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Weld ED, McGowan I, Anton P, Fuchs EJ, Ho K, Carballo-Dieguez A, Rohan LC, Giguere R, Brand R, Edick S, Bakshi RP, Parsons T, Manohar M, Seigel A, Engstrom J, Elliott J, Jacobson C, Bagia C, Wang L, Al-khouja A, Hartman DJ, Bumpus NN, Spiegel HML, Marzinke MA, Hendrix CW. Tenofovir Douche as HIV Preexposure Prophylaxis for Receptive Anal Intercourse: Safety, Acceptability, Pharmacokinetics, and Pharmacodynamics (DREAM 01). J Infect Dis 2024; 229:1131-1140. [PMID: 38019657 PMCID: PMC11011183 DOI: 10.1093/infdis/jiad535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Despite highly effective HIV preexposure prophylaxis (PrEP) options, no options provide on-demand, nonsystemic, behaviorally congruent PrEP that many desire. A tenofovir-medicated rectal douche before receptive anal intercourse may provide this option. METHODS Three tenofovir rectal douches-220 mg iso-osmolar product A, 660 mg iso-osmolar product B, and 660 mg hypo-osmolar product C-were studied in 21 HIV-negative men who have sex with men. We sampled blood and colorectal tissue to assess safety, acceptability, pharmacokinetics, and pharmacodynamics. RESULTS The douches had high acceptability without toxicity. Median plasma tenofovir peak concentrations for all products were several-fold below trough concentrations associated with oral tenofovir disoproxil fumarate (TDF). Median colon tissue mucosal mononuclear cell (MMC) tenofovir-diphosphate concentrations exceeded target concentrations from 1 hour through 3 to 7 days after dosing. For 6-7 days after a single product C dose, MMC tenofovir-diphosphate exceeded concentrations expected with steady-state oral TDF 300 mg on-demand 2-1-1 dosing. Compared to predrug baseline, HIV replication after ex vivo colon tissue HIV challenge demonstrated a concentration-response relationship with 1.9 log10 maximal effect. CONCLUSIONS All 3 tenofovir douches achieved tissue tenofovir-diphosphate concentrations and colorectal antiviral effect exceeding oral TDF and with lower systemic tenofovir. Tenofovir douches may provide a single-dose, on-demand, behaviorally congruent PrEP option, and warrant continued development. Clinical Trials Registration . NCT02750540.
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Affiliation(s)
- Ethel D Weld
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ian McGowan
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Orion Biotechnology, Ottawa, Ontario, Canada
| | - Peter Anton
- Division of Gastroenterology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Edward J Fuchs
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alex Carballo-Dieguez
- HIV Center for Clinical and Behavioral Studies, Columbia University and NewYork State Psychiatric Institute, New York, New York, USA
| | - Lisa C Rohan
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Columbia University and NewYork State Psychiatric Institute, New York, New York, USA
| | - Rhonda Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Stacey Edick
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rahul P Bakshi
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa Parsons
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Madhuri Manohar
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron Seigel
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Jared Engstrom
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie Elliott
- Division of Gastroenterology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Cindy Jacobson
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Christina Bagia
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Lin Wang
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Amer Al-khouja
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Douglas J Hartman
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Namandje N Bumpus
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hans M L Spiegel
- Kelly Government Solutions, Contractor to Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Mark A Marzinke
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Craig W Hendrix
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Clark JL, Oldenburg CE, Passaro RC, Segura ER, Godwin W, Fulcher JA, Cabello R. Changes in Inflammatory Cytokine Levels in Rectal Mucosa Associated With Neisseria gonorrheae and/or Chlamydia trachomatis Infection and Treatment Among Men Who Have Sex With Men in Lima, Peru. J Infect Dis 2024; 229:845-854. [PMID: 37584273 PMCID: PMC10938210 DOI: 10.1093/infdis/jiad349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/04/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Neisseria gonorrheae and Chlamydia trachomatis are associated with mucosal inflammation and human immunodeficiency virus 1 (HIV-1) transmission. We assessed levels of inflammatory cytokines in men who have sex with men (MSM) with and without rectal gonorrhea and/or chlamydia in Lima, Peru. METHODS We screened 605 MSM reporting condomless receptive anal intercourse for rectal N. gonorrheae/C. trachomatis using nucleic acid testing. We identified 101 cases of gonorrhea and/or chlamydia and randomly selected 50 N. gonorrheae/C. trachomatis positive cases and matched 52 negative controls. We measured levels of IL-1β, IL-6, IL-8, and TNF-α in rectal secretions. Tests for HIV-1, rectal N. gonorrheae/C. trachomatis, and mucosal cytokines were repeated after 3 and 6 months. Cytokine levels in cases and uninfected controls were compared using Wilcoxon rank-sum tests and linear regression. RESULTS MSM with gonorrhea/chlamydia had elevated levels of all cytokines in rectal mucosa compared with matched controls (all P values <.001). Following antibiotic treatment there were no significant differences in cytokine levels at 3- or 6-month follow-up evaluations (all P values >.05). DISCUSSION Rectal gonorrhea/chlamydia infection is associated with transient mucosal inflammation and cytokine recruitment. Our data provide proof of concept for rectal sexually transmitted infection screening as an HIV prevention strategy for MSM. Clinical Trials Registration. NCT03010020.
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Affiliation(s)
- Jesse L Clark
- David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Catherine E Oldenburg
- Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Ryan C Passaro
- Department of Emergency Medicine, University of Southern California, Los Angeles County Hospital, Los Angeles, California, USA
| | - Eddy R Segura
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - William Godwin
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Jennifer A Fulcher
- David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
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Blair CS, Fulcher JA, Cho GD, Gorbach PM, Shoptaw S, Clark JL. Brief Report: Impact of Methamphetamine Use and Rectal STIs on Systemic and Rectal Mucosal Inflammation. J Acquir Immune Defic Syndr 2023; 92:281-285. [PMID: 36515912 PMCID: PMC9974870 DOI: 10.1097/qai.0000000000003143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Methamphetamine (MA) use is associated with sexual risk behavior as well as systemic and mucosal inflammation, suggesting parallel biological and behavioral mechanisms of HIV transmission among men who have sex with men (MSM) who use MA. Data evaluating the combined biological effects of MA use with concomitant rectal gonococcal and/or chlamydial (GC/CT) infection on inflammation are limited. SETTING Secondary analysis of stored rectal and plasma specimens from 100 MSM participating in an NIDA-funded longitudinal cohort in Los Angeles, CA. METHODS This cross-sectional analysis evaluated systemic and rectal inflammatory markers under 2 conditions: (1) recent MA use (by urine drug screen) and (2) rectal GC/CT infection. We evaluated 50 participants with recent MA use (25 with and 25 without rectal GC/CT) and 50 MSM without MA use (25 with and 25 without rectal GC/CT). Log-transformed plasma and rectal immune markers were regressed on MA exposure and rectal GC/CT, controlling for HIV status and age. RESULTS Median age was 32 (range 19-45) years, and 58% of participants were living with HIV. Plasma tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, IL-1ß, and rectal IL-6 were associated with rectal GC/CT and MA use, independent of HIV status. Higher levels of rectal TNF-α, IL-1ß, and IL-17a were associated with rectal GC/CT. CONCLUSIONS Systemic and rectal inflammation was positively associated with rectal GC/CT and MA use. Condomless sex in the setting of GC/CT- and MA-induced immune activation may provide a basis for synergistic biobehavioral mechanisms that promote HIV/STI transmission among MSM who use MA.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jennifer A Fulcher
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Grace D Cho
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Pamina M Gorbach
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Epidemiology, Fielding School of Public Health at UCLA, Los Angeles, CA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; and
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; and
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Blair CS, Lake JE, Passaro RC, Chavez-Gomez S, Segura ER, Elliott J, Fulcher JA, Shoptaw S, Cabello R, Clark JL. Brief Report: HIV-1 Seroconversion Is Not Associated With Prolonged Rectal Mucosal Inflammation. J Acquir Immune Defic Syndr 2021; 86:e134-e138. [PMID: 33351532 PMCID: PMC7933122 DOI: 10.1097/qai.0000000000002601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Determine the impact of HIV-1 seroconversion on inflammatory cytokines in the rectal mucosa. SETTING Secondary analysis of data from men who have sex with men and transgender women who participated in a HIV prevention trial Lima, Peru. METHODS From July to December 2017, 605 men who have sex with men and transgender women were screened for rectal gonorrhea/chlamydia (GC/CT). Fifty GC/CT-positive cases were randomly selected and matched with 52 GC/CT-negative controls by age and number of receptive anal intercourse partners in the last month. All participants were HIV-negative at baseline and those with GC/CT at baseline and/or follow-up received appropriate antibiotic therapy. Participants underwent sponge collection of rectal secretions for the measurement of inflammatory cytokines (IL-1β, IL-6, IL-8, and TNF-α) and were screened for rectal GC/CT and HIV at baseline, 3 months, and 6 months. Wilcoxon rank-sum tests compared inflammatory cytokine levels between participants diagnosed with HIV during follow-up and persons who remained HIV-negative. RESULTS Eight participants were diagnosed with HIV at the 3-month (n = 6) or 6-month (n = 2) visit. The median number of receptive anal intercourse partners in the month before HIV diagnosis was the same for those who acquired HIV and those who did not. There were no significant differences in inflammatory cytokine levels in rectal mucosa between participants who did and did not experience HIV seroconversion at any time point. CONCLUSIONS Despite a surge in viral replication during acute infection, findings from this study suggest that there is no prolonged effect of HIV-1 seroconversion on inflammatory cytokine levels in the rectal mucosa.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jordan E Lake
