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Journal of Virology, November 2006, p. 11019-11030, Vol. 80, No. 22
0022-538X/06/$08.00+0 doi:10.1128/JVI.01382-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Fusion-Induced Apoptosis Contributes to Thymocyte Depletion by a Pathogenic Human Immunodeficiency Virus Type 1 Envelope in the Human Thymus
Eric G. Meissner,1,2
Liguo Zhang,1,2
S. Jiang,3 and
Lishan Su1,2*
Department
of Microbiology and Immunology,1
The Lineberger Comprehensive
Cancer Center, The University of North
Carolina, Chapel Hill, North Carolina 27599,2
The Lindsley F. Kimball
Research Institute, New York Blood Center, New York, New York
100213
Received 30 June 2006/
Accepted 30 August 2006
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ABSTRACT
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The
mechanisms of CD4+ T-cell depletion during human
immunodeficiency virus type 1 (HIV-1) infection remain incompletely
characterized. Of particular importance is how CD4+
T cells are depleted within the lymphoid organs, including the lymph
nodes and thymus. Herein we characterize the pathogenic mechanisms of
an envelope from a rapid progressor (R3A Env) in the NL4-3 backbone
(NL4-R3A) which is able to efficiently replicate and deplete
CD4+ thymocytes in the human fetal-thymus organ
culture (HF-TOC). We demonstrate that uninterrupted replication is
required for continual thymocyte depletion. During depletion, NL4-R3A
induces an increase in thymocytes which uptake 7AAD, a marker of cell
death, and which express active caspase-3, a marker of apoptosis. While
7AAD uptake is observed predominantly in uninfected thymocytes
(p24), active caspase-3 is expressed in both
infected (p24+) and uninfected thymocytes
(p24). When added to HF-TOC with ongoing infection,
the protease inhibitor saquinavir efficiently suppresses NL4-R3A
replication. In contrast, the fusion inhibitors T20 and C34 allow for
sustained HIV-1 production. Interestingly, T20 and C34 effectively
prevent thymocyte depletion in spite of this sustained replication.
Apoptosis of both p24 and p24+
thymocytes appears to be envelope fusion dependent, as T20, but not
saquinavir, is capable of reducing thymocyte apoptosis. Together, our
data support a model whereby pathogenic envelope-dependent fusion
contributes to thymocyte depletion in HIV-1-infected thymus, correlated
with induction of apoptosis in both p24+ and
p24
thymocytes.
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INTRODUCTION
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Infection with human immunodeficiency virus type 1
(HIV-1) is characterized by progressive depletion of
CD4+ T cells and eventual progression to AIDS. The
mechanisms responsible for CD4+ T-cell depletion are
still not fully understood. While it was initially thought that direct
infection of target cells was responsible for T-cell depletion
(26,
55), subsequent
observations suggested a contribution of indirect or bystander killing
of uninfected cells (reviewed in reference
24). Throughout
infection, less than 1% of peripheral target cells are infected
(8,
11), while most apoptotic
T cells in lymphoid organs of infected children and simian
immunodeficiency virus (SIV)-infected macaques are not productively
infected (1,
19). Increased bystander
cell death during chronic infection may represent activation-induced
cell death consistent with an immune response to a chronic pathogen
(24,
42). Because lack of
immune activation in conjunction with high viral loads is observed in
sooty mangabees that do not develop disease
(9,
32,
43), bystander activation
likely plays a role in human progression to AIDS.
In
contrast to chronic infection, acute infection is characterized by
massive and rapid depletion of CD4+ memory T cells,
particularly in the gut-associated lymphoid tissue, that is thought to
occur primarily through direct viral infection and lysis
(7,
23,
25,
51,
52). Greater
understanding of the mechanisms by which transmitted viruses mediate
T-cell depletion during acute infection will improve our understanding
of HIV-1 pathogenesis. In particular, the dynamics and mechanisms of
cell depletion in solid lymphoid organs, including the gut, lymph
nodes, spleen, and thymus, require further
elucidation.
A number of in vivo and ex vivo organ
systems have been developed as models to study HIV-1-induced
CD4+ T-cell depletion. These peripheral
blood lymphocyte include the SCID-hu, SCID-hu thymus/liver,lymph node organ culture (or tonsil histoculture) and the human fetal
thymus-organ culture (HF-TOC). All offer primary cell microenvironments
that do not require exogenous stimulation for replication of primary
HIV-1 isolates (18,
21,
22) and in some cases are
refractory to replication by tissue culture-adapted isolates
(40,
49). These systems differ
from human infection in that they cannot support an adaptive immune
response against HIV. Rather, they serve as models for what might
happen in lymphoid organs in vivo if innate immunity was the lone
defense against viral replication, such as during acute infection.
