Infection with HIV-1 results in CD4+ T cell depletion and the subsequent loss of immune function results in AIDS. Although HAART lowers plasma viremia, it requires life-long drug therapy. However, elite controllers are able to exert control over viral replication in the absence of cART therapy by maintaining polyfunctional HIV-specific T cells with high avidity TCR binding that target CTL epitopes where escape mutants have reduced fitness.To mimic increase immunosurveillance of elite controllers and prevent viral replication in a non-controlled setting, we will transduce T cells with CD4-CAR vectors to bolster and redirect the “designer T cells” (dTc) towards an HIV-specific target. Chimeric antigen receptors (CARs) are fusion proteins of an extracellular antigenbinding domain linked to intracellular T cell signaling domains. In CD4-CARs, the CD4 extracellular domain binds directly to diverse HIV envelopes and redirects the CTL activity. Env/CD4 binding is independent of both the MHC restriction and Nef down regulation. As in elite controllers, CD4-CARs targets an essential viral function where mutations would lower viral fitness and make viral escape difficult to achieve. The first-generation CD4-CAR vector, with only the T-cell receptor zeta (TCRζ) intracellular domain, killed Env+ cells in vitro but failed to control viremia in clinical trials. Recent studies with anti-tumor CARs show that additional co-stimulatory signals (CD28 and 4-1BB) improved CTL function in vitro, in murine models, and showed objective tumor regression in clinical trials.We hypothesize that genetically modified T cells designed to increase CTL killing of HIV+ cells, to persist in vivo, and to prevent viral infection will provide durable viral suppression in vivo and eliminate the need for life-long drug therapy as modeled by elite controllers. To determine what signaling domains would be necessary to mimic this immune protection, we developed a series of CD4-CAR vectors with various intracellular signaling domains. To protect dTc from infection, we co-transduced cells with the membrane-associated C46 (maC46), a fusion inhibitor tethered to dTc, that binds HIV and blocks viral replication thereby providing a strong selective advantage to transduced cells. Therefore, we stimulated PBMCs with αCD3αCD28 and co-transduced T cells with the series of CD4-CAR and maC46 vectors. To evaluate the functional activity of the dTc, we measured 1) HIV Env-specific cytotoxicity, 2) cytokine production using IFN-γ ELIspot, and 3) CAR-specific proliferation of dTc. CD4-CAR T cells demonstrated Env+ specific killing, increased frequency of IFN-γ spot-forming cells, and CAR-specific proliferation.Our long-term goal, to adoptively transfer dTc with increased CTL function (cytokine production, proliferative capacity, viral suppression). The control of viremia in the absence of HAART would revolutionize HIV treatments for patients with AIDS.
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