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School at University of Texas at Houston, Houston, TX
| | - Ryan C Passaro
- Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
| | | | - Eddy R Segura
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru ; and
| | - Julie Elliott
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jennifer A Fulcher
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Shieh E, Marzinke MA, Fuchs EJ, Hamlin A, Bakshi R, Aung W, Breakey J, Poteat T, Brown T, Bumpus NN, Hendrix CW. Transgender women on oral HIV pre-exposure prophylaxis have significantly lower tenofovir and emtricitabine concentrations when also taking oestrogen when compared to cisgender men. J Int AIDS Soc 2019; 22:e25405. [PMID: 31692269 PMCID: PMC6832671 DOI: 10.1002/jia2.25405] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/17/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Oral HIV Pre-Exposure Prophylaxis (PrEP) with tenofovir (TFV) disoproxil fumarate (TDF)/emtricitabine (FTC) is highly effective. Transgender women (TGW) have increased HIV risk, but have been underrepresented in trials. For TGW on oestrogens for gender-affirming hormone treatment (GAHT), TDF/FTC-oestrogen interactions may negatively affect HIV prevention or gender-affirming goals. Our aim was to evaluate any pharmacokinetic drug-drug interaction between GAHT and TDF/FTC. METHODS We performed a pharmacokinetic study, in an urban outpatient setting in 2016 to 2018, of the effects of GAHT on TFV, FTC and the active forms TFV diphosphate (TFV-DP) and FTC triphosphate (FTC-TP) in eight TGW and eight cisgender men (CGM). At screening, participants were HIV negative. TGW were to maintain their GAHT regimens and have plasma oestradiol concentrations >100 pg/mL. Under direct observation, participants took oral TDF/FTC daily for seven days. At the last dose, blood was collected pre-dose, one, two, four, six, eight and twenty-four hours, and colon biopsies were collected at 24 hours to measure drug concentration. TGW versus CGM concentration comparisons used non-parametric tests. Blood and colon tissue were also obtained to assess kinase expression. RESULTS Plasma TFV and FTC C24 (trough) concentrations in TGW were lower by 32% (p = 0.010) and 32% (p = 0.038) respectively, when compared to CGM. Plasma TFV and FTC 24-hr area under the concentration-time curve in TGW trended toward and was significantly lower by 27% (p = 0.065) and 24% (p = 0.028) respectively. Peak plasma TFV and FTC concentrations, as well as all other pharmacokinetic measures, were not statistically significant when comparing TGW to CGM. Oestradiol concentrations were not different comparing before and after TDF/FTC dosing. Plasma oestrogen concentration, renal function (estimated creatinine clearance and glomerular filtration rate), and TFV and FTC plasma concentrations (trough and area under the concentration-time curve) were all correlated. CONCLUSIONS GAHT modestly reduces both TFV and FTC plasma concentrations. In TGW taking GAHT, it is unknown if this reduction will impact the HIV protective efficacy of a daily PrEP regimen. However, the combination of an on demand (2 + 1 + 1) PrEP regimen and GAHT may result in concentrations too low for reliable prevention of HIV infection.
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Affiliation(s)
- Eugenie Shieh
- Department of Medicine (Clinical Pharmacology)Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Mark A Marzinke
- Department of Medicine (Clinical Pharmacology)Johns Hopkins University School of MedicineBaltimoreMDUSA
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Edward J Fuchs
- Department of Medicine (Clinical Pharmacology)Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Allyson Hamlin
- Department of Medicine (Clinical Pharmacology)Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Rahul Bakshi
- Department of Medicine (Clinical Pharmacology)Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Wutyi Aung
- Department of Medicine (Clinical Pharmacology)Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Jennifer Breakey
- Department of Medicine (Clinical Pharmacology)Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Tonia Poteat
- Department of Social MedicineUniversity of North Carolina Chapel HillChapel HillNorth CarolinaUSA
| | - Todd Brown
- Department of Medicine (Endocrinology)Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Namandjé N Bumpus
- Department of Medicine (Clinical Pharmacology)Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Craig W Hendrix
- Department of Medicine (Clinical Pharmacology)Johns Hopkins University School of MedicineBaltimoreMDUSA
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Brand RM, Siegel A, Myerski A, Metter EJ, Engstrom J, Brand RE, Squiquera L, Hodge T, Sulley J, Cranston RD, McGowan I. Ranpirnase Reduces HIV-1 Infection and Associated Inflammatory Changes in a Human Colorectal Explant Model. AIDS Res Hum Retroviruses 2018; 34:838-848. [PMID: 29936861 DOI: 10.1089/aid.2017.0308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Ranpirnase (RNP) is a low molecular weight type III endoribonuclease, which demonstrates broad antiviral and antitumor properties. We sought to characterize the antiviral activity of RNP against HIV-1 and to determine whether RNP modulates local inflammatory changes associated with HIV infection in the colorectal explant model. Colorectal explants were incubated for 2 h with HIV-1BaL, in the presence of increasing concentrations of RNP (0-60 μg/mL). After washing, explants were cultured for 14 days, with supernatant collected at days 3, 7, 10, and 14. All samples were assayed for HIV-1 p24. Additionally, 30 soluble inflammatory biomarkers were assayed in the day 3 supernatant sample. Other biopsies were stimulated with lipopolysaccharides (LPS) (10 μg/mL) in the presence of RNP and soluble biomarkers assayed at day 3. RNP inhibited productive infection of the colorectal explants with HIV-1BaL and induced a dose-dependent decrease in 15/30 biomarkers. Affected biomarkers included IP-10, MDC, MIP-1α, MIP-1β, TARC, IL12-p40, IL-15, IL-17, IL-1α, IL-7, IFNγ, IL12-p70, IL-1β, IL-4, IL-5, and TNF-β. Similarly, RNP dose-dependent inhibition was demonstrated in 7/30 biomarkers after LPS stimulation, all of which overlapped with HIV-1BaL-induced biomarker changes. The ability of RNP to inhibit both colorectal explant HIV-1BaL infection and inflammatory changes associated with HIV-1 infection makes RPN a promising agent for topical rectal pre-exposure prophylaxis.
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Affiliation(s)
- Rhonda M Brand
- 1 Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
- 2 Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Aaron Siegel
- 2 Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Ashley Myerski
- 2 Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - E Jeffery Metter
- 3 Department of Neurology, University of Tennessee Health Science Center , Memphis, Tennessee
| | - Jarret Engstrom
- 2 Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Randall E Brand
- 1 Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | | | - Thomas Hodge
- 4 Tamir Biotechnology, Inc., Short Hills, New Jersey
| | - Jamie Sulley
- 4 Tamir Biotechnology, Inc., Short Hills, New Jersey
| | - Ross D Cranston
- 1 Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Ian McGowan
- 1 Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
- 2 Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
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Brand RM, Biswas N, Siegel A, Myerski A, Engstrom J, Jeffrey Metter E, Brand RE, Cranston RD, McGowan I. Immunological responsiveness of intestinal tissue explants and mucosal mononuclear cells to ex vivo stimulation. J Immunol Methods 2018; 463:39-46. [PMID: 30218652 DOI: 10.1016/j.jim.2018.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are limited data on the immunological responsiveness of healthy intestinal tissue when it is cultured and stimulated ex vivo. Such an ex vivo model has the potential to be a valuable tool in understanding disease pathogenesis and as a preclinical tool for the assessment of candidate therapeutic agents used to treat inflammatory bowel disease (IBD). AIM We undertook a comprehensive study to evaluate ex vivo immunological responses of intestinal tissue and isolated mucosal mononuclear cells (MMC) to a broad range of stimuli. METHODS Colorectal biopsies (explants) were obtained from healthy participants by flexible sigmoidoscopy and were placed either directly into culture or digested to isolate MMC prior to placement in culture. Explants or MMC were treated with polyinosinic:polycytidylic acid (Poly IC), phytohemagglutinin (PHA), lipopolysacccharides from E Coli (LPS), anti-CD3/CD28 antibodies, or IL-1β/TNF-α for 24 h. Supernatants were assayed for 40 inflammatory biomarkers using multiplexed enzyme-linked immunosorbent assay (ELISA). The isolated MMCs were further characterized using twelve color flow cytometry. RESULTS Explants have greater weight adjusted constitutive expression of inflammatory biomarkers than MMCs. Biomarker responses varied as a function of immunogen and use of intact tissue or isolated cells. PHA applied to intact explants was the most effective agent in inducing biomarker changes. Stimulation induced activated and memory cellular phenotypes in both explants and MMCs. CONCLUSIONS The breadth and magnitude of responses from intact and enzymatically digested intestinal tissue explants stimulated with exogenous immunogens are complex and vary by tissue form and treatment. Overall, PHA stimulation of intact explants produced the most robust responses in normal human colorectal tissue. This system could potentially serve as a preliminary model of the disease state, suitable for small scale screening of new therapeutic agents prior to using IBD patient derived tissue.
