Cytomegalovirus (CMV), the gut barrier and immune dysfunction in HIV

抽象的。此修订的协作R01应用程序解决了巨细胞病毒(CMV)对 胃肠黏膜在慢性HIV感染中的作用我们假设巨细胞病毒感染对 肠屏障功能障碍和随后的免疫激活在慢性艾滋病毒感染中持续存在，尽管 抑制性抗逆转录病毒疗法(ART)在目标1中，基于强有力的初步研究，我们假设 CMV在胃肠道中的持续存在部分是由于CMV特异性CD8+T细胞不能 定位到这个组织。为了确定肠道中CMV特异性T细胞反应的广度和功能，我们将 测量加州大学旧金山分校范围队列中参与者对结直肠组织的反应。要确定影响 针对巨细胞病毒感染对肠道抗原提呈的影响，我们将采用巨细胞病毒猕猴模型(RhCMV)。 和SIVmac研究粘膜树突状细胞(DC)与T细胞的体外相互作用。在目标2中，我们将 利用外部资助的临床试验(艾滋病临床试验小组研究#A5383)直接测试 无症状巨细胞病毒复制对治疗后HIV微生物易位有显著贡献的假说 疾病。我们将确定来特莫韦抑制CMV复制对系统生物标志物的影响 直接在肠道粘膜中评估微生物移位以及免疫激活和肠道屏障完整性 纸巾。综上所述，这些研究将确定巨细胞病毒对艾滋病毒免疫激活的贡献。 疾病，以及这些效应的机制基础。AIM 3利用ACTG的第二项研究(#A5355) 确定基于安卡拉(MVA)的改良疫苗是否可以增加全身和/或肠道- 治疗HIV感染时的归巢和粘膜巨细胞病毒特异性T细胞反应。一种治疗性抗CMV失败 诱导肠道CMV特异性T细胞反应并减少粘膜CMV脱落的疫苗可能 损害其在治疗艾滋病毒感染时减少系统免疫激活的能力，并将突出需要 用于优化疫苗接种策略，以改善粘膜反应。(注：目标2和目标3不符合 NIH对临床试验的定义；这些目标中的辅助研究只是在现有的基础上增加了额外的措施 试验)。

ABSTRACT. This REVISED collaborative R01 application addresses the impact of cytomegalovirus (CMV) on the gastrointestinal mucosa in chronic HIV infection. We hypothesize that CMV infection contributes to the intestinal barrier dysfunction and consequent immune activation that persist in chronic HIV infection despite suppressive antiretroviral therapy (ART). In Aim 1, based on strong preliminary studies, we hypothesize that CMV persistence in the gastrointestinal tract results in part from the failure of CMV-specific CD8+ T-cells to localize to this tissue. To determine the breadth and functionality of CMV-specific T-cell responses in gut, we will measure responses in colorectal tissue from participants in the SCOPE cohort at UCSF. To determine the effects of CMV infection on antigen presentation in gut, we will employ the rhesus macaque model of CMV (RhCMV) and SIVmac to study interactions between mucosal dendritic cells (DC) and T-cells ex vivo. In Aim 2, we will leverage an externally-funded clinical trial (AIDS Clinical Trials Group Study #A5383) to directly test the hypothesis that asymptomatic CMV replication contributes significantly to microbial translocation in treated HIV disease. We will determine the effects of suppression of CMV replication with letermovir on systemic biomarkers of microbial translocation as well as immune activation and gut barrier integrity assessed directly in gut mucosal tissues. Taken together, these studies will determine the contributions of CMV to immune activation in HIV disease, and the mechanistic bases for these effects. Aim 3 leverages a second ACTG study (#A5355) to determine whether a modified vaccine Ankara (MVA)-based CMV vaccine can increase systemic and/or gut- homing and mucosal CMV-specific T-cell responses in treated HIV infection. Failure of a therapeutic anti-CMV vaccine to elicit gut-homing CMV-specific T-cell responses and to reduce mucosal CMV shedding may compromise its ability to reduce systemic immune activation in treated HIV infection and would highlight the need for optimization of vaccination strategies to improve mucosal responses. (Note: Aims 2 and 3 do not meet the NIH definition of a clinical trial; the ancillary studies in these Aims only add additional measures to pre-existing trials).