An AIDS-related cytotoxic autoantibody reacts with a specific antigen on stimulated CD4+ T cells

A novel selective histone deacetylase I inhibitor CC-4a activates latent HIV-1 through NF-κB pathway

AIMS

The fact that HIV-1 inside human bodies can perform reverse transcription and integrate resultant DNA into host chromosome remains a challenge in AIDS treatment. "Shock and kill" strategy was proposed to achieve the functional cure, which requested latency reactivating agents (LRAs) to reactivate latent HIV-1 and then extirpate viruses and infected cells with antiviral agents and the immune system. However, there are no feasible LRAs clinically applied. Herein, we examined a synthesized HDAC I inhibitor, CC-4a, in reactivating latent HIV-1 and investigated its mechanisms.

MATERIALS AND METHODS

Two HIV-1 infected cell models and human PBMCs were used in this study. Flow cytometry, ELISA, luciferase, and RT-PCR assay were used to analyze the expression of viral protein and mRNA. The mechanisms were explored by using cytoplasmic nuclear protein isolation and western blotting assays.

KEY FINDINGS

CC-4a could successfully reactivate latent HIV-1 at the protein and gene levels with low cytotoxicity. Intriguingly, CC-4a showed the ability to induce apoptosis in HIV-1 infected cell models. CC-4a exerted a synergistic activation effect with prostratin without triggering global T cell activation and inflammatory factor storm. It was further found that CC-4a down-regulated the expressions of CCR5 and CD4. Moreover, CC-4a together with antiviral drugs was proved to antagonize HIV-1 without mutual interference. Finally, the enhanced histone acetylation and activated NF-κB pathway were detected in CC-4a mechanisms.

SIGNIFICANCE

The results suggested that CC-4a activated latent HIV-1 and showed promising clinical applications, demonstrating that CC-4a played a role in HIV-1 eradication in "shock and kill" strategy.

Strongyloides stercoralis infection in human immunodeficiency virus-infected patients and related risk factors: A systematic review and meta-analysis

Strongyloidiasis is caused by nematode infections of the genus Strongyloides, mainly Strongyloides stercoralis, and affects tens of millions of people around the world. S. stercoralis hyperinfection and disseminated strongyloidiasis are unusual but potentially fatal conditions mostly due to Gram-negative bacteremia and sepsis, primarily affecting immunocompromised patients. Infections with immunosuppressive viruses such as human immunodeficiency virus (HIV) and Human T-cell leucemia virus type 1 (HTLV-1) have been reported as risk factors for strongyloidiasis. Hyperinfection syndrome has been described in HIV-positive patients following the use of corticosteroids or during immune reconstitution inflammatory syndrome (IRIS). In this research, we conducted a global systematic review and meta-analysis to assess the seroprevalence and odds ratios (ORs) of S. stercoralis infections in HIV-infected patients. A total of 3,649 records were screened, 164 studies were selected and evaluated in more detail, and 94 studies were included in the meta-analysis. The overall pooled prevalence of S. stercoralis infection in HIV positive patients was 5.1% (CI95%: 4%-6.3%), and a meta-analysis on six studies showed that with a pooled OR of 1.79 (CI95%: 1.18%-2.69%) HIV-positive men are at a higher risk of S. stercoralis infections (p < .0052) compared to HIV positive women.

The effect of plasma auto-IgGs on CD4+ T cell apoptosis and recovery in HIV-infected patients under antiretroviral therapy

Although effective antiretroviral therapy (ART) suppresses HIV viral replication, prevents AIDS-related complications, and prolongs life, a proportion of patients fails to restore the patients' CD4⁺ T cell number to the level of healthy individuals. Increased mortality and morbidity have been observed in these patients. In the current study, we have investigated the role of auto-IgGs in CD4⁺ T cell apoptosis and recovery in a cross-sectional study. All HIV⁺ subjects were on viral-suppressive ART treatment with a different degree of CD4⁺ T cell reconstitution. Total auto-IgG binding on CD4⁺ T cell surfaces and its associated apoptosis and CD4⁺ T cell recovery were analyzed by flow cytometry ex vivo. Total IgGs from plasma were tested for their binding capacities to CD4⁺ T cell surfaces and their mediation to CD4⁺ T cell death through NK cell cytotoxicity in vitro. HIV⁺ subjects had increased surface binding of auto-IgGs on CD4⁺ T cells compared with healthy controls, and IgG binding was associated with elevated CD4⁺ T cell apoptosis in HIV⁺ subjects but not in healthy controls. Plasma IgGs from HIV⁺ subjects bound to CD4⁺ T cells and induced cell apoptosis through NK cytotoxicity in vitro. Soluble CD4 (sCD4) preincubation prevented NK cell-mediated CD4⁺ T cell death. Our results suggest that plasma autoantibodies may play a role in some HIV⁺ patients with poor CD4⁺ T cell recovery under viral-suppressive ART.

Autoimmune diseases and HIV infection: A cross-sectional study

To describe the clinical manifestations, treatments, prognosis, and prevalence of autoimmune diseases (ADs) in human immunodeficiency virus (HIV)-infected patients.All HIV-infected patients managed in the Infectious Diseases Department of the Lyon University Hospitals, France, between January 2003 and December 2013 and presenting an AD were retrospectively included.Thirty-six ADs were found among 5186 HIV-infected patients which represents a prevalence of 0.69% including immune thrombocytopenic purpura (n = 15), inflammatory myositis (IM) (n = 4), sarcoidosis (n = 4), Guillain-Barré syndrome (GBS) (n = 4), myasthenia gravis (n = 2), Graves' disease (n = 2), and 1 case of each following conditions: systemic lupus erythematosus, rheumatoid arthritis, autoimmune hepatitis, Hashimoto thyroiditis and autoimmune hemolytic anemia. One patient presented 2 ADs. Thirty patients were known to be HIV-infected when they developed an AD. The AD preceded HIV infection in 2 patients. GBS and HIV infection were diagnosed simultaneously in 3 cases. At AD diagnosis, CD4 T lymphocytes count were higher than 350/mm in 63% of patients, between 200 and 350/mm in 19% and less than 200/mm in 19%. Twenty patients benefited from immunosuppressant treatments, with a good tolerance.ADs during HIV infection are uncommon in this large French cohort. Immune thrombocytopenic purpura, sarcoidosis, IM, and GBS appear to be more frequent than in the general population. Immunosuppressant treatments seem to be effective and well tolerated.

