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Despite the development of effective antiretroviral treatments, there is still no cure for HIV-1. Major barriers to HIV-1 eradication include the diversity of intrapatient viral quasispecies and the establishment of reservoirs in tissue sanctuary sites. A better understanding of these populations is required for targeted treatments. While previous studies have examined the relationship between brain and blood or immune tissues, few have looked at and compared the properties of viruses from other tissue compartments. In this study, 75 full length HIV-1 envelopes were isolated from the frontal lobe, occipital lobe, parietal lobe, colon, lung, and lymph node of an HIV-1 infected subject. No envelopes could be amplified from the plasma or serum. Envelopes were subjected to genotypic and phenotypic characterization. Of the 75 envelopes, 53 were able to infect HeLa TZM-bl cells. The greatest proportion of non-functional envelopes was from the lung, a result of APOBEC-induced hypermutation. Lower frequencies of hypermutation were also observed in the occipital lobe and colon. Envelopes from regions of the brain were almost all macrophage tropic, while those from the body were predominantly non-macrophage tropic. All envelopes used CCR5 as a coreceptor. Phylogenetic analyses showed that sequences were compartmentalized inside the brain. These findings were also observed using PacBio next generation sequencing to examine 32,152 full length sequences. Envelopes from tissues of the body displayed greater variation in sequence length, charge, and number of potential N-linked glycosylation sites in comparison to envelopes from tissues of the brain. Increased variation was also observed in IC50s for inhibition and neutralization assays using sCD4, maraviroc, b12, PG16, 17b, and 447-52D. The increased variation observed in envelopes from tissues outside the brain suggests that different pressures may be influencing the evolution of these viruses and emphasizes the importance of further studies in these tissue sites.

Despite 30 years of intensive research，an effective human immunodeficiency virus (HIV) vaccine still remains elusive. The desirable immune response capable of providing protection against HIV acquisition is still not clear. The accumulating evidence learned from a recent vaccine efficacy correlate study not only confirmed the importance of antibody responses, but also highlighted potential protective functions of antibodies with a broad repertoire of HIV-1 epitope specificities and a wide range of different antiviral mechanisms. This necessitates a deep understanding of the complexity and diversity of antibody responses elicited by HIV-1 vaccines. My dissertation characterizes antibody response profiles of HIV-1 Env antibodies elicited by several novel immunogens or different immunization regimens, in terms of magnitude, persistence, epitope specificity, binding affinity, and biological function. First, to overcome the challenge of studying polyclonal sera without established assays, we expanded a novel platform to isolate Env-specific Rabbit mAbs (RmAb) elicited by DNA prime-protein boost immunization. These RmAbs revealed diverse epitope specificity and cross-reactivity against multiple gp120 antigens from more than one subtype, and several had potent and broad neutralizing activities against sensitive Tier 1 viruses. Further, structural analysis of two V3 mAbs demonstrated that a slight shift of the V3 epitope might have a dramatic impact on their neutralization activity. All of these observations provide a useful tool to study the induction of a desired type of antibody by different immunogens or different immunization regimens. Since heavily glycosylated HIV Env protein is a critical component of an HIV vaccine, we wanted to determine the impact of the HIV Env-associated glycan shield on antibody responses. We were able to produce Env proteins with a selective and homogeneous pattern of N-glycosylation using a glycoengineered yeast cell line. Antigenicity of these novel Env proteins was examined by well-characterized human mAbs. Immunogenicity studies showed that they were immunogenic and elicited gp120- specific antibody responses. More significantly, sera elicited by glycan-modified gp120 protein immunogens revealed better neutralizing activities and increased diversity of epitopes compared to sera elicited by traditional gp120 produced in Chinese Hamster Ovary (CHO) cells. Further, we examined the impact of the delivery order of DNA and protein immunization on antibody responses. We found that DNA prime-protein boost induced a comparable level of Env-specific binding Abs at the peak immunogenicity point to codelivery of DNA. However, antibody responses from DNA prime-protein boost had high avidity and diverse specificities, which improved potency and breadth of neutralizing Abs against Tier 1 viruses. Our data indicate that DNA vaccine priming of the immune system is essential for generation of high-quality antibodies. Additionally, we determined the relative immunogenicity of gp120 and gp160 Env in the context of DNA prime-protein boost vaccination to induce high-quality antibody responses. Immunized sera from gp120 DNA primed animals, but not those primed with gp160 DNA, presented with distinct antibody repertoire specificities, a high magnitude of CD4 binding site-directed binding capabilities as well as neutralizing activities. We confirmed the importance of using the gp120 Env form at the DNA priming phase, which directly determined the quality of antibody response.

