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Journal of Virology, November 2000, p. 10249-10255, Vol. 74, No. 21
0022-538X/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
A Significant Number of Human Immunodeficiency Virus
Epitope-Specific Cytotoxic T Lymphocytes Detected by Tetramer
Binding Do Not Produce Gamma Interferon
Paul A.
Goepfert,1,2,*
Anju
Bansal,1
Bradley H.
Edwards,1
G. Douglas
Ritter Jr.,1
Ildefonso
Tellez,1
Sylvia A.
McPherson,2
Steffanie
Sabbaj,1 and
Mark
J.
Mulligan1,2
Departments of
Medicine1 and
Microbiology,2 University of Alabama
at Birmingham, Birmingham, Alabama 35294-2170
Received 1 March 2000/Accepted 9 August 2000
 |
ABSTRACT |
Despite the seemingly important role of cytotoxic T-lymphocyte
(CTL) responses in human immunodeficiency virus (HIV) disease pathogenesis, their measurement has relied on a variety of different techniques. We utilized three separate methodologies for the detection of CTLs in a cohort of HIV-infected individuals who were also human
leukocyte antigen A2 (HLA-A2) positive. Among the different CTL assays,
a correlation was seen only when the Gag epitope-specific HLA
A*0201-restricted tetramer assay was compared with the ELISPOT assay
performed after stimulation with the Gag epitope; however, this
correlation was of borderline statistical significance. On average, the
tetramer reagent detected a 10-fold-higher number of cells than were
seen to produce gamma interferon by the ELISPOT assay. The implications
of this CTL assay comparison and the possibility of phenotypic
differences in HIV-specific CD8+ T lymphocytes are discussed.
 |
TEXT |
Cytotoxic T lymphocytes (CTLs) are
important in controlling viral replication in human immunodeficiency
virus (HIV)-infected individuals. Their appearance in blood coincides
with the initial decrease in plasma viral load during acute HIV
infection (5, 20) and declines proportionally with viral
load in patients receiving highly active antiretroviral therapy
(HAART) (13, 32). Additionally, CTLs demonstrate a
negative correlation with disease progression due to HIV infection
(3, 19, 30, 35), and in a simian immunodeficiency virus
(SIV) macaque model, the control of SIV replication correlated directly
with the presence of CD8+ T lymphocytes (16,
38).
Assays for the detection of CTLs have historically relied on direct
determination of cell lysis as measured by chromium release. While this
assay measures an effector characteristic of CD8+ T cells,
it is cumbersome and technically difficult to perform. Additionally,
the standard lytic assay is qualitative and must rely on a limiting
dilution analysis (LDA) for quantitative results (20).
Unfortunately, LDA frequently underestimates the true level of CTL
responses (22, 40).
In recent years, newer assays allowing for easier assessment of CTL
responses have been developed. Assays to detect gamma interferon (IFN-
) by use of the ELISPOT technique permit indirect visualization of antigen-specific CD8+ T cells and also
have an advantage over the standard lytic method in that they are
quantitative (12, 21, 22). The tetramer assay has allowed
quick, simple, and reliable detection of antigen-specific HLA-restricted CTL responses (1, 32). Furthermore, this
assay and other flow cytometric technologies can evaluate
other cellular phenotypic characteristics in the same experiment.
The tetramer assays, however, are limited in that they are specific
to one HLA-restricted epitope, and both the tetramer and
ELISPOT assays serve only as surrogate markers of CTL lysis. We
compared the CTL responses in a group of HIV-infected individuals
and uninfected controls utilizing the standard lytic method, the
ELISPOT assay for the detection of IFN-
, and the tetramer
reagent for the detection of antigen-specific CD8+ T
cells. Although a strong trend toward correlation between the ELISPOT and tetramer assays was observed, the latter method detected approximately a 10-fold-greater number of cells than were
demonstrated to produce IFN-
.
All volunteers had detectable CTL responses by the standard bulk
lysis method.
Patients were recruited from the University of
Alabama at Birmingham (UAB) AIDS clinic and were selected on the basis
of low but detectable plasma viral load (<10,000 copies/ml) and a
total CD4+ T-cell count above 200/µl (Table
1). Most patients (5 of 7) were taking
antiretroviral therapy at the time of the study. All were in good
health, and none had a history of opportunistic infection. The patient
cohort included six chronically infected individuals (average duration
of known infection, 6 years) and one with recent infection. HLA typing
was performed by standard serologic methods for all HIV-infected
patients (2). Seven healthy, uninfected individuals at low
risk of acquiring HIV infection served as controls. The Institutional
Review Board of the UAB approved the study.
The chromium release lytic assay was performed as the current CTL
"gold standard" (
4,
6,
30) for comparison to the
newer
methods. Responses to Gag were measured after a 2-week restimulation
of
effector cells. The percent lysis at three separate effector-to-target
(E:T) ratios is shown (Fig.
1). All
patients' peripheral blood
mononuclear cells (PBMCs) demonstrated a
positive response, as
defined by >10% HIV Gag-specific lysis at two
or more E:T ratios
(more than 3 standard deviations above the mean
value for the
negative controls). In contrast, only 3 of 6 (50%)
individuals'
PBMCs were able to lyse Env-expressing targets (Fig.
1;
see P3,
P4, and P5). Depletion of the CD8
+ T cells resulted
in ablation of the positive response in all
patients (data not shown).
Our findings are consistent with work
done by others demonstrating that
most HIV patients with chronic
infection have detectable HIV-specific
CTL precursor (CTLp) responses
as measured by the chromium release
assay (
5,
7,
10).