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Affiliation(s)
- Rhonda M Brand
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA.
| | - Nabanita Biswas
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Aaron Siegel
- Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
| | - Ashley Myerski
- Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
| | - Jarret Engstrom
- Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
| | | | - Randall E Brand
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ross D Cranston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ian McGowan
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
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Lama JR, Karuna ST, Grant SP, Swann EM, Ganoza C, Segura P, Montano SM, Lacherre M, De Rosa SC, Buchbinder S, Sanchez J, McElrath MJ, Lemos MP. Transient Peripheral Immune Activation follows Elective Sigmoidoscopy or Circumcision in a Cohort Study of MSM at Risk of HIV Infection. PLoS One 2016; 11:e0160487. [PMID: 27536938 PMCID: PMC4990246 DOI: 10.1371/journal.pone.0160487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/20/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Rectal and genital sampling in HIV prevention trials permits assessments at the site of HIV entry. Yet the safety and acceptability of circumcision and sigmoidoscopy (and associated abstinence recommendations) are unknown in uncircumcised men who have sex with men (MSM) at high risk of HIV infection. METHODS Twenty-nine HIV-seronegative high-risk Peruvian MSM agreed to elective sigmoidoscopy biopsy collections (weeks 2 and 27) and circumcision (week 4) in a 28-week cohort study designed to mimic an HIV vaccine study mucosal collection protocol. We monitored adherence to abstinence recommendations, procedure-related complications, HIV infections, peripheral immune activation, and retention. RESULTS Twenty-three (79.3%) underwent a first sigmoidoscopy, 21 (72.4%) were circumcised, and 16 (55.2%) completed a second sigmoidoscopy during the study period. All who underwent procedures completed the associated follow-up safety visits. Those completing the procedures reported they were well tolerated, and complication rates were similar to those reported in the literature. Immune activation was detected during the healing period (1 week post-sigmoidoscopy, 6 weeks post-circumcision), including increases in CCR5+CD4+T cells and α4β7+CD4+T cells. Most participants adhered to post-circumcision abstinence recommendations whereas reduced adherence occurred post-sigmoidoscopy. CONCLUSION Rectosigmoid mucosal and genital tissue collections were safe in high-risk MSM. Although the clinical implications of the post-procedure increase in peripheral immune activation markers are unknown, they reinforce the need to provide ongoing risk reduction counseling and support for post-procedure abstinence recommendations. Future HIV vaccine studies should also consider the effects of mucosal and tissue collections on peripheral blood endpoints in trial design and analysis. TRIAL REGISTRATION ClinicalTrials.gov NCT02630082.
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Affiliation(s)
| | - Shelly T. Karuna
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Shannon P. Grant
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Edith M. Swann
- Vaccine Clinical Research Branch, Division of AIDS, National Institutes of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, Maryland, United States of America
| | | | | | | | | | - Stephen C. De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Susan Buchbinder
- San Francisco Department of Health, San Francisco, California, United States of America
| | - Jorge Sanchez
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Maria P. Lemos
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
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In Vivo Rectal Mucosal Barrier Function Imaging in a Large-Animal Model by Using Confocal Endomicroscopy: Implications for Injury Assessment and Use in HIV Prevention Studies. Antimicrob Agents Chemother 2016; 60:4600-9. [PMID: 27185807 DOI: 10.1128/aac.00134-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/09/2016] [Indexed: 12/16/2022] Open
Abstract
Injury occurring on the surface of the rectal mucosal lining that causes defects in barrier function may result in increased risk for transmission of infection by HIV and other pathogens. Such injury could occur from microbicidal or other topical agents, mechanical trauma during consensual or nonconsensual intercourse, or inflammatory conditions. Tools for evaluation of rectal mucosal barrier function for assessing the mucosa under these conditions are lacking, particularly those that can provide in vivo structural and functional barrier integrity assessment and are adaptable to longitudinal imaging. We investigated confocal endomicroscopy (CE) as a means for in vivo imaging of the rectal epithelial barrier in the ovine model following spatially confined injury to the surface at a controlled site using a topical application of the microbicide test agent benzalkonium chloride. Topical and intravenous (i.v.) fluorescent probes were used with CE to provide subcellular resolution imaging of the mucosal surface and assessment of barrier function loss. A 3-point CE grading system based on cellular structure integrity and leakage of dye through the mucosa showed significant differences in score between untreated (1.19 ± 0.53) and treated (2.55 ± 0.75) tissue (P < 0.0001). Histological grading confirmed findings of barrier compromise. The results indicate that CE is an effective means for detecting epithelial injury and barrier loss following localized trauma in a large-animal model. CE is promising for real-time rectal mucosal evaluation after injury or trauma or topical application of emerging biomedical prevention strategies designed to combat HIV.
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McGowan I, Cranston RD, Mayer KH, Febo I, Duffill K, Siegel A, Engstrom JC, Nikiforov A, Park SY, Brand RM, Jacobson C, Giguere R, Dolezal C, Frasca T, Leu CS, Schwartz JL, Carballo-Diéguez A. Project Gel a Randomized Rectal Microbicide Safety and Acceptability Study in Young Men and Transgender Women. PLoS One 2016; 11:e0158310. [PMID: 27362788 PMCID: PMC4928823 DOI: 10.1371/journal.pone.0158310] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/13/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The purpose of Project Gel was to determine the safety and acceptability of rectal microbicides in young men who have sex with men (MSM) and transgender women (TGW) at risk of HIV infection. METHODS MSM and TGW aged 18-30 years were enrolled at three sites; Pittsburgh, PA; Boston, MA; and San Juan, PR. Stage 1A was a cross-sectional assessment of sexual health and behavior in MSM and TGW. A subset of participants from Stage 1A were then enrolled in Stage 1B, a 12-week evaluation of the safety and acceptability of a placebo rectal gel. This was followed by the final phase of the study (Stage 2) in which a subset of participants from Stage 1B were enrolled into a Phase 1 rectal safety and acceptability evaluation of tenofovir (TFV) 1% gel. RESULTS 248 participants were enrolled into Stage 1A. Participants' average age was 23.3 years. The most common sexually transmitted infection (STIs) at baseline were Herpes simplex (HSV)-2 (16.1% by serology) and rectal Chlamydia trachomatis (CT) (10.1% by NAAT). 134 participants were enrolled into Stage 1B. During the 12 week period of follow-up 2 HIV, 5 rectal CT, and 5 rectal Neisseria gonorrhea infections were detected. The majority of adverse events (AEs) were infections (N = 56) or gastrointestinal (N = 46) and were mild (69.6%) or moderate (28.0%). Of the participants who completed Stage 1B, 24 were enrolled into Stage 2 and randomized (1:1) to receive TFV or placebo gel. All participants completed Stage 2. The majority of AEs were gastrointestinal (N = 10) and of mild (87.2%) or moderate (10.3%) severity. CONCLUSIONS In this study we were able to enroll a sexually active population of young MSM and TGW who were willing to use rectal microbicides. TFV gel was safe and acceptable and should be further developed as an alternative HIV prevention intervention for this population. TRIAL REGISTRATION ClinicalTrials.gov NCT01283360.
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Affiliation(s)
- Ian McGowan
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Ross D. Cranston
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Kenneth H. Mayer
- Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Irma Febo
- University of Puerto Rico Medical Sciences Campus, Department of Pediatrics, Gama Project, San Juan, Puerto Rico
| | - Kathryn Duffill
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Aaron Siegel
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Jarret C. Engstrom
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Alexyi Nikiforov
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Seo-Young Park
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Rhonda M. Brand
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Cindy Jacobson
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Rebecca Giguere
- Columbia University and NY State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, New York, United States of America
| | - Curtis Dolezal
- Columbia University and NY State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, New York, United States of America
| | - Timothy Frasca
- Columbia University and NY State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, New York, United States of America
| | - Cheng-Shiun Leu
- Columbia University and NY State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, New York, United States of America
| | | | - Alex Carballo-Diéguez
- Columbia University and NY State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, New York, United States of America
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Mait-Kaufman J, Fakioglu E, Mesquita PM, Elliott J, Lo Y, Madan RP. Chronic HIV Infection Is Associated with Upregulation of Proinflammatory Cytokine and Chemokine and Alpha Defensin Gene Expression in Colorectal Mucosa. AIDS Res Hum Retroviruses 2015; 31:615-22. [PMID: 25768924 DOI: 10.1089/aid.2014.0085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
HIV may induce gastrointestinal (GI) mucosal immune dysregulation similar to inflammation observed in ulcerative colitis (UC). Colorectal biopsies from healthy controls (N=12) and from participants with HIV (N=20) or UC (N=9) were subjected to real time (RT)-PCR for selected cytokines, chemokines, antimicrobial peptides, Toll-like receptors, and inflammatory signaling and epithelial barrier proteins. HIV long terminal repeat relative copy number (RCN) in HIV participant biopsies was quantified by RT-PCR. Mean interleukin (IL)-6 mRNA levels did not differ significantly between HIV and UC participants (p=0.48) but were significantly higher relative to control mRNA levels only for HIV participants (p=0.03). Mean IL-8 and human defensin (HD) 5 mRNA levels were similar between HIV and UC participants (p=1.0 and p=0.35, respectively) and were significantly greater in both groups relative to controls (p<0.05 for all). Human beta-defensin (HBD)-2 mRNA levels were higher in UC relative to HIV and control participants (p<0.01 for both). Conversely, HBD-1 mRNA levels were downregulated in UC vs. HIV participants (p=0.01). Mediator gene expression did not differ significantly between HIV participants with detectable (N=10) or nondetectable (N=10) plasma viral loads. Tissue HIV relative copy number (RCN) correlated with plasma viral load (r=0.88, p<0.01) but not with mediator mRNA levels. The results of this study indicate that both chronic HIV infection and UC are associated with similar patterns of IL-6, IL- 8, and HD5 expression in colorectal biopsy tissue. These findings suggest overlapping mechanisms for GI mucosal inflammation in these two illnesses and merit further investigation in larger studies.
