1 00:00:06,240 --> 00:00:09,240 Speaker 1: HIV was one of the most important viruses of the 2 00:00:09,240 --> 00:00:13,640 Speaker 1: past century. It caused profound suffering, It led to intense 3 00:00:13,720 --> 00:00:19,320 Speaker 1: political and social confrontations and eventually transformations. And for scientists, 4 00:00:19,880 --> 00:00:23,439 Speaker 1: HIV posed a complicated set of problems that still have 5 00:00:23,560 --> 00:00:27,400 Speaker 1: not been entirely solved. On today's show, we're going to 6 00:00:27,400 --> 00:00:31,320 Speaker 1: focus on the scientists and the science. I'm Jacob Goldstein, 7 00:00:31,400 --> 00:00:34,479 Speaker 1: and this is Incubation, a show about viruses. In the 8 00:00:34,479 --> 00:00:36,800 Speaker 1: first half of the show, we'll talk with a virologist. 9 00:00:37,159 --> 00:00:39,600 Speaker 1: She was working at a hospital in the early nineteen 10 00:00:39,640 --> 00:00:42,239 Speaker 1: eighties when the first patients began to show up with 11 00:00:42,320 --> 00:00:46,040 Speaker 1: this deadly disease that no one understood. She was part 12 00:00:46,040 --> 00:00:49,320 Speaker 1: of a team that rushed to identify the virus behind 13 00:00:49,360 --> 00:00:52,360 Speaker 1: the disease. Then, in the second half of the show, 14 00:00:52,600 --> 00:00:55,560 Speaker 1: we'll hear from a physician who's been working for over 15 00:00:55,680 --> 00:01:02,560 Speaker 1: twenty years to develop an HIV vaccine. We're going to 16 00:01:02,640 --> 00:01:07,479 Speaker 1: start today with my conversation with Christine Ruzu. Christine became 17 00:01:07,560 --> 00:01:10,800 Speaker 1: part of a famous team that ultimately wound up in 18 00:01:10,840 --> 00:01:15,640 Speaker 1: an international fight over who discovered HIV in nineteen eighty one. 19 00:01:15,920 --> 00:01:19,479 Speaker 1: Christine was a young researcher in the virology lab at 20 00:01:19,560 --> 00:01:23,199 Speaker 1: Bishaw Claude Bernard Hospital. It's a hospital in Paris that's 21 00:01:23,240 --> 00:01:28,000 Speaker 1: dedicated to infectious diseases. Christine remembers when the first patients 22 00:01:28,040 --> 00:01:31,160 Speaker 1: with this mysterious new illness started coming to the hospital. 23 00:01:31,600 --> 00:01:36,080 Speaker 2: We start to see those patients. They were young, they 24 00:01:36,120 --> 00:01:41,520 Speaker 2: were gay, and they had a lot of infections and 25 00:01:41,640 --> 00:01:42,560 Speaker 2: they were dying. 26 00:01:43,720 --> 00:01:45,840 Speaker 1: Like did you see yourself in them at all? Like 27 00:01:45,920 --> 00:01:49,280 Speaker 1: here of just some young healthy person, suddenly they get 28 00:01:49,320 --> 00:01:50,280 Speaker 1: sick and die. 29 00:01:50,840 --> 00:01:55,880 Speaker 2: Yeah, we had patients with our age. I was thirty 30 00:01:56,680 --> 00:02:03,920 Speaker 2: at the beginning. Those who were hospitalized died rapidly. They 31 00:02:03,920 --> 00:02:07,720 Speaker 2: come to the hospital very late in the disease, and 32 00:02:08,800 --> 00:02:14,080 Speaker 2: within the gay community, I could see progressively some of 33 00:02:14,120 --> 00:02:17,800 Speaker 2: them with big lymphnods, some of them with the caposis 34 00:02:17,880 --> 00:02:19,800 Speaker 2: are comma very difficult. 35 00:02:20,160 --> 00:02:23,240 Speaker 1: And so what are you what are you thinking when 36 00:02:23,400 --> 00:02:27,799 Speaker 1: these when these people start showing up with these strange symptoms. 37 00:02:28,120 --> 00:02:32,120 Speaker 2: From the beginning, the sign of our infection was there. 38 00:02:33,000 --> 00:02:37,000 Speaker 2: When you look at the number in blood of cells, 39 00:02:37,160 --> 00:02:41,520 Speaker 2: you can make the difference between bacteria and virus. Is infection. 40 00:02:42,360 --> 00:02:48,160 Speaker 2: And we we discuss with the different teams and we 41 00:02:48,240 --> 00:02:52,840 Speaker 2: start with the ideas that could be a retrovirus, a 42 00:02:52,960 --> 00:02:55,160 Speaker 2: very specific retrovirus. 43 00:02:55,680 --> 00:02:58,400 Speaker 1: Why do you think retrovirus? We should say, by the way, 44 00:02:58,440 --> 00:03:01,560 Speaker 1: retrovirus is a virus that use is RNA instead of DNA. 45 00:03:01,600 --> 00:03:02,400 Speaker 1: Why do you think it's that? 46 00:03:03,400 --> 00:03:07,720 Speaker 2: So how can I say it was vious. 47 00:03:07,400 --> 00:03:10,640 Speaker 1: Alamodo alamode like it was sort of the fashionable virus. 48 00:03:10,639 --> 00:03:13,920 Speaker 1: It was the it kind of virus, fashionable virus. Yes, 49 00:03:14,280 --> 00:03:17,560 Speaker 1: you and your colleagues have this hypothesis, we think this 50 00:03:17,600 --> 00:03:19,960 Speaker 1: is a retrovirus. What is the first thing you do? 51 00:03:20,960 --> 00:03:23,600 Speaker 2: We went to see Luke Montagnier and Francos virus and 52 00:03:23,600 --> 00:03:24,560 Speaker 2: you see in Pastor in. 53 00:03:24,520 --> 00:03:29,240 Speaker 1: Situew Luke Montaigne worked with Francois Barressing. You see at 54 00:03:29,240 --> 00:03:32,679 Speaker 1: the Pastor Institute, these two scientists who will become very famous. 