Mary Ann Hausner

Shortened telomeres in the expanded CD28- CD8+ cell subset in HIV disease implicate replicative senescence in HIV pathogenesis

OBJECTIVE To test the hypothesis that the expanded population of non-proliferative CD28-CD8+ T cells in HIV disease have shortened telomeres, thereby providing evidence that increased rounds of CD8+ cell division occur during HIV disease, possibly leading to replicative senescence and exhaustion of CD8+ T-cell responses. DESIGN CD8+ cells play a central role in control of HIV infection. In late HIV disease, an expanded population of CD28-CD8+ cells with reduced proliferative potential has been documented. A similar population of CD28-CD8+ cells has been identified in ageing humans, where telomere length measurements have suggested that these cells have reached the irreversible state of replicative senescence. METHODS CD8+ cells from HIV-infected and control subjects were sorted by flow cytometry into CD28+ and CD28- fractions. Telomere lengths were determined as mean terminal restriction fragment (TRF) lengths by Southern hybridization. RESULTS The TRF lengths of sorted CD28-CD8+ cells in HIV-infected subjects ranged between 5 and 7 kilobases (kb) and were significantly shorter than TRF lengths of CD28-CD8+ cells in uninfected subjects (P = 0.003). The TRF length in CD28-CD8+ cells from HIV-infected subjects was the same as that observed for centenarian peripheral blood mononuclear cells and is compatible with a state of replicative senescence. CONCLUSIONS The shortened telomeres in the CD28-CD8+ cells in HIV-infected subjects and the poor proliferative potential of these cells identifies CD8+ cell replicative senescence as a newly described feature of HIV disease. Our results provide a mechanism for the loss of CD8+ cell control of viral replication that accompanies advanced HIV disease. Replicative senescence may contribute to exhaustion of the T-cell response as a result of chronic HIV disease. Whether this phenomenon occurs in other chronic viral infections is unknown.

LXR signaling couples sterol metabolism to proliferation in the acquired immune response

Cholesterol is essential for membrane synthesis; however, the mechanisms that link cellular lipid metabolism to proliferation are incompletely understood. We demonstrate here that cellular cholesterol levels in dividing T cells are maintained in part through reciprocal regulation of the LXR and SREBP transcriptional programs. T cell activation triggers induction of the oxysterol-metabolizing enzyme SULT2B1, consequent suppression of the LXR pathway for cholesterol transport, and promotion of the SREBP pathway for cholesterol synthesis. Ligation of LXR during T cell activation inhibits mitogen-driven expansion, whereas loss of LXRbeta confers a proliferative advantage. Inactivation of the sterol transporter ABCG1 uncouples LXR signaling from proliferation, directly linking sterol homeostasis to the antiproliferative action of LXR. Mice lacking LXRbeta exhibit lymphoid hyperplasia and enhanced responses to antigenic challenge, indicating that proper regulation of LXR-dependent sterol metabolism is important for immune responses. These results implicate LXR signaling in a metabolic checkpoint that modulates cell proliferation and immunity.

Natural Killer Cell Immunodeficiency in Hiv Disease is Manifest by Profoundly Decreased Numbers of Cd16 + Cd56+ Cells and Expansion of a Population of Cd16dim Cd56- Cells with Low Lytic Activity

Natural killer (NK) cells were enumerated by three-color immunofluorescence in 255 uninfected and 399 human immunodeficiency virus-infected adults. Several dramatic alterations were observed. First, the median number and percentage of CD16+CD56+ NK cells, the subset that comprises > 90% of the NK cells in healthy adults, were severely decreased (median, 175/mm3 in uninfected controls; 63/mm3 in HIV-infected non-AIDS subjects). Even subjects with > 800 CD4+ cells/mm3 had decreased CD16+CD56+ NK cell levels (97/mm3). Second, the number of CD16+CD56- cells, an NK population that is rare in healthy adults, was elevated (median, 20/mm3 in uninfected controls; 64/mm3 in HIV-seropositive non-AIDS subjects). Third, the expression of CD16 on the NK cells was markedly reduced; some CD56+ cells and virtually all CD56- cells were CD16dim. Fourth, fluorescence-activated cell-sorting studies revealed little NK- or antibody-dependent cellular cytotoxic activity in the CD16dimCD56- cell population. These results indicate that the pathogenesis of HIV disease includes numerical alterations in subpopulations of NK cells. A better understanding of how HIV infection causes this aspect of pathogenesis is needed.

