Anti-HBV DNA vaccination does not prevent relapse after discontinuation of analogues in the treatment of chronic hepatitis B: a randomised trial--ANRS HB02 VAC-ADN.

OBJECTIVE: The antiviral efficacy of nucleos(t)ide analogues whose main limitation is relapse after discontinuation requires long-term therapy. To overcome the risk of relapse and virological breakthrough during long-term therapy, we performed a phase I/II, open, prospective, multicentre trial using a HBV envelope-expressing DNA vaccine. DESIGN: 70 patients treated effectively with nucleos(t)ide analogues for a median of 3 years (HBV DNA <12 IU/mL for at least 12 months) were randomised into two groups: one received five intramuscular injections of vaccine (weeks 0, 8, 16, 40 and 44) and one did not receive the vaccine. Analogues were stopped after an additional 48 weeks of treatment in patients who maintained HBV DNA <12 IU/mL with no clinical progression and monthly HBV DNA for 6 months. The primary endpoint was defined as viral reactivation at week 72 (HBV DNA >120 IU/mL) or impossibility of stopping treatment at week 48. RESULTS: Reactivation occurred in 97% of each group after a median 28 days without liver failure but with an HBV DNA <2000 IU/mL in 33%; 99% of adverse reactions were mild to moderate. Immune responses were evaluated by enzyme-linked immunosorbent spot and proliferation assays: there was no difference in the percentage of patients with interferon-γ secreting cells and a specific T-cell proliferation to HBcAg but not to HBsAg after reactivation in each group. CONCLUSIONS: Although it is fairly well tolerated, the HBV DNA vaccine does not decrease the risk of relapse in HBV-treated patients or the rate of virological breakthrough, and does not restore the anti-HBV immune response despite effective viral suppression by analogues. TRIAL REGISTRATION NUMBER: NCT00536627.

Immunological and antiviral responses after therapeutic DNA immunization in chronic hepatitis B patients efficiently treated by analogues.

A substudy of a phase I/II, prospective, multicenter clinical trial was carried out to investigate the potential benefit of therapeutic vaccination on hepatitis B e antigen-negative patients with chronic hepatitis B (CHB), treated efficiently with analogues. Patients were randomized in 2 arms, one receiving a hepatitis B virus (HBV) envelope DNA vaccine, and one without vaccination. At baseline, HBV-specific interferon (IFN)-γ-producing T cells were detected in both groups after in vitro expansion of peripheral blood mononuclear cells. Vaccine-specific responses remained stable in the vaccine group, whereas in the control group the percentage of patients with HBV-specific IFN-γ-producing T cells decreased over time. The vaccine-specific cytokine-producing T cells were mostly polyfunctional CD4(+) T cells, and the proportion of triple cytokine-producer T cells was boosted after DNA injections. However, these T-cell responses did not impact on HBV reactivation after stopping analogue treatment. Importantly, before cessation of treatment serum hepatitis B surface antigen (HBsAg) titers were significantly associated with DNA or HBsAg clearance. Therapeutic vaccination in CHB patients with persistent suppression of HBV replication led to the persistence of T-cell responses, but further improvements should be searched for to control infection after treatment discontinuation.

Neonatal deletion and selective expansion of mouse T cells by exposure to rabies virus nucleocapsid superantigen.

The nucleocapsid (NC) of the rabies virus behaves as an exogenous superantigen (SAg) in humans. In the present report, we analyzed whether it is also a SAg in mice by studying the effect of NC on T cell receptor (TCR) V beta expression in BALB/c mice. Repeated injection of NC in newborn BALB/c mice led to a marked reduction by two- to sixfold of V beta 6 expressing CD4+ T cells in spleen and in peripheral blood. Decrease of V beta 6-expressing CD3+ mature T cells was also observed in thymus. Single NC injection in footpad resulted in a three- to sixfold expansion of V beta 6 CD4+ T cells, but not of CD8+ T cells, in the draining lymph nodes of BALB/c mice. The intensity of the stimulation was dose dependent and was maximal 3 d after the NC injection. The clonal deletion of T cells bearing a particular V beta demonstrates that NC is a SAg in mice. T cells, especially CD4+ T cells, are an essential factor in host resistance to rabies virus and also in the pathophysiology of paralysis; thus, we postulate that a rabies virus component, which stimulates T cells, such as a SAg, may increase virus immunopathogenicity. To evaluate this hypothesis, we compared the course of rabies in adult BALB/c lacking V beta 6, 7, 8.1, and 9 T cells and in normal BALB/c. Immune-related paralysis was decreased in BALB/c missing the NC target V beta T cells. Transfer of V beta 6 but not of V beta 8.1-3 T cells into recipient mice lacking V beta 6, 7, 8.1, and 9 allowed the immune-related paralysis to evolve. Taken together, these results strongly support the hypothesis that T cells expressing rabies SAg-specific V beta 6 T cells, are involved in the genesis of the immunopathology that is characteristic of paralytic rabies.