55 00:03:32,960 --> 00:03:36,240 Speaker 2: Yeah, yeah, And we asked them, do you think that 56 00:03:36,280 --> 00:03:40,600 Speaker 2: it's possible to try to isolate the virus retrovirus? And 57 00:03:40,640 --> 00:03:46,280 Speaker 2: he said, that's a good idea. Maybe we can try. Maybe, Okay, 58 00:03:46,560 --> 00:03:50,080 Speaker 2: we'll do the work. So we come back to the 59 00:03:50,160 --> 00:03:53,360 Speaker 2: working group and we decide to take the lymph nodes 60 00:03:53,400 --> 00:03:57,000 Speaker 2: because they were very big, and to take a blood 61 00:03:57,600 --> 00:04:00,720 Speaker 2: in a nearly a symptomatic patients. 62 00:04:01,120 --> 00:04:04,800 Speaker 1: Okay, So You're at the hospital seeing these patients sick 63 00:04:05,000 --> 00:04:08,080 Speaker 1: with what you think might be a retrovirus, and you're 64 00:04:08,120 --> 00:04:11,840 Speaker 1: taking samples from patients at what seemed like different stages 65 00:04:11,880 --> 00:04:15,720 Speaker 1: of the disease and sending them to these academic researchers 66 00:04:15,720 --> 00:04:17,080 Speaker 1: at the Pastor Institute. 67 00:04:17,400 --> 00:04:24,839 Speaker 2: What happens next fifteen days after Luc Montaignefon and we 68 00:04:25,000 --> 00:04:29,440 Speaker 2: have something. We have something, We have something. 69 00:04:29,800 --> 00:04:33,480 Speaker 1: Front Soise Barre Snusi. That researcher who was working with 70 00:04:33,520 --> 00:04:37,800 Speaker 1: Montagnier had discovered evidence that suggested a retrovirus was in 71 00:04:37,839 --> 00:04:41,520 Speaker 1: fact the culprit for this mysterious disease. The team developed 72 00:04:41,520 --> 00:04:45,480 Speaker 1: a blood test to identify patients with antibodies to this virus. 73 00:04:46,200 --> 00:04:49,600 Speaker 1: Test allowed researchers to diagnose the virus not only in 74 00:04:49,640 --> 00:04:53,960 Speaker 1: gay men, but also in IV drug users and hemophiliacs, 75 00:04:54,440 --> 00:04:57,680 Speaker 1: But the illness was still a mystery, and in particular, 76 00:04:58,200 --> 00:05:00,880 Speaker 1: even though they knew it was a retrovisvirus, no one 77 00:05:00,880 --> 00:05:05,080 Speaker 1: had actually seen and correctly identified it. So now researchers 78 00:05:05,080 --> 00:05:08,039 Speaker 1: around the world are in this race both to help 79 00:05:08,120 --> 00:05:11,960 Speaker 1: patients and to find the virus. On the team, Christine 80 00:05:12,000 --> 00:05:16,240 Speaker 1: was working with an electron microscopist a specialist in looking 81 00:05:16,279 --> 00:05:20,000 Speaker 1: for things through an electron microscope, spent his days trying 82 00:05:20,040 --> 00:05:21,360 Speaker 1: to find this virus. 83 00:05:22,080 --> 00:05:25,760 Speaker 2: He said, for the first days, no, I can't see nothing. 84 00:05:26,279 --> 00:05:29,599 Speaker 2: And then after three days he said, come and see. 85 00:05:29,680 --> 00:05:31,200 Speaker 2: I'm sure there is something. 86 00:05:31,920 --> 00:05:34,400 Speaker 1: What is the microscopycy happening in the cell? 87 00:05:35,200 --> 00:05:37,680 Speaker 2: He sees the budding of the virus at the surface 88 00:05:37,720 --> 00:05:38,760 Speaker 2: of the lymphosize. 89 00:05:38,960 --> 00:05:42,160 Speaker 1: Uh huh, And so does that mean coming out, going in? 90 00:05:42,240 --> 00:05:43,200 Speaker 1: What does budding mean? 91 00:05:43,360 --> 00:05:48,440 Speaker 2: In that kind of budding is when the virus has 92 00:05:48,480 --> 00:05:52,080 Speaker 2: been within the cells he has to get out, and 93 00:05:52,320 --> 00:05:55,840 Speaker 2: he could see free virl particles and he could see 94 00:05:55,880 --> 00:06:01,120 Speaker 2: also that those particles came from those infected cells. Budding 95 00:06:01,279 --> 00:06:03,960 Speaker 2: is a Commondi budding. 96 00:06:04,160 --> 00:06:07,320 Speaker 1: It's sort of exploding out of the cell or leaving the. 97 00:06:07,279 --> 00:06:10,320 Speaker 2: Cell, exactly, the moment of leaving the cell. 98 00:06:10,440 --> 00:06:12,920 Speaker 1: That's so this is like a big moment, right. You're 99 00:06:12,960 --> 00:06:15,680 Speaker 1: not only seeing the virus, but you're actually seeing it 100 00:06:15,839 --> 00:06:16,560 Speaker 1: as it's. 101 00:06:16,480 --> 00:06:18,520 Speaker 2: Leaving the host cell exactly. 102 00:06:19,320 --> 00:06:21,440 Speaker 1: Do you remember when you saw that image for the 103 00:06:21,480 --> 00:06:22,080 Speaker 1: first time. 104 00:06:22,640 --> 00:06:26,479 Speaker 2: Ah, yes, I remember very well, because at that time 105 00:06:26,960 --> 00:06:31,320 Speaker 2: we say, oh, now what we have to do with that. 106 00:06:32,520 --> 00:06:34,120 Speaker 2: We have to organize everything. 107 00:06:35,080 --> 00:06:37,720 Speaker 1: So your response is not Wow, we did it, it's 108 00:06:37,800 --> 00:06:39,640 Speaker 1: oh my god, We've got so much work to do. 109 00:06:40,000 --> 00:06:44,400 Speaker 2: Yeah. You know, in France we say we have the 110 00:06:44,560 --> 00:06:48,000 Speaker 2: nose in the bicycle, I mean. 111 00:06:49,720 --> 00:06:53,520 Speaker 1: The steering the handlebars, just looking at not looking at 112 00:06:53,760 --> 00:06:56,680 Speaker 1: your head down those to the handlebars. 113 00:06:57,040 --> 00:06:57,840 Speaker 2: Yeah, exactly. 