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Coetzee LM, Glencross DK. Performance verification of the new fully automated Aquios flow cytometer PanLeucogate (PLG) platform for CD4-T-lymphocyte enumeration in South Africa. PLoS One 2017; 12:e0187456. [PMID: 29099874 PMCID: PMC5669480 DOI: 10.1371/journal.pone.0187456] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The National Health Laboratory Service (NHLS) offers wide-scale CD4 testing through a network of laboratories in South Africa. A new "load and go" cytometer (Aquios CL, Beckman Coulter), developed with a PLG protocol, was validated against the predicate PLG method on the Beckman Coulter FC500 MPL/CellMek platform. METHODS Remnant routine EDTA blood CD4 reference results were compared to results from two Aquios/PLG instruments (n = 205) and a further n = 1885 samples tested to assess daily testing capacity. Reproducibility was assessed using ImmunotrolTM and patient samples with low, medium, high CD4 counts. Data was analyzed using GraphPad software for general statistics and Bland-Altman (BA) analyses. The percentage similarity (%Sim) was used to measure the level of agreement (accuracy) of the new platform versus the predicate and variance (%SimCV) reported to indicate precision of difference to predicate. RESULTS 205 samples were tested with a CD4 count range of 2-1228 cells/μl (median 365cells/μl). BA analysis revealed an overall -40.5±44.0cells/μl bias (LOA of 126.8 to 45.8cells/μl) and %Sim showing good agreement and tight precision to predicate results (94.83±5.39% with %SimCV = 5.69%). Workflow analysis (n = 1885) showed similar outcomes 94.9±8.9% (CV of 9.4%) and 120 samples/day capacity. Excellent intra-instrument reproducibility was noted (%Sim 98.7±2.8% and %SimCV of 2.8%). 5-day reproducibility using internal quality control material (Immunotrol™) showed tight precision (reported %CV of 4.69 and 7.62 for Normal and Low material respectively) and instrument stability. CONCLUSION The Aquios/PLG CD4 testing platform showed clinically acceptable result reporting to existing predicate results, with good system stability and reproducibility with a slight negative but precise bias. This system can replace the faded XL cytometers in low- to medium volume CD4 testing laboratories, using the standardized testing protocol, with better staff utilization especially where technical skills are lacking. Central monitoring of on-board quality assessment data facilitates proactive maintenance and networked instrument performance monitoring.
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Affiliation(s)
- Lindi-Marie Coetzee
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), CD4 Unit, Charlotte Maxeke Hospital, Johannesburg, South Africa
- * E-mail:
| | - Deborah K. Glencross
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), CD4 Unit, Charlotte Maxeke Hospital, Johannesburg, South Africa
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Li T, Qi S, Unger M, Hou YN, Deng QW, Liu J, Lam CMC, Wang XW, Xin D, Zhang P, Koch-Nolte F, Hao Q, Zhang H, Lee HC, Zhao YJ. Immuno-targeting the multifunctional CD38 using nanobody. Sci Rep 2016; 6:27055. [PMID: 27251573 PMCID: PMC4890012 DOI: 10.1038/srep27055] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/29/2016] [Indexed: 12/29/2022] Open
Abstract
CD38, as a cell surface antigen is highly expressed in several hematologic malignancies including multiple myeloma (MM) and has been proven to be a good target for immunotherapy of the disease. CD38 is also a signaling enzyme responsible for the metabolism of two novel calcium messenger molecules. To be able to target this multifunctional protein, we generated a series of nanobodies against CD38 with high affinities. Crystal structures of the complexes of CD38 with the nanobodies were solved, identifying three separate epitopes on the carboxyl domain. Chromobodies, engineered by tagging the nanobody with fluorescence proteins, provide fast, simple and versatile tools for quantifying CD38 expression. Results confirmed that CD38 was highly expressed in malignant MM cells compared with normal white blood cells. The immunotoxin constructed by splicing the nanobody with a bacterial toxin, PE38 shows highly selective cytotoxicity against patient-derived MM cells as well as the cell lines, with half maximal effective concentration reaching as low as 10−11 molar. The effectiveness of the immunotoxin can be further increased by stimulating CD38 expression using retinoid acid. These results set the stage for the development of clinical therapeutics as well as diagnostic screening for myeloma.