Advances in Pretransplant Donor-Specific Antibody Testing in Solid Organ Transplantation: From Bench to Bedside

Immunological risk stratification has a central role in determining both the feasibility of solid organ transplantation and the type (and amount) of induction and maintenance immunosuppressive therapy. Currently there is poor consensus on how to exactly estimate the global immunological risk, and most transplant centers adopt complicated internal guidelines for risk stratification. Here we systematically review published evidences that should drive appropriateness in risk stratification, focusing on donor-specific antibodies against HLA and other antigens.

HIV/AIDS pathogenesis and treatment options focusing on the viral entry inhibitors

The advent of highly active antiretroviral therapy (HAART) has revolutionized the treatment of HIV. A wide variety of antiretroviral agents are now available, allowing patients and physicians a choice of effective therapy. However, drug resistance and toxicities are emerging as major treatment challenges in the HAART era. The development of agents within existing and novel antiretroviral classes remains paramount in order to preserve the reduced morbidity and mortality we have come to expect from HAART use. This article details the development of the HIV epidemic, reviewing current and future treatment strategies, and concentrating upon the viral entry inhibitors.

Antigenic Complementarity Resulting in Idiotype–Antiidiotype Immune Complexes: Possible Contributor to AIDS Pathogenesis and Autoimmunity

One hundred and sixty seven combinations of viral + viral antibodies or viral + bacterial antibodies were tested for their ability to precipitate each other. Some antibodies produced against HIV epitopes recognize and precipitate some antibodies produced against cytomegalovirus (CMV), hepatitis B virus (HBV) core antigen, and Mycobacteria tuberculosis (MTb) and Staphylococcus epitopes but not those against HBV surface antigen, herpes simplex types 1 and 2 (HSV1 and HSV2) or Epstein-Barr virus (EBV), Streptococcus, or Escherichia coli. In addition, CMV antibodies precipitate those of HBV core and surface antigens as well as MTb, but not HSV, HSV2, EBV, Streptococcus or E. coli. HBV core (but not surface) antibodies precipitated Mycobacterium avium antibodies (MAv) but not MTb, Streptococcus, Staphylococcus or E. coli antibodies. Binding constants vary between kds of 10(-9) and 10(-7) M. Interactive antibodies act like idiotype-antiidiotype pairs suggesting that the inducing antigens are molecularly complementary. The resulting antibody interactions may explain the formation of circulating immune complexes that are commonly found in AIDS and in other diseases characterized by multiple, concurrent infections. This observation suggests that AIDS pathogenesis may involve autoimmune mechanisms in which the immune system attacks itself to form antibody-antibody circulating immune complexes that contribute to the hypergammaglobulinemia characteristic of AIDS. Complementary cofactor infections in AIDS may therefore contribute to the immunosuppression of the syndrome and difficulties treating these corresponding infections.

Association of progressive CD4(+) T cell decline in SIV infection with the induction of autoreactive antibodies

The progressive decline of CD4(+) T cells is a hallmark of disease progression in human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) infection. Whereas the acute phase of the infection is dominated by virus-mediated depletion of memory CD4(+) T cells, chronic infection is often associated with a progressive decline of total CD4(+) T cells, including the naïve subset. The mechanism of this second phase of CD4(+) T cell loss is unclear and may include immune activation-induced cell death, immune-mediated destruction, and regenerative or homeostatic failure. We studied patterns of CD4(+) T cell subset depletion in blood and tissues in a group of 20 rhesus macaques inoculated with derivatives of the pathogenic SIVsmE543-3 or SIVmac239. Phenotypic analysis of CD4(+) T cells demonstrated two patterns of CD4(+) T cell depletion, primarily affecting either naïve or memory CD4(+) T cells. Progressive decline of total CD4(+) T cells was observed only in macaques with naïve CD4(+) T cell depletion (ND), though the depletion of memory CD4(+) T cells was profound in macaques with memory CD4(+) T cell depletion (MD). ND macaques exhibited lower viral load and higher SIV-specific antibody responses and greater B cell activation than MD macaques. Depletion of naïve CD4(+) T cells was associated with plasma antibodies autoreactive with CD4(+) T cells, increasing numbers of IgG-coated CD4(+) T cells, and increased incidence of autoreactive antibodies to platelets (GPIIIa), dsDNA, and phospholipid (aPL). Consistent with a biological role of these antibodies, these latter antibodies were accompanied by clinical features associated with autoimmune disorders, thrombocytopenia, and catastrophic thrombotic events. More importantly for AIDS pathogenesis, the level of autoreactive antibodies significantly correlated with the extent of naïve CD4(+) T cell depletion. These results suggest an important role of autoreactive antibodies in the CD4(+) T cell decline observed during progression to AIDS.

Immunosuppressive human anti-lymphocyte autoantibodies specific for the type 1 sphingosine 1-phosphate receptor

Anti-lymphocyte antibodies (Abs) that suppress T-cell chemotactic and other responses to sphingosine 1-phosphate (S1P), but not to chemokines, were found in a lymphopenic patient with recurrent infections. Lymphocyte type 1 S1P receptor (S1P(1)) that transduces S1P chemotactic stimulation was recognized by patient Abs in Western blots of T cells, S1P(1) transfectants, and S1P(1)-hemagglutinin purified by monoclonal anti-hemagglutinin Ab absorption. The amino terminus of S1P(1), but not any extracellular loop, prevented anti-S1P(1) Ab suppression of S1P(1) signaling and T-cell chemotaxis to S1P. Human purified anti-S1P(1) Abs decreased mouse blood lymphocyte levels by a mean of 72%, suppressed mouse T-cell chemotaxis to S1P in vivo, and significantly reduced the severity of dextran sodium sulfate-induced colitis in mice. Human Abs to the amino terminus of S1P(1) suppress T-cell trafficking sufficiently to impair host defense and provide therapeutic immunosuppression.

Antigenic complementarity among AIDS-associated infectious agents and molecular mimicry of lymphocyte proteins as inducers of lymphocytotoxic antibodies and circulating immune complexes

BACKGROUND

People at risk for acquired immunodeficiency syndrome (AIDS) have high rates of cofactor infections in addition to HIV, including cytomegalovirus, hepatitis viruses, Mycobacteria, Mycoplasmas, and Staphylococcus aureus. Most people with AIDS also develop lymphocytotoxic antibodies (LCTA) and circulating immune complexes (CIC). While HIV proteins mimic HLA antigens, many cofactor agents mimic CD4 antigens. It has therefore been proposed that cofactor infections may interact with HIV by producing complementary antigens that induce LCTA and CIC, and that the resulting immunological dysfunction is part of AIDS pathogenesis.

OBJECTIVES

To test (1) whether HIV and its cofactor infections elicit complementary (idiotype-anti-idiotype) antibodies, and (2) if any of these antibodies mimic anti-lymphocyte antibodies.

