Current Molecular Medicine - Volume 2, Issue 8, 2002

Cytokines are major controller of HIV replication and represent, at the same time, a target for viral-induced immune dysregulation. This mutual relationship has profound implications for both active HIV replication and immune-mediated governance of latency, in addition, cytokines have therapeutic value in the perspective of immune reconstitution. In the current article we will review the most relevant aspects emerged in almost 20 years of research in this area with particular reference to the distinct, but interconnected contribution of the most simple (cell lines) to the most complex (animal) models of HIV infection.

The unexpected encounter between the fields of HIV and chemokines has opened new perspectives for understanding the mechanisms of AIDS pathogenesis, as well as for the development of effective therapies and vaccines. Selected chemokines act as potent natural inhibitors of HIV infection, as they bind and downmodulate chemokine receptors that serve as critical coreceptors for HIV to gain access into cells. The differential usage of the two major HIV coreceptors, CCR5 and CXCR4, determines the biological diversity among HIV variants. Most primary HIV strains use CCR5 as a coreceptor and thereby are sensitive to inhibition by the CCR5-ligand chemokines, RANTES, MIP-1αand MIP-1β. The high level of expression of these proinflammatory chemokines in HIV-infected secondary lymphoid tissues may help to explain the inherently slow course of HIV disease. The crucial role played by CCR5 in the physiology of HIV infection is further attested by the near-complete resistance to HIV infection in people carrying a homozygous 32bp deletion within the CCR5 gene (CCR5-Δ32). A smaller proportion of HIV isolates, commonly emerging in concomitance with the clinical progression toward AIDS, uses CXCR4 as a coreceptor and is inhibited by the CXCR4 ligand, SDF-1. The high level of expresion of SDF-1 in the genital mucosa may help to explain the inefficient transmission of CXCR4-tropic HIV. Although chemokines or derivative molecules could be exploited as therapeutic agents against HIV, the risk of inducing inflammatory side-effects or of interfering with the physiology of the homeostatic chemokine system represents a potential limitation. However, the ability of chemokines to block HIV infection can be uncoupled from their receptor-mediated signaling activity, thus providing a theoretical foundation for the rational design of safe and effective chemokine receptor inhibitors.

Similar to other pathogens, HIV can directly activate the complement pathway even in the absence of antibodies. During and after seroconversion, HIV-specific antibodies enhance the activation of complement and increase deposition of complement fragments on virions dramatically. However, even in the presence of HIV-specific antibodies, no or only poor lysis occurs. HIV has adapted different protection mechanisms to keep complement activation under the threshold necessary to induce virolysis. In addition to its own envelope proteins, the viral envelope contains membrane-anchored host molecules. Among those are complement regulatory proteins that remain functionally active on the surface of HIV and turn down the complement cascade. In addition, serum proteins with complement regulatory activities become secondarily attached onto the virus, thereby enhancing the protection of HIV against complement-mediated damage. Therefore, opsonised virions accumulate in HIV-infected individuals, which subsequently interact with complement receptor (CR) expressing cells. This review is mainly focused on these interactions, which result either in infection of CR-positive cells with high efficiency, or retention of viral particles on their surface via CRs, thereby promoting transmission of virus to other permissive cells.

The correlates of protective immunity in HIV-1 infection include the endogenous production of compounds with anti-HIV-1 activity. These compounds can be produced independently of specific humoral or cellular immune responses. A model of compartmental inhibition of HIV-1 infection is the placenta, an organ that prevents transmission of HIV-1 to the fetus in the majority of HIV-1 pregnancies. Studies of this organ elucidated new compounds and mechanisms for prevention and treatment of HIV including the potent inhibitor of HIV-1, leukemia inhibitory factor (LIF).Besides coordinating the humoral and cellular immune responses, cytokines such as IFN-? exhibit intrinsic antiviral activity that represents the first line of defense against pathogens prior to the development of a specific immune response. The study of antiviral factors is particularly important in HIV / AIDS because of the direct destruction of the immune system by HIV-1. In this report, we focus on the identification and mechanism of endogenously produced anti-HIV factors and the overall function of these factors in the prevention and treatment of HIV / AIDS.

