The complex and contrasting immune alterations in HIV infection are currently thought to have distinct etiologies [
11,
32]. Instead, our results suggest that the complexity of immune dysfunction in infection with HIV may simply reflect the functional heterogeneity of its targets. Conditional virus-free killing of activated CD4
+ T cells, which include both memory and regulatory subsets, was directly responsible for the development not only of immune deficiency, but also of activation.
As a result of the expression pattern of their receptors/co-receptors [
13-
15], replication of immunodeficiency viruses is largely restricted to the activated fraction of CD4
+ T cells. The finding that viruses such as HIV and FIV, which use different combinations of receptors/co-receptors to infect activated CD4
+ T cells, cause similar disease [
13-
15] indicates that specificity for target cells is more important for disease development than the cellular receptor conferring this specificity. Another important determinant of the rate of disease progression is the age at which HIV infection is acquired. Neonates generally develop symptomatic infection faster than adults, possibly because of the relative immaturity of the neonatal immune system and thus its inability to fully respond to the infection. Although a difference in an antiviral immune response would not influence the phenotype resulting from DTA-mediated CD4
+ T cell killing between neonate and adult mice, other factors may influence its severity. A limitation of the current approach is that CD4
+ T cell killing by CD134-driven DTA activation starts as soon as activated T cells are generated (within the first 3 days of birth in mice), which would thus correspond only to neonatal HIV infection. It would be important, once the tools become available, to compare the effect of DTA-mediated CD4
+ T cell killing in neonate and adult mice.
During the chronic phase of HIV or SIV infection only a small proportion of total CD4
+ T cells thought to be susceptible have been found to be infected at any one time [
33]. In contrast, studies with SIV in rhesus macaques have revealed that up to 50% of all memory CD4
+ T cells are systemically killed during acute SIV infection [
34,
35]. Similarly, although approximately 50% of memory CD4
+ T cells were cumulatively marked by selection-neutral YFP expression in
Tnfrsf4Cre/+R26Yfp/+ mice, the potential for DTA-mediated death upon CD4
+ T cell activation in
Tnfrsf4Cre/+R26Dta/+ mice had surprisingly little effect on memory CD4
+ T cell survival and homeostasis. The reasons for this apparent 'resistance' to virus-mediated killing of susceptible CD4
+ T cell targets during the chronic phase of HIV infection are not known, but may be related to the naturally short lifespan of activated CD4
+ T cells, even when uninfected. The lifespan of HIV-infected CD4
+ T cells (the interval between virus entry and T cell death) has been estimated to be about 48 hours [
36], which is very similar to the lifespan of activated CD4
+ T cells in
Tnfrsf4Cre/+ R26Dta/+ mice (there is about a 48 hour interval between T cell activation and DTA-mediated death). It has been postulated that HIV replication is mostly restricted to relatively short-lived cellular targets [
11], and it is therefore possible that the high natural turnover of activated CD4
+ T cells masks virus-induced death. Alternatively, the apparent 'resistance' of activated CD4
+ T cells during chronic HIV infection may represent selection for true HIV resistance in the CD4
+ T cell population [
37].
Despite being the major target of virus replication, the proportion of CCR5
+CD4
+ T cells paradoxically increases during less pathogenic HIV and SIV infection [
11]. It may thus be unsurprising that despite efficient killing of memory CD4
+ T cells, their numbers in
Tnfrsf4Cre/+ R26Dta/+ mice are preserved or even elevated under conditions of low thymic output. Although it will be important to establish why memory CD4
+ T cell replenishment eventually fails in more pathogenic HIV and SIV infection, our results also indicate that there is still CD4
+ T cell immunodeficiency even though numbers of memory CD4
+ T cells are not reduced at the population level. Studies in HIV infection have established that susceptibility to different infections is related to the degree of reduction in CD4
+ T cell counts in the blood [
38]. These findings could suggest that protection against different infections requires a different number of CD4
+ T cells. Alternatively, susceptibility to different infections at different CD4
+ T cell counts could indicate a progressive decline in other arms of the adaptive immune system, especially CD8
+ T cells, a decline that correlates with the decline in CD4
+ T cells. The finding that
Tnfrsf4Cre/+R26Dta/+ mice show immunodeficiency in assays for CD4
+ T cell-mediated protection suggests that apart from the total number of memory CD4
+ T cells, the lifespan of individual clones and the clonal composition of the total memory pool are also crucial for immune competence.
In addition to immunodeficiency, conditional deletion of activated/memory CD4
+ T cells by CD134-driven DTA activation also leads to generalized immune activation, which shares many features with HIV infection-associated immune activation. Several distinct mechanisms have recently been proposed to underlie immune activation in HIV infection. A strong innate response to HIV components is thought to contribute to generalized immune activation and an attenuated innate response has been correlated with the non-pathogenic nature of SIV infection in sooty mangabeys [
39]. Incomplete removal of apoptotic material as a result of accelerated T cell death in HIV infection has been proposed to induce self-reactive CD8
+ T cells [
28]. HIV infection induces an early and extensive depletion of effector CD4
+ T cells at the intestinal mucosa, and it is thought that diminishing local immunity permits translocation of microbial products, which in turn causes generalized immune activation [
32]. Lastly, the regulatory subset of CD4
+ T cells is targeted by HIV, SIV and FIV [
40-
43] and a relative deficit in this subset has been linked by certain studies to immune activation and disease progression [
29,
30,
40,
42,
44,
45].