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Affiliation(s)
- Ting Li
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen 518055, China
| | - Shali Qi
- School of Biomedical Sciences, Li Ka Shing School of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mandy Unger
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Yun Nan Hou
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen 518055, China
| | - Qi Wen Deng
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen 518055, China
| | - Jun Liu
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen 518055, China
| | - Connie M C Lam
- School of Biomedical Sciences, Li Ka Shing School of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xian Wang Wang
- Functional Laboratory, School of Medicine, Yangtze University, 1 Nanhuan Road, Jingzhou, Hubei 434023, China
| | - Du Xin
- Department of Hematology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518029, China
| | - Peng Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Friedrich Koch-Nolte
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Quan Hao
- School of Biomedical Sciences, Li Ka Shing School of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hongmin Zhang
- Department of Biology, and Shenzhen Key Laboratory of Cell Microenvironment, South University of Science and Technology of China, Shenzhen 518055, China
| | - Hon Cheung Lee
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen 518055, China
| | - Yong Juan Zhao
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen 518055, China
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Early ART Results in Greater Immune Reconstitution Benefits in HIV-Infected Infants: Working with Data Missingness in a Longitudinal Dataset. PLoS One 2015; 10:e0145320. [PMID: 26671450 PMCID: PMC4699458 DOI: 10.1371/journal.pone.0145320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022] Open
Abstract
Background Early initiation of anti-retroviral treatment (ART) decreases mortality as compared to deferred treatment, but whether it preserves immune cells from early loss or promotes their recovery remains undefined. Determination of complex immunological endpoints in infants is often marred by missing data due to missed visits and/or inadequate sampling. Specialized methods are required to address missingness and facilitate data analysis. Methods We characterized the changes in cellular and humoral immune parameters over the first year of life in 66 HIV-infected infants (0–1 year of age) enrolled in the CHER study starting therapy within 12 weeks of birth (n = 42) or upon disease progression (n = 24). A convenience cohort of 23 uninfected infants aged 0–6 months born to mothers with HIV-1 infection was used as controls. Flow cytometry and ELISA were used to evaluate changes in natural killer (NK) cells, plasmacytoid dendritic cells (pDC), and CD4+ or CD8+ T-cell frequencies. Data missingness was assessed using Little's test. Complete datasets for analysis were created using Multiple Imputation (MI) or Bayesian modeling and multivariate analysis was conducted on the imputed datasets. Results HIV-1-infected infants had greater frequency of CD4+ T cells with naïve phenotype, as well as higher serum IL-7 levels than HIV exposed/uninfected infants. The elevated data missingness was completely at random, allowing the use of both MI and Bayesian modeling. Both methods indicate that early ART initiation results in higher CD4+ T cell frequency, lower expression of CD95 in CD8+ T cell, and preservation of naïve T cell subsets. In contrast, innate immune effectors appeared to be similar independently of the timing of ART initiation. Conclusions Early ART initiation in infants with perinatal HIV infection reduces immune activation and preserves an early expansion of naïve T-cells with undiminished innate cell numbers, giving greater immune reconstitution than achieved with deferred ART. Both statistical approaches concurred in this finding.
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Ondoa P, Shamu T, Bronze M, Wellington M, Boender TS, Manting C, Steegen K, Luethy R, Rinke de Wit T. Performance and logistical challenges of alternative HIV-1 virological monitoring options in a clinical setting of Harare, Zimbabwe. BIOMED RESEARCH INTERNATIONAL 2014; 2014:102598. [PMID: 25025031 PMCID: PMC4082876 DOI: 10.1155/2014/102598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/25/2014] [Accepted: 05/18/2014] [Indexed: 11/29/2022]
Abstract
We evaluated a low-cost virological failure assay (VFA) on plasma and dried blood spot (DBS) specimens from HIV-1 infected patients attending an HIV clinic in Harare. The results were compared to the performance of the ultrasensitive heat-denatured p24 assay (p24). The COBAS AmpliPrep/COBAS TaqMan HIV-1 test, version 2.0, served as the gold standard. Using a cutoff of 5,000 copies/mL, the plasma VFA had a sensitivity of 94.5% and specificity of 92.7% and was largely superior to the VFA on DBS (sensitivity = 61.9%; specificity = 99.0%) or to the p24 (sensitivity = 54.3%; specificity = 82.3%) when tested on 302 HIV treated and untreated patients. However, among the 202 long-term ART-exposed patients, the sensitivity of the VFA decreased to 72.7% and to 35.7% using a threshold of 5,000 and 1,000 RNA copies/mL, respectively. We show that the VFA (either on plasma or on DBS) and the p24 are not reliable to monitor long-term treated, HIV-1 infected patients. Moreover, achieving acceptable assay sensitivity using DBS proved technically difficult in a less-experienced laboratory. Importantly, the high level of virological suppression (93%) indicated that quality care focused on treatment adherence limits virological failure even when PCR-based viral load monitoring is not available.