STUDY DESIGN

Two immunological methods are employed to test for antibody complementarity: (1) double antibody diffusion, a modification of Ouchterlony immunodiffusion, in which antibodies are tested for their ability to precipitate each other; (2) double-antibody ELISA, in which an antibody against one infectious agent is adsorbed to an ELISA plate and an antibody against a second agent is used to detect the first.

RESULTS

Data on over a thousand double antibody diffusion (DAD) and about 70 DA-ELISA experiments are reported. These show that only specific pairs of antibodies are complementary: HIV-CMV; HIV-HBV; HIV-tuberculosis; HIV-mycoplasmas; HIV-S. aureus; and CMV-mycoplasmas. In addition, HIV antibodies precipitate CD4 antibodies; CMV antibodies precipitate HLA-DR antibodies; while mycobacteria and mycoplasma antibodies precipitate macrophage antibodies.

CONCLUSIONS

Antibodies elicited by HIV infection can interact with antibodies elicited by cofactor infections to form CIC, and some of these antibodies mimic lymphocyte antibodies so that they may function as LCTA. Since LCTA and CIC are associated with increased lymphocyte death in AIDS, the immune response against cofactors in HIV may play a significant role in AIDS pathogenesis. The fact that both HIV and cofactors elicit antibodies with LCTA characteristics may pose problems for vaccine development.

Identification of potential antibody markers in HIV-associated dementia

Markers for HIV-associated dementia (HAD) are needed for diagnosis and management. Specific antibodies to brain and immune complexes (IC) in the cerebrospinal fluid (CSF) are potential markers. CSF IC were found in 4 of 4 HAD patients, 2 of 2 AIDS-central nervous system (CNS) lymphoma patients with dementia, 0 of 1 AIDS-CNS lymphoma patient without dementia, 0 of 1 AIDS-CNS toxoplasmosis patient without dementia, and 0 of 10 neurologic disease controls. By blinded immunoblots, antibrain antibodies in serum and CSF were found in 11 of 12 HAD cases and 7 of 19 HIV-1 patients without HAD. All 11 non-HIV-1 controls were negative. These and published data suggest antibrain antibodies and IC may serve as markers of HAD.

Involvement of human intracisternal A-type retroviral particles in autoimmunity

Prior studies have linked retroviruses to various arthropathies and autoimmune diseases. Sjögren's syndrome (SS), a systemic autoimmune disease, is characterized by aggressive infiltration of lymphocytes into the salivary and lacrimal glands, resulting in destruction of the glands and dry mouth and eyes (sicca syndrome). The infiltrating lymphocytes in SS may become overtly malignant, and thus, the incidence of lymphoma is greatly increased in SS patients. A human intracisternal A-type retroviral particle type I (HIAP-I) has been isolated from persons with SS. HIAP-I shares a limited number of antigenic epitopes with human immunodeficiency virus (HIV), but is distinguishable from HIV by morphological, physical, and biochemical criteria. A substantial majority of patients with SS or systemic lupus erythematosus (SLE) have serum antibodies to the proteins of this human retrovirus. Fewer than 3% of the normal blood donor population have antibodies to any HIAP-associated proteins. A second type of a human intracisternal A-type retrovirus, HIAP-II, was detected in a subset of patients with idiopathic CD4 lymphocytopenia (ICL), an AIDS-like immunodeficiency disease. Most HIAP-II positive ICL patients were also antinuclear antibody positive. Reviewed here are additional studies from several laboratories suggesting that HIAP or related viruses may be involved in SLE and other autoimmune conditions. Additionally, results of comprehensive surveys of autoimmune patients to determine seroreactivity to HIAP, and other human retroviruses, including HIV and human T-lymphotropic virus type I, are reported.

Autoimmune markers in HIV-associated dementia

The etiology of HIV-associated dementia (HAD) is still unknown although direct viral effects have not been supported. Although evidence supports a role for products of activated macrophages, other evidence suggested the possibility of associated autoimmune phenomena at least as a marker. In a blinded analysis, non-HIV-infected whole brain material was immunoblotted with samples of serum, and in certain cases cerebrospinal fluid (CSF), from HAD patients and controls. Distinct antibrain antibodies were detected in 11/12 of HIV+ HAD patients, 7/19 of HIV+ patients without HAD, and 0/11 HIV seronegative controls who were either healthy or had other neurologic diseases. Reactivity against control tissue was negative. Though the etiopathogenetic relation of these antibrain antibodies remains to be delineated, the data suggest that they may be a marker of HAD.

Role of viruses in etiology and pathogenesis of multiple sclerosis

Multiple sclerosis (MS) is the most prevalent demyelinating disease of young adults, affecting an estimated 300,000 individuals in the United States alone. The majority of affected individuals have a relapsing–remitting course while a smaller subset has a more chronic–progressive presentation. Women are affected more often than men, a phenomenon associated with a number of auto-immune diseases. Although the etiology of MS is unknown, it is generally believed that genetic, immunologic, and environmental factors are involved. This chapter discusses these issues as they suggest that exogenous factors are associated with the pathogenesis of this disorder. Recently, the human herpes virus 6 (HHV-6) has received considerable attention as an infectious agent candidate that might be associated with the pathogenesis of MS. The chapter focuses on this agent and the data that support the role of this virus in MS disease pathogenesis. A model is proposed, whereby in genetically susceptible individuals, multiple viruses may trigger either a virus-specific or a cross-reactive auto-immune response that results in clinical MS. Epidemiologic evidence suggests that it is a multifactorial disease that develops as a result of host genetics, immune response, and environment.

Autoantibodies to leukocyte alphaMbeta2 integrin glycoproteins in HIV infection

HIV infection is often associated with polyclonal B-cell activation, autoantibodies, and clinically evident autoimmune disease. Because neutropenia and anti-neutrophil autoantibodies are common clinical features of HIV disease, we studied a series of HIV+ patients to determine whether anti-alphaMbeta2 integrin (MAC-1) specific anti-neutrophil autoantibodies occur in HIV disease, as we have shown to occur in patients with immune neutropenia not associated with HIV. Two new assays specific for anti-alphaMbeta2 IgG were developed to carry out these studies: an ELISA method using affinity-purified alphaMbeta2 integrin protein, and a flow cytometry method using subclones of the 293 human fetal kidney cell line, stably transfected with cDNAs for the alphaM and/or beta2 integrin subunits. In studies of the sera of 20 untreated HIV+ individuals, anti-alphaMbeta2 activity was detected in 9 (45%) by one or the other of these assays and in 5 (25%) by both assays. Seven of the 20 HIV+ study subjects had unexplained neutropenia, and of these, 6 (86%) were positive for anti-alphaMbeta2 autoantibodies. Our findings indicate that anti-alphaMbeta2 integrin autoantibodies are frequent in HIV+ individuals, particularly when unexplained neutropenia is also present, and raise the possibility that these autoantibodies may have a role in the acquired neutrophil dysfunction and increased risk of nonopportunistic bacterial infections observed in HIV disease.