[Cryptococcal meningo-encephalitis in an apparently immunocompetent patient]. / Cryptococcose neuroméningée chez un sujet en apparence immunocompétent.

INTRODUCTION: Cryptococcal meningo-encephalitis is a rare disease occurring more frequently in immunocompromised hosts. CASE REPORT: We report the case of an apparently immunocompetent patient who developed a recurrent neurological deficit with lymphocytic meningitis. The time from the first symptoms to diagnosis was 8 months. We noted mild CD4+ lymphocytopenia (500 cells/mm3) without HIV infection. CD4+ lymphocytes were not reactive for a panel of antigens. CONCLUSION: This case illustrates the usefulness of cerebrospinal fluid Cryptococcus Neoformans antigen test in patients with an unexplained neurological syndrome with a lymphocytic meningitis together with quantification of circulating lymphocytes clusters and analyse of their function in opportunistic infections.

[Resistance to HIV1 infection in exposed uninfected individuals: light and shadow in the research of mechanisms]. / Résistance au VIH1 chez les individus exposés non infectés : la recherche des mécanismes entre lumière et zones d'ombre.

Some individuals, dubbed here « EU ¼ (exposed but uninfected), do not show any sign of infection in spite of repeated exposures to HIV1. For more than ten years a considerable research effort is made to uncover the mechanisms of resistance to HIV1 in EUs including host factors of protection. Two main not exclusive hypotheses are explored : 1) EUs are resistant to HIV1 infection ought to antiviral innate defences, either genetic or immune ; 2) EUs are protected from infection by immune specific responses that neutralise or eliminate the virus. Various mechanisms have been associated to the resistance to HIV1 infection in studies on different high-risk populations, although none of them can explain all the cases. The resistance to HIV1 infection seems to be linked to the contribution of multiple factors whose relative weight can differ according to EUs ethnic origin, environment and way of exposure.

Restoration of TRAIL-induced apoptosis in resistant human pancreatic cancer cells by a novel FAK inhibitor, PH11.

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) emerges as one of the most-promising experimental cancer therapeutic drugs and is currently being tested in clinical trials. However, both intrinsic and acquired resistance of human cancer cells to TRAIL-induced apoptosis poses a huge problem in establishing clinically efficient TRAIL therapies. To assess the regulation of TRAIL-resistance in human pancreatic cancer cells, we studied the TRAIL resistant pancreatic cell line PANC-1. We show that treatment with PH11, a novel Focal Adhesion Kinase (FAK) inhibitor in association with TRAIL rapidly induces apoptosis in TRAIL-resistant PANC-1 cells, but not in normal human fibroblast cells. To explain sensitization, we showed that PH11 restores TRAIL apoptotic pathway in PANC-1 cells through down-regulation of c-FLIP via inhibition of FAK and the phosphatidylinositol-3 kinase (PI3K)/AKT pathways. These findings suggest that this combined treatment may offer an attractive therapeutic strategy for safely and efficiently treating pancreatic cancer.

Flow cytometric analysis of protein-tyrosine phosphorylation in peripheral T cell subsets. Application to healthy and HIV-seropositive subjects.