Human immunodeficiency type 1 (HIV-1) is able to elicit broadly potent neutralizing antibodies in a very small subset of individuals only after several years’ infection and as a result, vaccines that elicit these types of antibodies have been difficult to design. The RV144 trial showed that a moderate protection is possible, which may correlate with antibody dependent cellular cytotoxicity (ADCC) activity. Previous studies in the Lu lab demonstrated that in an HIV-1 vaccine phase I trial, DP6-001, a polyvalent Env DNA prime-protein boost formulation, could elicit potent and broadly reactive, gp120-specific antibodies with positive neutralization activities along with multiple Fc mediated effector functions. I developed a protocol for the production and analysis of HIV-1 Env-specific human monoclonal antibodies (mAbs) isolated from these DP6-001 vaccinees. By utilizing a labeled gp120 bait to isolate Env specific B cells, paired heavy and light chain immunoglobulin (Ig) genes were cloned and allowed for the production of monoclonal antibodies with specificity for gp120. By using this protocol, 13 isolated mAbs from four DP6-001 vaccinees showed broad binding activities to gp120 proteins of diverse subtypes, both autologous and heterologous to vaccine immunogens, with mostly conformational epitopes and a few V3 and C5 specific mAbs. Equally cross-reactive Fc-mediated functional activities, including ADCC and antibody dependent cellular phagocytosis (ADCP), were present with both immune sera and isolated mAbs, confirming the induction of non-neutralizing functional antibodies by the DNA prime- protein boost vaccination. Elicitation of broadly reactive mAbs by vaccination in healthy human volunteers confirms the value of the polyvalent formulation in this HIV-1 vaccine design.

Alors que d’énormes efforts sont mis de l’avant pour mettre en place des stratégies thérapeutiques contre l’infection au VIH-1, il est nécessaire de mieux cerner les déterminants viraux qui aideront à l’efficacité de celles-ci. En ce sens, une volumineuse littérature scientifique suggère que les anticorps contre le VIH-1 possédant une capacité à induire une réponse effectrice dépendante de leur portion Fc puissent jouer un rôle important dans la prévention de l’infection et dans la progression de la maladie. Cependant, peu d’information est disponible concernant les déterminants reconnus par ces anticorps et comment le virus s’en protège. Le but des travaux présentés dans cette thèse est donc d’élucider les mécanismes viraux contrôlant la reconnaissance des cellules infectées par ces anticorps capables d’induire une réponse effectrice. De par les corrélats de protection identifiés au cours de l’essai vaccinal RV144, les travaux présentés ici se concentrent sur la réponse cytotoxique dépendante des anticorps (ADCC), puisqu’il s’agit d’une réponse effectrice suggérée pour avoir joué un rôle dans la protection observée dans le RV144, seul essai vaccinal anti-VIH à avoir démontré un certain degré de protection. De plus, plusieurs anticorps capables d’induire cette réponse contre le VIH sont connus pour reconnaître les glycoprotéines de surface du virus (Env) dans une conformation dite ouverte, c’est-à-dire la conformation adoptée lors de la liaison d’Env avec son récepteur CD4 (épitopes CD4i). Nous avons mis au point deux techniques in vitro permettant d’étudier ces changements de conformation ainsi que leur impact sur la réponse ADCC. Les techniques mises au point, un ÉLISA sur base cellulaire pour mesurer les changements de conformation d’Env ainsi que la mesure de la réponse ADCC par cytométrie en flux, nous ont permis de démontrer comment le virus empêche l’exposition des épitopes d’Env CD4i. L’activité simultanée des protéines accessoires virales Nef et Vpu sur le retrait du récepteur CD4 de la surface des cellules infectées et l’inhibition du facteur de restriction Tétherine / BST-2 par Vpu contrôlent à la fois les niveaux d’Env et de CD4 à la surface cellulaire et donc modulent l’interaction Env-CD4 et ultimement la susceptibilité à la réponse ADCC contre les épitopes CD4i reconnus par des anticorps hautement prévalents lors de l’infection au VIH. Également, nous démontrons comment de petits composés mimant la liaison de CD4 sur Env sont capables de forcer l’exposition des épitopes CD4i, même en présence des protéines Nef et Vpu, et donc d’augmenter la susceptibilité des cellules infectées à la réponse ADCC. Une autre découverte présentée ici est la démonstration que la portion soluble d’Env produite par les cellules infectées peut interagir avec le récepteur CD4 des cellules non-infectées avoisinantes et induire leur reconnaissance et élimination par la réponse ADCC contre Env. Somme toute, la modulation de la réponse ADCC par l’interaction Env–CD4 représente un important pilier de la relation hôte – pathogène du VIH-1 de la perspective des réponses Fc-dépendantes. Les travaux présentés dans cette thèse ont le potentiel d’être utilisés dans l’élaboration de nouvelles stratégies antivirales tout en élargissant les connaissances fondamentales de cette interaction hôte – pathogène. / While huge efforts are put forth to develop therapeutic strategies against HIV-1 infection, it is necessary to better understand the viral determinants that will help the effectiveness of these approaches. Moreover, a voluminous scientific literature suggests that antibodies against HIV-1 that have the ability to induce an Fc-mediated effector response can play an important role in the prevention and control of the disease. However, little information is available regarding the determinants recognized by these antibodies and how the virus protects itself from this response. The aim of the work presented in this thesis is therefore to better elucidate the viral mechanisms controlling recognition of infected cells by antibodies capable of inducing effector responses. In regards to the correlates of protection identified in the RV144 vaccine trial, the work presented here focuses on antibody-dependant cellular cytotoxicity (ADCC), since this effector response was suggested to have played a role in the protection observed in the RV144 trial. In addition, many antibodies that induce this response against HIV are known to recognize the virus surface glycoprotein (Env) in an open conformation, that is to say, the conformation adopted by the binding of Env with the CD4 receptor (CD4i epitopes). We have developed two in vitro techniques to study these conformational changes and their impact on ADCC responses. The techniques developed, a cell-based ELISA to measure Env conformational changes and the measure of ADCC responses by flow cytometry, allowed us to demonstrate how the virus prevents exposure of Env CD4i epitopes. The simultaneous activity of viral accessory proteins Vpu and Nef on the removal of CD4 from the surface of infected cells and the Vpu-mediated inhibition of the restriction factor Tetherin / BST-2 control both Env and CD4 levels at the cell surface, thus modulating Env-CD4 interaction. This ultimately results in a decrease in the susceptibility of infected cells to ADCC responses against CD4i epitopes recognized by antibodies that are highly prevalent during HIV infection. Also, we demonstrate how using small compounds mimicking the CD4 binding of Env forces the exposure of CD4i epitopes, even in the presence of Nef and Vpu proteins, and therefore increases the susceptibility to ADCC responses against infected cells. Another discovery is presented here that demonstrates how the soluble portion of Env produced by infected cells can interact with the CD4 receptor on the bystanders non-infected cells and induce their recognition and elimination by ADCC responses against Env. Overall, the modulation of ADCC responses by Env-CD4 interaction is an important pillar of HIV-1 host – pathogen interaction from the perspective of Fc effector functions. The work presented in this thesis has the potential to be used in the development of new antiviral strategies while expanding the fundamental understanding of HIV-1 host - pathogen interactions.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 124-147).

