Submitted by Marcelo De Paula Mendes Castilho (barcarena2004@hotmail.com) on 2018-10-24T02:50:52Z No. of bitstreams: 1 pos mestrado2 (3).pdf: 4009077 bytes, checksum: 419f6b14136acbd4404a3308130a15b8 (MD5) / Rejected by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: problema 1: Financiamento recebido No formulário de submissão consta a Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) como financiadora do seu projeto mas, no arquivo submetido, não localizei nos agradecimentos referência a esta. Caso tenha recebido o apoio favor incluí-la nos agradecimentos. Assim que tiver efetuado a correção submeta o arquivo, em PDF, novamente. Agradecemos a compreensão. on 2018-10-30T11:54:52Z (GMT) / Submitted by Marcelo De Paula Mendes Castilho (barcarena2004@hotmail.com) on 2018-11-01T18:33:31Z No. of bitstreams: 1 mestrado 4.pdf: 4010812 bytes, checksum: 8c50c5c790df0ee889ddec8b025c467e (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-11-06T16:03:02Z (GMT) No. of bitstreams: 1 castilho_mpm_me_bot.pdf: 4010812 bytes, checksum: 8c50c5c790df0ee889ddec8b025c467e (MD5) / Made available in DSpace on 2018-11-06T16:03:03Z (GMT). No. of bitstreams: 1 castilho_mpm_me_bot.pdf: 4010812 bytes, checksum: 8c50c5c790df0ee889ddec8b025c467e (MD5) Previous issue date: 2018-08-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / 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 o registro de efeitos adversos. Resultados: Ao todo foram selecionados 159 pacientes, durante o período do estudo, os quais preenchiam os critérios estabelecidos para participarem da pesquisa. Contudo, 68 foram excluídos, pois no momento da entrevista já haviam recebido alta, ou não estavam no leito, ou, ainda, a cirurgia havia sido cancelada. No total foram entrevistados 91 pacientes, sendo 46 (50,5%) do sexo masculino e 45 (49,5%) do sexo feminino. A maioria dos entrevistados (86,8%) relataram presença de dor no 1º PO . Os escores médios de dor e pior dor na Escala Numérica Verbal (ENV) foram, respectivamente: 3,1/10 e 5,6/10. Todos relataram terem recebido analgesia, sendo a medicação considerada muito efetiva ou efetiva para 84,6% dos entrevistados. A grande maioria dos entrevistados se sentiram muito respeitados/muitos satisfeitos ou respeitado/satisfeitos com a analgesia recebida. Em 60,4% dos prontuários analisados, não houve qualquer registro quanto a presença ou a ausência de dor, sendo que uma escala padronizada (ENV) foi utilizada em apenas dois dos 91 pacientes. Houve registro de analgesia regular para 84,6% dos pacientes, sendo que ela consistia na maioria dos casos (51,94%) de analgésicos simples associados a opioides fracos. Aproximadamente 54% (53,84%) dos pacientes receberam analgesia sob demanda, que consistia na maioria dos casos (55,10%) de opioides fracos. Os Resumo opioides fortes foram pouco prescritos tanto no regime regular quando no de demanda (2,6% e 4,0%, respectivamente). Conclusão: Embora a grande maioria dos entrevistados tenham relatado dor no 1 oPO, e a avaliação da mesma não ter sido feita de forma sistematizada, a analgesia foi considerada muito efetiva ou efetiva para 84,6% dos entrevistados, havendo grande sentimento de satisfação e respeito pela analgesia recebida. / 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 to participate in the study and were selected to participate. However, 68 were excluded. The excusions were due discharge, absence at the moment of the interview or surgery postponed. A total of 91 patients were interviewed, of which 46 (50.5%) were male and 45 (49.5%) were female. Most of the interviewees (86.8%) reported some type of pain on the first postoperative period. The mean pain score and the mean worst pain score in NRS were, respectively, 3.1/10 and 5.6/10. All reported having received analgesia, and the medication was considered very effective or effective for 84.6% of the interviewees. The vast majority of the interviewees felt very respected / many satisfied or respected / satisfied with the analgesia received. In 60.4% of the charts analyzed, there was no record of presence or absence of pain. A standardized scale (NRS) was used in only two patients. There was registration of regular analgesia for 84.6% of the patients, and it consisted, in the majority of cases (51.94%), of simple analgesics associated with weak opioids. On-demand analgesia was recorded for 53.84% of patients, and it consisted, in the majority of cases (55.10%), of weak opioids only. Strong opioids were poorly prescribed in both the regular and non-demand regimens (2.6% and 4.0%, respectively). Conclusions: Although the great majority of the interviewees complained of pain in the 1st PO, and the pain evaluation was not done in a systematized way, analgesia was considered very effective or effective for 84.6% of the interviewees, with a great feeling of satisfaction and respect by the analgesia received / CAPES: 1578855

No description available.

