Immunodefisiensi
(HIV sebagai Role Model)
Ricky Herlianto (2012-060-152)
Jopi Chandra Sindhutomo (2012-060-153)
Jason Julianus (2012-060-172)
Alfredo Bambang (2012-060-193)
Definisi
• Penyakit immunodefisiensi didefinisikan
sebagai kegagalan, kerusakan atau
kemunduran fungsi dari satu atau lebih
komponen dalam sistem imun yang pada
akhirnya dapat menyebabkan penyakit
atau kelainan yang serius
Jenis Immunodefisiensi
Secara umum terdapat 2 jenis immunodefisiensi
immunodefisiensi primer (congenital)
Immunodefisiensi sekunder (didapat / acquired)
Immunodefisiensi baik primer maupun sekunder
dapat meningkatkan kerentanan terhadap infeksi,
terkena kanker dan juga dapat mencetuskan
penyakit autoimun.
Immunodefisiensi Primer
Penyakit immunodefisiensi primer disebabkan
karena adanya kelainan genetik
Ada berbagai jenis kelainan immunodefisiensi
primer, contohnya
kelainan pada sistem imun innate
defisiensi antibody
defisiensi sel T
Terapi
Transplantasi antibody, sumsum tulang atau stem
cell
enzyme replacement.
Saat ini juga berkembang gene therapy dengan
menggunakan virus yang telah dimodifikasi.(1)(5)
Immunodefisiensi Sekunder
HIV/AIDS
Pendahuluan
HIV termasuk dalam keluarga lentivirus, dan
merupakan suatu retrovirus.(2)
Salah satu karakteristik unik dari lentivirus adalah
kemampuannya untuk menyebabkan efek sitopatik
dalam jangka pendek, dan infeksi yang latent
dalam jangka panjang
Pendahuluan
Terdapat dua tipe virus HIV, yaitu HIV-1 dan HIV-2.
HIV-1 paling banyak menyebabkan AIDS. HIV-2
menyebabkan AIDS yang progresinya lebih
lambat.(1)
Pendahuluan
Menurut penelitian, HIV-1 kemungkinan berasal
dari virus yang menyerang simpanse
(Pantroglodytes), yang banyak terdapat di Afrika
Pusat.
Di sisi lain, HIV-2, dengan gen 40-60% homolog
dengan HIV-1, datang dari sooty mangabey
(Cercocebus atys), yang banyak terdapat di Africa
Barat dari Senegal sampai Pantai Gading
Filogenetik HIV
A phylogenetic tree based on the complete genomes of primate immunodeficiency viruses. The scale (0.10) indicates a 10% difference at the nucleotide level.
Epidemiologi HIV
Struktur HIV
Genom HIV
Mekanisme Masuknya HIV dan Siklus Kehidupan HIV
Tahapan Infeksi HIV
Infeksi HIV
Infeksi HIV dibagi menjadi tiga fase, yaitu
infeksi awal atau akut
Pada infeksi akut, infeksi terjadi di jaringan mukosa,
yang merupakan reservoir untuk sel T dan tempat
dimana sebagian besar sel T memori berdiam. Dalam
2 minggu, jumlah sel T CD4 berkurang drastis.(1)(5)
transisi dari infeksi akut ke infeksi kronis
infeksi lanjutan atau kronis
Fase Transisi
Fase transisi dimulai dengan sel dendritik yang
memfagosit virus dan membawanya ke nodus
limfatikus. Di nodus limfatikus, sel dendritik
mentransfer virus HIV kepada sel T CD4.
Fase transisi diakhiri dengan bekerjanya sistem imun
humoral dan selular, yang menyebabkan jumlah
virus di plasma berkurang dalam waktu 12 minggu
menjadi jauh lebih rendah (berakhirnya viremia).