Evidence from these models has indicated a prominent role for bystander
apoptosis (31,
41) and direct viral
lysis (22,
33) as mechanisms of
T-cell depletion.
The thymus is an apoptotic factory designed to
produce new naïve T cells and eliminate auto- or nonreactive T
cells by apoptosis. It is a target for HIV-1 infection, and its
disruption has been correlated with disease progression in pediatric
patients (13,
34,
53). Furthermore,
recovery of thymic function after highly active antiretroviral therapy
has been correlated with immune recovery
(15-17,
36). Thymic sections from
HIV-1-infected humans or SIV/SHIV-infected macaques show
increased apoptosis, suggesting that HIV-1 can either directly or
indirectly hasten thymocyte depletion
(28,
29,
45,
47,
56). A number of studies
addressing mechanisms of CD4+ thymocyte death in the
thymus organ have indicated that both direct viral lysis and bystander
apoptosis occur during thymocyte depletion
(5,
6,
30,
48). Whether bystander
apoptosis is specifically induced by HIV-1 or occurs nonspecifically
after the bulk of lysis-induced thymocyte depletion remains a subject
of ongoing debate.
Herein we characterize the
pathogenic mechanisms of an envelope from a rapid progressor (R3A Env)
in the NL4-3 backbone (NL4-R3A) which is able to mediate efficient
replication and depletion of CD4+ thymocytes in the
human fetal-thymus organ culture (HF-TOC). Notably, the R3A Env is
capable of using both CCR5 and CXCR4 as entry coreceptors
(37,
38). We demonstrate that
uninterrupted replication is required for continual thymocyte
depletion. During depletion, NL4-R3A induces an increase in thymocytes
which uptake 7AAD, a marker of cell death, and express active
caspase-3, a marker of apoptosis. While 7AAD is observed predominantly
in uninfected thymocytes (p24), active caspase-3 is
expressed in both infected (p24+) and uninfected
thymocytes (p24). While the anti-HIV drug
saquinavir efficiently suppresses ongoing NL4-R3A replication, the
fusion inhibitors T20 and C34 allow for sustained HIV-1 production.
Interestingly, T20 and C34 effectively prevent thymocyte depletion in
spite of this sustained replication. Apoptosis of both
p24 and p24+ thymocytes appears
to be envelope fusion dependent, as the fusion inhibitors T20 and C34,
but not the protease inhibitor saquinavir, are capable of reducing
thymocyte apoptosis. These data are the first to describe Env-specific
and fusion-dependent induction of apoptosis in a relevant lymphoid
organ model.
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MATERIALS AND METHODS
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Viral isolates and drugs.
The NL4-R3A and NL4-R3B viruses have
been previously described
(38). Saquinavir
(National Institute of Allergy and Infectious Diseases [NIAID],
National Institutes of Health [NIH]) was dissolved in dimethyl
sulfoxide at a 10 mM concentration and was used in HF-TOC at a 1
µM concentration. Peptides T20 and C34 were synthesized by a
standard solid-phase 9-fluorenylmethoxy carbonyl method at the
MicroChemistry Laboratory of the New York Blood Center. The peptides
were purified to homogeneity (>95% purity) by high-performance
liquid chromatography and identified by laser desorption mass
spectrometry (PerSeptive Biosystems, Framingham, MA). T20 was
reconstituted at a stock concentration of 0.5 mg/ml in 50% ethanol and
was used at a concentration of 10 to 50 µg/ml in HF-TOC. C34
was reconstituted at a stock concentration of 1 mg/ml in
phosphate-buffered saline and was used at a concentration of 10
µg/ml in
HF-TOC.
Fluorescent-activated cell sorter (FACS) analysis.
CD4-PE and CD8-TC (Caltag) were used
for surface staining of thymocytes. 7AAD was used to stain dead
thymocytes prior to intracellular staining. The Cytofix/Cytoperm kit
(BD Biosciences) was used for intracellular staining with active
caspase-3-phycoerythrin (BD Biosciences) and anti-p24
KC57-fluorescein isothiocyanate (FITC) (Beckman
Coulter).
