Inhibition of HIV-1 replication with stable RNAi-mediated knockdown of autophagy factors

Autophagy is a cellular process leading to the degradation of cytoplasmic components such as organelles and intracellular pathogens. It has been shown that HIV-1 relies on several components of the autophagy pathway for its replication, but the virus also blocks late steps of autophagy to prevent its degradation. We generated stable knockdown T cell lines for 12 autophagy factors and analyzed the impact on HIV-1 replication. RNAi-mediated knockdown of 5 autophagy factors resulted in inhibition of HIV-1 replication. Autophagy analysis confirmed a specific defect in the autophagy pathway for 4 of these 5 factors. We also scored the impact on cell viability, but no gross effects were observed. Upon simultaneous knockdown of 2 autophagy factors (Atg16 and Atg5), an additive inhibitory effect was scored on HIV-1 replication. Stable knockdown of several autophagy factors inhibit HIV-1 replication without any apparent cytotoxicity. We therefore propose that targeting of the autophagy pathway can be a novel therapeutic approach against HIV-

Differential Role of Autophagy in CD4 T Cells and Macrophages during X4 and R5 HIV-1 Infection

BACKGROUND: HIV-1 can infect and replicate in both CD4 T cells and macrophages. In these cell types, HIV-1 entry is mediated by the binding of envelope glycoproteins (gp120 and gp41, Env) to the receptor CD4 and a coreceptor, principally CCR5 or CXCR4, depending on the viral strain (R5 or X4, respectively). Uninfected CD4 T cells undergo X4 Env-mediated autophagy, leading to their apoptosis, a mechanism now recognized as central to immunodeficiency. METHODOLOGY/PRINCIPAL FINDINGS: We demonstrate here that autophagy and cell death are also induced in the uninfected CD4 T cells by HIV-1 R5 Env, while autophagy is inhibited in productively X4 or R5-infected CD4 T cells. In contrast, uninfected macrophages, a preserved cell population during HIV-1 infection, do not undergo X4 or R5 Env-mediated autophagy. Autophagosomes, however, are present in macrophages exposed to infectious HIV-1 particles, independently of coreceptor use. Interestingly, we observed two populations of autophagic cells: one highly autophagic and the other weakly autophagic. Surprisingly, viruses could be detected in the weakly autophagic cells but not in the highly autophagic cells. In addition, we show that the triggering of autophagy in macrophages is necessary for viral replication but addition of Bafilomycin A1, which blocks the final stages of autophagy, strongly increases productive infection. CONCLUSIONS/SIGNIFICANCE: Taken together, our data suggest that autophagy plays a complex, but essential, role in HIV pathology by regulating both viral replication and the fate of the target cells

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Autophagy, a mechanism involved in the physiopathology of HIV-1 infection