Macrophages are infected early during HIV infection and are thought to play the role of a Trojan horse by spreading infection in tissues. Most recent studies point out to a more complex role for macrophages in HIV infection: macrophages could contribute to both host defense and viral persistence and pathogenesis. Infected macrophages are a reservoir for HIV and modulate apoptosis of T cells present in their vicinity. Also, a functional impairment of HIV-infected macrophages may play a role in AIDS pathogenesis. Nevertheless, both activation and differentiation of monocyte / macrophages can interfere with susceptibility of these cells to infection. Therefore, a wide variety of stimuli result in HIV suppression through macrophage activation. At present times, a dynamic view on the role of macrophages in HIV infection arises which indicates that macrophages are a target for the virus and at the same time regulate its replication. Therefore, macrophages are at the cross-road between protection and pathogenesis in HIV infection due to their involvement both as a viral target and a key modulator of non-specific and specific immune responses. Future studies will help unravel the cellular and molecular mechanisms that underlie HIV-macrophage interactions and might result in new vaccine and / or therapeutic strategies.

Dendritic cells (DCs) were recently found to be innate immunity effectors against tumoral cells and viruses. (i) In response to most viruses, including HIV, plasmacytoid DCs are responsible for most of the type I IFN secretion, which is strongly anti-viral and induces TH1 type responses. Myeloid DCs secrete IL-12, which is also important for TH1-type and cytotoxic responses. In HIV patient blood, both DC population numbers decrease as early as the primary stage. Plasmacytoid DC numbers correlate with type I IFN secretion, which is a prognosis predictor, particularly under treatment. IL-12 secretion is also defective. Immunotherapies to replace the defective cytokines or to restore a potentially defective DC-T lymphocyte feed-back might help patients restore their immune responses under antiviral therapy. (ii) After measles and other viral infections, or incubation with dsRNA, DCs become cytotoxic and consequently exhibit natural killer function, through upregulation of type I IFN secretion which enhances TRAIL expression. In HIV infection, this mechanism was not demonstrated yet, but it might a) be responsible for the massive apoptosis of uninfected lymphocytes, and b) increase specific immunity through cross-presentation of antigens from infected cells killed by DCs. (iii) DCs direct expansion and effector functions of NK cells in the absence of adaptive-type cytokines and modulate NKT cell IFN-γ production. Reciprocally, NK activation triggers DC maturation. HIV-1 Tat inhibits NK cell cytotoxicity directly and probably through inhibition of IL-12 secretion by DC. Therefore, understanding the functions of DCs in innate immune responses and in pathogenesis will help obtain better HIV replication control.

Although the means by which NK cells may contribute to anti viral defense are still incompletely understood, various studies merge to a better comprehension of pathways that mediate NK cell activation (NK cell mediated cytotoxic activity and cytokine production) and their implications during the immune response towards a variety of viruses. Characterization of a specific expression pattern of ligands for NK receptors on virally infected cells and consequent modulation of NK cell activity have provided new insights in the field. A major break through to a direct evidence of a role for NK cells and NK cell receptors in immune protection against viral infection, was the recent implication of the murine activating Ly49H receptors in immune protection against MCMV infection. Although much remains to be learned concerning implication of NK cells in HIV infection, various reports have documented alteration in NK cell function and numbers during the course of HIV infection or treatment of AIDS. This review will focus on the current knowledge about the factors which might influence NK cell activation during various viral challenge and an emerging view of their alteration during HIV infection.

There is growing interest in the use of innate immune reactions in the therapy and prophylaxis of various diseases. Natural T (NT) lymphocytes that recognize infected cells or microbial compounds without the classical genetic restriction by polymorphic MHC molecules are crucial components of innate immunity. NT cells bearing the Vγ9Vδ2 T-cell receptor (TCR) are broadly reactive against intracellular pathogens, can lyse human immunodeficiency virus (HIV) infected cells, and release cytokines capable of regulating HIV replication. The potent antiviral activities of Vγ9Vδ2 T cells may help to contain viral spread during acute HIV infection and / or to prevent the establishment of viral persistence. Substantial changes in the composition and function of circulating γδ T-cell pools occur in HIV-infected patients. These changes a) may contribute to the etiopathogenesis of opportunistic infections and neoplasms, and b) are partly reversed by highly active anti-retroviral therapy (HAART). In addition to direct antiviral activities, activated γδ T cells influence dendritic cell maturation and the adaptive αβ T-cell response. Vγ9Vδ2 T cells can be stimulated in vivo and in vitro by various nonpeptidic antigens (NpAgs) and recent animal experimental data suggest that activated Vγ9Vδ2 T cells may help to control SIV replication. Currently, NpAgs are being assessed as potential therapeutic agents in AIDS, tuberculosis and certain cancers susceptible to Vγ9Vδ2 T-cell effector mechanisms.