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Henrich TJ, Schreiner C, Cameron C, Hogan LE, Richardson B, Rutishauser RL, Deitchman AN, Chu S, Rogers R, Thanh C, Gibson EA, Zarinsefat A, Bakkour S, Aweeka F, Busch MP, Liegler T, Baker C, Milush J, Deeks SG, Stock PG. Everolimus, an mTORC1/2 inhibitor, in ART-suppressed individuals who received solid organ transplantation: A prospective study. Am J Transplant 2021; 21:1765-1779. [PMID: 32780519 PMCID: PMC9177122 DOI: 10.1111/ajt.16244] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/30/2020] [Accepted: 07/19/2020] [Indexed: 01/25/2023]
Abstract
Pharmacologic inhibition of the mammalian target of rapamycin (mTOR) in the setting of renal transplantation has previously been associated with lower human immunodeficiency virus 1 (HIV-1) DNA burden, and in vitro studies suggest that mTOR inhibition may lead to HIV transcriptional silencing. Because prospective clinical trials are lacking, we conducted an open-label, single-arm study to determine the impact of the broad mTOR inhibitor, everolimus, on residual HIV burden, transcriptional gene expression profiles, and immune responses in HIV-infected adult solid organ transplant (SOT) recipients on antiretroviral therapy. Whereas everolimus therapy did not have an overall effect on cell-associated HIV-1 DNA and RNA levels in the entire cohort, participants who maintained everolimus time-averaged trough levels >5 ng/mL during the first 2 months of therapy had significantly lower RNA levels up to 6 months after the cessation of study drug. Time-averaged everolimus trough levels significantly correlated with greater inhibition of mTOR gene pathway transcriptional activity. Everolimus treatment also led to decreased PD-1 expression on certain T cell subsets. These data support the rationale for further study of the effects of mTOR inhibition on HIV transcriptional silencing in non-SOT populations, either alone or in combination with other strategies. Trial Registration: ClinicalTrials.gov NCT02429869.
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Affiliation(s)
- Timothy J. Henrich
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Corinna Schreiner
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA,Institute of Biochemistry and Molecular Biology, Ulm University, Germany
| | - Cheryl Cameron
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - Louise E. Hogan
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Brian Richardson
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - Rachel L. Rutishauser
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Amelia N. Deitchman
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA
| | - Simon Chu
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Rodney Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Cassandra Thanh
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erica A. Gibson
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Arya Zarinsefat
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Francesca Aweeka
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA
| | | | - Teri Liegler
- Division of HIV, Infectious Diseases & Global Medicine, University of California San Francisco, San Francisco, CA
| | - Christopher Baker
- Division of HIV, Infectious Diseases & Global Medicine, University of California San Francisco, San Francisco, CA
| | - Jeffrey Milush
- Division of HIV, Infectious Diseases & Global Medicine, University of California San Francisco, San Francisco, CA
| | - Steven G. Deeks
- Division of HIV, Infectious Diseases & Global Medicine, University of California San Francisco, San Francisco, CA
| | - Peter G. Stock
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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2
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Peluso MJ, Thanh C, Prator CA, Hogan LE, Arechiga VM, Stephenson S, Norris PJ, Di Germanio C, Fuchs D, Zetterberg H, Deeks SG, Gisslén M, Price RW, Henrich TJ. Cerebrospinal fluid soluble CD30 elevation despite suppressive antiretroviral therapy in individuals living with HIV-1. J Virus Erad 2020; 6:19-26. [PMID: 32175087 PMCID: PMC7043898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess soluble CD30 (sCD30), a protein that colocalises with HIV-1 RNA and DNA in lymphoid cells and tissues, in cerebrospinal fluid (CSF) as a marker of HIV-1 infection in the central nervous system (CNS). METHODS This was a cross-sectional study using archived samples from two clinical cohorts. Soluble CD30 concentrations were measured in paired CSF and plasma from untreated viraemic individuals (n=52), individuals on suppressive antiretroviral therapy (ART) (n=33), HIV-1 controllers (n=10), participants with CSF HIV-1 'escape' (n=11) and controls without HIV-1 infection (n=16). Nonparametric tests were used to compare levels across groups and evaluate correlations with HIV-1 RNA, CSF neurofilament light chain protein (NFL) and neopterin. RESULTS Compared with controls (median 30 ng/mL, interquartile range [IRQ] 23-50), plasma sCD30 levels were elevated in viraemic participants (75 ng/mL, 52-116; P<0.001), but not in those on suppressive ART (38 ng/mL, 32-62). In contrast, CSF sCD30 levels were elevated in ART-suppressed individuals (34 ng/mL, 19-46; P=0.001) and in those with CSF 'escape' (33 ng/mL, 27-40; P=0.004) compared with controls (18 ng/mL, 11-23), but not in untreated viraemic individuals. No association was observed between CSF sCD30 and plasma HIV-1 RNA, concurrent or nadir CD4+ T cell count, duration of infection or plasma sCD30. CSF sCD30 correlated with CSF NFL (r=0.34, P=0.001). CONCLUSIONS In contrast to plasma, sCD30 levels are elevated in the CSF of individuals with HIV-1 infection who are on suppressive ART. Elevated levels of sCD30 in the CSF may be an indicator of persistent CNS HIV-1 infection, although the mechanism underlying this elevation warrants further investigation.
