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Journal of Virology, July 2006, p. 6757-6763, Vol. 80, No. 14
0022-538X/06/$08.00+0 doi:10.1128/JVI.00094-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Gabriela Bleiber,2
Ying Qi,3
Holli Hutcheson,1
Traci Yamashita,4
Randall C. Johnson,3
Jie Cheng,3
Galit Alter,5
James J. Goedert,6
Susan Buchbinder,7
Keith Hoots,8
David Vlahov,4
Margaret May,9
Frank Maldarelli,10
Lisa Jacobson,4
Stephen J. O'Brien,1
Amalio Telenti,2 and
Mary Carrington3*
Laboratory of Genomic Diversity, National Cancer Institute, Frederick, Maryland 21702,1 Institute of Microbiology and Division of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland,2 Laboratory of Genomic Diversity, SAIC-Frederick, Inc., National Cancer Institute, Frederick, Maryland 21702,3 Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland,4 Partners AIDS Research Center, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Massachusetts 02129,5 Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland,6 University of California, San Francisco, California,7 Gulf States Hemophilia Center, University of Texas Health Science Center, Houston, Texas,8 Department of Social Medicine, University of Bristol, Bristol, United Kingdom,9 HIV Drug Resistance Program, National Cancer Institute, Bethesda, Maryland,10
Received 13 January 2006/ Accepted 16 April 2006
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TSG101 is an evolutionarily conserved gene located on human chromosome 11p15. It encodes a 46-kDa multidomain protein that contains an N-terminal ubiquitin-conjugating enzyme E2 variant (UEV) domain, a proline-rich domain, a coiled-coil region including a leucine zipper, and a C-terminal
-helical domain. The TSG101 protein has been detected in the nucleus and cytoplasm, and its localization is cell cycle dependent (38, 39).
A potential role for TSG101 as a tumor suppressor that was suggested in an early study of the gene (17) remains controversial (22, 34). Identification of molecules with which TSG101 interacts has suggested its involvement in transcriptional regulation (5, 13, 24, 32) and cell cycle control (6, 18, 27). Targeted deletion of tsg101 in mice results in early embryonic death due to a defect in cellular proliferation (29), and reports of cell cycle arrest and death in TSG101-deficient cells have further confirmed a critical role for TSG101 in cell survival (6, 16).
Many recent studies of TSG101 have focused on its role in endosomal trafficking. TSG101 and its yeast orthologue, Vps23, belong to the so-called "class E" proteins whose functions are essential for vacuolar protein sorting (1). TSG101/Vps23, along with two other proteins, Vps28 and Vps37, form a
350-kDa complex named ESCRT-I (endosomal sorting complex required for transport) (14). ESCRT-I is involved in a series of protein-protein interactions that result in sorting of ubiquitylated proteins from early endosomes into multivesicular bodies (MVBs). During this process, early endosomes carrying protein cargo bud into MVBs, organelles that eventually fuse with lysosomes for subsequent protein degradation. This process entails direct binding of the TSG101/Vps23 UEV domain to ubiquitin, resulting in the delivery of ubiquitylated proteins (that are destined for degradation) into MVBs (2, 12, 14, 20, 28, 33).
Some viruses have developed an ingenious mechanism for budding from cells that involves the host endosomal sorting process. This became evident after the discovery of the direct interaction between the UEV domain of TSG101 and a highly conserved motif in the p6 region of the HIV-1 Gag protein, Pro-Thr/Ser-Ala-Pro (PTAP), an interaction that was shown to be critical for the release of HIV-1 particles from the cellular membrane (10, 12, 21, 35). The HIV-1 PTAP motif belongs to a family of late (L) domains, so named for their late involvement in the viral life cycle. The viral L domains are also characterized by conserved PPXY and YXXL motifs, which, along with PTAP, interact with host proteins involved in the MVB pathway (reviewed in reference 9). The TSG101-HIV-1 relationship has been studied intensively by several laboratories, resulting in the identification of additional host proteins involved in the process of HIV-1 budding (30, 31, 36). The TSG101 molecule has also been shown to be involved in the budding of HIV-2 (25), Ebola virus (21), human T-cell leukemia virus type 1 (4), and bluetongue virus (37).