HIV-1-induced perturbations of glycosphingolipid metabolism are cell-specific and can be detected at early stages of HIV-1 infection

The metabolism of glycosphingolipids (GSL) has been investigated in peripheral blood mononuclear cells (PBMC) from 8 patients at an early stage of HIV-1 infection. Following metabolic labeling of these cells with [14C]galactose, the GSL were purified and the radioactivity incorporated into each individual GSL quantitated by phosphoimaging. Compared with PBMC from seronegative donors, the GSL metabolism in PBMC from HIV-1-infected individuals was characterized by an increased synthesis of two GSL: the B-lymphocyte differentiation antigen globotriaosylceramide (Gb3, also referred to as CD77), and the monosialoganglioside GM3, a marker of T-lymphocytes and macrophages. The accumulation of Gb3 and GM3 in PBMC from HIV-1-infected patients was associated with the appearance of anti-Gb3 and anti-GM3 antibodies. Because these GSL are involved in the control of cell proliferation and signal transduction, such anti-GSL autoantibodies may contribute to the immune suppression during the course of HIV-1 infection. Studies on purified cell populations showed that GM3 accumulation occurred preferentially in HIV-1-infected monocytes/macrophages, whereas the synthesis glucosylceramide, the common precursor of complex GSL, was enhanced in both macrophages and CD4+ lymphocytes. Taken together, our data suggest that the dysregulation of GSL metabolism is an early event of HIV-1 pathogenesis that can induce important effects on immune cells homeostasis.

Shared antigenic epitopes on the V3 loop of HIV-1 gp120 and proteins on activated human T cells

Proliferation of HIV-1 in the infected host is characterized by a progressive loss of CD4+ T lymphocytes and consequent dysregulation of the immune system. Both direct and indirect mechanisms have been proposed. We show here that proteins with molecular weights 35, 48, and 110 kDa on stimulated primary human T cells are recognized by neutralizing antibodies against the V3 loop of HIV-1 gp120. Recognition is specific since it can be blocked by a recombinant HIV-1 gp120. Furthermore, these V3 monoclonal antibodies, as well as sera from AIDS patients that recognized these V3-like proteins, induced killing of HIV-1-infected as well as uninfected T cells. This killing was also inhibited by HIV-1 gp120 V3 peptides. These results indicate that the V3 loop shares epitopes with proteins on stimulated T cells. This may be an additional autoimmune mechanism contributing to CD4+ T cell disappearance in AIDS. V3 antibodies have been proposed as potential prophylactic agents. However, if such vaccines were based on certain epitopes, they might induce cross-reacting immune responses with cellular proteins. Vaccine candidates should be evaluated for such potential effects.

Identification of cytotoxic peptide as possible mechanism for neurotoxicity of HIV viral envelope and AIDS pathogenesis

A major segment of acquired immunodeficiency syndrome (AIDS) patients suffer from neurological complications, including impairments in concentration and motor functions. This neuronal injury, although related to the human immunodeficiency virus (HIV), occurs even though the neurons themselves are not infected by the virus. A complex web of interactions of the immune system with noxious substances released from gp120-stimulated macrophages is hypothesized as the mechanism of the injury. This study has identified an antimicrobial peptide resident in the human small intestine as a candidate for these noxious substances. This peptide is neither cell nor tumor specific and mediates cytolysis by membrane permeabilization based on membrane potential. The identified peptide is, however, type specific against viruses, only attacking enveloped viruses. This study hypothesizes that the peptide is sequestered in the HIV viral envelope and is released in very toxic concentrations when localized membrane potential is high. The peptide is localized in the Paneth cells of the human small intestine, and a transmission pathway is identified through the abrogation of intestinal tissue occurring during receptive anal intercourse. A study of amino acid sequences between this peptide and three variants of HIV confirmed homologies. The identification of this peptide as a possible mechanism could substantially alter AIDS treatment protocols.

Cross-linking of Fas by antibodies to a peculiar domain of gp120 V3 loop can enhance T cell apoptosis in HIV-1-infected patients

Previous studies have demonstrated that T cell-reactive antibodies in HIV-1 infection contribute to lymphocyte depletion by cytotoxicity that involves differential membrane targets, such as the 43.5-kD receptor on CEM cells. Here, we show that these antibodies bind Fas as result of a molecular mimicry of the gp120. Both flow cytometry and immunoblotting using the human Fas-transfected mouse WC8 lymphoma revealed positive binding of immunoglobulin G from several patients to a 43.8-kD membrane receptor that also reacts with the CH11 anti-Fas monoclonal antibody. Specificity to Fas was further confirmed to chimeric recombinant human Fas-Fc by ELISA, whereas overlapping peptide mapping of a Fas domain (VEINCTR-N) shared by gp120 V3 loop demonstrated a predominant affinity to the full-length 10-mer peptide. Four anti-Fas affinity preparations greatly increased the subdiploid DNA peak of CEM cells similar to agonist ligands of Fas. In addition, anti-Fas immunoglobulin G strongly inhibited the [3H]thymidine uptake of CEM cells in proliferative assays, inducing a suppression as high as provoked by both CH11 mAb and recombinant human Fas ligand. Since anti-Fas were reactive to gp120, it is conceivable that antibodies binding that domain within the V3 region are effective cross-linkers of Fas and increase apoptosis in peripheral T cells. These results suggest that autologous stimulation of the Fas pathway, rather than of lymphocytotoxic antibodies, may aggravate lymphopenia in a number of HIV-1+ subjects.

Acquired immune deficiency syndrome caused by hyperimmunity

Normal immunocytes including T and B cells are equilibrated by a reciprocal attacking mechanism called a network. Continuous disequilibrium of this network results in general immunodeficiency with oligo- and polyclonal hyperimmunity, for example, T-cell activation due to spontaneous reticuloendotheliosis, paraneoplastic autoimmune syndromes, and human immunodeficiency virus infection. In these disorders, reciprocal self-reactivity, including autologous graft-versus-host reaction, plays a role in the immunodeficiency. A priori self-targeting immunity is a key mechanism to explain autoimmunity in the acquired immunodeficiency syndrome. In the treatment of the immunodeficiency due to hyperimmunity, I propose immunological suppression by agents and reconstitution of the network by bone-marrow transplantation.