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Affiliation(s)
- Michael J Peluso
- Division of HIV,
Infectious Diseases, and Global Medicine,
Zuckerberg San Francisco General Hospital,
University of California San Francisco,
San Francisco,
USA,Corresponding author: Michael Peluso, MD
1001 Potrero Ave. Building 3,
San Francisco,
CA94110
| | - Cassandra Thanh
- Division of Experimental Medicine,
University of California San Francisco,
San Francisco,
USA
| | - Cecilia A Prator
- Division of Experimental Medicine,
University of California San Francisco,
San Francisco,
USA
| | - Louise E Hogan
- Division of Experimental Medicine,
University of California San Francisco,
San Francisco,
USA
| | - Victor M Arechiga
- Department of Neurology,
University of California San Francisco,
San Francisco,
USA
| | - Sophie Stephenson
- Department of Neurology,
University of California San Francisco,
San Francisco,
USA
| | | | | | - Dietmar Fuchs
- Division of Biological Chemistry,
Innsbruck Medical University,
Innsbruck,
Austria
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry,
Institute for Neuroscience and Physiology,
University of Gothenburg,
Gothenburg,
Sweden
| | - Steven G Deeks
- Division of HIV,
Infectious Diseases, and Global Medicine,
Zuckerberg San Francisco General Hospital,
University of California San Francisco,
San Francisco,
USA
| | - Magnus Gisslén
- Department of Infectious Diseases,
Institute of Biomedicine, Sahlgrenska Academy,
University of Gothenburg,
Gothenburg,
Sweden,Region Västra Götaland,
Sahlgrenska University Hospital,
Department of Infectious Diseases,
Gothenburg,
Sweden
| | - Richard W Price
- Department of Neurology,
University of California San Francisco,
San Francisco,
USA
| | - Timothy J Henrich
- Division of Experimental Medicine,
University of California San Francisco,
San Francisco,
USA
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3
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Peluso MJ, Thanh C, Prator CA, Hogan LE, Arechiga VM, Stephenson S, Norris PJ, Di Germanio C, Fuchs D, Zetterberg H, Deeks SG, Gisslén M, Price RW, Henrich TJ. Cerebrospinal fluid soluble CD30 elevation despite suppressive antiretroviral therapy in individuals living with HIV-1. J Virus Erad 2020. [DOI: 10.1016/s2055-6640(20)30006-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Morley D, Lambert JS, Hogan LE, De Gascun C, Redmond N, Rutishauser RL, Thanh C, Gibson EA, Hobbs K, Bakkour S, Busch MP, Farrell J, McGetrick P, Henrich TJ. Correction to: Rapid development of HIV elite control in a patient with acute infection. BMC Infect Dis 2019; 19:877. [PMID: 31640575 PMCID: PMC6805619 DOI: 10.1186/s12879-019-4485-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Deirdre Morley
- Mater Misericordae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - John S Lambert
- Mater Misericordae University Hospital, Eccles Street, Dublin 7, Ireland.,University College Dublin School of Medicine, Dublin, Ireland
| | - Louise E Hogan
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Cillian De Gascun
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | | | - Rachel L Rutishauser
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Cassandra Thanh
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Erica A Gibson
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Kristen Hobbs
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Sonia Bakkour
- Vitalant Research Institute, 270 Masonic Ave, San Francisco, CA, 94118, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Michael P Busch
- Vitalant Research Institute, 270 Masonic Ave, San Francisco, CA, 94118, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Jeremy Farrell
- Mater Misericordae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Padraig McGetrick
- Mater Misericordae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Timothy J Henrich
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
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5
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Morley D, Lambert JS, Hogan LE, De Gascun C, Redmond N, Rutishauser RL, Thanh C, Gibson EA, Hobbs K, Bakkour S, Busch MP, Farrell J, McGetrick P, Henrich TJ. Rapid development of HIV elite control in a patient with acute infection. BMC Infect Dis 2019; 19:815. [PMID: 31533639 PMCID: PMC6749690 DOI: 10.1186/s12879-019-4374-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background Elite controllers (EC), a small subset of the HIV-positive population (< 1%), suppress HIV viremia below the limit of quantification of clinical viral load assays in the absence of antiretroviral therapy (ART). However, there is a paucity of longitudinal data detailing the viral and immune dynamics or HIV reservoir seeding during acute infection in individuals that go on to become Elite Controllers. Case presentation In this report, we