Selama fase transisi, ada kemungkinan terjadi
peningkatan jumlah sel T CD4 karena diferensiasi
dari progenitor.(1)
Fase Infeksi Kronis dan Clinical Latency
Pada fase infeksi kronis, penderita asimptomatik
atau hanya mendapat gejala ringan. Hal ini karena
jumlah virus HIV di plasma menurun secara drastis
Fase clinical latency dapat berlangsung selama
bertahun-tahun. Dengan berjalannya waktu,
penderita juga akan menjadi lebih mudah terinfeksi
penyakit karena berkurangnya sel T CD4 secara
bertahap
Pathogenesis HIV
Untuk lebih jelasnya, gambarnya dapat dilihat di file pdf asli poster nature reviews immunology *dilampirkan pada slide paling akhir (slide versi PDF)
Awal
Infeksi HIV dimulai dari penerobosan virus melewati
sawar mukosa (mucosal barrier)
melewati celah antar sel
melalui mikroabrasi atau sobekan pada epitel
mekanisme transcytosis
Sel dendritik juga memegang peranan penting
dalam penerobosan virus melewati sawar mukosa
Infeksi Makrofag
Selain sel T CD4, terdapat juga sel-sel lain yang
juga diinfeksi oleh virus HIV seperti makrofag, sel
dendritik, dan sel folikular dendritik
Makrofag memiliki kadar CD4 yang rendah, tetapi
memiliki banyak proteoglikan heparan sulfat yang
disebut syndecan pada permukaannya
Syndecan juga dapat memediasi absorpsi virus HIV
dengan menempel ke gp120
Infeksi sel Dendritic
Sel dendritik memiliki kadar CD4, CXCR4, dan
CCR5 yang lebih rendah dari sel T CD4, sehingga
tidak terlalu rentan terhadap virus HIV
sel dendritik memiliki DC-SIGN pada
permukaannya yang berfungsi untuk
mengagregasikan virus pada permukaan, sehingga
saat berkontak dengan sel T CD4, virus HIV dapat
dengan mudah berpindah
• Sel dendritik bertanggungjawab untuk menginisiasi respon imun adaptif terhadap virus di nodus limfatikus. Lebih jauh lagi, sel dendritik dapat mengaktifasi sel NK dengan sekresi IL-12, IL-15 dan IL-18.
• Sel dendritik memiliki SAMHD1 dan APOBEC3G yang dapat menginhibisi replikasi virus HIV, tetapi interaksi dari capsid HIV dengan cyclophilin (CYPA) di sel dendritik dapat menginduksi terbentuknya interferon tipe 1 yang bersifat antiviral melalui cryptic cytoplasmic sensor
Sel T CD4+ sebagai reservoir virus
infeksi dapat menyebabkan sel T CD4 menjadi
berhenti berproliferasi dan tidak aktif.
Dalam kondisi seperti itu, sel T CD4 disebut sebagai
latent reservoir, dan memiliki masa hidup yang
sangat panjang, dengan waktu paruh 44 bulan,
bahkan setelah 7 tahun penderita menjalani supresi
replikasi virus.(8)
Transmisi Virus HIV
Transmisi HIV dapat melalui berbagai cara. Cara
yang paling umum adalah melalui kontak seksual,
baik pada lawan jenis ataupun sesama jenis.
HIV pada anak-anak paling banyak ditransfer dari
ibunya, baik saat didalam rahim, saat melahirkan,
ataupun saat menyusui anaknya.
Metode lain yang juga sering terjadi adalah
pemakaian jarum suntik secara bersama-sama. (1)
Terapi
REFERENSI • 1. Abbas AK, Lichtman AH, Pillai S. Cellular and Molecular immunology. 7th
Edition. United States of America: Elsevier; 2012. • 2. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Localzo J. Harrison’s
Principles of Internal Medicine. 18th edition. New York: McGrawHill; 2012. • 3. Arason G, Jorgensen G, Ludviksson B. Primary Immunodeficiency and
Autoimmunity: Lessons From Human Diseases. Scand J Immunol. 2010;71:317–28. • 4. Ballow M. Primary immunodeficiency disorders: Antibody deficiency. J Allergy
Clin Immunol. 2002 Apr;109(4):581–91. • 5. Rich RR, Fleisher TA, Shearer WT, Schroeder HW, Frew AJ, Weyand CM. Clinical
Immunology Principles and Practice. 3rd edition. China: Elsevier; 2008. • 6. Bhardwaj N, Hladik F, Moir S. The immune response to HIV. 2012 [cited 2013
Sep 2]; Available from: http://web2.mendelu.cz/af_239_nanotech/data/up/mats/nri1201_hiv_references.pdf
• 7. Levy JA. HIV pathogenesis: 25 years of progress and persistent challenges: AIDS. 2009 Jan;23(2):147–60.
• 8. Stebbing J, Gazzard B, Douek DC. Where Does HIV Live? N Engl J Med. 2004;350(18):1872–80.