Colocalisation of human immunodeficiency virus and human cytomegalovirus infection in brain autopsy tissue from AIDS patients

We have examined 26 human AIDS brains obtained at post mortem for infection by human immunodeficiency virus (HIV) and human cytomegalovirus (HCMV), and for dual infection of cells by both viruses. The techniques used were enzyme-linked immunocytochemistry for HCMV and in situ hybridisation using a cDNA probe for HIV. Using these techniques, HCMV infection was detected in 14 brains, HIV infection in 14 brains, and coinfection with HIV and HCMV in 7 brains. Four case of dual HIV/HCMV infection were found where no colocalisation could be detected. In randomly chosen dually infected areas 19.2% of infected cells were coinfected with both viruses. Although cells identified morphologically as macrophages were the most common infected cell type, astrocytes and neurons were both singly and doubly infected with HIV and HCMV. Complete clinical data were available for 4 of the 7 cases with coinfection and each had AIDS dementia complex.

Does AIDS emerge from a disequilibrium between two complementary groups of molecules that mimic MHC?

There is increasing evidence that a disturbance of self-nonself-recognition plays an important role in the immunopathogenesis of AIDS. Here, Caner Susal, Volker Daniel and Gerhard Opelz speculate that the immune system is balanced between two groups of molecules that mimic major histocompatibility complex (MHC) proteins; AIDS is suggested to emerge as a consequence of human immunodeficiency virus (HIV) disturbing this balance in favor of anti-MHC class II responses.

Predictors of survival in human immunodeficiency virus type 1-seropositive intravenous drug users

In an ongoing prospective study of street-recruited intravenous drug users (IDUs) in Miami, Fla., 116 human immunodeficiency virus type 1 (HIV-1)-infected IDUs were monitored for up to 7 years. This provided an opportunity to evaluate baseline immunological parameters as potential predictors of survival among HIV-1-infected IDUs. As expected, HIV-1-infected IDUs who had an advanced stage of the disease (Centers for Disease Control and Prevention classification III or IV); p24 antigenemia; human T-cell leukemia virus type 1/2 seropositivity; low CD4 counts (< or = 200); low hemoglobin (< or = 14), high serum immunoglobulin A (IgA) (> 500 mg/dl), or high serum IgG (> or = 3,500 mg/dl) levels; or low proliferative responses to pokeweed mitogen (< or = 1,500 cpm) and to phytohemagglutinin (< or = 80,000 cpm) at baseline had worse survival rates. Results from multivariate Cox's models of survival showed that the baseline serum IgG level, serum IgA level, and CD4 count independently predict survival in HIV-1-infected IDUs. Cross-validation procedures verified the above-mentioned findings. These findings support the routine consideration of serum immunoglobulin levels in addition to CD4 count, especially in early evaluation of disease stage, as these evaluations may modify application of prophylaxis and treatment for HIV-1-infected IDUs. We recommend consideration of use of serum IgG and IgA as immunological markers for long-range prediction of survival in HIV-1-infected IDUs. These determinations are less onerous and more appropriate for use in field studies and financially less favored settings.

Sequential occurrence of IgM, IgM/IgG, and gp120-IgM/IgG complement complexes on CD4+ lymphocytes in relation to CD4+ blood lymphocyte depletion in HIV+ hemophilia patients: results of a 10-year study

The concept of autoimmune mechanisms playing an integral role in the pathogenesis of HIV disease is rapidly gaining ground. In this study, we determined IgM and IgG antibodies, complement fragments and gp120 on the surface of CD4+ lymphocytes using double-fluorescence flow cytometry. Sequential analysis demonstrated an inverse relationship of autoantibodies and CD4+ lymphocyte counts in the peripheral blood. HIV+ patients without autoantibodies (16/104 = 15%) had the highest CD4+ blood cell counts (324 +/- 264/microliters; mean +/- SD). CD4+ counts were successively lower in patients with complement-fixing IgM (243 +/- 240/microliter), complement-fixing IgG and IgM (139 +/- 138/microliter), or gp120-IgM/IgG complement complexes on the surface of CD4+ cells (38 +/- 45/microliter, P = 0.03). Individual patient profiles show that IgM autoantibodies typically are formed early after HIV infection and appear to deplete CD4+ lymphocytes very slowly, whereas complement-fixing IgG autoantibodies are generated at a later stage and deplete CD4+ lymphocytes more efficiently. The presence of both soluble gp120 and complement-fixing autoantibodies on CD4+ lymphocytes is associated with very low CD4+ cell counts and coincides with progression to terminal disease. Early during HIV infection autoantibody production is rather unstable, but it becomes more stable with disease progression and persists in advanced stages of the disease. These data suggest that autoantibody formation against CD4+ lymphocytes is a pathogenic mechanism for CD4+ cell depletion.

In vitro cytokine treatment of B cell defects in HIV-infected hemophilia patients

HIV-infected patients exhibit defects in B cell differentiation and in the IL-6 response of B cells, in association with autoantibody formation against T cells. These autoantibodies have been implicated as important factors in the development of immunodeficiency disease. As the restoration of defective B cell responses might prevent autoantibody formation and the resulting immunosuppression, we studied whether in vitro treatment with recombinant IL-2 (rIL-2), recombinant IL-4 (rIL-4) or recombinant IL-6 (rIL-6) might restore the response of B cells of HIV-infected patients. B cells of 6 HIV-negative hemophilia patients, 4 HIV-positive patients at CDC stage II, III, 4 HIV-positive patients at CDC stage IV, and 6 healthy controls were tested in Staphylococcus aureus Cowan I (SAC-I)-stimulated B cell cultures and Pokeweed mitogen (PWM)-stimulated allogeneic B and T cell cocultures. B cell differentiation was assessed in a reverse hemolytic plaque assay and by ELISA determination of IgM, IgG and IL-6 in culture supernatants. In vitro application of rIL-6 resulted in suppression of both elevated unstimulated and mitogen-stimulated B cell responses in a dose-dependent manner which was in part due to feedback inhibition. PWM- and SAC-I-stimulated IgG and IgM responses, respectively, could be restored after addition of 10 U/ml rIL-2 in HIV-negative patients, but not in HIV-positive patients. Addition of rIL-4 to cultures resulted in suppression of both unstimulated and mitogen-stimulated IL-6 secretion and B cell responses. Severely depressed B cell responses in CDC IV patients were not significantly affected by cytokine application. These results indicate that defective Ig responses in HIV-negative patients may be restored by rIL-2 treatment whereas HIV-induced B cell defects are not corrected by supply of T cell help or cytokines promoting B cell growth and differentiation.