Die Familie der Retrovirinae wird in zwei Unterfamilien untergliedert, die Orthoretrovirinae und die Spumaretrovirinae. Foamyviren stellen aufgrund einiger besonderer Eigenschaften die einzigen Vertreter dieser Unterfamilie, die sie als Bindeglied zwischen den Retroviren und den Hepadnaviren erscheinen lassen. So erfolgt beispielsweise die reverse Transkription des viralen Genoms nicht erst nach Eintritt in die Zielzelle, sondern, anders als bei Orthoretroviren, bereits in der Produzentenzelle noch während oder kurz nach der Morphogenese. Diese Eigenschaft teilen Foamyviren mit den Hepadnaviren ebenso wie die obligate Koexpression der Kapsidproteine mit den viralen Hüllproteinen für die Freisetzung von Viruspartikeln. Im Gegensatz zu Orthoretroviren sind Foamyviren folglich nicht in der Lage virusähnliche Partikel (VLP) zu sekretieren und die spezifische Funktion des PFV Env Proteins kann nicht durch heterologe Hüllproteine übernommen werden. Die Synthese des PFV Env Vorläuferproteins erfolgt am rER, wobei es eine Typ III Membrantopologie erhält, mit sowohl dem N- als auch dem C-Terminus im Zytoplasma. Während des Transports des Proteins zum Ort der Partikelknospung, wird es posttranslational im Golgi-Apparat, oder dem trans-Golgi Netzwerk, durch Furin oder eine Furin-ähnliche Protease in drei partikelassoziierte Untereinheiten prozessiert. Eine Partikelassoziation retroviraler Signalpeptide ist bislang nur für Foamyviren nachgewiesen worden, genauso wie eine essentielle Rolle dieses Proteins bei der Interaktion zwischen dem

Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-01-26T14:08:26Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_RelacaoNiveisCelulas.pdf: 1497302 bytes, checksum: 78ac1c0249801de7e4874f91cccef7f3 (MD5) / Approved for entry into archive by Edisangela Bastos (edisangela@ufpa.br) on 2017-01-27T13:37:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_RelacaoNiveisCelulas.pdf: 1497302 bytes, checksum: 78ac1c0249801de7e4874f91cccef7f3 (MD5) / Made available in DSpace on 2017-01-27T13:37:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_RelacaoNiveisCelulas.pdf: 1497302 bytes, checksum: 78ac1c0249801de7e4874f91cccef7f3 (MD5) Previous issue date: 2015-08-31 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Estudos anteriores mostraram haver uma relação direta entre níveis de linfócitos T CD4+ e taxas evolutivas do HIV-1 (DIAZ et al., 2008; LEMEY et al., 2007; NOSTROM et al., 2014). Além disso, outros fatores também afetam a variabilidade do no gene env: por exemplo ação de anticorpos neutralizantes - Nabs (FROST et al., 2005), a variação nos sítios de glicosilação (LEAL et al., 2012; LEAL et al., 2008), a ligação nos receptores da célula alvo (i.e., CD4, CXCR4, CCR5), e ainda, a escolha dos receptores CCR5 para CXCR4 (MILD et al., 2013). Com isso a relação entre diversificação viral e níveis células T CD4+ no gene env pode ser circunstancial. O gene vif, por outro lado, é mais conservado e não sujeito ao viés presente no gene env (i.e., sítios de glicosilação, etc.). Assim, para estudar a influência dos níveis de células T CD4+ na variabilidade do HIV, foi usado a estimativa do regime seletivo (dN e dS) através do modelo de códons e análise filogenética de indivíduos não relacionados (inter-hospedeiro). Foram utilizadas sequências do HIV-1 de indivíduos não correlacionados, obtidas a partir do banco de dados de Los Alamos. As sequências foram separadas em categorias de níveis de linfócitos T CD4, e posteriormente analisadas. A análise mostrou não haver relação direta entre os níveis de células T CD4+ e as taxas evolutivas em gp120 e no gene vif do HIV-1 dos subtipos B e C em uma abordagem populacional. / Previous studies have shown a direct relationship between levels of CD4+ Tlymphocytes and evolutionary rates of HIV-1 (DIAZ et al, 2008; LEMEY et al, 2007; NOSTROM et al, 2014.). Other factors also affect the variability of the env gene: for example function of neutralizing antibodies - Nabs (FROST et al., 2005), the variation in glycosylation sites; (LEAL et al, 2012 LEAL et al., 2008), binding to target cell receptors (i.e, CD4, CXCR4, CCR5), and also the switch from CCR5 to CXCR4 receptor (MILD et al., 2013). Thus, the relationship between viral levels diversification and CD4 + T cells in the env gene can be circumstantial. The vif gene, on the other hand, it is retained and not subject to bias present in the env gene (i.e, glycosylation sites, etc.). Thus, to study the influence of CD4 + T cells levels in HIV variability, the estimate of the selective regimes was used (Nonsynonymous Substitutions - dN and Synonymous Substitutions - dS) by a codon-based model and phylogenetic analysis of unrelated individuals (inter-host). HIV-1 sequences were used of the not-correlated individuals, obtained from the Los Alamos Database. The sequences were separated into CD4+ levels of categories and then analyzed. The analysis revealed no direct correlation between CD4+ T cell levels and evolutionary rates in gp120 and vif gene from HIV-1, subtypes B and C in a population approach.

