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Journal of Virology, December 2005, p. 15368-15375, Vol. 79, No. 24
0022-538X/05/$08.00+0 doi:10.1128/JVI.79.24.15368-15375.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Joseph Church,3
Christina M. R. Kitchen,4
Ryan Kilpatrick,1
Ayub Ali,1
Yongzhi Geng,5
M. Scott Killian,1
Rachel Lubong Sabado,1
Hwee Ng,1
Jeffrey Suen,5
Yvonne Bryson,5
Beth D. Jamieson,1 and
Paul Krogstad5,6,
UCLA AIDS Institute and Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California,1 Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, California,2 Childrens Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, California,3 Department of Biostatistics, School of Public Health, University of California, Los Angeles, California,4 Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California,5 Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, California6
Received 22 July 2005/ Accepted 27 September 2005
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In the setting of such fluid mutability, a major force shaping viral evolution in vivo is antiviral pressure applied by major histocompatibility complex class I (MHC I)-restricted HIV-1-specific CD8+ cytotoxic T lymphocytes (CTL). This arm of immunity is believed to have an important role in suppressing viremia; the development of the CTL response temporally correlates with the decline of viremia during primary infection (5, 16), and experimental in vivo CD8+ T-cell depletion in simian immunodeficiency virus (SIV)-infected macaques results in markedly increased viremia (13, 19, 26). Several studies in humans and macaques have demonstrated that mutations in CTL epitopes in vivo evolve to permit evasion of immunity (reviewed in reference 30); thus, CTL exert constraints on HIV-1 coding sequences in vivo. Associations of specific HIV-1 sequence polymorphisms with specific MHC I alleles across human populations (21) further confirm the central role of CTL in shaping HIV-1 evolution. The determinants of escape at the individual and cellular level, however, remain poorly defined (34).
Targeting of HIV-1 by CTL is also incompletely understood. The HIV-1 genome varies substantially, even between viruses within the same subtype, affecting the sequences of potential epitopes for CTL recognition. Furthermore, the CTL response in infected persons tends to target a small minority of the many potential epitopes defined by their MHC I haplotypes, and different persons with the same MHC I molecules usually target different epitopes restricted by those molecules (3). It is therefore unclear to what extent host genetic, viral genetic, or other factors contribute to this variability of viral targeting by CTL between infected individuals.
Unraveling the determinants of CTL targeting and evolution of HIV-1 sequences in vivo is therefore complicated by the variability of viral sequences and host genetic factors. Here we evaluate identical twins who were perinatally infected from a common transfusion source. This unfortunate circumstance allowed examination of CTL responses and viral evolution in a clinical setting, where host genetic factors and initial viral sequence are controlled.
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MHC class I typing. High-resolution class I typing was performed by Pel-Freez Biologicals.
Peripheral blood T-cell counts and viremia quantitation. Peripheral blood CD4+ and CD8+ T-lymphocyte subset measurements were determined by the clinical laboratory of Childrens Hospital Los Angeles. Plasma HIV-1 RNA concentrations were determined by reverse transcription-PCR (RT-PCR; Roche Amplicor HIV-1 Monitor).
Mapping of CD8+ T-cell responses against HIV-1. (i) Cells. Cryopreserved peripheral blood mononuclear cells (PBMC) were utilized to generate polyclonally expanded CD8+ T cells as previously described (33). Briefly, unfractionated PBMC were exposed to a CD3:4 bispecific antibody that preferentially expands CD8+ T cells, resulting in a polyclonal line of >95% CD3+/CD8+ after 14 days of expansion (by flow cytometric analysis) (data not shown).
(ii) IFN-
ELISpot.
After 14 days, these cells were then screened for responses by gamma interferon (IFN-
) ELISpot using peptides from the NIH AIDS Research and Reference Reagent Repository as previously described (32). These peptides were 15-mers overlapping by 11 amino acids. The Pol (catalog no. 6208), Nef (no. 5189), Tat (no. 5138), Vpr (no. 6447), Vpu (no. 6444), Vif (no. 6446), and Rev (no. 6445) peptides were based on consensus B sequences from the Los Alamos National Laboratory HIV database. The Gag (no. 6869) and Env (no. 6451) peptides were based on HIV-1 DU422 and MN strain sequences, respectively. The initial screening was performed on pools of 16 or fewer peptides, and positive pools were then screened using 4-by-4 matrix pools as per the strategy described by Betts et al. (3). Candidate peptides identified by the matrices were then confirmed by individual testing by ELISpot. Positive responses were defined as being at least two standard deviations above the mean for triplicate negative control wells.