Homeostasis of the Naive CD4+ T Cell Compartment during Aging

Despite thymic involution, the number of naive CD4+ T cells diminishes slowly during aging, suggesting considerable peripheral homeostatic expansion of these cells. To investigate the mechanisms behind, and consequences of, naive CD4+ T cell homeostasis, we evaluated the age-dependent dynamics of the naive CD4+ T cell subsets CD45RA+CD31+ and CD45RA+CD31−. Using both a cross-sectional and longitudinal study design, we measured the relative proportion of both subsets in individuals ranging from 22 to 73 years of age and quantified TCR excision circle content within those subsets as an indicator of proliferative history. Our findings demonstrate that waning thymic output results in a decrease in CD45RA+CD31+ naive CD4+ T cells over time, although we noted considerable individual variability in the kinetics of this change. In contrast, there was no significant decline in the CD45RA+CD31− naive CD4+ T cell subset due to extensive peripheral proliferation. Our longitudinal data are the first to demonstrate that the CD45RA+CD31+CD4+ subset also undergoes some in vivo proliferation without immediate loss of CD31, resulting in an accumulation of CD45RA+CD31+ proliferative offspring. Aging was associated with telomere shortening within both subsets, raising the possibility that accumulation of proliferative offspring contributes to senescence of the naive CD4+ T cell compartment in the elderly. In contrast, we observed retention of clonal TCR diversity despite peripheral expansion, although this analysis did not include individuals over 65 years of age. Our results provide insight into naive CD4+ T cell homeostasis during aging that can be used to better understand the mechanisms that may contribute to immunosenescence within this compartment.

Optimization of methods to assess human mucosal T-cell responses to HIV infection

The majority of HIV-1 infections occur via sexual transmission at mucosal epithelia lining the vagina, cervix or rectum. Mucosal tissues also serve as viral reservoirs. However, our knowledge of human mucosal T-cell responses is limited. There is a need for reliable, sensitive, and reproducible methods for assessing mucosal immunity. Here we report on the collaborative efforts of two laboratories to optimize methods for processing, culturing, and analyzing mucosal lymphocytes. Rectal biopsy tissue was obtained by flexible sigmoidoscopy, which is rapid, minimally invasive, and well tolerated. Of the four methods compared for isolating mucosal mononuclear cells (MMC), collagenase digestion reproducibly yielded the most lymphocytes (4-7 x 10(6)). Furthermore, 0.5-1 x 10(6) MMC could be polyclonally expanded to yield 17 x 10(6) CD8+ T cells allowing mapping of responses to overlapping peptides spanning the HIV-1 genome using IFN-gamma enzyme-linked immunospot (ELISpot). Expansion also reduced the spontaneous IFN-gamma production normally detected in fresh MMC. Piperacillin-tazobactam and amphotericin B reduced contamination of MMC cultures to 4%. Taken together, these methods will be useful for studies of mucosal immunity to HIV-1 and other pathogens during natural infection and following vaccination.

Epitope escape mutation and decay of human immunodeficiency virus type 1-specific CTL responses.

To investigate possible mechanisms behind HIV-1 escape from CTL, we performed detailed longitudinal analysis of Gag (SLYNTVATL)- and RT (ILKEPVHGV)-specific CTL responses and plasma epitope sequences in five individuals. Among those with CTL against consensus epitope sequences, epitope mutations developed over several years, invariably followed by decay of the CTL targeting the consensus epitopes. The maturation state of the CTL varied among individuals and appeared to affect the rate of epitope mutation and CTL decay, despite similar IFN-γ production. Escape mutations were oligoclonal, suggesting fitness constraints. The timing of escape indicated that the net selective advantage of escape mutants was slight, further underscoring the importance of understanding factors determining selective pressure and viral fitness in vivo. Our data show surprisingly consistent decay of CTL responses after epitope escape mutation and provide insight into potential mechanisms for both immune failure and shifting CTL specificities.

The dual impact of HIV-1 infection and aging on naive CD4 T-cells: additive and distinct patterns of impairment.

HIV-1-infected adults over the age of 50 years progress to AIDS more rapidly than adults in their twenties or thirties. In addition, HIV-1-infected individuals receiving antiretroviral therapy (ART) present with clinical diseases, such as various cancers and liver disease, more commonly seen in older uninfected adults. These observations suggest that HIV-1 infection in older persons can have detrimental immunological effects that are not completely reversed by ART. As naïve T-cells are critically important in responses to neoantigens, we first analyzed two subsets (CD45RA+CD31+ and CD45RA+CD31-) within the naïve CD4+ T-cell compartment in young (20–32 years old) and older (39–58 years old), ART-naïve, HIV-1 seropositive individuals within 1–3 years of infection and in age-matched seronegative controls. HIV-1 infection in the young cohort was associated with lower absolute numbers of, and shorter telomere lengths within, both CD45RA+CD31+CD4+ and CD45RA+CD31-CD4+ T-cell subsets in comparison to age-matched seronegative controls, changes that resembled seronegative individuals who were decades older. Longitudinal analysis provided evidence of thymic emigration and reconstitution of CD45RA+CD31+CD4+ T-cells two years post-ART, but minimal reconstitution of the CD45RA+CD31-CD4+ subset, which could impair de novo immune responses. For both ART-naïve and ART-treated HIV-1-infected adults, a renewable pool of thymic emigrants is necessary to maintain CD4+ T-cell homeostasis. Overall, these results offer a partial explanation both for the faster disease progression of older adults and the observation that viral responders to ART present with clinical diseases associated with older adults.

