Investigate the mechanism of autoreactive B cell-mediated immunological failure despite virologic suppression in HIV-infected individuals on antiretroviral therapy

在HIV感染中，循环中的CD4+T细胞计数可以预测疾病的进展。即使在长期的压制下 抗逆转录病毒疗法(ART)，高达25%的病毒抑制的艾滋病毒携带者(PLWH)未能恢复 CD4+T细胞计数与健康对照组相似，发病率和死亡率的增加 已经在这些免疫无反应者身上得到了证明。我们是第一个报告抗CD4免疫球蛋白的组织 在抗逆转录病毒治疗下，介导CD4+T细胞死亡，并在免疫恢复不良中发挥作用。虽然发病机制很可能是 多因素，如胸腺和淋巴纤维化，全身免疫激活和炎症，我们的 提出的病理性抗CD4-Ig G介导的CD4+T细胞耗竭提供了一种独特的靶向机制 特别是CD4+T细胞。在本研究中，我们将探讨病理性抗癌的分子机制。 免疫无应答者的CD4Igs和抗CD4自身反应性B细胞及其治疗靶点的确定 与传统抗逆转录病毒治疗联合预防抗CD4Ig G介导的发病机制，促进免疫恢复和 减少艾滋病毒阳性退伍军人和非退伍军人的并发症、发病率和死亡率。 目的1.检测抗CD4Igs对CD4+T细胞活化和功能的影响及对HIV的影响 HIV+免疫无反应者通过CD4受体信号通路的潜伏期。 目的2.测定抗CD4自身抗体的B细胞受体特性和基因表达谱。 从HIV+免疫无反应者产生B细胞。 目的3.测定病理性抗CD4的生化特性和共有抗原结合表位 HIV+免疫无应答者中的单抗免疫球蛋白。 这条调查路线对退伍军人和非退伍军人艾滋病毒阳性者具有巨大的治疗潜力 表现为CD4+T细胞恢复较差的个人，发病风险特别高的人群 死亡率，因此是公共卫生的一个重要领域。

In HIV infection, circulating CD4+ T cell counts predict disease progression. Even under long-term suppressive antiretroviral therapy (ART), up to 25% of virologically suppressed people living with HIV (PLWH) fail to restore CD4+ T cell counts to the levels similar to those in healthy controls, and increased morbidity and mortality have been demonstrated in these immune non-responders. We were the first group to report that anti-CD4 IgGs mediate CD4+ T cell death and play a role in poor immune recovery under ART. While the pathogenesis is likely multifactorial, such as thymic and lymphatic fibrosis, systemic immune activation, and inflammation, our proposed pathologic anti-CD4 IgG-mediated CD4+ T cell depletion provides a unique mechanism for targeting CD4+ T cells specifically. In the current study, we will investigate the molecular mechanisms of pathologic anti- CD4 IgGs and anti-CD4 autoreactive B cells from immune non-responders and identify the therapeutic targets to prevent anti-CD4 IgG-mediated pathogenesis together with traditional ART to increase immune recovery and reduce complications, morbidity and mortality in HIV+ Veterans and non-Veterans. AIM 1. Determine the pathologic activities of anti-CD4 IgGs on CD4+ T cell activation and function and HIV latency through the CD4 receptor signaling pathway in HIV+ immune non-responders. AIM 2. Determine the B cell receptor characteristics and gene expression landscape of anti-CD4 autoantibody- producing B cells from HIV+ immune non-responders. AIM 3. Determine the biochemical properties and shared antigen binding epitopes of pathologic anti-CD4 monoclonal IgGs in HIV+ immune non-responders. This line of investigation possesses great therapeutic potential for Veteran and non-Veteran HIV-positive individuals presenting with poor CD4+ T cell recovery, a population with particularly high risk for morbidity and mortality and thus an area of public health importance.