Journal of Virology, April 2002, p. 3587-3595, Vol. 76, No. 8
0022-538X/02/$04.00+0 DOI: 10.1128/JVI.76.8.3587-3595.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
Departments of Internal Medicine,1 Medical Microbiology, School of Medicine, University of California, Davis, California 956162
Received 5 September 2001/ Accepted 9 January 2002
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Nef, a 25- to 27-kDa multifunctional accessory protein of HIV and SIV, has been shown to play a key role in HIV and SIV pathogenesis (47, 59). While Nef is not required for viral replication in tissue culture, it is necessary for the development of high viral loads and disease progression in rhesus macaques (29). Rhesus macaques infected with SIV harboring nef mutants with deletions do not develop high viral loads and maintain stable CD4+ T-cell counts (9). Similarly, HIV-infected long-term nonprogressor individuals, who remain asymptomatic for more than 10 years, maintain low viral loads and stable CD4 T-cell counts. In some of these individuals, evaluation of the viral genomes has identified deletions in the nef gene. Taken together, these studies suggest that Nef may be involved in CD4 T-cell loss associated with HIV pathogenesis in humans (9, 30). Consistent with these observations, transgenic mice expressing HIV Nef have been shown to develop an AIDS-like disease characterized by depletion of CD4 T cells, alterations in CD4 T-cell activation, and defects in precursor CD4 T-cell differentiation and proliferation in lymphoid organs (20, 56).
Nef can have multiple independent effects on T cells in vitro (23, 46, 47): Nef downregulates the surface expression of CD4 (16, 35, 49), CD28 (58), and major histocompatibility complex class I (53) molecules from the cell surface, increases viral infectivity (7), and modulates signal transduction pathways in T cells (3, 38, 56). It is speculated that the ability of Nef to mediate CD4 T-cell depletion probably results directly from the interaction of Nef with CD4 activation and signaling molecules. SIV Nef directly interacts with the
subunit of CD3 and downregulates expression of the CD3-T-cell receptor (TCR) complex from the cell surface, thus disrupting TCR-initiated signaling in CD4 T cells. Additional effects of Nef on CD4 T-cell signaling involve modulation of calcium levels (56) and interaction with serine and tyrosine kinases, protein kinase C, and the Src family kinase p56lck signaling pathways (2, 19, 32, 51, 57). In spite of attempts to elucidate the molecular mechanisms of these interactions, few studies have examined the physiological consequences of these Nef interactions for CD4+ T cells.
Recent studies have demonstrated that HIV and SIV Nef proteins induce apoptotic cell death in T cells through Nef-mediated upregulation of Fas ligand on the surfaces of infected cells. This induction of apoptosis involves direct association between the Nef protein and the ITAM motif of the CD3
subunit (62). In a contradictory report, Nef expression was shown to inhibit apoptosis by inhibiting activation of caspases 8 and 3 (63). In addition, Geleziunas et al. (17) reported that HIV Nef inhibits ASK-1 activation, thus blocking both Fas- and tumor necrosis factor alpha-induced apoptosis in HIV-infected and Nef-transfected cells. In light of these conflicting reports, we opted to examine the effects of SIV Nef on cell proliferation, apoptosis, and expression of cell cycle-related genes in CD4+ T cells by using the Jurkat T-cell line. Previous studies using retrovirus vectors to stably express Nef proteins in transfected or transduced T cells provided variable and sometimes contradictory results, which may be attributed to various possibilities (31). The Nef-expressing cells had different levels of Nef expression, leading to differing cytotoxic effects of Nef. Constant expression of the Nef protein could lead to the selection of particular cell phenotypes resistant to Nef cytotoxicity. This is evidenced by the emergence of mutations that inhibited the expression of the full-length Nef protein (3). Some of these problems can be overcome by developing an inducible Nef-expressing stable CD4+ T-cell line, thus providing a consistent and reliable system for studying the effects of Nef on CD4+ T-cell proliferation and apoptosis immediately following Nef expression.
