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Dr. Josep M. Gatell

head of the Infectious Diseases and AIDS Service at IDIBAPS-Hospital Clínic of Barcelona and co-director of HIVACAT

Professor, head of the Infectious Diseases and AIDS Service at IDIBAPS-Hospital Clínic of Barcelona and co-director of HIVACAT, a project researching an AIDS vaccine in Catalonia developed by a private-public consortium, which has put our country on the international forefront in this arena. Dr. Josep M. Gatell began treating HIV patients in 1982, during his tenure at Massachusetts General Hospital in Boston. At that time, there were no cases of this disease in Spain. Today, his name is closely linked to a possible candidate for a therapeutic vaccine for this disease.

AIDS is the epidemic with the highest impact worldwide and one of the most serious public health problems, according to the World Health Organization (WHO). In Spain, there are some 140,000 people infected with HIV (the Acquired Auto-Immune Deficiency Virus), some 30,000 of which are in Catalonia.

The first antiretroviral drug dates from 1987. Just a few years later, by 1996, this drug was allowing patients a normal quality of life, similar to other chronic diseases, which was a major breakthrough in the medical history of this pandemic. Treatment with antiretroviral drugs, however, is only available to 30% of the 10 million patients who need it. The hope is to reduce the impact of AIDS with a preventative vaccine.

Last September, the 8th International Retroviral NC Symposium was held in Barcelona by “la Caixa” Welfare Projects, HIVACAT and the International Center for Scientific Debate (ICSD) under the scientific direction of Dr. Gilles Mirambeau and Josep M. Gatell. This event brought together one hundred international experts in virology, molecular biology, biophysics, structural biology, genetics, biological chemistry and molecular pharmacology to share the latest breakthroughs in their research. The aim was to find new lines of collaboration to accelerate the study and exploitation of these proteins applied to antiviral therapies for illnesses like AIDS and the flu. The event featured Dr. Françoise Barré Sinoussi, 2008 Nobel Laureate in Medicine for the discovery of HIV and researcher at the Pasteur Institute in Paris, who opened the symposium with a keynote conference entitled Past success and future challenges in identifying key HIV pathogens.

Scientists have been working on a vaccine for carriers of the HIV virus for the past five years.

We are working on two different lines, the therapeutic vaccine and the preventative vaccine, which are complementary but each have a completely different end goal. HIV is the only infectious disease that must be treated throughout the patient’s life. What we aim to do with the therapeutic vaccine is to administer it and then take the patient off antiretroviral drugs without an increase in viral load. For the past five years —before HIVACAT was created— we have been working on a type of therapeutic vaccine based on dendritic cells, for which we have carried out three pilot studies in Phase I. Two studies have been published and are very encouraging, and the third has just finished and will be published soon.

Did you present this work at the symposium last September?

At the HIVACAT —symposium parallel to the International Retroviral NC Symposium— we spoke about preventative vaccines. We presented two complementary lines that are currently in the preliminary stages. One line is composed of vaccines that stimulate cell immunity, which is done by using a vector to which selected HIV genes are added. Dr. Christian Brander —scientific coordinator of HIVACAT— has prepared a series of immunogenes to incorporate into these vectors. The second line, led by Dr. Eloísa Yuste, is based on neutralizing antibodies. Most preventative vaccines, those routinely used, are based on this type of antibodies. In the case of HIV, this had been discarded as it seems highly problematic. However, research carried out over the past four years seems to show that the only way to obtain a true preventative vaccine is to stimulate the production of antibodies  —neutralizing or non-neutralizing.

What value added is derived from the fact that these scientific debates are international and multidisciplinary?