Mode of action of SDZ NIM 811, a nonimmunosuppressive cyclosporin A analog with activity against human immunodeficiency virus (HIV) type 1: interference with HIV protein-cyclophilin A interactions

Cyclosporins, in particular the nonimmunosuppressive derivative SDZ NIM 811, exhibit potent anti-human immunodeficiency virus type 1 (HIV-1) activity in vitro. SDZ NIM 811 interferes at two stages of the viral replication cycle: (i) translocation of the preintegration complex to the nucleus and (ii) production of infectious virus particles. Immunosuppressive activity is not correlated with anti-HIV-1 activity of cyclosporins. However, binding to cyclophilin A, the major cellular receptor protein of cyclosporins, is a prerequisite for HIV inhibition: all structural changes of the cyclosporin A molecule leading to loss of affinity to cyclophilin abolished the antiviral effect. Cyclosporin derivatives did not interact directly with HIV-1 proteins; cyclophilin was the only detectable receptor protein for antivirally active cyclosporins. There is no evidence that inhibition of HIV occurs via a gain of function of cyclophilin in the presence of cyclosporins: the complex of cyclophilin A with SDZ NIM 811 does not bind to calcineurin or to any other viral or cellular proteins under conditions in which calcineurin binding to the cyclophilin A-cyclosporin A complex is easily detectable. Thus, the loss of function caused by binding of cyclosporins to cyclophilin seems to be sufficient for the anti-HIV effect. Cyclophilin A was demonstrated to bind to HIV-1 p24gag, and the formation of complexes was blocked by cyclosporins with 50% inhibitory concentrations of about 0.7 microM. HIV-2 and simian immunodeficiency virus are only weakly or not at all inhibited by cyclosporins. For gag-encoded proteins derived from HIV-1, HIV-2, or simian immunodeficiency virus particles, cyclophilin-binding capacity correlated with sensitivity of the viruses to inhibition by cyclosporins. Cyclophilin A also binds to HIV-1 proteins other than gag-encoded proteins, namely, p17gag, Nef, Vif, and gp120env; the biological significance of these interactions is questionable. We conclude that HIV-1 Gag-cyclophilin A interaction may be essential in HIV-1 replication, and interference with this interaction may be the molecular basis for the antiviral activity of cyclosporins.

The T cell receptor and AIDS pathogenesis

An idiotypic network model of AIDS pathogenesis is described in which the T cell receptor plays a role both in infection and as a target of autoimmunity. This is an extension of a previously published autoimmunity model, and provides explanations for several otherwise puzzling aspects of AIDS pathogenesis. In the model HIV-specific T cells are preferentially infected, and HIV, acting as an antigen, stimulates the expansion of the infectable pool of T cells. The HIV variants that are most strongly selected are those that are recognized by the most helper T cells. HIV and suppressor T cells are subject to the same selective environment, and consequently undergo a process of convergent selection to resemble each other more and more with time. Eventually immunity against HIV cross-reacts with suppressor T cell idiotypes, disrupting the normal regulation of helper T cells. Autoimmunity ensues. The model leads to novel vaccine and therapy approaches involving the targeting and elimination of HIV-specific T cells.

Semen alloantigens and lymphocytotoxic antibodies in AIDS and ICL

More than 90% of people with AIDS develop circulating immune complexes (CICs) and lymphocytotoxic antibodies (LCTAs). Animals infected with HIV, however, never display CICs or LCTAs, and remain healthy. Similarly, HIV-infected people who do not develop CICs or LCTAs also do not progress to AIDS. The appearance of CICs and LCTAs is, however, highly prognostic for AIDS and death. Since HIV infection does not, per se, lead to the development of CICs and LCTAs, other causes are likely. One such cause, for which both epidemiologic and experimental evidence exists, is semen. Semen components include sperm, seminal fluid, lymphocytes, and sometimes infectious agents, including HIV, mycoplasmas, and herpes and hepatitis viruses, all of which independently cause immune suppression. Extensive evidence demonstrates sperm (and various viruses) contains many proteins mimicking the CD4 protein of T-helper cells, while HIV, mycoplasmas, and seminal fluid mimic class II MHC proteins of other lymphocytes. We identify a large number of protein sequences that display such mimicry using computer homology searching, and demonstrate experimentally that sperm antibodies specifically precipitate antibodies against class II MHC mimics such as mycoplasmas, which in turn precipitate antibodies to lymphocyte antigens. These data prove that immunologic exposure to sperm and lymphocytes (as may occur in receptive anal intercourse, needle sharing, or blood transfusions) is theoretically capable of initiating lymphocytotoxic autoimmunity. Such autoimmunity may play a significant role in the pathogenesis of AIDS, and will need to be addressed clinically in high risk individuals regardless of HIV status and regardless of the success of anti-HIV prophylaxis and treatment.

HIV-1-induced thymocyte depletion is associated with indirect cytopathogenicity and infection of progenitor cells in vivo

Direct and indirect cytopathic mechanisms have been proposed to account for the loss of CD4+ T cells after infection with human immunodeficiency virus type 1 (HIV-1). We report here that HIV-1 infection of the human thymus in vivo results in thymocyte depletion by at least two different mechanisms. Thymocytes within multiple stages of differentiation are induced to die of apoptosis; most of these cells are uninfected. Additionally, thymopoiesis is interrupted by direct infection and destruction of intrathymic CD3-CD4+CD8- progenitor cells. These mechanisms are differentially induced by distinct isolates of HIV-1.

Five myths about AIDS that have misdirected research and treatment

A number of widely repeated and factually incorrect myths have pervaded the AIDS research literature, misdirecting research and treatment. Five of the most outstanding are: 1) that all risk groups develop AIDS at the same rate following HIV infection; 2) that there are no true seroreversions following HIV infection; 3) that antibody is protective against HIV infection; 4) that the only way to treat AIDS effectively is through retroviral therapies; and 5) that since HIV is so highly correlated with AIDS incidence, it must be the sole necessary and sufficient cause of AIDS. A huge body of research, reviewed in this paper, demonstrates the falsity of these myths. 1) The average number of years between HIV infection and AIDS is greater than 20 years for mild hemophiliacs, 14 years for young severe hemophiliacs, 10 years for old severe hemophiliacs, 10 years for homosexual men, 6 years for transfusion patients of all ages, 2 years for transplant patients, and 6 months for perinatally infected infants. These differences can only be explained in terms of risk-group associated cofactors. 2) Seroreversions are common. Between 10 and 20 percent of HIV-seronegative people in high risk groups have T-cell immunity to HIV, and may have had one or more verified positive HIV antibody tests in the past. 3) Antibody, far from being protective against HIV, appears to be highly diagnostic of loss of immune regulation of HIV, and some evidence of antibody-enhancement of infection exists. 4) Non-retroviral treatments of HIV infection, including safer sex practices, elimination of drug use, high nutrient diets, and limited reexposure to HIV and its cofactors have proven to be effective means of preventing or delaying onset of AIDS. 5) Many immunosuppressive factors, including drug use, multiple concurrent infections, and exposure to alloantigens, are as highly correlated with AIDS risk groups as HIV. These data are more consistent with AIDS being a multifactorial or synergistic disease than a monofactorial one.

