【翻譯】艾滋疫苗對某些人有「治癒作用」

AIDS vaccine may be 『functional cure』 for some

艾滋疫苗對某些人有「治癒作用」

Jon Cohen

SEATTLE, WASHINGTON—Positive resultsfrom small clinical studies without control groups often get dismissed asanecdote, and for good reason: Many don』t pan out in more rigorous trials. Butwhen a field suffers as much failure as the search for an AIDS vaccine has overthe past 30 years, researchers sometimes celebrate glimpses of hope.

西雅圖，華盛頓——來自沒有控制組的小型臨床研究的積極結果總是被作為杜撰而排除，並且都有一個不錯的原因：這些實驗沒有經過更加嚴苛的實驗。但是當一個領域像艾滋病疫苗研究一樣，在過去的三十年里，研究者們一旦發現一絲希望，便會欣喜若狂。

That』s whathappened here last week when scientists showed that a vaccine may have helpedfive people already infected with HIV keep the virus in check—a 「functionalcure」 as some call it. The results, which need to be confirmed in largerstudies, suggest the vaccine may boost the immune system enough to allowinfected people to drive down HIV levels without taking drugs—although it』s notclear for how long.

這正是在西雅圖上個星期所發生的，科學家展示疫苗可能幫助五個艾滋病患者檢查——正如他們所言「功能性解藥」（譯者註：只事實上有效果，但以目前科技無法解釋其原理。我國許多中藥屬於這一範疇）這一結果需要在大型的研究之中得到證實，疫苗會先行攻擊患者免疫系統，使其HIV病毒濃度降低而無需藉助藥物——儘管時長並未獲得確認。

「It』s the proofof concept that through therapeutic vaccination we can really re-educate our Tcells to control the virus,」 says Beatriz Mothe, a clinician at IrsiCaixa AIDSResearch Institute in Barcelona, Spain, who presented theresults here at the Conference on Retroviruses and Opportunistic Infections.「This is the first time that we see this is possible in humans.」

「這是對於這種概念的證明，我們能夠通過使用治療性的疫苗來重新培育T細胞以控制病毒。」貝特·莫斯說道，他是一位臨床醫師，工作於西班牙一家rsiCaixa艾滋研究所。他在這裡的逆轉錄病毒酶和可能的影響的會議上展示了實驗結果。「這是我們第一次在人類中看到這種可能性」

Despiteintensive efforts and massive investments, no vaccine to prevent HIV infectionhas yet proved itself and come to market. Researchers have also testedso-called therapeutic vaccines, which aim to help infected people keep thevirus at bay for months or even years without antiretroviral (ARV) drugs. Motheand her colleagues tried that strategy with an HIV vaccine made by Tomá? Hankeof the University of Oxford in the United Kingdom.

儘管有著不懈的努力和高額的投資，目前為止，還沒有疫苗能證明疫苗能夠抵禦HIV,並被准入市場。研究者們還在檢測所謂的治療性疫苗，這指望能幫助被感染人群能使病毒潛伏數月甚至數年而無需ARV藥物。莫斯和她的同僚們嘗試了這種治療方法，使用由英國牛津大學的教授托馬斯·漢克研製的疫苗。

The 13participants in the study had taken ARVs on average for 3.2 years; all hadstarted treatment within 6 months after becoming infected, which helped keepHIV in their blood down to undetectable levels on standard tests. (Moresensitive tests used solely for research purposes can detect HIV in allinfected people.) The researchers theorized this had limited HIV』s ability tointegrate into their chromosomes, leaving them with relatively small「reservoirs」 of infected cells. This, in turn, should make it easier for themto contain the virus if ARVs are stopped—especially with a helping hand from avaccine.

實驗中的13名參與者都已經平均使用ARV藥物3.2年了。他所有已經開始的治療都在感染後的六個月以內，這幫助他們他們講HIV病毒的濃度降至可被發現的限度以下。（更加銘感的測試使用單獨的研究目的在感染者中檢測HIV病毒）研究者們理論化了這有限的HIV病毒能力來綜合他們的被感染的細胞。這，反過來，應該是獲得病毒更加容易，一旦他們停止使用ARV藥物——尤其是從疫苗中獲得一臂之力。

After receivinga series of three shots of the vaccine, the participants stopped taking ARVs.Within 4 weeks, the virus came roaring back in eight of them. The other five,however, have now gone between 6 and 28 weeks without having to restarttreatment. Each of these 「controllers」 has had the virus become temporarily detectableat some point, but these 「blips」 have never gone above 2000 copies permilliliter on two occasions—the study』s criterion for restarting ARVs.

