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Walker NF, Opondo C, Meintjes G, Jhilmeet N, Friedland JS, Elkington PT, Wilkinson RJ, Wilkinson KA. Invariant Natural Killer T-cell Dynamics in Human Immunodeficiency Virus-associated Tuberculosis. Clin Infect Dis 2021; 70:1865-1874. [PMID: 31190065 PMCID: PMC7156773 DOI: 10.1093/cid/ciz501] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/11/2019] [Indexed: 01/04/2023] Open
Abstract
Background Tuberculosis (TB) is the leading cause of mortality and morbidity in people living with human immunodeficiency virus (HIV) infection (PLWH). PLWH with TB disease are at risk of the paradoxical TB-associated immune reconstitution inflammatory syndrome (TB-IRIS) when they commence antiretroviral therapy. However, the pathophysiology is incompletely understood and specific therapy is lacking. We investigated the hypothesis that invariant natural killer T (iNKT) cells contribute to innate immune dysfunction associated with TB-IRIS. Methods In a cross-sectional study of 101 PLWH and HIV-uninfected South African patients with active TB and controls, iNKT cells were enumerated using α-galactosylceramide-loaded CD1d tetramers and subsequently functionally characterized by flow cytometry. In a second study of 49 people with HIV type 1 (HIV-1) and active TB commencing antiretroviral therapy, iNKT cells in TB-IRIS patients and non-IRIS controls were compared longitudinally. Results Circulating iNKT cells were reduced in HIV-1 infection, most significantly the CD4+ subset, which was inversely associated with HIV-1 viral load. iNKT cells in HIV-associated TB had increased surface CD107a expression, indicating cytotoxic degranulation. Relatively increased iNKT cell frequency in patients with HIV-1 infection and active TB was associated with development of TB-IRIS following antiretroviral therapy initiation. iNKT cells in TB-IRIS were CD4+CD8– subset depleted and degranulated around the time of TB-IRIS onset. Conclusions Reduced iNKT cell CD4+ subsets as a result of HIV-1 infection may skew iNKT cell functionality toward cytotoxicity. Increased CD4– cytotoxic iNKT cells may contribute to immunopathology in TB-IRIS.
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Affiliation(s)
- Naomi F Walker
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Infectious Diseases and Immunity, and Imperial College Wellcome Trust Centre for Global Health, Imperial College London, United Kingdom.,Department of Medicine, University of Cape Town, Observatory, South Africa.,Tuberculosis Centre and Department of Clinical Research
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Nishtha Jhilmeet
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - Jon S Friedland
- Institute of Infection and Immunity, St George's, University of London
| | - Paul T Elkington
- Infectious Diseases and Immunity, and Imperial College Wellcome Trust Centre for Global Health, Imperial College London, United Kingdom.,National Institute for Health Research Biomedical Research Centre, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Medicine, University of Cape Town, Observatory, South Africa.,Francis Crick Institute, London.,Department of Medicine, Imperial College London, United Kingdom
| | - Katalin A Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa.,Department of Medicine, University of Cape Town, Observatory, South Africa.,Francis Crick Institute, London
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Maymone MBC, Laughter M, Venkatesh S, Dacso MM, Rao PN, Stryjewska BM, Hugh J, Dellavalle RP, Dunnick CA. Leprosy: Clinical aspects and diagnostic techniques. J Am Acad Dermatol 2020; 83:1-14. [PMID: 32229279 DOI: 10.1016/j.jaad.2019.12.080] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/26/2019] [Accepted: 12/11/2019] [Indexed: 01/27/2023]
Abstract
Leprosy, also known as Hansen's disease, is a curable infectious disease that remains endemic in >140 countries around the world. Despite being declared "eliminated" as a global public health problem by the World Health Organization in the year 2000, approximately 200,000 new cases were reported worldwide in 2017. Widespread migration may bring leprosy to nonendemic areas, such as North America. In addition, there are areas in the United States where autochthonous (person-to-person) transmission of leprosy is being reported among Americans without a history of foreign exposure. In the first article in this continuing medical education series, we review leprosy epidemiology, transmission, classification, clinical features, and diagnostic challenges.
