The History and Future of a Single Mutation

The CCR5delta32 confers resistance to HIV. Where did it come from?

We are edging into an age of precision medicine, where the causes of our maladies will be known in molecular detail, allowing treatments that address them at the root. Given the parlous state of medicine today, in the midst of financial breakdown and a continued mediocre level of basic diagnosis, it is hard to believe this is a corner we can turn. But vaccines have long been in this category, of addressing the precise pathogenic causes of disease, and oncology is fitfully getting there, given advances in DNA sequencing and in treatments based on specific mutations.

HIV is also a beneficiary of this approach, since the discovery of its pathogen led directly to a variety of effective (if not yet permanent) treatments. A researcher in China created gene-edited humans with a specific mutation that will render them resistant to HIV. The mutation he chose for this work is called CCR5delta32, and it does not naturally exist in Chinese populations. 

But it does exist in European populations, at a roughly 10% rate in single copy. When present in two copies, it provides complete immunity to HIV, while if present in one copy, it slows infection substantially. A recent paper rooted through the available ancient and present genomes to figure out where this mutation came from. 

CCR5 is a cell surface receptor for cytokines 3, 4, and 5. These are all pro-inflammatory cytokines, and they interact with multiple receptors. Here, as in so many other respects, the immune system is riven with redundancy, so that it can grapple with as many contingencies as possible. Cytokines are signaling molecules for the immune system, which is an unusual organ, being dispersed all over the body with numerous cell types all patrolling around, and communicating with each other by long- and short-range chemical messages. It turns out that the major form of HIV uses the CCR5 protein to get into our immune cells, explaining why CCR5delta32, which is totally non-functional, has such a dramatic effect on HIV susceptibility. 

While people carrying CCR5delta32 are generally fine, this defect does confer a variety of subtle changes to their susceptibility to other infectious diseases and cancers. That explains why this mutation has settled at its low level in the European populations, probably balancing the occasional benefit against a specifically CCR5-seeking pathogen against its natural functions that form the basis of its existence in the first place as a part of immune system that is conserved in all mammals. The Chinese gene-editing researcher came under withering criticism not only for breaching the generally agreed moratorium on human germline gene editing, but also because the net effect of this mutation is, on the whole, negative, raising risks of numerous diseases, despite its beneficial effect on HIV. 

The authors run several models and populations in an attempt to time the origin of the CCR5delta32 mutation, and portray its positive selection over the ensuing millenia.  CHG- Caucasus hunter-gatherer; EHG- Eastern hunter-gatherer; WHG- Western hunter-gatherer; ANA- Anatolian Neolithic ancestry. The bottom axis is time, and the Y axis is the frequency of the mutation in these populations. "Modern DAF" refers to the inclusion of the data set of current (not ancient) population frequencies, (top), which the authors claim leads to continued rates of selection (last 2,000 years) that are artifactual.

So where did it come from? The new authors gather up a large variety of population samples from around the world, and from ancient humans, back to about ten thousand years ago. They find the first instance of the mutation in one sample at 5.8 thousand years ago. After that, its frequency rises dramatically, up to about two thousand years ago, when it levels off. They conclude that this mutation originated about seven to nine thousand years ago, in the steppes of Eastern Europe / Western Asia, and was under strong positive selection at first, spreading to the current frequency of about 10% of the population / alleles. All occurrences on other continents can be accounted by the spread from this source.

Does this mean that HIV was prevalent long, long before the current pandemic? Hardly. The authors can not say anything about it, but one theory would be that some other disease had a similar profile. It certainly was not the Black Death, as the authors show that this mutation had no change in frequency over that gruesome pandemic. Another hypothesis is that general reduction in inflammatory response might be beneficial in some settings, as has been found for Covid-19, though here again, this mutation does not have any known positive or negative net effect on Covid-19 susceptibility or course. 

It is amazing that we have enough sequences of ancient DNA to be able to reconstruct this kind of thing- to be able to trace where and when some influential mutation occurred, and how it traveled and spread. It is a tour-de-force of bio-archeological reconstruction.

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