T-cell receptor Vß spectratyping analysis. T-cell receptor Vß CDR3 length mapping was performed by RT-PCR as previously described (14). Briefly, CD8+ T cells were isolated from cryopreserved PBMC (12/00 and 6/01) by negative selection (Dynal, Great Neck, NY) as per the manufacturer's protocol. TCR Vß transcripts were amplified by RT-PCR using a constant region primer, followed by Vß-specific PCR and visualization of the CDR3 regions of 24 TCR Vß families. The nucleotide lengths and intensities of the fluorescently labeled CDR3 region amplicons were measured using a 310 Genetic Analyzer (Applied Biosystems, Foster City, CA).
T-cell expansions were analyzed with a modification of a previously described method (14). Briefly, all measured CDR3 length peak areas were summed for each Vß family to yield a total area. The proportion of this area contributed by each measured peak was then calculated and standardized by the median ratio to obtain an adjusted standardized proportion (aSP) for each peak in the experimental set. To obtain an expansion factor, the ratio of each aSP to the mean aSP of the corresponding peaks in a set of control individuals was calculated. Pair-wise comparisons then were made between measured Vß peaks for all expansion factor values of >1 in either peak set being analyzed, using two-tailed Spearman rank correlation coefficients.
Peptide stimulation of CTL. For spectratyping after peptide stimulation, cryopreserved PBMC from 9/01 were cultured in RPMI with 50 U/ml interleukin-2 (NIH AIDS Research and Reference Repository) at 2 x 106 cells per well in a 24-well plate for 7 days in the presence or absence of the synthetic peptide HKAIGTVLVGPTPVN (protease 69-83; NIH AIDS Research and Reference Repository, catalog no. 5492) at 5 µg/ml. Spectratyping after CD8+ cell isolation was then performed as described above.
HIV-1 sequencing. Proviral sequences were derived from cryopreserved PBMC by direct PCR previously described (17). Briefly, simple lysates of PBMC DNA prepared were used as the template for limiting dilution nested PCR amplification (23). Limiting dilution was determined by serial twofold dilutions to the point at which less than 50% of six PCR mixtures generated a product. Agarose gel electrophoresis was used to identify successful PCR amplification. PCR was performed in a total volume of 50 µl. Platinum Taq polymerase (Gibco BRL) was used in buffer containing 20 mM Tris-HCl (pH 8.4), 50 mM KCl, 1.75 mM MgCl2, 0.1 mM deoxynucleoside triphosphate, and 0.1 mM of each primer. Thermocycling conditions were as follows: 94°C (5 min) and then 30 cycles of denaturation at 94°C (40 s), hybridization at 54°C (40 s), and extension at 72°C (60 s). A final extension at 72°C (10 min) was then performed. Genomic sequences for most portions of the genome were amplified using the PCR primer sets described by Altfeld et al. (1). For all sequences, at least four individual clones were evaluated. To analyze proviral nef sequences, amplification with the first-round forward primer Nef8687F (5'-GTA GCT GAA GGG ACA GAT AGG GTT AT-3') and reverse primer NEF9589R (5'-TAG TTA GCC AGA GAG CTC CCA-3') was used to generate a 0.8-kb fragment (12). Five microliters of the first-round product was transferred to new reaction mixtures. Primers Nef8748F (5'-CGT CTA GAA CAT ACC TAG AAG AAT AAG ACA GG-3') and NEF9495R (5'-TTA TAT GCA GCA TCT GAG GCC-3') were used in the second round to yield a 0.7-kb fragment (12). Sequence was obtained from the forward strand using primer Nef8748F and from the reverse strand using primer NEF9495R. Envelope gene sequences were amplified from DNA as described elsewhere (17) using primers described by Delwart et al. (8). To detect HIV nef or env RNA sequences, viral RNA was extracted from 1 ml plasma using QIAGEN columns and used as the template for reverse transcription reactions using the NEF9495R primer or the ED12 primer (8) to generate nef and env cDNA, respectively.