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Affiliation(s)
- Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Melissa Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Samantha Venkatesh
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Mara M Dacso
- National Hansen's (Leprosy) Disease Program, Baton Rouge, Louisiana; University of Texas Southwestern Medical Center, Dallas, Texas
| | - P Narasimha Rao
- Special Interest Group on Leprosy, Indian Association of Dermatologists, Venereologists and Leprologists, Hyderabad, India
| | | | - Jeremy Hugh
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado.
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Papotto PH, Maeda S, Tomimori J, Xavier MB, Rizzo LV, Kallas EG, Carvalho KI. New Players in the Same Old Game: Disturbance of Group 2 Innate Lymphoid Cells in HIV-1 and Mycobacterium leprae Co-infected Patients. PLoS Negl Trop Dis 2015; 9:e0004030. [PMID: 26335023 PMCID: PMC4559394 DOI: 10.1371/journal.pntd.0004030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/04/2015] [Indexed: 12/14/2022] Open
Abstract
Leprosy control is achieved through a fine-tuning of TH1 and TH2 immune response pattern balance. Given the increasing epidemiological overlay of HIV and M. leprae infections, immune response in co-infected patients consists in an important contemporary issue. Here we describe for the first time the innate lymphoid cells compartment in peripheral blood of leprosy and HIV/M. leprae co-infected patients, and show that co-infection increases group 2 innate lymphoid whilst decreasing group 1 innate lymphoid cells frequencies and function.
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Affiliation(s)
- Pedro Henrique Papotto
- Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa, São Paulo, Brazil
| | - Solange Maeda
- Universidade Federal de São Paulo, Dermatology Department, São Paulo, Brazil
| | - Jane Tomimori
- Universidade Federal de São Paulo, Dermatology Department, São Paulo, Brazil
| | | | - Luiz Vicente Rizzo
- Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa, São Paulo, Brazil
| | - Esper Georges Kallas
- Universidade de São Paulo, Faculdade de Medicina, Disciplina de Imunologia Clínica e Alergia (LIM60), São Paulo, Brazil
| | - Karina Inácio Carvalho
- Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa, São Paulo, Brazil
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Interleukins 15 and 12 in combination expand the selective loss of natural killer T cells in HIV infection in vitro. Clin Exp Med 2014; 15:205-13. [PMID: 24748538 DOI: 10.1007/s10238-014-0278-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/10/2014] [Indexed: 12/20/2022]
Abstract
The present study evaluated the frequency and receptor expression pattern of invariant natural killer T (iNKT) cells in human immunodeficiency virus (HIV)-infected individuals. Further, the effect of IL-15 + IL-12 stimulation on iNKT cells was also assessed. The study included 15 individuals each from normal healthy subjects, pulmonary tuberculosis patients, HIV-infected individuals, and patients with HIV and tuberculosis coinfection (HIV-TB). The frequency of iNKT cells and the expression of phenotype, cytotoxic and chemokine receptors were studied by flow cytometry. The number of iNKT cells was significantly depleted in HIV and HIV-TB patients, which upon IL-15 + IL-12 stimulation expanded in HIV. The constitutively expressed natural cytotoxicity receptor, NKp46 was increased in HIV and HIV-TB, which might be the host's response to HIV replication. The distinct expression patterns of chemokine and adhesion receptors suggest that iNKT subsets might traffic to different microenvironment and tissues. High expression of chemokine receptor CCR5 by most iNKT cells suggests that these cells might be more favorable targets of HIV infection. Our results show that IL-15 and IL-12 combination has the ability to expand the selective depletion of iNKT cells in vitro in HIV-infected individuals, but of limited value when coinfected with TB.
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