L'autophagie est une voie majeure de dégradation et de recyclage des constituants cytoplasmiques. C'est également un mécanisme de l'immunité innée et adaptative. Au cours de l'infection par le VIH-1, l'autophagie est déclenchée dans les lymphocytes T CD4 non infectés après contact avec les glycoprotéines d'enveloppe virale (Env). Cette autophagie participe alors à l'induction de l'apoptose dans ces cellules, mécanisme connu pour être responsable de la disparition des lymphocytes T CD4 au cours de l'infection, et donc de l'évolution vers la phase SIDA. Nos travaux ont permis de montrer que l'activité fusogénique de gp41 est responsable de l'induction d'autophagie et de la mort des lymphocytes T CD4 non infectés après leur contact avec Env. De façon tout à fait surprenante, il apparaît que l'autophagie est bloquée dans les lymphocytes T CD4 productivement infectés par le VIH-1 (souches X4 ou R5). Par contre, les macrophages, autre population cellulaire ciblée par ce virus, ne présentent aucun signe d'autophagie en réponse à la fixation de Env (souches X4 ou R5), alors qu'elle est induite dans les macrophages infectés par ces mêmes virus. Enfin, les derniers résultats nous ont permis de mettre en évidence une phase d'autophagie plus précoce, intervenant dans les deux heures suivant le contact avec Env. L'étude des acteurs impliqués dans l'induction de cette première phase a montré qu'elle était indépendante de la fusion membranaire induite par gp41, ainsi que de la liaison de Env aux récepteurs CD4 et CXCR4. Cette première phase d'autophagie est également présente dans les premières étapes d'infection des lymphocytes T CD4 par du virus libre, et est nécessaire à la réplication du VIH-1. Le VIH-1 adopte donc une stratégie d'exploitation du mécanisme autophagique afin d'optimiser sa réplication, mais également la propagation de l'infection.Autophagy is a major catabolic pathway involved in the degradation and recycling of cytoplasmic components. It is also a mechanism of adaptive and innate immunity. During HIV-1 infection, autophagy is induced in uninfected CD4 T lymphocytes after contact with cells expressing HIV-1 envelope glycoproteins (Env, gp120/gp41). This process is a pre-requisite to their apoptosis. Thus, autophagy is implicated in the depletion of CD4 T lymphocytes during HIV-1 infection, mechanism leading to AIDS. The results obtained during my PhD have shown that the fusogenic function of gp41 is responsible for the induction of autophagy in the uninfected CD4 T lymphocytes. Surprisingly, this process is blocked in productively HIV-1-infected CD4 T lymphocytes (X4 or R5 strains). In contrast, uninfected macrophages, a preserved cell population during HIV-1 infection, do not undergo X4 or R5 Env-mediated autophagy. However, autophagosomes are present in infected macrophages. Our last results demonstrated that an early autophagic phase is triggered in target CD4 T cells 2h after the contact with Env-expressing cells. Neither the fusogenic function of gp41, nor gp120 binding to CD4 and CXCR4 is implicated in the induction of this early autophagic phase. Interestingly, this process seems necessary to establish an efficient HIV-1 replication. Our results suggest that HIV-1 adopts a strategy to use the autophagic pathway to its own profit and pointes this process as a key for the HIV-1-associated physiopathology

Facteurs professionnels et non professionnels associés à la prévalence de lésions pré-invasives bronchiques

ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

L'autophagie, un mécanisme impliqué dans la physiopathologie de l'infection par le VIH-1

L'autophagie est une voie majeure de dégradation et de recyclage des constituants cytoplasmiques. C'est également un mécanisme de l'immunité innée et adaptative. Au cours de l'infection par le VIH-1, l'autophagie est déclenchée dans les lymphocytes T CD4 non infectés après contact avec les glycoprotéines d'enveloppe virale (Env). Cette autophagie participe alors à l'induction de l'apoptose dans ces cellules, mécanisme connu pour être responsable de la disparition des lymphocytes T CD4 au cours de l'infection, et donc de l'évolution vers la phase SIDA. Nos travaux ont permis de montrer que l'activité fusogénique de gp41 est responsable de l'induction d'autophagie et de la mort des lymphocytes T CD4 non infectés après leur contact avec Env. De façon tout à fait surprenante, il apparaît que l'autophagie est bloquée dans les lymphocytes T CD4 productivement infectés par le VIH-1 (souches X4 ou R5). Par contre, les macrophages, autre population cellulaire ciblée par ce virus, ne présentent aucun signe d'autophagie en réponse à la fixation de Env (souches X4 ou R5), alors qu'elle est induite dans les macrophages infectés par ces mêmes virus. Enfin, les derniers résultats nous ont permis de mettre en évidence une phase d'autophagie plus précoce, intervenant dans les deux heures suivant le contact avec Env. L'étude des acteurs impliqués dans l'induction de cette première phase a montré qu'elle était indépendante de la fusion membranaire induite par gp41, ainsi que de la liaison de Env aux récepteurs CD4 et CXCR4. Cette première phase d'autophagie est également présente dans les premières étapes d'infection des lymphocytes T CD4 par du virus libre, et est nécessaire à la réplication du VIH-1. Le VIH-1 adopte donc une stratégie d'exploitation du mécanisme autophagique afin d'optimiser sa réplication, mais également la propagation de l'infection.Autophagy is a major catabolic pathway involved in the degradation and recycling of cytoplasmic components. It is also a mechanism of adaptive and innate immunity. During HIV-1 infection, autophagy is induced in uninfected CD4 T lymphocytes after contact with cells expressing HIV-1 envelope glycoproteins (Env, gp120/gp41). This process is a pre-requisite to their apoptosis. Thus, autophagy is implicated in the depletion of CD4 T lymphocytes during HIV-1 infection, mechanism leading to AIDS. The results obtained during my PhD have shown that the fusogenic function of gp41 is responsible for the induction of autophagy in the uninfected CD4 T lymphocytes. Surprisingly, this process is blocked in productively HIV-1-infected CD4 T lymphocytes (X4 or R5 strains). In contrast, uninfected macrophages, a preserved cell population during HIV-1 infection, do not undergo X4 or R5 Env-mediated autophagy. However, autophagosomes are present in infected macrophages. Our last results demonstrated that an early autophagic phase is triggered in target CD4 T cells 2h after the contact with Env-expressing cells. Neither the fusogenic function of gp41, nor gp120 binding to CD4 and CXCR4 is implicated in the induction of this early autophagic phase. Interestingly, this process seems necessary to establish an efficient HIV-1 replication. Our results suggest that HIV-1 adopts a strategy to use the autophagic pathway to its own profit and pointes this process as a key for the HIV-1-associated physiopathology.MONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF

HIV-1 Env induces pexophagy and an oxidative stress leading to uninfected CD4 + T cell death

International audienceThe immunodeficiency observed in HIV-1-infected patients is mainly due to uninfected bystander CD4+ T lymphocytes death. The viral envelope glycoproteins (Env), expressed at the surface of infected cells, play a key role in this process. Env triggers autophagy, process necessary to subsequent apoptosis, and to production of Reactive Oxygen Species (ROS) in bystander CD4+ T cells. Here, we demonstrate that Env-induced oxidative stressisresponsible for their death by apoptosis. Moreover, we report that peroxisomes, organelles involved in the control of oxidative stress, are targeted by Env-mediated autophagy. Indeed, we observe a selective autophagy-dependent decrease in the expression of peroxisomal proteins, catalase and PEX14, upon Env exposure, since the down-regulation of either BECLIN 1 or p62/SQSTM1 restores their expression levels. Fluorescence studies allowed us to conclude that Envmediated autophagy degrades these entire organelles and specifically the mature ones.Together, our results on Env-induced pexophagy provide new clues on HIV-1-induced immunodeficiency

Autophagy restricts HIV-1 infection by selectively degrading Tat in CD4+ T lymphocytes

International audienceAutophagy is a ubiquitous mechanism involved in the lysosomal-mediated degradation of cellular components when they are engulfed in vacuoles called autophagosomes. Autophagy is also recognized as an important regulator of the innate and adaptive immune responses against numerous pathogens, which have, therefore, developed strategies to block or use the autophagy machinery to their own benefit. Upon human immunodeficiency virus type 1 (HIV-1) infection, viral envelope (Env) glycoproteins induce autophagy-dependent apoptosis of uninfected bystander CD4(+) T lymphocytes, a mechanism likely contributing to the loss of CD4(+) T cells. In contrast, in productively infected CD4(+) T cells, HIV-1 is able to block Env-induced autophagy in order to avoid its antiviral effect. To date, nothing is known about how autophagy restricts HIV-1 infection in CD4(+) T lymphocytes. Here, we report that autophagy selectively degrades the HIV-1 transactivator Tat, a protein essential for viral transcription and virion production. We demonstrated that this selective autophagy-mediated degradation of Tat relies on its ubiquitin-independent interaction with the p62/SQSTM1 adaptor. Taken together, our results provide evidence that the anti-HIV effect of autophagy is specifically due to the degradation of the viral transactivator Tat but that this process is rapidly counteracted by the virus to favor its replication and spread. IMPORTANCE: Autophagy is recognized as one of the most ancient and conserved mechanisms of cellular defense against invading pathogens. Cross talk between HIV-1 and autophagy has been demonstrated depending on the virally challenged cell type, and HIV-1 has evolved strategies to block this process to replicate efficiently. However, the mechanisms by which autophagy restricts HIV-1 infection remain to be elucidated. Here, we report that the HIV-1 transactivator Tat, a protein essential for viral replication, is specifically degraded by autophagy in CD4(+) T lymphocytes. Both Tat present in infected cells and incoming Tat secreted from infected cells are targeted for autophagy degradation through a ubiquitin-independent interaction with the autophagy receptor p62/SQSTM1. This study is the first to demonstrate that selective autophagy can be an antiviral process by degrading a viral transactivator. In addition, the results could help in the design of new therapies against HIV-1 by specifically targeting this mechanism