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Chiu CY, Bayan SL, Yi ES, Cummins NW. Vocal cord nodules caused by Mycobacterium avium infection. QJM 2024:hcae091. [PMID: 38696764 DOI: 10.1093/qjmed/hcae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Indexed: 05/04/2024] Open
Affiliation(s)
- Chia-Yu Chiu
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Semirra L Bayan
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Eunhee S Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Nathan W Cummins
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota
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Zeuli JD, Rivera CG, Wright JA, Kasten MJ, Mahmood M, Ragan AK, Rizza SA, Temesgen Z, Vergidis P, Wilson JW, Cummins NW. Pharmacogenomic panel testing provides insight and enhances medication management in people with HIV. AIDS 2023; 37:1525-1533. [PMID: 37199600 DOI: 10.1097/qad.0000000000003598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Our study aimed to assess the impact of pharmacogenomic panel testing in people with HIV (PWH). DESIGN Prospective, observational intervention assessment. METHODS One hundred PWH were provided a comprehensive pharmacogenomic panel during routine care visits within the HIV specialty clinic of a large academic medical center. The panel determined the presence of specific genetic variants that could predict response or toxicity to commonly prescribed antiretroviral therapy (ART) and non-ART medications. An HIV specialty pharmacist reviewed the results with participants and the care team. The pharmacist (1) recommended clinically actionable interventions based on the participants' current drug therapy, (2) assessed for genetic explanations for prior medication failures, adverse effects, or intolerances, and (3) advised on potential future clinically actionable care interventions based on individual genetic phenotypes. RESULTS Ninety-six participants (median age 53 years, 74% white, 84% men, 89% viral load <50 copies/ml) completed panel testing, yielding 682 clinically relevant pharmacogenomic results (133 major, 549 mild-moderate). Ninety participants (89 on ART) completed follow-up visits with 65 (72%) receiving clinical recommendations based on current medication profiles. Of the 105 clinical recommendations, 70% advised additional monitoring for efficacy or toxicity, and 10% advised alteration of drug therapy. Panel results offered explanation for prior ART inefficacy in one participant and ART intolerance in 29%. Genetic explanation for non-ART toxicity was seen in 21% of participants, with genetic contributors to inefficacy of non-ART therapy identified in 39% of participants. CONCLUSION Preliminary data in a small cohort of PWH demonstrates benefit of routine pharmacogenomic panel testing.
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Affiliation(s)
- John D Zeuli
- Department of Pharmacy
- Section of Infectious Diseases
| | | | - Jessica A Wright
- Department of Pharmacy
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Castro-Varela A, Gallego-Navarro C, Bhaimia E, Gupta A, Spencer PJ, Daly RC, Clavell AL, Knop GL, Maleszewski JJ, Villavicencio MA, Cummins NW. Heart Transplantation from COVID-19-Positive Donors: A Word of Caution. Transplant Proc 2023; 55:533-539. [PMID: 36948960 PMCID: PMC9981670 DOI: 10.1016/j.transproceed.2023.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, efforts to maintain solid-organ transplantation have continued, including the use of SARS-CoV-2-positive heart donors. METHODS We present our institution's initial experience with SARS-CoV-2-positive heart donors. All donors met our institution's Transplant Center criteria, including a negative bronchoalveolar lavage polymerase chain reaction result. All but 1 patient received postexposure prophylaxis with anti-spike monoclonal antibody therapy, remdesivir, or both. RESULTS A total of 6 patients received a heart transplant from a SARS-CoV-2-positive donor. One heart transplant was complicated by catastrophic secondary graft dysfunction requiring venoarterial extracorporeal membrane oxygenation and retransplant. The remaining 5 patients did well postoperatively and were discharged from the hospital. None of the patients had evidence of COVID-19 infection after surgery. CONCLUSION Heart transplants from SARS-CoV-2 polymerase chain reaction-positive donors are feasible and safe with adequate screening and postexposure prophylaxis.
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Affiliation(s)
| | | | - Eric Bhaimia
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Aanchal Gupta
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Philip J Spencer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Alfredo L Clavell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gustavo L Knop
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph J Maleszewski
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Nathan W Cummins
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Chandrasekar AP, Cummins NW, Natesampillai S, Misra A, Alto A, Laird G, Badley AD. The BCL-2 Inhibitor Venetoclax Augments Immune Effector Function Mediated by Fas Ligand, TRAIL, and Perforin/Granzyme B, Resulting in Reduced Plasma Viremia and Decreased HIV Reservoir Size during Acute HIV Infection in a Humanized Mouse Model. J Virol 2022; 96:e0173022. [PMID: 36448802 PMCID: PMC9769373 DOI: 10.1128/jvi.01730-22] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
The BCL-2 prosurvival protein is implicated in HIV persistence and is a potential therapeutic target for HIV eradication efforts. We now know that cells harboring HIV are preferentially enriched for high BCL-2 expression, enabling their survival, and that the BCL-2 inhibitor venetoclax promotes the death of actively replicating HIV-infected cells in vitro and ex vivo. Herein, we assess the effect of venetoclax on immune clearance of infected cells and show that BCL-2 inhibition significantly enhances target cell killing induced by Fas ligand, TRAIL (tumor necrosis factor-related apoptosis-inducing ligand), and perforin/granzyme B and synergistically enhances autologous NK (natural killer) and CD8 cells' killing of target cells. In a humanized mouse model of acute HIV infection, venetoclax monotherapy significantly decreases plasma viremia and normalizes CD4:CD8 ratios, and results in more mice with undetectable provirus levels than control. In this model, treatment was associated with leukopenia, as has been described clinically in patients receiving venetoclax for other indications. These data confirm meaningful anti-HIV effects of venetoclax during HIV infection but suggest that venetoclax use should be combined with ART (antiretroviral therapy) to reduce toxicity. IMPORTANCE This study is the first to examine the applicability of BCL-2 inhibition in the setting of active HIV infection in vivo. Furthermore, this study demonstrates that venetoclax significantly enhances target cell killing induced by Fas ligand, TRAIL, and perforin/granzyme B and synergistically enhances autologous NK and CD8 cells' killing of target cells.
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Affiliation(s)
| | - Nathan W. Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Anisha Misra
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Alecia Alto
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Greg Laird
- Accelevir Diagnostics, Baltimore, Maryland, USA
| | - Andrew D. Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Saeed H, Cano EJ, Khan MQ, Yetmar ZA, Smith B, Rizza SA, Badley AD, Mahmood M, Leise MD, Cummins NW. Changing Landscape of Liver Transplantation in the Post-DAA and Contemporary ART Era. Life (Basel) 2022; 12:1755. [PMID: 36362910 PMCID: PMC9693252 DOI: 10.3390/life12111755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/07/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 07/30/2023] Open
Abstract
Combination anti-retroviral therapy has drastically improved solid organ transplantation outcomes in persons living with HIV. DAA therapy has led to the successful eradication of HCV. While recent data have suggested improvement in outcomes in HIV/HCV-coinfected liver transplant recipients, temporal trends in patient survival within pre- and post-DAA eras are yet to be elucidated. The UNOS database was utilized to identify deceased donor liver transplant recipients between 1 January 2000 and 30 September 2020 and stratify them by HIV and HCV infection status. A total of 85,730 patients met the inclusion criteria. One-year and five-year patient survival improved (93% and 80%, respectively) for all transplants performed post-2015. For HIV/HCV-coinfected recipients, survival improved significantly from 78% (pre-2015) to 92% (post-2015). Multivariate regression analyses identified advanced recipient age, Black race, diabetes mellitus and decompensated cirrhosis as risk factors associated with higher one-year mortality. Liver transplant outcomes in HIV/HCV-coinfected liver transplant recipients have significantly improved over the last quinquennium in the setting of the highly effective combination of ART and DAA therapy. The presence of HIV, HCV, HIV/HCV-coinfection and active HCV viremia at the time of transplant do not cause higher mortality risk in liver transplant recipients in the current era.
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Affiliation(s)
- Huma Saeed
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Edison J. Cano
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Mohammad Qasim Khan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55902, USA
| | - Zachary A. Yetmar
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Byron Smith
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55902, USA
| | - Stacey A. Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Andrew D. Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Maryam Mahmood
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Michael D. Leise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55902, USA
| | - Nathan W. Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902, USA
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Higgins E, Gupta A, Cummins NW. Polymicrobial Infections in the Immunocompromised Host: The COVID-19 Realm and Beyond. Med Sci (Basel) 2022; 10:medsci10040060. [PMID: 36278530 PMCID: PMC9589947 DOI: 10.3390/medsci10040060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/17/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Immunosuppression changes both susceptibility to and presentation of infection. Infection with one pathogen can also alter host response to a different, unrelated pathogen. These interactions have been seen across multiple infection domains where bacteria, viruses or fungi act synergistically with a deleterious impact on the host. This phenomenon has been well described with bacterial and fungal infections complicating influenza and is of particular interest in the context of the COVID-19 pandemic. Modulation of the immune system is a crucial part of successful solid organ and hematopoietic stem cell transplantation. Herein, we present three cases of polymicrobial infection in transplant recipients. These case examples highlight complex host–pathogen interactions and the resultant clinical syndromes.
