Immune recovery in HIV-infected patients after candida esophagitis is impaired despite long-term antiretroviral therapy.

OBJECTIVE Candida esophagitis belongs to the most common AIDS-defining diseases, however, a comprehensive immune pathogenic concept is lacking. DESIGN We investigated the immune status of 37 HIV-1-infected patients from the Swiss HIV cohort study at diagnosis of Candida esophagitis, 1 year before, 1 year later and after 2 years of suppressed HIV RNA. We compared these patients to 3 groups: 37 HIV-1-infected patients without Candida esophagitis but similar CD4 counts as the patients at diagnosis (advanced HIV group), 15 HIV-1-infected patients with CD4 counts >500 cells/μl, CD4 nadir >350 cells/μl and suppressed HIV RNA under combination antiretroviral therapy (cART) (early cART group), and 20 healthy individuals. METHODS We investigated phenotype, cytokine production and proliferative capacity of different immune cells by flow cytometry and ELISpot. RESULTS We found that patients with Candida esophagitis had nearly abolished CD4 proliferation in response to C. albicans, significantly increased percentages of dysfunctional CD4 cells, significantly decreased cytotoxic NK-cell counts and peripheral innate lymphoid cells and significantly reduced IFN-γ and IL-17 production compared to the early cART group and healthy individuals. Most of these defects remained for more than 2 years despite viral suppression. The advanced HIV group without opportunistic infection showed partly improved immune recovery. CONCLUSIONS Our data indicate that Candida esophagitis in HIV-1-infected patients is caused by an accumulation of multiple, partly Candida-specific immunological defects. Long-term immune recovery is impaired, illustrating that specific immunological gaps persist despite cART. These data also support the rationale for early cART initiation to prevent irreversible immune defects.

Antiretroviral Treatment as Prevention in African HIV-1 Serodiscordant Couples: Understanding the Challenges and Opportunities

Thesis (Ph.D.)--University of Washington, 2016-06

Systemic monocyte activation levels and developmental milestone attainment in HIV-infected infants initiating antiretroviral therapy

Thesis (Master's)--University of Washington, 2016-06

IL-10 Mediates Suppression of the CD8 T Cell IFN-γ Response to a Novel Viral Epitope in a Primed Host

Priming to Ag can inhibit subsequent induction of an immune response to a new epitope incorporated into that Ag, a phenomenon referred to as original antigenic sin. In this study, we show that prior immunity to a virus capsid can inhibit subsequent induction of the IFN-gamma effector T cell response to a novel CD8-restricted antigenic epitope associated with the virus capsid. Inhibition does not involve Ab to the virus capsid, as it is observed in animals lacking B cells. CD8-restricted virus-specific T cell responses are not required, as printing to virus without CTL induction is associated with inhibition. However, IL-10(-/-) mice, in contrast to IL-10(+/+) mice, generate CD8 T cell and Ab responses to novel epitopes incorporated into a virus capsid, even when priming to the capsid has resulted in high titer Ab to the capsid. Furthermore, capsid-primed mice, unable to mount a response to a novel epitope in the capsid protein, are nevertheless able to respond to the same novel epitope delivered independently of the capsid. Thus, inhibition of responsiveness to a novel epitope in a virus-primed animal is a consequence of secretion of IL-10 in response to presented Ag, which inhibits local generation of new CD8 IFN-gamma-secreting effector T cells. Induction of virus- or tumor Ag-specific CD8 effector T cells in the partially Ag-primed host may thus be facilitated by local neutralization of IL-10.

Suppression of HIV-1 viral load after multiple changes in high active antiretroviral therapy: A case report

High active antiretroviral therapy (HAART) can reduce plasma viremia to levels below the limit of detection, leading to adequate immune recovery and clinical stability in most HIV-1-infected patients. However, the virus persists in reservoirs, and free virions can be found in the plasma. We report here the case of an HIV-infected patient diagnosed in 1999, who exhibited good adherence to medication and HAART efficacy after multiple protocol changes. In this study, we describe the clinical features, chronological changes in HIV viral load and CD4+ T-cell count, and treatment outcomes of multiple combinations of antiretrovirals (ARV).The patient presented cycles of viral load during treatment ranging from undetectable, low, and intermediate HIV-1 RNA levels, to levels above the limits of quantification. A therapeutic regimen intensified with raltegravir (RAL) promoted constant depletion of HIV viral load and an increase in CD4+ T-cells. The report shows that enhanced HAART efficacy using RAL can reduce HIV viral load.