Thesis (Ph. D.)--University of Virginia, 2008. / Title from title page. Includes bibliographical references. Also available online through Digital Dissertations.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 98-107).

Orientador: Fernanda Bono Fukushima / Resumo: Introdução: A dor aguda é um fenômeno universal. O tratamento desse evento, entretanto, ainda é visto através de diversos vieses culturais, sociais e econômicos. Em situação de dor aguda pós-operatória estima-se que 40% dos pacientes apresentam controle inadequado da dor (intensidade moderada a intensa). O presente trabalho visa analisar a percepção de pacientes recém operados quanto à analgesia pós-operatória que receberam em um hospital escola terciário de natureza pública, bem como descrever as medidas prescritas e realizadas para analgesia pós-operatória de acordo com seu registro em prontuário. Método: Estudo transversal, descritivo, realizado em pacientes internados, submetidos a procedimentos cirúrgicos cardiovasculares, gastrointestinais, ginecológicos, hemodinâmicos, mastológicos, neurológicos, ortopédicos, torácicos, urológicos ou vasculares no período de junho a dezembro de 2017 no Hospital das Clínicas da Faculdade de Medicina da UNESP, em Botucatu. Os pacientes foram entrevistados no 2º dia pós-operatório (2º PO) sobre sua experiência no 1º dia pós-operatório (1º PO) quanto ao controle da dor. Através de entrevista semiestruturada o paciente foi inquerido quanto a intensidade da sua dor, a satisfação quanto a analgesia recebida, e sua impressão geral do atendimento prestado pela equipe de saúde assistente. Foi realizada revisão dos prontuários e registrados dados quanto a frequência do registro de avaliação da dor, analgesia prescrita e fornecida, bem como sobre ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Justifications and Objectives: Acute pain is a universal phenomenon. However, the treatment of this event still has a diversity of cultural, social and economical biases. It is estimated that 40% of patients present inadequate management of pain (moderate to severe intensity) in a situation of acute postoperative pain. The aim of the present study is to analyze the perception of patients, who recently operated, regarding postoperative analgesia in a public tertiary hospital school. In addition, to describe the prescribed and performed postoperative analgesia according to registration in medical records. Methods: A cross-sectional, descriptive study was performed in hospitalized patients submitted to cardiovascular, gastrointestinal, gynecological, hemodynamic, mastological, neurological, orthopedic, thoracic, urological or vascular surgical procedures from June 2017 to December 2017 at Hospital das Clínicas, Faculdade de Medicina da UNESP, Botucatu, Brazil. Patients were interviewed on the second day of the postoperative period about their experience on the first day postoperative as to their pain control. Through a semi-structured interview, patients were asked about the intensity of pain, satisfaction as to the analgesia, and general impression of the process. Medical records were reviewed, and data were recorded as to the frequency of recorded pain, analgesia prescription and its administration, and side effects as well. Results: 159 patients met the criteria established t... (Complete abstract click electronic access below) / Mestre