114 00:06:58,080 --> 00:07:01,240 Speaker 1: And so that's the moment when you're basic saying we 115 00:07:01,440 --> 00:07:04,760 Speaker 1: found it, we found the virus that is causing this 116 00:07:04,880 --> 00:07:05,960 Speaker 1: mysterious disease. 117 00:07:06,320 --> 00:07:09,400 Speaker 2: Yeah, and a paper with the publish in science. 118 00:07:10,280 --> 00:07:13,680 Speaker 1: Meanwhile, in the United States there is another team working 119 00:07:13,720 --> 00:07:17,280 Speaker 1: to study the disease. It's led by Robert Gallo, a 120 00:07:17,320 --> 00:07:21,360 Speaker 1: famous virologist at the National Institutes of Health. And this 121 00:07:21,600 --> 00:07:25,320 Speaker 1: is where a story of discovery becomes a story of 122 00:07:25,360 --> 00:07:29,480 Speaker 1: a competition, of a fight over who really discovered the virus. 123 00:07:30,040 --> 00:07:32,680 Speaker 1: But it didn't start out as a fight. It started 124 00:07:32,720 --> 00:07:33,960 Speaker 1: out as a collaboration. 125 00:07:35,280 --> 00:07:38,520 Speaker 2: Luke Montagne decided, because he knows very well Bob Gelou 126 00:07:38,600 --> 00:07:41,800 Speaker 2: at that time, he decided to collaborate and to cooperate, 127 00:07:42,440 --> 00:07:46,679 Speaker 2: and he sent samples with the virus to Bob Galu. Okay, 128 00:07:46,800 --> 00:07:48,040 Speaker 2: can you imagine that? 129 00:07:48,360 --> 00:07:51,520 Speaker 1: Well, that's like the ideal of science, right, They're not rivals. 130 00:07:51,520 --> 00:07:56,360 Speaker 1: They're working together to increase humanity's understanding exactly. 131 00:07:57,080 --> 00:08:04,560 Speaker 2: Yeah. Yeah. And then Bob Galou publish a discovery of 132 00:08:04,760 --> 00:08:05,600 Speaker 2: AS virus. 133 00:08:05,960 --> 00:08:08,960 Speaker 1: H huh, you're using air quotes as you say discovery. 134 00:08:09,040 --> 00:08:15,640 Speaker 2: Yeah, yeah, in April nineteen eighty four, and he said, 135 00:08:16,080 --> 00:08:18,520 Speaker 2: we discovers the virus. 136 00:08:18,600 --> 00:08:21,400 Speaker 1: Just from Gallo's point of view, what is his claim 137 00:08:21,560 --> 00:08:23,680 Speaker 1: in eighty four of discovery. 138 00:08:23,720 --> 00:08:29,760 Speaker 2: He claims that the virus was not completely identical to 139 00:08:30,080 --> 00:08:34,640 Speaker 2: our virus, and he says mine is really AS virus 140 00:08:34,679 --> 00:08:35,560 Speaker 2: in the United States. 141 00:08:35,600 --> 00:08:38,720 Speaker 1: So Gallo was saying he discovered the AIDS virus in 142 00:08:38,760 --> 00:08:42,960 Speaker 1: the United States. From your perspective, your lab already discovered 143 00:08:42,960 --> 00:08:46,200 Speaker 1: the virus. What do you think when you read this paper? 144 00:08:47,800 --> 00:08:50,760 Speaker 2: It was a very difficult period of time for us. 145 00:08:51,160 --> 00:08:54,960 Speaker 2: And in France he said, you can't imagine. Of course, 146 00:08:55,000 --> 00:08:57,600 Speaker 2: Bob Gallo is right and your virus is not the 147 00:08:57,720 --> 00:08:58,160 Speaker 2: right one. 148 00:08:58,559 --> 00:09:01,079 Speaker 1: Oh, I would not have guessed that. Wait, even even 149 00:09:01,120 --> 00:09:03,400 Speaker 1: in France they said that. I am surprised. 150 00:09:03,640 --> 00:09:07,400 Speaker 2: Even in France. You know, we were young frenchie. Yeah yeah, 151 00:09:08,720 --> 00:09:13,719 Speaker 2: those little frenchie compared to the bag Gallo, it's not possible. 152 00:09:14,960 --> 00:09:18,959 Speaker 2: Bob Gallo is very important in the nine i H 153 00:09:19,640 --> 00:09:23,240 Speaker 2: compared to us. We are not professor, We were just 154 00:09:23,400 --> 00:09:26,440 Speaker 2: assistant in labs. We are so young. 155 00:09:27,120 --> 00:09:29,360 Speaker 1: What do you think when this is happening and people 156 00:09:29,440 --> 00:09:31,440 Speaker 1: are saying this you personally, we. 157 00:09:31,800 --> 00:09:37,120 Speaker 2: Thought that we had to go more rapidly for the 158 00:09:37,200 --> 00:09:44,160 Speaker 2: demonstration of our RUS and with particularly with zero logical tests. 159 00:09:44,200 --> 00:09:46,439 Speaker 2: I'm in the screening with my test. 160 00:09:46,880 --> 00:09:48,240 Speaker 1: Yeah, you know, we. 161 00:09:48,040 --> 00:09:52,880 Speaker 2: Were working and working and working publishing with US, with Italian, 162 00:09:53,000 --> 00:09:57,560 Speaker 2: with CDC. We have to work more and more to 163 00:09:57,679 --> 00:10:01,600 Speaker 2: show that we were right at that time. So we 164 00:10:01,840 --> 00:10:07,080 Speaker 2: progress a lot with the number of patients which increased. 165 00:10:07,080 --> 00:10:08,680 Speaker 2: That'side time everywhere. 166 00:10:11,080 --> 00:10:14,600 Speaker 1: In nineteen eighty five, the Pastor Institute sued the United 167 00:10:14,640 --> 00:10:17,920 Speaker 1: States government, claiming that Bob Gallo's team had used the 168 00:10:17,960 --> 00:10:21,520 Speaker 1: French samples to isolate the virus and create an HIV 169 00:10:21,600 --> 00:10:25,480 Speaker 1: blood test. The lawsuit was eventually settled, and in April 170 00:10:25,559 --> 00:10:28,440 Speaker 1: nineteen eighty seven, Ronald Reagan, the President of the US, 171 00:10:28,520 --> 00:10:31,560 Speaker 1: and Jacques Chirack, the Prime Minister of France, actually held 172 00:10:31,640 --> 00:10:35,160 Speaker 1: a joint press conference where they announced that both countries 173 00:10:35,160 --> 00:10:39,080 Speaker 1: would share the discovery. That same month, Bob Gallo and 174 00:10:39,160 --> 00:10:42,839 Speaker 1: Luke Montagnier co published a paper explaining the sequence of 175 00:10:42,880 --> 00:10:45,520 Speaker 1: events and sharing credit for discoveries. 