Bone marrow is a special human organ responsible for hematopoiesis, or rather, for the reproduction of erythrocytes, immune cells and, to some extent, even neurons. Bone marrow is a kind of liquid substance located in the cavities of the large bones of the skeleton, consisting mainly of the stroma - cells of unformed connective tissue and stem cells.
Stem cells are special cells of the body from which the human embryo is formed. During the period of embryonic development, these cells divide very actively, and then acquire specialization, transforming, for reasons only they know, into certain tissues and organs.
In an adult, the remnants of these cells, located in the bone marrow, remain, which have lost the ability to reproduce, but can still reproduce any tissues of the body, patching up the gaps formed due to the mass death of cells for various reasons. These cells keep the secret of eternal youth, and possibly eternal life, however, they are not fully understood.
Experiments on mass stem injections for the purpose of rejuvenation have safely failed due to massive cancer among the people who underwent the procedure. But transplantation of stem cells to sick people whose body has suffered from anti-cancer therapy in order to restore immunity, blood or other tissues shows excellent results.
The stroma is a kind of base (and from Greek it translates at all as a litter) for stem cells, capable of producing phagocytosis - eating disease-causing or alien cells.
The stroma consists of two types of cells:
- Osteoblasts - cells that separate the bone marrow and blood, which are the support of the bone marrow.
- Resorblasts - giant cells with a huge number of nuclei, 12 pieces, which remove bone tissue, destroying mineral components.
Simply put, the former build bones, while the latter destroy them. This continuous process ensures that the skeleton is constantly renewed.
Also in the bone marrow there are special hematopoietic cells - a type of stem cells that can reproduce blood cells according to the number of their sprouts, of which there are 5 in a mature state, each of which reproduces a certain type of blood cells.
Human bone marrow is divided into two types: red and yellow. Red is just responsible for hematopoiesis, and yellow does not produce anything and replaces red as a person grows up.
It is the red bone marrow that is of interest for transplantology and is located in the spongy substance of flat bones, in the middle of the tubular, and also contains spinal cord but this body is inviolable.
Amplatz Children "s Hospital. Photo from archdaily.com
A 12-year-old American who has been tried to cure HIV and leukemia with a donor bone marrow transplant has died as a result of a graft-versus-host reaction, according to Medical Daily. The death of Eric Blue (Eric Blue) came on July 5, but it became known about this only now.
On April 23, 2013, at Amplatz Children 's Hospital at the University of Minnesota (Minneapolis), the boy underwent surgery similar to the one that cured Timothy Brown of HIV and leukemia, the so-called "Berlin Patient", currently considered the only documented case of complete cure In 2007, an American, who lives in Berlin, Brown underwent a stem cell transplant from a donor who had a genetic mutation, thanks to which he had natural immunity to HIV. until now, he completely lacks signs of both diseases.
In addition, at the conference of the International Society for the Study of AIDS, held from June 28 to July 3, 2013 in Kuala Lumpur, Malaysia, a group of researchers from Brigham and Women 's Hospital (Boston, USA) on successful treatment of HIV and lymphoma with bone transplantation. brain in two men who had previously lived with the virus in their blood for about three decades.At the same time, the authors of the report stressed that there can be no talk of a complete cure.
Eric Blue received umbilical cord blood cells from a donor with natural immunity to HIV. The ultimate goal of the procedure was to completely replace Eric's immune system cells with donor cells. For this, the boy's own immune system was suppressed with the help of chemotherapy.
Everything went well at first, laboratory tests showed that Eric's blood was free of both HIV and leukemia even after he stopped taking his medication. However, in June, the boy developed a graft-versus-host reaction, in which the donor's immune cells attack the recipient's body. This reaction develops in 60-80 percent of cases of unrelated donation.
“In Eric's case, we understood that this is a big risk and success is not guaranteed at all,” said Michael Vernaris, a transplant specialist. “Nevertheless, we will continue, based on the experience gained, attempts to introduce a new method of HIV therapy.”