Abstract Feline immunodeficiency virus (FIV) is an important infectious agent of domestic cats worldwide. It has been classified into the Lentivirus genus of the Retroviridae family, together with human immunodeficiency virus (HIV). Five FIV subtypes (A, B, C, D and E) have been described based on sequence variation of the V3-V5 region of the envelope (env) gene. There is considerable sequence diversity within and between subtypes, which has been a major obstacle in the development of a successful vaccine. However, an FIV vaccine that incorporates inactivated whole viruses from subtypes A and D is now commercially available. Although the vaccine has been shown to be efficacious in protecting against challenge with homologous and a heterologous (subtype B) subtypes, its effectiveness against other viral variants is unknown. Therefore, identifying the type and diversity of FIV strains in different regions is important to establish the potential efficacy of the vaccine in areas where vaccination is to be implemented. The proviral DNA sequence of the V3-V5 region of the env gene was determined for 102 FIV-infected cats from locations in Australia, New Zealand and South Africa. Subtype A was the predominant subtype in Australia and South Africa, although subtype B and C were also identified in each of these countries, respectively. Both subtypes A and C were also present in New Zealand. Of interest, there were some samples in New Zealand and South Africa that demonstrated subtype assignment discrepancies when different regions of the genome were analysed, suggesting co-infection and/or recombination. Cats infected with FIV exhibit varying degrees of immunological impairment. Currently, prognosis for an FIV-infected cat is based on clinical signs alone, which is a relatively subjective measure. In HIV-infected patients it is recognised that viral RNA load correlates with disease stage and prognosis. This PhD research tested whether viral RNA load may be a useful prognostic marker in FIV infection. A real-time PCR assay was developed to quantify plasma viral RNA load in 42 FIV-infected cats at three different clinical stages (1:healthy, 2:unwell without signs of immunodeficiency, 3:unwell with signs of immunodeficiency). In cats older than 5 years of age, log-transformed viral RNA loads were significantly higher in cats in category 3 compared to cats in category 1. There were no significant differences in the viral RNA load of older cats in category 2 compared to category 1. There were no cats younger than 5 years of age in category 3 and there was no significant difference in viral RNA load between young cats in categories 1 and 2. Of the 15 cats for which follow-up data was available, eight showed no change in clinical signs, and seven showed a worsening of clinical signs with six of these showing a progression of clinical category including death. One of the cats in category 2 that progressed clinically had one of the highest viral RNA loads of cats in that category. Three of four cats from category 3 that were followed had either died or been euthanised. Two of these cats had among the highest viral RNA loads in the whole study, while the remaining cat (for which the definitive cause of death was not confirmed) had a relatively low viral RNA load. In summary, measurement of viral RNA load was found to be a potentially useful clinical and prognostic marker but further work is required to better assess its usefulness to veterinarians. Serum acute phase proteins were investigated as possible candidate markers of FIV disease with the aim of developing a more simplified assay that could be used as a prognostic marker for FIV infection. Blood samples from 43 FIV-infected and 25 FIV-negative cats were assayed for the concentration of four acute phase proteins. Both healthy and sick cats were included in the study. Compared to healthy cats, sick cats had significantly higher concentrations of serum amyloid A (P<0.05). Alpha 1-acid glycoprotein and haptoglobin were also found to be in higher concentrations in sick cats (P<0.1). Other variables such as age and gender were also associated with acute phase protein concentrations. With respect to FIV infection, it was found that in sick cats, serum amyloid A, in combination with the age of the cat, was the best predictor of FIV viral RNA load. Alpha 1-acid glycoprotein and haptoglobin were not significantly associated with FIV viral RNA load. Although health status did not influence albumin levels, they were found to be significantly lower in FIV-positive cats in comparison to FIV-negative cats (P<0.05). The frequent monitoring of viral RNA loads and CD4+ lymphocyte counts that is performed on HIV-infected patients is cost prohibitive in veterinary patients. This study showed that there is potential for the use of acute phase protein concentrations (in particular serum amyloid A) as alternative prognostic tools in FIV-infected cats. Further work, particularly longitudinal studies, is required to more definitively define changes in viral RNA load and acute phase protein concentrations throughout the course of FIV infection.

