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Clinical and Vaccine Immunology, January 2007, p. 74-80, Vol. 14, No. 1
1071-412X/07/$08.00+0 doi:10.1128/CVI.00250-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Nancy C. Connolly,2
William G. Buchanan,1 and
Charles R. Rinaldo Jr.1,3*
Department of Infectious Diseases and Microbiology, Graduate School of Public Health,1 Departments of Medicine,2 Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 152613
Received 8 July 2006/ Returned for modification 16 August 2006/ Accepted 23 October 2006
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The association of phenotypes of human immunodeficiency virus type 1 (HIV-1)-specific CD8+ T cells with disease progression remains controversial. While HIV-1-specific CD8+ T cells in long-term nonprogressors have been reported to be phenotypically enriched for an effector subset (CD27 CD45RA+) (12), others have reported that HIV-1-specific CD8+ T cells remain enriched in an intermediate stage (CD27+ CD28) regardless of clinical status (9) and duration of infection (2). It is not clear from these latter studies, however, whether the differentiation of HIV-1-specific CD8+ T cells during chronic HIV-1 infection is impaired prior to the effector stage. Moreover, since continuous replication of HIV-1 during chronic persistent infection provides a constant supply of HIV-1 antigens, long-term HIV-1 infection should theoretically drive HIV-1-specific CD8+ T cells to the effector stage. Phenotypic enrichment observed in these studies (2, 9), therefore, could be a consequence of a blockade in CD8+ T-cell differentiation prior to the effector stage. Thus, HIV-1-specific CD8+ T-cell memory effector differentiation needs to be clarified in relation to the natural course of memory CD8+ T-cell differentiation.
In the present study, we assessed the differentiation of HIV-1-specific CD8+ T cells by phenotypic analysis based on CD27, CD28, CD57, and CD62L expression in a cohort of HIV-1-infected subjects with a range of T-cell counts and viral loads and uninfected participants. We found that, in contrast to Epstein-Barr virus (EBV)- and cytomegalovirus (CMV)-specific CD8+ T cells, the majority of HIV-1-specific CD8+ T cells were phenotypically enriched in CD27high CD57 and CD27high CD57low subsets and showed no evidence of progression to the effector subset (CD27 CD57high). These results suggest that the phenotypic enrichment of HIV-1-specific CD8+ T cells that persists in spite of the continuous presence of HIV-1 antigen is due to impaired CD8+ T-cell effector differentiation.
(This work was in partial fulfillment of the requirements for a Ph.D. for A.H. from the University of Pittsburgh.)
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TABLE 1. HLA types, tetramer reactivity, and clinical data of study participants
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MHC-I tetrameric reagents used in the study are listed in Table 2. All of the tetrameric agents except A2pp65 CMV and A2BMLF1 EBV were obtained from the NIH Tetramer Synthesis Facility. A2pp65 CMV and A2BMLF1 EBV tetramers were obtained from Coulter Immunomics (San Diego, CA). All of the tetramers were labeled with PE and used at a 1/50 to 1/200 dilution for staining 2 x 106 to 5 x 106 peripheral blood mononuclear cells (PBMCs).
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TABLE 2. List of epitopes used for MHC class I tetramer analysis
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Flow cytometry. The MoFlo flow cytometer was calibrated for laser fluctuation/alignment and photomultiplier tube voltage adjustment by using FlowCheck beads (Coulter, Miami, FL) and Ultra Rainbow Calibration beads (Spherotech, Inc., Libertyville, IL) prior to the sample acquisition. A six-color compensation matrix was created by FlowJo (TreeStar, Cupertino, CA), which was based on six singly stained PBMC samples from actual donors. A PE-conjugated mouse anti-human CD8 MAb was used for PE compensation in place of the MHC-I tetramer.
We used a flow cytometric analysis described previously (8) with a few modifications. A minimum of 500 total tetrameter-positive CD8high events were collected for the fully stained sample and isotype control (the same number of events were collected for both samples), and this resulted in a collection of approximately 1 x 106 to 3 x 106 total events. We used a compounded gating scheme as previously described (7, 8), with necessary modifications. Briefly, cells were first gated on the CD8high population on a CD8 and side scatter (SS)-log plot, followed by a lymphocyte gate on an forward scatter (FS)- and SS-log plot. Potential doublets were excluded based on an FS-area and FS-height plot. The resulting tetrameter-positive population was visualized on a tetramer-PE versus SS-log plot for determining phenotypic analysis and the frequency of tetrameter-positive CD8+ T cells. Proper gating was established by using tetramer and CD8-PECy7 doubly stained cells in the presence of fluorescent-labeled isotype controls. Data analysis and graphic representations were performed with FlowJo software.