Role of retroviral restriction factors in the interferon-α-mediated suppression of HIV-1 in vivo.

The antiviral potency of the cytokine IFN-α has been long appreciated but remains poorly understood. A number of studies have suggested that induction of the apolipoprotein B mRNA editing enzyme, catalytic polypeptide 3 (APOBEC3) and bone marrow stromal cell antigen 2 (BST-2/tetherin/CD317) retroviral restriction factors underlies the IFN-α-mediated suppression of HIV-1 replication in vitro. We sought to characterize the as-yet-undefined relationship between IFN-α treatment, retroviral restriction factors, and HIV-1 in vivo. APOBEC3G, APOBEC3F, and BST-2 expression levels were measured in HIV/hepatitis C virus (HCV)-coinfected, antiretroviral therapy-naïve individuals before, during, and after pegylated IFN-α/ribavirin (IFN-α/riba) combination therapy. IFN-α/riba therapy decreased HIV-1 viral load by -0.921 (±0.858) log(10) copies/mL in HIV/HCV-coinfected patients. APOBEC3G/3F and BST-2 mRNA expression was significantly elevated during IFN-α/riba treatment in patient-derived CD4+ T cells (P < 0.04 and P < 0.008, paired Wilcoxon), and extent of BST-2 induction was correlated with reduction in HIV-1 viral load during treatment (P < 0.05, Pearson's r). APOBEC3 induction during treatment was correlated with degree of viral hypermutation (P < 0.03, Spearman's ρ), and evolution of the HIV-1 accessory protein viral protein U (Vpu) during IFN-α/riba treatment was suggestive of increased BST-2-mediated selection pressure. These data suggest that host restriction factors play a critical role in the antiretroviral capacity of IFN-α in vivo, and warrant investigation into therapeutic strategies that specifically enhance the expression of these intrinsic immune factors in HIV-1-infected individuals.

Suppression of short interfering RNA-mediated gene silencing by the structural proteins of hepatitis C virus.

Viruses have evolved strategies to overcome the antiviral effects of the host at different levels. Besides specific defence mechanisms, the host responds to viral infection via the interferon pathway and also by RNA interference (RNAi). However, several viruses have been identified that suppress RNAi. We addressed the question of whether hepatitis C virus (HCV) suppresses RNAi, using cell lines constitutively expressing green fluorescent protein (GFP) and inducibly expressing HCV proteins. It was found that short interfering RNA-mediated GFP gene silencing was inhibited when the entire HCV polyprotein was expressed. Further studies showed that HCV structural proteins, and in particular envelope protein 2 (E2), were responsible for this inhibition. Co-precipitation assays demonstrated that E2 bound to Argonaute-2 (Ago-2), a member of the RNA-induced silencing complex, RISC. Thus, HCV E2 that interacts with Ago-2 is able to suppress RNAi.

Cognitive dysfunction in HIV patients despite long-standing suppression of viremia.

OBJECTIVE:: To determine the prevalence of cognitive complaints and HIV-associated neurocognitive disorders (HANDs) in a cohort of aviremic HIV-positive patients. To evaluate the relevance of the HIV dementia scale to detect HANDs. DESIGN:: Assessment of HANDs with neuropsychological tests. METHODS:: Two hundred HIV-infected patients with undetectable HIV-1 RNA concentrations in the plasma, no history of major opportunistic infection of the central nervous system in the past 3 years, no current use of intravenous drugs, and no major depression answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of 50 complaining and 50 noncomplaining HIV-positive patients were assessed. RESULTS:: Patients had undetectable HIV-1 RNA concentrations for a median time of 48 months (range 3.2-136.6). The prevalence of cognitive complaints was 27%. The prevalence of HANDs was 84% among patients with cognitive complaints (asymptomatic neurocognitive impairment 24%, mild neurocognitive disorders 52%, and HIV-associated dementia 8%) and 64% among noncomplainers (asymptomatic neurocognitive impairment 60%, mild neurocognitive disorders 4%, and HIV-associated dementia 0%; P < 0.001). A score of 14 points or less on the HIV dementia scale yielded a positive predictive value of HANDs of 92% in complainers and 82% in noncomplainers. CONCLUSION:: The prevalence of HANDs is high even in long-standing aviremic HIV-positive patients. However, HANDs without functional repercussion in daily life (asymptomatic neurocognitive impairment) is the most frequent subtype observed. In this population, the HIV dementia scale with a cutoff of 14 points or less seems to provide a useful tool to screen for the presence of HANDs.