La diversité génétique du virus de l'immunodéficience humaine, le VIH-1 responsable de la pandémie du SIDA, représente un challenge dans le développement d'un vaccin qui doit conférer une protection contre différentes formes du virus pour être efficace. L'identification de populations de lymphocytes T CD8+ (CTL) capables de reconnaître des variants peptidiques d'un épitope est donc une étape importante. Dans le modèle singes rhésus, j'ai montré en utilisant des tétramères spécifiques de 9 variants peptidiques d'un épitope qu'une même population de CTL générés par la vaccination, peut reconnaître l'épitope relatif à l'immunogène et un certain nombre de ses variants provenant de diverses formes du VIH-1. Ces études ont également permis de caractériser les populations de CTL spécifiques de chaque variant de cet épitope en analysant l'expression des différents gènes codant pour la chaîne variable β du TCR (Vβ répertoire) et par un large séquençage des régions complémentaires déterminantes 3 (CDR3) du TCRβ. Ces travaux ont montré qu'une vaccination utilisant la séquence du clade C de l'enveloppe du VIH-1 conduit à des réponses divergentes chez 2 singes rhésus Mamu-A*01+. De plus, ces résultats ont mis en évidence que l'usage de certainβes nVe permet pas de déterminer le potentiel cross-réactif des CTL. Par ailleurs, une immunisation utilisant des séquences de l'enveloppe du clade B du VIH-1 peut générer des CTL capables de reconnaître un large nombre de variants de l'épitope testé. L'analyse de 8112 séquences CDR3 du TCRβ a permis de les caractériser. Cependant, les tests fonctionnels ont démontré que bon nombre de ces variants peptidiques stimulent une production suboptimale de cytokines par les CTL générés après vaccination. Ces résultats démontrent que la reconnaissance de variant peptidiques d'un épitope est nécessaire mais pas suffisante pour protéger contre différentes formes du VIH-1 exprimant ces séquences. L'identification de variants peptidiques capables d'induire une réponse fonctionnelle des CTL pourrait contribuer au développement d'un vaccin efficace contre le VIH-1. / The sequence diversity of HIV-1 presents a challenge for the development of an effective vaccine, since such a vaccine must confer protection against diverse forms of the virus. Identifying CD8+ T lymphocytes (CTL) recognizing variants of an epitope sequence is an important step. In the rhesus monkey model, I showed by tetramer binding assays, that the same vaccine elicited CD8+ T lymphocyte populations comparably recognize the epitope relative to the immunogen and a number of variant epitope peptides from diverse forms of HIV-1. During my thesis, I also characterized populations of CD8+ T ymphocytes specific for each variant of the tested epitope by studying their Vβ repertoire and by a large sequencing of the complementarity determining region (CDR3) of the TCRβ. These studies showed that a single clade C env immunization generate CTL with differences in the ability to cross-react to variant epitope in monkeys sharing the same MHC class-Imolecule. Moreover, the data showed that Vβ employed by CTL can not predict the capacity of these CTL to recognize epitopes from diverse HIV-1 isolates. Additionally, I showed that clade B Env immunizations generate populations of CTLrecognizing wild type and a number of variant epitope peptides. However, functional assays demonstrate that many of them stimulate suboptimal cytokine production by the vaccineelicited CTL. These finding demonstrate that the recognition of variant epitope peptides is necessary but not sufficient to protect against different forms of HIV-1. Identifying variant epitopesinducing functional responses of CTL should contribute to the development of an effective vaccine.

