By Georgia Parmelee
A new HIV treatment aimed at women could be on the horizon with Phil Santangelo’s RNA-based solutions
Women continue to be disproportionally affected by HIV around the world, but particularly in sub-Saharan Africa, where three in four new HIV infections are among young girls. For women seeking care in developing countries, preventing and managing HIV is an expensive proposition. Truvada, the pre-exposure HIV treatment drug commonly known as PrEP, costs about $1,500 a month and must be taken daily for continual HIV protection. Likewise, the antiretroviral therapies that attempt to control HIV infection are costly at nearly $20,000 a year. These oral medications as therapy are a non-starter in developing nations like Africa, where nearly 30 million people are infected with HIV.
But Phil Santangelo, biomedical engineering professor at Georgia Tech, has another approach in mind. He’s working on an aerosolized RNA-based HIV preventative that eventually could protect women against the disease. It’s applied vaginally and, currently, the aerosol has been tested in pre-clinical trials. The early results are promising; it’s been shown to create HIV antibodies that ward off the infection. It also has the potential to protect against genital herpes and other pathogens, depending on what protein the RNA encodes for.
“A single administration of this aerosol is showing expression of antibodies against HIV for up to three months in pre-clinical trials,” said Santangelo. “Our hope is that this will be more affordable, granting easier access to women in developing countries, especially. With women’s health at the forefront of many conversations today, this has the potential to revolutionize disease prevention.”
Eventually, Santangelo says RNA could be used for contraception as well – the RNA would express antibodies that inhibit sperm. Again, if birth control can’t be accessed in developing countries, a self-administered, inexpensive aerosol could change the lives of many women.
So, how does this seemingly magical preventative work? In Santangelo’s lab, he manufactures RNA – the messenger molecule that typically encodes proteins, which help the body create cells and thrive. Because RNA can more easily enter the body’s cells, it is very effective when used for various therapeutics and vaccines. It’s a safer option, and it’s transient – meaning the RNA therapy can be used for a shorter amount of time to treat the disease, but also be administered again if needed. RNA can easily cross into the body via mucosal membranes existing in the cervix, vagina and uterus, which is especially important for the female HIV preventative.
“With RNA-based solutions, the body can easily produce the antibodies that prevent the disease when administered as an aerosol,” said Santangelo. “It also ensures the treatment is localized, which is critical.”
Women and HIV
18.8 million women and girls are living with HIV
AIDS-related illnesses are the leading cause of death among females between the age of 15 and 49
1.8 million children are born with HIV, contracted from their mothers
In sub-Saharan Africa, 3 in 4 new HIV infections in teenagers are among girls
There are 5,000 new HIV infections per day
Santangelo envisions greater access to this type of treatment as well.
“Women would be able to discreetly purchase an aerosol that protects against various diseases, use it and then throw it away, avoiding social stigma,” said Santangelo. “They would have complete control of their health. We still need to work on applicator design, but the data is really exciting and promising.”
Santangelo also works on RNA therapies that prevent RSV – a respiratory illness that affects babies and immunocompromised people. The treatment is inhaled, so it goes directly to the lungs to administer the antibodies. A patient could be protected for months with one dose of the therapy. Currently in pre-clinical trials, the aerosol is seen to protect against RSV for more than a month.
Another aerosolized treatment, a flu vaccine taken via an inhaler, could also be on the horizon, helping the lungs resist flu infection.
“In addition to RNA expression of antibodies, we have also moved towards the use of RNA editors as antiviral drugs,” said Santangelo. “We are working with the U.S. Department of Defense to aerosolize these with the goal of eventually coming up with a flu treatment. If we can administer it via the lung, protection is going to be far greater than an injection, and the general public will greatly benefit from this.”
While the future of aerosol treatments is still uncertain, Santangelo is excited by the prospect of having treatments ready for human drug trials by 2024.
Santagelo in his lab.