describe a case of a 42 year old woman diagnosed during acute infection who rapidly and permanently suppressed her viremia in the absence of antiretroviral therapy (ART). Rapid antibody/antigen testing was either negative or equivocal during acute infection, despite subsequent viral load testing at that time point with 71,550 plasma HIV RNA copies/mL, making initial diagnosis challenging. The patient subsequently developed detectable anti-HIV antibodies and an increase in HIV-specific CD8+ T cell responses to overlapping subtype C HIV gag peptide; very low-level plasma viremia (0.84 RNA copies/mL) was detected by an ultrasensitive assay 2 years following infection. Subsequently, she was started on ART for multifocal furunculosis despite continued suppression of virus and stable CD4+ T cell counts. Following ART initiation, HIV specific antibody levels and CD8+ T cell responses increased, but no HIV DNA or RNA was able to be isolated from large numbers of peripheral blood CD4+ T cells. Conclusion This case provides important information regarding the establishment of elite HIV control during acute infection and also demonstrates an increase in HIV-specific immune responses following ART despite undetectable peripheral blood cellular measures of HIV persistence. This case also highlights the challenges in diagnosing acute HIV infection without the use of viral load testing in this rare elite controller phenotype.
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Affiliation(s)
- Deirdre Morley
- Mater Misericordae University Hospital, Eccles Street, Dublin, 7, Ireland.
| | - John S Lambert
- Mater Misericordae University Hospital, Eccles Street, Dublin, 7, Ireland.,University College Dublin School of Medicine, Dublin, Ireland
| | - Louise E Hogan
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Cillian De Gascun
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | | | - Rachel L Rutishauser
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Cassandra Thanh
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Erica A Gibson
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Kristen Hobbs
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
| | - Sonia Bakkour
- Vitalant Research Institute, 270 Masonic Ave, San Francisco, CA, 94118, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Michael P Busch
- Vitalant Research Institute, 270 Masonic Ave, San Francisco, CA, 94118, USA.,Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Jeremy Farrell
- Mater Misericordae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Padraig McGetrick
- Mater Misericordae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Timothy J Henrich
- Department of Medicine, University of California San Francisco Division of Experimental Medicine, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
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6
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Vásquez JJ, Aguilar-Rodriguez BL, Rodriguez L, Hogan LE, Somsouk M, McCune JM, Deeks SG, Laszik ZG, Hunt PW, Henrich TJ. CD32-RNA Co-localizes with HIV-RNA in CD3+ Cells Found within Gut Tissues from Viremic and ART-Suppressed Individuals. Pathog Immun 2019; 4:147-160. [PMID: 31139759 PMCID: PMC6508427 DOI: 10.20411/pai.v4i1.271] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/08/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Identifying biomarkers for cells harboring replication-competent HIV is a major research priority. Recently, there have been mixed reports addressing the possibility that CD32-expressing T cells are enriched for HIV. There is growing evidence that CD32 expression increases with cellular activation that may be related to, but not necessarily specific for, infection with HIV. However, the relationship of CD32 expression to HIV-infection in subtypes of tissue-resident leukocytes is unclear. METHODS First, we used duplex chromogenic in situ hybridization to identify cells actively transcribing RNA for both CD32 and HIV on human gut tissues. Then we performed multiplexed immunofluorescence and in situ hybridization (mIFISH) on sections from the same tissues to determine the phenotype of individual cells co-expressing HIV-RNA and CD32-RNA. RESULTS HIV-RNA+ cells were more abundant in tissues from viremic individuals than in those receiving suppressive anti-retroviral therapy (ART). However, staining by both methods indicated that a higher proportion of HIV-RNA+ cells co-expressed CD32-RNA in ART-suppressed individuals than in those with viremia. The majority of HIV-RNA+ cells were CD3+. CONCLUSIONS Our data suggest that the transcription of CD32-RNA is correlated with HIV transcriptional activity in CD3+ cells found within human gut tissue. Whether or not up-regulation of CD32-RNA is a direct result of HIV transcription or more global T-cell activation remains unclear.