• 9. http://www.nature.com/nri/posters/hiv
Thank You For Your
Attention
Scientists Helping Scientists™ | WWW.STEMCELL.COM
SAMHD1
APOBEC3G
CYPA
TRIM5
TReg cell
HIV uptake by DC-SIGN blocksDC maturation
Lack ofeffective antiviralimmunity
DC dysfunction
SAMHD1 andAPOBEC3G restrict HIV replication
CD8+ T cellresponse
CD8+ T cell
IL-12, IL-15,IL-18
Type I IFNs
NK cell activation
Inhibition ofviral replication
Type IIFNs
CD4
CTLA4
TRAIL
IL-10
Monocyte
IDO
pDC
T cell-attractingchemokines
Viral spread
CYPA and TRIM5recognize HIV capsid
Conventional DC
TLR7
Viral RNA
HIV uptake by langerin leads to virus degradation
Chemokine-mediated recruitment of newCD4+ T cells for HIV to infect
NK cell
HIV-infecteddonor cell
Donor virus population
HIV virionMucuslayer
Stratifiedsquamousepithelium
Vagina or ectocervix Endocervix
Stroma
HIV-bearingstromal DC
Internalizedvirion
CD4DC-SIGN
CCR5
Infected CD4+ memory T cell
Inserted HIV genome
Tear in themucosalepithelium
HIV penetration and infection
Subepithelial DC
Lack of tight junctions between cells
InfectedintraepithelialCD4+ T cell Impermeable
tight junctionsbetween cells
T cell-attractingchemokines
Local amplification of initial founder virus(es) in a single focus of CD4+ T cells
CD1a+
Langerhans cell
pDC
Columnarepithelium
Transcytosisof HIV virions
CD1a
InfectedCD4+ T cell
Draininglymphatic vessels
A few hours
HIV-specificCD8+ T cell
TIM3
Galectin 9
TIM3LAG3 CTLA4
PD1
Upregulation of inhibitory receptors on CD8+ T cells
• ↓ MHC class I binding• ↓ TCR recognition• ↓ Epitope processing
CD4+ T cell depletion and immunodeficiency
Decreased T helper cell function
T cell-escape mutations in HIV• First Env and Nef• Later Gag and Pol
T cell exhaustion (loss of effector function and proliferative capacity)
Cytokines and other soluble factors
HIV-infected CD4+ T cell
TCRMHC class I Perforin and
granzymes
Perforin pore
Apoptosis
Viralreplication
CD8+ T cell response insufficient to clear infection
• Chronic infection• Repeated T cell activation
Suppression of CD8+ T cell response
TReg cell
Severalmonths
Decreased response to antigens
Chronic infection
Early infection
Advanced disease
Follicular hyperplasia
Decreased natural immunity to secondary pathogens
Poor antibodyresponse
Weeks Months Years Several years
CD4-bindingsite
Few high-affinity broadly neutralizing antibodies
Hypergamma-globulinaemia
Increased turnover and polyclonal activation of B cells
CD4+ T celllymphopenia
Naivemature B cell
Activatedmature B cell
Exhaustedmemory B cell
Short-livedplasmablast
• Non-neutralizing• Lack of viral
control
• Neutralizing, but limited breadth
• Virus acquires escape mutations
• Neutralizing with wider breadth
• ~20% of infected individuals
• Affinity matured, broadly neutralizing
• ~1% of infected individuals
gp41 gp41 gp120gp120gp120
IL-7
Decreased number of resting memory B cells and splenic marginal zone B cells
Increased B cell apoptosis and GC destruction
Immune activation(pro-inflammatorycytokines)
Inadequate CD4+ T cell help
Paucity of HIV-specific IgA at mucosal sites
Decreased class-switch recombination (Nef-mediated)
Inadequate CD4+ T cell help
Increased number of immature transitional B cells
Increased in association with HIV viraemia
Systemic infection
1 week
HIV-specific B cell and antibodyresponse
HIV reservoirs in gut-associated and other lymphoid tissues
Subcapsularsinus macrophage
CD4+ T cell
MHC class II
MHC class I
TCR
B cell follicle
Follicular DC
Follicular B cell
TFH cell
Medulla
Efferent lymphatic
HIV virions and HIV-bearing cells
CD8+ T cell
HIV-bearingDC
T cell zone
Severalyears
Clonal expansionof HIV-specificCD8+ T cells
2–4 weeks
IL-10
TReg celldifferentiationpromoted by IDO
TRAIL-inducedT cell apoptosis
IFN-inducedT cell apoptosis
Langerin
Supp
lem
ent
to N
atur
e Pu
blis
hing
Gro
up
The B cell response to HIVThe DC
response to HIV
The T cell response to HIV
Amplification in draining lymph nodes
Breaching the mucosal barrier
The immune response to HIVNina Bhardwaj, Florian Hladik and Susan Moir
Since HIV was discovered as the causative agent of AIDS almost 30 years ago, HIV infection has become a devastating pandemic, with millions of individuals becoming infected and dying from HIV-related disease every year. A global research effort over the past three decades has discovered more about HIV than perhaps any other pathogen. Immunologists continue to be intrigued by the capacity of HIV to effectively knock out an essential component of the
adaptive immune system — CD4+ T helper cells. This Poster summarizes how HIV establishes infection at mucosal surfaces, the ensuing immune response to the virus involving DCs, B cells and T cells, and how HIV subverts this response to establish a chronic infection. Based on a clearer understanding of HIV infection and the response to it, the field has now entered an era of renewed optimism for the development of a successful vaccine.