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Jeffery MM, Oliveira J E Silva L, Bellolio F, Garovic VD, Dempsey TM, Limper A, Cummins NW. Association of outpatient use of renin-angiotensin-aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: a cohort study. BMJ Open 2022; 12:e060305. [PMID: 35793915 PMCID: PMC9260198 DOI: 10.1136/bmjopen-2021-060305] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Evaluate the associations between patients taking ACE inhibitors and angiotensin receptor blockers (ARBs) and their clinical outcomes after an acute viral respiratory illness (AVRI) due to COVID-19. DESIGN Retrospective cohort. SETTING The USA; 2017-2018 influenza season, 2018-2019 influenza season, and 2019-2020 influenza/COVID-19 season. PARTICIPANTS People with hypertension (HTN) taking an ACEi, ARB or other HTN medications, and experiencing AVRI. MAIN OUTCOME MEASURES Change in hospital admission, intensive care unit (ICU) or coronary care unit (CCU), acute respiratory distress (ARD), ARD syndrome (ARDS) and all-cause mortality, comparing COVID-19 to pre-COVID-19 influenza seasons. RESULTS The cohort included 1 059 474 episodes of AVRI (653 797 filled an ACEi or ARB, and 405 677 other HTN medications). 58.6% were women and 72.9% with age ≥65. The ACEi/ARB cohort saw a larger increase in risk in the COVID-19 influenza season than the other HTN medication cohort for four out of five outcomes, with an additional 1.5 percentage point (pp) increase in risk of an inpatient stay (95% CI 1.2 to 1.9 pp) and of ICU/CCU use (95% CI 0.3 to 2.7 pp) as well as a 0.7 pp (0.1 to 1.2 pp) additional increase in risk of ARD and 0.9 pp (0.4 to 1.3 pp) additional increase in risk of ARDS. There was no statistically significant difference in the absolute risk of death (-0.2 pp, 95% CI -0.4 to 0.1 pp). However, the relative risk of death in 2019/2020 versus 2017/2018 for the ACEi/ARB group was larger (1.40 (1.36 to 1.44)) than for the other HTN medication cohort (1.24 (1.21 to 1.28)). CONCLUSIONS People with AVRI using ACEi/ARBs for HTN had a greater increase in poor outcomes during the COVID-19 pandemic than those using other medications to treat HTN. The small absolute magnitude of the differences likely does not support changes in clinical practice.
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Affiliation(s)
- Molly Moore Jeffery
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Visiting Fellow, OptumLabs, Eden Prairie, Minnesota, USA
| | | | | | - Vesna D Garovic
- Department of Medicine, Division of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy M Dempsey
- David Grant Medical Center, US Air Force, Travis Air Force Base, California, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew Limper
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan W Cummins
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Cummins NW. Metabolic Complications of Chronic HIV Infection: A Narrative Review. Pathogens 2022; 11:pathogens11020197. [PMID: 35215140 PMCID: PMC8879342 DOI: 10.3390/pathogens11020197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
As persons who are HIV positive and on suppressive antiretroviral therapy live longer, there is increased incidence and recognition of several metabolic complications of this chronic infection. These metabolic complications of HIV infection can result from the infection itself and/or otherwise effective antiviral treatment and can have significant impacts on morbidity and mortality. Some metabolic complications of HIV infection are preventable but most are modifiable, and therefore, active surveillance and screening are warranted. The purpose of this narrative review is to highlight the most common metabolic complications of chronic HIV infection, associated risk factors, diagnosis, and management.
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Affiliation(s)
- Nathan W Cummins
- Section of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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Oliveira J E Silva L, Gerberi DJ, Cummins NW, Shah AS, Bellolio F. Representativeness of Racial and Ethnic Groups in COVID-19 Outpatient Trials in the United States. Mayo Clin Proc 2022; 97:184-186. [PMID: 34996551 PMCID: PMC8554176 DOI: 10.1016/j.mayocp.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/12/2021] [Accepted: 10/22/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Lucas Oliveira J E Silva
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN; Research Fellow and Assistant Professor of Emergency Medicine.
| | | | - Nathan W Cummins
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Aditya S Shah
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN
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Cummins NW. Yes, It Does. Mayo Clin Proc 2021; 96:2934-2935. [PMID: 34863388 PMCID: PMC8633938 DOI: 10.1016/j.mayocp.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022]
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Cummins NW, Baker J, Chakraborty R, Dean PG, Garcia-Rivera E, Krogman A, Kumar S, Kuzmichev YV, Laird GM, Landay A, Lichterfeld M, Mahmood M, Martinson J, Maynes M, Natesampillai S, Rajkumar V, Rassadkina Y, Ritter KD, Rivera CG, Rizza SA, Subramanian K, Tande AJ, Wonderlich ER, Whitaker JA, Zeuli J, Badley AD. Single center, open label dose escalating trial evaluating once weekly oral ixazomib in ART-suppressed, HIV positive adults and effects on HIV reservoir size in vivo. EClinicalMedicine 2021; 42:101225. [PMID: 34901797 PMCID: PMC8639424 DOI: 10.1016/j.eclinm.2021.101225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Achieving a functional or sterilizing cure for HIV will require identification of therapeutic interventions that reduce HIV reservoir size in infected individuals. Proteasome inhibitors, such as ixazomib, impact multiple aspects of HIV biology including latency, transcription initiation, viral replication, and infected cell killing through the HIV protease - Casp8p41 pathway, resulting in latency reversal and reduced measures of HIV reservoir size ex vivo. METHODS We conducted a phase 1b/2a dose escalating, open label trial of weekly oral ixazomib for 24 weeks in antiretroviral (ART)-suppressed, HIV positive adults (NCT02946047). The study was conducted from March 2017 to August 2019 at two tertiary referral centers in the United States. The primary outcomes were safety and tolerability of oral ixazomib. Secondary outcomes included changes in immunologic markers and estimates of HIV reservoir size after ixazomib treatment. FINDINGS Sixteen participants completed the study. Ixazomib up to 4mg weekly was safe and well-tolerated, yielding no treatment-emergent events above grade 1. In exploratory analyses, ixazomib treatment was associated with detectable viremia that was below the lower limit of quantification (LLQ) in 9 participants, and viremia that was above LLQ in 4 of 16 participants. While treatment was associated with reduced CD4 counts [baseline 783 cells/ mm3 vs. week-24 724 cells/ mm3 p=0.003], there were no changes in markers of cellular activation, exhaustion or inflammation. Total HIV DNA and proviral sequencing were not altered by ixazomib treatment. Intact proviral DNA assay (IPDA) identified intact proviruses in 14 patients pre-treatment, and in 10/14 of those subjects post treatment values were reduced (P=0.068), allowing a calculated intact proviral half life of 0.6 years (95% CI 0.3, 2.5), compared to 7.1 years (95% CI 3.9, 18, p=0.004) in historical controls. Differentiation Quantitative Viral Outgrowth Assays (dQVOA) identified measurable proviruses in 15 subjects pre-treatment; post-treatment values were numerically reduced in 9, but overall differences were not significantly different. INTERPRETATION Our study successfully met its primary endpoint of demonstrating the safety of ixazomib for 24 weeks in HIV infected persons. Exploratory analyses suggest that the effects observed ex vivo of latency reversal and reductions in HIV reservoir size, also occur in vivo. Future controlled studies of ixazomib are warranted. FUNDING This study was funded by Millennium Pharmaceuticals Inc..; the Mayo Clinic Foundation; the National Institutes of Health, including the National Institute of Allergy and Infectious Diseases, Division of AIDS, the National Heart, Lung and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, and the National Institute on Drug Abuse. Mayo Clinic also acknowledges generous funding support from Mr. Joseph T. and Mrs. Michele P. Betten.
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Affiliation(s)
- Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason Baker
- Division of Infectious Diseases, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Patrick G Dean
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ashton Krogman
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yury V Kuzmichev
- Department of Infectious Disease Research, Southern Research, Frederick, Maryland, USA
| | | | - Alan Landay
- Division of Geriatrics, Rush University Medical Center, Chicago, IL, USA
| | - Mathias Lichterfeld
- Ragon Institute of MGH, MIT, and Harvard; Brigham and Women's Hospital, Boston, MA, USA
| | - Maryam Mahmood
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey Martinson
- Division of Geriatrics, Rush University Medical Center, Chicago, IL, USA
| | - Mark Maynes
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Yelizaveta Rassadkina
- Ragon Institute of MGH, MIT, and Harvard; Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Stacey A Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Krupa Subramanian
- Department of Infectious Disease Research, Southern Research, Frederick, Maryland, USA
| | - Aaron J Tande
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jennifer A Whitaker
- Division of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - John Zeuli
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Corresponding author.
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Puskarich MA, Cummins NW, Ingraham NE, Wacker DA, Reilkoff RA, Driver BE, Biros MH, Bellolio F, Chipman JG, Nelson AC, Beckman K, Langlois R, Bold T, Aliota MT, Schacker TW, Voelker HT, Murray TA, Koopmeiners JS, Tignanelli CJ. A multi-center phase II randomized clinical trial of losartan on symptomatic outpatients with COVID-19. EClinicalMedicine 2021; 37:100957. [PMID: 34195577 PMCID: PMC8225661 DOI: 10.1016/j.eclinm.2021.100957] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 virus enters cells via Angiotensin-converting enzyme 2 (ACE2), disrupting the renin-angiotensin-aldosterone axis, potentially contributing to lung injury. Treatment with angiotensin receptor blockers (ARBs), such as losartan, may mitigate these effects, though induction of ACE2 could increase viral entry, replication, and worsen disease. METHODS This study represents a placebo-controlled blinded randomized clinical trial (RCT) to test the efficacy of losartan on outpatients with COVID-19 across three hospital systems with numerous community sites in Minnesota, U.S. Participants included symptomatic outpatients with COVID-19 not already taking ACE-inhibitors or ARBs, enrolled within 7 days of symptom onset. Patients were randomized to 1:1 losartan (25 mg orally twice daily unless estimated glomerular filtration rate, eGFR, was reduced, when dosing was reduced to once daily) versus placebo for 10 days, and all patients and outcome assesors were blinded. The primary outcome was all-cause hospitalization within 15 days. Secondary outcomes included functional status, dyspnea, temperature, and viral load. (clinicatrials.gov, NCT04311177, closed to new participants). FINDINGS From April to November 2020, 117 participants were randomized 58 to losartan and 59 to placebo, and all were analyzed under intent to treat principles. The primary outcome did not differ significantly between the two arms based on Barnard's test [losartan arm: 3 events (5.2% 95% CI 1.1, 14.4%) versus placebo arm: 1 event (1.7%; 95% CI 0.0, 9.1%)]; proportion difference -3.5% (95% CI -13.2, 4.8%); p = 0.32]. Viral loads were not statistically different between treatment groups at any time point. Adverse events per 10 patient days did not differ signifcantly [0.33 (95% CI 0.22-0.49) for losartan vs. 0.37 (95% CI 0.25-0.55) for placebo]. Due to a lower than expected hospitalization rate and low likelihood of a clinically important treatment effect, the trial was terminated early. INTERPRETATION In this multicenter blinded RCT for outpatients with mild symptomatic COVID-19 disease, losartan did not reduce hospitalizations, though assessment was limited by low event rate. Importantly, viral load was not statistically affected by treatment. This study does not support initiation of losartan for low-risk outpatients.