176 00:10:46,480 --> 00:10:53,160 Speaker 2: But maybe few years after we had the technology for 177 00:10:53,880 --> 00:10:58,280 Speaker 2: genome sequencing, and you know, the story is the end 178 00:10:58,320 --> 00:11:02,760 Speaker 2: of the story. Genetics sequencing of the virus from Bob 179 00:11:02,800 --> 00:11:06,600 Speaker 2: Gallow's lab and from our LAMB show that the Bob's 180 00:11:06,640 --> 00:11:10,200 Speaker 2: Gatherous lab was exactly the same that our virus. 181 00:11:12,679 --> 00:11:16,119 Speaker 1: After that, genetic sequencing proved that the viruses were identical. 182 00:11:16,480 --> 00:11:18,760 Speaker 1: Bob Gallow's lab said the whole thing was a kind 183 00:11:18,760 --> 00:11:21,960 Speaker 1: of a mix up, the result of an accidental contamination. 184 00:11:22,920 --> 00:11:25,440 Speaker 1: The final verdict in the fight over the discovery of 185 00:11:25,559 --> 00:11:27,719 Speaker 1: HIV came decades later. 186 00:11:28,240 --> 00:11:32,160 Speaker 2: And we waited until two thousand and eight against the 187 00:11:32,200 --> 00:11:37,000 Speaker 2: Nobel price, and Bob Gallo did not receive the Nobel price. 188 00:11:37,600 --> 00:11:40,520 Speaker 2: And the people from the Nobel Price, the jury of 189 00:11:40,679 --> 00:11:45,160 Speaker 2: a Nobel Price, explain us they look for They looked 190 00:11:45,160 --> 00:11:49,920 Speaker 2: at everything in Bob Gatherous lab, everything in Luc Montagni labs, 191 00:11:49,960 --> 00:11:52,679 Speaker 2: and they understood very well as the story with a 192 00:11:52,679 --> 00:11:57,600 Speaker 2: sequencing showing that the virus was our virus. 193 00:11:58,920 --> 00:12:01,960 Speaker 1: Bob Gallo is still all credited with important research on 194 00:12:02,000 --> 00:12:05,600 Speaker 1: the links between HIV and AIDS, and even when the 195 00:12:05,640 --> 00:12:09,000 Speaker 1: Nobel was announced, Luke Montaigner was quoted as saying that 196 00:12:09,040 --> 00:12:12,160 Speaker 1: the Gallo team deserved to share. How did you feel 197 00:12:12,200 --> 00:12:14,319 Speaker 1: when you found out about the Nobel Prize? 198 00:12:15,800 --> 00:12:21,319 Speaker 2: Very well satisfied because you know, we started with history 199 00:12:21,320 --> 00:12:24,440 Speaker 2: in nineteen eighty three and it was a long time 200 00:12:24,559 --> 00:12:28,720 Speaker 2: ago after, yeah, and it was very important to be 201 00:12:28,920 --> 00:12:30,760 Speaker 2: recognized even later. 202 00:12:31,600 --> 00:12:36,560 Speaker 1: Yes, I mean the Nobel Prize is legit recognition. It's 203 00:12:36,640 --> 00:12:39,640 Speaker 1: for real, Like if you want to be vindicated in science, 204 00:12:39,679 --> 00:12:41,440 Speaker 1: it's tough to beat the Nobel Prize. 205 00:12:41,679 --> 00:12:47,319 Speaker 2: Yeah. After yeah, after fighting a lot with US people 206 00:12:47,559 --> 00:12:52,160 Speaker 2: with even in France, it was a Greek moment in Stockholm. 207 00:12:52,640 --> 00:12:59,240 Speaker 2: But we built a working group with the physicians, semanologist 208 00:12:59,320 --> 00:13:06,520 Speaker 2: and self biologists in order to try to understand what 209 00:13:06,640 --> 00:13:09,640 Speaker 2: I want with those patients. And that's a very important 210 00:13:09,679 --> 00:13:14,320 Speaker 2: point of the story because we were a multidisciplinary working 211 00:13:14,400 --> 00:13:18,800 Speaker 2: group and you know it's a listen learned. You can't 212 00:13:19,120 --> 00:13:23,080 Speaker 2: do such a research alone, you can't. 213 00:13:24,000 --> 00:13:27,120 Speaker 1: Wonderful, Thank you so much for your time. It was 214 00:13:28,000 --> 00:13:28,920 Speaker 1: great to talk with you. 215 00:13:29,240 --> 00:13:30,120 Speaker 2: Thank you very much. 216 00:13:31,640 --> 00:13:35,800 Speaker 1: Christine, whoso has spent the last forty years studying HIV 217 00:13:36,000 --> 00:13:39,600 Speaker 1: and AIDS, including work on preventing transmission of the virus 218 00:13:39,640 --> 00:13:43,480 Speaker 1: from mothers to children. She's currently a professor of virology 219 00:13:43,559 --> 00:13:57,959 Speaker 1: at Paris Descartes University. So can we talk about HIV? 220 00:13:58,640 --> 00:13:59,960 Speaker 3: Sure, that would be wonderful. 221 00:14:01,080 --> 00:14:02,880 Speaker 1: My guest for the second half of the show is 222 00:14:03,000 --> 00:14:06,960 Speaker 1: Richard Koup. Richard is the Deputy director of the Vaccine 223 00:14:07,040 --> 00:14:10,320 Speaker 1: Research Center at the National Institutes of Health. He has 224 00:14:10,360 --> 00:14:14,720 Speaker 1: spent his career studying and testing HIV vaccines, and, as 225 00:14:14,720 --> 00:14:20,040 Speaker 1: he explains, creating a vaccine against HIV is this extraordinarily 226 00:14:20,120 --> 00:14:23,520 Speaker 1: hard problem that goes to the heart of why this 227 00:14:23,760 --> 00:14:28,160 Speaker 1: virus is so insidious? Why did you become an infectious 228 00:14:28,200 --> 00:14:28,880 Speaker 1: disease doctor? 