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Affiliation(s)
| | - Esra Fakioglu
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Pedro M.M. Mesquita
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Julie Elliott
- Center for Prevention Research in the Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Yungtai Lo
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, New York
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Mcgowan I, Cranston RD, Duffill K, Siegel A, Engstrom JC, Nikiforov A, Jacobson C, Rehman KK, Elliott J, Khanukhova E, Abebe K, Mauck C, Spiegel HML, Dezzutti CS, Rohan LC, Marzinke MA, Hiruy H, Hendrix CW, Richardson-Harman N, Anton PA. A Phase 1 Randomized, Open Label, Rectal Safety, Acceptability, Pharmacokinetic, and Pharmacodynamic Study of Three Formulations of Tenofovir 1% Gel (the CHARM-01 Study). PLoS One 2015; 10:e0125363. [PMID: 25942472 PMCID: PMC4420274 DOI: 10.1371/journal.pone.0125363] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/04/2015] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The CHARM-01 study characterized the safety, acceptability, pharmacokinetics (PK), and pharmacodynamics (PD) of three tenofovir (TFV) gels for rectal application. The vaginal formulation (VF) gel was previously used in the CAPRISA 004 and VOICE vaginal microbicide Phase 2B trials and the RMP-02/MTN-006 Phase 1 rectal safety study. The reduced glycerin VF (RGVF) gel was used in the MTN-007 Phase 1 rectal microbicide trial and is currently being evaluated in the MTN-017 Phase 2 rectal microbicide trial. A third rectal specific formulation (RF) gel was also evaluated in the CHARM-01 study. METHODS Participants received 4 mL of the three TFV gels in a blinded, crossover design: seven daily doses of RGVF, seven daily doses of RF, and six daily doses of placebo followed by one dose of VF, in a randomized sequence. Safety, acceptability, compartmental PK, and explant PD were monitored throughout the trial. RESULTS All three gels were found to be safe and acceptable. RF and RGVF PK were not significantly different. Median mucosal mononuclear cell (MMC) TFV-DP trended toward higher values for RF compared to RGVF (1136 and 320 fmol/106 cells respectively). Use of each gel in vivo was associated with significant inhibition of ex vivo colorectal tissue HIV infection. There was also a significant negative correlation between the tissue levels of TFV, tissue TFV-DP, MMC TFV-DP, rectal fluid TFV, and explant HIV-1 infection. CONCLUSIONS All three formulations were found to be safe and acceptable. However, the safety profile of the VF gel was only based on exposure to one dose whereas participants received seven doses of the RGVF and RF gels. There was a trend towards higher tissue MMC levels of TFV-DP associated with use of the RF gel. Use of all gels was associated with significant inhibition of ex vivo tissue HIV infection. TRIAL REGISTRATION ClinicalTrials.gov NCT01575405.
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Affiliation(s)
- Ian Mcgowan
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Ross D. Cranston
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Kathryn Duffill
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Aaron Siegel
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Jarret C. Engstrom
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Alexyi Nikiforov
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Cindy Jacobson
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Khaja K. Rehman
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Julie Elliott
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Elena Khanukhova
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Kaleab Abebe
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | | | - Hans M. L. Spiegel
- HJF-DAIDS, a Division of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Charlene S. Dezzutti
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Lisa C. Rohan
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Mark A. Marzinke
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hiwot Hiruy
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Craig W. Hendrix
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Peter A. Anton
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
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Preza GC, Yang OO, Elliott J, Anton PA, Ochoa MT. T lymphocyte density and distribution in human colorectal mucosa, and inefficiency of current cell isolation protocols. PLoS One 2015; 10:e0122723. [PMID: 25856343 PMCID: PMC4391713 DOI: 10.1371/journal.pone.0122723] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/12/2015] [Indexed: 12/12/2022] Open
Abstract
Mucosal tissues are critical immune effector sites containing complex populations of leukocytes in a tissue microenvironment that remains incompletely understood. We identify and quantify in human distal colorectal tissue absolute mucosal CD3+ lymphocytes, including CD4+ and CD8+ subsets, by direct visualization using immunohistochemistry (IHC), immunofluorescence (IF), and an automated counting protocol (r2=0.90). Sigmoid and rectal mucosal tissues are both densely packed with T lymphocytes in the mucosal compartment. Both compartments had similar densities of CD3+ T lymphocytes with 37,400 ± 2,801 cells/mm3 and 33,700 ± 4,324 cell/mm3, respectively. Sigmoid mucosa contained 57% CD3+CD4+ and 40% CD3+CD8+ T lymphocytes which calculates to 21,300 ± 1,476/mm3 and 15,000 ± 275/mm3 T lymphocytes, respectively. Rectal mucosa had 57% CD3+CD4+ and 42% CD3+CD8+ or 21,577 ± 332, and 17,090 ± 1,206 cells/mm3, respectively. By comparison, sigmoid mucosal biopsies subjected to conventional collagenase digestion, mononuclear cell (MMC) isolation and staining for flow cytometry yielded 4,549 ± 381/mm3 and 2,708 ± 245/mm3 CD4+ and CD8+ T lymphocytes. These data suggest only ~20.7% recovery compared to IHC results for these markers. Further studies will determine if this reflects a selective bias in only CD3+, CD4+ and CD8+ T cells or can be generalized to all flow-analyzed cells from mucosal tissues for phenotyping and functional testing.
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Affiliation(s)
- Gloria Cuevas Preza
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Otto O. Yang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- UCLA AIDS Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- AIDS Healthcare Foundation, Los Angeles, CA, United States of America
| | - Julie Elliott
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- UCLA AIDS Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Peter A. Anton
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- UCLA AIDS Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Maria T. Ochoa
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- * E-mail:
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McGowan I, Janocko L, Burneisen S, Bhat A, Richardson-Harman N. Variability of cytokine gene expression in intestinal tissue and the impact of normalization with the use of reference genes. Cytokine 2015; 71:81-8. [DOI: 10.1016/j.cyto.2014.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/30/2014] [Accepted: 08/19/2014] [Indexed: 12/20/2022]
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15
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Microbicides: Molecular Strategies for Prevention of Sexually Transmitted Viral Disease. Antiviral Res 2014. [DOI: 10.1128/9781555815493.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jespers V, Harandi AM, Hinkula J, Medaglini D, Grand RL, Stahl-Hennig C, Bogers W, Habib RE, Wegmann F, Fraser C, Cranage M, Shattock RJ, Spetz AL. Assessment of mucosal immunity to HIV-1. Expert Rev Vaccines 2014; 9:381-94. [DOI: 10.1586/erv.10.21] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
The last few years have seen important progress in demonstrating the efficacy of oral pre-exposure prophylaxis, vaginal microbicides, and treatment as prevention as effective strategies for reducing the risk of acquiring or transmitting HIV infection. There has also been significant progress in the development of rectal microbicides. Preclinical non-human primate studies have demonstrated that antiretroviral microbicides can provide significant protection from rectal challenge with SIV or SHIV. Recent Phase 1 rectal microbicide studies have characterized the safety, acceptability, compartmental pharmacokinetics (PK), and pharmacodynamics (PD) of both UC781 and tenofovir gels. The tenofovir gel formulation used in vaginal studies was not well tolerated in the rectum and newer rectal-specific formulations have been developed and evaluated in Phase 1 studies. The PK/PD data generated in these Phase 1 studies may reduce the risk of advancing ineffective candidate rectal microbicides into late stage development. Tenofovir gel is currently poised to move into Phase 2 evaluation and it is possible that a Phase 2B/3 effectiveness study with this product could be initiated in the next 2-3 years.
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Affiliation(s)
- Ian McGowan
- University of Pittsburgh School of Medicine, 204 Craft Ave Room B621, Pittsburgh, PA, 15213, USA,
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Tong M, Li X, Wegener Parfrey L, Roth B, Ippoliti A, Wei B, Borneman J, McGovern DPB, Frank DN, Li E, Horvath S, Knight R, Braun J. A modular organization of the human intestinal mucosal microbiota and its association with inflammatory bowel disease. PLoS One 2013; 8:e80702. [PMID: 24260458 PMCID: PMC3834335 DOI: 10.1371/journal.pone.0080702] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/07/2013] [Indexed: 02/08/2023] Open
Abstract
Abnormalities of the intestinal microbiota are implicated in the pathogenesis of Crohn's disease (CD) and ulcerative colitis (UC), two spectra of inflammatory bowel disease (IBD). However, the high complexity and low inter-individual overlap of intestinal microbial composition are formidable barriers to identifying microbial taxa representing this dysbiosis. These difficulties might be overcome by an ecologic analytic strategy to identify modules of interacting bacteria (rather than individual bacteria) as quantitative reproducible features of microbial composition in normal and IBD mucosa. We sequenced 16S ribosomal RNA genes from 179 endoscopic lavage samples from different intestinal regions in 64 subjects (32 controls, 16 CD and 16 UC patients in clinical remission). CD and UC patients showed a reduction in phylogenetic diversity and shifts in microbial composition, comparable to previous studies using conventional mucosal biopsies. Analysis of weighted co-occurrence network revealed 5 microbial modules. These modules were unprecedented, as they were detectable in all individuals, and their composition and abundance was recapitulated in an independent, biopsy-based mucosal dataset 2 modules were associated with healthy, CD, or UC disease states. Imputed metagenome analysis indicated that these modules displayed distinct metabolic functionality, specifically the enrichment of oxidative response and glycan metabolism pathways relevant to host-pathogen interaction in the disease-associated modules. The highly preserved microbial modules accurately classified IBD status of individual patients during disease quiescence, suggesting that microbial dysbiosis in IBD may be an underlying disorder independent of disease activity. Microbial modules thus provide an integrative view of microbial ecology relevant to IBD.