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Affiliation(s)
- Pascale Ondoa
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, Academic Medical Center, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Tinei Shamu
- Newlands Clinic, 56 Enterprise Road, Newlands, Harare, Zimbabwe
| | - Michelle Bronze
- Department of Molecular Medicine and Haematology, University of the Witwatersrand 7 York Road, Parktown, Johannesburg 2193, South Africa
| | | | - Tamara Sonia Boender
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, Academic Medical Center, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Corry Manting
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, Academic Medical Center, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Kim Steegen
- Department of Molecular Medicine and Haematology, University of the Witwatersrand 7 York Road, Parktown, Johannesburg 2193, South Africa
| | - Rudi Luethy
- Newlands Clinic, 56 Enterprise Road, Newlands, Harare, Zimbabwe
| | - Tobias Rinke de Wit
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, Academic Medical Center, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
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Landis RC. Issue highlights--July 2013. CYTOMETRY PART B-CLINICAL CYTOMETRY 2014; 84:205-6. [PMID: 23788472 DOI: 10.1002/cyto.b.21100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hudig D, Hunter KW, Diamond WJ, Redelman D. Properties of human blood monocytes. II. Monocytes from healthy adults are highly heterogeneous within and among individuals. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 86:121-34. [PMID: 24327358 DOI: 10.1002/cyto.b.21141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 09/17/2013] [Accepted: 10/18/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Human blood monocytes are known to include subsets defined by the expression of CD14 and CD16 but otherwise are often assumed to be relatively homogeneous. However, we had observed additional heterogeneity that led us to a more extensive examination of monocytes. METHODS Blood samples from 200 healthy adults without known immunological abnormalities were examined by analysis with a hematology analyzer and by flow cytometry (FCM) to determine leukocyte differential counts, to identify subsets and to measure expression of monocyte-associated molecules. RESULTS The estimated cell counts of monocytes, neutrophils, total lymphocytes, and T cells all varied to a similar extent, that is, ±30-35%. The fractions of monocyte subsets defined by CD14 and CD16 or by CD163 expression also varied among individuals. FCM examinations showed that all the monocyte-associated molecules that were examined varied in expression in this increasing order-CD244, CD4, CD38, CD91, CD11b, toll-like receptor 2 (TLR2), TIA-1, CD14 (on CD14(Br+) cells), CD86, CD80, HLA-DQ, CD33, and HLA-DR. CONCLUSIONS Human blood monocytes are heterogeneous among healthy adults with respect to cell counts, subsets, and the levels of expression of monocyte-associated molecules. An increase in the "non-classical" (CD14(Lo/Neg) /CD16(+) ) monocyte subset or in the expression of CD11b or TLR2 have known diagnostic/prognostic implications. CD244 and CD4 have well-defined functions on lymphocytes but perform unknown activities on monocytes although their expression appears more narrowly controlled. Together, these data suggest that monocytes should be more extensively examined in both clinical and basic contexts.