Cell Isolation Solutions for HIV Research From STEMCELL Technologies
STEMCELL Technologies offers a complete portfolio of fast and easy cell isolation solutions for HIV research, allowing viable, functional cells to be isolated from virtually any sample source for use in cell-based models and assays. STEMCELL Technologies’ products are used by leading HIV research groups worldwide, including the National Institute of Allergy and Infectious Disease and the Ragon Institute.
• EasySep™ (www.EasySep.com) is a fast, easy and column-free immunomagnetic cell separation system for isolating highly purified immune cells in as little as 25 minutes. Cells are immediately ready for downstream functional assays.
• RoboSep™ (www.RoboSep.com) fully automates the immunomagnetic cell isolation process, reducing hands-on time, minimizing human exposure to potentially hazardous samples and eliminating cross-contamination, making it the method of choice for HIV research labs.
• RosetteSep™ (www.RosetteSep.com) is a unique immunodensity-based cell isolation system for one-step enrichment of untouched human cells directly from whole blood during density gradient centrifugation.
• SepMate™ (www.SepMate.com) allows hassle-free PBMC isolation in just 15 minutes. The SepMate™-50 tube contains a unique insert that prevents mixing between the blood and density medium, allowing all density gradient centrifugation steps to be carried out quickly and consistently.
To learn more about our specialized cell isolation products for HIV research, or to request a sample or demonstration, visit www.stemcell.com/HIV.
AbbreviationsAPOBEC3G, apolipoprotein B mRNA editing, catalytic polypeptide-like 3G; CCR5, CC-chemokine receptor 5; CDR3, complementarity-determining region 3; CTLA4, cytotoxic T lymphocyte antigen 4; CYPA, cyclophilin A; DC, dendritic cell; DC-SIGN, DC-specific ICAM3-grabbing non-integrin; GC, germinal centre; IDO, indoleamine 2,3-dioxygenase; IFN, interferon; IL, interleukin; LAG3, lymphocyte activation gene 3; NK, natural killer; PD1, programmed cell death protein 1; PDC, plasmacytoid DC; SAMHD1, SAM domain- and HD domain-containing protein 1; TCR, T cell receptor; TFH cell, T follicular helper cell; TIM3, T cell immunoglobulin domain- and mucin domain-containing protein 3; TLR7, Toll-like receptor 7; TRAIL, TNF-related apoptosis-inducing ligand; TReg cell, regulatory T cell; TRIM5, tripartite motif-containing protein 5.
AcknowledgementsN.B. thanks D. Frleta for his review and contributions to the poster.
AffiliationsNina Bhardwaj is at the NYU Langone Medical Center, Smilow Research Building, New York 10016, USA. e-mail: [email protected]
Florian Hladik is at the Department of OBGYN, University of Washington, Seattle, Washington 98195, USA. e-mail: [email protected]
Susan Moir is at the Laboratory of Immunoregulation, NIAID/NIH, Bethesda, Maryland 20892, USA. e-mail: [email protected]
The authors declare no competing financial interests.
Edited by Kirsty Minton; copyedited by Isabel Woodman; designed by Simon Bradbrook.© 2012 Nature Publishing Group. All rights reserved.http://www.nature.com/nri/posters/hiv
Supplementary text and further reading available online.
IMMUNOLOGY
Broadly neutralizing HIV-specific antibodies
Name of antibody
Source or approach
Target on HIV Properties
2G12 B cell immortalization
Carbohydrates on gp120
Unique heavy-chain domain swap
IgG1 b12 Phage-display library
CD4-binding site of gp120
Long heavy-chain CDR3; heavy-chain-dominant binding
2F5 and 4E10
B cell immortalization
Membrane-proximal external region of gp41
Autoreactive; bind host lipids
PG9 and PG16
Large screen; cultured clone
gp120 conformational epitope in variable loops (V1–V2)
Dependent on quaternary structure; long heavy-chain CDR3
VRC01 and NIH45-46
Large screen; single-cell sort
CD4-binding site of gp120
Highly mutated; mimic CD4 binding to gp120
PGT121 and PGT125
Large screen; cultured clone
gp120 V3 carbohydrate-dependent epitope
Diverse, with similarities to 2G12
10E8 Large screen; cultured clone
Membrane-proximal external region of gp41
Binds cell-surface epitopes
© 2012 Macmillan Publishers Limited. All rights reserved