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FIG. 1.
CTL lytic activity for HIV-infected patients (P1 through
P5 and P7) and a representative control (C4). Fresh PBMCs were
stimulated for 2 weeks with vP1291 (encoding HIV Gag, Pro, and Env) and
mixed with autologous B-lymphocyte cell lines (BLCL) infected with vSC8
(control for Gag), vDK1 (Gag), vP1170 (control for Env), or vP1174
(Env) at the indicated E:T ratios (x axis). The percent
release of 51Cr-labeled targets relative to spontaneous
release in a 5-h assay is depicted (y axis). The spontaneous
release of 51Cr was <20% for all experiments.
|
|
The ELISPOT assay after three separate antigenic-stimulation
methods detected responses in most volunteers.
ELISPOT
assays have been used increasingly due primarily to ease of
performance, ability to utilize frozen cells, and quantitative results.
We employed the standard ELISPOT assay (28, 37) to quantify
the number of PBMCs capable of secreting IFN-
after antigenic
stimulation by one of three separate stimulation techniques: (i) a pool
of overlapping 20-mer Gag peptides, (ii) an HLA A*0201-restricted Gag
p17 epitope (SLYNTVATL), or (iii) a recombinant vaccinia virus (rVV) encoding Gag (vDK1). Freshly isolated or thawed PBMCs were placed into 96-well nitrocellulose plates that were coated with an
anti-human IFN-
antibody (Mabtech, Nacka, Sweden) and were stimulated with the antigen for 18 h. A biotinylated anti-human IFN-
monoclonal antibody was then added to the plates, followed by
treatment with streptavidin-alkaline phosphatase. After plates were
washed with tap water and dried overnight, the spot-forming cells (SFC)
were counted using a stereomicroscope. IFN-
-secreting T lymphocytes
were detected in the PBMCs of a majority of individuals irrespective of the stimulation technique utilized (Fig.
2). The highest numbers of SFC per
million PBMCs were observed after Gag peptide pool
stimulation (mean, 147; range, 3 to 336) compared to Gag stimulation
either by SLYNTVATL (SL9) (mean, 66; range, 11 to 129) or by rVV (mean,
82; range, 11 to 178). The frequencies of IFN-
-producing PBMCs
in the negative controls were uniformly low (mean, 1.4; range, 0 to
14). By using the results from the HIV-negative controls, a positive
response was defined as more than 15 SFC/106 PBMCs
(more than 3 standard deviations above the mean). Due to the
large number of PBMCs required to perform three separate
assays, we did not repeat experiments on all of the volunteers;
however, we did repeat the ELISPOT assays for patients P3 and P7,
yielding findings similar to the first result (data not shown).