Viral quantitation.
A p24 enzyme-linked immunosorbent
assay (ELISA) kit (Perkin-Elmer or AIDS Vaccine Program, NIH) was used
to detect Gag present in the HF-TOC
supernatant.
Human fetal-thymus organ culture.
The procedure for
HF-TOC has been previously described
(6,
38,
40). Briefly, human fetal
thymuses (19 to 24 gestational weeks) were dissected into
2-mm3 fragments using a dissecting microscope. Five
to six fragments were placed on organotypic culture membranes
(Millipore) underlaid by media (RPMI with 10% fetal bovine serum, 50
µg of streptomycin/ml, 50 U of penicillin G/ml, 1x
minimal essential medium vitamin solution [Gibco-BRL], 1x
insulin-transferrin-sodium selenite medium supplement [Sigma], and
beta-mercaptoethanol) in 6-well tissue culture plates. An equal amount
of virus (100 to 800 IU) in 15 µl of supernatant from infected
phytohemagglutinin-stimulated peripheral blood mononuclear cells
(PBMCs) or mock supernatant was applied to each fragment. Viral and
mock supernatants produced from the same PBMC donor were used within
each experiment. Fragments were cultured at 37°C in 5%
CO2 for up to 12 days with daily changes of culture media.
Thymocytes were teased out of the fragments using pestles (Bellco Co.)
and were stained as described
above.
Immunofluorescence.
Thymus fragments were fixed in
formaldehyde and embedded in paraffin. Sections were probed with rabbit
anti-active caspase-3 (Promega, Madison, WI) and/or HIV p24 monoclonal
antibody (AIDS Research and Reference Reagent Program, Division of
AIDS, NIAID, NIH), followed by the secondary antibodies Fluor
546-conjugated goat anti-rabbit immunoglobulin G (IgG) and/or Fluor
488-conjugated goat anti-mouse IgG (Invitrogen, Carlsbad, CA). Stained
slides were analyzed by confocal
microscopy.
Statistical analysis.
Trend line
significance was tested with simple linear regression. A P
value of less than 0.05 was considered significant. Differences in
"mock/no drug versus treatment" trends were tested by
the significance of the regression coefficient of the interaction term
between the "mock/no drug and treatment" variables. A
P value of less than 0.05 was considered significant. All
analyses were performed using SAS statistical software (version 9.1;
SAS Institute,
Inc.).
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RESULTS
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Depletion of thymocytes requires ongoing HIV-1 replication.
To assess mechanisms of
HIV-1-induced thymocyte depletion, we analyzed a pathogenic virus
(NL4-R3A) which efficiently depletes CD4+ thymocytes
in the HF-TOC. For comparison, we also studied a related virus
(NL4-R3B) which is less pathogenic
(37,
38). The NL4-R3A and
NL4-R3B viruses contain env genes transmitted to a rapid
progressor cloned into the NL4-3 backbone, but they lack nef
(37,
38). Both R3A and R3B Env
are capable of using CCR5 and CXCR4 as entry coreceptors. During a
typical infection with NL4-R3A, there is a reduction in the percentage
of live cells gated by forward and side scatter light profiles and the
percentage of live thymocytes which are CD4+ (Fig.
1A and B). This loss of thymocytes typically occurs rapidly
around 8 to 10 days postinfection (dpi) at the peak of viral infection,
likely after a threshold of viral replication is reached
(10,
38). In contrast, live
cell and CD4+ thymocyte depletion during infection
with NL4-R3B occur at a much slower rate (Fig.
1A and B).

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FIG. 1. CD4+
thymocyte depletion is dependent on sustained viral replication. (A and
B) Thymocytes from mock-, NL4-R3A-, and NL4-R3B-infected HF-TOC were
analyzed using flow cytometry for forward and side scatter (% gated
live) (A) and expression of CD4 on cells which were gated
live (B). Shown are data from at least seven independent experiments.
(*, P < 0.05 for the NL4-R3A trend line
relative to mock and NL4-R3B.) (C and D) Saquinavir was added to
NL4-R3A-infected HF-TOC 6 (C) or 8 (D) days
postinfection and each day thereafter, with the first day of drug
addition indicated by the arrow. CD4+ thymocyte
depletion was assessed at the indicated times. Error bars are from
quadruplicate samples (*, P < 0.05 by the
student's t test for NL4-R3A with drug relative to NL4-R3A
without
drug).
