Control of HIV-induced MDSC expansion and immunosuppression by cytotoxic lymphocytes

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Elevated frequencies of granulocytic myeloid-derived suppressor cells (PMN-MDSCs) precede and contribute to immune dysfunction in persons living with HIV (PLHIV). The underlying mechanisms of this dysregulation are poorly understood. Potential mechanisms under investigation include PMN-MDSCs impacting CD4+ T cell recovery, expanding T-regulatory cells (T-reg), inducing immune checkpoints (IC), and suppressing the antiviral functions of cytotoxic lymphocytes. While the initiation of combined antiretroviral therapy (cART) can reduce peripheral blood PMN-MDSCs levels in PLHIV, PMN-MDSCs levels can remain elevated despite cART, and cART does not remedy all PMN-MDSC-induced immune dysfunction. The tumor-necrosis-factor-related- apoptosis-inducing-ligand (TRAIL) is a cell-surface and secreted apoptosis-inducing protein expressed by activated human Natural Killer (NK) cells and cytotoxic T lymphocytes (CD8+ T cells, CTL). TRAIL ligation of its receptors (also called death receptors (DRs)) induces apoptosis on DR-expressing cells. PMN-MDSCs express TRAIL-R1 (DR4) and 2 (DR5). Recently published work showed a link between serum levels of agonistic soluble TRAIL (sTRAIL) and PMN-MDSC frequency in PLHIV. Early in HIV infection, PMN-MDSC frequency inversely correlates with plasma levels of sTRAIL, and recombinant TRAIL induces PMN-MDSC apoptosis in vitro. Thus, DR ligation, currently being explored as an immunotherapy for cancer, may be a way to reduce PMN-MDSCs frequencies in PLHIV. In addition to TRAIL, PMN-MDSCs also express NKG2D-ligands. NKG2D is an NK cell activating receptor and a positive costimulatory receptor of human CTLs, and NKG2D-ligand expression renders PMN-MDSCs highly susceptible to NK cell killing. However, despite data implicating PMN-MDSCs as essential contributors to immune dysfunction and HIV disease, approaches targeting PMN-MDSCs in PLHIV have yet to be explored. Using a mouse model with a competent and HIV susceptible humanized immune system, we found that PMN-MDSCs expand rapidly upon HIV infection. Like in humans, PMN-MDSCs correlated positively with HIV viral titers and T-reg in this model. Mechanistic studies in cytotoxic lymphocyte-depleted animals revealed that NK cells and perhaps also CTLs controlled PMN-MDSC expansion, expressed NKG2D, and upregulated TRAIL upon HIV infection. We propose to explore the mechanisms by which PMN-MDSC and consequent Treg expansions are controlled. We propose to test the hypothesis that therapeutic PMN-MDSCs reduction during HIV infection prevents PMN-MDSCs-caused immune dysfunction, improving viral control. Our studies will leverage novel tools and therapeutic approaches to define the impact of the TRAIL and NKG2D pathways on controlling PMN-MDSC and resultant Treg expansion upon HIV infection. We will explore therapeutic strategies to reduce PMN-MDSC and prevent T-reg expansion upon HIV infection in vivo. The knowledge gained from our work will facilitate new insight into the mechanisms that control or exacerbate HIV-infection-induced immune disturbance and disease.