Higher Frequency of NK and CD4+ T-Cells in Mucosa and Potent Cytotoxic Response in HIV Controllers

RESEARCH ARTICLE Higher Frequency of NK and CD4+ T-Cells in Mucosa and Potent Cytotoxic Response in HIV Controllers Natalia Andrea Taborda1, Sandra Milena González1, Cristiam Mauricio Alvarez2, Luis Alfonso Correa3,4, Carlos Julio Montoya1, María Teresa Rugeles1* 1 Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, UdeA, Medellín, Colombia, 2 Grupo de Inmunología Celular e Inmunogenética, Facultad de Medicina, Universidad de Antioquia, UdeA, Medellín, Colombia, 3 Sección de Dermatología, Departamento de Medicina interna, Facultad de Medicina, Universidad de Antioquia, UdeA, Medellín, Colombia, 4 Coordinador Laboratorio de Patología, Laboratorio Clínico VID, Obra de la Congregación Mariana, Medellín, Colombia * Abstract OPEN ACCESS Citation: Taborda NA, González SM, Alvarez CM, Correa LA, Montoya CJ, Rugeles MT (2015) Higher Frequency of NK and CD4+ T-Cells in Mucosa and Potent Cytotoxic Response in HIV Controllers. PLoS ONE 10(8): e0136292. doi:10.1371/journal. pone.0136292 Editor: R. Keith Reeves, Harvard Medical School, UNITED STATES Received: April 22, 2015 Accepted: August 1, 2015 Published: August 20, 2015 Copyright: © 2015 Taborda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. HIV infection induces immune alterations, mainly in gut mucosa, where the main target cells reside. However, the evolution of the infection is variable among infected individuals, as evidenced by HIV controllers who exhibit low or undetectable viral load in the absence of treatment. The aim of this study was to evaluate the frequency, phenotype and activity of T and NK cells in peripheral blood and gut mucosa in a cohort of Colombian HIV controllers. Blood and gut biopsies were included. The frequency and the activation status of T and NK cells were performed by flow cytometry. In addition, Gag-stimulated CD8+ T-cells and cytokine-stimulated NK cells were tested for cytotoxic activity. Finally, microbial translocation was measured by plasma lipopolysaccharide quantification. Compared with HIV-progressors, HIV controllers exhibited higher frequency of CD4+ T and NK cells, and lower expression of activation molecules in blood and mucosal immune cells, as well as lower microbial translocation. An increased production of molecules associated with cytotoxic activity of CD8+ T-cells in blood and mucosa and a higher percentage of polyfunctional CD8+ T cells in blood were also observed in HIV controllers. In addition, an increased activity of NK cells was observed in blood. These findings suggest that HIV controllers have a potent immune response, mainly mediated by cytotoxic cells that control HIV replication, which contribute to reducing alterations at the gut mucosa. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This investigation was financially supported by CODI-Universidad de Antioquia convocatoria mediana cuantía 2011; Estrategia para Sostenibilidad de Grupos 2014–2015 Universidad de Antioquia; CIHR IID&GH Program of the University of Manitoba, Canada; Natalia Taborda received a scholarship from Colciencias “Convocatoria Nacional 511 para el estudio de Doctorado en Colombia año 2010”. Introduction One of the most important pathogenic mechanisms during HIV infection is immune hyperactivation [1], which is induced initially by viral antigens, and then exacerbated by the destruction of the gut-associated lymphoid tissue (GALT), the major site for HIV replication [2]. Viral replication leads to the loss of mucosal integrity and translocation of microbial products, such PLOS ONE | DOI:10.1371/journal.pone.0136292 August 20, 2015 1 / 15 Role of Cytotoxic Cells in HIV Controllers Competing Interests: The authors have declared that no competing interests exist. as lipopolysaccharides (LPS), from intestinal lumen to systemic circulation [3]. As a result, there is an increased number of activated cells, apoptosis, mainly of CD4+ T-cells, anergy, and a generalized immune dysfunction [2]. Compiled evidence suggests that the immune response achieved in GALT could be the key factor to control viral replication, delaying AIDS progression [4]. The natural history of HIV infection is heterogeneous [5]. There are HIV controllers, who exhibit a spontaneous and sustained control of viral replication, at least for one year, without antiretroviral therapy (HAART) [6]. Although mechanisms related to the viral control are not completely understood, the cytotoxic response seems to play an important role in delaying AIDS progression [7,8]. NK cells are widely distributed in the body, including the gastrointestinal tract and peripheral blood (PB) [9]. Depending on the expression of CD16 and CD56 molecules, these cells can be classified in the following subsets: i) CD56dim (CD16+ or CD16-) with a high cytotoxic response; ii) CD56bright, mostly cytokine producers; and iii) CD56-, that exhibits functional alterations and accumulate in patients with advanced AIDS [10]. In intestinal mucosa, NK cells are located mainly in intraepithelial compartments and lamina propria [9]. Previous reports showed an increased frequency of NK cells in GALT as viral load decreases after HAART [11]. In addition, the frequency of intraepithelial NK cells has been positively correlated with CD4+ T-cell counts [12]. Additionally, cytotoxic T-lymphocytes (CTLs) have also been associated with viral control [7,8,13]. Long-term-non progressors (LTNP) exhibit polyfunctional CTL responses in PB and GALT [7,14]. Based on this, we hypothesized that compared to HIV progressors, HIV controllers have increased proportions of adaptive and innate cytotoxic cells with enhanced functionality in the PB and the GALT, which might contribute to preserve the integrity of the gut mucosa. To test this, we evaluated the frequency of T and NK cell subpopulations, their activation level, and their function in PB and GALT, as well as the level of microbial translocation in a cohort of Colombian HIV controllers who were compared with HIV-progressors. Material and Methods Study Population Two groups of HIV-infected individuals recruited from health insurance programs in Medellín-Colombia were included: i) 14 HIV controllers, defined as previously described [15]; briefly, they are patients who have been infected for more than one year, naïve for antiretroviral therapy, and exhibiting a spontaneous and sustained control of viral replication with viral loads lower than 2000 copies/mL; and ii) 18 chronic HIV-progressors, who exhibited CD4+ T-cell counts >250 cells/μL, HIV viral load between 10.000–100.000 RNA copies/mL and naïve for antiretroviral therapy (Table 1). Gut biopsies from 10 HIV controllers and 12 progressors from these two cohorts were available. Thirteen HIV controller (...truncated)