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Affiliation(s)
- Joshua J. Vásquez
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco, Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, Department of Medicine, Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco
| | | | - Leonardo Rodriguez
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco
| | - Louise E. Hogan
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco
| | - Ma Somsouk
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco, Department of Medicine, Division of Gastroenterology, University of California, San Francisco
| | - Joseph M. McCune
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco
| | - Steven G. Deeks
- Department of Medicine, Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco
| | - Zoltan G. Laszik
- Department of Pathology, University of California, San Francisco
| | - Peter W. Hunt
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco, Department of Medicine, Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, These two authors contributed equally to this work
| | - Timothy J. Henrich
- Department of Medicine, Division of Experimental Medicine, University of California, San Francisco, Department of Medicine, Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, These two authors contributed equally to this work
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7
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Vasquez JJ, Hussien R, Aguilar-Rodriguez B, Junger H, Dobi D, Henrich TJ, Thanh C, Gibson E, Hogan LE, McCune J, Hunt PW, Stoddart CA, Laszik ZG. Elucidating the Burden of HIV in Tissues Using Multiplexed Immunofluorescence and In Situ Hybridization: Methods for the Single-Cell Phenotypic Characterization of Cells Harboring HIV In Situ. J Histochem Cytochem 2018; 66:427-446. [PMID: 29462571 PMCID: PMC5977441 DOI: 10.1369/0022155418756848] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022] Open
Abstract
Persistent tissue reservoirs of HIV present a major barrier to cure. Defining subsets of infected cells in tissues is a major focus of HIV cure research. Herein, we describe a novel multiplexed in situ hybridization (ISH) (RNAscope) protocol to detect HIV-DNA (vDNA) and HIV-RNA (vRNA) in formalin-fixed paraffin-embedded (FFPE) human tissues in combination with immunofluorescence (IF) phenotyping of the infected cells. We show that multiplexed IF and ISH (mIFISH) is suitable for quantitative assessment of HIV vRNA and vDNA and that multiparameter IF phenotyping allows precise identification of the cellular source of the ISH signal. We also provide semi-quantitative data on the impact of various tissue fixatives on the detectability of vDNA and vRNA with RNAscope technology. Finally, we describe methods to quantitate the ISH signal on whole-slide digital images and validation of the quantitative ISH data with quantitative real-time PCR for vRNA. It is our hope that this approach will provide insight into the biology of HIV tissue reservoirs and to inform strategies aimed at curing HIV.
