Imaging B Cell Follicles to Investigate HIV/SIV Persistence. Elizabeth Connick, M.D. University of Arizona May 8, 2017

Transcription

1 Imaging B Cell ollicles to Investigate HIV/SIV Persistence Elizabeth Connick, M.D. University of Arizona May 8, 2017

2 Most HIV Replication Occurs In Secondary Lymphoid Tissues Tenner-Racz K et al. Am J Pathol 1986;123:9; Pantaleo G et al. Nature 1993:362:355; Embretson J et al. Nature 1993:362:3359 Lymph Node Structure

3 HIV Replication is Concentrated in in CD4+ T Cells in B Cell ollicles (i.e., TH) (Tenner-Racz K et al. Am J Pathol 1986;123:9; Biberfeld P et al. Am J Pathol 1986:125:436123:9; Hufert T et al. AIDS 1997;11:849; Tenner-Racz K et al. J Exp Med 1998;187:949) H IV-1 producing cells/m m A CD4+ cell in has a 31-fold (range, 6- to 155-fold) greater likelihood of being HIV RNA+ as a CD4+ cell in E. p = Subject inside follicle outside follicle olkvord J, et al. ARHR 2005: 21:363.

4 HIV Replication is Concentrated within Germinal Centers of ollicles GC Kohler S, et al. J Immunol, 2016; 196:2711

5 Are GC TH More Permissive than Tonsil Cell Infection with GP Reporter Virus Other CD4+ T Cells? GC T H CXCR5+PD-1 low Non-GC T H E Kohler S, et al. J Immunol, 2016; 196:2711

6 GP Expression in Tonsil Subsets R5 Virus X4 Virus % GP+ Percentage of GP+ Cells E CXCR5+ PD -1 low *** ns non-gc T H *** GC T H Percentage of GP+ Cells E CXCR5+ PD -1 low *** ns non-gc T H *** GC T H MI of GP gm I of G P+ C ells *** *** *** gm I of G P+ C ells ** *** *** 0 E CXCR5+ PD -1 low non-gc T H GC T H 0 E CXCR5+ PD -1 low non-gc T H GC T H Kohler S, et al. J Immunol, 2016; 196:2711

7 GP Expression in Sorted Tonsil Cell Subsets Percentage of GP+ Cells E CXCR5+PD-1 lo w GC T H T282 T290 T294 T165 T169 T171 R5 GC TH are highly permissive, but alter their phenotype during productive infection. X4 Kohler S, et al. J Immunol, 2016; 196:2711

8 Why Are CTL Unable to Suppress HIV Replication in B Cell ollicles? Inadequate numbers of CTL Escape from immune recognition Impaired effector mechanisms Immune privileged site

9 CD8+ T Cells and Many Antiviral Proteins Are Less Abundant in B-cell ollicles Protein HIV-1 seropositive subjects (N=15) Median Cells/mm 2 (range) E Median Cells/mm 2 (range) p value IN-α 0.4 ( ) 2.7 ( ) α-defensins 1, 2, ( ) 4.9 ( ) RANTES 282 ( ) 1025 ( ) MIP-1α 32 (6-132) 105 (21 577) MIP-1β 14 (0 299) 23 (9-244) Interferon-ɣ 1.0 ( ) 2.7 ( )) Perforin 4.7 ( ) 4.1 ( ) Granzyme A 158 (15 444) 465 ( ) CD ( ) 56.7 ( ) < olkvord J, et al. ARHRV 2005; 21:363

10 Are HIV-Specific CTL deficient in B cell follicles? Skinner, et al, In situ tetramer staining of antigen-specific T cells in tissues. J Immunol 165:613 Skinner, et al, In situ tetramer staining. J Immunol Methods 268:29 Dr. Pamela Skinner

11 CTL ail to Accumulate in ollicles of Untreated HIV+ Lymph Node HLA-A*0201 gag CD20 Connick E.Skinner P. J Immunol 2007;178:6975

12 SIV-Infected Rhesus Macaque Model 1. Does the SIV-infected macaque model recapitulate the distribution of virus and CTL in humans? 2. Does the same pattern occur in all secondary lymphoid tissues?