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Affiliation(s)
- Dorothy Hudig
- Department of Microbiology and Immunology, University of Nevada School of Medicine, Reno, Nevada, 89557
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Vanker N, Ipp H. Large unstained cells: a potentially valuable parameter in the assessment of immune activation levels in HIV infection. Acta Haematol 2013; 131:208-12. [PMID: 24296523 DOI: 10.1159/000355184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/22/2013] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Chronic immune activation is associated with the accelerated progression of HIV to AIDS; however, affordable markers reflecting this have not yet been determined. The percentage of large unstained cells (%LUCs) is a differential count parameter measured by certain routine hematology analyzers and reflects activated lymphocytes and peroxidase-negative cells. We hypothesized that the %LUCs would be increased in HIV infection and would correlate with markers of immune activation [i.e. CD38 expression on CD8+ T cells (%CD38onCD8) and lipopolysaccharide-binding protein (LBP)] and CD4 counts. METHODS In this cross-sectional study, 78 HIV-infected, antiretroviral therapy-naïve adults and 52 uninfected controls were recruited. %CD38onCD8 and CD4 counts were determined by flow cytometry, LBP levels were assessed by immunoassay, and the %LUCs was tested on a Siemens ADVIA 2120. RESULTS Significant differences were found between the HIV-infected and control groups for %LUCs (95% CI 2.3-2.7 vs. 1.8-2.2, respectively; p = 0.001), as well as for %CD38onCD8, LBP, and CD4 counts. Furthermore, %LUCs correlated directly with %CD38onCD8 and LBP and inversely with CD4 counts. CONCLUSION The %LUCs was significantly increased in this untreated, asymptomatic, HIV-infected group and correlated with markers of immune activation and CD4 counts. Therefore, the %LUCs may be of value in identifying HIV-infected patients at risk of accelerated disease progression.
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Affiliation(s)
- Naadira Vanker
- Division of Haematology, Faculty of Health Sciences, National Health Laboratory Service and Stellenbosch University, Cape Town, South Africa
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Ernst IMA, Fliegert R, Guse AH. Adenine Dinucleotide Second Messengers and T-lymphocyte Calcium Signaling. Front Immunol 2013; 4:259. [PMID: 24009611 PMCID: PMC3756424 DOI: 10.3389/fimmu.2013.00259] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/15/2013] [Indexed: 11/14/2022] Open
Abstract
Calcium signaling is a universal signal transduction mechanism in animal and plant cells. In mammalian T-lymphocytes calcium signaling is essential for activation and re-activation and thus important for a functional immune response. Since many years it has been known that both calcium release from intracellular stores and calcium entry via plasma membrane calcium channels are involved in shaping spatio-temporal calcium signals. Second messengers derived from the adenine dinucleotides NAD and NADP have been implicated in T cell calcium signaling. Nicotinic acid adenine dinucleotide phosphate (NAADP) acts as a very early second messenger upon T cell receptor/CD3 engagement, while cyclic ADP-ribose (cADPR) is mainly involved in sustained partial depletion of the endoplasmic reticulum by stimulating calcium release via ryanodine receptors. Finally, adenosine diphosphoribose (ADPR) a breakdown product of both NAD and cADPR activates a plasma membrane cation channel termed TRPM2 thereby facilitating calcium (and sodium) entry into T cells. Receptor-mediated formation, metabolism, and mode of action of these novel second messengers in T-lymphocytes will be reviewed.
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Affiliation(s)
- Insa M A Ernst
- The Calcium Signalling Group, Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Quarona V, Zaccarello G, Chillemi A, Brunetti E, Singh VK, Ferrero E, Funaro A, Horenstein AL, Malavasi F. CD38 and CD157: a long journey from activation markers to multifunctional molecules. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 84:207-17. [PMID: 23576305 DOI: 10.1002/cyto.b.21092] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/06/2013] [Accepted: 03/21/2013] [Indexed: 12/17/2022]
Abstract
CD38 (also known as T10) was identified in the late 1970s in the course of pioneering work carried out at the Dana-Farber Cancer Center (Boston, MA) that focused on the identification of surface molecules involved in antigen recognition. CD38 was initially found on thymocytes and T lymphocytes, but today we know that the molecule is found throughout the immune system, although its expression levels vary. Because of this, CD38 was considered an "activation marker," a term still popular in routine flow cytometry. This review summarizes the findings obtained from different approaches, which led to CD38 being re-defined as a multifunctional molecule. CD38 and its homologue CD157 (BST-1), contiguous gene duplicates on human chromosome 4 (4p15), are part of a gene family encoding products that modulate the social life of cells by means of bidirectional signals. Both CD38 and CD157 play dual roles as receptors and ectoenzymes, endowed with complex activities related to signaling and cell homeostasis. The structure-function analysis presented here is intended to give clinical scientists and flow cytometrists a background knowledge of these molecules. The link between CD38/CD157 and human diseases will be explored here in the context of chronic lymphocytic leukemia, myeloma and ovarian carcinoma, although other disease associations are also known. Thus CD38 and CD157 have evolved from simple leukocyte activation markers to multifunctional molecules involved in health and disease. Future tasks will be to explore their potential as targets for in vivo therapeutic interventions and as regulators of the immune response.
