1
|
Gonzalez SM, Aguilar-Jimenez W, Su RC, Rugeles MT. Mucosa: Key Interactions Determining Sexual Transmission of the HIV Infection. Front Immunol 2019; 10:144. [PMID: 30787929 PMCID: PMC6373783 DOI: 10.3389/fimmu.2019.00144] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 01/17/2019] [Indexed: 12/26/2022] Open
Abstract
In the context of HIV sexual transmission at the genital mucosa, initial interactions between the virus and the mucosal immunity determine the outcome of the exposure. Hence, these interactions have been deeply explored in attempts to undercover potential targets for developing preventative strategies. The knowledge gained has led to propose a hypothetical model for mucosal HIV transmission. Subsequent research studies on this topic further revealed new mechanisms and identified new host-HIV interactions. This review aims at integrating these findings to inform better and update the current model of HIV transmission. At the earliest stage of virus exposure, the epithelial integrity and the presence of antiviral factors are critical in preventing viral entry to the submucosa. However, the virus has been shown to enter to the submucosa in the presence of physical abrasion or via epithelial transmigration using paracellular passage or transcytosis mechanisms. The efficiency of these processes is greater with cell-associated viral inoculums and can be influenced by the presence of viral and immune factors, and by the structure of the exposed epithelium. Once the virus reaches the submucosa, dendritic cells and fibroblasts, as recently described, have been shown in vitro of being capable of facilitating the transfer of viral particles to susceptible cells, leading to viral dissemination, most likely in a trans-infection manner. The presence of activated CD4+ T cells in submucosa increases the probability of infection, where the predominant microbiota could be implicated through the modulation of an inflammatory microenvironment. Other factors such as genital fluids and hormones could also play an essential role in HIV transmission. Here, we review the most recent evidence described for mucosal HIV-transmission contributing with the understanding of this phenomenon.
Collapse
Affiliation(s)
- Sandra M Gonzalez
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.,National HIV and Retrovirology Laboratory, JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, MB, Canada
| | | | - Ruey-Chyi Su
- National HIV and Retrovirology Laboratory, JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, MB, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Maria T Rugeles
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| |
Collapse
|
2
|
Anaya-Saavedra G, Ramirez-Amador V. Challenges in HIV-persistent viral replication regardless of potent antiretroviral therapy. Oral Dis 2016; 22:585-6. [PMID: 27009676 DOI: 10.1111/odi.12482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G Anaya-Saavedra
- Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, México City, Mexico
| | - V Ramirez-Amador
- Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, México City, Mexico
| |
Collapse
|
3
|
Vernon LT, Jayashantha P, Chidzonga MM, Komesu MC, Nair RG, Johnson NW. Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report. Oral Dis 2016; 22 Suppl 1:135-48. [PMID: 27109282 PMCID: PMC5986297 DOI: 10.1111/odi.12412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 12/23/2022]
Abstract
In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.
Collapse
Affiliation(s)
- L T Vernon
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Plp Jayashantha
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia and Dental Hospital, and Sri Lanka Air Force Station Colombo, Sri Lanka, Australia
| | - M M Chidzonga
- College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - M C Komesu
- Department of Morphology, Stomatology Physiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - R G Nair
- Oral Medicine, School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia and Cancer Services, Gold Coast University Hospital, Queensland Health, Qld, Autralia, Australia
| | - N W Johnson
- Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
| |
Collapse
|
4
|