Proliferation through the cell cycle is regulated by the cyclins and their catalytic subunits, the cyclin-dependent kinases (CDK). Cyclin A associates with CDK-2 and Cdc2 and is important for S-phase progression as well as for the G2-M transition (41, 42). Cyclin D, with its catalytic partners CDK-4 and CDK-6, and cyclin E, with its catalytic partner CDK2, can both phosphorylate the retinoblastoma (Rb) protein (22, 24, 28). Rb phosphorylation results in the release of bound transcription factor E2F1-3 from the E2F-Rb complex, thus promoting transcription of genes encoding proteins required for DNA replication (40). Other members of the Rb family, p107 and p130, bind to E2F4. The p130-E2F complexes are mainly found in quiescent or differentiated cells, while p107-E2F complexes are most commonly found in proliferating cells during S phase (8, 11, 43, 44). Cyclin A, along with its catalytic partner CDK-2 or cdc2, is essential for DNA replication and thus for S-phase progression. The activity of cyclins and CDK is negatively regulated by CDK inhibitors (CKIs) (37, 54). There are two main classes of CKIs. The INK4 family, which includes inhibitor p16, specifically inhibits cdk4 and cdk6, while the CIP/KIP family, which includes inhibitors p21 and p27, inhibits a wide range of cyclins and CDKs (55). The effects of Nef on cyclins and the cell cycle are not known.
In the present study, we have developed a CD4+ Jurkat T-cell line that stably expresses the CD8 Nef protein under the control of an inducible promoter. We used this cell line to study the effects of Nef on cell proliferation and apoptosis. Our results demonstrated that Nef could cause a delay in cell cycle progression by modulating cell cycle regulation genes. The Nef-associated inhibition of cell proliferation could be a contributing mechanism to the viral persistence and T-cell depletion seen in HIV and SIV infection.
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Plasmids.
Plasmid pCMV/CD8-Nef, carrying the coding sequence for the extracellular and transmembrane domains of the human CD8
chain fused to the SIVmac239 nef gene, was a generous gift from Earl Sawai and has previously been described (52). The use of the CD8-Nef construct facilitated the detection of Nef-expressing cells by anti-CD8 antibodies. The CD8-Nef chimera has been used by other investigators and was shown to have effects on T cells similar to those of constructs expressing wild-type Nef (3, 61).
Inducible-expression plasmid pIND/CD8-Nef was generated by cloning the coding sequence for the CD8-Nef chimera into ecdysone-inducible mammalian expression vector pIND (Invitrogen, Carlsbad, Calif.) containing a neomycin selection marker. Expression is under the control of Drosophila melanogaster minimal heat shock promoter and the ecdysone and glucocorticoid response element (E/GRE) hybrid promoter. Briefly, the CD8-Nef-coding fragment from pCMV/CD8-Nef was excised with HindIII and XbaI and cloned into the HindIII-XbaI sites of the pIND vector. Plasmid pVgRxR (Invitrogen) encodes the RxR and VgEcR ecdysone receptor subunits and contains a Zeocin selection marker.
Transfection and establishment of a Nef-inducible stable cell line. Jurkat E6-1 T cells were transfected with 20 µg of linearized pIND-CD8-Nef plasmid by electroporation of 5 x 106 cells in 0.5 ml of growth medium without serum at 250 V and 975 µF using a Gene Pulser (Bio-Rad, Hercules, Calif.) and grown overnight. Transfected cells were plated in 96-well plates in growth media containing G-418 (1,000 µg/ml; GIBCO-BRL) for 14 days. The resulting stable clones were selected by limiting dilution and maintained in the growth media containing 250 µg of G-418/ml. Cells from stable clones were expanded and transfected by electroporation with linearized pVgRxR using conditions similar to those described for pIND-CD8-Nef transfection. Cells were grown overnight and plated in 96-well plates followed by dual selection in the presence of 250 µg of G418/ml and 200 µg of Zeocin/ml for 14 days. Double-transfected clones and clones resistant to both G-418 and Zeocin were amplified and tested for the expression of Nef following induction with ponasterone A, a synthetic analog of ecdysone. The anti-SIV Nef clone 17.2 antibody (AIDS Research and Reagents Repository Program) was used to detect Nef by Western blotting. Ecdysone-inducible Nef-expressing clone B5 was maintained in RPMI 1640 supplemented with 10% fetal calf serum, 100 U of penicillin-streptomycin/ml, 250 µg of G-418/ml, and 100 µg of Zeocin/ml. Expression of Nef was induced by addition of 10 µM ponasterone A to the cells, and cells were incubated for 12 h.