Hepatitis B and C virus coinfection: a novel model system reveals the absence of direct viral interference.

Coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) has been associated with severe liver disease and frequent progression to cirrhosis and hepatocellular carcinoma. Clinical evidence suggests reciprocal replicative suppression of the two viruses, or viral interference. However, interactions between HBV and HCV have been difficult to study due to the lack of appropriate model systems. We have established a novel model system to investigate interactions between HBV and HCV. Stable Huh-7 cell lines inducibly replicating HBV were transfected with selectable HCV replicons or infected with cell culture-derived HCV. In this system, both viruses were found to replicate in the same cell without overt interference. Specific inhibition of one virus did not affect the replication and gene expression of the other. Furthermore, cells harboring replicating HBV could be infected with cell culture-derived HCV, arguing against superinfection exclusion. Finally, cells harboring replicating HBV supported efficient production of infectious HCV. Conclusion: HBV and HCV can replicate in the same cell without evidence for direct interference in vitro. Therefore, the viral interference observed in coinfected patients is probably due to indirect mechanisms mediated by innate and/or adaptive host immune responses. These findings provide new insights into the pathogenesis of HBV-HCV coinfection and may contribute to its clinical management in the future.

Suppression of a pro-apoptotic K+ channel as a mechanism for hepatitis C virus persistence

An estimated 3% of the global population are infected with hepatitis C virus (HCV), and the majority of these individuals will develop chronic liver disease. As with other chronic viruses, establishment of persistent infection requires that HCV-infected cells must be refractory to a range of pro-apoptotic stimuli. In response to oxidative stress, amplification of an outward K(+) current mediated by the Kv2.1 channel, precedes the onset of apoptosis. We show here that in human hepatoma cells either infected with HCV or harboring an HCV subgenomic replicon, oxidative stress failed to initiate apoptosis via Kv2.1. The HCV NS5A protein mediated this effect by inhibiting oxidative stress-induced p38 MAPK phosphorylation of Kv2.1. The inhibition of a host cell K(+) channel by a viral protein is a hitherto undescribed viral anti-apoptotic mechanism and represents a potential target for antiviral therapy.

Inibição do vírus da hepatite C utilizando siRNAs direcionados para o genoma viral e proteínas celulares Hsps

Pós-graduação em Microbiologia - IBILCE

Avaliação da produção e concentração viral em pimentão infectado por tospovírus com o uso de piraclostrobina + metiram

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

MRKAd5 HIV-1 Gag/Pol/Nef Vaccine-Induced T-Cell Responses Inadequately Predict Distance of Breakthrough HIV-1 Sequences to the Vaccine or Viral Load