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Affiliation(s)
- Michael A. Puskarich
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Nathan W. Cummins
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicholas E. Ingraham
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - David A. Wacker
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ronald A. Reilkoff
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Michelle H. Biros
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Fernanda Bellolio
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew C. Nelson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth Beckman
- University of Minnesota Genomics Center, University of Minnesota, Minneapolis, MN, USA
| | - Ryan Langlois
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Tyler Bold
- Division of Infectious Diseases, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, MN, USA
| | - Timothy W. Schacker
- Division of Infectious Diseases, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Helen T. Voelker
- Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Thomas A Murray
- Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph S. Koopmeiners
- Department of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Christopher J. Tignanelli
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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13
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Cummins NW. Remdesivir: An antiviral still seeking a raison d'être. Clin Infect Dis 2021; 73:1857-1859. [PMID: 33749746 PMCID: PMC8083721 DOI: 10.1093/cid/ciab220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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14
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Jeffery MM, Cummins NW, Dempsey TM, Limper AH, Shah ND, Bellolio F. Association of outpatient ACE inhibitors and angiotensin receptor blockers and outcomes of acute respiratory illness: a retrospective cohort study. BMJ Open 2021; 11:e044010. [PMID: 33737435 PMCID: PMC7978099 DOI: 10.1136/bmjopen-2020-044010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Evaluate associations between ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) and clinical outcomes in acute viral respiratory illness (AVRI). DESIGN Retrospective cohort analysis of claims data. SETTING The USA; 2018-2019 influenza season. PARTICIPANTS Main cohort: people with hypertension (HTN) taking an ACEi, ARB or other HTN medications, and experiencing AVRI. Falsification cohort: parallel cohort receiving elective knee or hip replacement. MAIN OUTCOME MEASURES Main cohort: hospital admission, intensive care unit, acute respiratory distress (ARD), ARD syndrome and all-cause mortality. Falsification cohort: complications after surgery and all-cause mortality. RESULTS The main cohort included 236 843 episodes of AVRI contributed by 202 629 unique individuals. Most episodes were in women (58.9%), 81.4% in people with Medicare Advantage and 40.3% in people aged 75+ years. Odds of mortality were lower in the ACEi (0.78 (0.74 to 0.83)) and ARB (0.64 (0.61 to 0.68)) cohorts compared with other HTN medications. On all other outcomes, people taking ARBs (but not ACEis) had a >10% reduction in odds of inpatient stays compared with other HTN medications.In the falsification analysis (N=103 353), both ACEis (0.89 (0.80 to 0.98)) and ARBs (0.82 (0.74 to 0.91)) were associated with decreased odds of complications compared with other HTN medications; ARBs (0.64 (0.47 to 0.87)) but not ACEis (0.79 (0.60 to 1.05)) were associated with lower odds of death compared with other HTN medications. CONCLUSIONS Outpatient use of ARBs was associated with better outcomes with AVRI compared with other medications for HTN. ACEis were associated with reduced risk of death, but with minimal or no reduction in risk of other complications. A falsification analysis conducted to provide context on the possible causal implications of these findings did not provide a clear answer. Further analysis using observational data will benefit from additional approaches to assess causal relationships between these drugs and outcomes in AVRI.
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Affiliation(s)
- Molly Moore Jeffery
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
- Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan W Cummins
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy M Dempsey
- Pulmonary Critical Care Medicine, David Grant Medical Center, Travis AFB, California, USA
| | - Andrew H Limper
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Robert D and Patricia E Kern Center for the Sciences of the Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nilay D Shah
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D and Patricia E Kern Center for the Sciences of the Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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15
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Pereira NL, Ahmad F, Byku M, Cummins NW, Morris AA, Owens A, Tuteja S, Cresci S. COVID-19: Understanding Inter-Individual Variability and Implications for Precision Medicine. Mayo Clin Proc 2021; 96:446-463. [PMID: 33549263 PMCID: PMC7713605 DOI: 10.1016/j.mayocp.2020.11.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by heterogeneity in susceptibility to the disease and severity of illness. Understanding inter-individual variation has important implications for not only allocation of resources but also targeting patients for escalation of care, inclusion in clinical trials, and individualized medical therapy including vaccination. In addition to geographic location and social vulnerability, there are clear biological differences such as age, sex, race, presence of comorbidities, underlying genetic variation, and differential immune response that contribute to variability in disease manifestation. These differences may have implications for precision medicine. Specific examples include the observation that androgens regulate the expression of the enzyme transmembrane protease, serine 2 which facilitates severe acute respiratory syndrome coronavirus 2 viral entry into the cell; therefore, androgen deprivation therapy is being explored as a treatment option in males infected with COVID-19. An immunophenotyping study of COVID-19 patients has shown that a subset develop T cytopenia which has prompted a clinical trial that is testing the efficacy of interleukin-7 in these patients. Predicting which COVID-19 patients will develop progressive disease that will require hospitalization has important implications for clinical trials that target outpatients. Enrollment of patients at low risk for progression of disease and hospitalization would likely not result in such therapy demonstrating efficacy. There are efforts to use artificial intelligence to integrate digital data from smartwatch applications or digital monitoring systems and biological data to enable identification of the high risk COVID-19 patient. The ultimate goal of precision medicine using such modern technology is to recognize individual differences to improve health for all.
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Affiliation(s)
- Naveen L Pereira
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Ferhaan Ahmad
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine Iowa City, IA
| | - Mirnela Byku
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Anjali Owens
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sony Tuteja
- Division of Translational Medicine and Human Genetics, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sharon Cresci
- Department of Medicine and Genetics, Washington University, St Louis, MO
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16
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Corsini Campioli C, Esquer Garrigos Z, Assi M, Go JR, Razonable RR, Beam E, Yao J, Cummins NW. Transient Hepatitis B Surface Antigenemia Following Immunization with Heplisav-B. Mayo Clin Proc Innov Qual Outcomes 2021; 5:542-547. [PMID: 34195546 PMCID: PMC8240146 DOI: 10.1016/j.mayocpiqo.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 01/03/2023] Open
Abstract
Objective To delineate the rate and duration of transient hepatitis B surface antigenemia following Heplisav-B vaccination. Patients and Methods We retrospectively reviewed the medical records of all adult patients who received Heplisav-B vaccination at our institution from January 1, 2019, through March 31, 2020, and who had hepatitis B surface antigen (HBsAg) testing within 30 days following immunization. Patients with laboratory evidence of prior hepatitis B virus infection or immunization were excluded. Results A total of 39 of 1933 patients were tested for HBsAg within 30 days after completing the Heplisav-B vaccination series; of these 39, only 6 (15.4 %) had a positive HBsAg result. Compared with the patients with negative HBsAg results, those with a positive HBsAg result had a significantly lower body mass index (24.8 kg/m2 [interquartile range (IQR), 23 to 26.4 kg/m2] vs 28.6 kg/m2 [IQR, 26.4 to 30.6 kg/m2]; P=.01) and higher prevalence of chronic kidney disease (2 of 6 [33.3%] vs 2 of 33 [6%]; P=.04). The timing of HBsAg testing after completing the vaccination series in the HBsAg-positive group was significantly earlier compared with that of the HBsAg-negative group (2 days [IQR, 0.43 to 2.25 days) vs 12 days [IQR, 10 to 15 days]; P=.0008). Active hepatitis B infection was excluded in all 6 patients. In the HBsAg-positive group, the median time from the date of Heplisav-B administration to a negative HBsAg test result was 17 days (IQR, 8 to 36 days). Conclusion As with all conventional hepatitis B vaccines, transient hepatitis B surface antigenemia can be observed with Heplisav-B vaccine, particularly in those with chronic kidney disease and low body mass index.
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Affiliation(s)
| | - Zerelda Esquer Garrigos
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN.,Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Mariam Assi
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN.,Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA
| | | | - Raymund R Razonable
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN.,William J. Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Elena Beam
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN.,William J. Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Joseph Yao
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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17
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Sangarlangkarn A, Rizza SA, Mahmood M, Cummins NW, Temesgen Z. A National Survey of Provider's Preparedness to Care for Persons Living With HIV Aged ≥50 Years. J Contin Educ Health Prof 2021; 41:82-84. [PMID: 33433129 DOI: 10.1097/ceh.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION With increasing longevity among persons living with HIV (PLWH), HIV providers must manage age-related diseases despite limited geriatric training. We surveyed HIV providers to assess perceived preparedness in caring for aging PLWH and knowledge gaps. METHODS We surveyed HIV providers from October to December 2018 on preparedness (1 = strongly unprepared to 5 = strongly prepared), topics of interest, and participant characteristics including the number of years after training, number of PLWH aged ≥50 years seen/month, degree types (MD/DO versus others), and practice setting (academic versus nonacademic). We grouped "strongly prepared/somewhat prepared" responses as "prepared" and "neutral/somewhat unprepared/strongly unprepared" as "unprepared." The effects of participant characteristics on preparedness were determined using chi-square test. RESULTS Of 226 participants, 54% were physicians, 27% were NP/PA, 19% were PharmD, and 40% practiced in academic settings. The average preparedness score was 3.37 out of 5.0. Approximately half of participants (56%) were classified as "prepared." The mode number of years in practice was "10 to <20" (22%); mode number of PLWH aged ≥50 years seen/month was "1 to 25" (50%). HIV-associated neurocognitive disorder (73%) and geriatric syndrome screening (63%) were the most chosen areas of interest. Unprepared participants were interested in topics of cardiovascular disease (odds ratio [OR], 2.38; P = .002) and palliative care (OR, 1.92; P = .02). Having >20 years after training increased preparedness ("20 to <30" years versus "none": OR, 3.37; P = .03; "≥30 years" versus "none": OR, 3.66; P = .04). CONCLUSION Approximately half of the surveyed HIV providers felt prepared to care for aging PLWH. HIV-associated neurocognitive disorder, geriatric syndrome screening, cardiovascular diseases, and palliative care were areas of interest. Having >20 years after training increases preparedness.