Comments (10)
20.07.2013 13:54
Kostya
it is necessary to put this technology on stream and cure all HIV-infected, and let the pharmaceutical suction cups with their ineffective drugs be sucked off
20.07.2013 15:49
Welder
Quote 1, heading:
"Bone marrow transplant did not save a boy with HIV and leukemia"
Quote 2, text:
"Cord blood cells were transplanted to Eric Blue"
Do you distinguish between donor materials "Bone Marrow" and "Umbilical Cord Blood" on the medical portal?
20.07.2013 23:48
Lemmy666
"In other words, they used the boy as a guinea pig."
Which is better - 20-40% success rate or zero?
21.07.2013 19:08
Laura
To the welder. Bone marrow is transplanted, roughly speaking, just blood transfusion. And in the umbilical cord blood there are many stem cells that populate the empty bone marrow of the patient and begin to mature and multiply there. This is schematic.
21.07.2013 20:52
A vampire
Bone marrow - spongy substance bone tissue, umbilical cord (placental) blood - blood obtained during natural childbirth in the delivery room or after a cesarean section in the operating room.
Hematopoietic stem cells are isolated both from the bone marrow and from the umbilical cord blood, which are used later for transplantation; however, cord blood generally contains fewer stem cells than bone marrow.
22.07.2013 00:47
Lemmy666
Vladimir Ramenskii, what's the point? After all, the task was to transplant the cells of a person with immunity from HIV, and the relatives probably did not have one.
22.07.2013 07:47
Welder
For Vladimir Ramenskii
As for the experimental mouse, the lad had nothing to lose. The operation that was performed on Timothy Brown and this boy is used only as a last resort when chemotherapy and ART do not give the desired effect. Note, both patients were treated at once for TWO fatal diseases. It worked with the first one, it turned out to have good compatibility, there, from a small bank of donors with the CCR5 delta12 mutation, they were able to find several compatible samples at once and select the most suitable one.
29.07.2013 21:34
Violet
My neighbors have a little daughter, she's only 2 years old. So small and active all the time I can remember. And then her mother somehow comes and asks for help with money for treatment. The baby was diagnosed with leukemia, underwent chemotherapy, but a bone marrow transplant is needed, and this operation is expensive. They found a clinic in Turkey, where they promised to help them, and the prices there are lower than European ones. Upon their arrival, we went to see the baby, said that the operation went well and now the child is gradually recovering, and she no longer looked so yellow. Alina said that the doctors of the Memorial clinic are very courteous and take care of each ward. They didn’t take an extra penny, the amount they agreed on initially, and they paid that one. Now the main thing is that this whole nightmare leaves their lives and never returns.
The American, who suffered from leukemia and HIV infection, was able to defeat both diseases thanks to a bone marrow transplant from a donor genetically immune to the AIDS virus. This was stated by the specialists of the Berlin clinic Charite (Charite hospital), dealing with the treatment of the patient, reports AP. A 42-year-old HIV-infected US citizen, whose name has not yet been disclosed, was observed at the Charite clinic for leukemia, said hematologist Gero Huetter. When a patient required a bone marrow transplant, doctors deliberately chose a donor with a special genetic mutation that makes him immune to all known strains of the HIV virus. This mutation, which occurs in about 3% of Europeans, affects the structure of the CCR5 receptor, preventing the AIDS virus from binding to cells in the human body.
Before the organ transplant, the patient underwent a course of radiation and drug therapy to destroy his own bone marrow cells and the immune system. All were canceled at the same time. medications against HIV infection, doctors said.
Twenty months after the bone marrow transplant, doctors were unable to detect signs of HIV in the patient. The tests did not reveal infections in the blood, bone marrow, or in other organs and tissues - possible reservoirs of the virus, Hütter said.
“However, we cannot rule out the possibility that the virus is still in the body,” the doctor added.