Phylogenetic analysis. Sequences for each viral gene were aligned using ClustalW and manually edited. All sequences were checked for G-to-A hypermutation using the HYPERMUT program (24). Mutations in pol were compared to known resistance mutations in the Stanford and Los Alamos HIV Resistance databases. Phylogenetic trees were created assuming the HKY 85 model with gamma distribution (HKY + G) and also by using a Bayesian hierarchical model as previously described (15, 27).
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FIG. 1. Clinical course and treatment of identical twins infected with HIV-1 via neonatal blood transfusion. Peripheral blood CD4+ T-lymphocyte counts (closed symbols) and plasma HIV-1 RNA levels (open symbols) are plotted for both twins (circles, twin 1-05; triangles, twin 1-06). The antiretroviral drug treatment history is indicated. ZDV, zidovudine; ddc, dideoxycytidine; ddI, didanosine; NVP, nevirapine; 3TC, lamivudine; NLV, nelfinavir; EFV, efavirenz; D4T, stavudine; SQV, saquinavir; LPV/r, lopinavir-ritonavir.
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FIG. 2. HIV-1-specific CTL targeting of the twins. (a) The schematic indicates CTL targeting in the twins in 12/00 and 6/01. Upper and lower arrows indicate locations of recognized peptides for twins 1-05 and 1-06, respectively. (b) The screening clade B consensus peptides eliciting these responses by ELISpot are shown. The HIV-1 sequences in the twins (consensus of sequences obtained from PBMC) from 12/00 corresponding to recognized peptides or overlapping regions of consecutive peptides (containing the recognized epitope) are indicated. A dash indicates an amino acid identical to the clade B consensus sequence; x indicates lack of consensus among sequences.
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FIG. 3. T-cell receptor Vß spectratype analysis of CD8+ T lymphocytes. TCR Vß distributions were assessed and compared. (a) Spectratyping was performed using CD8+ T lymphocytes from both twins from 12/00. Representative profiles are shown for four Vß families. Of the numerous expanded peaks deviating from Gaussian distribution, a few were common to both twins (e.g., Vß13.2), but most were discordant (e.g., Vß11, Vß15, and Vß22). (b) Spectratyping was performed on CD8+ lymphocytes from the twins in 12/00 and 6/01. Spearman correlation coefficients of expanded peaks in intra- and intertwin comparisons are given. Identical analyses of eight unrelated HIV-1-seropositive control subjects (28 interindividual comparisons) revealed a mean correlation coefficient of 0.28 ± 0.19 (data not shown).
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FIG. 4. Peptide-specific T-cell receptor Vß spectratype analysis. PBMC from 9/01 were cultured in the presence or absence of the Pol peptide HKAIGTVLVGPTPVN (Pol 125-139; protease 69-83), which was the dominantly recognized peptide for both twins (accounting for approximately 50% of the detected HIV-1-specific CTL [data not shown]). Spectratyping then was performed on the CD8+ cells from each twin. Histograms from four representative Vß families are shown; peptide-stimulated expansions are shaded (peaks whose ratio versus the median of all peaks in the family increased by at least 2 and rose at least twofold after stimulation). The accompanying table indicates the specific peaks within each of the 24 Vß families that were expanded in response to peptide stimulation. N.D. indicates that data were not available.
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FIG. 5. Phylogenetic analysis of HIV-1 pol, env, and nef sequences. Phylogenetic relationships between pol (A), env (B), and nef (C) sequences from 1995 and 2000 are shown. Open and closed circles represent twin 1-05 sequences from 1995 and 2000, respectively; open and closed triangles represent twin 1-06 sequences from 1995 and 2000, respectively. HXB2, RF, and JR-CSF sequences were used as outgroups for the phylogenetic tree.