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Affiliation(s)
- Aroonsiri Sangarlangkarn
- Ms. Sangarlangkarn: Assistant Professor, Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Ms. Rizza: Professor, Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Ms. Mahmood: Assistant Professor, Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Mr. Cummins: Assistant Professor, Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Mr. Temesgen: Professor, Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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18
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Aboulnasr F, Krogman A, Graham RP, Cummins NW, Misra A, Garcia-Rivera E, Anderson JR, Natesampillai S, Kogan N, Aravamudan M, Nie Z, Chung TDY, Buick R, Feldman AL, King RL, Novak AJ, Ansell SM, Kenderian S, Badley AD. Human Cancers Express TRAILshort, a Dominant Negative TRAIL Splice Variant, Which Impairs Immune Effector Cell Killing of Tumor Cells. Clin Cancer Res 2020; 26:5759-5771. [PMID: 32669373 PMCID: PMC7642027 DOI: 10.1158/1078-0432.ccr-20-0251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/20/2020] [Revised: 05/29/2020] [Accepted: 07/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE TNF-related apoptosis inducing ligand (TRAIL) expression by immune cells contributes to antitumor immunity. A naturally occurring splice variant of TRAIL, called TRAILshort, antagonizes TRAIL-dependent cell killing. It is unknown whether tumor cells express TRAILshort and if it impacts antitumor immunity. EXPERIMENTAL DESIGN We used an unbiased informatics approach to identify TRAILshort expression in primary human cancers, and validated those results with IHC and ISH. TRAILshort-specific mAbs were used to determine the effect of TRAILshort on tumor cell sensitivity to TRAIL, and to immune effector cell dependent killing of autologous primary tumors. RESULTS As many as 40% of primary human tumors express TRAILshort by both RNA sequencing and IHC analysis. By ISH, TRAILshort expression is present in tumor cells and not bystander cells. TRAILshort inhibition enhances cancer cell lines sensitivity to TRAIL-dependent killing both in vitro and in immunodeficient xenograft mouse models. Immune effector cells isolated from patients with B-cell malignancies killed more autologous tumor cells in the presence compared with the absence of TRAILshort antibody (P < 0.05). CONCLUSIONS These results identify TRAILshort in primary human malignancies, and suggest that TRAILshort blockade can augment the effector function of autologous immune effector cells.See related commentary by de Miguel and Pardo, p. 5546.
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Affiliation(s)
- Fatma Aboulnasr
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Ashton Krogman
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Rondell P Graham
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Anisha Misra
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Jeff R Anderson
- Office of Translation to Practice, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Zilin Nie
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Thomas D Y Chung
- Office of Translation to Practice, Mayo Clinic, Rochester, Minnesota
| | | | | | - Rebecca L King
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Anne J Novak
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Saad Kenderian
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
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19
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French AJ, Natesampillai S, Krogman A, Correia C, Peterson KL, Alto A, Chandrasekar AP, Misra A, Li Y, Kaufmann SH, Badley AD, Cummins NW. Reactivating latent HIV with PKC agonists induces resistance to apoptosis and is associated with phosphorylation and activation of BCL2. PLoS Pathog 2020; 16:e1008906. [PMID: 33075109 PMCID: PMC7595626 DOI: 10.1371/journal.ppat.1008906] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 05/05/2020] [Revised: 10/29/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023] Open
Abstract
Eradication of HIV-1 by the "kick and kill" strategy requires reactivation of latent virus to cause death of infected cells by either HIV-induced or immune-mediated apoptosis. To date this strategy has been unsuccessful, possibly due to insufficient cell death in reactivated cells to effectively reduce HIV-1 reservoir size. As a possible cause for this cell death resistance, we examined whether leading latency reversal agents (LRAs) affected apoptosis sensitivity of CD4 T cells. Multiple LRAs of different classes inhibited apoptosis in CD4 T cells. Protein kinase C (PKC) agonists bryostatin-1 and prostratin induced phosphorylation and enhanced neutralizing capability of the anti-apoptotic protein BCL2 in a PKC-dependent manner, leading to resistance to apoptosis induced by both intrinsic and extrinsic death stimuli. Furthermore, HIV-1 producing CD4 T cells expressed more BCL2 than uninfected cells, both in vivo and after ex vivo reactivation. Therefore, activation of BCL2 likely contributes to HIV-1 persistence after latency reversal with PKC agonists. The effects of LRAs on apoptosis sensitivity should be considered in designing HIV cure strategies predicated upon the "kick and kill" paradigm.
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Affiliation(s)
- Andrea J. French
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sekar Natesampillai
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ashton Krogman
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Cristina Correia
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kevin L. Peterson
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Alecia Alto
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Aswath P. Chandrasekar
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Anisha Misra
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ying Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Scott H. Kaufmann
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Andrew D. Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Nathan W. Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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20
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Affiliation(s)
- Karen M Meagher
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Linda L Chlan
- Department of Nursing, Mayo Clinic College of Medicine and Science, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - R Scott Wright
- Department of Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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21
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Abstract
Human immunodeficiency virus-1 (HIV-1) causes CD4 T cell depletion through a number of mechanisms, including programmed cell death pathways (both apoptotic and nonapoptotic). In the setting of HIV-1 infection, the enhanced lymphocyte cell death occurs as a consequence of complex interactions between the host immune system and viral factors, which are reviewed herein. On the other hand, the main challenge to HIV-1 eradication is the development of latent infection in a subset of long lived cells, including CD4+ T cells and macrophages, which resist HIV-induced cell death. Understanding the potential mechanisms of how HIV-1 induces lymphocyte cell death is critical to the "kick and kill" cure strategy, which relies on the effective killing of reactivated, HIV-1-infected cells.
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Affiliation(s)
- Ana C. Paim
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Andrew D. Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
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22
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Paim AC, Cummins NW, Natesampillai S, Garcia-Rivera E, Kogan N, Neogi U, Sönnerborg A, Sperk M, Bren GD, Deeks S, Polley E, Badley AD. HIV elite control is associated with reduced TRAILshort expression. AIDS 2019; 33:1757-1763. [PMID: 31149947 PMCID: PMC6873462 DOI: 10.1097/qad.0000000000002279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) dependent apoptosis has been implicated in CD4 T-cell death and immunologic control of HIV-1 infection. We have described a splice variant called TRAILshort, which is a dominant negative ligand that antagonizes TRAIL-induced cell death in the context of HIV-1 infection. HIV-1 elite controllers naturally control viral replication for largely unknown reasons. Since enhanced death of infected cells might be responsible, as might occur in situations of low (or inhibited) TRAILshort, we tested whether there was an association between elite controller status and reduced levels of TRAILshort expression. DESIGN Cohort study comparing TRAILshort and full length TRAIL expression between HIV-1 elite controllers and viremic progressors from two independent populations. METHODS TRAILshort and TRAIL gene expression in peripheral blood mononuclear cells (PBMCs) was determined by RNA-seq. TRAILshort and TRAIL protein expression in plasma was determined by antibody bead array and proximity extension assay respectively. RESULTS HIV-1 elite controllers expressed less TRAILshort transcripts in PBMCs (P = 0.002) and less TRAILshort protein in plasma (P < 0.001) than viremic progressors. CONCLUSION Reduced TRAILshort expression in PBMCs and plasma is associated with HIV-1 elite controller status.
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Affiliation(s)
- Ana C Paim
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Ujjwal Neogi
- Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sönnerborg
- Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Maike Sperk
- Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
| | - Gary D Bren
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Steve Deeks
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, California
| | - Eric Polley
- Division of Biomedical Statistics and Informatics
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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23
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Natesampillai S, Paim AC, Cummins NW, Chandrasekar AP, Bren GD, Lewin SR, Kiem HP, Badley AD. TRAILshort Protects against CD4 T Cell Death during Acute HIV Infection. J Immunol 2019; 203:718-724. [PMID: 31189571 PMCID: PMC6785036 DOI: 10.4049/jimmunol.1900271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023]
Abstract
CD4 T cells from HIV-1 infected patients die at excessive rates compared to those from uninfected patients, causing immunodeficiency. We previously identified a dominant negative ligand that antagonizes the TRAIL-dependent pathway of cell death, which we called TRAILshort. Because the TRAIL pathway has been implicated in CD4 T cell death occurring during HIV-1 infection, we used short hairpin RNA knockdown, CRISPR deletion, or Abs specific for TRAILshort to determine the effect of inhibiting TRAILshort on the outcome of experimental acute HIV infection in vitro. Strikingly, all three approaches to TRAILshort deletion/inhibition enhanced HIV-induced death of both infected and uninfected human CD4 T cells. Thus, TRAILshort impacts T cell dynamics during HIV infection, and inhibiting TRAILshort causes more HIV-infected and uninfected bystander cells to die. TRAILshort is, therefore, a host-derived, host-adaptive mechanism to limit the effects of TRAIL-induced cell death. Further studies on the effects of TRAILshort in other disease states are warranted.
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Affiliation(s)
| | - Ana C Paim
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905
| | - Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905
| | | | - Gary D Bren
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria 3000, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria 3004, Australia
| | - Hans-Peter Kiem
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109; and
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905;
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55905
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Arslan S, Litzow MR, Cummins NW, Rizza SA, Badley AD, Navarro W, Hashmi SK. Risks and Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation for Hematologic Malignancies in Patients with HIV Infection. Biol Blood Marrow Transplant 2019; 25:e260-e267. [PMID: 30926447 DOI: 10.1016/j.bbmt.2019.03.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/20/2019] [Indexed: 11/24/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapy for hematologic malignancies in persons living with HIV (PLHIV), however, uncertainties exist in many domains related to their care, including optimal donor selection, conditioning regimen, immunosuppression for graft-versus-host disease (GVHD), and long-term outcomes. We undertook a comprehensive systematic review from multiple databases to evaluate the foregoing uncertainties. The final sample comprised 49 patients (median age at HCT, 34 years; 46 males [93.8%]). Acute GVHD (aGVHD) was reported in 19 patients (59.3%) in the overall cohort, with grade II in 12 (37.5%) and grade III in 2 (6.2%). In the entire cohort, overall survival (OS) was 81.6% at 6 months and 56.6% at 12 months. Among 32 patients, the OS at 6 months was 73.3% for patients who received myeloablative conditioning (MAC) and 88.2% for those who received reduced-intensity conditioning (RIC), and OS at 12 months was 53.3% for MAC and 58.8% for RIC. Twenty-four patients were alive in complete remission on long-term follow-up, with 25 deaths reported. Fifteen deaths (60%) occurred due to relapse, including 3 (12%) from infection, 2 (8%) from GVHD, and 5 (20%) from other causes, including renal failure, respiratory failure, and liver failure. To our knowledge, this is the largest series of allo-HCT in PLHIV reported to date, and our results indicate that clinical outcomes (including engraftment, infection rate, and survival) are not significantly different from those in patients without HIV (historical controls). RIC regimens are associated with a slightly greater likelihood of survival compared with MAC regimens. Prospective trials are critically needed to evaluate the optimal conditioning regimens, ideal donor source, and most appropriate GVHD prophylaxis.