This paper describes an improved method for detecting tyrosine phosphorylation levels in T cell subsets by flow cytometry early after CD3 crosslinking stimulation. It consists in introducing gentle paraformaldehyde fixation between CD3 crosslinking in cold conditions and the shift to 37 degrees C, which activates downstream signalling machinery. We used the combined properties of monoclonal antibodies for stimulating cells and for detecting surface markers to analyze protein-tyrosine phosphorylation levels in T cells subsets following stimulations which mimic physiological activation. Overall data obtained in healthy subjects, using two- or three-color immunofluorescence, indicated that: (1) most CD3 positive cells phosphorylate tyrosine substrates following CD3 crosslinking stimulation and (2) helper cells phosphorylate tyrosine to a slightly better extent than cytotoxic cells after CD3 crosslinking. Nevertheless, the two subsets follow similar kinetic patterns and tend to retain a homogeneous profile. Processing of samples from HIV-seropositive patients showed heterogeneous phosphorylation levels in both subsets, when compared to normal donors. This assay should, in the future, lead to easy and rapid exploration of the signal transduction pathway in different subsets of T cells under normal and pathological conditions.

Suppression of the in vitro parent antihybrid reaction by spleen cells from F1 hybrids pretreated with spleen cells from the opposite parent strain.

Spleen cells from B6C3F1 hybrid mice pretreated i.v. with 5 X 10(7) C3H spleen cells seven days earlier (C3H-pretreated B6C3F1) suppress the in vitro B6 anti-B6C3F1 proliferative and cytotoxic responses, when they are added to cultures of B6 responding and B6C3F1 stimulating spleen cells. This suppression is mediated by a Thy-1+Lyt-1+2+ cell of C3H origin that is radiosensitive at 2000 rads. This suppressor cell is not induced by the injection to B6C3F1 hybrids of spleen cells from the other parent strain (B6) or an allogeneic strain (D2). It does not suppress either the response of the other parent (C3H) or an allogeneic strain (D2) to B6C3F1 antigens, or the response of B6 cells to an allogeneic strain (D2). Its induction depends upon the number and the subpopulation of C3H spleen cells injected since suppression is observed after the injection of more than 2.5 X 10(7) C3H cells, and the suppression inducing cells have the phenotype Thy-1+Lyt-1+2+. This phenomenon is not limited to the C3H-B6C3F1 genetic combination, since it has been observed in all parent hybrid combinations tested to date.

Specific resistance to local graft-versus-host reaction in F1 hybrids pretreated intravenously with parent-strain spleen cells. Role of cytotoxic T lymphocytes directed against receptors for the major histocompatibility complex.

Pretreatment of B6D2F1 hybrids by injection of B6 spleen cells by subcutaneous or intravenous routes induces specific resistance to the local graft versus host reaction provoked by s.c. engraftment of B6 spleen cells. This resistance has been attributed to the presence in the pretreated F1 hybrids of cytotoxic T lymphocytes directed against receptors that recognize the D2 alloantigens (anti-D2-receptor CTL). However, this hypothesis would seem to be challenged, at least partially, by our previously published results showing that a) when tested before induction of GVHR, the anti-D2-receptor CTL are detectable in F1 hybrids pretreated only by the s.c. route but not by the i.v. route; and b) specific resistance to GVHR observed in i.v.-pretreated F1 hybrids is mediated by a nylon-adherent, Thy-1-, radioresistant (2000 rads) suppressor cell of B6 origin that does not manifest any anti-D2-receptor CTL activity. However, these results did not allow us to exclude the possibility of the presence, in the i.v.-pretreated F1 hybrids, of anti-D2-receptor precursor CTL that could be reactivated during the GVHR by the D2-receptors expressed on the proliferating clone of grafted B6 cells, then differentiate to the receptor-specific CTL effectors that control the development of the GVHR. That is why we have studied in the present work the CTL activity developed against D2-receptors after induction of GVHR in either normal or resistant F1 hybrids. Our results show that F1 hybrids protected against GVHR by i.v. pretreatment with B6 cells or by a transfer of nylon-adherent spleen cells from i.v.-pretreated syngeneic F1 mice do not manifest enhanced anti-D2-receptor CTL activity. When considered along with our previous observations, these results favor our hypothesis that anti-D2-receptor CTL are not involved in the specific resistance to GVHR observed in the i.v.-pretreated F1 hybrids.

Specific and nonspecific resistance to local graft-versus-host reaction in F1 hybrids pretreated intravenously with parent-strain spleen cells. I. Two distinct mechanisms.