Background: The sieve analysis for the Step trial found evidence that breakthrough HIV-1 sequences for MRKAd5/HIV-1 Gag/Pol/Nef vaccine recipients were more divergent from the vaccine insert than placebo sequences in regions with predicted epitopes. We linked the viral sequence data with immune response and acute viral load data to explore mechanisms for and consequences of the observed sieve effect. Methods: Ninety-one male participants (37 placebo and 54 vaccine recipients) were included; viral sequences were obtained at the time of HIV-1 diagnosis. T-cell responses were measured 4 weeks post-second vaccination and at the first or second week post-diagnosis. Acute viral load was obtained at RNA-positive and antibody-negative visits. Findings: Vaccine recipients had a greater magnitude of post-infection CD8+ T cell response than placebo recipients (median 1.68% vs 1.18%; p = 0.04) and greater breadth of post-infection response (median 4.5 vs 2; p = 0.06). Viral sequences for vaccine recipients were marginally more divergent from the insert than placebo sequences in regions of Nef targeted by pre-infection immune responses (p = 0.04; Pol p = 0.13; Gag p = 0.89). Magnitude and breadth of pre-infection responses did not correlate with distance of the viral sequence to the insert (p. 0.50). Acute log viral load trended lower in vaccine versus placebo recipients (estimated mean 4.7 vs 5.1) but the difference was not significant (p = 0.27). Neither was acute viral load associated with distance of the viral sequence to the insert (p>0.30). Interpretation: Despite evidence of anamnestic responses, the sieve effect was not well explained by available measures of T-cell immunogenicity. Sequence divergence from the vaccine was not significantly associated with acute viral load. While point estimates suggested weak vaccine suppression of viral load, the result was not significant and more viral load data would be needed to detect suppression.

Induktion tolerogener dendritischer Zellen zur Suppression von experimenteller autoimmuner Enzephalomyelitis und Kontaktallergie

Dendritische Zellen (DC) spielen als professionelle antigenpräsentierende Zellen (APC) eine zentrale Rolle in der Aktivierung und Regulierung antigenspezifischer Immunantworten. Aus diesem Grund wird der therapeutische Einsatz von DC zur Behandlung von Autoimmunerkrankungen und Allergien sowie zur Tumorbekämpfung erforscht. Im ersten Teil der vorliegenden Arbeit untersuchten wir das Potenzial einer biolistischen DNA-Vakzinierung zur Induktion tolerogener DC in vivo. Im Tiermodell der Myelin-Oligodendrozyten-Glykoprotein Peptid 35-55 (MOGp35-55) induzierten experimentellen autoimmunen Enzephalomyelitis (EAE) sollte mittels präventiver biolistischer Kovakzinierung von Plasmid-DNA kodierend für MOG und die immunregulatorischen Zytokine TGFβ oder IL-10 eine protektive Immunität induziert werden. Die MOG-Expression stand dabei entweder unter der Kontrolle des ubiquitär aktiven CMV-Promotors oder des murinen Fascin-Promotors, um eine ektopische MOG-Expression spezifisch in dermalen DC und Langerhanszellen zu erreichen. Dass MOGp35-55-präsentierende DC nach biolistischer DNA-Vakzinierung von der Haut in die drainierenden Lymphknoten migrieren und dort T-Zellen aktivieren, konnte im Vorfeld anhand einer substanziellen Proliferation von MOGp35-55-reaktiven 2D2 T-Zellen nachgewiesen werden. Im präventiven Ansatz der MOGp35-55-induzierten EAE zeigten Mäuse, die mit MOG-kodierenden Plasmiden biolistisch transfiziert wurden, eine leicht reduzierte EAE-Symptomatik. Die Kotransfektion von MOG und TGFβ führte zu einer Verstärkung der EAE-Suppression – unabhängig davon, ob die MOG-Expression unter der Kontrolle des CMV- oder des Fascin-Promotors stand. Interessanterweise resultierte die Koapplikation von MOG- und IL-10-kodierender Plasmid-DNA nur bei DC-fokussierter MOG-Expression zu reduzierter EAE-Symptomatik. Für biolistische DNA-Vakzinierungen stellt somit der Fascin-Promotor eine potente Alternative zu viralen Promotoren dar. Entsprechend der milderen EAE-Symptome beobachteten wir bei behandelten EAE-Mäusen einen geringeren Grad an Demyelinisierung sowie eine reduzierte Infiltration des ZNS mit IFNγ-produzierenden CD4+ Th1- und IL-17-produzierenden CD4+ Th17-Zellen. Desweiteren zeigten Milzzellen ex vivo nach MOGp35-55-Restimulation eine inhibierte Proliferation und eine signifikant reduzierte IFNγ- und IL-17-Zytokinproduktion. Überraschenderweise ging die antigenspezifische Immunsuppression nicht mit der Expansion von Foxp3+ regulatorischen T-Zellen einher. Da die Milzen aber erhöhte Mengen an CD8+IFNγ+ T-Zellen aufweisen, könnte ein zytotoxisch-suppressiver Mechanismus für die Inhibition der Th1- und Th17-Immunantwort verantwortlich sein. Nachfolgende Untersuchungen sind notwendig, um die induzierten immunologischen Mechansimen mittels biolistischer DNA-Vakzinierung aufzuklären. Der zweite Teil der Arbeit befasst sich mit der Generierung von tolerogenen DC in vitro. Dafür wurden murine Knochenmarkszellen unter DC-differenzierenden Bedingungen in Gegenwart des synthetischen Glucocorticoids Dexamethason (DEX) kultiviert. Die DEX-Zugabe führte zur Differenzierung von APC mit geringer CD11c-Expression. DEX-APC waren in vitro weitestgehend gegen LPS stimulierungsresistent und zeigten eine reduzierte Expression von MHC-II und den kostimulatorischen Molekülen CD80, CD86 und CD40. Ihrem tolerogenen Phänotyp entsprechend besaßen DEX-APC ein geringeres syngenes T-Zellstimulierungspotenzial als unbehandelte BM-DC. Anhand der erhöhten Oberflächenexpression von CD11b, GR1 und F4/80 besteht eine phänotypische Ähnlichkeit zu myeloiden Suppressorzellen. Die Fähigkeit von DEX-APC in vivo antigenspezifische Toleranz zu induzieren, wurde durch einen therapeutischen Ansatz im murinen Krankheitsmodell der Kontaktallergie überprüft. Die therapeutische Applikation von DEX-APC führte hierbei im Vergleich zur Applikation von PBS oder unbehandelten BM-DC zu einer signifikant reduzierten Ohrschwellungsreaktion. Zusammenfassend demonstrieren die Ergebnisse dieser Arbeit, dass potente tolerogene DC sowohl in vivo als auch in vitro induziert werden können. Dass diese Zellpopulation effektiv antigenspezifische Immunreaktionen supprimieren kann, macht sie zu einem vielversprechenden Werkzeug in der Behandlung von Autoimmunerkrankungen und Allergien.rn

