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HIV Remains Suppressed in Some Patients After Treatment Withdrawal

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For millions of people with HIV (PWH), a daily regimen of medications is a lifelong necessity. If they stop taking antiretroviral therapy (ART), the virus usually rushes back within weeks.

But this isn’t the case for everyone. Scientists have been baffled by rare individuals who, after stopping the drug regimen, still keep the virus under control for months or even years. “Strikingly, a small number of people rebound much more slowly and take multiple months or even longer to rebound,” said Nadia Roan, PhD, senior investigator at Gladstone Institutes.

Studies by Roan and her team have now started to reveal why that is. Among the key findings, the team discovered two specific genes inside infected cells that act like security locks to keep the virus asleep. And perhaps most significantly, they also found that a common diabetes drug, metformin, can activate one of these locks to keep the virus in its dormant state. The results could point to potential new paths toward long-term health for people living with HIV, without the need for antiretroviral therapy.

“Our data suggest metformin might be able to delay, or possibly even prevent HIV rebound in some individuals, which is exciting because it’s a very safe and affordable drug,” said Roan. “We are now very interested in pushing forward with preclinical and eventually clinical studies to directly test these potential benefits.” Roan is senior author of the team’s published paper in Immunity, titled “Multiomic analysis of ART-interruption cohorts identifies cell-extrinsic and -intrinsic mechanisms driving lymphocyte-mediated control of HIV rebound.”

For people with HIV, antiretroviral therapy successfully controls the virus, but “reservoirs” of immune cells containing a permanent copy of HIV’s genetic code persist. “Antiretroviral therapy (ART) has been transformative for people with HIV (PWH) but is not curative as it cannot eliminate the long-lived reservoir of HIV-infected cells,” the authors wrote. If treatment is disrupted, this genetic code typically begins to generate active HIV, leading to a return of symptoms and, if left untreated, to acquired immunodeficiency syndrome (AIDS). “For most PWH, viremia typically rebounds within a period of a few weeks upon ART cessation.”

Rarely, people exhibit delayed rebound after ART withdrawal, and some, known as post-treatment controllers (PTCs), may stay in viral remission for months or even years after stopping ART. By studying these rare individuals who continue to suppress the virus even after treatment ends, Roan and her team sought to pinpoint features of immune cells that can keep the virus locked down.

A team of Gladstone scientists—including Ashley George (left) and Nadia Roan (right)—uncovered a new path toward life without daily HIV pills, suggesting that a common diabetes pill could help achieve long-term remission. [Michael Short/Gladstone Institutes]
A team of Gladstone scientists—including Ashley George (left) and Nadia Roan (right)—uncovered a new path toward life without daily HIV pills, suggesting that a common diabetes pill could help achieve long-term remission. [Michael Short/Gladstone Institutes]

They turned to four recently completed clinical trials in which people with HIV deliberately went off treatment—underwent analytical treatment interruption (ATI)—in some cases to test potential HIV cures, and were carefully monitored for HIV rebound, at which time the individuals restarted antiretroviral therapy. “Our goal was to leverage a variety of ‘omics’ tools to identify host immune responses that associate with viral rebound time upon ART cessation, and to relate these findings to HIV persistence measurements, using specimens from four recent ATI trials,” the team stated.

Roan’s group obtained blood specimens taken from 75 trial participants immediately before they paused therapy, and measured levels of genes and proteins within multiple types of immune cells from the samples to uncover associations between these features and how long it took for HIV to rebound. These efforts yielded several important discoveries. In two of the trials, delayed rebound was associated with higher levels of a specific type of immune cell known as stem cell memory CD8+ T cells. In fact, the two patients with the most extremely delayed rebound—more than 22 weeks for one and over 33 weeks for the other—also had the highest levels of these cells.

“These CD8+ T cells appear to have ‘stem-like’ features and might be able to stick around to continue replenishing themselves for prolonged periods of time, which may help them contribute to long periods of ART-free HIV control,” Roan said.