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To
understand whether thymocyte depletion during infection is dependent
upon continual viral replication, we added the antiviral drug
saquinavir during infection, which blocks HIV-1 protease function and
virion maturation. Notably, the dose used was sufficient to completely
inhibit NL4-R3A infection of HF-TOC when added at the time of initial
infection (data not shown).
Daily addition of
saquinavir starting at 6 dpi, before the peak in viral replication and
depletion, resulted in prevention of CD4+ thymocyte
depletion observed at 10 dpi (Fig.
1C). When saquinavir was
added at 8 dpi at the peak of viral replication and depletion, there
was still a drop in CD4+ percentage at 10 dpi, but
this depletion was attenuated relative to no drug (Fig.
1D). Furthermore, there
was no subsequent depletion of CD4+ thymocytes at 12
dpi. Together, these data suggest that cell death continues in part
after the addition of saquinavir, followed by complete inhibition of
subsequent CD4+ thymocyte depletion. Inhibition of
replication, even during the peak of depletion, is sufficient to rescue
at least some remaining thymocytes from cell death, indicating that
continual viral replication is necessary for continued thymocyte
depletion.
Depletion of CD4+ thymocytes is accompanied by an increase in the frequency of 7AAD+ cells, the majority of which are not productively infected.
We
next determined the frequency of dead cells in the scatter-defined gate
using 7AAD, a dye that stains cells with permeable membranes. We
additionally stained for intracellular p24 to delineate thymocytes
which are productively infected. Figure
2A shows a representative plot at 9 and 12 dpi. Infection with NL4-R3A is
accompanied by an increase in 7AAD+ thymocytes and a
large number of infected cells but little overlap between the two
populations. An analysis of multiple HF-TOC assays with multiple donor
thymuses indicates that the frequency of
7AAD+ cells increases around 9 to 10 dpi at the time
of maximal thymocyte depletion but occurs predominantly in
NL4-R3A-infected HF-TOC, not NL4-R3B-infected HF-TOC (Fig.
2B). Furthermore, the
increase in 7AAD positivity occurs predominantly in
p24 thymocytes (Fig.
2C). Even at 11 to 12 dpi,
when many cells are infected and dying, there is no significant
detection of p24+ 7AAD+
thymocytes. Together, these data indicate that infection with NL4-R3A
increases the frequency of 7AAD+ thymocytes only in
the p24 population. Infected thymocytes appear to
die in a way that does not involve or does not allow for detection of
7AAD+ p24+
cells.

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FIG. 2. Increase
in 7AAD+ thymocytes in NL4-R3A-infected HF-TOC is
predominantly in the p24 population. (A)
Cells in the scatter-defined live cell gate were stained for 7AAD to
measure dead cells and p24 to measure productively infected cells.
Shown are representative plots for mock-, NL4-R3A-, and
NL4-R3B-infected thymus at 9 and 12 dpi. (B) The percentage
of 7AAD+ thymocytes in the live gate for mock-,
NL4-R3A-, and NL4-R3B-infected thymus over time. (*, P
< 0.05 for NL4-R3A trend line relative to mock and NL4-R3B.)
(C) The increase in 7AAD+ cells occurs
predominantly in the uninfected (p24) population of
the NL4-R3A-infected thymus. The proportion of uninfected thymocytes
(p24 thymocytes) and infected thymocytes
(p24+ thymocytes) which are 7AAD+
is shown. (B and C) Data are from seven independent experiments.
(*, P < 0.05 for p24 trend
line relative to
p24+.)
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Infection with NL4-R3A increases apoptosis of p24+ and p24 thymocytes.
We next determined whether
infected or uninfected thymocytes in NL4-R3A-infected HF-TOC were dying
by apoptosis. To measure apoptosis, we analyzed active caspase-3
expression, a downstream effecter caspase of both the intrinsic and
extrinsic apoptosis pathways that is activated in HIV-1-infected
patients (14) and upon
exposure of PBMCs and cell lines to HIV-1 Env
(4,
12,
44). For these analyses,
only 7AAD-negative cells in the live cell gate were considered. In
mock-infected thymus,
0.3% of cells express active caspase-3
throughout HF-TOC culture (Fig.