229 00:14:29,600 --> 00:14:33,080 Speaker 3: You know, when I was in medical school and my training, 230 00:14:34,160 --> 00:14:38,320 Speaker 3: I noticed that almost all of the different specialties in 231 00:14:38,400 --> 00:14:42,040 Speaker 3: medicine dealt with chronic illness, and infectious disease was the 232 00:14:42,280 --> 00:14:46,920 Speaker 3: one specialty where you didn't have to deal with chronic illnesses. 233 00:14:46,960 --> 00:14:51,960 Speaker 3: What you actually did was you cured people. So people 234 00:14:52,000 --> 00:14:55,440 Speaker 3: would come in with infections, you gave them antibiotics and 235 00:14:55,480 --> 00:14:58,520 Speaker 3: they were cured, and that felt very good. 236 00:14:59,400 --> 00:15:02,760 Speaker 1: Like Christine lose you. Richard Kaup started his career at 237 00:15:02,760 --> 00:15:06,400 Speaker 1: the beginning of the AIDS epidemic, and over time HIV 238 00:15:06,560 --> 00:15:09,800 Speaker 1: would in fact become a chronic disease, but that was 239 00:15:09,840 --> 00:15:10,440 Speaker 1: in the future. 240 00:15:10,800 --> 00:15:16,360 Speaker 3: What we knew then was the genetics of the virus, 241 00:15:16,360 --> 00:15:20,480 Speaker 3: but we didn't really know much about the immune response, 242 00:15:20,920 --> 00:15:24,040 Speaker 3: so we were just sort of mapping out what they 243 00:15:24,080 --> 00:15:25,160 Speaker 3: were responding to. 244 00:15:25,720 --> 00:15:28,840 Speaker 1: It was like we knew what the virus was, but 245 00:15:28,920 --> 00:15:32,120 Speaker 1: we didn't really understand what it did, how it worked. 246 00:15:32,520 --> 00:15:36,000 Speaker 3: Yeah, not really, And we knew that for most viruses, 247 00:15:36,200 --> 00:15:40,080 Speaker 3: in a vaccine, you want to target the envelope protein, 248 00:15:40,200 --> 00:15:42,800 Speaker 3: the protein that's on the surface of the virus that 249 00:15:42,960 --> 00:15:46,320 Speaker 3: is used to enter cells, and so that's what most 250 00:15:46,360 --> 00:15:48,920 Speaker 3: of the first vaccines were directed against. 251 00:15:49,040 --> 00:15:52,760 Speaker 1: Which is like very reasonable, right, Like that's what scientists 252 00:15:52,960 --> 00:15:55,000 Speaker 1: just did with COVID, and it's like that is sort 253 00:15:55,040 --> 00:15:58,240 Speaker 1: of what's floating around in your body and it's what 254 00:15:58,360 --> 00:16:00,720 Speaker 1: the immune system sees. So it seemed it's logical that 255 00:16:00,720 --> 00:16:05,040 Speaker 1: you would want to do that. What happened when when 256 00:16:05,120 --> 00:16:08,120 Speaker 1: you and other researchers tried that with HIV. 257 00:16:08,720 --> 00:16:12,960 Speaker 3: Well, you generated an immune response, so you've got antibodies 258 00:16:12,960 --> 00:16:15,920 Speaker 3: against the envelope protein. 259 00:16:16,400 --> 00:16:18,680 Speaker 1: Seems good, that's what you want, Yeah. 260 00:16:18,600 --> 00:16:23,720 Speaker 3: But those antibodies didn't do anything, they didn't neutralize the virus. 261 00:16:23,960 --> 00:16:26,720 Speaker 1: What was the next thought, What was the next idea? 262 00:16:27,280 --> 00:16:30,440 Speaker 3: The thought then was, well, what we should do is 263 00:16:30,560 --> 00:16:35,840 Speaker 3: stimulate T cells, so T cells recognize virally infected cells 264 00:16:35,840 --> 00:16:38,800 Speaker 3: and kill them. And there were there was a lot 265 00:16:38,840 --> 00:16:42,040 Speaker 3: of data to suggest that people who were long term 266 00:16:42,120 --> 00:16:45,680 Speaker 3: non progressors, so these are people who are infected with 267 00:16:45,880 --> 00:16:52,120 Speaker 3: HIV but they don't progress to full blown AIDS, they 268 00:16:52,160 --> 00:16:56,000 Speaker 3: had really good T cells that were attacking the virus. 269 00:16:56,760 --> 00:17:01,880 Speaker 1: So basically there is this universe of people who have HIV, 270 00:17:02,000 --> 00:17:06,080 Speaker 1: who are HIV positive, but who are not getting really sick. 271 00:17:06,119 --> 00:17:08,120 Speaker 1: And this is an era when most people who get 272 00:17:08,280 --> 00:17:12,480 Speaker 1: HIV get AIDS and die essentially right, get very sick. 273 00:17:12,520 --> 00:17:15,320 Speaker 1: And so you look at these patients and you see 274 00:17:15,960 --> 00:17:19,000 Speaker 1: that there is a particular kind of a cell in 275 00:17:19,040 --> 00:17:22,000 Speaker 1: their immune system that seems to be fighting the disease. 276 00:17:22,080 --> 00:17:25,680 Speaker 3: Is that right, That's absolutely correct. You hit the nail 277 00:17:25,720 --> 00:17:30,720 Speaker 3: on the head there. And so with this insight, people said, 278 00:17:30,840 --> 00:17:36,080 Speaker 3: what we should do is stimulate with a vaccine, not antibodies, 279 00:17:36,480 --> 00:17:38,720 Speaker 3: but CD eight positive T cells. 