In another trial, people with an atypical type of natural killer cells rebounded later than patients with the conventional version. Natural killer cells are a type of immune cell typically thought of as destroyers of virus-infected cells. But they can also help regulate how other immune cells operate, which may impact post-therapy HIV rebound.

“All together, our findings suggest there’s probably not just one solution for suppressing HIV,” commented co-author Ashley George, PhD, research scientist at Gladstone and co-first author on the study. “By leveraging different features of immune cells that can help fight infection, we likely have multiple opportunities to control HIV without the need for ART.”

The study’s most striking findings came from some of the patients’ CD4+ T cells—the main cell type that serves as a reservoir for HIV. People whose reservoir cells had higher levels of two particular genes, DDIT4 and ZNF254, tended to have longer HIV rebound times after stopping antiretroviral therapy. In follow-up lab experiments, Roan and her team confirmed that both genes can suppress HIV.

George added, “Both genes represent possible new targets for a promising ‘block and lock’ strategy for curing HIV, in which drugs would first be used to block HIV activation, followed by ways to make this block permanent.”

This approach is a major focus of the HIV Obstruction by Programmed Epigenetics (HOPE) Collaboratory, a multidisciplinary group of researchers, including Roan and other co-authors on the new study, working toward an HIV cure. When the scientists further analyzed publicly available data, they uncovered more supporting evidence. They found that people with higher levels of the two genes had reduced HIV activity in their cells. And, in “elite controllers”—people whose bodies naturally suppress HIV from the start of infection, even without therapy—levels of the gene ZNF254 among CD4+ T cells are much higher. “One possibility we’re imagining for the future is that we could somehow deliver ZNF254 to infected cells in order to turn people into elite controllers,” George said. “We could also try to engineer an even stronger version of this gene.”

But of all findings in the new study, the link between gene DDIT4 and delayed rebound may have the most immediate ramifications for patients. That’s because levels of this gene can be boosted by the drug metformin—something that had already been observed by the scientific community in non-immune cells, and which this study demonstrated is also true in T cells.

This led the scientists to conduct a series of experiments to validate whether metformin can help suppress HIV. In one notable experiment, treating cells taken from people with HIV with metformin blocked the ability of HIV to reactivate, suggesting a possible role for this drug in helping achieve “block and lock.” In their paper, they stated, “Metformin induced DDIT4 and suppressed HIV expression in primary cells and cells from ART-suppressed PWH, suggesting that this affordable diabetes drug could be repurposed to silence HIV. Our  results support the pursuit of both immune- and HIV-silencing strategies to achieve ART-free HIV remission.” Next, the team is planning to test metformin and related compounds in a variety of preclinical models for their ability to prevent HIV reservoir cells from generating active HIV upon interruption of antiretroviral treatment.

“Future studies should examine the extent to which DDIT4 and ZNF254 can mediate post-ATI control in other cohorts, and test the therapeutic potential of targeting the pathways associated with these genes,” the team stated.  “For example, we propose the implementation of a placebo-controlled ATI trial testing the effects of metformin treatment both during ART and post ATI,” they further wrote.

Drugs that effectively silence HIV could also have health benefits even for those who stay on antiretroviral therapy. This is because the drugs can limit the levels of viral gene products—a driver of inflammation—that these individuals are chronically exposed to.

“We are excited to pursue HIV silencing strategies both as a way to achieve block and lock, but also as a strategy to improve the overall health of people with HIV by lessening chronic inflammation,” Roan said.

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GEN – Genetic Engineering & Biotechnology News

Bioengineered Implants Deliver Multi-Drug Therapy in Animal Models

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In a new paper, scientists from Northwestern University and their collaborators at Rice University and Carnegie Mellon University report on their progress towards developing so-called implantable “living pharmacies.” These are tiny devices containing engineered cells that continuously produce medicines inside the body. Details of the study, which was done in rats, are published in Device in a paper titled “Design of a wireless, fully implantable platform for in-situ oxygenation of encapsulated cell therapies.” 