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Affiliation(s)
- Shukaib Arslan
- Department of Hematology/Hematopoietic Stem Cell Transplant, City of Hope National Cancer Center, Duarte, California
| | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nathan W Cummins
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stacey A Rizza
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew D Badley
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Willis Navarro
- Department of Blood and Marrow Transplant, University of California, San Francisco, California; Clinical Research and Development, Atara Biotherapeutics, San Francisco, California
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Paim AC, Rizza SA, Badley AD, Prieto M, Taler SJ, Chong PP, Cummins NW. Transient Loss of HIV-1 DNA in an HIV-1 Positive Patient After Kidney Transplantation: A Case Report. Am J Med 2018; 131:e423-e424. [PMID: 29730357 PMCID: PMC8564750 DOI: 10.1016/j.amjmed.2018.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Ana C Paim
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minn.
| | - Stacey A Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minn
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minn
| | - Mikel Prieto
- William J. Von Liebig Center for Transplantation and Clinical Regeneration
| | - Sandra J Taler
- Division of Nephrology and Hypertension, Mayo Clinic,Rochester, Minn
| | - Pearlie P Chong
- Division of Infectious Diseases, UT Southwestern Medical Center,Dallas, Tex
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Nie Z, Aboulnasr F, Natesampillai S, Burke SP, Krogman A, Bren GD, Chung TDY, Anderson JR, Smart MK, Katzmann DJ, Rajagopalan G, Cummins NW, Badley AD. Correction: Both HIV-Infected and Uninfected Cells Express TRAILshort, Which Confers TRAIL Resistance upon Bystander Cells within the Microenvironment. J Immunol 2018; 201:1599. [PMID: 30006376 DOI: 10.4049/jimmunol.1800867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cummins NW, Badley AD. Allogeneic stem cell transplantation alone is unlikely to provide the HIV-1 cure. Future Virol 2018. [DOI: 10.2217/fvl-2018-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
- Office of Translation to Practice, Mayo Clinic, Rochester, MN 55905, USA
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Arslan S, Cummins NW, Rizza SA, Badley AD, Litzow MR, Navarro WH, Hashmi SK. Outcomes and Risks of Allogeneic Hematopoietic Stem Cell Transplant for Hematological Malignancies in Patients with HIV Infection. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.405] [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: 11/17/2022]
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Arslan S, Lee J, Shoukat S, Cummins NW, Badley AD, Litzow MR, Navarro WH, Hashmi SK. Outcomes and Risks of Autologous Hematopoietic Stem Cell Transplant for Hematological Malignancies in Patients with HIV Infection. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.083] [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: 11/26/2022]
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Nie Z, Aboulnasr F, Natesampillai S, Burke SP, Krogman A, Bren GD, Chung TDY, Anderson JR, Smart MK, Katzmann DJ, Rajagopalan G, Cummins NW, Badley AD. Both HIV-Infected and Uninfected Cells Express TRAILshort, Which Confers TRAIL Resistance upon Bystander Cells within the Microenvironment. J Immunol 2018; 200:1110-1123. [PMID: 29263214 PMCID: PMC5808399 DOI: 10.4049/jimmunol.1701113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/28/2017] [Indexed: 12/17/2022]
Abstract
TNF-related apoptosis-inducing ligand (TRAIL) was initially described to induce apoptosis of tumor cells and/or virally infected cells, although sparing normal cells, and has been implicated in the pathogenesis of HIV disease. We previously identified TRAILshort, a TRAIL splice variant, in HIV-infected patients and characterized it as being a dominant negative ligand to subvert TRAIL-mediated killing. Herein, using single-cell genomics we demonstrate that TRAILshort is produced by HIV-infected cells, as well as by uninfected bystander cells, and that the dominant stimulus which induces TRAILshort production are type I IFNs and TLR7, TLR8, and TLR9 agonists. TRAILshort has a short t1/2 by virtue of containing a PEST domain, which targets the protein toward the ubiquitin proteasome pathway for degradation. Further we show that TRAILshort binds preferentially to TRAIL receptors 1 and 2 with significantly reduced interaction with the decoy TRAIL receptors 3 and 4. Recombinant TRAILshort is sufficient to protect cells against TRAIL-induced killing, whereas immunodepletion of TRAILshort with a specific Ab restores TRAIL sensitivity. Importantly we show that TRAILshort is shed in microvesicles into the cellular microenvironment and therefore confers TRAIL resistance not only on the cell which produces it, but also upon neighboring bystander cells. These results establish a novel paradigm for understanding and overcoming TRAIL resistance, in particular how HIV-infected cells escape immune elimination by the TRAIL:TRAILshort receptor axis.
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Affiliation(s)
- Zilin Nie
- HIV Immunology Laboratory, Mayo Clinic, Rochester, MN 55905
| | | | | | | | - Ashton Krogman
- HIV Immunology Laboratory, Mayo Clinic, Rochester, MN 55905
- Department of Immunology, Mayo Clinic, Rochester, MN 55905
| | - Gary D Bren
- HIV Immunology Laboratory, Mayo Clinic, Rochester, MN 55905
| | - Thomas D Y Chung
- Office of Translation to Practice, Mayo Clinic, Rochester, MN 55905
| | - Jeff R Anderson
- Office of Translation to Practice, Mayo Clinic, Rochester, MN 55905
| | | | - David J Katzmann
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905; and
| | | | | | - Andrew D Badley
- HIV Immunology Laboratory, Mayo Clinic, Rochester, MN 55905;
- Office of Translation to Practice, Mayo Clinic, Rochester, MN 55905
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55905
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Cummins NW, Rizza S, Litzow MR, Hua S, Lee GQ, Einkauf K, Chun TW, Rhame F, Baker JV, Busch MP, Chomont N, Dean PG, Fromentin R, Haase AT, Hampton D, Keating SM, Lada SM, Lee TH, Natesampillai S, Richman DD, Schacker TW, Wietgrefe S, Yu XG, Yao JD, Zeuli J, Lichterfeld M, Badley AD. Extensive virologic and immunologic characterization in an HIV-infected individual following allogeneic stem cell transplant and analytic cessation of antiretroviral therapy: A case study. PLoS Med 2017; 14:e1002461. [PMID: 29182633 PMCID: PMC5705162 DOI: 10.1371/journal.pmed.1002461] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 06/09/2017] [Accepted: 10/25/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Notwithstanding 1 documented case of HIV-1 cure following allogeneic stem cell transplantation (allo-SCT), several subsequent cases of allo-SCT in HIV-1 positive individuals have failed to cure HIV-1 infection. The aim of our study was to describe changes in the HIV reservoir in a single chronically HIV-infected patient on suppressive antiretroviral therapy who underwent allo-SCT for treatment of acute lymphoblastic leukemia. METHODS AND FINDINGS We prospectively collected peripheral blood mononuclear cells (PBMCs) by leukapheresis from a 55-year-old man with chronic HIV infection before and after allo-SCT to measure the size of the HIV-1 reservoir and characterize viral phylogeny and phenotypic changes in immune cells. At day 784 post-transplant, when HIV-1 was undetectable by multiple measures-including PCR measurements of both total and integrated HIV-1 DNA, replication-competent virus measurement by large cell input quantitative viral outgrowth assay, and in situ hybridization of colon tissue-the patient consented to an analytic treatment interruption (ATI) with frequent clinical monitoring. He remained aviremic off antiretroviral therapy until ATI day 288, when a low-level virus rebound of 60 HIV-1 copies/ml occurred, which increased to 1,640 HIV-1 copies/ml 5 days later, prompting reinitiation of ART. Rebounding plasma HIV-1 sequences were phylogenetically distinct from proviral HIV-1 DNA detected in circulating PBMCs before transplantation. The main limitations of this study are the insensitivity of reservoir measurements, and the fact that it describes a single case. CONCLUSIONS allo-SCT led to a significant reduction in the size of the HIV-1 reservoir and a >9-month-long ART-free remission from HIV-1 replication. Phylogenetic analyses suggest that the origin of rebound virus was distinct from the viruses identified pre-transplant in the PBMCs.