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Affiliation(s)
- Valeria Quarona
- Department of Medical Sciences, Laboratory of Immunogenetics, University of Torino Medical School, Torino, Italy
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Portales P, Psomas KC, Tuaillon E, Mura T, Vendrell JP, Eliaou JF, Reynes J, Corbeau P. The intensity of immune activation is linked to the level of CCR5 expression in human immunodeficiency virus type 1-infected persons. Immunology 2012; 137:89-97. [PMID: 22862553 DOI: 10.1111/j.1365-2567.2012.03609.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Immune activation is a main driver of AIDS- and non-AIDS-linked morbidities in the course of HIV-1 infection. As CCR5, the main HIV-1 co-receptor, is not only a chemokine receptor but also a co-activation molecule expressed at the surface of T cells, it could be directly involved in this immune activation. To test this hypothesis, we measured by flow cytometry the mean number of CCR5 molecules at the surface of non-activated CD4(+) T cells (CCR5 density), which determines the intensity of CCR5 signalling, and the percentage of CD8(+) T cells over-expressing CD38 (CD38 expression), a major marker of immune activation, in the blood of 67 HIV-1-infected, non-treated individuals. CCR5 density was correlated with CD38 expression independently of viral load (P=0.016). CCR5 density remained unchanged after highly active anti-retroviral therapy (HAART) introduction or cessation, whereas CD38 expression decreased and increased, respectively. Moreover, pre-therapeutic CCR5 density was highly predictive (r=0.736, P<10(-4) ) of residual CD38 over-expression after 9 months of HAART. Hence, CCR5 might play an immunological role in HIV-1 infection as a driver of immune activation. This could explain why CCR5 antagonists may have an inhibitory effect on immune activation.
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Affiliation(s)
- Pierre Portales
- Département d'Immunologie, CHU de Montpellier, Université Montpellier 1, Montpellier, France
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Abstract
Flow cytometry is increasingly recognized as an invaluable technology in biomarker research. Owing to its multiparametric nature it can provide highly detailed information on any single cell in a heterogeneous population. Its versatility means it can be conducted in both the preclinical and clinical setting, generating biomarker data that can drive decisions pertaining to dose selection in clinical trials, treatment options for cancer sufferers and even suitability of patients to receive transplants. Most tissue types can be utilized by the flow cytometrist, allowing the technology to be applied to many fields of research, yet consensus still needs to be reached on standardization, regulation and validation of multiparametric flow cytometry assays. In parallel, continual innovation in analysis software to manage the huge datasets that can be generated is also needed. Nevertheless, the flexibility of flow cytometry means that it remains at the forefront of both routine and exploratory biomarker studies.