Detection of Nef protein. To determine the amount of Nef in transfected cells, Western blot analysis was performed using ECL-plus (Amersham Pharmacia Biotech Piscataway, N.J.) and STORM imaging analysis systems. Briefly, 106 cells were lysed in NP-40 lysis buffer, followed by protein concentration determination with a bicinchoninic acid microassay (Bio-Rad, Hercules, Calif.). Proteins were separated by sodium dodecyl sulfate-12% polyacrylamide gel electrophoresis (SDS-12% PAGE) and blotted onto nitrocellulose membranes (Schleicher & Schuell, Keene, N.H.). Membranes were probed with anti-SIV Nef monoclonal antibody 17.2 (AIDS Research and Reference Reagent Program). ImageQuant, version 3.0 (Molecular Dynamics, Sunnyvale, Calif.), software was used to quantitate protein levels.
Induction and analysis of apoptosis. To determine whether Nef induced or inhibited apoptosis in Nef-expressing cells, 2 x 106 cells were incubated at 37°C for 12 h in growth media containing 2.5 µg of an anti-Fas monoclonal antibody (clone DX2; BD PharMingen, San Diego, Calif.)/ml and 2.5 µg of protein G (Sigma, St. Louis, Mo.)/ml. Cells were washed and analyzed for apoptosis by annexin V-fluorescein isothiocyanate (FITC) and propidium iodide staining using flow cytometry (BD PharMingen).
CFSE tracking assay. To determine the effect of Nef on cell proliferation, Jurkat cells, uninduced and induced B5 cells, were labeled with 5- and 6-carboxyfluorescein diacetate succinimidyl ester (CFSE; Molecular Probes Inc., Eugene, Oreg.) as previously described (33). Briefly, cells were washed once in phosphate-buffered saline (PBS) and resuspended at 106 cells/ml in PBS containing 0.1% bovine serum albumin (BSA). CFSE was added to a final concentration of 10 µM, and cells were incubated for 10 min at room temperature. Cells were subsequently washed with PBS-BSA solution, suspended in RPMI 1640 medium, and cultured at 37°C for 5 days in a humidified 5% CO2 incubator. Labeled cells were harvested, washed, and analyzed by FACScan (Becton Dickinson, San Jose, Calif.) using CellQuest software (Becton Dickinson) and FlowJo software (Tree Star Inc., San Carlos, Calif.). Cell division was calculated based on the sequential halving of fluorescence intensity in daughter cells. CFSE peaks were individually gated, and the proportion of cells in each round of cell division was calculated as previously described (21). Briefly, to calculate CFSE intensity for different divisions, the geometric mean fluorescence intensity (MFI) of unlabeled cells (autofluorescence) was subtracted from the MFI of CFSE-labeled cells to give the MFI of cells after zero to five divisions. The FlowJo software was also used to calculate the MFI boundaries in order to define M0 (parental), M1 (one division), M2, M3, M4, M5, and M6 cells.
Measurement of BrdU incorporation and DNA content. Cells were seeded at 106 cells/ml in T-25 flasks, cultured for 1 to 5 days, and incubated with 10 µM bromodeoxyuridine (BrdU; Sigma) for the final 1 h of the culture period. Cells were then harvested, washed twice in PBS-BSA solution, fixed, and permeabilized with a BrdU Flow kit (BD PharMingen) according to manufacturer's instructions. DNA of fixed and permeabilized cells was digested by incubating them with 10 U of DNase I (Boehringer GmbH, Mannheim, Germany)/ml for 2 h at 37°C. Finally the BrdU-treated cells were intracellularly stained with an anti-BrdU-FITC antibody and 7-aminoactinomycin D (7-AAD) and analyzed by flow cytometry.