The device, which is called the hybrid oxygenation bioelectronics system for implanted therapy or HOBIT, is roughly the size of a folded stick of gum. It integrates engineered cells with oxygen-producing bioelectronics and is designed in such a way that the cells are shielded from the body’s immune system while also receiving oxygen and nutrients needed to keep them alive and producing drugs for several weeks. In the future, these devices could be deployed to treat chronic conditions without requiring patients to carry, inject, or remember to take medications. 

“This work highlights the broad potential of a fully integrated biohybrid platform for treating disease,” said Jonathan Rivnay, PhD, a professor of biomedical engineering and materials science and engineering at Northwestern and a co-principal investigator of the project. “Traditional biologic drugs often have very different half-lives, so maintaining stable levels of multiple therapies can be challenging. Because our implanted ‘cell factories’ continuously produce these biologics, keeping the cells alive with our oxygenation technology allows us to sustain steady levels [of] multiple different therapeutics at once.”

Solving the oxygenation challenge was critical to the success of HOBIT. When engineered cells are packed together in an implant, they compete for oxygen to live. Without a steady supply, many cells die, which limits how much medicine the implants can produce. In an earlier study, Rivnay and his collaborators demonstrated how a tiny electrochemical device could generate oxygen by splitting nearby water molecules, and showed that supplying oxygen locally dramatically improved the survival of implanted therapeutic cells. The latest iteration of their device integrates that oxygen-generation technology in a fully implantable, wireless system.

Digging into the details of the device, HOBIT contains three primary components: a cell chamber that holds the genetically engineered cells, a miniature oxygen generator, and electronics and a battery to regulate oxygen production and wirelessly communicate with external devices. Because the device produces oxygen directly inside the implant, the cells receive a steady supply even in hypoxic environments. “We are producing oxygen directly where the cells need it,” Rivnay said. “That allows us to support much higher cell densities in a much smaller space.” In fact, “cell densities in HOBIT were roughly six times higher than conventional unoxygenated encapsulation approaches.”

According to the paper, the team engineered the cells to produce three different biologics—an anti-HIV antibody, a GLP-1-like peptide used to treat type 2 diabetes, and leptin, a hormone that regulates appetite and metabolism. They implanted the devices under the skin of rats and monitored drug levels in their bloodstreams for 30 days. Blood measurements of animals with the implanted devices showed sustained levels of all three biologics throughout the study period. In contrast, in animals that were implanted with devices without oxygenation, the biologics that had shorter half-lives were undetectable by the seventh day. Drugs with longer half-lives in these animals also declined steadily over time. At the end of the testing period, roughly 65% of the cells in the oxygenated devices remained viable compared with roughly 20% in control devices.

For their next steps, the scientists intend to test their devices in larger animal models and explore disease-specific applications, including therapies based on transplanted pancreatic cells. “As these technologies continue to develop, devices like this could eventually act as programmable drug factories inside the body—delivering complex therapies in ways that simply aren’t possible today,” Rivnay said. 

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Gut-Immune Link Identified in Multiple Sclerosis-Related Neuroinflammation

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Multiple sclerosis (MS) is a debilitating neurological disorder caused by malfunctioning immune responses that target the brain and spinal cord of the central nervous system (CNS). New research led by Shohei Suzuki, MD, PhD, assistant professor, division of gastroenterology and hepatology, and Tomohisa Sujino, PhD, associate professor, School of Medicine, at Keio University, Japan, has now indicated how the gut can initiate neuroinflammation in multiple sclerosis.

Their study found that intestinal epithelial cells (IECs) promote the development of pathogenic T cells that migrated to the spinal cord and induced disease symptoms in mouse models of the disorder.

The researchers examined intestinal tissues from patients with MS and mice with experimental autoimmune encephalomyelitis (EAE), a close analog of MS. In both cases, they observed an increase in TH17 cells and an upregulation of major histocompatibility complex class II (MHC II) expression in IECs. Deleting MHC II in IECs reduced the accumulation of TH17 cells in the gut and lowered the severity of EAE. They suggest the results could inform future strategies for developing targeted therapeutics against autoimmunity.