En l'absence d'un vaccin efficace et avec des thérapies antirétrovirales incapables d'éradiquer le virus, le VIH-1 reste un problème de santé publique mondial. Des immunothérapies à base d'anticorps sont à l'étude pour éliminer les réservoirs cellulaires, qui représentent un obstacle incontournable à la guérison du VIH-1. Les glycoprotéines d'enveloppe du VIH-1 (Env) représentent le seul antigène du virus exposé à la surface des cellules infectées et constituent donc la principale cible des anticorps. L’Env non-liée adopte sa conformation « fermée », reconnue préférentiellement par les anticorps neutralisants. L'interaction avec CD4 fait passer Env dans sa conformation « ouverte », exposant des épitopes conservés reconnus par les anticorps non-neutralisants (nnAbs) présents dans le sérum d’individus infectés par le VIH-1 (sérums VIH+). Les nnAbs peuvent éliminer les cellules infectées par la cytotoxicité cellulaire dépendante des anticorps (ADCC). Cependant, les protéines accessoires Nef et Vpu diminuent l’expression de surface de CD4 et BST-2 afin d’évader à la reconnaissance et l'élimination des cellules infectées par les nnAbs. Dans cette thèse, nous caractérisons en détail la contribution d’Env, Nef et Vpu pour échapper aux réponses humorales et explorons de nouvelles stratégies pour sensibiliser les cellules infectées à l’ADCC. Pour quantifier plus adéquatement la réponse ADCC, nous avons identifié des biais dans les tests largement utilisés, notamment pour évaluer les corrélats de protection vaccinale. Il s'agit de l'incapacité à faire la distinction entre l'élimination des cellules infectées et des cellules non-infectées, et l'utilisation de constructions virales comportant un gène rapporteur empêchant l’expression de Nef. En utilisant un nouveau marquage intracellulaire, nous avons confirmé l’effet protecteur de Nef et Vpu contre l’ADCC. Ensuite, nous avons étudié les déterminants d’Env et Vpu modulant la susceptibilité des cellules infectées à l’ADCC médiée par les nnAbs. Certaines caractéristiques structurelles d'Env modulent ses transitions conformationnelles, incluant le domaine d'association du trimère, le site de clivage de la furine et la cavité Phe43. L’altération de ces composantes augmente la sensibilité des cellules infectées à l'ADCC par les sérums VIH+. Outre l’inhibition de CD4 et BST-2, Vpu cible également NTB-A et PVR, des ligands de récepteurs activateurs des cellules NK. Cependant, la polyfonctionnalité de Vpu est compromise par l’augmentation de BST-2 par les interférons de type I (IFN-I), sensibilisant ainsi les cellules infectées aux réponses NK. En utilisant un modèle de souris humanisée, nous validons l'importance de Vpu pour échapper à la pression immunitaire des nnAbs in vivo. Enfin, nous avons exploré de nouvelles stratégies pour sensibiliser les cellules infectées à l'ADCC en modulant la conformation d’Env avec des mimétiques moléculaires de CD4 (CD4mc). Nous avons identifié des résidus bordant la cavité Phe43 modulant la sensibilité au CD4mc. L’accumulation d’Env induite par les IFN-I augmente la capacité du CD4mc à sensibiliser les cellules infectées à l'ADCC par les sérums VIH+. Globalement, cette thèse dévoile une caractérisation approfondie des déterminants viraux et cellulaires modulant la susceptibilité des cellules infectées par le VIH-1 aux réponses humorales. Une meilleure compréhension de ces mécanismes est nécessaire pour développer des nouvelles stratégies capables d’éradiquer les réservoirs viraux. / In the absence of an effective vaccine and with antiretroviral therapies unable to eradicate the virus, HIV-1 remains a global public health problem. Antibody-based immunotherapies are currently being investigated to eliminate cellular reservoirs, which represent a major obstacle towards an HIV-1 cure. HIV-1 envelope glycoproteins (Env) represent the only virus-specific antigen exposed at the surface of infected cells and therefore is the main target for antibodies. In its unliganded form, Env samples a ‘closed’ conformation, preferentially recognized by neutralizing antibodies. Interaction with CD4 drives Env into its ‘open’ conformation, exposing conserved epitopes recognized by non-neutralizing antibodies (nnAbs) present in sera from HIV-1 infected individuals (HIV+ sera). NnAbs can eliminate infected cells by antibody-dependent cellular cytotoxicity (ADCC). However, HIV-1 encodes for the accessory proteins Nef and Vpu which decrease cell surface levels of CD4 and BST-2, thus avoiding recognition and elimination of infected cells by nnAbs. In this thesis, we characterize in detail the contribution of Env, Nef, and Vpu to evade humoral responses and explore new strategies for sensitizing infected cells to ADCC. In an effort to develop a more adequate quantification of ADCC responses, we identified major biases in widely used assays, including the ones used to assess correlates of vaccine protection. These include the inability to distinguish between the elimination of infected and uninfected cells and the use of viral constructs coding for a reporter gene that prevents Nef expression. Using a novel intracellular staining, we confirmed the protective effect of Nef and Vpu against ADCC responses. Next, we studied the different Env and Vpu determinants modulating the susceptibility