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Moodley K, Coetzee LM, Glencross DK. Decentralised CD38 activation monitoring: aspects of practical implementation and standardisation. J Immunol Methods 2012; 378:121-7. [PMID: 22398190 DOI: 10.1016/j.jim.2012.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND In light of the HIV pandemic, significant strides have been made in improving treatment options for patients. Technologies to monitor the progress of a patient on such treatment have therefore also been scaled up. Immune activation as measured by CD38 mean fluorescence intensity (MFI) on CD8 T cells has been successfully shown in a clinical trial to predict response to antiretroviral therapy (ART) and reported as a cost effective real time test to supplement more costly VL testing. In this study we report transfer of this technology from the research into the routine environment. METHODS This study was conducted in 2 parts: Firstly, fresh random samples (n=75) were tested at four time intervals (0, 24, 36 and 48 h) post-venesection to review reproducibility of CD38 MFI expression. Secondly, the CD38 MFI assay was introduced into a pilot regional testing facility and random samples (n=40) were validated against values obtained on matched samples tested at the reference laboratory. RESULTS The CD38 assay showed acceptable accuracy and reproducibility up to 36 h (98% similarity) after venesection with some reduction in CD38 MFI to 94% at 48 h (bias<0.2MFI, %CV<5). Implementation at the secondary testing site was successful with 98% similarity (% SIM CV<5%) compared to the reference laboratory. CONCLUSION The assay proved stable over time and could be tested until 48 h after venesection with no loss of CD38 MFI. Off-site implementation also proved successful, as such, the CD38 assay offers a reliable real time supplementary test to long-term VL monitoring of HIV infected patients on the national ART programme.
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Affiliation(s)
- Keshendree Moodley
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa.
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Lichtfuss GF, Hoy J, Rajasuriar R, Kramski M, Crowe SM, Lewin SR. Biomarkers of immune dysfunction following combination antiretroviral therapy for HIV infection. Biomark Med 2011; 5:171-86. [PMID: 21473720 DOI: 10.2217/bmm.11.15] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Combination antiretroviral therapy (cART) has significantly reduced morbidity and mortality of HIV-infected patients, yet their life expectancy remains reduced compared with the general population. Most HIV-infected patients receiving cART have some persistent immune dysfunction characterized by chronic immune activation and premature aging of the immune system. Here we review biomarkers of T-cell activation (CD69, -25 and -38, HLA-DR, and soluble CD26 and -30); generalized immune activation (C-reactive protein, IL-6 and D-dimer); microbial translocation (lipopolysaccharide, 16S rDNA, lipopolysaccharide-binding protein and soluble CD14); and immune dysfunction of specific cellular subsets (T cells, natural killer cells and monocytes) in HIV-infected patients on cART and their relationship to adverse clinical outcomes including impaired CD4 T-cell recovery, as well as non-AIDS clinical events, such as cardiovascular disease.
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Carbone J, del Pozo N, Gallego A, Sarmiento E. Immunological risk factors for infection after immunosuppressive and biologic therapies. Expert Rev Anti Infect Ther 2011; 9:405-13. [PMID: 21504398 DOI: 10.1586/eri.10.178] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immunosuppressive and biologic therapies are costly and can involve a considerable risk of infection. Noninvasive diagnostic tools for early prediction of infection before and after administration of these therapies are of major interest. Serial longitudinal immune monitoring would provide data on immunocompetence and complement clinical follow-up protocols. Biomarkers of immune response may be useful to identify patients at risk of developing infection and who could be candidates for immunosuppressant dose reduction. This article focuses on the potential use of biomarkers of immune response to predict development of infection after immunosuppressive and biologic therapies in selected settings of autoimmune disease (rituximab for treatment of rheumatoid arthritis) and solid organ transplantation.
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Affiliation(s)
- Javier Carbone
- Transplant Immunology Group, Clinical Immunology Department, University Hospital Gregorio Marañon, Doctor Esquerdo 46, 28007 Madrid, Spain.
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Azzoni L, Foulkes AS, Firnhaber C, Yin X, Crowther NJ, Glencross D, Lawrie D, Stevens W, Papasavvas E, Sanne I, Montaner LJ. Metabolic and anthropometric parameters contribute to ART-mediated CD4+ T cell recovery in HIV-1-infected individuals: an observational study. J Int AIDS Soc 2011; 14:37. [PMID: 21801351 PMCID: PMC3163506 DOI: 10.1186/1758-2652-14-37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 07/29/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The degree of immune reconstitution achieved in response to suppressive ART is associated with baseline individual characteristics, such as pre-treatment CD4 count, levels of viral replication, cellular activation, choice of treatment regimen and gender. However, the combined effect of these variables on long-term CD4 recovery remains elusive, and no single variable predicts treatment response. We sought to determine if adiposity and molecules associated with lipid metabolism may affect the response to ART and the degree of subsequent immune reconstitution, and to assess their ability to predict CD4 recovery. METHODS We studied a cohort of 69 (48 females and 21 males) HIV-infected, treatment-naïve South African subjects initiating antiretroviral treatment (d4T, 3Tc and lopinavir/ritonavir). We collected information at baseline and six months after viral suppression, assessing anthropometric parameters, dual energy X-ray absorptiometry and magnetic resonance imaging scans, serum-based clinical laboratory tests and whole blood-based flow cytometry, and determined their role in predicting the increase in CD4 count in response to ART. RESULTS We present evidence that baseline CD4+ T cell count, viral load, CD8+ T cell activation (CD95 expression) and metabolic and anthropometric parameters linked to adiposity (LDL/HDL cholesterol ratio and waist/hip ratio) significantly contribute to variability in the extent of CD4 reconstitution (ΔCD4) after six months of continuous ART. CONCLUSIONS Our final model accounts for 44% of the variability in CD4+ T cell recovery in virally suppressed individuals, representing a workable predictive model of immune reconstitution.
