Combined Molecular Excision Therapy (CMET) for Eliminating HIV-1

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Abstract The elimination of the human immunodeficiency virus (HIV) from its central nervous system (CNS) and peripheral reservoirs is a requirement for a disease-cure. To our knowledge, we are the first to have achieved this goal in tests performed in a limited number of infected humanized mice. To validate such early successes we propose to build a four-step ladder with a final crest of latent virus eradication. First, a newly developed humanized mouse brain-lymphoid model of neuroAIDS will identify productively infected perivascular and meningeal macrophages and restricted infection in parenchymal cells. This rodent model most closely reflects human brain disease as demonstrated by robust molecular, virologic and neuroimmunologic tests. Second, long acting slow effective release antiretroviral therapy (LASER ART) also now fully developed in our laboratories can now facilitate a pinpoint localization of the latently infected viral brain reservoir. Third, viral excision strategies will be employed to eliminate residual virus and preclude HIV reactivation. The gene editing CRISPR/Cas9 system developed by Temple University Medical Center investigators including CCR5 and viral excision strategies will reduce then eliminate any ongoing infection and integrated proviral DNA from infected cells. The CRISPR/Cas9 constructs will deliver its cargo to brain and peripheral tissue sites using specific serotypes of adeno-associated virus. This will enable permanent HIV eradication in humanized mice without viral reactivation and as such preclude any ongoing brain infection and subsequent neural damage. Fourth, in order to prove the therapeutic strategy effective both for brain and peripheral lymphoid tissue virus (including the gut-associated lymphoid tissue, lymph node, spleen and genitourinary system) we will cease ART administrations and following time periods measured in months to provide cross validating evidence for viral eradication by measure rebound. Given the risks associated with HIV reactivation in the CNS this approach must show effectiveness for its abilities to target latent virus. Taken together, the proposal seeks support to employ combination LASER ART and potent molecular viral and immune-based regimens for elimination of viral depots. The overall premise is to develop the “state of the art” tools required to permanently eliminate virus detected in the CNS and peripheral infectious reservoirs.