Miami Herald - Tuesday, December 29, 1992
Linda Roach Monroe, Herald Health Writer

The method, cell therapy, will be tested in 20 San Francisco General Hospital patients with Kaposi's sarcoma, the otherwise rare cancer that is common in AIDS patients, said Dr. Alton Kremer, medical director for AIDS and cancer at Applied Immune Sciences, the Santa Clara, Calif., firm whose cell-separating machine makes the experiment possible.

The company also sponsored a year of Miami experiments that -- although designed only to show the technique's safety -- have hinted at cell therapy's effectiveness. A 10-person trial in Kaposi's patients began in Miami last July.

Cell therapy takes infection-fighting white blood cells out of the body, grows them in special chemicals in the lab, then returns them to the patient with a boost from interleukin-2, a protein that makes them work better.

"We're seeing what we term a partial response, pretty much across the board," said Dr. Nancy Klimas, director of AIDS research for the Veterans Administration Medical Center in Miami.

In none of the 10 patients has the result been as dramatic as in an earlier trial that included two Kaposi's patients. One of them, unable to walk because of swollen legs, went dancing after cell therapy.

In the current Miami experiment, the most notable improvement was reduced swelling, although it wasn't that dramatic, Klimas said. Dark Kaposi's tumors under the skin also regressed somewhat in most of the patients, she said.

"It's not as dramatic a response as I'd hoped," Klimas added. "I wouldn't call it a breakthrough, but I wouldn't call it disappointing."

Only one patient experienced an adverse effect from the therapy -- allergic hives that were controlled with antihistamines.

"That was the only adverse reaction I saw, which was remarkable, considering how intense this therapy is," Klimas said.

Commonly, interleukin-2 causes high fever and other symptoms that make it difficult for doctors to use it against cancer. Cell therapy avoids that problem by making the cells extra-sensitive to the protein, so lower doses can be used.

Klimas' results have not been finalized, but in combination with the studies in Miami and Pittsburgh, they allowed the San Francisco experiment to begin.

Applied Immune Sciences and Dr. James Kahn at San Francisco General recruited the first of 20 patients last week, Kremer said.

"We need to find other and powerful ways to affect HIV, to affect the consequences of immune suppression and begin to explore ways to even restore immune functions," Kahn told Associated Press recently. "This is one novel way to evaluate that. That's its promise."

Kahn said he hopes to present preliminary results from the study at the international conference on AIDS in Berlin in June.

Klimas also is looking at how to make cell therapy work better and more broadly. She is talking with Applied Immune Sciences about trying cell therapy in children, against viral eye infections that blind AIDS patients, and against the AIDS virus itself.

"I'd like to take the same idea and do adaptations to the cells that make it more effective," Klimas said. "For instance, exposing the cells in the culture dish to the antigens (disease agents) you want them to attack. That would make them more targeted, and that would be exciting."

Her aim is to do the small, ground-breaking experiments that convince other researchers to test cell therapy in more patients.

"This is a clever method, but there's still a lot unknown about this," she said. "We don't know if we should be using patients whose immune systems are so far gone, or if we should be doing this to people whose immune systems are much healthier."

CAPTION: PHOTO Nancy Klimas (AIDS)
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