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Affiliation(s)
- Joshua J. Vasquez
- Division of Experimental Medicine, Department of
Medicine, University of California, San Francisco, CA, USA
- Division of Pulmonary, Critical Care, Allergy,
and Sleep Medicine, Department of Medicine, University of California, San
Francisco, CA, USA
| | - Rajaa Hussien
- Division of Experimental Medicine, Department of
Medicine, University of California, San Francisco, CA, USA
| | - Brandon Aguilar-Rodriguez
- Division of Experimental Medicine, Department of
Medicine, University of California, San Francisco, CA, USA
| | - Henrik Junger
- Department of Pathology, University of
California, San Francisco, CA, USA
| | - Dejan Dobi
- Department of Pathology, University of
California, San Francisco, CA, USA
| | - Timothy J. Henrich
- Division of Experimental Medicine, Department of
Medicine, University of California, San Francisco, CA, USA
- Division of HIV/AIDS, Department of Medicine,
University of California, San Francisco, CA, USA
- Division of Infectious Diseases, Department of
Medicine, University of California, San Francisco, CA, USA
| | - Cassandra Thanh
- Division of Experimental Medicine, Department
of Medicine, University of California, San Francisco, CA, USA
| | - Erica Gibson
- Division of Experimental Medicine, Department
of Medicine, University of California, San Francisco, CA, USA
| | - Louise E. Hogan
- Division of Experimental Medicine, Department
of Medicine, University of California, San Francisco, CA, USA
| | - Joseph McCune
- Division of Experimental Medicine, Department
of Medicine, University of California, San Francisco, CA, USA
| | - Peter W. Hunt
- Division of Experimental Medicine, Department
of Medicine, University of California, San Francisco, CA, USA
- Division of HIV/AIDS, Department of Medicine,
University of California, San Francisco, CA, USA
- Division of Infectious Diseases, Department of
Medicine, University of California, San Francisco, CA, USA
| | - Cheryl A. Stoddart
- Division of Experimental Medicine, Department
of Medicine, University of California, San Francisco, CA, USA
| | - Zoltan G. Laszik
- Department of Pathology, University of
California, San Francisco, CA, USA
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8
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Hogan LE, Vasquez J, Hobbs KS, Hanhauser E, Aguilar-Rodriguez B, Hussien R, Thanh C, Gibson EA, Carvidi AB, Smith LCB, Khan S, Trapecar M, Sanjabi S, Somsouk M, Stoddart CA, Kuritzkes DR, Deeks SG, Henrich TJ. Increased HIV-1 transcriptional activity and infectious burden in peripheral blood and gut-associated CD4+ T cells expressing CD30. PLoS Pathog 2018; 14:e1006856. [PMID: 29470552 PMCID: PMC5823470 DOI: 10.1371/journal.ppat.1006856] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/05/2018] [Indexed: 12/11/2022] Open
Abstract
HIV-1-infected cells persist indefinitely despite the use of combination antiretroviral therapy (ART), and novel therapeutic strategies to target and purge residual infected cells in individuals on ART are urgently needed. Here, we demonstrate that CD4+ T cell-associated HIV-1 RNA is often highly enriched in cells expressing CD30, and that cells expressing this marker considerably contribute to the total pool of transcriptionally active CD4+ lymphocytes in individuals on suppressive ART. Using in situ RNA hybridization studies, we show co-localization of CD30 with HIV-1 transcriptional activity in gut-associated lymphoid tissues. We also demonstrate that ex vivo treatment with brentuximab vedotin, an antibody-drug conjugate (ADC) that targets CD30, significantly reduces the total amount of HIV-1 DNA in peripheral blood mononuclear cells obtained from infected, ART-suppressed individuals. Finally, we observed that an HIV-1-infected individual, who received repeated brentuximab vedotin infusions for lymphoma, had no detectable virus in peripheral blood mononuclear cells. Overall, CD30 may be a marker of residual, transcriptionally active HIV-1 infected cells in the setting of suppressive ART. Given that CD30 is only expressed on a small number of total mononuclear cells, it is a potential therapeutic target of persistent HIV-1 infection. Previous studies have shown that higher levels of soluble CD30 are associated with HIV-1 disease progression. Many of these studies, however, were performed prior to the implementation of combination ART, and the relationship between surface CD30 expression, soluble CD30 and HIV-1 infection in ART suppressed individuals, or those with viremic control off ART, is not known. We demonstrate that cell-associated HIV-1 RNA is highly enriched in CD4+ T cells expressing CD30, a member of the tumor necrosis factor receptor superfamily. These findings were observed in several HIV-1 infected donor groups, regardless of whether or not the participants were receiving suppressive ART. Furthermore, we demonstrate that ex vivo treatment with brentuximab vedotin, an antibody-drug conjugate that targets CD30, reduces the total amount of HIV-1 DNA in PBMC obtained from infected individuals. Finally, we show through in situ RNA hybridization studies that CD30 and HIV transcriptional activity co-localize in cells from gut biopsies obtained from HIV-1 infected donors. These data suggest that CD30 may be a marker of residual, transcriptionally active HIV-1 infected cells in the setting of suppressive ART.