Dillon SM, Lee EJ, Donovan AM, Guo K, Harper MS, Frank DN, McCarter MD, Santiago ML, Wilson CC. Enhancement of HIV-1 infection and intestinal CD4+ T cell depletion ex vivo by gut microbes altered during chronic HIV-1 infection. Retrovirology 2016; 13:5. [PMID: 26762145 PMCID: PMC4712466 DOI: 10.1186/s12977-016-0237-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/04/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Early HIV-1 infection is characterized by high levels of HIV-1 replication and substantial CD4 T cell depletion in the intestinal mucosa, intestinal epithelial barrier breakdown, and microbial translocation. HIV-1-induced disruption of intestinal homeostasis has also been associated with changes in the intestinal microbiome that are linked to mucosal and systemic immune activation. In this study, we investigated the impact of representative bacterial species that were altered in the colonic mucosa of viremic HIV-1 infected individuals (HIV-altered mucosal bacteria; HAMB) on intestinal CD4 T cell function, infection by HIV-1, and survival in vitro. Lamina propria (LP) mononuclear cells were infected with CCR5-tropic HIV-1BaL or mock infected, exposed to high (3 gram-negative) or low (2 gram-positive) abundance HAMB or control gram-negative Escherichia coli and levels of productive HIV-1 infection and CD4 T cell depletion assessed. HAMB-associated changes in LP CD4 T cell activation, proliferation and HIV-1 co-receptor expression were also evaluated. RESULTS The majority of HAMB increased HIV-1 infection and depletion of LP CD4 T cells, but gram-negative HAMB enhanced CD4 T cell infection to a greater degree than gram-positive HAMB. Most gram-negative HAMB enhanced T cell infection to levels similar to that induced by gram-negative E. coli despite lower induction of T cell activation and proliferation by HAMB. Both gram-negative HAMB and E. coli significantly increased expression of HIV-1 co-receptor CCR5 on LP CD4 T cells. Lipopolysaccharide, a gram-negative bacteria cell wall component, up-regulated CCR5 expression on LP CD4 T cells whereas gram-positive cell wall lipoteichoic acid did not. Upregulation of CCR5 by gram-negative HAMB was largely abrogated in CD4 T cell-enriched cultures suggesting an indirect mode of stimulation. CONCLUSIONS Gram-negative commensal bacteria that are altered in abundance in the colonic mucosa of HIV-1 infected individuals have the capacity to enhance CCR5-tropic HIV-1 productive infection and depletion of LP CD4 T cells in vitro. Enhanced infection appears to be primarily mediated indirectly through increased expression of CCR5 on LP CD4 T cells without concomitant large scale T cell activation. This represents a novel mechanism potentially linking intestinal dysbiosis to HIV-1 mucosal pathogenesis.
Collapse
Affiliation(s)
- Stephanie M Dillon
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Eric J Lee
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Andrew M Donovan
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Kejun Guo
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Michael S Harper
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Daniel N Frank
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,University of Colorado Microbiome Research Consortium, Aurora, CO, USA.
| | - Martin D McCarter
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Mario L Santiago
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Cara C Wilson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| |
Collapse
|
5
|
Patyka M, Malamud D, Weissman D, Abrams WR, Kurago Z. Periluminal Distribution of HIV-Binding Target Cells and Gp340 in the Oral, Cervical and Sigmoid/Rectal Mucosae: A Mapping Study. PLoS One 2015; 10:e0132942. [PMID: 26172445 PMCID: PMC4501766 DOI: 10.1371/journal.pone.0132942] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/21/2015] [Indexed: 12/01/2022] Open
Abstract
Studies have shown that the transmission of HIV is most likely to occur via rectal or vaginal routes, and rarely through oral exposure. However, the mechanisms of virus entry at mucosal surfaces remain incompletely understood. Prophylactic strategies against HIV infection may be attainable once gaps in current knowledge are filled. To address these gaps, we evaluated essentially normal epithelial surfaces and mapped the periluminal distribution of CD4+ HIV target cells, including T cells and antigen-presenting cells, and an HIV-binding molecule gp340 that can be expressed by epithelial cells in secreted and cell-associated forms. Immunohistochemistry for CD4, CD16, CD3, CD1a and gp340 in human oral, rectal/sigmoid and cervical mucosal samples from HIV-negative subjects demonstrated that periluminal HIV target cells were more prevalent at rectal/sigmoid and endocervical surfaces lined by simple columnar epithelium, than at oral and ectocervical surfaces covered by multilayered stratified squamous epithelium (p<0.001). gp340 expression patterns at these sites were also distinct and strong in oral minor salivary gland acini and ducts, including ductal saliva, in individual rectum/sigmoid and endocervix periluminar columnar cells, and in ectocervix squamous cells. Only weak expression was noted in the oral non-ductal squamous epithelium. We conclude that periluminal HIV target cells, together with periluminal epithelial cell-associated gp340 appear to be most accessible for HIV transmission at rectal/sigmoid and endocervical surfaces. Our data help define vulnerable structural features of mucosal sites exposed to HIV.