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The subjects of our study provide an unfortunate but unique opportunity to compare CTL responses and HIV-1 evolution in a setting where host genetic factors and initial viral sequences are controlled in two individuals. CTL targeting of HIV-1 by these twins is remarkably similar, shedding light on this poorly understood process. In contrast to other viral infections, few clear patterns of true immunodominance have emerged for HIV-1 (3), and most infected individuals sharing a common MHC I allele do not target the same subset of potential epitopes restricted by that allele (7). The present study finds that when the host and viral genetic factors are held constant, the targeting of HIV-1-specific CTL is then similar. This suggests that epitope targeting is primarily determined by host and/or pathogen genetics and not particularly subject to stochastic influences. CTL targeting differences between persons sharing common MHC I alleles is therefore likely to be determined primarily by differences in infecting HIV-1 genotype or the influence of additional host genetic factors, such as competing HLA alleles or polymorphisms in antigen processing factors.
T-cell receptor generation, however, is a stochastic process. Epitope-specific CTL responses within individuals tend to be comprised of multiple clones with differing TCR (10). In contrast to their shared targeting, the spectratype profiles of the twins are strikingly dissimilar, and the dominant detected CTL response is comprised of multiple clones that are clearly distinct between twins. Thus, despite phenotypic similarities in targeting, the responding CTL differ at the TCR molecular level. Because different TCR recognizing the same epitope vary in functional properties, such as ligand avidity and recognition of different epitope escape variants (34), important aspects of CTL function are stochastically determined, as reflected by divergent viral sequence evolution in the twins. Our observations are consistent with the findings of Biggar et al., who studied HIV-1 evolution following mother-to-child transmission for 14 fraternal and 5 identical twins (4). Although the period of follow-up was relatively brief (12 to 16 weeks on average), HIV-1 sequences diverged between twins, and there did not appear to be a difference in the divergence rates between identical versus fraternal twins.
In a landmark study, Moore et al. demonstrated significant associations of MHC I alleles with specific HIV-1 sequence polymorphisms across a population of infected persons (21). These data suggest that among persons sharing certain MHC I alleles, there are generalized patterns of epitope targeting and escape mutations across populations. Less clear is the extent to which MHC I phenotype predicts targeting and escape at the level of the individual. Our results suggest that interactions of CTL and HIV-1 are not consistent at the level of the individual, due to the stochastic differences of TCR, despite the existence of some shared escape patterns across populations (as observed by Moore et al.). Thus, there is great variability in CTL escape within individuals due to stochastic factors.
The differences in targeted epitope sequences are consistent with stochastic TCR variability, given the tendency of different TCR targeting the same epitope to vary in recognition of epitope variants (34). A caveat to this finding are the differences in the early antiretroviral treatment regimens of the twins, which could have affected Pol sequences and the CTL targeting them. However, the twins had been on the same treatment regimens for 2 years at the time of sequencing. Additionally, two of the three observed protease sequence differences between the twins in amino acids 69 to 83 were not attributable to known protease inhibitor resistance mutations, and none of the drugs would be expected to affect the integrase region targeted by both twins, which also varied in sequence.
Moreover, the presence of a greater degree of diversity and progressive divergence in one twin reflects the unpredictability of immune pressure on HIV-1 despite genetically identical backgrounds and similar immunological targeting. While the twins had similar clinical and immunologic parameters from the time of diagnosis and treatment, it is unknown whether they had the same rate of disease progression before development of AIDS (1983 to 1990). However, because different mutations were selected by CTL in each twin, it seems possible that viral fitness costs for escape could vary significantly between twins and, thus, that the efficacy or durability of CTL containment could also vary.
In summary, our results illustrate the importance of stochastic influences in the interaction of the cellular immune response and HIV-1 despite the genetic determination of CTL targeting and variability in the constraints imposed by immunity. It is unclear whether vaccination approaches can yield cellular immune responses that will interact with HIV-1 in a predictable manner. For the production of a CTL-based vaccine to prevent disease but not infection, this may be a substantial barrier to consistent efficacy even when viral sequences and host genetics are considered in the vaccine design.
Paul Krogstad is an Elizabeth Glaser Scientist supported by the Pediatric AIDS Foundation. This work was also supported by Public Health Service grants AI051996 (P.K.), AI043203 (O.O.Y.), and AI028697 (UCLA CFAR).
Supplemental material for this article may be found at http://jvi.asm.org/. ![]()
P.K. and O.O.Y. contributed equally to this work. ![]()
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A hypermutation. Bioinformatics 16:400-401.
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