The specialists of the Charite clinic emphasized that the method they have tested will not be widely used for the treatment of HIV infection. This is due not only to the shortage of potential donors, but also to its danger to the patient's life. Bone marrow transplantation requires complete destruction of the cells of the patient's immune system and is associated with a high risk of infectious complications. Nevertheless, this study may contribute to the development of a new direction - gene therapy - in the treatment of HIV infection, experts say.
The Ministry of Health of Uzbekistan denied information about the mass infection of children with HIV, allegedly recorded in a hospital in the city of Namangan. In an interview with a REGNUM correspondent, the head of the Main Department of Sanitary and Epidemiological Surveillance of the Ministry, Sailmurod Saidaliev, said that all media reports about the incident in the hospital were untrue.
“There are indeed cases of HIV infection in Namangan region, but this has nothing to do with this hospital, or with the use of disposable syringes, or with the infection of 43 children and newborns mentioned in the press,” the official said.
It should be reminded that the news of the HIV outbreak in the Namangan hospital was published on November 10 by the Ferghana.Ru website. The report indicated that information about the incident was confirmed by Namangan doctors, as well as sources in the Ministry of Health and law enforcement agencies of the Republic of Uzbekistan. It was also noted that a criminal case was opened on the fact of infection of children, and a group of several dozen employees of the Service is conducting a check in the Namangan regional hospital. national security and the prosecutor's office.
This hospital is all right, there are no 43 children with HIV, and we do not understand the source of this information in the press, ”the representative of the Ministry of Health of Uzbekistan emphasized.
The doctors managed to save the patients suffering from the human immunodeficiency virus with the help of blood stem cell transplantation. Experts from the medicine department of the economic publication for modern investors, "Market Leader", examined the details.
Doctors were able to increase the number of patients who were rid of the human immunodeficiency virus to four. This time, the lucky ones are two patients who also suffered from blood cancer, so they had to undergo a bone marrow transplant.
Until recently, there were only two cases in medicine when HIV patients got rid of the virus. The first is Timothy Ray Brown (also known as the "Berlin Patient") - the only adult to have recovered from AIDS. The second case is a two-year-old girl who was relieved of the disease because she started treatment early.
It looks like two more people will join these two lucky ones. Now in Kuala Lumpur (Malaysia) a conference of the International Society for the Study of Human Immunodeficiency Virus is taking place. On it, Daniel Kuritzkes and his colleagues from Brigham Women's Hospital in Boston (United States of America) made a report that they were able to rid two adults of the virus in their bodies. These are two American women who have suffered from HIV for the past three decades. They did this by transplanting stem cells into them.
Thus, one of the "Boston patients" underwent a bone marrow transplant 3 years ago, and another 5 years ago. And now both are no longer receiving antiretroviral drugs. One does not use them for 15 weeks, and the second - 7. At the same time, there are no traces of viral RNA or DNA in their blood. But, as the researchers themselves say, it is still premature to say that the patients have completely recovered, because such conclusions can only be drawn after a year, because HIV tends to hide in the human body. That is, some time will pass, and if the tests are good, it will be possible to celebrate the victory over the disease.
By the way, stem cells were also transplanted to the "Berlin patient". But the Boston version of therapy has one difference, which is significant.
When in the capital of Germany, the patient was injected with stem cells into the blood, while the latter carried the mutant protein CCR5, which HIV needed to enter the cell, that is, they specially created resistance to the human immunodeficiency virus in the transplanted stem cells. But in the United States of America, patients were transplanted with ordinary stem cells, which were not subjected to any antiviral mutations. Doctors acted according to the standards of anticancer therapy, since, among other things, lymphoma was also found in AIDS patients - a disease that is associated with the fact that tumors appear in the lymph nodes, and internal organs destroyed by "tumor" lymphocytes. Thus, the only thing that protected them from the virus was taking conventional antiretroviral drugs.
According to scientists, the reason for the miraculous recovery from the virus lies in the fact that the transplanted stem cells have swallowed the host's, that is, those that were infected with HIV in the body, thus, they led to the destruction of potential reservoirs of the human immunodeficiency virus.