Given the central role of TSG101 in release of HIV-1 from infected cells, we hypothesized that genetic variations in TSG101 could potentially affect the functional activity of TSG101 protein in viral budding, thereby altering levels of circulating virus in the blood of infected individuals and the clinical course of AIDS. Here, we report two single-nucleotide polymorphism (SNP) variants, located at positions 183 and +181 relative to the translation start site, that associate with differences in viral load dynamics, in CD4 T-cell decline, and, correspondingly, with the rate of AIDS progression after infection. The 183 variant has been recently reported to be associated with faster CD4 decline in the Swiss HIV Cohort Study (SHCS) (3). Here, we demonstrate a more detailed analysis of the association between TSG101 variation and several outcomes of HIV-1 infection, which are consistent in the SHCS and a large sample of U.S. AIDS cohorts.
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Genotyping. The single-strand conformation polymorphism technique was performed as described by Cullen et al. (8). The TSG101 SNPs were typed using TaqMan Genotyping Assays (Applied Biosystems, Foster City, CA) according to the manufacturer's protocol. Haplotypes were estimated in compound heterozygotes using the expectation maximization algorithm (19) and SAS software (SAS Institute, Cary, NC).
Statistical analysis. Four end points reflecting disease progression (AIDS outcome) were evaluated: time to CD4 < 200 cells/mm3; progression to AIDS according to the 1987 definition by the Centers for Disease Control and Prevention; progression to AIDS according to the 1993 definition by CDC; and AIDS-related death. Defined categorical analysis was performed comparing genotype and haplotype frequencies between groups of patients using a two-tailed Fisher's exact test. Analyses presented (see Tables 1 to 3, Fig. 2, and tables in the supplemental material) were carried out using the SAS software. Participants were stratified by ethnic group, sex, and age at seroconversion (0 to 20, 20 to 40, and over 40 years).
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TABLE 1. Effects of TSG101 haplotypes on AIDS progression among Caucasians from the combined U.S. AIDS cohorts (dominant model)
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TABLE 3. Frequencies of TSG101 genotypic groups among HIV-1-positive vs. HIV-1-negative Caucasian individuals
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FIG. 2. Kaplan-Meier plots for the three TSG101 haplotypic groups. Four AIDS outcomes were analyzed using the Cox proportional-hazards model.
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FIG. 3. Decline in CD4 T-cell count among AIDS patients with different TSG101 haplogenotypes. The data were analyzed using a random-effects linear model (see Materials and Methods). (A) Square-root CD4 counts for 380 individuals from the MACS cohort were plotted as a function of time from seroconversion, and fitted lines for each genotype group were generated based on 4,918 measurements. Slopes for protective, neutral, and susceptible genotypic groups are as follows (95% CI in parentheses): 1.11 (1.22, 1.00), 1.33 (1.42, 1.25), and 1.39 (1.50, 1.27), respectively. (B) CD4 data from the SHCS patients were plotted starting from the point at which CD4 cell counts fell in the range of 500 to 600 cells/mm3. By chance, the susceptible haplogenotypic group had a mean CD4 count that was higher in this range than that of the protective or neutral group. The fitted lines are based on 3,551 measurements for 310 people. Slopes (95% CI) for protective, neutral, and susceptible groups are 0.52 (0.64, 0.39), 0.57 (0.69, 0.47), and 0.81 (0.99, 0.64), respectively.
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FIG. 4. Viral-load increase over time in 373 MACS patients. Fitted lines for the three TSG101 genotypic groups were constructed based on 3,569 measurements of log10 HIV RNA over time after seroconversion. Statistical analysis was performed using the multivariate random-effects linear model (see Materials and Methods). The best-fit lines for the protective, neutral, and susceptible haplogenotypic groups have slopes (95% CI) of 0.01 (0.01, 0.02), 0.04 (0.03, 0.05), and 0.05 (0.04, 0.07), respectively.
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2 kb around exon 1, where nine SNPs were identified (Fig. 1A). Analysis of the SNP genotypes revealed six haplotypes with estimated frequencies of >1% that could be defined by four haplotype-tagging SNPs (Fig. 1B) (positions 600 [rs3802966], 518 [rs1857909], 183 [rs2292179], and +181 [rs1395319] relative to the translation start site.
