track a basic science report
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TRACK A BASIC science report. TRACK A : BASIC science. THE TEAM. Nichole Klatt USA. Uriel Moreno-Nieves Mexico. Clovis Palmer Australia. and behind the stage….the IAS people !!. TRACK A : the KEY words. Immune activation and Inflammation Mucosal infection Acute infection - PowerPoint PPT PresentationTRANSCRIPT
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
TRACK A
BASIC science report
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
TRACK A : BASIC scienceTHE TEAM
Nichole KlattUSA
Clovis PalmerAustralia
Uriel Moreno-NievesMexico
and behind the stage….the IAS people !!
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
TRACK A : the KEY words
• Immune activation and Inflammation• Mucosal infection• Acute infection• Myeloid cells• Restriction factors• Reservoir• Recovery
SIV
mod
el :
path
ogen
inc
vs n
on p
atho
geni
c
HIV
Klatt et al. Immunol Rev 2013
Microbial translocation
InflammationCoagulation
Odds of Mortality (4th vs 1st Quartile)(Independent of CD4 count and virus load)
Markers of Inflammation and GI Dysfunction Predict Mortality
%CD38+DR+
%CD57+DR+
T cells
Innate activation is a stronger predictor of death than T cell activation
OTHER markers (IP10, CD163, et al) to add to
(HUNT)
Monocyte cellular phenotypes are independently linked to IL-6, CRP and D-dimer
Monocyte Phenotype (%) OR (95% CI) for CAC Progression* p-valueCD14+/CD16+ 1.65 (1.08, 2.52) 0.02CD14dim/CD16+ 1.36 (0.98, 1.88) 0.06CD14var/CD16+ 1.69 (1.12, 2.54) 0.01*CAC Progression defined as ‘B’ or ‘C’ above; OR per 1% greater frequency of given phenotype, adjusted for age, gender, race, smoking, diabetes, hepatitis B or C co-infection, current CD4 count, HIV RNA <400 copies/mL, and cholesterol and blood pressure lowering treatment
Monocyte Activation Independently Predicts Greater 2-yr Coronary Artery Calcium Progression (SUN Study)
I. SERETIROLE In CARDIOVASCULAR DISEASE
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Myeloid cells matter…..
Dysregulation of Metabolic pathways
Non-communicable diseases
Reservoir of HIVAnd approaches to release
HIV-related dementia
Opportunistic infections
IRIS
Borrowed from Crowe
(Anzinger)
(F. Graziano)
(M.I. Sada-Ovalle)(H.Tran)
The Lymph node : a major player
By T. SchackerLYMPH NODE FIBROSIS in HIV infection
Start ARV
Pirfenidone (anti-fibrotic) therapy in macaque is associated with preservation of LN CD4 T cell population
(Schacker)
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Probiotics + ARV in SIV infected macaques decreased fibrosis and enhanced CD4 reconstitution
In the gut : fibrosis and CD4 loss N. Klatt
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
ACE/ARBsSchacker/UMHatano/UCSFSandler/ACTG
Anti-IL-6Lederman/CWRU
RifaximinTenorio/ACTG
Hsue/UCSF
SevelamerSandler/ACTG
MesalamineSomsouk/UCSF
StatinsNixon/ACTG
MethotrexateHsue/ACTG
ChloroquineJacobson/ACTG
IsotretinoinKwon/ACTG
CLINICAL trials to decrease immune activation: Many approaches are in the field
or are planned
Courtesy of S. Deeks & P. Hunt, with permission from M.P.
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Attention to unexpected results: peg-IFN alpha vs. type I IFN R antagonist
MACAQUE STUDY interphering with type I IFN pathway to protected from disease.
Although administration of IFNa delayed acquisition of the infection, both treatments
accelerated progression to disease. D. Douek
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Where is the virus….hidden ?• Full RNA transcription (highest levels) is associated with
CD4 down regulation in vivo (Koup)• In lymph nodes of SIV loss of T cell in paracortical area and
expansion of in germinal center. The GC CD4 cells are highly infected. >> GC hypertrophy >> higher immune activation (Koup)
• T Follicular cells are supporting HIV infection and replication.
• Tscm (memory stem cells, long-lived, pluripotent) are infected but do contribute little to the total reservoir (Silvestri and Lichterfeld)
CD4+ TSCM are numerically preserved during BOTH pathogenic and nonpathogenic SIV infections.
G. SILVESTRI
Robust levels of CD4+TSCM infection in vivo are observed in SIV-infected RMs but not in SIV-infected SMs.
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Tscm in HIV infection
• Tscm are a cell reservoir with the highest DNA content compared to other T cell subsets. The contribution to the total reservoir is not high, as Tscm represent 2-3% of all T cells, BUT is consistent in time.
Can the virus in Tscm be eradicated ?• Susceptibility of TSCM and TCM to HDACi in vitro but in vivo not
clear.• Beta-catenin inhibitors induce differentiation of TSCM and TCM
into more short-lived CD4 T cell subsets.• Evidence for synergistic activity of HDACi and beta-catenin
inhibitors for increasing chromatin acetylation and HIV-1 reactivation.
M. Lichterfeld
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
When limit the virus ? SPARTAC (John Frater)
VISCONTI (French study group)
RV254 (Jintanat Ananworanich)
Boston cohort (Marcus Altfeld)
ELITE controllers (Olivier Lambotte)
…….
ANRS workshop
THE EARLIER THE BEST !! ??
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
How to regulate the virus ?New players and old ones with new functions
• BST2/Tetherin (isoforms): promote HIV release, but interphere with pDC antiviral responses (control INFa release). (Cohen)
• ERAP2 (ER aminopeptidase) : trims peptides for optima MHC1 presentation (haplotypes) : different resistance to HIV infection. (Salle)
• CTP2 : multifunctional cellular factor establishment of latency/HDAC and inhibits viral reactivation/P-TEFb (Rohr. HIVCure)
• p21 : repression of the dNTP biosynthetic enzyme RNR2 to restrict HIV reverse transcription in macrophages (Pancino)
• SAMHD1 : is inhibited by infected DC/Tcell crosstalk (Su) and in Elite controllers (Martin-Gayo)
• LEDGF/p75 and TNPO3 : altered HIV replication (pre and integration) in mDC of elite controllers (Martin-Gayo)
OTHERS to come…. Potential targets for new therapies
HIV PREVENTION Symposium Vaccine Efficacy Trials
NOTE: Phambili (HVTN 503) began to explore a regime similar to STEP in South Africa (not included).
No
From Diffenbach
>12Abs
1
>25
>25>5
gp41
gp120
viralmembrane
MPER(10E8)CD4bs
(VRC01)
V3 / V4 / glycans(cluster of targets:
PGT120s, PGT130s)
Glycans(2G12)
V1/V2 / glycans(PG9)
V3/CD4i(3BC176)2
N332 Abs
HIV is vulnerable : bnMAbs show sites
that could be targeted by vaccine-induced
Abs
Rational HIV immunogen design to target specific germline B cell receptors.
Jardine, Science 2013
“N322 gp120 moAbs series“ ….. PGT121D. BurtonGermline sequencing
Neutralization strength (IC50)
Neu
tral
izatio
n Br
eath
(n o
f iso
late
s)
100%
low high
PGT121
Precursor
Precursor
? Do we need the most potent or is a pool of intermediate sufficient ?
Klatt et al. Immunol Rev 2013
To complete the gaps
MORE BASIC RESEARCH