3A). In NL4-R3A-infected thymus, there is a clear detection of cells which
costain for active caspase-3 and p24, indicating that a fraction of
infected cells are likely dying by apoptosis. Additionally, we observed
the significant induction of bystander apoptosis
(7AAD, p24, active
caspase-3+) in NL4-R3A- but not NL4-R3B-infected
thymus.

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FIG. 3. Infection
with NL4-R3A increases the frequency of thymocytes expressing active
caspase-3. (A) 7AAD-negative live cells were stained for p24
and active caspase-3. Shown is a representative of seven independent
experiments from 9 and 12 dpi for mock-, NL4-R3A-, and NL4-R3B-infected
thymus. (B) NL4-R3A increases the frequency of total
thymocytes with active caspase-3 expression (*, P
< 0.05 for NL4-R3A trend line relative to mock and NL4-R3B.)
(C) The increase in active caspase-3+
cells in NL4-R3A-infected HF-TOC occurs in both uninfected
(p24) and infected (p24+)
thymocytes in proportion to the level of NL4-R3A replication.
(*, P < 0.05 for the strength of significance
for each trend line.) (B and C) Data are from seven independent
experiments.
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An analysis of the total percentage of
thymocytes expressing active caspase-3 over time indicates that
apoptosis is specifically induced in NL4-R3A-infected thymus relative
to either mock- or NL4-R3B-infected thymus (Fig.
3B). Furthermore, this
increase is observable as early as 7 dpi, before significant thymocyte
depletion typically occurs (Fig.
1). The increase in active
caspase-3 expression observed in both uninfected and infected
thymocytes correlates with the extent of NL4-R3A replication, as
measured by FACS detection of intracellular p24, with a greater number
of bystander apoptotic cells than infected apoptotic cells at all
levels of infection (Fig.
3C). Using annexin-V as an
additional marker for the detection of apoptotic cells, we
confirmed the presence of apoptosis in both bystander and infected
apoptotic cells in NL4-R3A-infected thymus relative to mock-infected
thymus (data not shown).
Immunofluorescent staining of
mock- and NL4-R3A-infected thymus at 12 dpi confirmed the
increase in active caspase-3+ thymocytes in infected
thymus (Fig.
4). Furthermore, the majority of apoptotic thymocytes do not costain for
p24, suggesting they are not productively infected. Together, these
data implicate apoptosis of infected and uninfected thymocytes as
contributors to the rapid thymocyte depletion induced by
NL4-R3A.

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FIG. 4. Most
caspase-3+ thymocytes in NL4-R3A-infected HF-TOC do
not express p24. Fragments from mock- and NL4-R3A-infected thymus at 12
dpi were stained for p24 (green; Fluor 546) and active caspase-3 (red;
Fluor 488). Shown is a representative of two independent experiments.
Low (x20) and high (x60) magnifications are shown.
Isotype control antibodies showed no specific signals (data not
shown).
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T20 and C34 fail to efficiently inhibit ongoing viral replication but efficiently prevent thymocyte depletion.
We next
assessed whether kinetics of viral replication and depletion
are altered by inhibition with saquinavir or the envelope fusion
inhibitors T20 and C34. Drugs were added starting at 7 dpi and daily
thereafter. The doses used for T20, C34, and saquinavir were sufficient
to completely inhibit NL4-R3A infection of HF-TOC when added at the
time of initial infection (data not shown). In saquinavir-treated
HF-TOC, viral replication was inhibited very rapidly after addition of
drug, as assessed by p24 ELISA (Fig.
5A). To address whether unprocessed gag-pol may limit detection of
p24 by ELISA, we tested HIV-1 mutants with defective gag
processing treated with two different detergents and demonstrated that
unprocessed gag was detected as efficiently as processed
gag in our ELISA (data not shown), as previously described
(46), suggesting these
results were not a detection bias.

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FIG. 5. Prevention
of thymocyte depletion in T20- and C34-treated HF-TOC in spite of
sustained replication. (A to C) NL4-R3A-infected HF-TOC was treated
with C34, T20, or saquinavir from 7 dpi for 6 days. Arrows indicate the
day of drug addition. (A) Viral load was quantitated by ELISA
detection of Gag antigen in the HF-TOC supernatant on the indicated
days. Error bars are derived from triplicate samples. (*,
P < 0.05 by the student's t test for drug
treatment relative to no drug.) (B and C) Similar percentages of
CD4+ thymocyte protection after T20, C34, and
saquinavir treatment were detected 6 days after drug treatment by CD4
and CD8 staining. Error bars are derived from triplicate samples. Shown
is a representative of three independent experiments. (*,
P < 0.05 by the student's t test relative to
no
drug.)
