Can a combination immune therapy reduce genital herpes outbreaks?

[Forest]

https://news.yale.edu/2019/08/01/can-combination-immune-therapy-reduce-genital-herpes-outbreaks

[LightafterDarkness]

Very intriguing and great to see continued momentum in the space. Would love to see this go to Phase I in 2020/2021

This is the first news (in awhile?) regarding the HSV-2 Trivalent vaccine from Penn (Dr. Harvey Friedman) that had some serious buzz about it 1-2 years ago. I am also a fan of the prime and pull since it comes from the highly regarded Akiko Iwaski who is an all-star in the field. If you play this forward I think that the pull (addition of the cream) needs to be done directly in the clinic, I would be suspicious of asking patients to do this at home as uptake rates would likely be lower.

From Jan 2017:

https://www.acsh.org/news/2017/01/19/and-then-there-were-three-new-trivalent-herpes-vaccine-enters-scene-10748

 

 

[JHenry]

5 hours ago, LightafterDarkness said:

Very intriguing and great to see continued momentum in the space. Would love to see this go to Phase I in 2020/2021

This is the first news (in awhile?) regarding the HSV-2 Trivalent vaccine from Penn (Dr. Harvey Friedman) that had some serious buzz about it 1-2 years ago. I am also a fan of the prime and pull since it comes from the highly regarded Akiko Iwaski who is an all-star in the field. If you play this forward I think that the pull (addition of the cream) needs to be done directly in the clinic, I would be suspicious of asking patients to do this at home as uptake rates would likely be lower.

From Jan 2017:

https://www.acsh.org/news/2017/01/19/and-then-there-were-three-new-trivalent-herpes-vaccine-enters-scene-10748

 

 

This isn’t Trivalent is it?  I was thinking this last week that Trivalent had been partnered with someone, but couldn’t remember who.  Was it my imagination?

I did see where Dr. Friedman was mentioned as a part of this prime and pull strategy.  

[MikeHerp]

This is in fact the trivalent vaccine, but  a therapeutic application of it,  I corresponded with both Dr Friedman and Dr. Iwasaki and I’ve been waiting for this news to come out. I’ll post the correspondence later,

According to Friedman, he expected to be in clinical trials by the end of this year for the prophylactic version. He said the therapeutic prime and pull application led by Iwasaki was coming along more slowly.

But with the news of funding for the Einstein vaccine coming out recently, I wonder if the UPenn vaccine might be in a holding pattern now, out of luck. Not necessarily, but we will see.

Edited August 2, 2019 by MikeHerp

[iFdUp]

""The study showed that the effect of the combination therapy was far greater than either the vaccine or cream alone. “It’s the first time that a study has shown that prime-and-pull strategy can block existing recurrent disease,” said co-corresponding author Akiko Iwasaki, the Waldemar Von Zedtwitz Professor of Immunobiology at Yale School of Medicine.""

Well then, looks like it is proven that the methodology used for HIV with Laser ART and CRISPR is also a methodology that will work well with Herpes. 

Edited August 7, 2019 by iFdUp

[BioHacker]

The more detailed article is here: https://www.nature.com/articles/s41541-019-0129-1

The shedding result is interesting, especially considering that the CpG ODN used in the study was B-Class (rather than C-Class, which typically produces a stronger T-cell result in animal studies). The method of the prime and pull was also not complex (simply using 5% Imiquimod).

It would be interesting to see this same experiment run with C-Class ODN.

It would also be interesting to see the results without the repeating once-weekly Imiquimod applications post-vaccination (something which would be impractical in humans).

[RNY18]

Prime and Pull: Dr. Iwasaki’s latest research :

https://www.nature.com/articles/s41541-019-0129-1

 

“...Reducing recurrent HSV disease using immunotherapy is a major goal for HSV vaccine developers. Recent efforts have used a bivalent HSV vaccine and adjuvant to achieve an ~ 50% reduction in recurrent HSV disease and recurrent shedding.13,14 Although this demonstrates the proof of concept for a therapeutic vaccine it falls somewhat short when compared to newer antiviral therapies, which can reduce recurrent disease and shedding by almost 90%.16,17 Nevertheless, the advantages of vaccine strategies, requiring infrequent administration less than yearly vs. drugs that must be given daily suggest that improving vaccine effectiveness is a worthwhile endeavor....”

 

Edited August 6, 2019 by RNY18

[JHenry]

3 hours ago, RNY18 said:

Prime and Pull: Dr. Iwasaki’s latest research :

https://www.nature.com/articles/s41541-019-0129-1

 

“...Reducing recurrent HSV disease using immunotherapy is a major goal for HSV vaccine developers. Recent efforts have used a bivalent HSV vaccine and adjuvant to achieve an ~ 50% reduction in recurrent HSV disease and recurrent shedding.13,14 Although this demonstrates the proof of concept for a therapeutic vaccine it falls somewhat short when compared to newer antiviral therapies, which can reduce recurrent disease and shedding by almost 90%.16,17 Nevertheless, the advantages of vaccine strategies, requiring infrequent administration less than yearly vs. drugs that must be given daily suggest that improving vaccine effectiveness is a worthwhile endeavor....”

 

What therapy is available that reduces shedding by 90%?

[LightafterDarkness]

The article cites the studies related to Pritelivir re: 90% shedding rate

Example: https://www.nejm.org/doi/10.1056/NEJMoa1301150

 

[JHenry]

8 minutes ago, LightafterDarkness said:

The article cites the studies related to Pritelivir re: 90% shedding rate

Example: https://www.nejm.org/doi/10.1056/NEJMoa1301150

 

Thank you!   Hoping it becomes available soon—very soon....

[T9000]

On 8/2/2019 at 8:26 AM, MikeHerp said:

But with the news of funding for the Einstein vaccine coming out recently, I wonder if the UPenn vaccine might be in a holding pattern now, out of luck. Not necessarily, but we will see.

This was my hunch as well, and very frustrating. Why can't we have two major prophylactic trials going on at once? We already know that statistically they're both more likely to fail than succeed anyway. I guess they have to go into in the best position possible, being for sure they are the only vaccine on the market. Maybe they don't want to have to compete for continued investment from stockholders?

[hk81]

From the research it's not clear how long the therapeutic effect lasts, if it's enough to make a few doses of vaccination + imiquimod, or if the imiquimod should be applied regularly after vaccination, or if also the vaccination should be repeated with a certain frequency.

Did anyone find that information in the articles? Or perhaps it's too early for such a study.

The article also reports a small reduction of the outbreaks by application of imiquimod.

Did any of you ever try that?

I did, 1 year ago. And the result was devastating. Genital herpes has always given me tolerable/no pain, beside a badly dry skin. When I applied imiquimod, the skin turned all red, inflamed, it cracked, it started to bleed, and blisters started to grow, break and heal again, until 1 week - 10 days after the application. It made the condition very painful and hardly manageable.

Some articles also reports contradictory results with the application of the cream when a herpes infection is present. The cream itself is not approved for use with herpes.

It's a bit curious that together with the vaccine it leads to suppression of the symptoms; I would expect an even more aggressive reaction of the immune system.