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Affiliation(s)
- Livio Azzoni
- HIV-1 Immunopathogenesis Laboratory, the Wistar Institute, Philadelphia, PA, USA
| | - Andrea S Foulkes
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Xiangfan Yin
- HIV-1 Immunopathogenesis Laboratory, the Wistar Institute, Philadelphia, PA, USA
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Deborah Glencross
- Department of Hematology and Molecular Medicine, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Denise Lawrie
- Department of Hematology and Molecular Medicine, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Wendy Stevens
- Department of Hematology and Molecular Medicine, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Emmanouil Papasavvas
- HIV-1 Immunopathogenesis Laboratory, the Wistar Institute, Philadelphia, PA, USA
| | - Ian Sanne
- Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Luis J Montaner
- HIV-1 Immunopathogenesis Laboratory, the Wistar Institute, Philadelphia, PA, USA
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Antiretroviral therapy down-regulates innate antiviral response genes in patients with AIDS in sub-saharan Africa. J Acquir Immune Defic Syndr 2011; 55:428-38. [PMID: 20838227 DOI: 10.1097/qai.0b013e3181ef4963] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE HIV pathogenesis is characterized by destructive imbalances between virus-mediated immune damage, antiviral immune responses, and immune activation. We characterized the effects of successful antiretroviral therapy (ART) to identify the breadth and patterns of HIV-associated gene expression. METHODS In a prospective observational, longitudinal cohort study of 10 ART-naive Ugandans with AIDS (median 30 CD4/μL), we measured mRNA gene profiles in peripheral blood using Affymetrix U133_Plus2.0 microarrays at 0, 2, 4, 8, and 24 weeks after ART initiation. RESULTS We identified 160 mRNA transcripts that were consistently down-regulated and 48 that were up-regulated after ART at each point over 24 weeks based on linear regression modeling (adjusted P < 0.05), Of these 208 transcripts, approximately half represent heretofore unrecognized ART-responsive genes and one-third have no known function. The down-regulated genes with known function encoded mediators of innate antiviral responses, including antiviral restriction factors, pattern recognition receptors, and interferon response proteins, and mediators of immune activation, cellular proliferation, and apoptosis. CONCLUSIONS By using ART to block the viral stimulus, we identified transcripts involved in innate antiviral immunity, including antiviral restriction factors and pattern recognition receptors, that were not previously known to be induced by HIV infection.