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In T20- and C34-treated
samples, however, p24 production from NL4-R3A infection was not
significantly inhibited. In spite of this difference in viral
replication, similar rescue of CD4+ thymocytes was
observed for all three drugs assessed at 13 dpi, 6 days after the
addition of drug (Fig. 5B and
C). Because T20 and C34 do not efficiently inhibit viral
replication but preserve CD4+ thymocytes to a level
similar to that of saquinavir, we conclude that fusion-dependent
thymocyte depletion plays a major role in NL4-R3A pathogenesis in the
thymus.
Together, these data suggest that HIV-infected thymocytes
die rapidly after de novo infection is inhibited by saquinavir. In
contrast, although T20 and C34 should inhibit de novo
infection of thymocytes, viral production is relatively spared
through extended periods of culture. This suggests that T20 and C34
either incompletely inhibit viral spread in HF-TOC during ongoing
infection or that inhibition of fusion preserves viral production from
an infected cellular reservoir.
Apoptosis of both bystander and infected cells is inhibited by T20.
We next assessed whether saquinavir or
T20 is capable of modulating the level of apoptosis observed during
infection with NL4-R3A. Neither drug affected the level of apoptosis in
mock-infected HF-TOC (data not shown). Interestingly, while viral
replication was inhibited more efficiently by saquinavir than by T20,
only T20 reduced apoptosis of both bystander and HIV-1-infected
thymocytes (Fig.
6A). When observed over multiple experiments with multiple donor
thymus tissues, the frequency of
caspase-3+ p24 cells was not
significantly changed for saquinavir-treated samples but was notably
reduced for T20-treated samples relative to no-drug controls (Fig.
6B). When this analysis
was extended to HIV-1-infected (p24+) cells,
saquinavir was found to cause a significant increase and
T20 a significant decrease in apoptosis relative to no-drug controls at
comparable levels of replication (Fig.
6C). Since T20 has been
shown to inhibit HIV-1 fusion by targeting both gp41 and gp120
(3,
57), another HIV-1 fusion
inhibitor, C34, which only interacts with gp41, was used to confirm
this finding. Addition of C34 to HIV-1-infected HF-TOC also resulted in
a reduction of apoptosis in both p24+ and
p24 thymocytes (data not shown).

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FIG. 6. Apoptosis
in NL4-R3A-infected HF-TOC is inhibited by T20. (A)
NL4-R3A-infected HF-TOC was treated with saquinavir or T20 at 6 dpi for
up to 4 days. Thymocytes were stained with 7AAD, p24, and active
caspase-3. Shown is a representative of five experiments for
7AAD live cells 3 days after drug addition.
(B) The frequency of bystander apoptosis (percent
caspase-3+ p24) was determined
for each experimental treatment. The combined data for all time points
from five independent experiments are shown with standard error bars.
(mean percentage p24+ of 14% for no drug, 4.5% for
saquinavir, and 5.7% for T20). (C) Saquinavir increased, but
T20 decreased, apoptosis of infected thymocytes. To compare HF-TOC with
similar levels of replication, only samples with less than 7%
p24+ were considered for "no drug"
treatment (mean percent p24+ of 4.4% for no drug,
4.5% for saquinavir, and 5.7% for T20). (*, P
< 0.05 by the student's t test relative to no drug for
panels B and
C.)
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In multiple
experiments we observed similar p24 production in the presence of T20
or C34 compared to no drug treatment assessed by p24 ELISA, as depicted
in Fig. 5A, but a reduced
percentage of p24+ cells measured by FACS analysis,
as depicted in Fig. 6A.
This is likely explained by the massive depletion in no-drug-treated
thymus, leading to observed increases in the relative percentage of
p24+ thymocytes but an overall equal amount of p24
production compared to T20-treated samples which have CD4 preservation.
Thus, similar numbers of productively infected
(p24+) thymocytes per HF-TOC are detected in
T20-treated and no-drug-treated HF-TOC samples (data not shown).
Together, these data suggest that Env-mediated fusion plays a role in
the induction of apoptosis of both bystander and infected
thymocytes in the NL4-R3A-infected
thymus.
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DISCUSSION
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In
this study, we characterize the depletion of CD4+
thymocytes in the intact thymus by a highly pathogenic envelope
obtained from a rapid progressor at the time of transmission.