Immunoblot analysis. Cells were lysed in radioimmunoprecipitation buffer (50 mM Tris-HCl [pH 7.4], 0.1% NP-40, 0.25% sodium deoxycholate, 150 mM NaCl, 1 mM EDTA, 1 mM phenylmethylsulfonyl fluoride, 1 µg of leupeptin/ml, 1 mM Na3VO4, 1 mM NaF), and equal amounts of protein were separated by SDS-PAGE, transferred onto nitrocellulose membranes (Schleicher & Schuell), and blocked with 5% nonfat dry milk in PBS-0.1% Tween prior to the addition of specific antibodies. The following antibodies were used: cyclin E antibody (generous gift from G. Lozano); antibodies to cyclin A, cyclin D1, cyclin D2, cyclin D3, p21, p27, p107, p130, E2F1, E2F4, Bcl-2, Bax, Cdk2, and actin (Santa Cruz Biotechnology, Santa Cruz, Calif.); and Rb and hyperphosphorylated Rb monoclonal antibodies (BD PharMingen). After membranes were washed, immunodetection was accomplished by incubating them with a horseradish peroxidase-conjugated antibody against mouse immunoglobulin G (IgG) or rabbit IgG (1:10,000) followed by enhanced chemiluminescence (Amersham Pharmacia Biotech) in accordance with the manufacturer's recommendations. For control, membranes were stripped in 100 mM 2-mercaptoethanol-62.5 mM Tris-HCl (pH 6.8)-2% SDS for 30 min at 55°C and reblotted with actin monoclonal antibodies.
In vitro kinase assays. In vitro kinase assays were performed as previously described (10). Briefly, cells were lysed in NP-40 lysis buffer and the extracts were precleared and incubated with specific antibodies. The antibody-protein complexes were isolated on protein A/G beads, washed, and resuspended in kinase buffer (1 mg of histone/ml, 1 mM ATP, 1 µCi of 32P/µl, 20 mM HEPES [pH 7.0], 80 mM glycerolphosphate, 20 mM EGTA, 50 mM MgCl2, 5 mM MnCl2, 1 mM dithiothreitol, 2.5 mM phenylmethylsulfonyl fluoride, 10 µM cyclic AMP [cAMP] protein kinase inhibitor). The kinase reaction was terminated by addition of gel loading buffer, and the proteins were separated by SDS-10% PAGE. The gel was fixed, dried, and autoradiographed.
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FIG. 1. Inducible stable expression of CD8-Nef in Jurkat cells. (A) Schematic diagram of the pIND-CD8-Nef construct. The coding sequence for the CD8-Nef chimera was cloned into the pIND vector downstream of the coding sequence for the hybrid E/GRE and minimal Hsp promoters. (B) Schematic diagram of the pVgRxR regulatory plasmid. This plasmid encodes Drosopila ecdysone hormone receptor subunits RxR and EcR under the control of Rous sarcoma virus (RSV) and cytomegalovirus (CMV) promoters, respectively. (C) Generation of the B5 stable cell line. Jurkat cells were stably transfected with pIND-CD8-Nef and pVgRxR plasmids. Clones resistant to both G-418 and Zeocin were screened for Nef expression by immunoblotting using an anti-Nef antibody. Clone B5 was selected and showed a fivefold increase in Nef expression following induction. There was a basal level of Nef expression in the absence of ponasterone A. (D) Induction of CD8-Nef expression is dependent on ponasterone A concentrations. B5 cells were treated with increasing concentrations of ponasterone A. Cell lysates containing equal amounts of proteins were immunoblotted with an anti-Nef antibody. Nef expression peaked at 10 µM ponasterone A but declined at 15 and 20 µM ponasterone A.
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FIG. 2. Analysis of Fas-induced apoptosis. Jurkat and B5 uninduced and induced cells were treated for 6 h with anti-human Fas antibody DX2 (2 µg/ml), and protein G (2 µg/ml) to induce apoptosis. Cells were stained with annexin V-FITC and propidium iodide and analyzed by flow cytometry. The results are averages of three independent experiments.
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FIG. 3. Analysis of the effects of Nef on cell proliferation. Jurkat, B5 uninduced, and B5 induced cells were labeled with CFSE and cultured for 5 days. Cells were harvested, and fluorescence intensity and cell counts were analyzed by flow cytometry. Proliferation and cell division were characterized by sequential reduction in CFSE fluorescence intensity, generating a series of shifted equally spaced peaks on a logarithmic scale. (A) Comparison of CFSE intensity profiles of freshly labeled Jurkat cells (left) and cells after 5 days of culture (right). (B) Histograms showing different discrete cycles of cell division. Shown are cell division cycles of Jurkat and B5 uninduced cells (top) and B5 induced cells (bottom) after 5 days of culture.