Parallel human immunodeficiency virus type 1-specific CD8(+) T-lymphocyte responses in blood and mucosa during chronic infection

ABSTRACT Gut-associated lymphoid tissue is the major reservoir of lymphocytes and human immunodeficiency virus type 1 (HIV-1) replication in vivo, yet little is known about HIV-1-specific CD8+ T-lymphocyte (CTL) responses in this compartment. Here we assessed the breadth and magnitude of HIV-1-specific CTL in the peripheral blood and sigmoid colon mucosa of infected subjects not on antiretroviral therapy by enzyme-linked immunospot analysis with 53 peptide pools spanning all viral proteins. Comparisons of blood and mucosal CTL revealed that the magnitude of pool-specific responses is correlated within each individual (mean r2 = 0.82 ± 0.04) and across all individuals (r2 = 0.75; P < 0.001). Overall, 85.1% of screened peptide pools yielded concordant negative or positive results between compartments. CTL targeting was also closely related between blood and mucosa, with Nef being the most highly targeted (mean of 2.4 spot-forming cells [SFC[/106 CD8+ T lymphocytes/amino acid [SFC/CD8/aa]), followed by Gag (1.5 SFC/CD8/aa). Finally, comparisons of peptide pool responses seen in both blood and mucosa (concordant positives) versus those seen only in one but not the other (discordant positives) showed that most discordant results were likely an artifact of responses being near the limit of detection. Overall, these results indicate that HIV-1-specific CTL responses in the blood mirror those seen in the mucosal compartment in natural chronic infection. For protective or immunotherapeutic vaccination, it will be important to determine whether immunity is elicited in the mucosa, which is a key site of initial infection and subsequent HIV-1 replication in vivo.

Acute HIV syndrome after discontinuation of antiretroviral therapy in a patient treated before seroconversion