B6D2F1 hybrid mice pretreated i.v. with 5 X 10(7) spleen cells from B6 donors seven days earlier (B6-pretreated B6D2F1 hybrids) develop resistance to local GVHR induced by the subcutaneous injection of spleen cells of either B6 (GVHR-B6) or D2 (GVHR-D2) origin. This resistance has specific and a nonspecific components that concern the GVHR-B6 and the GVHR-D2, respectively. The two types of resistance to GVHR are neither induced under the same conditions nor mediated by the same mechanism. Specific resistance to GVHR is observed in B6D2F1 hybrids pretreated with unseparated, anti-Lyt-1.2+C' treated or 1000 rads-irradiated B6 cells, but not in B6D2F1 hybrids pretreated with anti-Thy-1.2+C' or anti Lyt-2.2+C'-treated B6 cells. In contrast, nonspecific resistance to GVHR is induced only by pretreatment with unseparated B6 cells. Treatment of B6 cells with anti-Thy-1.2, anti-Lyt-1.2, or anti-Lyt-2.2 moAb plus C', or their irradiation at 1000 rads completely abolishes their capacity to induce the nonspecific resistance to GVHR. Moreover, specific resistance to GVHR can be transferred to normal B6D2F1 mice by injection of nylon-adherent, anti-Thy-1.2+C'-treated or 2000-rads-irradiated, but not unseparated or nylon-nonadherent, B6-pretreated B6D2F1 spleen cells. Treatment of nylon-adherent B6-pretreated B6D2F1 cells with anti H-2d antiserum plus C' does not affect their capacity to transfer specific resistance to GVHR. Nonspecific resistance to GVHR can be transferred by unseparated, anti-Lyt-1.1+C' or anti Lyt-2.1+C'-treated, but not by anti-Thy-1.2+C' anti-Lyt-1.2+C', anti-Lyt-2.2+C'-treated or 2000-rads-irradiated B6-pretreated B6D2F1 spleen cells. Both types of resistance are observed in B6D2F1 hybrids pretreated with more than 2.5 X 10(7) B6 spleen cells.

Nucleocapsid specific T and B cell responses in humans after rabies vaccination.

The importance of the immune response directed to the internal component of the rabies virus, the nucleocapsid (NC), was evaluated in humans after rabies vaccination. T cell activation was measured with a bulk proliferative assay and relative frequencies of circulating NC-specific PBL were calculated with the limiting dilution technique. Vaccinees were classified into two groups: NC responders and NC non-responders. In NC responders, the frequency of NC-specific circulating lymphocytes was up to 6 times higher than the frequency of virus-specific lymphocytes. In non-responders, NC-specific lymphocytes were up to 25 times less common than virus-specific ones. The NC capacity to induce a secondary antibody response was tested in vitro. After a stimulation with complete virus, lymphocytes originating from donors vaccinated with tissue culture vaccine produced a secondary antibody-response composed mainly of glycoprotein-specific neutralizing antibodies, whereas lymphocytes from suckling mouse brain vaccines produced essentially NC-specific antibodies. This result confirmed the serological status of suckling mouse brain vaccinees, who usually developed high titres of NC-specific antibodies. After an in vitro NC stimulation, lymphocytes collected from NC responders produced not only NC-specific antibodies, provided they have NC-specific B cells at the time of blood sampling, but most surprisingly, they also produce glycoprotein-specific neutralizing antibodies. This finding indicates that NC free of glycoprotein is capable, in some individuals, of boosting an heterologous glycoprotein response.

Serum levels of IL-2, IL-1 alpha, TNF-alpha, and soluble receptor of IL-2 in HIV-1-infected patients.

Serum levels of the interleukins (IL-1 alpha, IL-2), tumor necrosis factor-alpha (TNF-alpha), and soluble receptor of IL-2 (sIL-2R) were studied by enzyme-linked immunosorbent assay (ELISA) in 12 normal healthy controls and 52 HIV-1 seropositive patients. Results indicated that: (1) sIL-2R levels were significantly increased in most HIV-1 seropositive patients. This increase appeared to be correlated with low CD4 cell counts and with the presence of detectable levels of p25 antigen. Furthermore, initially high levels of sIL-2R appeared to be correlated with progression of disease. (2) IL-2 levels were found to be increased in about 43% of asymptomatic carriers (ASY) and subjects with lymphoadenopathy-associated syndrome (LAS) compared with 12% in the case of AIDS-related complex (ARC) and AIDS patients. (3) There was a positive correlation between serum levels of TNF-alpha and IL-1 alpha in nearly all patients. Detectable levels of both cytokines were found in 34% of ASY and LAS patients and only rarely were detectable in ARC and AIDS patients. (4) Sixteen patients in whom progression of disease was observed were studied initially and at the moment they upstaged. No significant modification of serum levels of the three cytokines and sIL-2R studied could be evidenced. It was concluded that sIL-2R could be a useful marker of disease activity and progression, though a prospective study is necessary. For IL-2, IL-1 alpha, and TNF-alpha, this study indicated the presence of variable alterations in serum levels in HIV-1-infected patients.