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FIG. 2.
ELISPOT analysis for HIV-positive patients (P1 through
P7) and controls (C1 through C7). Fresh or thawed PBMCs were
stimulated with the indicated antigen and incubated for 18 h.
After being developed, the SFC were counted under a stereomicroscope.
|
|
For all of the experiments using vaccinia virus-based stimulation, a
vaccinia virus recombinant devoid of HIV antigen expression
(vSC8) was
utilized for the control reaction. Vaccinia virus stimulation
produced
a high "background" (see Table
2, patients P2, P5, and
P6) in 3 of
7 (43%) patients and probably represented cellular
immune responses
directed toward the vaccinia virus itself. The
high background response
in a significant number of individuals
made it difficult to determine
whether responses were Gag
specific.
Comparison of SFC frequencies after three types of antigenic
stimulation revealed no clear patterns, and these varied results
are
not unexpected, since none of the stimulation techniques presented
identical antigens. The 9-mer SL9 peptide ELISPOT assay is limited
to
one epitope, while the rVV Gag presents HIV antigens in the
context
of vaccinia virus products. Finally, the Gag peptide pool
was
made up of 20-mers in contrast to the 8- to 10-mers generally
believed to be optimal for major histocompatibility complex (MHC)
class
I-restricted antigen presentation (
14,
23,
25). The
possibility that the 20-mer stimulation technique was detecting
a
CD4
+ T-lymphocyte response was not ruled out in all cases
but was
unlikely for two reasons. First, helper T-cell responses
to HIV
type 1 (HIV-1) are generally believed to be unusual during
chronic
infection except in a small subset of patients termed long-term
nonprogressors (LTNPs) (
36). None of the individuals in our
cohort were LTNPs. Secondly, CD8
+ T-cell depletions were
performed on two patients' PBMCs (P5 and
P7) using the
Dynabead method (Dynal Inc., Lake Success, N.Y.)
(
8). In
both experiments the positive responses seen with
unfractionated
PBMCs were absent following the depletion
(data not shown). Therefore,
it seems likely that the IFN-

