Pioneering Precision Medicine Approaches for Immune Control of Pediatric HIV-1 Infection

项目摘要/摘要，免疫控制（项目4） 找到治疗HIV-1感染的方法对越来越多的HIV-1感染婴儿特别重要， 儿童和青少年，如果治愈性治疗方案不能 随时待命最近的进展表明，实现HIV-1感染的功能性治愈可能不需要 完全消除所有完整的HIV-1前病毒;相反，它可能足以靶向完整的前病毒 整合在允许的染色质位置，支持HIV-1转录，更容易受到病毒感染， 重新激活信号。这种治愈HIV-1感染的模式似乎以精英控制者为例， 我们记录了一个高度不同的染色体整合位点景观，其特征是完整的 异染色质区域的前病毒。值得注意的是，前病毒整合位点的这种“封闭和锁定”模式 可能代表了细胞免疫选择力的结果， 前病毒在可接近的染色质位置，而在异染色质位置的前病毒可以长期存在。 这一概念提出了免疫介导的选择机制可以加强或加速的可能性 通过治疗性疫苗接种，并且可能在开始ART的HIV-1感染婴儿中优先诱导， 感染的早期阶段在这里，我们建议对婴儿体内的病毒库动态进行详细分析 接受含度鲁特韦的抗逆转录病毒治疗（ART），最终目的是为未来的临床 旨在通过个性化治疗mRNA诱导“封闭和锁定”病毒储库结构的试验 掺入自体前病毒序列的疫苗。在具体目标1中，我们将研究病毒序列 接近出生时，并确定在开始接受含度鲁特韦的ART的婴儿中完整前病毒的频率， 相对于接受含洛匹那韦/利托那韦ART的婴儿的现有相应数据;这些研究 将使我们能够跟踪完整和有缺陷的前病毒的自然进化，并生成完整的前病毒图谱。 可以考虑包含在个性化治疗性mRNA疫苗中的前病毒， 未来的原理验证研究。在具体目标2中，我们将纵向评估染色体定位 在这些婴儿中，在连续的ART期间，完整的前病毒的数量增加;我们假设免疫介导的选择 至少在一些婴儿中，这些机制可以促进和促进前病毒整合位点景观， 近似于在精英控制者中观察到的“阻塞和锁定”前病毒结构;这种选择 然后，在未来的研究中，通过计划的个性化mRNA疫苗接种，可以进一步加强机制。 在具体目标3中，我们将进行开创性研究，以表征细胞和细胞外基质的数量和功能， SARS-CoV 2 mRNA疫苗在HIV-1感染儿童中诱导的体液免疫应答 这些研究将为所有未来的HIV-1特异性治疗提供高度信息。 mRNA平台上的疫苗接种方法。

Project Summary/Abstract, Immune Control (Project 4) Finding a cure for HIV-1 infection is of particular importance for the growing number of HIV-1-infected infants, children and teenagers who will have to take lifelong antiretroviral therapy if curative treatment options will not be available. Recent advances suggest that achieving a functional cure of HIV-1 infection may not require complete elimination of all intact HIV-1 proviruses; instead, it may be sufficient to target intact proviruses integrated in permissive chromatin positions that support HIV-1 transcription and are more susceptible to viral reactivation signals. This model for a cure of HIV-1 infection seems to be exemplified by elite controllers, in whom we documented a highly distinct chromosomal integration site landscape characterized by location of intact proviruses in heterochromatin regions. Notably, such a “blocked and locked” pattern of proviral integration sites likely represents the consequence of cellular immune selection forces that have successfully eliminated proviruses in accessible chromatin locations, while proviruses in heterochromatin positions can persist long term. This concept raises the possibility that immune-mediated selection mechanisms can be intensified or accelerated through therapeutic vaccination, and may be preferentially inducible in HIV-1-infected infants starting ART at early stages of infection. Here, we propose to conduct a detailed analysis of viral reservoir dynamics in infants undergoing dolutegravir-containing antiretroviral therapy (ART), with the ultimate aim of informing future clinical trials designed to induce a “blocked and locked” viral reservoir structure through personalized therapeutic mRNA vaccines incorporating autologous proviral sequences. In specific aim 1, we will investigate viral sequences near birth and determine the frequency of intact proviruses in infants started on dolutegravir-containing ART, relative to existing corresponding data from infants undergoing lopinavir/ritonavir-containing ART; these studies will allow us to track the natural evolution of intact and defective proviruses, and generate an atlas of intact proviruses that can be considered for inclusion into personalized therapeutic mRNA vaccines to be tested in future proof-of-principle studies. In specific aim 2, we will longitudinally evaluate the chromosomal positioning of intact proviruses during continuous ART in these infants; we hypothesize that immune-mediated selection mechanisms can at least in some infants promote and facilitate a proviral integration site landscape that approximates the “blocked and locked” proviral architecture observed in elite controllers; such selection mechanisms may then be further intensified through planned personalized mRNA vaccination in future studies. In specific aim 3, we will conduct pioneering studies to characterize the quantity and functionality of cellular and humoral immune responses induced by the licensed SARS-CoV2 mRNA vaccine in HIV-1-infected pediatric patients from Botswana; such studies will be highly informative for all future HIV-1-specific therapeutic vaccination approaches on the mRNA platform.