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Affiliation(s)
- Maomeng Tong
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Xiaoxiao Li
- Cedars-Sinai F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California, United States of America
| | - Laura Wegener Parfrey
- Department of Chemistry & Biochemistry, University of Colorado, Boulder, Colorado, United States of America
| | - Bennett Roth
- Department of Medicine, Division of Digestive Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Andrew Ippoliti
- Cedars-Sinai F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California, United States of America
| | - Bo Wei
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - James Borneman
- Department of Plant Pathology and Microbiology, University of California Riverside, Riverside, California, United States of America
| | - Dermot P. B. McGovern
- Cedars-Sinai F. Widjaja Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, California, United States of America
| | - Daniel N. Frank
- Division of Infectious Diseases, University of Colorado, School of Medicine, Aurora, Colorado, United States of America
- Union Council, Denver Microbiome Research Consortium (MiRC), University of Colorado, School of Medicine, Aurora, Colorado, United States of America
| | - Ellen Li
- Department of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Steve Horvath
- Department of Human Genetics and Biostatistics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Rob Knight
- Department of Chemistry & Biochemistry, University of Colorado, Boulder, Colorado, United States of America
- Howard Hughes Medical Institute, University of Colorado, Boulder, Colorado, United States of America;
| | - Jonathan Braun
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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Comprehensive assessment of HIV target cells in the distal human gut suggests increasing HIV susceptibility toward the anus. J Acquir Immune Defic Syndr 2013; 63:263-71. [PMID: 23392465 DOI: 10.1097/qai.0b013e3182898392] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prevention of rectal HIV transmission is a high-priority goal for vaccines and topical microbicides because a large fraction of HIV transmissions occurs rectally. Yet, little is known about the specific target-cell milieu in the human rectum other than inferences made from the colon. METHODS We conducted a comprehensive comparative in situ fluorescence study of HIV target cells (CCR5-expressing T cells, macrophages, and putative dendritic cells) at 4 and 30 cm proximal of the anal canal in 29 healthy individuals, using computerized analysis of digitized combination stains. RESULTS Most strikingly, we find that more than 3 times as many CD68 macrophages express the HIV coreceptor CCR5 in the rectum than in the colon (P = 0.0001), and as such rectal macrophages seem biologically closer to the HIV-susceptible CCR5 phenotype in the vagina than the mostly HIV-resistant CCR5 phenotype in the colon. Putative CD209 dendritic cells are generally enriched in the colon compared with the rectum (P = 0.0004), though their CCR5 expression levels are similar in both compartments. CD3 T-cell densities and CCR5 expression levels are comparable in the colon and rectum. CONCLUSIONS Our study establishes the target-cell environment for HIV infection in the human distal gut and demonstrates in general terms that the colon and rectum are immunologically distinct anatomical compartments. Greater expression of CCR5 on rectal macrophages suggests that the most distal sections of the gut may be especially vulnerable to HIV infection. Our findings also emphasize that caution should be exercised when extrapolating data obtained from colon tissues to the rectum.
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Servidoni MF, Sousa M, Vinagre AM, Cardoso SR, Ribeiro MA, Meirelles LR, de Carvalho RB, Kunzelmann K, Ribeiro AF, Ribeiro JD, Amaral MD. Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for clinical trials feasibility. BMC Gastroenterol 2013; 13:91. [PMID: 23688510 PMCID: PMC3679995 DOI: 10.1186/1471-230x-13-91] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 05/16/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. METHODS We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. RESULTS Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r = -0.438 and -0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. CONCLUSIONS Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials.
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Affiliation(s)
- Maria F Servidoni
- Gastrocentro - Endoscopy Unit - State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
- Post-graduate Course, Pediatrics Department, State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
| | - Marisa Sousa
- University of Lisboa - Faculty of Sciences, BioFIG - Centre for Biodiversity, Functional and Integrative Genomics, Campo Grande, 1749-016, Lisbon, Portugal
- Department of Genetics, National Institute of Health – Av. Padre Cruz, 1649-016, Lisbon, Portugal
| | - Adriana M Vinagre
- Faculty of Medical Sciences - State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
| | - Silvia R Cardoso
- Post-graduate Course, Pediatrics Department, State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
- Endoscopy Unit – University Hospital of Campinas, Campinas, Brazil
| | - Maria A Ribeiro
- CIPED - Research Center in Pediatrics - State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
| | - Luciana R Meirelles
- Pathological Anatomy Department, University Hospital of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
| | - Rita B de Carvalho
- Pathological Anatomy Department, University Hospital of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
| | - Karl Kunzelmann
- Institut für Physiologie - Universität Regensburg, Universitat Strasse 31, D-93053, Regensburg, Germany
| | - Antônio F Ribeiro
- Post-graduate Course, Pediatrics Department, State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
- Faculty of Medical Sciences - State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
- CIPED - Research Center in Pediatrics - State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
| | - José D Ribeiro
- Post-graduate Course, Pediatrics Department, State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
- Faculty of Medical Sciences - State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
- CIPED - Research Center in Pediatrics - State University of Campinas (Unicamp) - Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP 13083-872, Brazil
| | - Margarida D Amaral
- University of Lisboa - Faculty of Sciences, BioFIG - Centre for Biodiversity, Functional and Integrative Genomics, Campo Grande, 1749-016, Lisbon, Portugal
- Department of Genetics, National Institute of Health – Av. Padre Cruz, 1649-016, Lisbon, Portugal
- Edifício C8, Departamento de Química e Bioquímica, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016, Lisbon, Portugal
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21
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McGowan I, Hoesley C, Cranston RD, Andrew P, Janocko L, Dai JY, Carballo-Dieguez A, Ayudhya RKN, Piper J, Hladik F, Mayer K. A phase 1 randomized, double blind, placebo controlled rectal safety and acceptability study of tenofovir 1% gel (MTN-007). PLoS One 2013; 8:e60147. [PMID: 23573238 PMCID: PMC3616022 DOI: 10.1371/journal.pone.0060147] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 02/21/2013] [Indexed: 11/25/2022] Open
Abstract
Objective Rectal microbicides are needed to reduce the risk of HIV acquisition associated with unprotected receptive anal intercourse. The MTN-007 study was designed to assess the safety (general and mucosal), adherence, and acceptability of a new reduced glycerin formulation of tenofovir 1% gel. Methods Participants were randomized 1∶1:1∶1 to receive the reduced glycerin formulation of tenofovir 1% gel, a hydroxyethyl cellulose placebo gel, a 2% nonoxynol-9 gel, or no treatment. Each gel was administered as a single dose followed by 7 daily doses. Mucosal safety evaluation included histology, fecal calprotectin, epithelial sloughing, cytokine expression (mRNA and protein), microarrays, flow cytometry of mucosal T cell phenotype, and rectal microflora. Acceptability and adherence were determined by computer-administered questionnaires and interactive telephone response, respectively. Results Sixty-five participants (45 men and 20 women) were recruited into the study. There were no significant differences between the numbers of ≥ Grade 2 adverse events across the arms of the study. Likelihood of future product use (acceptability) was 87% (reduced glycerin formulation of tenofovir 1% gel), 93% (hydroxyethyl cellulose placebo gel), and 63% (nonoxynol-9 gel). Fecal calprotectin, rectal microflora, and epithelial sloughing did not differ by treatment arms during the study. Suggestive evidence of differences was seen in histology, mucosal gene expression, protein expression, and T cell phenotype. These changes were mostly confined to comparisons between the nonoxynol-9 gel and other study arms. Conclusions The reduced glycerin formulation of tenofovir 1% gel was safe and well tolerated rectally and should be advanced to Phase 2 development. Trial Registration ClinicalTrials.gov NCT01232803.
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Affiliation(s)
- Ian McGowan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
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22
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McGowan I, Tanner K, Elliott J, Ibarrondo J, Khanukhova E, McDonald C, Saunders T, Zhou Y, Anton PA. Nonreproducibility of "snap-frozen" rectal biopsies for later use in ex vivo explant infectibility studies. AIDS Res Hum Retroviruses 2012; 28:1509-12. [PMID: 22831398 DOI: 10.1089/aid.2012.0062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sexual transmission accounts for the majority of new HIV infections worldwide with sexually exposed cervicovaginal and colorectal mucosae being primary sites of infection. Two recent Phase 1 rectal microbicide trials included, as an ancillary endpoint, suppression of ex vivo HIV infection of in vivo microbicide-exposed rectal mucosal tissue biopsies. Both trials demonstrated significant suppression of biopsy infectibility in drug-exposed versus placebo-exposed tissue. This potential early biomarker of efficacy has raised the feasibility of utilizing "snap-frozen" tissue samples, acquired at multiple trial sites to be shipped for central processing, providing a mechanism to correlate tissue drug concentrations with a functional index of HIV prevention. While previous reports have indicated acceptable comparability of fresh versus freeze-thawed cervicovaginal tissue samples, no similar evaluations with colorectal tissue biopsies have been done. In this study, rectal biopsies from healthy, HIV-seronegative participants were assessed for structural integrity (histology), viability (MTT assays), and tissue infectibility to compare results from fresh versus combinations of freeze/thaw protocols. Results indicated that while all protocols showed equivalent viability with fresh samples (MTT), histology documented poor preservation of tissue integrity following freezing. Infectibility results from freeze-thawed colorectal tissue were markedly lower (usually<25% of fresh samples) and varied greatly and unpredictably. Centralized colorectal tissue infectibility assays using biopsies from remote trial sites cannot currently be supported under these protocols.