SFC seen
after Gag 20-mer peptide
pool stimulation were due to CD8
+
T
lymphocytes.
The HLA A*0201-restricted tetramer detects SLYNTVATL-specific
CD8+ T cells in a majority of chronically infected
HIV-1 patients.
We next tested MHC-peptide tetramer binding to
thawed PBMCs that had been frozen from the identical blood draw
used for the ELISPOT assays. The HLA A*0201-restricted Gag (p17) SL9
tetramer was chosen because it was shown to be an immunodominant CTL
epitope during chronic HIV infection (11, 17, 41, 42).
The tetramer reagent was produced in our facility utilizing bacterial
plasmids expressing the HLA A*0201 heavy chain or
2
microglobulin molecules (kindly provided by John Altman
and Beckman Coulter, Fullerton, Calif.) as previously described
(1). Three-color analysis for flow cytometry (1, 29,
32, 33) used the SL9 tetramer, anti-human CD8 (Becton Dickinson,
San Diego, Calif.), and anti-human CD3 (PharMingen, San Jose,
Calif.) conjugated to phycoerythrin (PE), peridin chlorophyll
protein (PerCP), and allophycocyanin (APC), respectively. Flow
cytometry was performed on a FACSCaliber (Becton Dickinson), and data
were analyzed using the WINMIDI software program, version 2.8 (Joseph
Trotter, La Jolla, Calif.).
This HLA A*0201-restricted tetramer bound to >95% of cells derived
from an HLA A*0201 CD8
+ T-cell clone (kindly provided by
Bruce Walker) specific for the
SL9 epitope (data not shown). The
range of results for HIV-infected
subjects varied from 0.01 to 0.45%
of CD8
+ T cells, with a mean response of 0.19% (Fig.
3). A low background
was observed, as the
SL9 tetramer stained a very small number
(e.g., <0.01%) of
CD8
+ T cells in either of the uninfected controls (Fig.
3).
By calculating
the SL9 tetramer response for negative controls (2 shown
and 10
others not shown), a positive response was defined as more than
3 standard deviations above the mean response of the controls
(>0.05%
of the CD8
+ T cells). By use of this definition,
SL9-specific CD8
+ T lymphocytes were detected in 6 of 7 (86%) HIV-infected individuals.
One patient (P6) did not have
SL9-specific cells as determined
by either the tetramer (Fig.
3) or the
ELISPOT (Fig.
2) assay.
P6 was also HLA-B27 positive; therefore, it is
possible that an
HLA-B27-restricted Gag-specific response was
immunodominant over
the HLA-A2 response, as the former was also
associated with a
highly immunodominant epitope (
31) and
correlated with the lack
of HIV disease progression (
18,
27). However, due the fact
that genotyping was not performed on
our cohort, it is also possible
that individual P6 did not have HLA
A*0201 but another subtype
of HLA-A2. Although we did not perform viral
sequencing for this
study, P6 could have harbored a virus not
encoding the SLYNTVATL
peptide sequence. Overall, the high
percentage of HIV-positive
patients with positive responses using the
SL9 tetramer is consistent
with previously published findings (
11,
33).

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FIG. 3.
SL9 HLA A*0201-restricted tetramer staining of thawed
PBMCs from HLA-A2-positive patients. Cells were gated by using
three parameters (forward and side light scatter and CD3+ T
cells) in order to focus on the CD3+ T lymphocyte
population. In addition to the HIV-infected cohort (P1 through P7), two
types of control individuals were included (control A was HIV negative
and HLA-A2 positive; control B was HIV positive and HLA-A2 negative).
The percentage of CD8+ T cells that stained with the SL9
tetramer is given in the upper right quadrant of each dot plot.
|
|
The HLA A*0201-restricted tetramer detects a 10-fold-greater
frequency of Gag-specific PBMCs than the IFN-
ELISPOT
assay.
The results from the three CTL assays are summarized in
Table 2. As expected, no significant
correlation was seen between the SL9 epitope-specific assays and
the Gag-specific CTL assays, i.e., the Gag lytic assay or the ELISPOT
assay using either rVV Gag or the Gag peptide pool. Additionally, no
significant correlation was seen among any of the ELISPOT assays.
We next wanted to compare the SL9-specific ELISPOT assay to the
SL9-specific tetramer assay. Since the ELISPOT assay includes
PBMCs
and the tetramer data was gated on CD3
+ T lymphocytes, we
enlarged the collecting gate on the flow cytometer
to include other
PBMCs in addition to lymphocytes (e.g., monocytes
and neutrophils)
(
40). In this manner, cells that would be counted
with a
hemocytometer as PBMCs would more likely be included in
the flow
analysis. We then converted the tetramer assay data into
the number of
positive responses per million PBMCs (
40) (Fig.
4A). A correlation was demonstrated
between the SL9 ELISPOT assay
and the respective tetramer assay when
the number of IFN-

-producing
cells was compared to the number of
cells that recognized the
tetramer (Fig.
4B). This correlation was not
statistically significant
at the 95% confidence interval (
P = 0.06); however, a larger number
of patients may have given a
significant correlation. Additionally,
it is possible that PBMCs
obtained from individuals at various
stages of HIV infection may have
different cytokine profiles.
Although all of the volunteers had CD4
counts greater than 400
at the time of the study (Table
1), the range
was 403 to 857
cells/µl, with a mean of 541 cells/µl. When the
results from the
patient with the lowest CD4 count (P5) were excluded
from the
analysis, the correlation became significant (
r = 0.94;
P = 0.006).
A correlation between the tetramer and
ELISPOT assays was also
seen for Epstein-Barr virus (EBV) in healthy
virus carriers (
40).
These findings suggest that
quantitative comparison across CTL
assays should be viewed with caution
and that direct comparisons
should be made only when the antigen
specificity of the assays
is identical.

