa 16% di persone di origine europea che portano sia la versione normale che una versione mutata del recettore Ccr5 nelle loro cellule (rendendole 'eterozigoti' per la mutazione delta 32). Non è chiaro se questo dettaglio abbia contribuito alla guarigione. Oltre a Brown, il cui caso è stato reso pubblico nel 2008, le altre persone ritenute guarite dall'Hiv sono Adam Castillejo (il 'paziente di Londra', data di pubblicazione del suo caso 2019), Marc Franke (il 'paziente di Düsseldorf', 2023), il caso noto come 'paziente di New York' (nel 2023, una donna), Paul Edmonds (il 'paziente di City of Hope', 2023) e infine c'è il 'paziente di Ginevra', su cui al momento però ci sono valutazioni diverse riguardo alla sua completa guarigione dall'Hiv. Franke, Edmonds e Castillejo, diventati amici, dovrebbero partecipare alla conferenza sull'Hiv a Monaco, secondo quanto riferisce 'Nbc News'. di Adnkronos   19-07-2024 - 17:34 Link copiato Commenti Leggi la Netiquette

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