Immunosuppression by a noncytolytic virus via T cell mediated immunopathology. Implication for AIDS

HIV is basically a non- or poorly cytocidal virus. Therefore, HIV infections in humans represent an apparent perversity in the balance between the host immune system and infectious agent: This noncytopathic virus infects macrophages, antigen presenting cells, helper T cells and other host cells which are then destroyed by the CD8+ T cell immune response. Thus, HIV infects some of the key cells involved in immune reactions and therefore induces the immune system to destroy itself and thereby enables the virus to persist. Accordingly, immunosuppression is not a cause of HIV cytopathogenicity but a consequence of conventional T cell mediated immunopathology that destroys macrophages antigen presenting cells, T helper cells and facilitates infection by trivial intracellular parasites which eventually cause fatal disease. This immunopathological view of AIDS is testable and, if correct, impinges on rationales for AIDS prevention and treatment.

Lysis of uninfected HIV-1 gp120-coated peripheral blood-derived T lymphocytes by monocyte-mediated antibody-dependent cellular cytotoxicity

Previous reports from our laboratory have demonstrated that peripheral blood monocytes (PBM) from HIV-1 infected individuals are de novo activated and are cytotoxic in vitro. Significant monocyte-antibody-dependent cellular cytotoxicity (ADCC) was obtained against HIV-1 inactivated CD4+ CEM target cells coated with HIV-1 in the presence of autologous seropositive serum. Based on these findings, we hypothesized that in HIV-seropositive individuals the monocytes may play an important role in vivo in the autodestruction of non-infected CD4+ T lymphocytes. The present study was designed to test this hypothesis. Monocytes from normal donors activated with M-CSF lysed CD4+ T cells (CEM) coated with gp120 sensitized by plasma from asymptomatic HIV-1+ individuals in a 8 h 51Cr release assay. ADCC cytotoxic activity varied from one individual to another and was a function of the dilution of the individual seropositive plasma used. We then used circulating CD3+ T lymphocytes as targets for ADCC following treatment with actinomycin D to facilitate the release of radioactive 51Cr. Like CEM, ADCC was obtained with CD3+ T cells coated with gp120 in the presence of HIV seropositive plasma and monocytes. Lysis was specific as T cells that were not coated with gp120 were not destroyed. These findings demonstrate that activated peripheral blood derived monocytes can destroy non-infected gp120-coated circulating T lymphocytes by an ADCC-mediated mechanism. Thus, these findings suggest that ADCC may be one mechanism operating in vivo for the destruction of non-infected CD4+ T lymphocytes.

CD4 similarity to proteins of infectious agents in AIDS and their role in autoimmunity

Lymphocytotoxic autoimmunity (LA) is ubiquitous in AIDS. Its causes are unknown. We report that significant amino acid sequence similarities exist between the proteins of infectious organisms associated with AIDS and the CD4 protein of T-helper lymphocytes. These included: HIV, cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex viruses (HSV), Varicella Zoster virus (VZV), Escherichia coli, Mycobacteria, Mycoplasmas, Plasmodium, and Staphylococcus. It has been reported previously that HIV proteins have significant similarities with human class II MHC (HLA class II) proteins. Since CD4 and HLA class II proteins are chemically complementary, pairs of homologous antigens will also be complementary. It follows that concurrent infections with CD4 and HLA class II-homologous antigens will result in idiotype-antiidiotype antibody pairs that cannot distinguish 'self' from 'nonself', that acts as lymphocytotoxins, and form circulating immune complexes. Thus, combined HIV-CMV, HIV-EBV, HIV-HBV, HIV-mycoplasma, or other appropriate infectious pairs may suffice to trigger LA in AIDS.

Altered glycosylation of leukosialin, CD43, in HIV-1-infected cells of the CEM line

CD43 (leukosialin, gpL115, sialophorin) is a major sialoglycoprotein widely expressed on hematopoietic cells that is defective in the congenital immunodeficiency Wiskott-Aldrich syndrome. It is thought to play an important role in cell-cell interactions and to be a costimulatory molecule for T lymphocyte activation. Using a metabolic 35SO4(2-) radiolabeling assay or biotinylation of cell surface proteins, we describe here that CD43 are sulfated molecules the glycosylation of which is altered in human immunodeficiency virus type 1 (HIV-1)-infected leukemic T cells of the CEM line. Hyposialylation of O-glycans and changed substitution on N-acetylgalactosamine residues are observed. The glycosylation defect is associated with an impairment of CD43-mediated homotypic aggregation which can be restored by resialylation. The hyposialylation of CD43 on HIV-1+ cells may explain the high prevalence of autoantibodies directed against nonsialylated CD43 that have been detected in HIV-1-infected individuals. A defect in glycosylation of important molecules such as CD43 or, as we recently described, CD45 may explain alterations of T cell functions and viability in HIV-1-infected individuals. In addition, a possible implication of hyposialylation in the HIV-1-infected cells entrapment in lymph nodes could be envisioned.

Anti-lymphocyte antibodies in plasma of HIV-1-infected patients preferentially react with MHC class II-negative T cells and are linked to antibodies against gp41

It has previously been shown that HIV-infected patients develop anti-lymphocyte antibodies. The relationship between anti-lymphocyte antibodies and antibodies against different viral antigens is unknown, and it remains controversial whether some lymphocyte subpopulations are targeted preferentially. We have set out using three-colour flow cytometry to measure antibodies against different lymphocyte subsets. Staining with anti-human immunoglobulin and two MoAbs was performed to characterize the immunoglobulin load of different lymphocyte subsets. Comparison was done between patients' antibody reactivity against HIV-1 antigens and anti-lymphocyte antibodies. We were able to demonstrate the presence of anti-lymphocyte antibodies in approximately 75% of the HIV-infected patients (n = 78) (healthy controls were all negative). MHC class II-negative T cells showed a stronger reaction with anti-lymphocyte antibodies than B cells or MHC class II-positive T cells. Patients with antibodies against CD4 lymphocytes showed a significantly higher antibody reaction with the retroviral antigen gp41 than patients without these antibodies. An association between anti-lymphocyte antibodies and antibody reactivity against other HIV-1 antigens was not noticed. In conclusion, anti-lymphocyte antibodies in HIV-1-infected patients show a preferential reactivity with T cells which lack expression of MHC class II molecules. There is an increased antibody reactivity against gp41 in patients with anti-CD4+ T cell antibodies. The association hints at a specific origin of anti-lymphocyte antibodies in HIV-1-infected patients due to cross-reactivity with viral epitopes or network phenomena. These anti-CD4 cell antibodies could be of interest in the clinical course of HIV infection.