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FIG. 4.
Direct comparison of the ELISPOT and tetramer assays.
(A) Both the percentage of CD8+ T cells and the number of
positive cells per million PBMCs are shown. (B) The correlation
between the numbers of PBMCs as detected by the SL9 tetramer assay
(x axis) or the SL9 ELISPOT assay (y axis) is
graphically represented. For the tetramer assay, the forward and side
light scatter gates were enlarged to include PBMCs as counted in
the hemocytometer, thereby allowing more direct comparison with the
"nongated" ELISPOT assay.
|
|
Despite the correlation trend for the SL9 tetramer and SL9 ELISPOT
assays, the absolute number of SL9-specific IFN-

-producing
PBMCs
detected by the latter assay (mean, 66) was more than 10-fold
less than
the number of SL9 epitope-specific PBMCs detected by
tetramer
staining (mean, 917) (Fig.
4A). Since separate tetramer
and ELISPOT
assays were performed, we did not directly measure
IFN-

production
in tetramer-positive cells; however, both assays
were performed on
identical blood draws. It was also possible
that the ELISPOT assay did
not detect all of the IFN-

-producing
PBMCs. To address this
issue, we placed a dilution of cell culture
medium containing
approximately 100 cells that constitutively
express IFN-

(C10/MJ
cells; National Institutes of Health [NIH]
AIDS Research and
Reference Reagent Program) onto an ELISPOT plate.
An average of 83 SFC/well resulted; therefore, the IFN-

ELISPOT
assay is sensitive in
detecting IFN-
production.
To further address the sensitivity of the IFN-

ELISPOT assay, we
also performed flow cytometric analysis of IFN-

-producing
cells as
detected by intracellular cytokine staining. Fresh PBMCs
were
stimulated for 6 h with the SL9 peptide, and brefeldin A
was added
after 2 h. Cells were then stained with anti-human CD8-PerCP
and
anti-human CD3-APC. After fixation and permeabilization of
the cells,
staining was performed with anti-IFN-

-fluorescein
isothiocyanate
(FITC) and analyzed by flow cytometry. Using this
technique to analyze
IFN-

production in the cells from two of
the individuals (P1 and P7)
gave results that were below the level
of detection of the flow assay
(~0.05%). This result was expected,
since the ELISPOT assay detected
less than 100 SFC/10
6 PBMCs in both individuals. We
therefore performed tetramer and
IFN-

detection assays by both
ELISPOT and intracellular cytokine
staining with PBMCs derived from
an LTNP not included in the original
cohort (CD4
+ T-cell
count, 1,078/µl; plasma viral load, 190 copies/ml; infected
for more
than 12 years). A large number of PBMCs taken from this
individual
(P8) were previously shown to secrete IFN-

by an ELISPOT
assay after
SL9 peptide stimulation (data not shown). We found
that 0.74% of this
individual's CD8
+ T cells stained with the SL9 tetramer, a
higher percentage than
those seen for individuals P1 through P7 (Fig.
5). Additionally,
following SL9 peptide
stimulation, the ELISPOT assay detected
735 SFC/10
6
PBMCs, also a higher number than those seen for the other
volunteers.
Flow cytometric analysis of cells stained for the presence
of
intracellular cytokines demonstrated that 0.11% of CD8
+
T cells secreted IFN-