Establishment of long term cell lines from 2 patients with large granular lymphocyte lymphocytosis displaying an unusual phenotype.

Two long-term cell lines obtained from two cases of large granular lymphocyte lymphocytosis (LGLL) displaying an unusual phenotype are reported here. Patient n. 1 was CD2+ CD3- CD16+ CD8+ CD56- CD57- CD29+ CD45RA+, whereas patient n. 2 was CD2-CD3+ CD8+ CD16+ CD56- CD57+ CD29+ CD45RA+. The cells were large granular lymphocytes by light and electron microscopic criteria and displayed strong antibody-dependent cell mediated cytotoxicity (ADCC) and NK activity. Northern blot analysis revealed aberrant transcripts of TCR beta chains for patient n. 1, and full length TCR alpha and beta transcripts for patient n. 2. In both cases, we were able to establish a long term cell line which functionally revealed strong ADCC and NK activity. Functional implications of these 2 subpopulations are discussed.

Natural killer (NK) cell activity during HIV infection: a decrease in NK activity is observed at the clonal level and is not restored after in vitro long-term culture of NK cells.

NK cell activity is impaired in HIV-infected patients. The mechanisms behind the altered NK functions are not clear, and conflicting data concerning NK and antibody-dependent cellular cytotoxicity (ADCC) activity have been reported. In order to investigate whether this impairment is also observed at the clonal level and whether it is related to a defect at the target cell binding and/or the post-binding level, we evaluated highly purified NK cell lines and cloned NK cells obtained from 22 HIV-infected patients at different stages of disease and compared them with normal controls for their ability to: (i) kill K-562 and U-937 cell lines using a 51Cr release assay; (ii) bind and kill K-562 and U-937 cells at the single cell binding level; (iii) release NK cytotoxic factor (NKCF), tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma); (iv) kill anti-IgM preincubated Daudi cell line (ADCC activity). This study with cloned NK cells or NK cell lines from HIV-infected individuals showed: (i) a decrease in their lytic capability against target cell lines; (ii) a low ability to form conjugates with K-562 and U-937 cell lines with respect to controls; (iii) a decreased ability to kill bound target cells; (iv) low levels of released NKCF, TNF-alpha and IFN-gamma after incubation with U-937 cells. Taken together, these findings suggest that the impaired NK cell function during HIV infection is also observed at the clonal level and is related to defects both at the target and post-binding levels. However, the precise mechanisms remain to be determined. The inability to restore normal NK activity after long-term culture in the presence of high levels of recombinant IL-2 is in agreement with the hypothesis of a 'general anergic process' during HIV infection.

Extensive analysis of lymphocyte subsets in normal subjects by three-color immunofluorescence.

In the present work, 30 normal controls were studied with 11 combinations of 3 monoclonal antibodies in order to define CD20, CD4, CD8, CD16 and CD56 subsets as well as their activation status. Our results indicated that among B cells, CD5- cells predominated (about 92%), the minor CD5+ fraction showed variations between individuals but sometimes was as high as 20% in B cells; the CD45RA+CD29- subset (naive cells) accounted for 31.56 +/- 10.03% in CD4 cells, as compared to CD4+CD29+CD45RA- (memory cells) (46.54 +/- 10.35%), while CD4+CD29+CD45RA+ (transition cells between naive and memory state) represented 9.6 +/- 5.3% as compared to double-negatives (12.3 +/- 5.24%). Some uncertainties persist in defining CD8 subsets. NK CD8 cells accounted for about 20% of total CD8 according to CD16 and CD56 expression. Cytotoxic T lymphocytes could be delineated by S6F1 (76.22 +/- 11.28% within CD8 cells), though this marker appeared to be expressed by both cytotoxic and NK cells. Phenotypic definition of suppressive CD8 cells remains uncertain despite the fact that suppressor activity was found among CD8 lymphocytes expressing CD11b and probably CD57. NK cells coexpressed CD16 and CD56 markers in about 5% of all lymphocytes, while NK cells expressing CD16 alone accounted about 6%. Exclusive expression of CD56 was found in about 5%. Finally, while activated cells characterized by DR expression represented about 4% of CD4 and 9% of CD8 cells, CD25 appeared to be poorly represented among CD4, CD8 and CD20.(ABSTRACT TRUNCATED AT 250 WORDS)