Differential priming to programmed cell death of superantigen-reactive lymphocytes of HIV patients

Programmed cell death or apoptosis has been shown to play a central role in CD4+ T cell depletion following HIV infection. Because most apoptotic signals are delivered through T cell receptor stimulation, we investigated whether T cell depletion in AIDS is a stochastic phenomenon or if it preferentially affects T cell subsets defined by their interaction with superantigens. To address this problem we have taken advantage of the exclusive property of superantigens to trigger T cells expressing selective sets of T cell receptor V beta elements. Here we report that CD4+ T cells from HIV-infected patients can proliferate in vitro to T cell receptor mobilization by some superantigens, but not others. Furthermore, the failure of T cells to respond to some superantigens was shown to be due to an active cell death process that differentially affected T cells capable of interacting with different superantigens. The selective programmed cell death priming of T cells responsive to particular superantigens, observed in this study, suggests that T cell depletion in HIV infection is not simply due to the cytopathic effect of the virus. The possible link between programmed cell death and T cell receptor variable regions suggested by the present experiments may help to better define current models of AIDS pathogenesis.

Inhibition of human immunodeficiency virus type 1 replication by SDZ NIM 811, a nonimmunosuppressive cyclosporine analog

(Me-Ile-4)cyclosporin (SDZ NIM 811) is a 4-substituted cyclosporin which is devoid of immunosuppressive activity but retains full capacity for binding to cyclophilin and exhibits potent anti-human immunodeficiency virus type 1 (HIV-1) activity. SDZ NIM 811 selectively inhibits HIV-1 replication in T4 lymphocyte cell lines, in a monocytic cell line, and in HeLa T4 cells. Furthermore, its antiviral activity against laboratory strains and against clinical isolates from geographically distinct regions in primary T4 lymphocytes and in primary monocytes (50% inhibitory concentration = 0.011 to 0.057 micrograms/ml) was demonstrated. SDZ NIM 811 does not inhibit proviral gene expression or virus-specific enzyme functions, either free or bound to cyclophilin. The compound does not influence CD4 expression or inhibit fusion between virus-infected and uninfected cells. SDZ NIM 811 was, however, found to block formation of infectious particles from chronically infected cells. Oral administration to mice, rats, dogs, and monkeys resulted in levels in blood considerably exceeding the drug concentration, which completely blocked virus replication in primary cells. SDZ NIM 811 caused changes of toxicity parameters in rats to a smaller degree than cyclosporine (formerly cyclosporin A). Thus, the potent and selective anti-HIV-1 activity of SDZ NIM 811 and its favorable pharmacokinetic behavior together with its lower nephrotoxicity than that of cyclosporine make this compound a promising candidate for development as an anti-HIV drug.

Co-selection in immune network theory and in AIDS pathogenesis

Co-selection is a term used to denote the mutual positive selection of individual members from within two diverse populations, such that selection of members within one population is dependent on interaction with (recognition of) one or more member(s) within the other population. Co-selection is a recurring theme of the idiotypic network model that my colleagues and I have developed. This paper discusses the role that co-selection plays in basic symmetrical network theory and in a network model that resolves the I-J paradox. It proposes that co-selection of helper T cells and HIV variants plays a role in the pathogenesis of AIDS. The AIDS model involves a role for the T cell receptor in the infection of T cells. Finally, a way in which a co-selection process may potentially be used in the prevention and therapy of harmful forms of immunity is described.

Autoantibodies against ganglioside GM3 represent a portion of anti-lymphocyte antibodies in AIDS patients

In this study we analysed the relationship between anti-lymphocytic ganglioside antibodies and anti-lymphocyte antibodies in AIDS patients. Anti-lymphocytic ganglioside antibodies were detected by thin layer chromatography (TLC) immunostaining; three colour flow cytometry was used to analyse circulating antibodies against different lymphocyte subsets. Anti-lymphocytic ganglioside antibodies were detected in 23 out of 49 AIDS patients sera (46.9%). All positive sera reacted selectively with the GM3 comigrating band from AIDS lymphocytes. Twenty two out of the 23 anti-lymphocytic GM3 positive sera also had antibodies against CD4+T cells, versus 17/26 anti-GM3 negative. Furthermore, patients with lymphocytic GM3 antibodies showed a significantly higher antibody reactivity against CD4+ T cells than patients in which these antibodies were not detected. The absorption tests revealed that preincubation of positive sera with GM3 was followed by a decrease in the reaction with target lymphocytes. These findings suggest that anti-GM3 antibodies are a portion, but not the majority, of antibodies reacting with CD4+ T cells.

Circulating autoantibodies directed against conjugated fatty acids in sera of HIV-1-infected patients

Several reports have demonstrated that major changes occur in the fatty acid content of HIV-infected cells. In order to evaluate if these changes are recognized by the immune system, we have attempted to assay the possible presence of autoantibodies (autoAb) directed against conjugated fatty acids (CFA). Using an adapted ELISA, anti-CFA autoAb were assayed in sera of 150 HIV-1-infected patients and 116 controls (healthy donors and patients suffering from other diseases). Significantly increased anti-CFA autoAb of IgG class were found in HIV-1-infected patients (alpha < 0.001). Using our ELISA method and CFA differing in their length and their degree of unsaturation (lauric, myristic, palmitic, palmitoleic, stearic, oleic, linolenic, linoleic, lignoceric, arachidonic, eicosapentaenoic and docosahexaenoic acids), it was demonstrated that the acyl chain of CFA is the immunodominant part recognized by these autoAb. Anti-CFA autoAb were present in 15/52 asymptomatic carriers, 14/36 symptomatic carriers, 16/39 ARC patients, but only 3/23 AIDS patients. Anti-CFA activity seemed to be linked with the CD4+ T cell count, and was not related to the total IgG amounts. Anti-CFA autoAb could result from self-antigen presentation to immunological cells, and may reflect lipid membrane modifications occurring in HIV-infected cells.

T-cell-mediated immunopathology versus direct cytolysis by virus: implications for HIV and AIDS

It has been much debated as to whether CD4+ T-cell depletion and the pathogenesis of AIDS is the result of direct cytolytic effects of human immunodeficiency virus (HIV), T-cell apoptosis by nonspecific activation, dysregulation of cytokine production, or autoimmunity. In this context, Rolf Zinkernagel and Hans Hengartner discuss data from model infections with non-cytopathic viruses. They suggest that HIV may cause immunosuppression, not by direct cytolytic effects, but rather by a conventional virus-specific cytotoxic T-cell-mediated immunopathology.