Distributional and functional analysis of regulatory and conventional CD4+ T cells during HIV and TB co infection and their modulation by the adrenal hormone DHEA

La Tuberculosis representa el principal agente de mortalidad a nivel mundial en pacientes infectados con el HIV-1. Ambas infecciones conllevan a una desregulación de los ejes inmune y adrenal que influirán en el desarrollo de las correctas respuestas frente a los patógenos. Así, investigamos la subpoblacion de LT CD4+CD25-FoxP3+ (uTreg, LTreg “no convencionales”) en pacientes co infectados con tuberculosis activa (HIV-TB), en individuos HIV+ con TB latente (HIV-TBL), en individuos HIV+ sin TB y en dadores sanos (DS). En primer lugar se comparó la expresión de CD39, PD1, GITR y el estado de maduración (CD27/CD45RA) de las células uTreg entre los distintos grupos de estudio. Los pacientes HIV-TB mostraron menores niveles de expresión de CD39 y mayores de PD1 que los DS, así como un estado de maduración alterado con respecto a los demás grupos. Más aun, se observaron menores niveles de CD39 y mayores de PD1 en células uTreg de pacientes HIV-TB y DS, al compararse con la expresión en LT CD4+CD25+FoxP3+ (cTreg). Además la población uTreg mostro mayores frecuencias de la subpoblacionTreg EM, así como una capacidad de producción de IFN-γ incrementada respecto de cTreg, en ambos grupos e pacientes. Luego, evaluamos una cohorte de pacientes HIV-TB durante el transcurso del tratamiento anti tuberculoso (TaT), analizando parámetros endocrinos e inmunológicos. De esta forma se observaron valores disminuidos de DHEA-s al incio del TaT con respecto a las concentraciones presentadas por DS, que se normalizaron a través del tiempo. Además, esto se vio acompañado por un aumento en la frecuencia de células productoras de IFN-γ Mtb específicas, y por una disminución del número de células uTreg hasta alcanzar los valores presentes en DS. Finalmente, al analizar citoquinas asociadas a inflamación, se observaron niveles incrementados al inicio del TaT, que luego de seis meses retornaron a valores normales. Por último, se investigó la respuesta Mtb especifica de linfocitos T CD4+ de pacientes HIV-TB y DS, caracterizando la producción de IFN-γ y TNF-α, su distribución memoria/efectora, y la modulación por parte de DHEA sobre la respuesta y la maduración de LT. En principio se observó que el agregado de DHEA no logro modular la respuesta antígeno especifica ni en HIV-TB ni en DS. Por otro lado, se encontró una disminución de células Naive y un aumento de LT EM en el grupo HIV-TB. Además, al evaluar la producción de citoquinas de cada subpoblacion de memoria, los DS presentaron mayores niveles de IFN-γ/TNF-α en las LT EM, mientras en HIV-TB todas las poblaciones presentaron niveles similares de producción de dichas citoquinas. La adición de DHEA moduló la producción de citoquinas en los LT CM de DS y logró disminuir las diferencias existentes en la distribución memoria/efectora observadas en los LT CD4 Mtbespecíficos entre los HIV-TB y DS. El conjunto de resultados demuestran que la población uTreg a pesar de presentar diferencias en el fenotipo, el grado de maduración y en su capacidad de producir IFN-γ, posee una acción supresora similar a la de las células cTreg. Además, el trabajo permite evidenciar que el TaT logro normalizar parámetros endocrinos e inmunes a lo largo de 6 meses de terapia. Por último, se consiguió discriminar la producción de citoquinas Th1 para distintas subpoblaciones de Memoria en el contexto de la coinfeccion, y sugerir un rol modulador de DHEA sobre la diferenciación de las células antígeno específicas.Tuberculosis is the most common opportunistic infection and represents the main cause of death worldwide in HIV-1 infected patients. Both infections lead to a deregulation of the immune and adrenal axes that influence the development of normal responses to pathogens, resulting in alterations of lymphocyte frequencies and in their functional capabilities. In this context, we aimed to investigate the previously described expanded subpopulation of LT CD4+CD25-FoxP3 + (uTreg) in co-infected patients with active tuberculosis (HIV-TB) and compared them with those uTregs analyzed in HIV+ individuals with latent TB (HIV- TBL), HIV+ individuals without TB (HIV) and a group of healthy donors (HD). So, first we evaluated the expression of CD39, PD1, GITR and the maturation status through CD27/CD45RA in the uTreg population along the different study groups. HIV-TB patients showed higher expression levels of CD39 and PD1 compared with HD. Moreover, we found significant differences in the maturation status of uTregs from HIV-TB when compared with the other study groups. We also compared uTreg vs. cTreg (CD4+CD25+FoxP3+) in HIV-TB patients and in HD. Besides this, the production of IFN-γ, TGF-β, IL-10 and suppressor capacity between both cell populations was assessed. Thus, we observed lower levels of CD39 and increased expression of PD1 in uTreg cells of both groups. Similar differences were found in these groups of individuals when maturation profile and cytokine production was analyzed, showing that uTreg cells had higher frequencies of Treg EM, as well as an increased capacity to produce IFN-γ than cTreg cells both in HIV-TB and HD groups. Secondly, we evaluated a cohort of HIV-TB patients during the course of the antituberculosis therapy (ATT), evaluating both endocrine and immunological markers. Thus, diminished plasma levels of DHEA-s were observed at the initiation of therapy, reaching normal levels after 6 months. Moreover, this was accompanied by an increase in the frequency of IFN-γMtb specific-producing cells, and a decrease in uTreg frequencies, which reached HD values at six months of therapy. Furthermore, when several cytokines associated with inflammation were analyzed during ATT, we observed a modulation of IL -6, IL-8, IL-7 and IL-12 levels, whose values decreased along anti TB therapy. Finally, we compared the responsiveness of Mtb specific LT CD4+ of HIV-TB and HD, analyzing the IFN-γ and TNF-α production, memory/effector distribution, and the modulation by DHEA of functionality and maturation status of CD4+ T cells.We observed that the DHEA did not modulate Mtb specific responses of CD4+ T cells in either group. On the other hand, when the memory/ effector distribution was compared between HIV-TB and HD, decreased proportions of naïve T cells and increased percentages of LTEM cells in HIV-TB group were found. In addition, cytokine production of memory subsets was assessed, therefore while the T CM subset produced a greater amount of IFN-γ/TNF-α compared with the other subsets of HD individuals, HIV-TB memory/effector subsets showed a similar production capacity. Addition of DHEA modified cytokine production only in TCM cells from HD. Interestingly, DHEA reduced the existing differences in CD4 T cells memory/effector distributions between Mtb-specific CD4+ cells from HIV-TB and HD. Together, these results uncover alterations of the immune-endocrine axes during HIVTB co infection. Our work also demonstrates that uTreg population, despite having an altered phenotype, maturation status and ability to produce IFN-γ, has a conserved suppressive capacity. Furthermore, this work demonstrates that ATT normalizes immune-endocrine parameters over 6 months of therapy. Finally, it was possible to discriminate Th1 cytokine production from different memory/effector subpopulations in the context of this coinfection, and to suggest a modulatory role for DHEA on the differentiation of Mtb-specific cells.Fil:Angerami, Matías Tomás. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina

Adrenal steroids modulate the phenotype and function of M. tuberculosis-stimulated human dendritic cells

Cell-mediated immunity, cytokines induced during the specific immune response and T-cell populations are crucial factors for containing Mycobacterium tuberculosis infection. Recent reports suggest a cross-regulation between adrenal steroids (glucocorticoids and dehydroepiandrosterone, DHEA) and the function of antigen-presenting cells (APCs). Therefore, we investigated the role of adrenal hormones on the functional capacity of M. tuberculosis-induced dendritic cells (DCs). Cortisol significantly inhibited the functions of M. tuberculosis-induced DCs. Interestingly, the presence of DHEA enhanced the M. tuberculosis-induced expression of MHC I, MHC II and CD86 and also increased ERK1/2 phosphorylation. Moreover, DHEA improved the production of IL-12 in response to M. tuberculosis stimulation, diminished IL-10 secretion and could not modify TNF-α synthesis. Importantly, we observed that DHEA enhanced the antigen-specific T-cell proliferation and IFN-γ production induced by M. tuberculosis-stimulated DC. These data show for the first time the relevance of the adrenal axis (especially of DHEA) in the modulation of DC function in the context of tuberculosis, a disease where the induction of a Th1 environment by APCs is crucial for the development of an effective immune response to the mycobacteria.Fil: Angerami, Matías. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina; Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia del Sida; Argentina;Fil: Suárez, Guadalupe Verónica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina;Fil: Pascutti, María Fernanda. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina;Fil: Salomon, Horacio Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina; Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología; Argentina;Fil: Bottasso, Oscar Adelmo. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Instituto de Inmunología; Argentina;Fil: Quiroga, Maria Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina; Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia del Sida; Argentina

Determination of dehydroepiandrosterone and its biologically active oxygenated metabolites in human plasma evinces a hormonal imbalance during HIV-TB coinfection

Abstract An estimated one third of the world’s population is affected by latent tuberculosis (TB), which once active represents a leading cause of death among infectious diseases. Human immunodeficiency virus (HIV) infection is a main predisposing factor to TB reactivation. Individuals HIV-TB co-infected develop a chronic state of inflammation associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation. This results in a hormonal imbalance, disturbing the physiological levels of cortisol and dehydroepiandrosterone (DHEA). DHEA and its oxygenated metabolites androstenediol (AED), androstenetriol (AET) and 7-oxo-DHEA are immunomodulatory compounds that may regulate physiopathology in HIV-TB co-infection. In order to study possible changes in plasma levels of these hormones, we developed an approach based on high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). To our knowledge, this represents the first report of their simultaneous measurement in HIV-TB individuals and the comparison with healthy donors, obtaining statistically higher plasma levels of DHEA, AET and 7-oxo-DHEA in patients. Moreover, we found that concentrations of 7-oxo-DHEA positively correlated with absolute CD4+ T cell counts, nadir CD4+ T cell values and with individuals who presented TB restricted to the lungs. This research contributes to understanding the role of these hormones in HIV-TB and emphasizes the importance of deepening their study in this context