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FIG. 1. SNPs and the corresponding haplotypes observed in the 5' area of TSG101. (A) Schematic map of the nine SNPs identified in the 5' area of TSG101. SNP positions are determined relative to the "A" nucleotide of the ATG start codon, which is shown within exon 1 (black box). (B) Haplotypes based on the nine SNPs. The haplotype frequencies were estimated based on sequencing data among 79 randomly chosen Caucasian seroconverters. Only haplotypes with frequencies of >0.01 are listed. Alleles with minor frequencies are shown in boldface. F, frequency, CI, confidence interval. (C) Haplotypes based on four SNPs estimated in 1,895 Caucasian individuals. (D) Structure and frequencies of haplotypes A, B, and C estimated in 2,071 Caucasian individuals.
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The association of the individual SNPs and the five related haplotypes with disease progression was tested using the Cox proportional hazards model (7) and categorical analysis in which frequencies of genotypes were compared in people who developed AIDS during certain time periods. The Cox model did not reveal any significant effect for the four individual SNPs or for the five haplotypes (see Tables S1 and S2 in the supplemental material). However, we did observe differences in the frequencies of the 600G and 183C variants among individuals who developed AIDS before 7 years compared to those who developed AIDS later (see Table S3 in the supplemental material). In similar analyses, haplotype 2 conferred a susceptible effect (odds ratio [OR] = 1.6 to 2.5; P = 0.002 to 0.01), haplotypes 3 and 5 were protective (OR = 0.6 to 0.8, P = 0.007 to 0.2, and OR = 0.5 to 0.8, P = 0.06 to 0.5), while haplotype 4 was relatively neutral (OR = 0.8 to 1.1; P = 0.2 to 0.8) compared to a reference haplotype 1 (see Table S4 in the supplemental material). Of note, the 600G variant, which is in strong linkage disequilibrium (LD) with the 183T and +181C variants, specifies haplotype 3, and the protective effect of this haplotype corresponded to the effect of the individual SNP. Based on these data and the haplotype structures, we concluded that susceptibility and protection are associated with variation at positions 183 and +181. Three of the four possible haplotypes composed of these two SNPs were observed, indicating strong LD between the variants. The corresponding haplotypes, T-A, T-C, and C-C, were termed A, B, and C, respectively (Fig. 1D).
Haplotypes B and C are associated with different rates of AIDS progression.
The frequencies of haplotypes A, B, and C among individuals who developed AIDS in one of six distinct time periods after seroconversion (
3, 3 to 5, 5 to 7, 7 to 10, 10 to 12, and >12 years) were compared (data not shown). In this analysis, seroprevalent individuals were included in the last three groups depending on the date of an AIDS-defining outcome after their first HIV+ visit. This analysis suggested that the effect of the TSG101 haplotypes on HIV disease is not gradual over time, an observation that was further elucidated by the absence of a significant effect of these variants on AIDS progression in survival analysis using the Cox model, where time is a continuous variable starting from seroconversion (see Table S5 in the supplemental material). Rather, differences in susceptible (C) and protective (B) haplotypic frequencies appeared somewhat bimodal in that the frequency of the susceptible haplotypic group was significantly greater among individuals who progressed to AIDS within 7 years after seroconversion relative to those who remained AIDS-free for at least 7 years (dominant model; OR = 1.72 to 2.30; P = 0.0001 to 0.002) (Table 1). Conversely, the protective haplotypes were observed significantly more frequently among those who remained AIDS free for 7 years or longer after seroconversion compared to those who had progressed within 7 years (dominant model; OR = 0.56 to 0.64; P = 0.0005 to 0.01). Both the B and C haplotypes appeared to have dominant effects, since a codominant model did not fit the data as well as a dominant model. Haplotype A was relatively neutral (Table 1).
Protective, susceptible, and neutral TSG101 haplotype groups. Haplotypes B and C exhibited opposite dominant effects over the neutral haplotype A (Table 1), so it follows that the haplogenotypes A/B and B/B would both be protective, and A/C and C/C would both confer susceptibility in terms of AIDS progression before or after 7 years after seroconversion. We hypothesized that the dominant effects of haplotypes B and C would result in a neutral phenotype among B/C heterozygotes similar to the A/A haplogenotype. Thus, the three nonoverlapping groups based on genotypic data were tested for their effects on AIDS progression. As expected, the A/C-C/C grouping showed a strong susceptible effect (OR = 1.74 to 2.61; P = <0.0001 to 0.003), A/B-B/B associated with protection (OR = 0.51 to 0.61; P = <0.0001 to 0.01), and the A/A-B/C grouping appeared neutral (Table 2). The protective and susceptible haplotype groups were further compared to the neutral group by the Cox proportional-hazards model (Fig. 2). The relative shapes of the curves in the Kaplan-Meier plots confirm that the effects of the TSG101 variants are not constant over time, but rather occur most obviously between about 4 and 12 years after seroconversion.