of infected cells to nnAbs-mediated ADCC responses. Certain Env structural features modulate its conformational transitions, including the trimer association domain, the furin cleavage site and the Phe43 cavity. Alterations of these components increase the susceptibility of HIV-1-infected cells to ADCC mediated by HIV+ sera. In addition to inhibiting CD4 and BST-2, Vpu also targets NTB-A and PVR, which act as ligands for NK cell activating receptors. However, we found that the polyfunctionality of Vpu can be compromised by the upregulation of BST-2 by type I interferons (IFN-I), thereby sensitizing infected cells to NK cell responses. Using a humanized mouse model, we validate the importance of Vpu to escape the immune pressure of nnAbs in vivo. Finally, we explored new strategies to bypass the protective effect of Vpu and Nef and sensitize HIV-1-infected cells to ADCC by modulating Env conformation using small CD4-mimetic compounds (CD4mc). We identified a network of residue lining the Phe43 cavity that modulates Env sensitivity to CD4mc. The enhanced surface expression of Env by type I IFNs boosts the ability of CD4mc to sensitize HIV-1-infected cells to ADCC by HIV+ sera. Overall, this thesis sheds light on a thorough characterization of viral and cellular determinants modulating the susceptibility of HIV-1-infected cells to humoral responses. A better understanding of these mechanisms is needed to develop new strategies able to eradicate viral reservoirs.

A number of viral diseases such as Hepatitis B, small pox, measles, rubella and polio have effective vaccines to control or eradicate them. HIV-1 is a lentivirus which infects human immune cells and leads to the disease called AIDS (Acquired Immuno Deficiency Syndrome). Despite much effort since the three decades of its discovery, there is no effective vaccine against HIV-1. The envelope glycoprotein of HIV-1 is the most accessible protein on the virion surface and is essential for HIV-1 infection. Thus, this protein is the primary target for HIV-1 vaccine design. However, HIV-1 has acquired numerous immune evasive mechanisms to escape from the human immune system. Various factors such as high variability of the envelope sequence, presence of immune dominant variable loop regions, extensive glycosylation which masks conserved epitopes on the envelope, weak non-covalent interactions between gp120 and gp41 subunits of the envelope and the metastable nature of the envelope hinder the development of an effective vaccine against HIV-1. Various approaches have been carried out to design immunogens based on the envelope glycoprotein but so far none of these have succeeded in elicitation of a broad neutralizing antibody response. In chapter 1, brief descriptions of the HIV-1 epidemic, structural and genomic organization of HIV-1 along with the difficulties faced and progress in the development of an HIV-1 vaccine are described. HIV-1 envelope glycoprotein (Env) is a trimer of gp120-gp41 heterodimers. The gp41 subunit in the native, pre-fusion trimeric Env exists in a metastable conformation and attains a stable post-fusion six helix bundle (6HB) conformation comprised of a trimer of N-heptad repeat (NHR) and C-heptad repeat (CHR) heterodimers, that drives fusion of viral and cellular membranes. The metastable nature of gp41 drives the equilibrium towards the post-fusion conformation which favours shedding of gp120 and formation of the gp41 six helix bundle remnants from the Env trimer. These dissociated products display non-neutralizing epitopes to the immune system to drive non-neutralizing antibody responses. Design and purification of Env glycoprotein in its native trimeric form is challenging due to the instability of the functional HIV-1 native Env trimer. In chapter 2, we describe our attempts to stabilize native Env trimers by incorporation of mutations at the NHR:CHR interface that disrupt the post-fusion 6HB of gp41. The mutations V570D and I573D stabilize native JRFL Env and occlude non-neutralizing epitopes to a greater extent than the previously identified I559P mutation that it is at the interface of the NHR trimers in the 6HB. The mutations prevent sCD4 induced gp120 shedding and 6HB formation. The data suggest that positions 570 and 573 are surface proximal in the native Env. Aspartic acid substitutions at these positions stabilize native trimers through destabilization of the post fusion 6HB conformation. These mutations should enhance the exposure of native Env forms to the immune system and therefore can be used to stabilize Env in a DNA vaccine format. In previous studies, a disulfide bond was engineered between gp120 and gp41 of Env to stabilize the interactions between them (SOS gp140). An I559P mutation was also introduced to stabilize the native gp41 conformation in the context of disulfide engineered Env (SOSIP gp140). The purified, soluble SOSIP gp140 immunogens were trimeric and cleaved properly. However, these immunogens failed to elicit broad neutralizing responses. The SOSIP gp140 immunogens appear to be good conformational mimics of the native trimeric Env. Thus, it is important to understand the details of the conformation and antigenic nature of SOSIP Env to further assist the design of Env immunogens in a native-like conformation. In