Collapse
Affiliation(s)
- Mariia Patyka
- Faculty of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Daniel Malamud
- NYU College of Dentistry, Department of Basic Sciences, HIV/AIDS Research Program (HARP), New York, New York, United States of America
- NYU School of Medicine, Infectious Disease, New York, New York, United States of America
| | - Drew Weissman
- Medicine (Infectious Disease), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - William R. Abrams
- NYU College of Dentistry, Department of Basic Sciences, HIV/AIDS Research Program (HARP), New York, New York, United States of America
| | - Zoya Kurago
- Oral Health and Diagnostic Sciences, College of Dental Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| |
Collapse
|
6
|
Pavan P, Pereira VT, Souza RC, Souza CO, Torres SR, Colombo APV, da Costa LJ, Sansone C, de Uzeda M, Gonçalves LS. Levels of HIV-1 in subgingival biofilm of HIV-infected patients. J Clin Periodontol 2014; 41:1061-8. [PMID: 25197037 DOI: 10.1111/jcpe.12306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 01/19/2023]
Abstract
AIM The aims of the current study were to compare the levels of HIV-1 in the subgingival biofilm (SHVL) between detectable and undetectable plasmatic HIV-1 viral load (PHVL) in HIV-infected patients as well as to determine the association of SHVL with PHVL and clinical periodontal parameters. MATERIAL AND METHODS Forty-one HIV-infected individuals were divided into two groups: detectable (21) and undetectable (20) PHVL. Subgingival biofilm samples were obtained for detection and quantification of HIV-1 by real-time RT-PCR. To estimate the effect of co-variables on the outcome undetectable SHVL, the Generalized Estimation Equation (GEE) was employed. RESULTS Detectable SHVL was observed only in the detectable PHVL group and the detection of the HIV-1 was observed in 40% of these individuals. In the bivariate analysis between co-variables from the individual level and the outcome SHVL, significant difference was observed only for the CD4+ T lymphocytes levels (p = 0.017). The multiple logistic model demonstrated that only CD4+ T lymphocytes levels had a significant effect on the outcome undetectable SHVL [OR 8.85 (CI 3.6-9.2), p = 0.002]. CONCLUSION HIV-1 can be detected and quantified in the subgingival biofilm of HIV-infected individuals, but these findings are not associated with PHVL and periodontal clinical parameters.
Collapse
Affiliation(s)
- Priscila Pavan
- Department of Dental Clinics, Division of Graduate Periodontics, School of Dentistry, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
HIV-1 impairs human retinal pigment epithelial barrier function: possible association with the pathogenesis of HIV-associated retinopathy. J Transl Med 2014; 94:777-87. [PMID: 24840331 DOI: 10.1038/labinvest.2014.72] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/09/2014] [Accepted: 04/14/2014] [Indexed: 01/28/2023] Open
Abstract
The breakdown of human retinal pigment epithelial (HRPE) barrier is considered as the etiology of retinopathy, which affects the quality of life of HIV/AIDS patients. Here we demonstrate that HIV-1 could directly impair HRPE barrier function, which leads to the translocation of HIV-1 and bacteria. HRPE cells (D407) were grown to form polarized, confluent monolayers and treated with different HIV-1 infectious clones. A significant increase of monolayer permeability, as measured by trans-epithelial electrical resistance (TEER) and apical-basolateral movements of sodium fluorescein, was observed. Disrupted tightness of HRPE barrier was associated with the downregulation of several tight junction proteins in D407 cells, including ZO-1, Occludin, Claudin-1, Claudin-2, Claudin-3, Claudin-4, and Claudin-5, after exposure to HIV-1, without affecting the viability of cells. HIV-1 gp120 was shown to participate in the alteration of barrier properties, as evidenced by decreased TEER and weakened expression of tight junction proteins in D407 monolayers after exposure to pseudotyped HIV-1, UV-inactivated HIV-1, and free gp120, but not to an envelope (Env)-defective mutant of HIV. Furthermore, exposure to HIV-1 particles could induce the release of pro-inflammatory cytokines in D407, including IL-6 and MCP-1, both of which downregulated the expression of ZO-1 in the HRPE barrier. Disrupted HRPE monolayer allowed translocation of HIV-1 and bacteria across the epithelium. Overall, these findings suggest that HIV-1 may exploit its Env glycoprotein to induce an inflammatory state in HRPE cells, which could result in impairment of HRPE monolayer integrity, allowing virus and bacteria existing in ocular fluids to cross the epithelium and penetrate the HRPE barrier. Our study highlights the role of HIV-1 in the pathogenesis of HIV/AIDS-related retinopathy and suggests potential therapeutic targets for this ocular complication.
Collapse
|
8
|
Dietrich EA, Gebhard KH, Fasching CE, Giacaman RA, Kappes JC, Ross KF, Herzberg MC. Short communication: HIV type 1 escapes inactivation by saliva via rapid escape into oral epithelial cells. AIDS Res Hum Retroviruses 2012; 28:1574-8. [PMID: 22077822 DOI: 10.1089/aid.2011.0069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Saliva contains anti-HIV-1 factors, which show unclear efficacy in thwarting mucosal infection. When incubated in fresh, unfractionated whole saliva, infectious HIV-1 IIIb and BaL (X4- and R5-tropic, respectively) persisted from 4 to at least 30 min in a saliva concentration-dependent manner. In salivary supernatant for up to 6 h, both infectious HIV-1 strains "escaped" into immortalized oral epithelial cells; infectious BaL showed selectively enhanced escape in the presence of saliva. Fluorescently labeled HIV-1 virus-like particles entered oral epithelial cells within minutes of exposure. Using a previously unrecognized mechanism, therefore, strains of HIV-1 escape inactivation by saliva via rapid uptake into oral epithelial cells.