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TABLE 2. TSG101 haplogenotypes and AIDS progression among Caucasians from the combined U.S. AIDS cohorts
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Effects of the TSG101 haplotypes on viral load increase over time. Given the central role of TSG101 in HIV-1 budding and the known correlation between the viral load and the rate of AIDS progression (23), we tested whether the effect of TSG101 variation on CD4 T-cell decline and AIDS progression was also reflected in viral load changes over time. For this analysis, the increase in viral load over time among 373 MACS patients was measured, stratified by the three TSG101 genotypic groups (Fig. 4). An average of 9.6 measurements (ranging from 2 to 28 measurements) of viral load per patient over a period of 13 years since seroconversion were available for the analysis. No significant difference in HIV-1 RNA levels between the three genotypic groups was observed at the time of seroconversion. Strikingly, however, highly significant differences in log10 HIV-1 RNA slopes were observed between the protective and susceptible groups (P < 0.0001), strongly suggesting that variation in the TSG101 gene affects the HIV-1 viral load, potentially through the differential efficiency of TSG101 variants to mediate viral budding.
TSG101 genotypes and HIV-1 infection. The TSG101 genotypic groups were also tested for potential effects on HIV-1 infection by comparing the distributions of these genotypes in HIV+ patients with those in seronegative or high-risk exposed uninfected individuals. Although only marginally significant values (P = 0.02 to 0.08) were determined (Table 3), the effects of these genotypes on HIV-1 infection each paralleled their respective effects on the viral load, on CD4 T-cell decline, and on the rate of progression to AIDS.
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The protective and susceptible effects of TSG101 haplotypes on AIDS progression are not constant over time, as indicated by the Kaplan-Meier curves (Fig. 2). The relative shapes of the curves suggest that TSG101 variation has little or no effect during the early (
4 years) and late (>12 years) stages of infection, but rather, only at an intermediate time period. Other host genetic, viral, or environmental factors that affect disease progression during the early and late stages of infection may override effects of TSG101. Alternatively, the TSG101 interaction with HIV and/or consequences of this interaction could be different during these two extreme time intervals compared with the intermediate period. However, the effects of TSG101 haplotypes occurring during the intermediate time interval were strong enough to be evident when the entire patient cohort was used in the categorical analysis, as well as the longitudinal analyses of CD4 T-cell decline and viral-load increase.
Recently, the 183 variant, corresponding to haplotype C, was shown to associate with lower virus production ex vivo, a paradoxical finding given its association with faster CD4 T-cell decline (3) and susceptibility to AIDS reported here. Although this finding appears to contradict the genetic epidemiological findings presented here, the ex vivo assay may not be physiologically relevant to the described effect of TSG101 on AIDS progression given its time dependence as discussed above.
The HapMap genotype data (http://www.hapmap.org) suggest that TSG101 is located in a region of strong LD: the corresponding haplotype block defined according to Gabriel et al. (11) spans 118 kb. This block includes the entire TSG101 gene; its partial paralogue, UEV-3 (15); and two additional gene fragments (the lactate dehydrogenase A-like 6A gene [GenBank accession no. NM144972] and a computationally predicted gene that may encode a protein similar to the mitochondrial carrier homolog 1 [XM497268]). Therefore, the (183, +181) haplogenotypes may mark the true disease variant(s) through LD. In support of this, no effect on disease progression was detected in a smaller sample of African-American seroconverters (although longitudinal CD4 and viral-load data from these individuals were not available for analysis; also, the susceptible haplotype group was observed at a frequency of only 4%). However, given the requirement of TSG101 for HIV-1 budding in vitro, it seems likely that the effect described herein is due to variation in TSG101 and not to polymorphism in a neighboring locus. If so, this study represents the first genetic epidemiological evidence to support previous in vitro studies indicating a primary role for TSG101 in HIV-1 pathogenesis.
The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
We thank Eric Freed, George Nelson, and Marcus Altfeld for helpful discussions.
Present address: Johns Hopkins University School of Medicine, Baltimore, MD 21231. ![]()
Supplemental material for this article may be found at http://jvi.asm.org. ![]()
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