280 00:17:39,280 --> 00:17:41,840 Speaker 1: So basically, like the first idea was sort of a 281 00:17:41,880 --> 00:17:45,240 Speaker 1: classic vaccine idea like let's create a vaccine based on 282 00:17:45,240 --> 00:17:48,560 Speaker 1: antibodies that didn't work, and so then the second idea 283 00:17:48,720 --> 00:17:52,240 Speaker 1: is to stimulate T cells, this particular part of the 284 00:17:52,240 --> 00:17:55,200 Speaker 1: immune response that vaccines don't usually deal with. 285 00:17:55,560 --> 00:17:59,400 Speaker 3: Instead, it was felt that those vaccines may not keep 286 00:17:59,440 --> 00:18:04,160 Speaker 3: people from getting infected, but if they had the vaccine 287 00:18:04,320 --> 00:18:07,280 Speaker 3: and the people got infected, that they may all become 288 00:18:07,400 --> 00:18:10,399 Speaker 3: long term non progressors, so they wouldn't get sick. 289 00:18:10,800 --> 00:18:13,240 Speaker 1: Which is actually what you care about, right, what you 290 00:18:13,280 --> 00:18:16,119 Speaker 1: want is for people to live long, healthy lives. 291 00:18:16,520 --> 00:18:17,840 Speaker 3: That's absolutely correct. 292 00:18:18,119 --> 00:18:21,679 Speaker 1: So you do this trial and what do you find? 293 00:18:22,359 --> 00:18:24,760 Speaker 3: It did not do what we had hoped it would do. 294 00:18:25,480 --> 00:18:27,640 Speaker 1: And what year more or less is this. 295 00:18:27,960 --> 00:18:32,320 Speaker 3: We've been doing this for twenty years of efficacy trials, 296 00:18:32,680 --> 00:18:35,760 Speaker 3: and seven different trials have been done and none of 297 00:18:35,800 --> 00:18:38,360 Speaker 3: them have shown really good protection. 298 00:18:39,080 --> 00:18:43,880 Speaker 1: So a long time into the history of this disease. 299 00:18:44,000 --> 00:18:47,639 Speaker 1: This is decades of work in and if you'll allow 300 00:18:47,720 --> 00:18:51,320 Speaker 1: me this sort of dumb journaloius question, what was that like? 301 00:18:52,920 --> 00:18:58,159 Speaker 3: It's terribly disappointing. You know, you put a lot of 302 00:18:58,200 --> 00:19:03,520 Speaker 3: effort into this, your hoping that finally something will work 303 00:19:03,560 --> 00:19:08,240 Speaker 3: against this illness. And when it doesn't work at all, 304 00:19:09,200 --> 00:19:13,160 Speaker 3: you're really back to square one. So it's extremely disheartening. 305 00:19:13,960 --> 00:19:15,960 Speaker 1: Why is it so hard to vaccinate against HIV? 306 00:19:16,520 --> 00:19:22,440 Speaker 3: So unlike most viruses, most viruses enter cells of your body, 307 00:19:22,560 --> 00:19:26,520 Speaker 3: they use the machinery of those cells to replicate, and 308 00:19:26,560 --> 00:19:29,560 Speaker 3: then they leave your body and they're gone. They leave, 309 00:19:30,040 --> 00:19:33,080 Speaker 3: and you're no longer sick. When they're not there. 310 00:19:33,440 --> 00:19:35,680 Speaker 1: You get a cold and then you get better. 311 00:19:35,640 --> 00:19:40,040 Speaker 3: Right, and there's no cold virus left in the cells 312 00:19:40,080 --> 00:19:40,520 Speaker 3: of your. 313 00:19:40,359 --> 00:19:44,840 Speaker 1: Body because your immune system destroys all the virus, right. 314 00:19:45,000 --> 00:19:48,200 Speaker 3: And so with a vaccine, all you need to do, 315 00:19:48,280 --> 00:19:50,800 Speaker 3: actually you don't need to prevent the infection. All you 316 00:19:50,840 --> 00:19:54,120 Speaker 3: have to do is knock down the amount of virus 317 00:19:54,160 --> 00:20:01,080 Speaker 3: it's replicating to decrease your symptoms until the virus goes away. 318 00:20:01,680 --> 00:20:02,080 Speaker 1: Okay. 319 00:20:02,640 --> 00:20:08,960 Speaker 3: HIV is different in that it infects certain cells of 320 00:20:09,000 --> 00:20:13,879 Speaker 3: your body and it actually integrates its genome into the 321 00:20:13,960 --> 00:20:17,520 Speaker 3: genome of those cells and it never goes away. 322 00:20:18,040 --> 00:20:18,840 Speaker 1: Huh. 323 00:20:18,920 --> 00:20:21,200 Speaker 3: I like to think of it like playing whack a mole. 324 00:20:21,800 --> 00:20:25,679 Speaker 3: So it's basically hibernating in those cells, and then the 325 00:20:25,800 --> 00:20:28,159 Speaker 3: virus will will pop out every now and then, and 326 00:20:28,240 --> 00:20:31,280 Speaker 3: you need to try and knock it down, and our 327 00:20:31,480 --> 00:20:37,960 Speaker 3: antiretroviral therapy that we give to individuals doesn't do anything 328 00:20:38,800 --> 00:20:44,840 Speaker 3: to the virus that's sitting there hibernating. It's only when 329 00:20:45,080 --> 00:20:49,240 Speaker 3: when it reactivates and pops itself up that the antiretrovirals 330 00:20:49,320 --> 00:20:50,160 Speaker 3: have any effect. 331 00:20:50,640 --> 00:20:53,600 Speaker 1: This is why the antiretrovirals can keep you from getting sick, 332 00:20:53,640 --> 00:20:55,680 Speaker 1: but they cannot cure you per se. 333 00:20:55,880 --> 00:20:58,520 Speaker 3: Yeah, because it it'll never get rid of all of 334 00:20:58,560 --> 00:21:00,920 Speaker 3: those hibernating viruses. 335 00:21:01,080 --> 00:21:03,880 Speaker 1: Uh huh. So what does that mean from the point 336 00:21:03,880 --> 00:21:05,760 Speaker 1: of view of developing a vaccine. 337 00:21:06,280 --> 00:21:10,359 Speaker 3: That means that you have to block every single infection 338 00:21:10,560 --> 00:21:11,320 Speaker 3: from occurring. 