Statistical analysis. We used analysis of variance and the Tukey-Kramer honest significant difference test for determining statistical significance between and among group means. We used the two-tailed Spearman correlation test for determining P values and a standard least square method for determining R2 correlation coefficients. A P value of <0.05 was considered statistically significant. Statistical analysis and graphical representation were performed using JMP IN, version 5.1 (JMP Sales, Cary, NC), and Aabel software (Gigawiz Ltd. Co., Tulsa, OK).
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FIG. 1. Visualization of virus-specific CD8+ T cells by staining ex vivo with MHC-I tetramers and surface expression of memory/effector phenotypic markers. All cells shown are a result of compound gating; an initial gate was set on the CD8high subset on CD8 and SS-log, followed by a lymph-gate on FS-area and SS-log. (A) Representative figure showing surface expression of CD27, CD28, CD57, and CD62L on EBV-, CMV-, and HIV-1-specific CD8+ T cells. Numbers in the quadrants indicate percentages of cells. (B) Comparison of percentages of CD27, CD28, CD57, and CD62L expressing EBV-, CMV-, and HIV-1-specific CD8+ T cells. Data are from the participants with EBV tetramer reactivity (n = 5), CMV tetramer reactivity (n = 9), and HIV-1 tetramer reactivity (n = 14).
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Correlation between proportions of CD27+ CD57+ HIV-1-specific CD8+ T cells and plasma viral load. We assessed CD57 expression as a surrogate marker of terminal differentiation. The majority of HIV-1-specific CD8+ T cells were enriched evenly (P > 0.05) in CD27+ CD57 (median, 28%; range, 16 to 77%) and CD27+ CD57+ (median, 36%; range, 8 to 67%) subsets (Fig. 2A). In contrast, CMV-specific CD8+ T cells were enriched predominantly in the CD27 CD57+ (median, 47%; range, 17 to 84%) subset (P < 0.05), and EBV-specific CD8+ T cells were relatively more enriched in the CD27+ CD57 (median, 56%; range, 35 to 80%) subset.
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FIG. 2. HIV-1-specific CD8+ T cells do not show effector maturation-associated progression from the CD27high CD57 subset to the CD27 CD57high subset. (A) Proportions of four binary CD27 CD57 subsets of EBV-, CMV-, and HIV-1-specific CD8+ T cells are compared. The green line indicates the mean of each subset. Data are from the participants with EBV tetramer reactivity (n = 5), CMV tetramer reactivity (n = 9), and HIV-1 tetramer reactivity (n = 14). (B to E) Proportions of the CD27+ CD57+ (CD27high CD57low) subsets of HIV-1-specific and bulk CD8+ T cells positively correlated with HIV-1 plasma viral load (B and D) but not with absolute CD4 counts (C and E). HIV-specific CD8+ T cells from HIV-infected individuals (n = 7) are plotted against HIV-1 plasma viral load (log10VL). Mean values of corresponding percent CD27+ CD57+ of HIV-specific and bulk CD8+ T cells are used for those with multiple HIV-1-specific tetramer reactivity. (F) Representative three-dimensional topographical plots of CD27 and CD57 expression on EBV (panel i)-, CMV (panel ii)-, and HIV-1 (panels iii and iv)-specific CD8+ T cells are shown. Color variation indicates a number of cells from low (purple) to high (red) on a z axis. The white arrow indicates the CD27 CD57high subset. Percent CD27 CD57+ of representative results (colored circles) are shown in Fig. 2A. Panels i and ii represent EBV- and CMV-specific CD8+ T cells from HIV-1 uninfected (red circles, participants 9 and 8, respectively), while panels iii (green circle, B8nef from participant 1), and iv (blue circle, A3pol from participant 7) represent HIV-1-infected participants.
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Progression of the HIV-1-specific CD8+ T cell to the atypical CD27high CD57low subset. Notably, the pattern of CD27 and CD57 expression revealed an additional aspect of virus-specific memory CD8+ T-cell differentiation. EBV- and CMV-specific CD8+ T cells appeared to uninterruptedly progress from CD27high CD57 (undifferentiated memory stage) to CD27 CD57high (effector stage) (Fig. 2F). This pattern of progression from an immature to mature stage was apparent in the relatively more differentiated EBV-specific CD8+ T cells (Fig. 2F, panel i) and in most of the CMV-specific CD8+ T cells (Fig. 2F, panel ii). In contrast, the CD57+ subset of HIV-1-specific CD8+ T cells typically appeared in the absence of CD27 down-regulation (Fig. 2F, panel iii). This pattern persisted even in HIV-1-specific CD8+ T cells with the highest proportion of the CD27 CD57+ subset (Fig. 2F, panel iv). Also, virtually all the CD27+ CD57+ HIV-1-specific CD8+ T cells were CD27high CD57low (Fig. 3).