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Affiliation(s)
- Louise E. Hogan
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail: (LEH); (TJH)
| | - Joshua Vasquez
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Kristen S. Hobbs
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Emily Hanhauser
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Brandon Aguilar-Rodriguez
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Rajaa Hussien
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Cassandra Thanh
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Erica A. Gibson
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Alexander B. Carvidi
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Louis C. B. Smith
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Shahzada Khan
- Virology and Immunology, Gladstone Institutes, San Francisco, California, United States of America
| | - Martin Trapecar
- Virology and Immunology, Gladstone Institutes, San Francisco, California, United States of America
| | - Shomyseh Sanjabi
- Virology and Immunology, Gladstone Institutes, San Francisco, California, United States of America
- Department of Microbiology and Immunology, University of California San Francisco, San Francisco, California, United States of America
| | - Ma Somsouk
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Cheryl A. Stoddart
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Daniel R. Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Steven G. Deeks
- Positive Health Program, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Timothy J. Henrich
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail: (LEH); (TJH)
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Henrich TJ, Hatano H, Bacon O, Hogan LE, Rutishauser R, Hill A, Kearney MF, Anderson EM, Buchbinder SP, Cohen SE, Abdel-Mohsen M, Pohlmeyer CW, Fromentin R, Hoh R, Liu AY, McCune JM, Spindler J, Metcalf-Pate K, Hobbs KS, Thanh C, Gibson EA, Kuritzkes DR, Siliciano RF, Price RW, Richman DD, Chomont N, Siliciano JD, Mellors JW, Yukl SA, Blankson JN, Liegler T, Deeks SG. HIV-1 persistence following extremely early initiation of antiretroviral therapy (ART) during acute HIV-1 infection: An observational study. PLoS Med 2017; 14:e1002417. [PMID: 29112956 PMCID: PMC5675377 DOI: 10.1371/journal.pmed.1002417] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/29/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND It is unknown if extremely early initiation of antiretroviral therapy (ART) may lead to long-term ART-free HIV remission or cure. As a result, we studied 2 individuals recruited from a pre-exposure prophylaxis (PrEP) program who started prophylactic ART an estimated 10 days (Participant A; 54-year-old male) and 12 days (Participant B; 31-year-old male) after infection with peak plasma HIV RNA of 220 copies/mL and 3,343 copies/mL, respectively. Extensive testing of blood and tissue for HIV persistence was performed, and PrEP Participant A underwent analytical treatment interruption (ATI) following 32 weeks of continuous ART. METHODS AND FINDINGS Colorectal and lymph node tissues, bone marrow, cerebral spinal fluid (CSF), plasma, and very large numbers of peripheral blood mononuclear cells (PBMCs) were obtained longitudinally from both participants and were studied for HIV persistence in several laboratories using molecular and culture-based detection methods, including a murine viral outgrowth assay (mVOA). Both participants initiated PrEP with tenofovir/emtricitabine during very early Fiebig stage I (detectable plasma HIV-1 RNA, antibody negative) followed by 4-drug ART intensification. Following peak viral loads, both participants experienced full suppression of HIV-1 plasma viremia. Over the following 2 years, no further HIV could be detected in blood or tissue from PrEP Participant A despite extensive sampling from ileum, rectum, lymph nodes, bone marrow, CSF, circulating CD4+ T cell subsets, and plasma. No HIV was detected from tissues obtained from PrEP Participant B, but low-level HIV RNA or DNA was intermittently detected from various CD4+ T cell subsets. Over 500 million CD4+ T cells were assayed from both participants in a humanized mouse outgrowth assay. Three of 8 mice infused with CD4+ T cells from PrEP Participant B developed viremia (50 million input cells/surviving mouse), but only 1 of 10 mice infused with CD4+ T cells from PrEP Participant A (53 million input cells/mouse) experienced very low level viremia (201 copies/mL); sequence confirmation was unsuccessful. PrEP Participant A stopped ART and remained aviremic for 7.4 months, rebounding with HIV RNA of 36 copies/mL that rose to 59,805 copies/mL 6 days later. ART was restarted promptly. Rebound plasma HIV sequences were identical to those obtained during acute infection by single-genome sequencing. Mathematical modeling predicted that the latent reservoir size was approximately 200 cells prior to ATI and that only around 1% of individuals with a similar HIV burden may achieve lifelong ART-free remission. Furthermore, we observed that lymphocytes expressing the tumor marker CD30 increased in frequency weeks to months prior to detectable HIV-1 RNA in plasma. This study was limited by the small sample size, which was a result of the rarity of individuals presenting during hyperacute infection. CONCLUSIONS We report HIV relapse despite initiation of ART at one of the earliest stages of acute HIV infection possible. Near complete or complete loss of detectable HIV in blood and tissues did not lead to indefinite ART-free HIV remission. However, the small numbers of latently infected cells in individuals treated during hyperacute infection may be associated with prolonged ART-free remission.