Our goal is to understand the mechanisms of thymocyte
death in the HIV-infected thymus organ. We observed a
replication- and Env-dependent depletion of
CD4+ thymocytes (Fig.
1). During
depletion with NL4-R3A, the percentage of thymocytes
which stain with 7AAD increases, predominantly in the uninfected
(p24) population (Fig.
2). Prior to and
concurrent with this depletion, we detected a significant increase in
the frequency of thymocytes expressing both active caspase-3 and
annexin-V, suggesting that they are undergoing apoptosis (Fig.
3 and
4; data not shown).
Notably, this apoptosis is detected in productively infected
(p24+) thymocytes as well as in uninfected
(p24) thymocytes. We show that induction of
apoptosis is preferentially observed in the NL4-R3A-infected thymus but
not in the less pathogenic NL4-R3B-infected thymus (Fig.
3). Although T20- and
C34-treated HF-TOC during ongoing infection showed higher HIV-1
replication levels than saquinavir-treated HF-TOC, T20 and C34 were
noticeably better at blocking the frequency of apoptosis in both
uninfected and infected thymocytes and efficiently protected total
CD4+ thymocyte depletion in spite of high levels of
HIV-1 (Fig. 5 and
6). In sum, these data
implicate envelope-mediated fusion in the induction of
apoptosis and thymocyte depletion during infection of HF-TOC
with the pathogenic NL4-R3A virus. These data are the first to describe
envelope-specific and fusion-dependent induction of apoptosis in a
relevant lymphoid organ model.
From previous studies it is still
unclear whether HIV-1 infection in lymphoid organs depletes only
infected cells or both infected and uninfected bystander cells
(6,
30,
39,
48). Our data suggest
that direct depletion of infected thymocytes is clearly involved, as
inhibition of HIV-1 infection during its peak levels of replication and
depletion halts further thymocyte depletion (Fig.
1). The mechanism of this
"lytic" depletion remains unclear, but it does not
appear to involve a cell which stains for both p24 and 7AAD (Fig.
2). Notably, we also
observe significant induction of apoptosis in
"bystander" p24 thymocytes and in
p24+ thymocytes (Fig.
3). Together, our data
suggest a model for thymocyte depletion induced by highly pathogenic
HIV-1 isolates such as NL4-R3A. During NL4-R3A replication, Env
expressed on virus or infected cells is likely capable of binding and
fusing uninfected cells. Bystander cells which encounter the
R3A Env are triggered to express active caspase-3 and
eventually die by apoptosis (Fig.
3), consistent with
findings from in vitro studies showing Env can trigger
caspase-3-dependent cell death
(4,
12,
44). Infected cells are
also observed to express active caspase-3 (Fig.
3), suggesting apoptosis
as one means of infected cell death. Intriguingly, T20 reduces
apoptosis of infected cells (Fig.
5 and
6), suggesting autologous
Env fusion may contribute to pathogenesis. Less fusogenic Env proteins,
such as R3B, are less capable of inducing apoptosis (Fig.
3), perhaps helping to
explain their lower level of activity in thymocyte
depletion.
Advantageously, our study does not involve prolonged
culture of isolated thymocytes outside of the thymic organ before
analysis, which could enhance their susceptibility to death. However,
the major mechanistic limitation to this study is the inability to
precisely determine the relative life span and eventual fate of
individual cells. For example, it is difficult to ascertain how long an
infected or an apoptotic cell resides as a single cell in the thymus
before engulfment or disintegration, even though estimates from other
studies suggest a half-life of 12 to 36 h for apoptotic cells
(2). Rather, our study
relies on a series of snapshots over time. This limitation prevents us
from attributing a contributory or a predominant role to apoptosis,
relative to other cell death pathways, in the context of overall
thymocyte depletion.
When added prior to or together with HIV-1
infection in HF-TOC, saquinavir, T20, and C34 all efficiently prevent
infection (E. Meissner, L. Zhang, and L. Su, unpublished results).
Interestingly, viral production in HF-TOC with ongoing infection was
efficiently suppressed by saquinavir but not by T20 or C34 (Fig.
5 and
6). In the presence of
high levels of HIV-1 replication, T20 and C34 both efficiently prevent
HIV-1-induced thymocyte depletion, suggesting a protective effect of
T20 and C34 on a cellular reservoir remaining in the thymic fragment
that has yet to be characterized. This higher level of replication may
explain the observation that although it is more efficient at blocking
bystander and infected cell apoptosis (Fig.