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Affiliation(s)
- Ian McGowan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Karen Tanner
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Julie Elliott
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Javier Ibarrondo
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Elena Khanukhova
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Charina McDonald
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Terry Saunders
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ying Zhou
- Department of Biostatistics, UCLA School of Public Health, Los Angeles, California
| | - Peter A. Anton
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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23
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Abstract
PURPOSE OF REVIEW Individuals practicing unprotected receptive anal intercourse are at particularly high risk of HIV infection. Men who have sex with men (MSM) in the developed and developing world continue to have disproportionate and increasing levels of HIV infection. The past few years have seen important progress in demonstrating the efficacy of oral pre-exposure prophylaxis (PrEP), vaginal microbicides, and treatment as prevention, but there has also been significant progress in the development of rectal microbicides. The purpose of this review is to summarize the status of rectal microbicide research and to identify opportunities, challenges, and future directions in this important field of HIV prevention. RECENT FINDINGS Recent phase 1 rectal microbicide studies have characterized the safety, acceptability, compartmental pharmacokinetics, and pharmacodynamics of both UC781 and tenofovir gels. The tenofovir gel formulation used in vaginal studies was not well tolerated in the rectum and newer rectal-specific formulations have been developed and evaluated in phase 1 studies. SUMMARY Complex phase 1 studies have provided important data on candidate rectal microbicides. Tenofovir gel is poised to move into phase 2 evaluation and it is possible that a phase 2B/3 effectiveness study could be initiated in the next 2-3 years.
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Affiliation(s)
- Ian McGowan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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24
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Anton PA, Cranston RD, Kashuba A, Hendrix CW, Bumpus NN, Richardson-Harman N, Elliott J, Janocko L, Khanukhova E, Dennis R, Cumberland WG, Ju C, Carballo-Diéguez A, Mauck C, McGowan I. RMP-02/MTN-006: A phase 1 rectal safety, acceptability, pharmacokinetic, and pharmacodynamic study of tenofovir 1% gel compared with oral tenofovir disoproxil fumarate. AIDS Res Hum Retroviruses 2012; 28:1412-21. [PMID: 22943559 DOI: 10.1089/aid.2012.0262] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study was designed to assess the safety, acceptability, pharmacokinetic (PK), and pharmacodynamic (PD) responses to rectal administration of tenofovir (TFV) 1% vaginally formulated gel and oral tenofovir disoproxil fumarate (TDF). This study was designed as a phase 1, randomized, two-site (United States), double-blind, placebo-controlled study of sexually abstinent men and women. Eighteen participants received a single 300-mg exposure of oral TDF and were then randomized 2:1 to receive a single and then seven daily exposures of rectal TFV or hydroxyethyl cellulose (HEC) placebo gel. Safety endpoints included clinical adverse events (AEs) and mucosal safety parameters. Blood and colonic biopsies were collected for PK analyses and ex vivo HIV-1 challenge. No serious AEs were reported. However, AEs were significantly increased with 7-day TFV gel use, most prominently with gastrointestinal AEs (p=0.002). Only 25% of participants liked the TFV gel. Likelihood of use "if somewhat protective" was ∼75% in both groups. Indices of mucosal damage showed minimal changes. Tissue TFV diphosphate (TFV-DP) C(max) 30 min after single rectal exposure was 6-10 times greater than single oral exposure; tissue TFV-DP was 5.7 times greater following 7-day versus single rectal exposure. In vivo exposure correlated with significant ex vivo tissue infectibility suppression [single-rectal: p=0.12, analysis of covariance (ANCOVA) p=0.006; 7-day rectal: p=0.02, ANCOVA p=0.005]. Tissue PK-PD was significantly correlated (p=0.002). We conclude that rectal dosing with TFV 1% gel resulted in greater TFV-DP tissue detection than oral dosing with reduced ex vivo biopsy infectibility, enabling PK-PD correlations. On the basis of increased gastrointestinal AEs, rectally applied, vaginally formulated TFV was not entirely safe or acceptable, suggesting the need for alternative rectal-specific formulations.
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Affiliation(s)
- Peter A. Anton
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ross D. Cranston
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Angela Kashuba
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Craig W. Hendrix
- Departments of Medicine and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Namandjé N. Bumpus
- Departments of Medicine and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Julie Elliott
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Laura Janocko
- Magee-Womens Research Institute, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - Elena Khanukhova
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Robert Dennis
- Computing Technology Research Laboratory (CTRL), David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Chuan Ju
- Department of Biostatistics, UCLA School of Public Health, Los Angeles, California
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York
| | | | - Ian McGowan
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
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25
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Richardson-Harman N, Mauck C, McGowan I, Anton P. Dose-response relationship between tissue concentrations of UC781 and explant infectibility with HIV type 1 in the RMP-01 rectal safety study. AIDS Res Hum Retroviruses 2012; 28:1422-33. [PMID: 22900504 DOI: 10.1089/aid.2012.0073] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A retrospective correlational analysis of UC781 (0.1, 0.25%) gel pharmacokinetics (PK) and pharmacodynamics (PD) was undertaken using data generated in the RMP-01/MTN-006 Phase 1 rectal safety study of the UC781 microbicide gel, where strong UC781-related inhibition of ex vivo biopsy infectibility (PD) was seen. Precision analysis, linear and logistical correlational methods were applied to model the dose-response relationship. Four analyses of explant virus growth were compared to determine tissue concentrations of UC781 needed to maintain ex vivo virus growth below a range of cut-points. SOFT, a cross-sectional index from a growth curve, and cumulative p24 endpoints were the most precise measurement of ex vivo HIV infection and significantly (p<0.01) correlated with rectal tissue UC781 concentrations. Cut-points reflecting infectibility, ranging from 200 to 1300 p24 pg/ml, provided EC(50,90,95) tissue levels of UC781. A cut-point of 200 p24 pg/ml provided an EC(50) of 2148 UC781 ng/g tissue; a cut-point of 1100 p24 predicted a lower EC(50) of 101 UC781 ng/g. A 30- to 170-fold EC(90):EC(50) ratio was found. Higher p24 cut-points provided more predictive models. Tissue UC781 levels and ex vivo infectibility data were correlated to model dose-response drug efficacy in this small Phase 1 trial. Logistic regression analyses showed EC(50,90,95) values were inversely related to p24 cut-point levels, providing clinically relevant insights into tissue drug concentration necessary for ex vivo suppression of HIV tissue infectibility. This first PK-PD assessment of topical microbicides demonstrates feasibility in Phase 1 trials, enabling comparisons of microbicide efficacy (i.e., EC(50,90,95)) between formulations, compartments, and application methods. (ClinicalTrials.gov; #NCT00408538).
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26
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Chang L, Adeyemo M, Karagiannides I, Videlock EJ, Bowe C, Shih W, Presson AP, Yuan PQ, Cortina G, Gong H, Singh S, Licudine A, Mayer M, Tache Y, Pothoulakis C, Mayer EA, Mayer EA. Serum and colonic mucosal immune markers in irritable bowel syndrome. Am J Gastroenterol 2012; 107:262-72. [PMID: 22158028 PMCID: PMC3297737 DOI: 10.1038/ajg.2011.423] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Low-grade colonic mucosal inflammation has been postulated to have an important role in the pathophysiology of irritable bowel syndrome (IBS). The objectives of this study were (i) to identify serum and tissue-based immunological and neuroendocrine markers associated with mucosal inflammation in male (M) and female (F) patients with non-post-infectious IBS (non-PI-IBS) compared with healthy controls and (ii) to assess possible correlations of such markers with IBS symptoms. METHODS Sigmoid mucosal biopsies were obtained from 45 Rome II positive IBS patients without a history of PI-IBS (26 F, 35.5% IBS-C, 33.3% IBS-D, 31.1% IBS-A/M) and 41 healthy controls (22 F) in order to measure immunological markers (serum cytokine levels, colonic mucosal mRNA levels of cytokines, mucosal immune cell counts) and neuroendocrine markers associated with mucosal inflammation (corticotropin releasing factor- and neurokinin (NK)-related ligands and receptors, enterochromaffin cells). Symptoms were measured using validated questionnaires. RESULTS Of all the serum and mucosal cytokines measured, only interleukin-10 (IL-10) mRNA expression showed a group difference, with female, but not male, patients showing lower levels compared with female controls (18.0±2.9 vs. 29.5±4.0, P=0.006). Mucosal mRNA expression of NK-1 receptor was significantly lower (1.15±0.19 vs. 2.66±0.56, P=0.008) in female, but not male, patients compared with healthy controls. No other significant differences were observed. CONCLUSIONS Immune cell counts and levels of cytokines and neuropeptides that are associated with inflammation were not significantly elevated in the colonic mucosa of non-PI-IBS patients, and did not correlate with symptoms. Thus, these findings do not support that colonic mucosal inflammation consistently has a primary role in these patients. However, the finding of decreased IL-10 mRNA expression may be a possible biomarker of IBS and warrants further investigation.