13 SIV RNA+ Cells Are More requent in vs E in Chronic Infection Without SAIDS p < p < p < Inguinal A xillary S IV R N A + cells/m m S pleen LN LN Mes LN Ileum Cecum Colon 0.01 :E ratio GM 95% CI E , 10.7 E E , 4.0 E E E , 43.4 E Connick E Skinner P. J Immunol 2014; 193:5613.

14 SIV RNA+ Cells Remain Concentrated in after Adjusting for requencies of Target Memory Cells p < SIV RNA+/CD4+CD95+ (X10000) :E ratio GM 95% CI Spleen E Lymph Node E , 12.4 Colon E Connick E Skinner P. J Immunol 2014; 193:5613.

15 SIV-Specific Tetramer Staining Cells Are Concentrated in Extrafollicular Zones p = Red = Mamu B*08/Vif RL8 tetramer Green = CD20 Blue = CD3 Tetram er + c e lls /m m P< E Connick E Skinner P. J Immunol 2014; 193:5613.

16 Effector to Target Cell Ratios are More than 10-old Higher in E vs R atio C TL cells:siv R N A + cells p = E Connick E Skinner P. J Immunol 2014; 193:5613.

17 requencies of CTL are Inversely Related to SIV RNA+ cells in E and SIV R N A + cells/m m p<0.001 LN Extrafollicular L N ollicu lar Spleen Extrafollicular S pleen ollicular C TL cells/m m 2 Connick E Skinner P. J Immunol 2014; 193:5613.

18 Is Virus Replication Concentrated in ollicles in the Absence of a Robust CTL Response? Acute SIV infection when CTL are evolving SAIDS when CTL are losing the ability to control virus CD8 Depletion CD8 cells transiently eliminated Hypothesis: Virus replication is not concentrated in in the absence of a robust CTL response.

19 requencies of SIV RNA+ Cells in ollicles () and Extrafollicular Zones (E) Vary by Disease Stage 14 Day Acute p = 0.99 Chronic p = SA ID S p = SIV R N A + cells/m m E E E :E GM % CI 0.66, , , 3.4 Connick E Skinner P. J Immunol 2014; 193:5613.

20 SIV RNA Increases Primarily in the Extrafollicular Zone after CD8 Depletion SIV RNA copies/m l ( ) Pre Depletion LN CD8 depleting antibodies Post Depletion LN CM9 Tetramer+ T cells/ml blood (-----) S IV R N A + cells/m m Pre ollicle Post E xtrafollicular Zone Pre Post Days post-infection Li S et al. J Virol (in press).

21 Why do CTL fail to accumulate in large numbers in where virus is Homing Phenotype highly concentrated? ew SIV-Specific CTL Exhibit a ollicular 70 %SIV-specific CTL CXCR5+ CXCR5+ CCR7+ CCR7+ CCR7- CXCR5- CXCR5- CCR7- Connick E Skinner P. J Immunol 2014; 193:5613

22 ollicles Are HIV Reservoirs in ART- Treated Individuals (Pallikkuth S, et al. J Virol 2015; 90:2718; Banga R, et al. Nature Med 2016;22:754) RNAscope in Lymph Node of ART-Treated Person (Connick E, unpublished data) HIV RNA in situ+ (red); CD20 (white), DC (green)

23 SIV Targeting CTL to B Cell ollicles To Induce a unctional Cure Isolate CTL and transduce CXCR5 Expand CXCR5+ CTL and CTL alone Discontinue ART and assess localization of CTL and virus vis a vis untransduced CTL Infuse into ARTtreated macaque

24 Acknowledgments Study Participants University of Colorado Joy olkvord Samantha MaWhinney Martin McCarter Mario Santiago Brodie Miles Shannon Miller Amie Meditz Alden Harken Karen Whalen Katie Lind Tessa Arends Wisconsin National Primate Research Center Eva Rakasz Nancy Wilson David Watkins University of Kansas Edward Stephens NYU Dental College David Levy University of MN Pamela Skinner Hyeon Kim Reese Wagstaff Hadia Mohamed Nathan Kemp Shengbin Li unding Agencies/Reagent Resources NIH Tetramer Core acility Nonhuman Primate Reagent Resource