在接受了一系列三針疫苗，實驗者停止使用ARV藥物。在四周以內他們中的八個又染上病毒，但是剩下的五個，在接下來的6到28周都無需再次治療。他們的每個「開關」都使得病毒智能在一些特定的位置才能被短暫的檢測到。但是這些「溢價結構」從來沒有超過千萬分之2000，在兩種情形下——需要重新使用ARV藥物的標準。

Of more than 50therapeutic vaccine trials so far, this is the first one that has bolstered theimmune system in a 「meaningful」 way, says Steven Deeks, an HIV/AIDS clinicianand researcher at the University of California, San Francisco, who is「cautiously optimistic」 that the data will inspire others to study theapproach.

在目前的超過五十份治療性疫苗實驗之中，這是第一個加固了免疫系統，以一種「有意義」的方式斯蒂夫·迪克斯說道，他是一位艾滋病的臨床醫師，同時也是加州大學舊金山分校的研究員。他對這份數據能否啟發其他研究者研究次途徑持「謹慎樂觀」的態度。

The evidence didnot bowl over immunologist Daniel Douek of the National Institute of Allergyand Infectious Diseases in Bethesda, Maryland, however. 「The results areencouraging, but it is difficult to gauge what the effect of the procedureactually was because of the uncontrolled nature of the study and the fact thatthe people who remain off [ARVs] are, nevertheless, viremic,」 Douek says.

證據並沒有並沒有超越免疫學家丹尼爾·多可的預期，他工作於馬里蘭的國家過敏及傳染病研究所。但是，「這結果是令人振奮的，但是並不能估計這療程的影響確實是由未經控制的自然研究並且和他們身體內殘留的藥物(ARV)引起說道」他如此說道。

But Mothestresses that previous 「treatment interruption studies」 in people who startedARVs soon after becoming infected have found that only 10% control theirinfections for longer than 4 weeks. In this case, 38% of the participantspassed that milestone. Deeks agrees. 「Should the current trends persist, it ishard to argue that the vaccine strategy did not do something, but controlledstudies are needed,」 he says.

但是莫斯強調之前的在哪些使用ARV藥物的「打斷治療研究」足夠迅速，他們只發現僅僅10%的殘留，而且持續也不超過四星期。在這例實驗中，38%的參與者越過了這一里程碑。迪克斯也同意：「應當是現在的堅持，難以爭辯這個疫苗策略無用，但是控制組仍然需要」他這麼說道。

HIV notoriouslydodges immune attack—and preventive vaccination—by mutating. Deeks and othersbelieve the trial may have been partly successful because the vaccine containsHIV genes that code for 「highly conserved」 internal structures and enzymes thatcannot change much without harming the virus. Before the vaccination, only 4%of the participants』 cytotoxic T lymphocytes (a type of white blood cell thathelps control infections) specifically targeted these conserved proteins; aftervaccination, that jumped to 67%.

艾滋病毒因親攻擊人體免疫系統而臭名昭著——還有預防性疫苗——通過轉變。迪克斯和其他研究者堅信這份實驗獲得了一些成功，因為這疫苗使得含有逆轉錄病毒基因的行為方式被「高度保存」其內部結構和並不能破壞病毒結構的酶。在疫苗之前，只有百分之四的參與者的T細胞（一種用來幫助控制癥狀的白細胞）對這種目標蛋白進行瞄準，在疫苗之後，這概率上升至67%。

「I』m prettyexcited about this,」 says Sharon Lewin, who heads the Peter Doherty Institutefor Infection and Immunity in Melbourne, Australia. 「But there are lots ofquestions.」 Mothe and colleagues hope to answer them by continuing to monitortheir participants and staging a larger, more rigorous trial of the conceptsoon.

「我對這一結果感到很興奮。沙朗·樂文說道。他領導位於澳大利亞墨爾本的皮特·多何地感染免疫研究所「但是仍有許多的問題」莫斯和他的同僚們希望能夠通過對參與者的持續觀察希望能獲得答案。他們將會呈現更大且更加困難的理念進行研究

本文來自Science官網

版權歸作者本人所有

譯者為南菁高中學生

譯文首發於微信公眾號：小橙同學MrChen

推薦閱讀：