Primary HIV infection is associated with high levels of viral replication and the development of HIV-specific immune responses [1-5]. Treating patients during primary HIV infection is recommended [6], but little is known about the effects of such therapy [7-9]. We report the results of virologic and immunologic studies in a patient who began receiving antiretroviral therapy during primary HIV infection and chose to discontinue therapy after 6 months. Case Report A 38-year-old homosexual man presented on day 5 of an acute retroviral syndrome characterized by fever, pharyngitis, myalgia, headache, lymphadenopathy, and rash. The patients leukocyte count was 2.6 109/L, his platelet count was 85.0 109/L, and his plasma HIV RNA level was 1 800 000 copies/mL. No HIV antibodies were detectable. Primary HIV infection was diagnosed. Infection was probably a result of a receptive orogenital sexual encounter that took place 13 days before presentation, when the patient had a hard-palate ulcer. Two days after presentation, HIV antibodies remained undetectable; the plasma HIV RNA level was 5 600 000 copies/mL; and therapy with standard doses of zidovudine, lamivudine, and ritonavir was started. Because of toxicity, therapy was altered several times over the next 6 months. At 6 months, the patient chose to stop antiretroviral treatment despite being counseled about the possible outcomes of doing so. Thirty-five days later, he developed an acute illness that was indistinguishable from the acute retroviral syndrome. Results of serologic evaluation for Epstein-Barr virus, cytomegalovirus, rubella, roseola, parvovirus B19, and human herpesvirus-6 were inconsistent with acute disease. The patient chose not to reinitiate treatment, and his acute symptoms resolved during the following 10 to 14 days. Methods Antibodies to HIV were measured by enzyme immunoassay (Abbott Laboratories, North Chicago, Illinois) and Western blot (Genetic Systems, Seattle, Washington). Plasma HIV RNA was quantified by a branched-DNA assay (version 2.0, Chiron Diagnostics, Emeryville, California), which measured as few as 500 copies/mL. Quantitative cultures of plasma and peripheral blood mononuclear cells [1, 10] and memory cytotoxic T-lymphocyte assays [11] were performed as described elsewhere. The funding sources had no role in gathering, analyzing, or interpreting the data or in the decision to submit the paper for publication. Results Our patient began receiving antiretroviral therapy before a humoral immune response was detected. Virologic and immunologic measurements were made during the treatment and post-treatment phases (Figure 1). As seen in other patients treated during primary HIV infection [7, 8], our patients plasma HIV RNA declined to undetectable levels. In addition, plasma titers of infectious virus declined to less than 1 tissue-culture infectious dose per mL; cellular titers of infectious virus decreased to less than 0.1 infectious units per million peripheral blood mononuclear cells. Although not tested earlier, cytotoxic T-lymphocyte memory-cell activity was undetectable after 5 months of treatment (Figure 2). Also at this time, minimal CD8+ cell activation was detected by using previously described methods [11, 12]. Figure 1. Temporal relation among clinical symptoms, antiretroviral therapy, plasma HIV RNA levels, and CD4+ and CD8+ T-lymphocyte counts in a patient treated during primary HIV infection before HIV-specific antibodies were detectable. Figure 2. Memory cytotoxic T-lymphocyte activity in blood, measured as the percentage of specific lysis at different effector-to-target ratios. Left. Right. Viremia rebounded after therapy was discontinued (Figure 1). In addition, memory cytotoxic T-lymphocyte activity (Figure 2) and high levels of CD8+ T-lymphocyte activation (data not shown), which correlate with the presence of cytotoxic T lymphocytes [13], were detected. The presence of memory cytotoxic T-cell activity against HIV Gag and Pol (but not against control cells, which do not express HIV proteins) indicates that the donor had CD8+ T cells primed against HIV antigens. These memory cells provide rapid secondary responses to antigens to which the host has been sensitized. Discussion Although declining cytotoxic T-lymphocyte activity has been described in patients treated during primary HIV infection [7, 14], we are not aware of such observations in treated patients with chronic HIV infection. Whether absence of memory cytotoxic T-lymphocyte activity is a frequent outcome of treatment during seronegative primary HIV infection needs to be confirmed in larger studies. Nevertheless, our results suggest that HIV replication sustained for some minimal period may be needed to establish a durable CD8+ cell-mediated response. This observation has implications for HIV vaccination protocols because brief exposures to viral antigens may not result in the sustained immune response needed for HIV immunity. This is in contrast to observations in other viral systems [15-17]. The rebound in viremia after our patient stopped therapy was anticipated because of the cellular reservoirs of infectious HIV [18-20]. In contrast, the associated clinical syndrome was unexpected and may be explained by the emergence, at that time, of a CD8+ cell-mediated immune response similar to the response in newly infected persons. Further investigation is required to determine the clinical significance of this second acute syndrome and the effect of early therapy on HIV-specific immune responses. Ms. Hausner, Mr. Majchrowicz, and Dr. Giorgi: University of California, Los Angeles, School of Medicine, 12-939 Factor Building, 10833 Le Conte Avenue, Los Angeles, CA 90024-1745.

Immunologic Profile of Highly Exposed Yet HIV Type 1-Seronegative Men

The host immune factors that determine susceptibility to HIV-1 infection are poorly understood. We compared multiple immunologic parameters in three groups of HIV-1-seronegative men: 14 highly exposed (HR10), 7 previously reported possibly to have sustained transient infection (PTI), and a control group of 14 low risk blood bank donors (BB). Virus-specific cellular immune assays were performed for CD4(+) T helper cell responses, CD8(+) cytotoxic T lymphocyte activity, CD8(+) cell chemokine release, and CD8(+) cell-derived antiviral soluble factor activity. General immune parameters evaluated included CCR5 genotype and phenotype, interferon alpha production by PBMCs, leukocyte subset analysis, and detailed T lymphocyte phenotyping. Comparisons revealed no detectable group-specific differences in measures of virus-specific immunity. However, the HR10 group differed from the BB group in several general immune parameters, having higher absolute monocyte counts, higher absolute CD8(+) T cell counts and percentages, lower naive and higher terminal effector CD8(+) cells, and lower levels of CD28(+)CD8(+) cells. These changes were not associated with seropositivity for other chronic viral infections. The PTI men appeared to have normal levels of monocytes and slightly elevated levels of CD8(+) T cells (also with increased effector and decreased naive cells). Although we cannot entirely exclude the contribution of other chronic viral infections, these findings suggest that long-lived systemic cellular antiviral immunity as detected by our assays is not a common mechanism for resistance to infection, and that resistance may be multifactorial. General immune parameters reflected by CD8(+) T cell levels and activation, and monocyte concentrations may affect the risk of infection with HIV-1, and/or serve as markers of exposure.