chapter 3, we expressed JRFL-SOSIP Env on the cell surface and probed with various gp120 and gp41 specific antibodies to investigate whether this Env protein mimics the native like Env conformation. We show that introduction of a disulfide bond between gp120 and gp41 perturbs the native Env conformation, though this effect is partially alleviated by furin expression. The introduction of the V570D mutation instead of the I559P mutation partially restored the native like conformation of disulfide engineered Env. Proper cleavage of the Env to gp120 and gp41 is essential for the formation of native Env conformation. Uncleaved Env attains non-native forms and binds to non-neutralizing antibodies. To overcome inefficient cleavage problems, we co-expressed gp120 and gp41 genes on separate plasmids in mammalian cells and monitored the formation of native like Env complexes on the cell surface. We observed a fraction of native-like Env complexes on the cell surface when gp120 and gp41 with the V570D mutation are co¬expressed. We also describe the expression of Env with a self-cleavable 2A peptide between gp120 and gp41-V570D. We conclude that co-expression of gp120 and gp41 to form native like Env complexes is possible. HIV-1 Env trimeric immunogens are believed to be better immunogens than monomeric gp120. The trimeric Env immunogens designed so far, elicited marginally better neutralizing antibody response than monomeric gp120. However, these immunogens failed to elicit antibodies which could neutralize multiple primary HIV-1 isolates. Thus, it is possible that these immunogens have failed to mimic the native Env conformation. Cryo-EM and crystal structures of Env suggested that three gp120 monomers are held together at the apex of the Env trimer and the V1V2 regions of each gp120 monomer contribute to this trimeric interface. It was also shown that two broadly neutralizing antibodies (PG9 and PG16) bind to quaternary epitopes formed by V1V2 regions. Based on these observations, we hypothesized that insertion of heterologous trimerization domains into V1V2 loops might help in the formation of native like gp120 trimers. In chapter 4, two different trimerization domains (6-helix bundle and foldon trimerization domains) were inserted at the V1 loop of gp120 and C1 and C5 regions of gp120 were deleted to reduce the conformational flexibility of gp120. The resulting constructs were not trimeric and lost binding to trimer specific antibodies, PG9 and PG16. Due to their large distances between N and C-termini, these trimerization domains might have altered the local conformation of V1V2 regions and destabilized gp120 trimer formation. Interestingly, introduction of a trimerization domain (hCMP) at the C-terminus of C1 and C5 deleted gp120 (gp120-hCMP-21), led to the formation of native-like trimers which bound to both PG9 and PG16 antibodies. These results suggest that it may be difficult to trimerize gp120 by insertion of heterologous trimerization domains into the V1V2 loop and that conformational integrity of the V1V2 region is essential for the formation of trimeric gp120 interface. V1V2 regions of gp120 form quaternary epitopes on the Env trimer and are target for several broadly neutralizing antibodies. Moreover, these regions are important for the formation of the gp120 trimeric interface in the Env. In chapter 4, we show that insertion of heterologous trimerization domains at the V1 loop failed to form native like gp120 trimers. To further investigate this issue, in chapter 5, we made cyclic permutants of the gp120 molecule to create new N and C-termini at the V1 or V2 loop regions. This allowed the insertion of heterologous trimerization domains at these loop regions without affecting the folding and stability of gp120. The hCMP trimerization domain was introduced at the N-terminus of cyclically permuted gp120 (V1cyc and V2cyc). The resulting cyclic permutants were trimeric and retained binding to several broadly neutralizing antibodies. These cyclic permutants showed 10-20 fold increased binding to quaternary epitope specific neutralizing antibodies PG9 and PGT 145. CD4 binding site directed broadly neutralizing antibodies b12 and VRC01 also showed increased affinities to these cyclic permutants. Immunization of guinea pigs with cyclic permutants elicited broad neutralizing antibody response to Tier-1 and Tier-2 HIV-1 isolates with substantially higher titers than the corresponding monomeric gp120 immunogens. The data demonstrate that cyclic permutation of gp120 did not affect the structural and functional properties of gp120. It is possible to elicit broadly neutralizing sera against HIV-1 using cyclically permuted gp120 trimers in small animals. Among several proposed cryo-EM tomography structures of trimeric Env, some suggested that the V1V2 loop regions of gp120 are located close to the trimer interface while some other structures suggested that the V1V2 loop regions of gp120 are located far from the trimer axis. The present study supports Env models in which the V1V2 loops are proximal to the trimer interface. This has recently been confirmed in high resolution cryo-EM and crystal structures of HIV-1 gp140 derivatives. HIV-1 Env subunit gp120 has 50% of its molecular mass comprised of glycans which shield Env from immune