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FIG. 4. BrdU incorporation and DNA content analysis. Cells were cultured with 10 µM BrdU for the final 1 h of the culture. Cell-incorporated BrdU (measured with FITC-conjugated anti-BrdU antibody) and total DNA content (measured with 7-AAD) were analyzed by flow cytometry. The proportions of cells at sub-G0/G1, G0/G1, S, and G2 plus M phases of the cell cycle were identified. (A) Dot plots showing percentages of cells in different phases of the cell cycle for Jurkat, B5 uninduced, and B5 induced cells. The data are representative of four independent experiments. (B) Bar graph showing the percentages of cells at various phases of the cell cycle.
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FIG. 5. Bcl-2 and Bax levels in Jurkat and B5 transfected Nef-expressing cells. Exponentially growing Jurkat, B5 uninduced, and B5 induced cells were subjected to Western blot analysis using 20 µg of protein for each cell line. Samples were analyzed on a SDS-10% PAGE gel and blotted to the membrane. Equal loading of the samples was determined by reblotting with actin antibodies.
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FIG. 6. Expression of cell cycle regulatory proteins in Jurkat and Nef-expressing cells. (A) Analysis of cyclin expression. Exponentially growing Jurkat, B5 uninduced, and B5 induced cells were subjected to Western blot analysis using 20 µg of protein for each cell line. The cyclin D1, cyclin A, and cyclin E proteins were detected by Western blot analysis. Membranes were reblotted with actin antibodies to ensure equal loading of the samples. (B) Analysis of CKI expression. Cells were subjected to Western blot analysis using 20 µg of protein for each cell line. Samples were analyzed on an SDS-12 (p21) or 10% (p27) PAGE gel. (C) Analysis of Rb family and E2F expression. Cells were subjected to Western blot analysis using 40 µg of protein. Samples were analyzed on an SDS-8 (Rb, hyperphosphorylated Rb, p130, and p107) or 10% (E2F1 and E2F4) PAGE gel.
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p130 levels are elevated in Nef-expressing Jurkat cells. CKIs p21 and p27 inhibit the phosphorylation of cyclin/CDK substrates including the tumor suppressor Rb. Since these CKIs were upregulated in Nef-expressing cells, we examined the status of Rb family members by Western blot analysis. Rb migrated as two species, a hyperphosphorylated species of approximately 117 kDa and a hypophosphorylated form (pRb) of approximately 110 kDa, in Jurkat cells. In Jurkat cells, both forms were present. Surprisingly, in B5 induced cells, the hypophosphorylated Rb was two- to threefold less abundant but there was no change in overall levels of Rb (Fig. 6C). The decrease in hypophosphorylated Rb was observed in several independent experiments. We also examined p107 and p130 levels. The p130 protein is expressed at high levels during quiescence, while p107 is associated with proliferation (8, 43, 44). We found a fivefold increase in the levels of p130 and a twofold decrease in the levels of p107 between control and uninduced cells, suggesting that these proteins are highly sensitive to the presence of Nef (Fig. 6C). We observed no difference in levels of the transcription factor E2F1, which interacts with pRb, but a slight twofold decrease in levels of E2F4, the protein that interacts with p107 and p130 (Fig. 6C).
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We have also demonstrated that SIV Nef suppresses cell proliferation by slowing the progression of cells through the cell cycle. The retardation of cells in the G1 stage is accompanied by a downregulation of cyclins D and A as well as cyclin A-dependent kinase activity (data not shown). However, the levels of cyclin E remained constant. While CDK activity is regulated by interaction with the cyclin regulatory subunit, it is also regulated by interaction with CKIs. Induction of SIV Nef expression resulted in an increase of CKIs p27 and p21. Our analysis of CDK-2 activity upon SIV Nef induction revealed only a slight decrease (data not shown). Moreover, a significant decrease in cyclin A and D levels as well as a significant induction of CKIs was observed. Since the levels of cyclin E are not altered on SIV Nef induction, we postulate that the majority of CDK-2 activity is cyclin E dependent. It is also possible that SIV Nef mediates alterations of other proteins, such as phosphatases, that are instrumental in the activation of CDK activity and that these modifications may counteract the effect of CDK inhibitors and permit the CDK-2 to remain active. However, flow-cytometric analysis demonstrated that the combined dysregulation of cyclins and CKIs resulted in G1 growth arrest. Since cyclin D levels were decreased, we analyzed cyclin D substrate Rb as well as Rb-related proteins p107 and p130. Hyperphosphorylation of the Rb protein results in the release of the E2F transcription factors and subsequent expression of growth-promoting genes. Rb relative p130 is associated with quiescence and growth arrest, while p107 is most abundant during S phase. Expression of basal levels of Nef led to significantly increased p130 levels and a decrease in p107 levels. However, while the level of Rb was unchanged, there was an increase in phosphorylated Rb, a change that is usually associated with proliferation. This suggests that the levels of Nef present in uninduced cells were sufficient to change the expression pattern of these proteins, but these changes did not appear to be the cause of the retardation of the cell cycle progression observed on Nef induction. This also suggests that, while cyclin D levels decreased on the Nef induction, the observed reduction in S phase was not due to a decreased cyclin D-dependent kinase activity. These results also argue that a deregulation of the Rb/E2F pathway is not the primary cause for the retardation of proliferation. We observed a 10-fold decrease in cyclin A, a cyclin that is essential for S phase. Cyclin A interacts with CDK-2 in early S phase and with cdc2 in late S phase and phosphorylates multiple substrates including proteins that are required for DNA replication. We propose that a 10-fold decline in cyclin A levels along with an increase of CKIs p21 and p27 would inhibit cyclin A activity and DNA replication.