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Affiliation(s)
- Nathan W. Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Stacey Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Mark R. Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Stephane Hua
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Guinevere Q. Lee
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Kevin Einkauf
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Tae-Wook Chun
- HIV Immunovirology Unit, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Frank Rhame
- Abbott Northwestern Hospital, Allina Health, Minneapolis, Minnesota, United States of America
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Jason V. Baker
- Division of Infectious Diseases, Hennepin County Medical Center, Minneapolis, Minnesota, United States of America
| | - Michael P. Busch
- Blood Systems Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Nicolas Chomont
- Centre de Recherche du CHUM, University of Montreal Hospital Centre, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, Canada
| | - Patrick G. Dean
- Division of Transplantation Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Rémi Fromentin
- Centre de Recherche du CHUM, University of Montreal Hospital Centre, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, Canada
| | - Ashley T. Haase
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Dylan Hampton
- Blood Systems Research Institute, San Francisco, California, United States of America
| | - Sheila M. Keating
- Blood Systems Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Steven M. Lada
- University of California, San Diego, San Diego, California, United States of America
- VA San Diego Healthcare System, San Diego, California, United States of America
| | - Tzong-Hae Lee
- Blood Systems Research Institute, San Francisco, California, United States of America
| | - Sekar Natesampillai
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Douglas D. Richman
- University of California, San Diego, San Diego, California, United States of America
- VA San Diego Healthcare System, San Diego, California, United States of America
| | - Timothy W. Schacker
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Stephen Wietgrefe
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Xu G. Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Joseph D. Yao
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - John Zeuli
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Mathias Lichterfeld
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Andrew D. Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Ramanan P, Cummins NW, Wilhelm MP, Heimbach JK, Dierkhising R, Kremers WK, Rosen CB, Gores GJ, Razonable RR. Epidemiology, risk factors, and outcomes of infections in patients undergoing liver transplantation for hilar cholangiocarcinoma. Clin Transplant 2017; 31:e13023. [DOI: 10.1111/ctr.13023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Poornima Ramanan
- Division of Infectious Diseases; Department of Medicine; Mayo Clinic; Rochester MN USA
- William J. von Liebig Center for Transplantation and Clinical Regeneration; Mayo Clinic; Rochester MN USA
- Division of Clinical Microbiology; Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester MN USA
| | - Nathan W. Cummins
- Division of Infectious Diseases; Department of Medicine; Mayo Clinic; Rochester MN USA
- William J. von Liebig Center for Transplantation and Clinical Regeneration; Mayo Clinic; Rochester MN USA
| | - Mark P. Wilhelm
- Division of Infectious Diseases; Department of Medicine; Mayo Clinic; Rochester MN USA
- William J. von Liebig Center for Transplantation and Clinical Regeneration; Mayo Clinic; Rochester MN USA
| | - Julie K. Heimbach
- William J. von Liebig Center for Transplantation and Clinical Regeneration; Mayo Clinic; Rochester MN USA
- Division of Transplantation Surgery; Mayo Clinic; Rochester MN USA
| | - Ross Dierkhising
- William J. von Liebig Center for Transplantation and Clinical Regeneration; Mayo Clinic; Rochester MN USA
- Division of Biomedical Statistics and Informatics; Department of Health Sciences Research; Mayo Clinic; Rochester MN USA
| | - Walter K. Kremers
- William J. von Liebig Center for Transplantation and Clinical Regeneration; Mayo Clinic; Rochester MN USA
- Division of Biomedical Statistics and Informatics; Department of Health Sciences Research; Mayo Clinic; Rochester MN USA
| | - Charles B. Rosen
- William J. von Liebig Center for Transplantation and Clinical Regeneration; Mayo Clinic; Rochester MN USA
- Division of Transplantation Surgery; Mayo Clinic; Rochester MN USA
| | - Gregory J. Gores
- William J. von Liebig Center for Transplantation and Clinical Regeneration; Mayo Clinic; Rochester MN USA
- Division of Gastroenterology and Hepatology; Department of Medicine; Mayo Clinic; Rochester MN USA
| | - Raymund R. Razonable
- Division of Infectious Diseases; Department of Medicine; Mayo Clinic; Rochester MN USA
- William J. von Liebig Center for Transplantation and Clinical Regeneration; Mayo Clinic; Rochester MN USA
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Sampath R, Cummins NW, Natesampillai S, Bren GD, Chung TD, Baker J, Henry K, Pagliuzza A, Badley AD. Increasing procaspase 8 expression using repurposed drugs to induce HIV infected cell death in ex vivo patient cells. PLoS One 2017. [PMID: 28628632 PMCID: PMC5476266 DOI: 10.1371/journal.pone.0179327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 02/07/2023] Open
Abstract
HIV persists because a reservoir of latently infected CD4 T cells do not express viral proteins and are indistinguishable from uninfected cells. One approach to HIV cure suggests that reactivating HIV will activate cytotoxic pathways; yet when tested in vivo, reactivating cells do not die sufficiently to reduce cell-associated HIV DNA levels. We recently showed that following reactivation from latency, HIV infected cells generate the HIV specific cytotoxic protein Casp8p41 which is produced by HIV protease cleaving procaspase 8. However, cell death is prevented, possibly due to low procaspase 8 expression. Here, we tested whether increasing procaspase 8 levels in CD4 T cells will produce more Casp8p41 following HIV reactivation, causing more reactivated cells to die. Screening 1277 FDA approved drugs identified 168 that increased procaspase 8 expression by at least 1.7-fold. Of these 30 were tested for anti-HIV effects in an acute HIVIIIb infection model, and 9 drugs at physiologic relevant levels significantly reduced cell-associated HIV DNA. Primary CD4 T cells from ART suppressed HIV patients were treated with one of these 9 drugs and reactivated with αCD3/αCD28. Four drugs significantly increased Casp8p41 levels following HIV reactivation, and decreased total cell associated HIV DNA levels (flurbiprofen: p = 0.014; doxycycline: p = 0.044; indomethacin: p = 0.025; bezafibrate: P = 0.018) without effecting the viability of uninfected cells. Thus procaspase 8 levels can be increased pharmacologically and, in the context of HIV reactivation, increase Casp8p41 causing death of reactivating cells and decreased HIV DNA levels. Future studies will be required to define the clinical utility of this or similar approaches.
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Affiliation(s)
- Rahul Sampath
- Division of Infectious Disease, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Nathan W. Cummins
- Division of Infectious Disease, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Sekar Natesampillai
- Division of Infectious Disease, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Gary D. Bren
- Division of Infectious Disease, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Thomas D. Chung
- Office of Translation to Practice, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Jason Baker
- Division of Infectious Diseases, University of Minnesota, Minneapolis, MN, United States of America
| | - Keith Henry
- HIV Program, Hennepin County Medical Center, Minnneapolis, MN, United States of America
| | - Amélie Pagliuzza
- Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Canada
| | - Andrew D. Badley
- Division of Infectious Disease, Mayo Clinic Rochester, Rochester, MN, United States of America
- Office of Translation to Practice, Mayo Clinic Rochester, Rochester, MN, United States of America
- * E-mail:
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Jin JJ, Keith PJ, Cummins NW, Kane SV, Pritt BS, Sanchez JL. Lysinibacillus massiliensis Panniculitis Masquerading as Erythema Nodosum: A Case Report. Open Forum Infect Dis 2017; 4:ofx072. [PMID: 28584854 PMCID: PMC5450899 DOI: 10.1093/ofid/ofx072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/17/2017] [Accepted: 04/03/2017] [Indexed: 11/26/2022] Open
Abstract
Lysinibacillus massiliensis, formerly Bacillus massiliensis, is an environmental Gram-positive bacillus that is generally non-pathogenic. Rare case reports in immunosuppressed patients have described sepsis with this organism. In this study, we report a case of L massiliensis as a cause of infectious panniculitis mimicking erythema nodosum after infusion of autologous adipose-derived stem cells in an immunosuppressed patient with refractory Crohn’s disease. This case highlights the importance of care providers to consider exposures and host factors when interpreting culture results with otherwise benign organisms.
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Affiliation(s)
| | | | | | | | - Bobbi S Pritt
- Infectious Diseases.,Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
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Sampath R, Cummins NW, Badley AD. Casp8p41: The Protean Mediator of Death in CD4 T-cells that Replicate HIV. J Cell Death 2016; 9:9-17. [PMID: 27721655 PMCID: PMC5040423 DOI: 10.4137/jcd.s39872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/05/2016] [Revised: 06/12/2016] [Accepted: 06/14/2016] [Indexed: 01/15/2023] Open
Abstract
HIV cure is now the focus of intense research after Timothy Ray Brown (the Berlin patient) set the precedent of being the first and only person cured. A major barrier to achieving this goal on a meaningful scale is an elimination of the latent reservoir, which is thought to comprise CD4-positive cells that harbor integrated, replication-competent HIV provirus. These cells do not express viral proteins, are indistinguishable from uninfected CD4 cells, and are thought to be responsible for HIV viral rebound—that occurs within weeks of combination anti retroviral therapy (cART) interruption. Modalities to engineer transcriptional stimulation (reactivation) of this dormant integrated HIV provirus, leading to expression of cytotoxic viral proteins, are thought to be a specific way to eradicate the latently infected CD4 pool and are becoming increasingly relevant in the era of HIV cure. HIV protease is one such protein produced after HIV reactivation that cleaves procaspase-8 to generate a novel protein Casp8p41. Casp8p41 then binds to the BH3 domain of BAK, leading to BAK oligomerization, mitochondrial depolarization, and apoptosis. In central memory T cells (TCMs) from HIV-infected patients, an elevated Bcl-2/procaspase-8 ratio was observed, and Casp8p41 binding to Bcl-2 was associated with a lack of reactivation-induced cell death. This was reversed by priming cells with a specific Bcl-2 antagonist prior to reactivation, resulting in increased cell death and decreased HIV DNA in a Casp8p41-dependent pathway. This review describes the biology, clinical relevance, and implications of Casp8p41 for a potential cure.
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Affiliation(s)
- Rahul Sampath
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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Affiliation(s)
- Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic Rochester, Rochester, MN, USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic Rochester, Rochester, MN, USA
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Cummins NW, Badley AD, Kasten MJ, Sampath R, Temesgen Z, Whitaker JA, Wilson JW, Yao JD, Zeuli J, Rizza SA. Twenty years of human immunodeficiency virus care at the Mayo Clinic: Past, present and future. World J Virol 2016; 5:63-67. [PMID: 27175350 PMCID: PMC4861871 DOI: 10.5501/wjv.v5.i2.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/05/2016] [Accepted: 03/25/2016] [Indexed: 02/05/2023] Open
Abstract
The Mayo human immunodeficiency virus (HIV) Clinic has been providing patient centered care for persons living with HIV in Minnesota and beyond for the past 20 years. Through multidisciplinary engagement, vital clinical outcomes such as retention in care, initiation of antiretroviral therapy and virologic suppression are maximized. In this commentary, we describe the history of the Mayo HIV Clinic and its best practices, providing a “Mayo Model” of HIV care that exceeds national outcomes and may be applicable in other settings.