“While current therapies for MS often target B cells, our study highlights the gut as an important therapeutic site,” Suzuki commented. “Modulating intestinal microbiota or antigen-presenting activity of IECs represents new approaches to treating autoimmune neurological diseases.”

Suzuki, Sujino, and colleagues reported on their findings in Science Immunology, in a paper titled “Intestinal Epithelial MHC Class II Induces Encephalitogenic CD4⁺ T Cells and Initiates Central Nerves System Autoimmunity,” in which they concluded, “Our findings reveal an interaction between gut IECs and neuroinflammatory diseases through MHC II expression in human MS and mouse EAE, providing a mechanistic link between gut immune education and CNS autoimmunity and opening new avenues for targeting intestinal immunity in neuroinflammatory diseases.

Failure of the immune system to distinguish ‘self’ from ‘non-self’ entities leads to excessive autoimmune responses against self-proteins like myelin, which forms a protective covering on the neurons. Multiple factors influence the onset and progression of MS, including genetic susceptibility, environmental triggers, and, more recently, the gut microenvironment. Patients with MS exhibit alterations in their gut microbiota, while the gut microbiota and microbial metabolites play a pivotal role in shaping the chronic autoreactive immune responses.  “…  in an experimental autoimmune encephalomyelitis (EAE) model, commensal or specific microbes were found to be essential for disease initiation and progression,” the authors wrote.

However, in trying to define this gut–CNS axis, the cellular mechanisms that relay the gut-derived signals to the immune system to influence autoimmune inflammation in the CNS remain poorly understood. “Increasing evidence shows that the gut microbiota influences neurological diseases such as Parkinson’s, Alzheimer’s, and MS,” Sujino stated. “However, the mechanisms linking gut microbes, intestinal immunity, and brain inflammation remain unclear. We were keen to identify how gut immune responses contribute to neuroinflammatory diseases.”

Prior research has shown that gut-derived signals can promote the differentiation of T cells into pathogenic T helper 17 (TH17) in mouse models of MS. Recent studies have suggested that IECs can function as antigen presenting cells that help induce these pathogenic cells, but the underlying mechanisms have been unclear.

Building on their previous observation that mild intestinal (ileal) inflammation exists in experimental autoimmune encephalomyelitis (EAE), which is a mouse model of MS, the authors set out to test whether similar inflammation is present in patients with MS. By performing single-cell RNA sequencing on intestinal biopsies, the team identified that inflammatory Th17 cells accumulate in the mouse EAE model as well as in the intestine of patients with MS, suggesting a conserved gut–CNS axis that may be active in human diseases.

In both EAE mice and patients with MS, intestinal epithelial cells upregulated antigen presentation pathways. Particularly, epithelial cells in the ileum had higher expression of major histocompatibility complex class II (MHC II) that presents antigens to CD4+ T cells. “Clinically, patients with MS exhibited an increased expression of epithelial MHC II–associated genes and an accumulation of CD4 T cells in the small intestine, suggesting the conservation of this gut-CNS axis in human diseases,” the scientists stated. Experiments showed that selective deletion of MHC II in IECs reduced pathogenic Th17 cell generation and disease severity. “Conditional deletion of MHC II in IECs showed that epithelial antigen presentation was indispensable for the local expansion of pathogenic Th17 cells in the gut and their subsequent migration to the CNS,” the team stated.