Specific inhibition of hybrid resistance in F1 hybrid mice pretreated with parent-strain spleen cells. II. Evidence for an Hh-1 antigen-specific tolerization.

Lethally irradiated F1 mice reject bone marrow graft from H-2b parents. In a previous paper we showed that pretreatment of F1 hybrid with H-2b parental spleen cells abrogates this hybrid resistance (HR) to parental bone marrow growth by inducing a Thy-1+Lyt-1+2- nylon-adherent suppressor cell. We studied the mechanism of induction of this suppressor cell. Two hypotheses were tested; both were based on the observation that parental spleen cells when injected into a F1 hybrid, recognize the alloantigens of the opposite parent and proliferate; the proliferation of these Hh-1+ cells may result in an overload of the pretreated F1 hybrids with Hh-1 Ag, and in the development of a graft-vs-host reaction that is followed by a non-specific immunodeficiency (GVHID). Thus abrogation of HR could be due to either a tolerization with high doses of Hh-1 Ag or the GVHID. Our results show that abrogation of HR does not correlate with the GVHID because 1) it is induced after pre-treatment with H-2b parental cells only, whereas GVHID is observed after injection with cells from either of the two parents; and 2) it is induced in several conditions where GVHID does not occur; after pre-treatment with 1000-rad-irradiated or T-cell depleted or only class I incompatible spleen cells or with spleen cells from nude parents as well as after pre-treatment with H-2b bone marrow cells. HR is overcome by the injection of H-2Db homozygous or of cross-reactive H-2Ds homozygous cells only. However, although pretreatment with H-2Db homozygous spleen cells is necessary, it is not sufficient for an efficient overcoming of HR. Indeed enhancement of H-2b bone marrow growth after pre-treatment with 1000-rad-irradiated, T-cell depleted or nude parent spleen cells is very short-lasting and never reaches the level observed after pre-treatment with normal spleen cells. We conclude that inhibition of HR in F1 hybrids pretreated with parental spleen cells is not a consequence of a GVHID but of a specific tolerization with Hh-1 Ag; however, the HR is inhibited more consistently when inoculum used for the pretreatment contains fully immunocompetent T cells. The role of the immunocompetent parental T cells in abrogation of HR is discussed.

Serial study of CD5+ and CD5- B cell subpopulations in 335 HIV seropositive patients.

B cell subpopulations, as defined by double-labelling techniques with CD5 and CD19 monoclonal antibodies (MoAbs), were serially studied in 335 HIV-1 seropositive patients. At the time of the first consultation, no important modifications in either CD5+ or CD5- subpopulations were observed, whatever the stage of the disease. However, in 18 out of the 335 patients (5.37%), a sharp increase in B cells exceeding 20% and 300/mm3 was observed. This increase in B cells was mainly accounted for CD5-CD19+ B cell subpopulations and was associated with: (i) evolution of the disease, since only four patients presented it at their first consultation (one lymphadenopathy-associated syndrome (LAS) and three AIDS); (ii) advanced stages of disease since, at the time of B cell augmentation, two patients were staged as LAS, four as ARC and 12 as AIDS; (iii) a high incidence of non-Hodgkin's lymphomas (NHL) since three out of the 18 patients presented a histologically confirmed NHL and three others a clinical pattern compatible with this diagnosis. However, in three patients with B hyperlymphocytosis, polymerase chain reaction (PCR) studies of immunoglobulin gene rearrangement revealed the existence of a polyclonal expansion of B cells. These results justify inclusion of a pan-B cell marker in routine phenotypic studies of HIV-infected individuals, as well as the search for NHL among patients presenting this abnormality.

Viral superantigen-induced hyporesponsiveness of T cells and polyclonal B cell activation in HIV-1 infection.