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Affiliation(s)
- Timothy J. Henrich
- Division of Experimental Medicine, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Hiroyu Hatano
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
| | - Oliver Bacon
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Louise E. Hogan
- Division of Experimental Medicine, University of California, San Francisco, California, United States of America
| | - Rachel Rutishauser
- Division of Experimental Medicine, University of California, San Francisco, California, United States of America
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
| | - Alison Hill
- Program for Evolutionary Dynamics, Harvard University, Cambridge, Massachusetts, United States of America
| | - Mary F. Kearney
- HIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
| | - Elizabeth M. Anderson
- HIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
| | - Susan P. Buchbinder
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Stephanie E. Cohen
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Mohamed Abdel-Mohsen
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
- The Wistar Institute, Philadelphia, Pennsylvania, United States of America
| | - Christopher W. Pohlmeyer
- Center for AIDS Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Remi Fromentin
- Centre de Recherche du CHUM and Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
| | - Albert Y. Liu
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Joseph M. McCune
- Division of Experimental Medicine, University of California, San Francisco, California, United States of America
| | - Jonathan Spindler
- HIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
| | - Kelly Metcalf-Pate
- Center for AIDS Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Kristen S. Hobbs
- Division of Experimental Medicine, University of California, San Francisco, California, United States of America
| | - Cassandra Thanh
- Division of Experimental Medicine, University of California, San Francisco, California, United States of America
| | - Erica A. Gibson
- Division of Experimental Medicine, University of California, San Francisco, California, United States of America
| | - Daniel R. Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robert F. Siliciano
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Howard Hughes Medical Institute, Baltimore, Maryland, United States of America
| | - Richard W. Price
- Department of Neurology, University of California, San Francisco, California, United States of America
| | - Douglas D. Richman
- University of California San Diego, La Jolla, California, United States of America
- Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - Nicolas Chomont
- Centre de Recherche du CHUM and Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | | | - John W. Mellors
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Steven A. Yukl
- San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
- University of California, San Francisco, California, Unites States of America
| | - Joel N. Blankson
- Center for AIDS Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Teri Liegler
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
| | - Steven G. Deeks
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, United States of America
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Henrich TJ, Hobbs KS, Hanhauser E, Scully E, Hogan LE, Robles YP, Leadabrand KS, Marty FM, Palmer CD, Jost S, Körner C, Li JZ, Gandhi RT, Hamdan A, Abramson J, LaCasce AS, Kuritzkes DR. Human Immunodeficiency Virus Type 1 Persistence Following Systemic Chemotherapy for Malignancy. J Infect Dis 2017; 216:254-262. [PMID: 28838149 DOI: 10.1093/infdis/jix265] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Systemic chemotherapies for various malignancies have been shown to significantly, yet transiently, decrease numbers of CD4+ T lymphocytes, a major reservoir for human immunodeficiency virus type 1 (HIV-1) infection. However, little is known about the impact of cytoreductive chemotherapy on HIV-1 reservoir dynamics, persistence, and immune responses. Methods We investigated the changes in peripheral CD4+ T-cell-associated HIV-1 DNA and RNA levels, lymphocyte activation, viral population structure, and virus-specific immune responses in a longitudinal cohort of 15 HIV-1-infected individuals receiving systemic chemotherapy or subsequent autologous stem cell transplantation for treatment of hematological malignancies and solid tumors. Results Despite a transient reduction in CD4+ T cells capable of harboring HIV-1, a 1.7- and 3.3-fold increase in mean CD4+ T-cell-associated HIV-1 RNA and DNA, respectively, were observed months following completion of chemotherapy in individuals on antiretroviral therapy. We also observed changes in CD4+ T-cell population diversity and clonal viral sequence expansion during CD4+ T-cell reconstitution following chemotherapy cessation. Finally, HIV-1 DNA was preferentially, and in some cases exclusively, detected in cytomegalovirus (CMV)- and Epstein-Barr virus (EBV)-responsive CD4+ T cells following chemotherapy. Conclusions Expansion of HIV-infected CMV/EBV-specific CD4 + T cells may contribute to maintenance of the HIV DNA reservoir following chemotherapy.