The Boston results also indicate that antiretroviral therapy alone is effective without engaging in gene therapy support, because the cells transplanted to patients in this case did not carry any special mutations.
But there is another side to all this: stem cell transplantation is not the safest procedure, which means that if you try to really make it a way to cure AIDS, then you need to think carefully about how you can lead to a decrease in the immune risks that are associated with bone marrow transplantation. brain.
Doctors hope that the treatment will give a positive result, and then it will become a breakthrough in the treatment of the human immunodeficiency virus, although it will not be a panacea. Usually, the percentage of deaths soon after bone marrow transplantation reaches 15-20 percent. Not to mention the fact that the operation is very expensive, so it will not be available to all patients. According to Dr. Timothy Heinrich, a specialist in viral diseases and one of the authors of the study, you need to think about the fact that today the level of development of pharmaceuticals that allows you to block the virus for a long time is very high, so you need to evaluate the feasibility of such operations.
One of the messages about the successful cure of a patient from HIV came from doctors in the United States, presented their results at the International AIDS Society Conference to Kuala Lumpur. Timothy Henrich and Daniel Kuritzkes from two Boston clinics talked about two of their patients who showed no traces of HIV in their blood after bone marrow transplantation, despite the fact that one of them had not received antiviral therapy for fifteen weeks after surgery, and the other - within seven. In both cases, transplantation was prescribed to patients in connection with developing Hodgkin's lymphoma, a type of cancer of the lymphatic system.
If in the future the message of Boston doctors is confirmed, it will be a very serious success, because today it is extremely difficult to rid a person of the HIV infection that has settled in him.
The virus tends to hide in human DNA in such a way that it becomes completely elusive. The antiretroviral therapy (ART) used today helps rid the patient of viruses in the blood, however, as soon as treatment is stopped, HIV viruses reappear and begin to multiply rapidly.
Both of the patients in question had been HIV positive for approximately 30 years. Both developed Hodgkin's lymphoma (or lymphogranulomatosis), and to such an extent that neither chemotherapy nor other methods of treatment helped, and the only way to save them was bone marrow transplantation. Both operations were successful, and after them, viruses in the blood were not detected in one of the patients for four years, and in the other for two years. Even after they stopped ART therapy.
This result indirectly confirms the opinion of many experts that the bone marrow, where blood cells originate, is the main refuge for AIDS viruses.
True, the doctors themselves emphasize that it is too early to talk about treating HIV infection in this way. “We have not proven that our patients are cured,” says Timothy Henrich. - This requires much longer observations. The only thing we can say with certainty is that transplantation does not return the virus to the bloodstream for a year or two after we stop treatment, and that the chances of it returning are extremely low. ”
“We have shown,” he adds, “that the number of viruses in the blood of these patients has decreased by 1000-10,000 times. However, the virus may still be present in the brain or digestive tract. ”
In fact, the Boston medical report is not the first of its kind. It was preceded by an article in Blood magazine in 2010 about Timothy Brown, a patient at the Charite Clinic Berlin medical university... The man suffered from acute myeloid leukemia, a cancer in which altered white blood cells develop abnormally quickly. He, too, was HIV-infected and also underwent a bone marrow transplant, after which no HIV viruses were found in his blood. True, there was one peculiarity - the donor had one very rare gene mutation that protected him from AIDS viruses. Therefore, all the assurances of doctors that it was bone marrow transplantation that cured the patient of the harmful viruses did not arouse complete confidence.
But even if it is 100% proven that bone marrow transplantation can surely save a person from HIV infection, it is unlikely that it will become the standard method.
In all cases, the transplant was prescribed for the treatment of cancer, not HIV infection. It is also prescribed for cancer as a last resort. It is not only very expensive, but also very dangerous - in 20% of cases, patients do not experience such an operation. In addition, before the operation, it is necessary to weaken the patient's immune system as much as possible in order to avoid the danger of graft rejection, which is also very risky. In the Boston report, by the way, there is a report about a third patient, also HIV-positive and also forced to undergo a bone marrow transplant: he died of cancer.