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Cummins NW, Sainski AM, Dai H, Natesampillai S, Pang YP, Bren GD, de Araujo Correia MCM, Sampath R, Rizza SA, O'Brien D, Yao JD, Kaufmann SH, Badley AD. Prime, Shock, and Kill: Priming CD4 T Cells from HIV Patients with a BCL-2 Antagonist before HIV Reactivation Reduces HIV Reservoir Size. J Virol 2016; 90:4032-4048. [PMID: 26842479 PMCID: PMC4810548 DOI: 10.1128/jvi.03179-15] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/28/2016] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Understanding how some HIV-infected cells resist the cytotoxicity of HIV replication is crucial to enabling HIV cure efforts. HIV killing of CD4 T cells that replicate HIV can involve HIV protease-mediated cleavage of procaspase 8 to generate a fragment (Casp8p41) that directly binds and activates the mitochondrial proapoptotic protein BAK. Here, we demonstrate that Casp8p41 also binds with nanomolar affinity to the antiapoptotic protein Bcl-2, which sequesters Casp8p41 and prevents apoptosis. Further, we show that central memory CD4 T cells (TCM) from HIV-infected individuals have heightened expression of BCL-2 relative to procaspase 8, possibly explaining the persistence of HIV-infected TCMdespite generation of Casp8p41. Consistent with this hypothesis, the selective BCL-2 antagonist venetoclax induced minimal killing of uninfected CD4 T cells but markedly increased the death of CD4 T cells and diminished cell-associated HIV DNA when CD4 T cells from antiretroviral therapy (ART)-suppressed HIV patients were induced with αCD3/αCD28 to reactivate HIVex vivo Thus, priming CD4 T cells from ART suppressed HIV patients with a BCL-2 antagonist, followed by HIV reactivation, achieves reductions in cell-associated HIV DNA, whereas HIV reactivation alone does not. IMPORTANCE HIV infection is incurable due to a long-lived reservoir of HIV(+)memory CD4 T cells, and no clinically relevant interventions have been identified that reduce the number of these HIV DNA-containing cells. Since postintegration HIV replication can result in HIV protease generation of Casp8p41, which activates BAK, causing infected CD4 T cell death, we sought to determine whether this occurs in memory CD4 T cells. Here, we demonstrate that memory CD4 T cells can generate Casp8p41 and yet are intrinsically resistant to death induced by diverse stimuli, including Casp8p41. Furthermore, BCL-2 expression is relatively increased in these cells and directly binds and inhibits Casp8p41's proapoptotic effects. Antagonizing BCL-2 with venetoclax derepresses this antagonism, resulting in death, preferentially in HIV DNA containing cells, since only these cells generate Casp8p41. Thus, BCL-2 antagonism is a clinically relevant intervention with the potential to reduce HIV reservoir size in patients.
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Affiliation(s)
- Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy M Sainski
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota, USA
| | - Haiming Dai
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Yuan-Ping Pang
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gary D Bren
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Rahul Sampath
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Stacey A Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel O'Brien
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph D Yao
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott H Kaufmann
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Marcelin JR, Berg ML, Tan EM, Amer H, Cummins NW, Rizza SA. Is Abnormal Urine Protein/Osmolality Ratio Associated with Abnormal Renal Function in Patients Receiving Tenofovir Disoproxil Fumarate? PLoS One 2016; 11:e0149562. [PMID: 26872144 PMCID: PMC4752319 DOI: 10.1371/journal.pone.0149562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/28/2015] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Risk factors for and optimal surveillance of renal dysfunction in patients on tenofovir disoproxil fumarate (TDF) remain unclear. We investigated whether a urine protein-osmolality (P/O) ratio would be associated with renal dysfunction in HIV-infected persons on TDF. METHODS This retrospective, single-center study investigated the relationship between parameters of renal function (estimated glomerular filtration rate (eGFR) and P/O-ratio) and risk factors for development of kidney dysfunction. Subjects were HIV-infected adults receiving TDF with at least one urinalysis and serum creatinine performed between 2010 and 2013. Regression analyses were used to analyze risk factors associated with abnormal P/O-ratio and abnormal eGFR during TDF therapy. RESULTS Patients were predominately male (81%); (65%) were Caucasian. Mean age was 45.1(±11.8) years; median [IQR] TDF duration was 3.3 years. [1.5-7.6]. Median CD4+ T cell count and HIV viral load were 451 cells/μL [267.5-721.5] and 62 copies/mL [0-40,150], respectively. Abnormal P/O-ratio was not associated with low eGFR. 68% of subjects had an abnormal P/O-ratio and 9% had low eGFR. Duration of TDF use, age, diabetes and hypertension were associated with renal dysfunction in this study. After adjustment for age, subjects on TDF > 5 years had almost a four-fold increased likelihood of having an abnormal P/O-ratio than subjects on TDF for < 1yr (OR 3.9; 95% CI 1.2-14.0; p = 0.024). CONCLUSION Abnormal P/O-ratio is common in HIV-infected patients on TDF but was not significantly associated with low eGFR, suggesting that abnormal P/O-ratio may be a very early biomarker of decreased renal function in HIV infected patients.
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Affiliation(s)
- Jasmine R. Marcelin
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Melody L. Berg
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Rochester, MN, United States of America
| | - Eugene M. Tan
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Hatem Amer
- Department of Medicine, Division of Nephrology & Hypertension, Mayo Clinic, Rochester MN, United States of America
| | - Nathan W. Cummins
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Stacey A. Rizza
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, United States of America
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Tan EM, Marcelin JR, Tande AJ, Rizza SA, Cummins NW. Fever and Cardiac Arrest in a Patient With a Left Ventricular Assist Device. Open Forum Infect Dis 2015; 2:ofv033. [PMID: 26380334 PMCID: PMC4567092 DOI: 10.1093/ofid/ofv033] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/27/2015] [Indexed: 11/13/2022] Open
Abstract
A 68-year-old avid deer hunter with ischemic cardiomyopathy underwent left ventricular assist device (LVAD) implantation for destination therapy two years ago. He was living an active lifestyle, tracking deer and fishing in a Midwestern forest in November. His wife removed an engorged tick on his thorax. A few days later, he experienced fever, confusion, and ataxia and was hospitalized with septic shock and ventricular fibrillation. The LVAD site had no signs of trauma, drainage, warmth, or tenderness. A peripheral blood smear revealed intraleukocytic anaplasma microcolony inclusions. After completing 14 days of doxycycline, he recovered. Typical non-device-associated infections in LVAD recipients include pneumonia, urinary tract infection, or Clostridium difficile colitis. Human granulocytic anaplasmosis (HGA) is a very atypical non-LVAD infection, and the incidence of tickborne illnesses in LVAD recipients is unknown.
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Affiliation(s)
- Eugene M Tan
- Division of Infectious Diseases, Department of Internal Medicine , Mayo Clinic , Rochester, Minnesota
| | - Jasmine R Marcelin
- Division of Infectious Diseases, Department of Internal Medicine , Mayo Clinic , Rochester, Minnesota
| | - Aaron J Tande
- Division of Infectious Diseases, Department of Internal Medicine , Mayo Clinic , Rochester, Minnesota
| | - Stacey A Rizza
- Division of Infectious Diseases, Department of Internal Medicine , Mayo Clinic , Rochester, Minnesota
| | - Nathan W Cummins
- Division of Infectious Diseases, Department of Internal Medicine , Mayo Clinic , Rochester, Minnesota
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Marcelin JR, Berg M, Cummins NW, Rizza S. 1571Risk factors for Tenofovir-associated Renal Dysfunction in HIV-positive Patients. Open Forum Infect Dis 2014. [PMCID: PMC5781765 DOI: 10.1093/ofid/ofu052.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sainski AM, Dai H, Natesampillai S, Pang YP, Bren GD, Cummins NW, Correia C, Meng XW, Tarara JE, Ramirez-Alvarado M, Katzmann DJ, Ochsenbauer C, Kappes JC, Kaufmann SH, Badley AD. Casp8p41 generated by HIV protease kills CD4 T cells through direct Bak activation. J Biophys Biochem Cytol 2014. [PMCID: PMC4195834 DOI: 10.1083/jcb.20140505109252014c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sainski AM, Dai H, Natesampillai S, Pang YP, Bren GD, Cummins NW, Correia C, Meng XW, Tarara JE, Ramirez-Alvarado M, Katzmann DJ, Ochsenbauer C, Kappes JC, Kaufmann SH, Badley AD. Casp8p41 generated by HIV protease kills CD4 T cells through direct Bak activation. ACTA ACUST UNITED AC 2014; 206:867-76. [PMID: 25246614 PMCID: PMC4178959 DOI: 10.1083/jcb.201405051] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HIV protease converts procaspase 8 into Casp8p41, which binds and activates Bak to induce cell death in infected CD4 T cells. Previous studies have shown that human immunodeficiency virus (HIV) protease cleaves procaspase 8 to a fragment, termed Casp8p41, that lacks caspase activity but nonetheless contributes to T cell apoptosis. Herein, we show that Casp8p41 contains a domain that interacts with the BH3-binding groove of pro-apoptotic Bak to cause Bak oligomerization, Bak-mediated membrane permeabilization, and cell death. Levels of active Bak are higher in HIV-infected T cells that express Casp8p41. Conversely, targeted mutations in the Bak-interacting domain diminish Bak binding and Casp8p41-mediated cell death. Similar mutations in procaspase 8 impair the ability of HIV to kill infected T cells. These observations support a novel paradigm in which HIV converts a normal cellular constituent into a direct activator that functions like a BH3-only protein.
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Affiliation(s)
- Amy M Sainski
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294 Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - Haiming Dai
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - Sekar Natesampillai
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - Yuan-Ping Pang
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - Gary D Bren
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - Nathan W Cummins
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - Cristina Correia
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - X Wei Meng
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294 Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - James E Tarara
- Department of Biochemistry and Molecular Biology and Department of Molecular Medicine, Mayo Clinic, Rochester MN 55905
| | - Marina Ramirez-Alvarado
- Department of Biochemistry and Molecular Biology and Department of Molecular Medicine, Mayo Clinic, Rochester MN 55905
| | - David J Katzmann
- Department of Biochemistry and Molecular Biology and Department of Molecular Medicine, Mayo Clinic, Rochester MN 55905
| | - Christina Ochsenbauer
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - John C Kappes
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - Scott H Kaufmann
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294 Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294
| | - Andrew D Badley
- Department of Molecular Pharmacology and Experiment Therapeutics, Division of Oncology Research, Division of Infectious Diseases, and Department of Medicine, University of Alabama, Birmingham, AL 35294 Department of Biochemistry and Molecular Biology and Department of Molecular Medicine, Mayo Clinic, Rochester MN 55905
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Cummins NW, Badley AD. Making sense of how HIV kills infected CD4 T cells: implications for HIV cure. Mol Cell Ther 2014; 2:20. [PMID: 26056587 PMCID: PMC4452072 DOI: 10.1186/2052-8426-2-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/16/2014] [Indexed: 02/07/2023]
Abstract
Defining how HIV does, and does not, kill the host CD4 T cell that it infects is of paramount importance in an era when research is approaching a cure for infection. Three mutually exclusive pathways can lead to the death of HIV-infected cells during the HIV life cycle, before, coincident and after HIV integration and consequently may affect viral replication. We discuss the molecular mechanism underlying these pathways, the evidence supporting their roles in vivo, and contemplate how understanding these pathways might inform novel approaches to promote viral cure of HIV.