Role of retroviral restriction factors in the interferon-α-mediated suppression of HIV-1 in vivo

The antiviral potency of the cytokine IFN-α has been long appreciated but remains poorly understood. A number of studies have suggested that induction of the apolipoprotein B mRNA editing enzyme, catalytic polypeptide 3 (APOBEC3) and bone marrow stromal cell antigen 2 (BST-2/tetherin/CD317) retroviral restriction factors underlies the IFN-α-mediated suppression of HIV-1 replication in vitro. We sought to characterize the as-yet-undefined relationship between IFN-α treatment, retroviral restriction factors, and HIV-1 in vivo. APOBEC3G, APOBEC3F, and BST-2 expression levels were measured in HIV/hepatitis C virus (HCV)-coinfected, antiretroviral therapy-naïve individuals before, during, and after pegylated IFN-α/ribavirin (IFN-α/riba) combination therapy. IFN-α/riba therapy decreased HIV-1 viral load by -0.921 (±0.858) log(10) copies/mL in HIV/HCV-coinfected patients. APOBEC3G/3F and BST-2 mRNA expression was significantly elevated during IFN-α/riba treatment in patient-derived CD4+ T cells (P < 0.04 and P < 0.008, paired Wilcoxon), and extent of BST-2 induction was correlated with reduction in HIV-1 viral load during treatment (P < 0.05, Pearson's r). APOBEC3 induction during treatment was correlated with degree of viral hypermutation (P < 0.03, Spearman's ρ), and evolution of the HIV-1 accessory protein viral protein U (Vpu) during IFN-α/riba treatment was suggestive of increased BST-2-mediated selection pressure. These data suggest that host restriction factors play a critical role in the antiretroviral capacity of IFN-α in vivo, and warrant investigation into therapeutic strategies that specifically enhance the expression of these intrinsic immune factors in HIV-1-infected individuals.