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Affiliation(s)
- Lin Chang
- Center for Neurobiology of Stress, University of California, Los Angeles, California, USA,Department of Medicine, University of California, Los Angeles, California, USA
| | - Mopelola Adeyemo
- Center for Neurobiology of Stress, University of California, Los Angeles, California, USA,Department of Medicine, University of California, Los Angeles, California, USA
| | - Iordanis Karagiannides
- Department of Medicine, University of California, Los Angeles, California, USA,Inflammatory Bowel Disease Center, Department of Medicine, University of California, Los Angeles, California, USA
| | - Elizabeth J. Videlock
- Center for Neurobiology of Stress, University of California, Los Angeles, California, USA,Department of Medicine, University of California, Los Angeles, California, USA
| | - Collin Bowe
- Department of Medicine, University of California, Los Angeles, California, USA,Inflammatory Bowel Disease Center, Department of Medicine, University of California, Los Angeles, California, USA
| | - Wendy Shih
- Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Angela P. Presson
- Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Pu-Qing Yuan
- Center for Neurobiology of Stress, University of California, Los Angeles, California, USA,Inflammatory Bowel Disease Center, Department of Medicine, University of California, Los Angeles, California, USA,VA GLA Healthcare System, Los Angeles, California, USA
| | - Galen Cortina
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Hua Gong
- Prometheus Laboratories, San Diego, California, USA
| | - Sharat Singh
- Prometheus Laboratories, San Diego, California, USA
| | - Arlene Licudine
- Center for Neurobiology of Stress, University of California, Los Angeles, California, USA,Department of Medicine, University of California, Los Angeles, California, USA
| | - Minou Mayer
- Center for Neurobiology of Stress, University of California, Los Angeles, California, USA,Department of Medicine, University of California, Los Angeles, California, USA
| | - Yvette Tache
- Center for Neurobiology of Stress, University of California, Los Angeles, California, USA,Inflammatory Bowel Disease Center, Department of Medicine, University of California, Los Angeles, California, USA,VA GLA Healthcare System, Los Angeles, California, USA
| | - Charalabos Pothoulakis
- Department of Medicine, University of California, Los Angeles, California, USA,Inflammatory Bowel Disease Center, Department of Medicine, University of California, Los Angeles, California, USA
| | - Emeran A. Mayer
- Center for Neurobiology of Stress, University of California, Los Angeles, California, USA,Department of Medicine, University of California, Los Angeles, California, USA,Department of Physiology, University of California, Los Angeles, California, USA,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA,Brain Research Institute, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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27
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Anton PA, Saunders T, Elliott J, Khanukhova E, Dennis R, Adler A, Cortina G, Tanner K, Boscardin J, Cumberland WG, Zhou Y, Ventuneac A, Carballo-Diéguez A, Rabe L, McCormick T, Gabelnick H, Mauck C, McGowan I. First phase 1 double-blind, placebo-controlled, randomized rectal microbicide trial using UC781 gel with a novel index of ex vivo efficacy. PLoS One 2011; 6:e23243. [PMID: 21969851 PMCID: PMC3182160 DOI: 10.1371/journal.pone.0023243] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 07/11/2011] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Successful control of the HIV/AIDS pandemic requires reduction of HIV-1 transmission at sexually-exposed mucosae. No prevention studies of the higher-risk rectal compartment exist. We report the first-in-field Phase 1 trial of a rectally-applied, vaginally-formulated microbicide gel with the RT-inhibitor UC781 measuring clinical and mucosal safety, acceptability and plasma drug levels. A first-in-Phase 1 assessment of preliminary pharmacodynamics was included by measuring changes in ex vivo HIV-1 suppression in rectal biopsy tissue after exposure to product in vivo. METHODS HIV-1 seronegative, sexually-abstinent men and women (N = 36) were randomized in a double-blind, placebo-controlled trial comparing UC781 gel at two concentrations (0.1%, 0.25%) with placebo gel (1∶1∶1). Baseline, single-dose exposure and a separate, 7-day at-home dosing were assessed. Safety and acceptability were primary endpoints. Changes in colorectal mucosal markers and UC781 plasma drug levels were secondary endpoints; ex vivo biopsy infectibility was an ancillary endpoint. RESULTS All 36 subjects enrolled completed the 7-14 week trial (100% retention) including 3 flexible sigmoidoscopies, each with 28 biopsies (14 at 10 cm; 14 at 30 cm). There were 81 Grade 1 adverse events (AEs) and 8 Grade 2; no Grade 3, 4 or procedure-related AEs were reported. Acceptability was high, including likelihood of future use. No changes in mucosal immunoinflammatory markers were identified. Plasma levels of UC781 were not detected. Ex vivo infection of biopsies using two titers of HIV-1(BaL) showed marked suppression of p24 in tissues exposed in vivo to 0.25% UC781; strong trends of suppression were seen with the lower 0.1% UC781 concentration. CONCLUSIONS Single and 7-day topical rectal exposure to both concentrations of UC781 were safe with no significant AEs, high acceptability, no detected plasma drug levels and no significant mucosal changes. Ex vivo biopsy infections demonstrated marked suppression of HIV infectibility, identifying a potential early biomarker of efficacy. (Registered at ClinicalTrials.gov; #NCT00408538).
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Affiliation(s)
- Peter A Anton
- Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, United States of America.
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28
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Abstract
More than 7000 new HIV infections are documented each day worldwide. In this Perspective, we dissect new results from a large clinical trial showing that genital and plasma HIV-1 RNA loads predict the risk of heterosexual transmission and that genital tract viral RNA load does so independently of plasma viral load. Furthermore, beyond its defined study end points, this well-conducted trial identified new research directions that should be pursued in smaller intensive basic and translational studies.
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Affiliation(s)
- Peter Anton
- Center for HIV Prevention Research, Division of Digestive Diseases and UCLA AIDS Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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29
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Abstract
The results of the CAPRISA 004 and iPrEx HIV prevention studies have demonstrated that topical or systemic use of antiretroviral agents can significantly reduce the risk of HIV acquisition associated with unprotected vaginal or anal sexual intercourse. However, the effect size in these studies was relatively modest and product adherence was generally poor. These observations suggest the need for new approaches to HIV prevention, especially for high risk MSM. Rates of lubricant use are high in MSM practicing receptive anal sex. Consequently, the development of an antiretroviral rectal microbicide gel may provide a safe and effective means of preventing HIV infection with an intervention that is likely to have high acceptability among the target population. The purpose of this article is to describe the challenges and progress in the development of rectal microbicides for HIV prevention.
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30
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Reliability of tumor markers, chemokines, and metastasis-related molecules in serum. Eur Cytokine Netw 2011; 20:21-6. [PMID: 19318317 DOI: 10.1684/ecn.2009.0146] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There is a growing interest in the role that cancer biomarkers, metastasis-related molecules, and chemokines may play in the development and progression of various cancers. However, few studies have addressed the reliability of such biomarkers in healthy individuals over time. The objective of this study was to investigate the temporal reliability of multiple proteins in serum samples from healthy women who donated blood over successive years. Thirty five, postmenopausal women with two, repeated annual visits, and thirty, premenopausal women with three, repeated annual visits were randomly selected among eligible subjects from an existing, prospective cohort. Multiplexing Luminex xMAPTM technology was used to measure the levels of 55 serum proteins representing cancer antigens, chemokines, angiogenic and anti-angiogenic factors, proteases, adipokines, apoptotic molecules, and other markers in these women. The biomarkers with high detection rates (> 60%) and acceptable reliability (intraclass correlation coefficient, ICCs > or = 0.55) using xMAPTM method were: cancer antigens: AFP, CA 15-3, CEA, CA-125, SCC, SAA; growth factors/related molecules: ErbB2, IGFBP-1; proteases and adhesion molecules: MMP-1, 8, 9, sE-selectin, human kallikreins (KLK) 8,10, ICAM-1, VCAM-1, chemokines: fractalkine, MCP-1,2, RANTES, MIP-1alpha, MIP-1beta, Eotaxin, GRO-alpha, IP-10; inhibitors of angiogenesis: angiostatin and endostatin; adipokines leptin and resistin; apoptotic factor: Fas, and other proteins mesothelin, myeloperoxidase (MPO), and PAI-1. The rest of the biomarkers under investigation either had ICCs less than 0.55 or had low levels of detection (< 60%). These included cancer antigens: CA 19-9, CA 72-4, MICA, S100, TTR, ULBP1, ULBP2, ULBP3; proteases: MMP 2, 3, 7, 12, 13; chemokines: MCP-3, MIF, MIG; adipokines: leptin and resistin; apoptotic factors: FasL, DR5, Cyfra 21-1; and inhibitors of angiogenesis and other markers: thrombospondin and heat shock protein (HSP) 27. In conclusion, 34 out of the 55 biomarkers investigated were present in detectable levels in > 60% of the samples, and with an ICC > or = 0.55, indicating that a single serum measurement can be used in prospective epidemiological studies using the xMAPTM method.
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Veronese F, Anton P, Fletcher CV, DeGruttola V, McGowan I, Becker S, Zwerski S, Burns D. Implications of HIV PrEP trials results. AIDS Res Hum Retroviruses 2011; 27:81-90. [PMID: 20969483 DOI: 10.1089/aid.2010.0226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract Six randomized clinical trials have been implemented to examine the efficacy of tenofovir disoproxil fumarate (TDF) and/or TDF/emtricitabine (TDF/FTC) as preexposure prophylaxis for HIV-1 infection (PrEP). Although largely complementary, the six trials have many similar features. As the earliest results become available, an urgent question may arise regarding whether changes should be made in the conduct of the other trials. To consider this in advance, a Consultation on the Implications of HIV Pre-Exposure Prophylaxis (PrEP) Trials Results sponsored by the Division of AIDS (DAIDS) of the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), and the Bill and Melinda Gates Foundation (BMGF) was held on January 29, 2010, at the Natcher Conference Center, NIH, Bethesda, MD. Participants included basic scientists, clinical researchers (including investigators performing the current PrEP trials), and representatives from the U.S. Food and Drug Administration (FDA) and the agencies sponsoring the trials: the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID), the BMGF, and the U.S. NIH. We report here a summary of the presentations and highlights of salient discussion topics from this workshop.