. Therefore, only 15% of the tetramer-positive
cells produced IFN-

in the intracellular cytokine assay. Converting
the intracellular cytokine staining results into the number of
cells per million PBMCs yielded numbers similar to those derived
from the ELISPOT assay (834 versus 735 positive events per
10
6 PBMCs, respectively). The above
results, with a cell line constitutively
expressing
IFN-

and with PBMCs from an LTNP, indicated that the
observation that the majority of tetramer-positive cells do not
produce
IFN-

after antigenic stimulation was not due to a lack
of
sensitivity of the IFN-

ELISPOT assay. Furthermore, our data
are
consistent with published findings showing that the tetramer
detected a
greater number of cells in mice than can be seen to
produce IFN-

(
29,
40,
43).

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FIG. 5.
Direct comparison of the tetramer and intracellular
cytokine assays. PBMCs derived from individual P8 were either
stained with the SL9 tetramer (A) or stimulated with the SL9 peptide
for 6 h and stained for the presence of IFN- (B). Results are
given in terms of the percentage of CD8+ T cells that
stained with either the tetramer or IFN- .
|
|
Not all tetramer-positive cells may produce IFN-

. The
tetramer-positive cells could be producing other cytokines or none
at
all. A related possibility is that some of the tetramer-positive
cells
are no longer able to proliferate and are undergoing apoptosis
(
15,
26). Evidence for this scenario comes from studies with
CD4
+ T-cell-deficient mice, where tetramer-positive T cells
specific
for a lymphocytic choriomeningitis virus (LCMV) epitope
failed
to produce IFN-

or other cytokines in response to that LCMV
peptide
(
43). The same study also demonstrated that not all
tetramer-positive
cells produced IFN-

in wild-type mice chronically
infected with
LCMV. The possibility that not all tetramer-positive
cells may
be functional has also recently been demonstrated in EBV,
HIV-1,
and tumor-associated antigen-specific CD8
+ T
lymphocytes (
24,
39,
40). Finally, two recently published
reports also demonstrated that not all tetramer-positive cells
derived
from HIV-1-infected volunteers were able to produce IFN-
as detected
by either ELISPOT (
34) or intracellular cytokine
staining
(
9) assays. Therefore, while the published data on
humans
remain anecdotal, it is possible that subsets of tetramer-positive
cells are not fully functional. Indeed both our own data and those
of
others (
9,
34) suggest that about 50 to 90% of SL9-specific
CD8
+ T cells fail to produce IFN-

upon exposure to SL9.
Whether the
different SL9-specific cell frequencies observed in these
two
assays reflect technique or actual biology, i.e., true differences
in the functionality of antigen-specific T cells, remains to be
determined. Furthermore, it is not currently clear whether these
differences are unique to HIV-1 infection. Studies are ongoing
in our
laboratory and others to more fully characterize the functional
capacity of tetramer-positive human cells. The near future should
provide better insights into this important
question.
 |
ACKNOWLEDGMENTS |
We thank Kevin Perez, Tina Rogers, Marion Spell, Xiaobing Ping, and
Veronica Owens for technical support, Peter Bonventre for volunteer
recruitment, Yuting Zhang for statistical analysis, and Yvonne McClain
for manuscript preparation. Recombinant vaccinia virus vectors and the
Gag peptide pool were obtained from the NIH AIDS Research and Reference
Reagent Program.
This work was supported by USPHS awards AI-45209 and AI-01380, the UAB
Center for AIDS Research (AI-27767), and a Howard Hughes Medical
Institute (HHMI) institutional award to UAB.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: 845 19th St.
South, BBRB 220, Birmingham, AL 35294-2170. Phone: (205) 975-5667. Fax: (205) 975-5718. E-mail: paulg{at}uab.edu.
 |
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Journal of Virology, November 2000, p. 10249-10255, Vol. 74, No. 21
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Hel, Z., Nacsa, J., Tryniszewska, E., Tsai, W.-P., Parks, R. W., Montefiori, D. C., Felber, B. K., Tartaglia, J., Pavlakis, G. N., Franchini, G.
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