Ending the epidemic

Jamie Mann

By Ciara Parsons, BA'15

Since taking the world by storm in 1981, the HIV/AIDS epidemic has grown into one of the largest health crises of its kind. Infecting almost 35 million people, the race to find a cure for HIV continues.
Noting the monumental challenge HIV poses, Jamie Mann, PhD, assistant professor in the Department of Microbiology and Immunology, has dedicated much of his work to the study of HIV in hopes of uncovering new information about the virus and helping to further cure-strategies.
“Originally I thought I wanted to work with Influenza, but it was actually during my PhD that I became very interested in HIV,” said Mann. “Recognizing HIV as one of the biggest epidemics of the moment, I realized that this was the field of study I wanted to spend my time in.”
Beginning his first postdoctoral fellowship to study HIV vaccines, Mann trained under the supervision of Robin Shattock, PhD, a mucosal immunologist at Imperial College in London, England. He was later recruited to work at Case Western Reserve University in Ohio with Eric Arts, PhD, who is now the Chair of Microbiology and Immunology Department at Schulich Medicine & Dentistry. To date, Mann continues to collaborate with Arts and Shattock on his HIV research.
Having trained under some of the top HIV researchers in the world, Mann has become a highly successful scientist and academic who is driven by his passion for HIV research. 
In 2016, Mann was awarded a grant from the Canadian Institutes of Health Research (CIHR) to advance his research on HIV vaccines.
“With this grant I am attempting to stimulate the HIV virus back into transcriptional activity and reveal itself to the immune response,” said Mann. “If the virus can be encouraged to do that, the immune response, we hope, can actually attack the virus and may eliminate it from the body.”
Reverse transcription is the process by which the HIV virus enters into the host cell's cytoplasm and then converts the viral ribonucleic acid (RNA) into viral deoxyribonucleic acid (DNA) using an enzyme called reverse transcriptase. Once this process is complete, the newly made viruses infects and destroys other healthy CD4 cells.
As well as destroying cells of the immune system, the virus can establish a state of latency. Latency is where the virus remains dormant within infected cells, not producing any viral proteins and therefore is not responsive to antiretroviral treatment.  Over time, the latent HIV reservoir continues to grow, while producing little to no symptoms and progressively weakening the body’s natural immune system.
Through his work, Mann is aiming to bring the HIV virus out of latency in the cells using a 'shock' tactic and effectively treat the infection further with antiretrovirals in a therapeutic setting. This would then help to reduce the size of the viral reservoir and stop the virus from infecting new cells in the body.
“The reason behind this course of action is so we can potentially take people off antiretrovirals after being on them for many years and not fear a viral rebound,” said Mann. 
To evaluate cure strategies and analyze at which points curative vaccines may have the best effect on individuals infected with HIV, Mann is employing a multi-centre study approach to his research as a means of testing the HIV virus under different conditions.
“The cohorts have been selected based on how long the individuals, in which the samples were collected from, have been infected with HIV and the time in between diagnosis and antiretroviral treatment,” he said.
Cohorts from both Imperial College and Case Western Reserve University have been used in Mann’s research.
The cohort from Imperial College includes samples from individuals diagnosed shortly after being infected with HIV and started on antiretrovirals quickly, whereas the cohort from Case Western Reserve draws its samples from individuals diagnosed with HIV at a more chronic stage and started on antiretrovirals late.
“In theory, the Imperial College cohort should be easier to find a cure for, since those individuals have a smaller viral reservoir than those from the Case Western Reserve University cohort, as they have a larger viral reservoir,” said Mann.
Mann says the nature of the virus adds another dimension of difficulty to finding a prophylactic or therapeutic remedy.
“If you asked people in the HIV field a few years ago if a cure was possible, many would have answered no,” said Mann. “But now, we’ve made so many advancements in the area, I think we could actually see some sort of cure—however, we still have a long way to go.”
With HIV diversifying every time it infects a cell, millions of different species of the virus exist within an individual. Mann says designer drugs are being weighed as an option to treat the virus since they can then be tailor-made for those infected with HIV and can uniquely attack the virus. But the high costs and the difficulty involved in delivering a designer drug solution is one that may put treatment out of reach for those who need it most.
“If you think about Africa, which is the epicentre of the HIV epidemic, designer drugs create a problem,” said Mann. “If you go down the route of a globally applicable vaccine, you will have one vaccine or treatment plan that you can distribute around the world. This option is less costly and helps the greatest amount of people.”
Citing 'out of the box' thinking as a critical factor in driving a cure for HIV, Mann says the influence of the trainees working in his lab helps him to reframe or think of ideas in a new way.
“It’s always refreshing working with trainees because they are so inquisitive and have a real interest in learning,” said Mann. “Sometimes when students ask questions it allows me to think of things in a way I wouldn’t necessarily have before.
When we’re working in the lab we can get caught up in our work, so when students come along and start asking questions, it’s always nice to pass along new information to them.”
Helping trainees demonstrate and understand just how crucial and important this field of study is serves as another goal of Mann’s.
“I think sometimes people think of HIV as ‘just HIV’ and that it’s not the killer disease that it was in the 1980s and 1990s—which is a complete mistake. It’s still a very serious infection,” he said.
As an end goal to his research, Mann aspires to continue contributing to what is known about HIV, uncover new research approaches and help form of cure for the virus.
“I’m really encouraged through the research that we’re doing, along with others studying HIV, that it will contribute to developing a cure for HIV,” he said.