339 00:21:11,640 --> 00:21:16,160 Speaker 1: That seems wildly difficult. Tell me, give me some hope. 340 00:21:16,160 --> 00:21:19,000 Speaker 1: Now I am here sitting here thinking there is no way. 341 00:21:20,520 --> 00:21:22,240 Speaker 1: You know, but I don't know anything. Tell me why 342 00:21:22,240 --> 00:21:22,840 Speaker 1: there is a way. 343 00:21:23,880 --> 00:21:27,719 Speaker 3: So certain individuals who are infected with HIV develop what 344 00:21:27,760 --> 00:21:33,960 Speaker 3: we call broadly neutralizing antibodies. So these are antibodies that 345 00:21:34,359 --> 00:21:41,119 Speaker 3: can neutralize seventy eighty ninety ninety five percent of hivs 346 00:21:41,160 --> 00:21:43,120 Speaker 3: that are circulating in the world. 347 00:21:43,400 --> 00:21:45,840 Speaker 1: These are just patients who have HIV who have this 348 00:21:45,960 --> 00:21:50,120 Speaker 1: particularly robust natural immune response absolutely. 349 00:21:50,400 --> 00:21:54,000 Speaker 3: So we know two things. One that there is a 350 00:21:54,000 --> 00:21:57,920 Speaker 3: way that the immune system can develop these types of antibodies. 351 00:21:58,720 --> 00:22:02,120 Speaker 3: The other thing that we know is that these antibodies 352 00:22:02,200 --> 00:22:08,800 Speaker 3: target multiple different sites on the HIV envelope protein. So 353 00:22:08,840 --> 00:22:12,960 Speaker 3: there are multiple targets on the HIV envelope that can 354 00:22:13,000 --> 00:22:16,680 Speaker 3: be used in the vaccine to stimulate these types of antibodies. 355 00:22:17,400 --> 00:22:20,920 Speaker 3: And we have actually done a clinical trial called the 356 00:22:20,960 --> 00:22:24,280 Speaker 3: AMP trial, where we took one of these broadly neutralizing 357 00:22:24,280 --> 00:22:27,000 Speaker 3: antibodies and we gave it to people who were at 358 00:22:27,080 --> 00:22:32,040 Speaker 3: risk of HIV infection, and at a certain level, those 359 00:22:32,200 --> 00:22:34,960 Speaker 3: individuals were protected against infection. 360 00:22:35,800 --> 00:22:39,800 Speaker 1: And as I understand it, that technique works to protect 361 00:22:39,800 --> 00:22:43,840 Speaker 1: people against some strains of HIV, but not all, right, 362 00:22:44,080 --> 00:22:48,000 Speaker 1: And so what percentage of strains were people protected against 363 00:22:48,040 --> 00:22:49,000 Speaker 1: in that trial. 364 00:22:49,000 --> 00:22:53,000 Speaker 3: For this antibody, It was it was about thirty percent 365 00:22:53,080 --> 00:22:53,879 Speaker 3: of viruses. 366 00:22:54,119 --> 00:22:58,880 Speaker 1: Okay, so that not that broadly neutralizing in that instance. 367 00:22:59,240 --> 00:23:02,640 Speaker 3: No, but this was one of the very first broadly 368 00:23:02,680 --> 00:23:06,000 Speaker 3: neutralizing antibodies that we had that we did this trial with. 369 00:23:06,119 --> 00:23:11,959 Speaker 3: There are much broader and better neutralizing antibodies that are 370 00:23:11,960 --> 00:23:15,520 Speaker 3: available now. But what this is also showing us is 371 00:23:15,600 --> 00:23:19,760 Speaker 3: the roadmap of if we can develop a vaccine that 372 00:23:19,880 --> 00:23:25,760 Speaker 3: will recapitulate the development of these broadly neutralizing antibodies in 373 00:23:25,880 --> 00:23:30,520 Speaker 3: people through immunization rather than through infection. If we can 374 00:23:30,600 --> 00:23:35,080 Speaker 3: get that level of antibody high enough, then we know 375 00:23:35,200 --> 00:23:36,680 Speaker 3: that they should be protected. 376 00:23:38,880 --> 00:23:41,840 Speaker 1: So the basic idea is, like, we have these antibodies 377 00:23:41,840 --> 00:23:44,560 Speaker 1: that seem to work, let's develop a vaccine that can 378 00:23:44,680 --> 00:23:46,480 Speaker 1: induce people to develop these antibodies. 379 00:23:47,040 --> 00:23:51,880 Speaker 3: Yes, that's exactly it. So there's still many big hurdles 380 00:23:51,880 --> 00:23:54,800 Speaker 3: to get over, but the initial studies have shown that 381 00:23:54,840 --> 00:24:00,560 Speaker 3: we can actually get the immune cells in the body 382 00:24:00,600 --> 00:24:03,960 Speaker 3: to start producing the correct type of antibodies. 383 00:24:04,320 --> 00:24:07,160 Speaker 1: These broadly neutralizing antibodies that we want. 384 00:24:07,080 --> 00:24:11,840 Speaker 3: Well, they're sort of the precursors of the broadly neutralizing anivites. 385 00:24:11,920 --> 00:24:14,800 Speaker 1: They're on the JV team. With some work, they can 386 00:24:14,920 --> 00:24:15,800 Speaker 1: make the varsity. 387 00:24:16,160 --> 00:24:20,720 Speaker 3: We need to shepherd them along, mentor them, tutor them, 388 00:24:20,760 --> 00:24:23,000 Speaker 3: and get them to be broadly neutralizing. 