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Affiliation(s)
- Fulvia Veronese
- Prevention Sciences Program (PSP), Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland
| | - Peter Anton
- Center for HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | | | - Victor DeGruttola
- Harvard School of Public Health, Harvard University, Boston, Massachusetts
| | - Ian McGowan
- Division of Gastroenterology, Hepatology, and Nutrition, Magee-Women's Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen Becker
- Global Health-HIV, Bill and Melinda Gates Foundation (BMGF), Seattle, Washington
| | - Sheryl Zwerski
- Prevention Sciences Program (PSP), Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland
| | - David Burns
- Prevention Sciences Program (PSP), Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland
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Youth-specific considerations in the development of preexposure prophylaxis, microbicide, and vaccine research trials. J Acquir Immune Defic Syndr 2010; 54 Suppl 1:S31-42. [PMID: 20571421 DOI: 10.1097/qai.0b013e3181e3a922] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Preventing HIV infection in adolescents and young adults will require a multimodal targeted approach, including individual-directed behavioral risk reduction, community-level structural change, and biomedical interventions to prevent sexual transmission. Trials testing biomedical interventions to prevent HIV transmission will require special attention in this population due to the unique psychosocial and physiologic characteristics that differentiate them from older populations. For example, microbicide research will need to consider acceptability, dosing requirements, and coinfection rates that are unique to this population. Preexposure prophylaxis studies also will need to consider potential unique psychosocial issues such as sexual disinhibition and acceptability as well as unique pharmacokinetic parameters of antiretroviral agents. Vaccine trials also face unique issues with this population, including attitudes toward vaccines, risks related to false-positive HIV tests related to vaccine, and different immune responses based on more robust immunity. In this article, we will discuss issues around implementing each of these biomedical prevention modalities in trials among adolescents and young adults to help to guide future successful research targeting this population.
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Mehra V, Musib R, Schito ML. Towards developing standardized protocols for evaluation of cellular mucosal immune responses - Recommendations from a DAIDS/NIH workshop, June 15-16, 2009. Vaccine 2010; 28:4689-94. [PMID: 20470800 DOI: 10.1016/j.vaccine.2010.04.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/15/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
Although 80% of HIV infections occur through mucosal routes and vaccine strategies need to be designed for inducing protective immune responses at the site of the viral entry, it has proven to be very challenging to measure these responses. A 2-day workshop was convened by Division of AIDS, National Institutes of Health on June 15-16, 2009 to address the challenges encountered in the evaluation of mucosal T cell immune responses. The goal of the workshop was to obtain recommendations/consensus for developing standardized protocols for the assessment of mucosal immunity. This report summarizes the areas of consensus and recommendations that should assist in developing standardized methodologies for the evaluation of mucosal immune responses.
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Affiliation(s)
- V Mehra
- Preclinical Research and Development Branch, Vaccine Research Program, Division of AIDS, NIAID, NIH, HHS, USA
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Hendrix CW, Cao YJ, Fuchs EJ. Topical microbicides to prevent HIV: clinical drug development challenges. Annu Rev Pharmacol Toxicol 2009; 49:349-75. [PMID: 19006450 DOI: 10.1146/annurev.pharmtox.48.113006.094906] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Microbicides, substances applied topically to prevent sexual HIV infection, are needed to empower receptive sexual partners with effective prevention methods. Several large microbicide trials, however, failed to demonstrate efficacy, thus motivating a reevaluation of the current microbicide development paradigm, which has been largely empirically based. Microbicide use occurs in a highly complex environment involving multi-level interactions, behavioral and biochemical, among host, virus, and drug, yet many details of these interactions remain unknown. Fundamental information regarding virus and drug distribution over time in sexually receptive body compartments that is necessary to design a microbicide able to outdistance and outlast the virus is largely absent. Recent efforts have been made to establish a simple conceptual framework for obtaining the knowledge that is likely to inform a more mechanistic, model-based development paradigm. These efforts have also advanced the development of numerous methodological approaches to obtain the knowledge needed to improve microbicide development.
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Affiliation(s)
- Craig W Hendrix
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, USA.
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Pantalone DW, Bimbi DS, Parsons JT. Motivations for the recreational use of erectile enhancing medications in urban gay and bisexual men. Sex Transm Infect 2009; 84:458-62. [PMID: 19028947 DOI: 10.1136/sti.2008.031476] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Recreational erectile enhancing medication (EEM) use has been associated with a number of health risk behaviours among gay and bisexual men. This study aims to extend previous findings about the associations between recent EEM use and illegal drug use, incident sexually transmitted infections (STIs) and unprotected sex, as well as to report on motivations for EEM use. METHODS A cross-sectional, street-intercept survey method was used to collect data from 912 gay/bisexual men at two large lesbian, gay and bisexual community events in New York City in 2006. RESULTS Lifetime EEM use was reported by 28.0% of the men; 17.4% used EEM in the past 3 months. EEM users were more likely to be white and HIV positive. EEM users were more likely to engage in unprotected anal insertive sex with seroconcordant and serodiscordant partners. EEM users who were HIV negative were more likely to report using alcohol and other drugs before and during sex, especially crystal methamphetamine (AOR 18.66; 95% CI 6.82 to 51.02) as well as to endorse incident STIs. The most frequent responses for EEM use were to "add to the fun", "maintain an erection while using a condom" and "to have sex for hours". Men with HIV were 2.93 times (95% CI 1.24 to 6.88) more likely to endorse using EEMs to bareback. CONCLUSIONS Gay and bisexual men use EEMs to enhance their sexual experiences among other motives. Different motives and correlates emerged by HIV status. Overall, EEM use was correlated with multiple health risk behaviours. EEM users who were HIV negative appear to be at particularly high risk of acquiring HIV.
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Affiliation(s)
- D W Pantalone
- Center for HIV/AIDS Educational Studies and Training, Hunter College & The Graduate Center, City University of New York, 250 West 26th Street, Suite 300, New York, NY 10001, USA
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Critchfield JW, Young DH, Hayes TL, Braun JV, Garcia JC, Pollard RB, Shacklett BL. Magnitude and complexity of rectal mucosa HIV-1-specific CD8+ T-cell responses during chronic infection reflect clinical status. PLoS One 2008; 3:e3577. [PMID: 18974782 PMCID: PMC2570490 DOI: 10.1371/journal.pone.0003577] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 10/07/2008] [Indexed: 11/18/2022] Open
Abstract
Background The intestinal mucosa displays robust virus replication and pronounced CD4+ T-cell loss during acute human immunodeficiency virus type 1 (HIV-1) infection. The ability of HIV-specific CD8+ T-cells to modulate disease course has prompted intensive study, yet the significance of virus-specific CD8+ T-cells in mucosal sites remains unclear. Methods and Findings We evaluated five distinct effector functions of HIVgag-specific CD8+ T-cells in rectal mucosa and blood, individually and in combination, in relationship to clinical status and antiretroviral therapy (ART). In subjects not on ART, the percentage of rectal Gag-specific CD8+ T-cells capable of 3, 4 or 5 simultaneous effector functions was significantly related to blood CD4 count and inversely related to plasma viral load (PVL) (p<0.05). Polyfunctional rectal CD8+ T-cells expressed higher levels of MIP-1β and CD107a on a per cell basis than mono- or bifunctional cells. The production of TNFα, IFN-γ, and CD107a by Gag-specific rectal CD8+ T-cells each correlated inversely (p<0.05) with PVL, and MIP-1β expression revealed a similar trend. CD107a and IFN-γ production were positively related to blood CD4 count (p<0.05), with MIP-1β showing a similar trend. IL-2 production by rectal CD8+ T-cells was highly variable and generally low, and showed no relationship to viral load or blood CD4 count. Conclusions The polyfunctionality of rectal Gag-specific CD8+ T-cells appears to be related to blood CD4 count and inversely related to PVL. The extent to which these associations reflect causality remains to be determined; nevertheless, our data suggest a potentially important role for mucosal T-cells in limiting virus replication during chronic infection.
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Affiliation(s)
- J. William Critchfield
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of Amerca
| | - Delandy H. Young
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of Amerca
| | - Timothy L. Hayes
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of Amerca
| | - Jerome V. Braun
- Department of Statistics, University of California Davis, Davis, California, United States of Amerca
| | - Juan C. Garcia
- Department of Medicine, Division of Gastroenterology, School of Medicine, University of California Davis, Sacramento, California, United States of America
| | - Richard B. Pollard
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of California Davis, Sacramento, California, United States of America
| | - Barbara L. Shacklett
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, United States of Amerca
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of California Davis, Sacramento, California, United States of America
- * E-mail:
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Anton PA, Ibarrondo FJ, Boscardin WJ, Zhou Y, Schwartz EJ, Ng HL, Hausner MA, Shih R, Elliott J, Hultin PM, Hultin LE, Price C, Fuerst M, Adler A, Wong JT, Yang OO, Jamieson BD. Differential immunogenicity of vaccinia and HIV-1 components of a human recombinant vaccine in mucosal and blood compartments. Vaccine 2008; 26:4617-23. [PMID: 18621451 DOI: 10.1016/j.vaccine.2008.05.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Revised: 05/07/2008] [Accepted: 05/14/2008] [Indexed: 12/16/2022]
Abstract
Mucosal immune responses induced by HIV-1 vaccines are likely critical for prevention. We report a Phase 1 safety and immunogenicity trial in eight participants using the vaccinia-based TBC-3B vaccine given subcutaneously to determine the relationship between HIV-1 specific systemic and gastrointestinal mucosal responses. Across all subjects, detectable levels of blood vaccinia- and HIV-1-specific antibodies were elicited but none were seen mucosally. While the vaccinia component was immunogenic for CD8(+) T lymphocyte (CTL) responses in both blood and mucosa, it was greater in blood. The HIV-1 component of the vaccine was poorly immunogenic in both blood and mucosa. Although only eight volunteers were studied intensively, the discordance between mucosal and blood responses may highlight mechanisms contributing to recent vaccine failures.
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Affiliation(s)
- Peter A Anton
- Center for Prevention Research and the UCLA AIDS Institute, David Geffen School of Medicine at UCLA, USA.
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