Global view on AIDS drives lab

[Guest guest]

Global view on AIDS drives lab

Trip to S. Africa launched a quest for new vaccine

By F. , Globe Staff / February 17, 2009

Dr. Bruce D. , an acclaimed AIDS specialist at Massachusetts

General Hospital, didn't really want to go to South Africa. He was

engrossed in his laboratory's AIDS research in Boston, and a trip to

see his team's field work seemed a risky distraction.

But just when the American AIDS epidemic was fading from the

headlines, the disease was exploding with a vengeance in the late

1990s in South Africa, and nowhere more savagely than in the teeming

Indian Ocean city of Durban and the surrounding villages in the green

hills of KwaZulu-Natal Province. About 60 percent of pregnant women

coming to clinics in and around Durban were infected with HIV, and

one-third of their babies were born with the virus.

In early 2001, traveled to Durban to see for himself. The trip

set in motion a chain of ever-deepening involvement for and his

AIDS research team at MGH in the worst killing fields of the global

AIDS pandemic. That work has transformed his career, and touched many

lives in Boston as well as South Africa. And now the South African

link has helped thrust and his Boston laboratory into a leading

role in the global hunt for an AIDS vaccine.

helped turn a ramshackle lab at Durban's medical school into a

state-of-the-art research facility. He organized and encouraged pilot

treatment and training programs in South Africa by MGH doctors, going

far beyond pure research at a time when South Africa's government was

denying the causes of the AIDS catastrophe. He helped raise tens of

millions from American funders to support innovative projects. And he

helped the South African government devise its belated nationwide

rollout of antiretroviral drugs.

's South African work also connected him with Terrence

Ragon, a Cambridge high-tech tycoon whose company sold software there.

The two visited Durban in early 2007 - and Ragon was as excited by the

immense possibilities as he was shocked by the suffering he saw.

This month, Ragon and his wife, , pledged $100 million to create

a new institute to develop an AIDS vaccine. The Ragon Institute will

draw in scientists from MGH, Harvard, and the Massachusetts Institute

of Technology, with at the helm.

Ragon was just one of a long line of potential benefactors who had

traipsed to Durban with on what colleagues dubbed " the Bruce

tour. "

On his first trip in 2001, brought along Elaine K. Gallin, head

of the medical research program for the Doris Duke Charitable

Foundation. They tramped through city hospital wards overflowing with

AIDS patients, and visited the decrepit lab at the Mandela

Medical School at the provincial university where the MGH field team

was borrowing space. A blacks-only school during the apartheid era,

the medical campus had not had a single new building in more than 50

years.

On a follow-up visit soon after, brainstormed over beers in a

pub with South African colleagues on what they could do that would

have the most impact.

" One thing led to another, " recalled in an interview, " and by

the end of the evening, we said, 'Let's build the best biomedical

research facility in the world, and put it right here in the middle of

the epidemic'. "

Gallin took the lead in funding the Durban laboratory, the first

overseas grant by the Duke organization. The $5 million laboratory

went up in just over a year, opening in July 2003. Within another

year, the lab's scientists published a research paper. Programs

assisted by visiting staff from the Partners AIDS Research Center,

which directs, and Harvard Medical School are producing a

stream of work.

" It is probably one of the best grants, if not the best, that we've

ever made, " Gallin said. " Bruce has partnered with a circle of

incredible young and senior people doing really extraordinary work. So

it's had an enormous ripple effect. "

Jerry Coovadia, a professor at the medical school and one of the

country's most prominent AIDS researchers, worked closely with

to get the Durban laboratory built. He said the facility is helping

train a new generation of South African research scientists.

Coovadia said " has been particularly careful to make sure

people aren't employed as just another pair of hands. He senses those

who have promise to do postgraduate work and to publish. "

Since then, has returned to South Africa about six times a

year, with deepening affection for its afflicted people and a growing

belief in its promise.

" Every time I go there I see opportunities for us to do something that

can have a significant impact. It keeps pulling me back, " said.