389 00:24:23,359 --> 00:24:26,640 Speaker 1: So still a long way away. Clearly, it's a profoundly 390 00:24:26,680 --> 00:24:31,679 Speaker 1: difficult virus to vaccinate against. Drug treatment for HIV, on 391 00:24:31,760 --> 00:24:35,920 Speaker 1: the other hand, has been quite successful, right, and now 392 00:24:35,960 --> 00:24:42,240 Speaker 1: you can do prophylaxis with drugs, which is great. Obviously, 393 00:24:42,359 --> 00:24:45,800 Speaker 1: it reduces human suffering a tremendous amount. Do we need 394 00:24:45,880 --> 00:24:48,359 Speaker 1: vaccines less because the drugs work so well. 395 00:24:49,240 --> 00:24:53,399 Speaker 3: It gives us a bit of a breather in that 396 00:24:53,440 --> 00:24:57,240 Speaker 3: we know that there are other ways to protect people 397 00:24:57,280 --> 00:25:01,359 Speaker 3: who are at risk of HIV infection. But there's a 398 00:25:01,520 --> 00:25:07,080 Speaker 3: lot of healthcare delivery that would need to go into 399 00:25:07,160 --> 00:25:12,000 Speaker 3: protecting the world against HIV in the absence of a vaccine, 400 00:25:12,400 --> 00:25:15,359 Speaker 3: and you need the infrastructure to do that, And in 401 00:25:15,400 --> 00:25:17,439 Speaker 3: parts of the world it's hard to get to the 402 00:25:17,520 --> 00:25:23,560 Speaker 3: people to actually give the medications that frequently. A vaccine 403 00:25:23,600 --> 00:25:27,160 Speaker 3: just makes it much easier to provide that protection. 404 00:25:27,840 --> 00:25:30,200 Speaker 1: And it seems like there is at least some correlation 405 00:25:30,400 --> 00:25:33,399 Speaker 1: between parts of the world where it's hard to get 406 00:25:33,520 --> 00:25:36,560 Speaker 1: people HIV drugs all the time and places where kind 407 00:25:36,560 --> 00:25:40,680 Speaker 1: of suffering from HIV is high. 408 00:25:40,720 --> 00:25:41,400 Speaker 3: Absolutely. 409 00:25:41,920 --> 00:25:49,080 Speaker 1: It's interesting how science generally is more often than not 410 00:25:49,200 --> 00:25:54,159 Speaker 1: the story of things not working. Right. We tend, you know, 411 00:25:54,600 --> 00:25:57,679 Speaker 1: in the media, say to focus on things that work, 412 00:25:58,440 --> 00:26:01,280 Speaker 1: but I feel like in the aggregate, science is things 413 00:26:01,320 --> 00:26:04,600 Speaker 1: not working. And I'm curious, you have spent a lot 414 00:26:04,600 --> 00:26:06,879 Speaker 1: of time working on things not working. Sort of what 415 00:26:07,000 --> 00:26:10,040 Speaker 1: have you learned from working on such a hard project. 416 00:26:10,760 --> 00:26:16,200 Speaker 3: The most difficult problems are the most interesting to work on. 417 00:26:17,119 --> 00:26:21,240 Speaker 3: For all the work we've done on HIV vaccines, we 418 00:26:21,280 --> 00:26:25,600 Speaker 3: don't have anything that's really working yet, but we learned 419 00:26:26,160 --> 00:26:30,639 Speaker 3: so much that actually helped with the development of the 420 00:26:30,960 --> 00:26:35,480 Speaker 3: RSV vaccine, with the development of the COVID vaccine, and 421 00:26:35,560 --> 00:26:39,560 Speaker 3: so we see these other successes that have come out 422 00:26:39,560 --> 00:26:43,199 Speaker 3: of our hard work on HIV, and so that really 423 00:26:43,400 --> 00:26:47,040 Speaker 3: helps us to say, well, we may not have gotten 424 00:26:47,080 --> 00:26:51,919 Speaker 3: there for HIV yet, but we've helped in other ways 425 00:26:52,400 --> 00:26:55,080 Speaker 3: and for other diseases are Do you. 426 00:26:55,119 --> 00:26:57,399 Speaker 1: Feel like you're generally an optimistic person. 427 00:26:58,600 --> 00:27:00,959 Speaker 3: I hope so. I don't think I I'm as optimistic 428 00:27:00,960 --> 00:27:04,040 Speaker 3: as some people I know, But you know I'm not 429 00:27:04,119 --> 00:27:05,000 Speaker 3: a Debbie downer. 430 00:27:05,240 --> 00:27:06,720 Speaker 1: Yes, you know. 431 00:27:06,800 --> 00:27:10,800 Speaker 3: I think if I were on my own trying to 432 00:27:10,880 --> 00:27:13,840 Speaker 3: do this, it wouldn't work. But the community of the 433 00:27:14,320 --> 00:27:21,240 Speaker 3: HIV vaccine researchers sort of keep each other optimistic and 434 00:27:21,320 --> 00:27:22,120 Speaker 3: moving forward. 435 00:27:24,200 --> 00:27:26,720 Speaker 1: Thanks very much for your time. I really appreciate it. 436 00:27:26,720 --> 00:27:27,840 Speaker 3: It was my pleasure. 437 00:27:27,960 --> 00:27:36,960 Speaker 1: Thank you very much. Richard Taut has been researching HIV 438 00:27:37,119 --> 00:27:40,359 Speaker 1: for thirty five years and working on vaccines for twenty 439 00:27:40,359 --> 00:27:43,720 Speaker 1: five He's the Deputy director at the Vaccine Research Center 440 00:27:43,840 --> 00:27:47,400 Speaker 1: at the National Institutes of Allergy and Infectious Disease at 441 00:27:47,440 --> 00:27:51,359 Speaker 1: Anahe thanks to both my guests, Christine Rouziu and Richard 442 00:27:51,440 --> 00:27:58,439 Speaker 1: Kaup next week. There's lots of mosquitoes in the world, 443 00:27:58,800 --> 00:28:01,080 Speaker 1: and not all of them are welly good at spreading disease, 444 00:28:01,160 --> 00:28:05,040 Speaker 1: butadies Agypty is one of the best mosquitoes viruses and 445 00:28:05,080 --> 00:28:13,679 Speaker 1: the history of the world. Incubation is a co production 446 00:28:13,760 --> 00:28:17,920 Speaker 1: of Pushkin Industries and Ruby Studio at iHeartMedia. It's produced 447 00:28:17,920 --> 00:28:21,080 Speaker 1: by Kate Ferby and Brittany Cronin. The show is edited 448 00:28:21,080 --> 00:28:24,960 Speaker 1: by Lacey Roberts. It's mastered by Sarah Brigueire, fact checking 449 00:28:25,080 --> 00:28:28,800 Speaker 1: by Joseph Friedman. Our executive producers are Lacey Roberts and 450 00:28:28,800 --> 00:28:31,920 Speaker 1: Matt Romano. I'm Jacob Goldstein. Thanks for listening.