Immunofluorescence analysis was performed on terminal ileum samples from Cnt, IECΔMHCII, Cnt + EAE, and IECΔMHCII + EAE mice. A total of 3–5 tissue sections were analyzed per mouse, with 3 mice included in each group. [Shohei Suzuki]
Immunofluorescence analysis was performed on terminal ileum samples from Cnt, IECΔMHCII, Cnt + EAE, and IECΔMHCII + EAE mice. A total of 3–5 tissue sections were analyzed per
mouse, with three mice included in each group. [Shohei Suzuki]

IECs do not typically present antigens to immune cells. So, the team conducted co-culture assays to test the antigen presentation function of IECs. Their findings demonstrate that IECs can directly present antigens in an MHC II-dependent manner to prime CD4+ T cells in the gut. Notably, in these assays, IECs induced Th17 polarization of activated CD4+ T cells. It became clear that the gut was a critical site for immune activation of pathogenic CD4+ T cells that polarized into pro-inflammatory Th17 cells. “These findings provide direct functional evidence that IEC-expressed MHC II is sufficient to drive Th17 polarization from primed CD4 T cells in an antigen-dependent manner, supporting a direct role for IECs as non-professional antigen-presenting cells,” the scientists reported.

To investigate whether the Th17 cells directly contribute to the pool of autoreactive cells in the CNS, they used transgenic mice that express the Kaede protein, which undergoes photoconversion from green to red fluorescence upon exposure to violet light. This model allowed for precise tracking of pathogenic Th17 cells induced in the intestinal lamina propria that then migrate to the spinal cord and drive neuroinflammation.

Taken together, the study findings reveal a critical role for MHC II expressed by IECs in the expansion of pathogenic Th17 cells that subsequently migrate to the CNS during EAE, providing a mechanistic link between gut immune responses and autoimmune neuroinflammatory diseases. The results demonstrate that while systemic circulation allows T cell exchange across immune tissues, the epithelial–immune interactions within the gut mucosal compartment can essentially shape effector T cell responses in the brain.

“This study reveals a previously unknown role of IECs in antigen presentation and Th17 programming, thereby defining a gut-CNS immunological axis with important implications for understanding and treating autoimmune neuroinflammation,” the authors concluded. “Our findings suggest that the modulation of epithelial antigen presentation could serve as a novel therapeutic approach for MS and related diseases. Given the accessibility of the gut epithelium to dietary, microbial, and pharmacological interventions, targeting IEC–T cell interactions may offer a tractable strategy for immunomodulation.”

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Agentic AI, Virtual Cell, LNP Vaccine Boosters, Engineered Organs, and Mergers

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This week, agentic AI steps into the limelight buoyed by the momentum from generative AI. And there’s a new virtual cell model in town courtesy of AI-drug developer Xaira Therapeutics. From the frontiers of AI, our discussion turned to feats of engineering in regenerative medicine and lipid nanoparticles. In one study, scientists redesigned LNPs to avoid the liver and accumulate in the lymph nodes. In the other, efforts to develop and implant a lab grown esophagus from donor pigs bear fruit. Finally, Novartis plans to spend up to $3 billion to expand its cancer pipeline with the acquisition of Pikavation Therapeutics. And Merck is acquiring Terns Pharmaceuticals for approximately $6.7 billion also with an eye towards boosting its cancer portfolio.

 

 

Listed below are links to the GEN stories referenced in this episode of Touching Base:

NVIDIA GTC 2026: Agentic AI Inflection Hits Healthcare and Life Sciences
By Fay Lin, PhD, GEN Edge, March 18, 2026

Xaira’s First Virtual Cell Model Is Largest To-Date, Toward Complex Biology
By Fay Lin, PhD, GEN Edge, March 25, 2026

Modified Lipid Nanoparticles Boost mRNA Vaccine Delivery to Lymph Nodes
GEN, March 24, 2026

Engineered Esophagus Rebuilds Missing Organ Segment in Pig Models
GEN, March 20, 2026

Novartis Acquires Pikavation for Up to $3B, Expanding Cancer Pipeline
GEN, March 22, 2026

Merck Bolsters Cancer Pipeline with $6.7B Terns Buyout
By Alex Philippidis, GEN Edge, March 25, 2026

Touching Base Podcast
Hosted by Corinna Singleman, PhD

Behind the Breakthroughs
Hosted by Jonathan D. Grinstein, PhD

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