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FIG. 3. Pattern of CD27 and CD57 expression on EBV-, CMV-, and HIV-specific CD8+ T cells from three HIV-1-infected participants with a triple tetramer reactivity. Shown are three-dimensional topographical plots of CD27 and CD57 expression on tetrameter-positive CD8+ T cells from participant 3 (A), participant 5 (B), and participant 2 (C). Refer to the legend for Fig. 2F for a description of the topographical plot.
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Based on these results, HIV-1-specific CD8+ T cells appear to differentiate to an atypical subset (CD27high CD57low) rather than to the typical effector subset (CD27 CD57high), even in the continuous presence of HIV-1 antigens. Furthermore, progression to the CD27high CD57low subset is positively correlated with HIV-1 viremia but not with absolute CD4+ T-cell counts.
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A novel finding of our study is the development and accumulation of the previously uncharacterized CD27high CD57low subset of HIV-1-specific CD8+ T cells, which is significantly correlated with plasma viral load. Since the functional significance of the CD27high CD57low subset is unknown at present, it is difficult to address the cause-and-effect relationships between disease progression and the development of the CD27high CD57low subset. This question is best addressed by a longitudinal study to determine whether the CD27high CD57low subset arises prior to the loss of immune control of HIV-1 chronic infection. Clearly, further elucidation of the functional significance of the CD27high CD57low subset is warranted.
Our hypothesis as to how the CD27high CD57low subset may develop during chronic HIV-1 infection is that HIV-1-specific CD8+ T cells lose the capacity to undergo differentiation from the early stage (CD27high CD57) to the effector stage (CD27 CD57high). They instead accumulate as an atypical CD27high CD57low subset, potentially due to the inability for coordinated down-regulation of CD27 and up-regulation of CD57. Recently it has been shown that CD27 down-regulation on CMV-specific CD8+ T cells requires CD70 expression induced by antigen-specific activation and the presence of interleukin-2 (6). Thus, long-term continuous activation of HIV-1-specific CD8+ T cells in the absence of IL-2 due to CD4+ T-cell loss could lead to impaired CD70 expression by activated HIV-1-specific CD8+ T cells.
Alternatively, the effector subset (CD27 CD57high) of HIV-1-specific CD8+ T cells is depleted in tissues and circulation during chronic HIV-1 infection. Interestingly, CD57+ CD8+ T cells are highly susceptible to activation-induced apoptosis (4). Also, chronic antigenic stimulation could deliver an excessive CD27-CD70-mediated costimulatory signal, ultimately leading to the exhaustion of antigen-specific CD8+ T cells (11). Thus, excessive and prolonged CD27-CD70 interaction during chronic HIV-1 infection may cause the deletion of CD27 CD57high HIV-1-specific CD8+ T cells.
Despite a large number of recent phenotypic and functional T-cell studies, it is still not entirely clear whether a particular phenotypic enrichment or differentiation stage of the virus-specific CD8+ T cells can provide necessary and sufficient protection from chronic viral infection. Intuitively, having a large proportion of the effector subset of virus-specific CD8+ T cells seems to be advantageous because of their capacities to mount immediate protection with direct cytotoxic functions. However, having a large proportion of effector cells may not be suitable for long-term protection if effectors readily undergo activation-induced apoptosis. This issue has remained controversial in the context of assessing phenotypic correlates of long-term survival in HIV-1 infection (3, 13). The mode of long-term nonprogression can be multifaceted, with HIV-1-infected individuals, including long-term survivors, being heterogeneous in their pathogenesis and clinical conditions (e.g., viral load, CD4+ T-cell counts, duration of infection, and types of medications) and bases of immune control of HIV-1 infection.
In conclusion, we assessed the state of differentiation of HIV-1-specific CD8+ T cells by characterizing and comparing phenotypes of HIV-1-, EBV-, and CMV-specific CD8+ T cells based on multiparameter flow cytometry. We found that HIV-1-specific CD8+ T cells predominantly displayed the phenotype CD27high CD28 CD57low CD62L. Moreover, our novel finding was that some EBV-specific and a majority of CMV-specific CD8+ T cells displayed coordinated modulation of CD27, CD28, and CD57 expression during T-cell differentiation, while a majority of HIV-1-specific CD8+ T cells did not. Particularly, HIV-1-specific CD8+ T cells did not appear to differentiate to the effector CD27 CD57high subset but were enriched in the atypical CD27high CD57low subset. There was a marked increase in enrichment of the CD27high CD57lowsubset with chronic disease. Based on these results, we propose a model wherein HIV-1-specific CD8+ T cells sustain impaired effector differentiation during the course of chronic HIV-1 infection.
This work was supported by NIH grants R37-AI41870, U01-AI35041, and P01-AI055794 and the AIDS Clinical Trials Group subcontract 204IC006.
Published ahead of print on 1 November 2006. ![]()
Present address: Department of Medicine, Division of Infectious Diseases, University of California-Los Angeles, Los Angeles, CA 90095. ![]()
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