In the field of AIDS research, and in that of vaccines specifically, it is key for collaborations to take place on a national and international level. We have collaborated with Dr. Mariano Esteban, who has also developed a candidate for a preventative vaccine in Madrid; vector production for the candidate Dr. Christian Brander is working on will be done in Oxford; on Dr. Eloísa Yuste’s project we collaborate with Dr. José Alcamí of the Carlos III Institute and two international groups…

With a complicated subject, like HIV has shown to be as 30 years have passed and we still don’t have a solution, there are voices that call for the incorporation of biochemists, bioinformatics technicians, crystallographers, physicists, etc. to contribute their ideas and collaborations. The results of this will be seen some times from now. For now, at the very least we can say that this enriches the process and in the best case scenario could help find a solution.

AIDS Vaccine 2013, the most prestigious scientific congress in the world focusing exclusively on research into an HIV vaccine, will be held in Barcelona. Are we close to finding a therapeutic vaccine?

After Boston (2012) the congress will come to Barcelona. I believe this is an international recognition of the critical mass of scientists we have here in this field. AIDS Vaccine is a yearly congress of some 1,500 people. If we don’t get stuck along the way, we hope to be close to finding a therapeutic vaccine.

What obstacles have you faced along the way?

Funding is progressing well. The first four years of the project were funded by the “la Caixa” Foundation, the Catalan Departments of Health and Universities, the Clínic Foundation and Laboratoris Esteve. In mid-2012 we will have to see how we renew our funding, for at least for more years. The aforementioned institutions have said they are committed to continuing, despite the fact that we are currently facing a difficult economic situation.

Regarding science, things have improved greatly. Barcelona has become a center of research with an ever-increasing critical mass, which offers the opportunity to collaborate with other fields. It is an attractive place for foreign researchers and some of the most representative members of our team —Christian Brander and Eloísa Yuste— left Harvard after 10 years to come to Barcelona. It is important to offer competitive salaries and this must be continued despite the current panorama.

Would you recommend that other research projects apply the Hivacat formula, a public/private consortium in which two cutting-edge hospitals —Clínic and Can Ruti— work together and set aside prior rivalries?

It isn’t easy. This formula has yielded positive results because it has allowed each center to continue with their AIDS research independently, but with regard to a specific topic, that of immunopathology and vaccines, we have joined teams and forces. It is difficult to do because it requires a culture of collaboration and not competition. It’s a formula that is worth taking into account, but the team leaders, in this case Dr. Bonaventura Clotet and myself, must be sure of the dynamic and set aside personal ambition in some cases. Afterwards, little by little, this is transmitted to the rest of the team. Externally the formula has also been well received, even on an international level, and on a local level has helped us find funding. We could say that it has yielded scientific, economic and image-related results.

When the time comes, Laboratoris Esteve will take over the clinical development through to the marketing of the vaccine. Is it important that a Catalan pharmaceutical company play this role?

Well, it’s very important. Laboratorios Esteve is a mid-sized Catalan company with a high degree of internationalization. This is important because it’s easier to work with people here at home. I wouldn’t be surprised, however, if, once we reach an advanced stage of development, we decide to team up with a larger partner to complete the development process (investment between €500 and 1,000 millions for Phase III).

Would the vaccine be available at a price that would make it affordable for continents that are highly affected by this disease, like Africa?

The cost is significant, but we can’t think about that now. If you have a vaccine that works against the AIDS virus and is viable from a technological standpoint, don’t worry, the resources will be found to make it available to everyone who needs it. Although there have been problems with access to retroviral drugs, with vaccines we always find a way for them to be made available wherever necessary. We can’t stop working on a vaccine just because it would be expensive.

How much of Catalonia’s healthcare budget goes to chronic diseases like AIDS?

30% of all pharmacy expenditure (in-hospital and outpatient) at Barcelona’s Hospital Clínic goes to AIDS-related illnesses. So, some €150 millions, approximately, must be spent in Catalonia, although this is one of the most cost-efficient medical interventions.

The doors have been opened so that the general public can make donations to fund research into this vaccine. What has response been like?

You can look for one large donor or move into the field of micro-donations. We came up with the idea to apply the latter, which can be done through the website, but we haven’t publicized it enough. We’re receiving donations but there is the potential for a lot more than what we have received so far.

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