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Affiliation(s)
- Timothy J Henrich
- Division of Experimental Medicine, University of California, San Francisco.,Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School
| | - Kristen S Hobbs
- Division of Experimental Medicine, University of California, San Francisco.,Division of Infectious Diseases, Brigham and Women's Hospital
| | - Emily Hanhauser
- Division of Experimental Medicine, University of California, San Francisco.,Division of Infectious Diseases, Brigham and Women's Hospital
| | - Eileen Scully
- Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School.,Dana-Farber Cancer Institute, Boston
| | - Louise E Hogan
- Division of Experimental Medicine, University of California, San Francisco.,Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School
| | - Yvonne P Robles
- Division of Infectious Diseases, Brigham and Women's Hospital
| | | | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School.,Dana-Farber Cancer Institute, Boston
| | - Christine D Palmer
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge
| | - Stephanie Jost
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge.,Beth Israel Deaconess Medical Center
| | - Christian Körner
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge
| | - Jonathan Z Li
- Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School
| | - Rajesh T Gandhi
- Harvard Medical School.,Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge.,Massachusetts General Hospital, Boston
| | - Ayad Hamdan
- Harvard Medical School.,Beth Israel Deaconess Medical Center
| | - Jeremy Abramson
- Harvard Medical School.,Massachusetts General Hospital, Boston
| | - Ann S LaCasce
- Harvard Medical School.,Dana-Farber Cancer Institute, Boston
| | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School
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Hogan LE, Jones DC, Allen RL. Expression of the innate immune receptor LILRB5 on monocytes is associated with mycobacteria exposure. Sci Rep 2016; 6:21780. [PMID: 26908331 PMCID: PMC4764857 DOI: 10.1038/srep21780] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/01/2016] [Indexed: 12/12/2022] Open
Abstract
Antigen presenting cells (APC) are critical components of innate immunity and consequently shape the adaptive response. Leukocyte Ig Like Receptors (LILR) are innate immune receptors predominantly expressed on myeloid cells. LILR can influence the antigen presenting phenotype of monocytic cells to determine the nature of T cell responses in infections including Mycobaterium leprae. We therefore investigated the relevance of LILR in the context of Mycobacterium tuberculosis. Real-time PCR studies indicated that the transcriptional profile of the orphan receptor LILRB5 was significantly up-regulated following exposure to mycobacteria. Furthermore, LILRA1 and LILRB5 were able to trigger signalling through direct engagement of mycobacteria using tranfectant cells incorporating a reporter system. We describe for the first time the expression of this receptor on T cells, and highlight the potential relevance to mycobacterial recognition. Furthermore, we demonstrate that crosslinking of this receptor on T cells increases proliferation of cytotoxic, but not helper, T cells.
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Affiliation(s)
- Louise E. Hogan
- Institute for Infection and Immunity, St George’s, University of London, Cranmer Terrace, London, SW17 0RE
- TB Research Group, Animal and Plant Health Agency, Weybridge, New Haw, KT15 3NB, UK
| | - Des C. Jones
- Immunology Division, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP
| | - Rachel L. Allen
- Institute for Infection and Immunity, St George’s, University of London, Cranmer Terrace, London, SW17 0RE
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12
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Hogan LE. Diet for Children. Am J Nurs 1916. [DOI: 10.2307/3405278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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