" For the amount of effort and investment, the impact is so great in

terms of being able to make a difference. "

At age 56, is tall and athletic, and conveys a soft-spoken

confidence and clarity that brings people along with him, whether they

are colleagues, funders or patients. His office at MGH's vast

town research complex is filled with mementos and photos of

those he has worked with, many of them from South Africa.

Yet acknowledged that he hadn't been keen to go at all. He

recalled that on his only other visit to Africa, to Senegal in 1989,

he had held infants who were rigid with neonatal tetanus, an easily

prevented illness. And he had heard South Africa wasn't very safe. But

Philip Goulder, an MGH post-doctoral fellow whom had dispatched

to Durban in 1999 to conduct research on AIDS babies, was pressing

to come see the possibilities.

Goulder, now a pediatric AIDS specialist at Oxford University, said of

's South African odyssey: " My achievement was to persuade Bruce

to come out. Once he did, he was absolutely hooked. "

In 1999, the Duke foundation gave a $3 million flexible grant,

its first such award for " distinguished clinical research. " His work

focused on understanding why some cells in the body are able to fight

off the HIV virus and why the virus ultimately prevails, resulting in

full-blown AIDS. used some of those funds to pay for his lab's

initial South African work.

From early on, 's researchers in South Africa went beyond basic

science.

sent another doctor, Krista Dong, to assist Goulder in late

2001, and let her set up a pilot treatment program at St. 's, a

former mission hospital on the edge of Durban, for infected mothers

and their babies. Starting with just 20 patients, the project gave

people antiretroviral drugs well before the South African government

agreed to make them widely available.

In late 2003, and Dong spent five weeks in Pretoria working day

and night with South African government planners and experts from the

Clinton Foundation to help devise a plan to finally distribute the

drugs to patients nationwide. The MGH-sponsored treatment project at

St. 's was one of the models the team studied to devise the

national program.

" MGH is a research hospital, but this was a 100 percent service

program, " Dong said. " There was not even research attached to it. But

Bruce let us start an HIV clinic. . . . The upshot is that he is so

willing to be behind things that are not his area of focus. "

Dong was so affected by the AIDS devastation that she moved to South

Africa, and is now working on treatment and education programs at

Edendale Hospital near Pietermaritzburg, in the heart of the AIDS

crisis. She remains on the Mass. General payroll.

Goulder said Dong was one of many young medical researchers with

potential whom had inspired. " He makes people optimistic; he

makes them believe anything is possible. "

, who is a professor at Harvard Medical School, showed early in

his career that he was willing to consider possibilities that others

wouldn't imagine. After graduating from the University of Colorado in

Boulder, where he grew up and where his father was a geology

professor, he went on to study medicine at Case Western Reserve

Medical School, and came to MGH in 1980 as a resident. He saw his

first AIDS patient the next year - before anyone knew what AIDS was.

As a young post-doctoral fellow at MGH in the mid-1980s, he recalled

being told that he should drop his first research project looking at

cells that try to fend off the virus, because it went against the

obvious nature of AIDS - that the disease defeats the body's immune

system. One colleague warned that the controversial work could end his

career before it began.

pressed ahead, and co-authored a paper with his mentor,

T. Schooley, for the journal Nature in 1987 that accurately challenged

the conventional view, and that still informs his thinking on how a

vaccine might work; understanding why certain cells are able to kill

the virus could provide clues to creating a vaccine.

Some colleagues occasionally express frustration that is in

such demand that it can be hard to get much time with him. But they

say his lifelong commitment to stay close to his patients remains his

watchword.

Zinhle Thabethe, an HIV-positive woman who got into an early

antiretrovirals pilot program, has worked with Dong and other MGH

researchers since 2002. She met when he visited an HIV women's

support group that had turned itself into a choir, which has performed

twice in Boston to emotion-charged crowds. Thabethe marvels that

, a research scientist, goes with her to visit AIDS patients in

their homes.

" He's been really on the ground, in the villages, " she said. " He is

involved in every aspect of getting someone's life better. There's

nothing that is he is too big for. "

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