The mechanisms of CD4 depletion and hyporesponsiveness during human immunodeficiency virus (HIV) infection are still unknown. Given the ability of superantigens to stimulate a higher number of lymphocytes than conventional antigens, they may play a major role in this process. Recently, a novel superantigen, the rabies virus nucleocapsid (NC), was described in humans. In the present work, we tested the responses of peripheral blood lymphocytes from asymptomatic HIV-infected patients to this superantigen. In contrast to its effect in normal controls, NC failed to expand T cells from HIV-infected individuals expressing the V beta 8 family, and induced a strong decrease in the response to CD3 activation. This absence of response was not the consequence of programmed cell death, and was explained by an anergic state induced by the superantigen. NC superantigen was also able to induce polyclonal activation of B cells, as measured by the secretion of anti-HIV antibodies and autoantibodies. Moreover, V beta 8 depletion experiments showed that induction of autoantibody secretion was V beta 8 dependent, whereas secretion of HIV-1 antibody was not. Interleukin secretion studies showed that NC was able to induce high levels of interleukin-4 and interleukin-10. Taken together, our results suggest a role for exogenous viral superantigens such as NC in the induction of T cell hyporesponsiveness and polyclonal B cell activation during HIV infection. The induction of a Th2 response and the role of these superantigens in the immunopathogenesis of acquired immunodeficiency syndrome are discussed.

Partial restoration of cytokine profile despite reconstitution of cytomegalovirus-specific cell-mediated immunity in human immunodeficiency virus-infected patients during highly active antiretroviral treatment.

We reconstituted cytomegalovirus (CMV)-specific T-cell responses in human immunodeficiency virus-1-positive, CMV-positive patients receiving highly active antiretroviral treatment (HAART). We used several combinations of functionality parameters to determine the degree of T-lymphocyte reconstitution obtained during 1 year of treatment. Untreated patients displayed CMV-specific cytotoxic T-lymphocyte (CTL) activity despite the absence of CMV-specific lymphoproliferative responses (LPRs) and despite the fact that interferon-gamma (IFN-gamma) and interleukin-2 (IL-2) were not secreted. The absence of LPRs, IFN-gamma and IL-2 before antiretroviral treatment suggests that CMV-specific immunity was deregulated despite the high CD4+ T-cell counts presented by our cohort, which are critical to the reactivation of CMV disease. After 6 months of HAART, CTL activity had increased compared with the baseline, as had the levels of secreted IFN-gamma and LPR. However, the levels of specific IL-2 produced did not change during therapy, and no specific IL-2 was detected during the follow-up period. Taken together, our findings suggest that 1 year of HAART led to the recovery of some, but not all, CMV-specific responses in our cohort of patients.

Functional monocyte-derived dendritic cells can be generated in chronic lymphocytic leukaemia.

Chronic lymphocytic leukaemia (CLL) remains an incurable disease. Although modern available treatments are able to induce disease regression, relapse almost inexorably occurs. Therefore, novel therapeutic strategies aimed at reducing the disease relapse rate are very much needed. Among these, the induction of tumour-associated antigen-specific cytotoxic T lymphocytes (CTL), through either DNA vaccines or injection of idiotype pulsed dendritic cells (DCs), has been actively investigated with encouraging preliminary results in B-cell malignancies. As the CLL B lymphocyte characteristically expresses low amounts of surface immunoglobulin (Ig) and T cells from these patients have been reported to display impaired functional activity, there are concerns related to the possibility of generating specific cytotoxic antitumoral T cells in this disease. In addition, no information is presently available regarding the functional ability of CLL-derived DCs. In the present work, freshly purified monocytes from CLL patients and normal donors were induced to differentiate in granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin (IL)-4 serum-free medium and compared for their morphological, phenotypic and functional characteristics. Our results demonstrate that: (1) functional DCs can be generated from CLL patients with similar phenotype and function to those observed from normal donors; (2) in contrast to normal control subjects, monocyte-derived DCs from CLL patients spontaneously secrete endogenous IL-10; and (3) interferon (IFN)-gamma in combination with CD40L plays a major role in priming DCs from CLL patients for IL-12 and IL-15 production. Overall, these results indicate that it is possible to derive functionally competent DCs from circulating monocytes in CLL patients.