6), T20 is not noticeably
better than saquinavir at blocking overall depletion of
CD4+ thymocytes (Fig.
5). One possible
explanation is that while T20 reduces the level of apoptosis, it may
allow for prolonged survival of infected cells, leading to
elevated HIV-1+ cells and virions, which may
contribute to elevated levels of fusion-independent cell killing.
Together, these data strongly suggest the contribution of
envelope-induced apoptosis to the depletion of infected
thymocytes.
How exactly does the R3A Env mediate thymocyte
depletion in the thymus? It is likely that the high levels of
replication supported by the R3A Env leads to thymocyte depletion
through a combination of direct and indirect effects, including but not
limited to the direct and bystander killing discussed above.
Interestingly, at levels of infection that were comparable to those of
NL4-R3A, we did not detect an increase in apoptosis by NL4-R3B,
suggesting that the depletion of thymocytes is specifically mediated in
part by the R3A Env protein, which shows enhanced affinity for CXCR4
and cytopathicity for T cells in vitro
(37,
38). Whether CXCR4
affinity is linked to the induction of apoptosis, as has been
previously observed (27,
54), remains to be
elucidated. Interestingly, when 200 nM AMD3100 was added to HF-TOC with
ongoing R3A HIV-1 infection, we observed little or no inhibition of HIV
replication or pathogenesis (data not shown). This may be due to the
increased resistance of R3A to AMD3100 or to the fact that R3A can use
CCR5 as well as CXCR4 in HF-TOC
(37). Future experiments
will focus on possible inhibition of apoptosis by blockade of CXCR4-Env
interactions in NL4-R3A-infected HF-TOC.
Because addition of AT-2
inactivated virions and transfer of supernatant from NL4-R3A-infected
thymus to uninfected thymus in the presence of HIV-1 inhibitors is
unable to recapitulate thymic pathogenesis (E. Meissner and L. Su,
unpublished results), productive infection and cell-associated Env is
likely essential for pathogenesis
(1,
20,
50). Alternatively and
additionally, other HIV-1 or host factors induced during HIV-1
infection may contribute to Env-mediated thymocyte depletion. Further
study of NL4-R3A in HF-TOC should help elucidate viral and cellular
mechanisms that result in rapid depletion of thymocytes.
The
HF-TOC thymus model, an intact human lymphoid organ with multiple cell
types in physiological orientation, is an ideal model for investigating
acute HIV-1 infection in lymphoid organs. Our data here contrast with
studies in cell lines in vitro which, like our study, show that
cytopathicity is dependent on fusion of envelope but, unlike our study,
do not detect any bystander cell death
(35). These disparities
highlight the differences that likely exist between mechanisms of death
in single-cell cultures and in complex, tightly knit lymphoid organs
that contain a variety of interacting cell types. The fact that T20
reduces apoptosis of cells productively infected with HIV-1 raises a
number of potential clinical implications. Encouragingly, these data do
indicate that C34 and T20 are capable of blocking most
CD4+ T-cell depletion in an intact lymphoid organ.
However, protection of HIV-1-infected cells from apoptosis and
depletion, even transiently, may lead to enhanced HIV-1 latency and/or
a viral reservoir in fusion inhibitor-treated patients. It will be of
importance to investigate the effect of T20 on the survival and
persistence of HIV-1+ cells in these
patients.
 |
ACKNOWLEDGMENTS
|
|---|
We thank Sunil Suchindran
for help with statistical analysis. We thank Dedeke Brouwer and Hua Su
for technical support. We thank the UNC flow cytometry and confocal
cores. Saquinavir was obtained through the AIDS Research and Reference
Reagent Program, Division of AIDS, NIAID, NIH.
We also
thank the UNC Center for AIDS Research, NIAID, DHHS, for
institutional support. This work was supported by NIH grants AI041356
and AI53804. E.M. was supported in part by the NIH training grant
T32-AI07419.
 |
FOOTNOTES
|
|---|
* Corresponding author. Mailing address: Lineberger Comprehensive Cancer Center,
CB#7295, Chapel Hill, NC 27599. Phone: (919) 966-6654. Fax: (919)
966-8212. E-mail:
lsu{at}med.unc.edu. 
Published
ahead of print on 6 September 2006. 
 |
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