recognition. Env has approximately 25 glycosylation sites of which ~4 are located in the inner domain, ~7-8 in the V1/V2 and V3 loops and the rest in the outer domain (OD). Earlier reports suggested that the glycans are indispensable for proper folding of Env and a certain level of glycan coverage is essential for maintaining infectivity of the virion. In chapter 6, we investigated the effect of removal of glycans from core gp120 on the infectivity of the HIV-1 and on the recognition of Env by various broadly neutralizing antibodies (bNAbs). We mutated the glycosylation sites in core gp120 to the second most frequent amino acids based on multiple sequence alignment. Pseudoviral infectivity assays and mammalian cell surface display experiments show that in the context of gp160, all core gp120 glycans are dispensable for viral infectivity and for recognition of bNAbs. We also show that deglycosylated molecules can serve as a starting point to re-introduce epitopes for specific glycan dependent bNAbs. Several of the constructs will also be useful for epitope mapping and Env structural characterization. Glycosylation of Env is known to inhibit binding to germline precursors of known bNAbs. In this study we show that recognition of VRC01 germline-bNAb increases substantially with the progressive loss of glycans from JRFL pseudoviruses. This work has so far resulted in the following publications (mentioned in next page).

Tese de mestrado integrado. Engenharia Civil (Área de Especialização de Construções). Faculdade de Engenharia. Universidade do Porto. 2012

The best known correlate of protection provided by vaccines is the presence of pathogen specific antibodies after immunization. However, against the Human Immunodeficiency Virus-1 (HIV-1) the mere presence of antibodies specific for the viral Envelope (Env) protein is not sufficient to provide protection. This necessitates in depth study of the humoral responses elicited during infection and by vaccination. While a significant amount of effort has been invested in studying the evolution of antibody responses to viral infection, only limited progress in understanding antibody responses elicited through vaccination has been made. In the studies described here, I attempt to rectify this deficiency by investigating how the quality of a humoral response is altered with the use of different immunization regimens, in particular a DNA prime-protein boost regimen, or with the use of different model HIV-1 Env gp120 immunogens. In a New Zealand White (NZW) rabbit model, we demonstrate that the broader neutralizing activity elicited with the DNA prime-protein boost regimen may be the result of the elicitation of a higher avidity antibody response and a unique profile of antibody specificities. Specifically, use of a DNA prime-protein boost regimen elicits antibodies targeted to the CD4 binding domain of the HIV-1 Env, a specificity that was not frequently observed when only protein based immunizations were administered. We extended this analysis to sera from healthy human volunteers who participated in early phase HIV vaccine trials utilizing either a protein alone immunization regimen, a canarypox prime-protein boost immunization regimen, or a DNA prime-protein boost immunization regimen. Evaluation of sera from these trials demonstrated that the use of a DNA prime-protein boost regimen results in an antibody response with greater neutralization breadth characterized by an increased frequency and titer of antibodies targeted toward the CD4 binding site (CD4bs). In addition to this, the antibody response elicited by the DNA prime-protein boost regimen also exhibited the capability to mediate antibody dependent cell-mediated cytotoxicity (ADCC) activity as well as activation of the complement system. Additionally, in an attempt to better understand the capabilities of antibodies elicited by a DNA prime-protein boost regimen, we generated gp120 specific monoclonal antibodies (mAbs) from a single DNA primed-protein boosted NZW rabbit. Analysis of mAbs produced from this animal revealed that use of this immunization regimen elicits an antibody repertoire with diverse epitope specificity and cross reactivity. Furthermore, these select mAbs are capable of neutralizing heterologous HIV isolates. Further application of mAb generation in rabbits may provide a valuable tool to study immunogenicity of different vaccines and immunization regimens. Concurrently, while demonstrating that a DNA prime-protein boost regimen elicits a higher quality antibody response than that observed with other leading techniques, we also demonstrated that immunogen selection can play a vital role in the quality of the resulting antibody response. By immunizing with two closely related but phenotypically distinct model gp120 immunogens, known as B33 and LN40, we demonstrated that disparate gp120s have different intrinsic abilities to raise a heterologous neutralizing antibody response. Additionally, we showed that residues found within and flanking the b12 and CD4 binding sites play critical roles in modulating neutralizing activity of sera from animals immunized with LN40 gp120, indicating that the broader neutralizing activity seen with this immunogen may be due to differential elicitation of antibodies to this domain.