I declare that I have no financial conflicts of interest

Transcription

1 I declare that I have no financial conflicts of interest

2 Cytotoxic T-Lymphocytes Eliminate Defective HIV Proviruses Without Impacting Infectious Reservoirs R. Brad Jones Assistant Professor The George Washington University

3 Strategies to Improve Upon Antiretroviral Therapy 1) Sterilizing cure eradicate all viral reservoirs from the body stop antiretroviral therapy 2) Functional cure enable long-term immune control of virus stop antiretroviral therapy

4 Strategies to Improve Upon Antiretroviral Therapy 1) Sterilizing cure eradicate all viral reservoirs from the body stop antiretroviral therapy 2) Functional cure enable long-term immune control of virus stop antiretroviral therapy 3) Reduce HIV proviral (DNA) burden continue with antiretroviral therapy but less inflammation? Improved health/quality of life?

5 HIVE Results ARV-Treated Subject #2 - Vorinostat Trend towards decrease in vorinostat only and vorinostat + CTL conditions but no additive kick and kill effect

6 Shock and Kill Paradigm Landmark study - vorinostat alone did not drive reductions in infectious viral reservoirs from ex vivo CD4+ T-cells (natural reservoirs) Shan et al, 2012 Can combinations of CTLs with LRAs drive reductions in natural reservoirs?

7 Shock and Kill Approach to HIV Eradication Cytotoxic T lymphocyte Latency reversing drug HIV

8 Natural Reservoirs Contain Intact and Defective HIV What is the reservoir that matters?

9 Some Defective Proviruses Can Express Antigens Data show CTLs responding to defective proviruses Reference Ψ deletion Hypermutation Internal deletion Internal deletion Internal deletion Nonsense mutation HXB2 45E6 31G4 48C8 E44E11 4F12 19B3 OM5267 B27-Gag-IK9 IRLRPGGKK MGARASVLSGGELDRWEKIRLRPGGKKKYKL I Q- I-----I I Q I-R-EK A----K H-M HXB2 45E6 31G4 48C8 E44E11 4F12 19B3 OM5011 B07-Gag-HA9 HPVHAGPIA EAAEWDRVHPVHAGPIAPGQ T *--L T D---L A T V---- HXB2 45E6 31G4 48C8 E44E11 4F12 19B3 OM5267 Cw08-Nef-AL9 AAVDLSHFL CAWLEAQEEEEVGFPVTPQVPLRPMTYKAAVDLSHFLKEK D R *-----D R G-L R *-----D R **** ** * 100 *** 100 * %CD107a 10 %CD107a 10 %CD107a 10 Ya Chi Ho 1 45E6 31G4 48C8 E44E11 4F12 19B3 Vector Peptide 1 45E6 31G4 48C8 E44E11 4F12 19B3 Vector Peptide 1 45E6 31G4 48C8 E44E11 4F12 19B3 Vector Peptide

10 Directly from participant Can CTLs Eliminate Intact / Defective HIV Reservoir

11 HIVE Results ARV-Treated Subject #1 Shock and kill 50% reduction in HIV DNA CD107a CD8 HIV-Gag-HA9 CTL clone specificity No Peptide + HIV Peptide Copies HIV DNA/10 6 CD4 + Cells Subject OM5011 ddpcr p < p = 0.01 No Tx Gag-spec Bryo. Bryo. + Gag-spec CTL Need elimination of defective proviruses to account for these decreases

12 HIVE Results ARV-Treated Subject #1 How much infectious virus is left in these cells (quantitative viral outgrowth assays) Surprisingly, no decrease in infectious virus! Infectious Units Per Million Subject OM5011 QVOA No Tx Bryostatin Bryostatin + Gag-spec CTL

13 CTLs Eliminated Defective but not Intact Virus

14 Maximal Latency Reversal Strongest Shock Again, decrease in HIV DNA but no change in infectious virus

15 No CTL Escape Mutations in Infectious Virus Uninfected Infect activated CD4+ T-cells with virus from single +QVOA well Co-culture infected targets with same CTL clone used in HIVE assay OM5011 CTL Killing Assay 0.0 Infected Infected + CTL Co-culture for 16 hours and then measure % Infected (Gag+) by flow cytometry No CTL control CD HIV-Gag (Infected) 1.8 Thus, failure to reduce intact-inducible virus not due to: i) immune escape ii) lack of CTL cytotoxicity

16 Similar Results with Other CTLs and Shocks Cell-associated HIV DNA Quantitative Viral Outgrowth Assays

17 Decrease in HIV DNA But No Delay in Viral Rebound

18 Conclusions Shock and Kill reduced defective HIV DNA but not infectious virus Precision of assay to measure infectious virus is limited, but need much greater decreases to delay viral rebound Defective HIV DNA can stimulate the immune system! Is this contributing to ongoing inflammation Potential benefit of reducing HIV DNA, even if ARV therapy must be continued

19 Strategies to Improve Upon HAART 1) Sterilizing cure eradicate all viral reservoirs from the body stop antiretroviral therapy 2) Functional cure enable long-term immune control of virus stop antiretroviral therapy 3) Reduce HIV proviral (DNA) burden continue with antiretroviral therapy but less inflammation? Improved health/quality of life?

20 Acknowledgments Lab Members Allison Thomas John Huang Sara Karandish Dora Chan Adam Ward Collaborators Bruce Walker Darrell Irvine Douglas Nixon John Mellors Ya Chi Ho Robert Siliciano Clinical Samples Participants Colin Kovacs Erika Benko Mario Ostrowski Altor Bioscience Hing Wong Emily Jeng

21 HIVE Results ARV-Treated Subject #2 - Vorinostat CD107a HIV-Gag-Spec CTL-HA9 + Peptide PE-A CD8 No Peptide Alexa Fluor 700-A 0.83 PE-A Copies HIV DNA/10 6 CD4 + Cells Vorinostat Cell-Associated HIV DNA No Tx Gag-spec CTL Vorinostat Voninostat + Gag-spec CTL No detectable decrease in cell-associated HIV DNA following treatment with vorinostat + CTL

22 Cytotoxic T Lymphocytes CTL Kill HIV Infected Cells Cyt CTL Sudha Kumari

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