The molecular mechanisms governing Nef-induced suppression of cell proliferation and apoptosis may involve multiple molecular interactions. SIV Nef may interact with multiple signaling pathways, and distinct pathways may govern the combined effect of an inhibition of apoptosis and proliferation. Several lines of evidence implicate SIV Nef in the modulation of signaling pathways of T cells such as those associated with PAK and protein kinase C (32, 57), activation of NFAT1 (34), and modulation of calcium signaling (3, 56). These pathways are also involved in the regulation of cyclin D abundance and turnover in proliferating T cells. The mechanism, biological consequences, and role of these effects remain speculative. We speculate that SIV Nef may be involved in the modulation of proliferation and apoptosis through the same signaling pathways.
Nef may be involved in the induction of anergy through several mechanisms. Nef has been shown to disrupt normal TCR-initiated signaling by interfering with the CD3-TCR complex (26). SIV Nef interacts directly with the
chain of CD3 and downregulates TCR-CD3 from the cell surface (4, 25, 58). Nef downmodulates CD28, a major costimulatory molecule that mediates effective T-cell activation (56). Lack of CD28 ligation during T-cell activation results in the induction of anergy (1, 5, 6). Since both the
chain and CD28 are involved in the pathways involved in the induction of anergy, it is most likely that the ability of Nef to induce anergy is mediated through Nef functions that involve these cellular molecules.
In our study, SIV Nef-expressing cells showed molecular and biochemical characteristics identical to those observed in anergized T-cell clones. The T cells undergo anergy when the TCR is engaged by an antigen in the absence of a costimulatory signal, usually provided by the CD28-B7 interaction or interleukin-2. Anergized T cells remain viable but are incapable of proliferating in response to stimulation. Specifically, anergy is characterized by lack of activation of lck, ZAP-70, Ras, ERK, JNK, AP-1, and NFAT (1, 39, 45, 48). Anergizing stimuli appear to activate protein tyrosine kinase Fyn and increase intracellular levels of calcium and cAMP. The cAMP upregulation provides a link between the induction of anergy and cell cycle regulatory mechanisms. Elevated levels of cAMP induce an upregulation of CKI p27, which in turn sequesters cyclin D1-CDK-4 and cyclin E-CDK-2 complexes and thus inhibits progression of T cells through the G1/S phase checkpoint control of the cell cycle. In addition, costimulation through the CD28 pathway can prevent p27 accumulation by promoting p27 downregulation by protein ubiquitination and degradation.
In conclusion, our results showed that Nef may suppress proliferation of CD4+ T cells through the modulation of cell cycle-associated gene expression. A potential model for the mechanism of Nef-induced cell cycle arrest has been developed (Fig. 7). Nef can increase Bcl-2 expression and inhibit Fas-mediated apoptosis, which can result in persistence of Nef-expressing cells. The decrease in cyclins D and A and the increase in CKIs p21 and p27 can lead to a cell cycle arrest at G1 stage. This may contribute to T-cell anergy. Thus, Nef can play an important role in the persistence of virally infected cells as well as in CD4+ T-cell depletion.
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FIG. 7. Model for Nef-mediated induction of T-cell anergy and viral persistence.
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This work was supported by NIH grants DK-43183 and AI-43274 and a University of California, Davis, Health System award.
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