Collapse
Affiliation(s)
- Elizabeth A. Dietrich
- University of Minnesota School of Dentistry, Minneapolis, Minnesota
- The Mucosal and Vaccine Research Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Kristin H. Gebhard
- University of Minnesota School of Dentistry, Minneapolis, Minnesota
- The Mucosal and Vaccine Research Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Claudine E. Fasching
- The Mucosal and Vaccine Research Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Rodrigo A. Giacaman
- University of Minnesota School of Dentistry, Minneapolis, Minnesota
- The Mucosal and Vaccine Research Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - John C. Kappes
- Departments of Medicine, Microbiology, and Pathology, University of Alabama at Birmingham, Birmingham, Alabama
- Birmingham Veterans Affairs Medical Center, Research Service, Birmingham, Alabama 352335
| | - Karen F. Ross
- University of Minnesota School of Dentistry, Minneapolis, Minnesota
- The Mucosal and Vaccine Research Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Mark C. Herzberg
- University of Minnesota School of Dentistry, Minneapolis, Minnesota
- The Mucosal and Vaccine Research Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| |
Collapse
|
9
|
Salivary basic proline-rich proteins are elevated in HIV-exposed seronegative men who have sex with men. AIDS 2012; 26:1857-67. [PMID: 22824632 DOI: 10.1097/qad.0b013e328357f79c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Innate mucosal factors are associated with protection in HIV-exposed seronegative (HESN) individuals, but studies of MSM have been very limited. We performed proteomic analysis of saliva from a cohort of HESN MSM who have regular unprotected oral receptive intercourse with their HIV-infected partner. METHODS Saliva samples from HESN (n = 25) and non-exposed male controls (n = 22) were analyzed by 2D-LC mass spectrometry. An overexpressed innate protein factor was further characterized by immunoblot, and compared with CC-chemokine expression, HIV-neutralizing activity, clinical factors, and sexual behavior. RESULTS Of 337 total proteins, seven were identified as differentially abundant in the HESN group. The five overabundant proteins (Basic salivary proline-rich proteins (bPRP) 2 and 3, Histatin-3, Lysozyme C, and SLPI) have known antimicrobial activity. bPRP2 showed the highest overabundance (>six-fold) in HESN individuals compared with controls (P = 0.009), including multiple isoforms. Salivary bPRP2 correlated with CC-chemokine levels in HESN individuals including RANTES (P = 0.02), MIP-1-alpha (P = 0.01), MIP-1-beta (P = 0.0002), MCP-1 (P = 0.005) and Eotaxin (P = 0.003) but not with frequency of HIV neutralizing activity, oral sexual practices, or viral load of the sexual partner. CONCLUSION This study identifies salivary bPRP2 as a novel soluble factor elevated in the oral compartment of HIV-exposed MSM.
Collapse
|
10
|
Tebit DM, Ndembi N, Weinberg A, Quiñones-Mateu ME. Mucosal transmission of human immunodeficiency virus. Curr HIV Res 2012; 10:3-8. [PMID: 22264040 PMCID: PMC3744389 DOI: 10.2174/157016212799304689] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 10/01/2011] [Accepted: 11/11/2011] [Indexed: 02/07/2023]
Abstract
Since the beginning of the AIDS pandemic, and following the discovery of the human immunodeficiency virus (HIV) as the etiological agent of the disease, it was clear that the virus gains access to the human host predominantly through the mucosal tissue after sexual exposure. As a consequence, the female genital tract (vaginal and cervical), as well as the rectal, penile, and oral mucosae have been extensively studied over the last thirty years towards a better understanding of--and to develop strategies to prevent--sexual HIV transmission. This review seeks to describe the biology of the events leading to HIV infection through the human mucosa and introduce some of the approaches attempted to prevent the sexual transmission of HIV.
Collapse
Affiliation(s)
- Denis M. Tebit
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Aaron Weinberg
- School of Medicine, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | | |
Collapse
|
11
|
Affiliation(s)
- M. Coogan
- Division of Oral Microbiology, University of the Witwatersrand, Johannesburg, South Africa
| | - S. Challacombe
- Department of Oral Medicine, Kings College London Dental Institute, London, United Kingdom
| |
Collapse
|