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Affiliation(s)
- Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, 200 - 1st Street SW, Rochester, MN 55905 USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, 200 - 1st Street SW, Rochester, MN 55905 USA
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Cummins NW, Badley AD. Making sense of how HIV kills infected CD4 T cells: implications for HIV cure. Mol Cell Ther 2014; 2:20. [PMID: 26056587 PMCID: PMC4452072] [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] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/16/2014] [Indexed: 11/21/2023]
Abstract
Defining how HIV does, and does not, kill the host CD4 T cell that it infects is of paramount importance in an era when research is approaching a cure for infection. Three mutually exclusive pathways can lead to the death of HIV-infected cells during the HIV life cycle, before, coincident and after HIV integration and consequently may affect viral replication. We discuss the molecular mechanism underlying these pathways, the evidence supporting their roles in vivo, and contemplate how understanding these pathways might inform novel approaches to promote viral cure of HIV.
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Affiliation(s)
- Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, 200 - 1st Street SW, Rochester, MN 55905 USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, 200 - 1st Street SW, Rochester, MN 55905 USA
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Cummins NW, Neuhaus J, Sainski AM, Strausbauch MA, Wettstein PJ, Lewin SR, Plana M, Rizza SA, Temesgen Z, Touloumi G, Freiberg M, Neaton J, Badley AD. Short communication: CD4 T cell declines occurring during suppressive antiretroviral therapy reflect continued production of Casp8p41. AIDS Res Hum Retroviruses 2014; 30:476-9. [PMID: 24344953 DOI: 10.1089/aid.2013.0243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Most patients on suppressive antiretroviral therapy (ART) experience improvements in CD4 T cell count. However, some patients with undetectable viral load continue to lose CD4 T cells for unknown reasons. Casp8p41 is a host-derived protein fragment that is present only in productively infected cells and that causes the death of HIV-infected cells. We questioned whether ongoing CD4(+) T cell losses while on suppressive ART were associated with subclinical HIV replication causing production of Casp8p41. We analyzed the association of Casp8p41 content with subsequent CD4 losses in patients on continuous suppressive ART and in patients who discontinued ART after Casp8p41 content was determined, adjusting for age, baseline CD4(+) T cell count, and baseline HIV RNA level. Casp8p41 expression in memory CD4(+) T cells was measured by intracellular flow cytometry and was correlated with viral load and CD4(+) T cell change over time. In patients who stopped therapy after Casp8p41 content was determined, baseline Casp8p41 content did not predict CD4(+) T cell change. However, in patients on continuous ART, higher baseline Casp8p41 content was associated with a greater odds of a CD4(+) T cell decline at 6 months (p=0.01). Therefore, patients on suppressive ART, who have ongoing production of Casp8p41, have an increased risk of CD4 T cell losses, suggesting that subclinical HIV replication is driving both Casp8p41, which in turn causes a CD4(+) T cell decline.
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Affiliation(s)
| | - Jacqueline Neuhaus
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Amy M. Sainski
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | | | - Peter J. Wettstein
- Departments of Surgery and Immunology, Mayo Clinic, Rochester, Minnesota
| | - Sharon R. Lewin
- Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
- Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Montserrat Plana
- Hospital Clinic-HIVACAT, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Stacey A. Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Zelalem Temesgen
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | - Matthew Freiberg
- Department of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Andrew D. Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
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Cummins NW, Sainski AM, Natesampillai S, Bren GD, Badley AD. Choice of antiretroviral therapy differentially impacts survival of HIV-infected CD4 T cells. Mol Cell Ther 2014; 2:1. [PMID: 26057236 PMCID: PMC4448955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/29/2013] [Indexed: 11/21/2023]
Abstract
BACKGROUND HIV eradication strategies are now being evaluated in vitro and in vivo. A cornerstone of such approaches is maximal suppression of viral replication with combination antiretroviral therapy (ART). Since many antiretroviral agents have off target effects, and different classes target different components of the viral life cycle, we questioned whether different classes of ART might differentially affect the survival and persistence of productively HIV-infected CD4 T cells. METHODS In vitro infections of primary CD4 T cells using clinical isolates of HIV-1 that were either protease inhibitor susceptible (HIV PI-S), or resistant (HIV PI-R) were treated with nothing, lopinavir, efavirenz or raltegravir. Cell viability, apoptosis, and the proportion of surviving cells that were P24 positive was assessed by flow cytometry. RESULTS In HIV PI-S infected primary cultures, all three antiretroviral agents decreased viral replication, and reduced the total number of cells that were undergoing apoptosis (P < 0.01) similarly. Similarly, in the HIV PI-R infected cultures, both efavirenz and raltegravir reduced viral replication and reduced apoptosis compared to untreated control (P < 0.01), while lopinavir did not, suggesting that HIV replication drives T cell apoptosis, which was confirmed by association by linear regression (P < 0.0001) . However since HIV protease has been suggested to directly induce apoptosis of infected CD4 T cells, and HIV PI are intrinsically antiapoptotic, we evaluated apoptosis in productively infected (HIV P24+) cells. More HIV p24 positive cells were apoptotic in the Efavirenz or raltegravir treated cultures than the lopinavir treated cultures (P = 0.0008 for HIV PI-R and P = 0.06 for the HIV PI-S), indicating that drug class impacts survival of productively infected CD4 T cells. CONCLUSIONS Inhibiting HIV replication with a PI, NNRTI or INSTI reduces total HIV-induced T cell apoptosis. However, blocking HIV replication with PI but not with NNRTI or INSTI promotes survival of productively HIV-infected cells. Thus, selection of antiretroviral agents may impact the success of HIV eradication strategies.
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Affiliation(s)
- Nathan W Cummins
- />Division of Infectious Diseases, Mayo Clinic Rochester, Rochester, MN USA
| | - Amy M Sainski
- />Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic Rochester, Rochester, MN USA
| | | | - Gary D Bren
- />Division of Infectious Diseases, Mayo Clinic Rochester, Rochester, MN USA
| | - Andrew D Badley
- />Division of Infectious Diseases, Mayo Clinic Rochester, Rochester, MN USA
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Cummins NW, Sainski AM, Natesampillai S, Bren GD, Badley AD. Choice of antiretroviral therapy differentially impacts survival of HIV-infected CD4 T cells. Mol Cell Ther 2014; 2:1. [PMID: 26057236 PMCID: PMC4448955 DOI: 10.1186/2052-8426-2-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/29/2013] [Indexed: 01/04/2023]
Abstract
Background HIV eradication strategies are now being evaluated in vitro and in vivo. A cornerstone of such approaches is maximal suppression of viral replication with combination antiretroviral therapy (ART). Since many antiretroviral agents have off target effects, and different classes target different components of the viral life cycle, we questioned whether different classes of ART might differentially affect the survival and persistence of productively HIV-infected CD4 T cells. Methods In vitro infections of primary CD4 T cells using clinical isolates of HIV-1 that were either protease inhibitor susceptible (HIV PI-S), or resistant (HIV PI-R) were treated with nothing, lopinavir, efavirenz or raltegravir. Cell viability, apoptosis, and the proportion of surviving cells that were P24 positive was assessed by flow cytometry. Results In HIV PI-S infected primary cultures, all three antiretroviral agents decreased viral replication, and reduced the total number of cells that were undergoing apoptosis (P < 0.01) similarly. Similarly, in the HIV PI-R infected cultures, both efavirenz and raltegravir reduced viral replication and reduced apoptosis compared to untreated control (P < 0.01), while lopinavir did not, suggesting that HIV replication drives T cell apoptosis, which was confirmed by association by linear regression (P < 0.0001) . However since HIV protease has been suggested to directly induce apoptosis of infected CD4 T cells, and HIV PI are intrinsically antiapoptotic, we evaluated apoptosis in productively infected (HIV P24+) cells. More HIV p24 positive cells were apoptotic in the Efavirenz or raltegravir treated cultures than the lopinavir treated cultures (P = 0.0008 for HIV PI-R and P = 0.06 for the HIV PI-S), indicating that drug class impacts survival of productively infected CD4 T cells. Conclusions Inhibiting HIV replication with a PI, NNRTI or INSTI reduces total HIV-induced T cell apoptosis. However, blocking HIV replication with PI but not with NNRTI or INSTI promotes survival of productively HIV-infected cells. Thus, selection of antiretroviral agents may impact the success of HIV eradication strategies. Electronic supplementary material The online version of this article (doi:10.1186/2052-8426-2-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic Rochester, Rochester, MN USA
| | - Amy M Sainski
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic Rochester, Rochester, MN USA
| | | | - Gary D Bren
- Division of Infectious Diseases, Mayo Clinic Rochester, Rochester, MN USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic Rochester, Rochester, MN USA
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Cummins NW, Badley AD. Anti-apoptotic mechanisms of HIV: lessons and novel approaches to curing HIV. Cell Mol Life Sci 2012; 70:3355-63. [PMID: 23275944 PMCID: PMC3753464 DOI: 10.1007/s00018-012-1239-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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: 08/25/2012] [Revised: 11/18/2012] [Accepted: 12/10/2012] [Indexed: 12/17/2022]
Abstract
Past efforts at curing infection with the human immunodeficiency virus (HIV) have been blocked by the resistance of some infected cells to viral cytopathic effects and the associated development of a latent viral reservoir. Furthermore, current efforts to clear the viral reservoir by means of reactivating latent virus are hampered by the lack of cell death in the newly productively infected cells. The purpose of this review is to describe the many anti-apoptotic mechanisms of HIV, as well as the current limitations in the field. Only by understanding how infected cells avoid HIV-induced cell death can an effective strategy to kill infected cells be developed.
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Affiliation(s)
- Nathan W Cummins
- Division of Infectious Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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