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Lawrie D, Coetzee LM, Glencross DK. A model for continuous quality control incorporating sample-to-sample assessment of optical alignment, fluorescence sensitivity, and volumetric operation of flow cytometers. CYTOMETRY PART B-CLINICAL CYTOMETRY 2010; 78:201-10. [PMID: 20419764 DOI: 10.1002/cyto.b.20520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bead count rate (BCR) monitoring successfully identifies pipetting error during single platform CD4 enumeration. Despite rigorous prescribed quality control performed, preliminary data suggested that BCR outliers could also be attributed to occasional failure of flow cytometric volumetric operation. The aim of this report was to use counting beads in a model of continuous quality control (CQC) to monitor overall flow cytometric performance (laser alignment, fluorescence stability and volumetric operation). METHODS The proposed CQC model used FlowCheck and IMMUNOTROL blood controls daily. Extended monitoring of fluidics (FPV; beads and sheath only) and sample preparation (SPV; blood, IMMUNOPREP and beads) was done daily on five flow cytometers over five consecutive days prior to testing patient samples. Sample-to-sample CQC included monitoring BCR, selected time/fluorescence histograms (Time vs. Count; Time vs. Fluorescence and Forward Scatter vs. Fluorescence) and full peak coefficient of variation (FPCV) for 2000 samples tested. RESULTS Prescribed quality controls showed Half Peak CV values of <2% (FlowCheck) with Immunotrol within 0.5SD of the target means. Laser stability was confirmed (FPCV values <2%). However, fluidics (volumetric operation) fluctuated as indicated by a 3.2% BCR outlier rate of 2,000 samples tested (minus pipetting error) despite optimal fluidics performance verified at start-up (FPV CV < 3%). CONCLUSIONS Sustained laser stability was confirmed with Time vs. Fluorescence histograms, but Time vs. Count histograms were insufficient to detect intermittent volumetric failure. The proposed CQC model, incorporating BCR monitoring with time/fluorescence histograms and FPCV monitoring can identify all volumetric inconsistencies in real-time.
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Affiliation(s)
- Denise Lawrie
- National Health Laboratory Services and Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Janossy G, Mandy F. Translational medicine as implementation science in the field of monitoring HIV and TB. New concepts emanating from resource-poor countries. CYTOMETRY PART B-CLINICAL CYTOMETRY 2010; 78:183-7. [DOI: 10.1002/cyto.b.20527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gudo ES, Bhatt NB, Bila DR, Abreu CM, Tanuri A, Savino W, Silva-Barbosa SD, Jani IV. Co-infection by human immunodeficiency virus type 1 (HIV-1) and human T cell leukemia virus type 1 (HTLV-1): does immune activation lead to a faster progression to AIDS? BMC Infect Dis 2009; 9:211. [PMID: 20028500 PMCID: PMC2813852 DOI: 10.1186/1471-2334-9-211] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 12/22/2009] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recent data have shown that HTLV-1 is prevalent among HIV positive patients in Mozambique, although the impact of HTLV-1 infection on HIV disease progression remains controversial. Our aim was to determine the phenotypic profile of T lymphocytes subsets among Mozambican patients co-infected by HIV and HTLV-1. METHODS We enrolled 29 patients co-infected by HTLV-1 and HIV (co-infected), 59 patients mono-infected by HIV (HIV) and 16 healthy controls (HC), respectively.For phenotypic analysis, cells were stained with the following fluorochrome-labeled anti-human monoclonal antibodies CD4-APC, CD8-PerCP, CD25-PE, CD62L-FITC, CD45RA-FITC. CD45RO-PE, CD38-PE; being analysed by four-colour flow cytometry. RESULTS We initially found that CD4+ T cell counts were significantly higher in co-infected, as compared to HIV groups. Moreover, CD4+ T Lymphocytes from co-infected patients presented significantly higher levels of CD45RO and CD25, but lower levels of CD45RA and CD62L, strongly indicating that CD4+ T cells are more activated under HTLV-1 plus HIV co-infection. CONCLUSION Our data indicate that HTLV-1/HIV co-infected patients progress with higher CD4+ T cell counts and higher levels of activation markers. In this context, it is conceivable that in co-infected individuals, these higher levels of activation may account for a faster progression to AIDS.
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Affiliation(s)
- Eduardo Samo Gudo
- Department of Immunology, National Institute of Health, Maputo, Mozambique
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Nilesh B Bhatt
- Department of Immunology, National Institute of Health, Maputo, Mozambique
| | - Dulce Ramalho Bila
- Department of Immunology, National Institute of Health, Maputo, Mozambique
| | - Celina Monteiro Abreu
- Departament of Genetics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amílcar Tanuri
- Departament of Genetics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wilson Savino
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Suse Dayse Silva-Barbosa
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Center for Bone Marrow Transplantation, National Cancer Institute, Rio de Janeiro, Brazil
| | - Ilesh V Jani
- Department of Immunology, National Institute of Health, Maputo, Mozambique
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