The Role of B Cell Follicles in HIV Replication and Persistence

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1 The Role of B Cell ollicles in HIV Replication and Persistence Elizabeth Connick, M.D. Professor of Medicine Chief, Division of Infectious Diseases University of Arizona July 17, 2016 IAS 2016 Towards an HIV Cure Symposium Durban, South Africa

2 Conflicts Dr. Connick has served as a member of data monitoring committees for Sangamo Biosciences-sponsored clinical trials.

3 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

4 Two Patterns of HIV RNA are ound in Lymph Nodes HIV RNA in situ+ (red); CD20 (white), DC (green) Intracellular HIV RNA In CD4+ Cells Virions Bound to ollicular Dendritic Cells (DC) Heath SL et al. Nature 1995;377:740; Smith BA et al. J Immunol 2001;166:690; Keele B J Virol 2008;82:5548.

5 HIV Replication is Concentrated in CD4+ clls in B Cell ollicles (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) A CD4+ cell in had a 31-fold (range, 6- to 155-fold) greater likelihood of being HIV RNA+ as a CD4+ cell in E. H IV -1 p r o d u c in g c e lls /m m p = in s id e fo llic le o u ts id e fo llic le S u b je c t olkvord J et al. AIDS Research and Human Retroviruses 2005: 21:363.

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

7 g M I o f G P + C e lls g M I o f G P + C e lls P e rc e n ta g e o f G P + C e lls P e rc e n ta g e o f G P + C e lls GP Expression in Tonsil Subsets R5 Virus X4 Virus 1 0 * * * n s * * * 3 0 * * * n s * * * % GP E C X C R 5 + P D -1 lo w n o n -G C T H G C T H 0 E C X C R 5 + P D -1 lo w n o n -G C T H G C T H * * * * * * * * * * * * * * * * * MI of GP E C X C R 5 + P D -1 lo w n o n -G C T H G C T H 0 E C X C R 5 + P D -1 lo w n o n -G C T H G C T H Kohler S, et al. J Immunol, 2016; 196:2711

8 P e rc e n ta g e o f G P + C e lls GP Expression in Sorted Tonsil Cell Subsets E C X C R 5 + P D -1 lo w G C T H T T T T T T R 5 X 4 GC TH are highly permissive, but alter their phenotype during productive infection. Kohler S, et al. J Immunol, 2016; 196:2711

9 Why Are CTL Unable to Suppress HIV Replication in B Cell ollicles? Hypothesis: B cell follicles are immune privileged sites.

10 CD8+ 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

11 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

12 CTL ail to Accumulate in of Untreated HIV+ Lymph Node HLA-A*0201 gag CD20 Connick E, et al. J Immunol 2007;178:6975

13 SIV RNA+ Cells Are More requent in Compared to E p < p < p < In g u in a l A x illa ry S p le e n L N L N M e s L N Ile u m C e c u m C o lo n 1 0 S IV R N A + c e lls /m m :E ra tio G M 9 5 % C I E , E E , 4.0 E E E , E Connick E, et al. J Immunol 2014; 193:5613;

14 SIV-Specific Tetramer Staining Cells Are Concentrated in E p = T e t r a m e r + c e l l s / m m Red = Mamu B*08/Vif RL8 tetramer Green = CD20 Blue = CD3 P< E Connick E, et. al. J Immunol 2014; 193:5613. Tjernlund A, et al. Retrovirology 2010;7:12.

15 S IV R N A + c e lls /m m 2 requencies of SIV RNA+ Cells in and E by Disease Stage 1 4 D a y A c u te C h ro n ic S A ID S p = p = p = E E E :E G M % C I 0.6 6, , , 3.4 Connick E, et al. J Immunol 2014; 193:5613.

16 S IV R N A c o p ie s /m l ( _ ) C M 9 T e tra m e r+ T c e lls /m l b lo o d (-----) CD8 depletion largely abrogates the concentration of SIV replication Pre Depletion LN C D 8 d e p le tin g a n tib o d ie s Post Depletion LN o llic le E x tr a fo llic u la r Z o n e S IV R N A + c e lls /m m P r e P o s t P r e P o s t D a y s p o s t-in fe c tio n olkvord J et al. CROI Abstract #23.

17 ew SIV-Specific CTL Exhibit a ollicular Homing Phenotype 7 0 % S IV -s p e c ific C T L C X C R 5 + C X C R 5 + C X C R 5 - C X C R 5 - C C R 7 - C C R 7 + C C R 7 + C C R 7 - Connick E, et al. J Immunol 2014; 193:5613

18 Summary Multiple factors promote HIV replication in B cell follicles: DC-bound virions Heightened permissivity of TH Paucity of CTL in B cell follicles

19 Increasing Evidence That B Cell ollicles are a Reservoir for HIV in Treated Disease DC Reservoir DC-bound virions decrease, but remain detectable in ART suppressed humans and macaques (Cavert W, et al. Science, 1997, 276:960; Rothenberger MK, et al. PNAS 2015;112:E , Deleage C, et al. Path and Immun 2016;1:doi /pai.v1i1.100) Targeting DC-bound virions B cell remain follicular infectious in a reservoirs non-permissive mouse is model and ART-treated humans (Smith BA, et al. J Immunol 2001;166:690; Heesters BA, et al. PLOS Pathogens 2015; 11:e ) essential to developing a cure for HIV T Cell Reservoir infection. Peripheral blood TH harbor the majority of HIV DNA in the central memory subset of CD4 T cells (Pallikkuth S, et al. J Virol 2015; 90:2718) PD-1+ and TH cells are responsible for persistent HIV transcription in ART treated individuals (Banga R, et al. Nature Med 2016;22:754)

20 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 IAS 2016 Towards an HIV Cure Symposium Durban, South Africa 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