Our results support a model in which generalized immune activation originates primarily from a relative insufficiency in Treg cells. The immune activation that develops in
Tnfrsf4Cre/+ R26Dta/+ mice is diminished upon restoration of CD4
+ T cell homeostasis by wild-type CD4
+ T cells in bone marrow chimeras, demonstrating that immune activation in these mice results from dysregulated CD4
+ T cell homeostasis. The two subsets of CD4
+ T cells that are affected in
Tnfrsf4Cre/+ R26Dta/+ mice include memory/effector and regulatory CD4
+ T cells, whereas naïve CD4
+ T cells are unaffected, suggesting that immune activation is due to insufficiency in either memory/effector or regulatory CD4
+ T cells, or both (general activated CD4
+ T cell lymphopenia). Treg cell numbers are reduced in
Tnfrsf4Cre/+ R26Dta/+ mice, and the degree of relative Treg cell-specific lymphopenia in these mice is fully revealed by the expansion of adoptively transferred wild-type Treg cells. Furthermore, adoptive transfer of wild-type Treg cells reduces the immune activation seen in untreated
Tnfrsf4Cre/+R26Dta/+ mice. In contrast, adoptive transfer of total CD4
+ T cells, consisting largely of memory/effector CD4
+ T cells, does not appreciably reduce immune activation in
Tnfrsf4Cre/+R26Dta/+ mice. Lastly, immune activation in
Tnfrsf4Cre/+ R26Dta/+ mice bears many similarities to the inflammatory disease that develops in mice with genetic deficiency in Treg cells [
46]. Together, these findings indicate a causal link between Treg cell insufficiency and generalized immune activation in
Tnfrsf4Cre/+ R26Dta/+ mice.
It is now clear that Treg cells are targeted by HIV, SIV and FIV [
40-
43]. However, their fate during infection remains controversial. The presence of Treg cell activity can be demonstrated during progression of HIV or SIV infection, and several studies have suggested that Treg cells are numerically increased and functionally activated during infection [
29,
47-
50]. In contrast, other studies have indicated that Treg cells are lost during progression of HIV and SIV infection and shown a correlation between this loss and immune activation [
29,
30,
40,
42,
44,
45]. Given that Treg cell homeostasis relies mainly on growth factors, such as interleukin (IL)-2, produced by activated effector T cells, loss of effector CD4
+ T cells during pathogenic HIV or SIV infection would be expected to contribute to the loss of Treg cells, in addition to virus-mediated destruction. Loss of Treg cells in our model seems to be mainly due to intrinsic CD134-driven DTA activation, rather than loss of effector CD4
+ T cells. Firstly, expansion and maintenance of wild-type Treg cells adoptively transferred into
Tnfrsf4Cre/+ R26Dta/+ mice is fully supported, indicating sufficient provision of Treg cell growth factors in these mice. Secondly, Treg cells of
Tnfrsf4Cre/+R26Dta/+ origin are severely reduced in numbers in bone marrow chimeras between
Tnfrsf4Cre/+ R26Dta/+ and wild-type cells, despite the presence of normal numbers of wild-type effector CD4
+ T cells in these chimeric mice. Lastly, reconstitution of effector T cells, by adoptive transfer of wild-type CD4
+ T cells into
Tnfrsf4Cre/+ R26Dta/+ mice, fails to restore the numbers of host Treg cells, suggesting that the defect in their homeostasis is intrinsic and not due to lack of effector CD4
+ T cells.
Thus, although a role for Treg cells in HIV disease progression is highlighted by all studies, it has remained unclear whether HIV infection is facilitated by excessive or insufficient Treg cell activity. Differences in methodology used to quantify Treg cells notwithstanding, whether Treg cell activity is increased or lost during progression of HIV infection will also depend on the behavior of cells that need to be regulated. Indeed, expansion and activation of Treg cells is not at odds with insufficient regulation if expansion and activation of effector CD4
+ and CD8
+ T cells is disproportionally higher. Furthermore, studies in natural hosts of SIV have suggested that preservation or functional redundancy of regulatory subsets could be responsible for the lack of immune activation and disease progression in non-pathogenic SIV infection [
42,
51].
The immune alterations that arise from conditional ablation of activated CD4
+ T cells in the system used here do not reproduce the entire spectrum of immune dysfunction that characterizes the various stages of HIV infection, indicating a multifactorial origin. Nevertheless, the enlargement of the lymph nodes, elevated serum levels of pro-inflammatory cytokines and chemokines, hyperplasia of the B cell compartment and increased T cell turnover and activation in
Tnfrsf4Cre/+ R26Dta/+ mice lend further support to the idea that generalized immune activation may result from Treg cell insufficiency. However, it also raises the question of why immune activation in the setting of HIV infection and in
Tnfrsf4Cre/+ R26Dta/+ mice is not associated with overt autoimmunity, as it is in Treg cell-deficient mice [
46]. Perhaps disastrous autoimmunity develops during complete Treg cell deficiency, whereas HIV infection and
Tnfrsf4Cre/+ R26Dta/+ mice show only partial Treg cell loss. Furthermore, most of the effector CD4
+ T cells that would otherwise mediate self-tissue damage are also targeted in HIV infection and in
Tnfrsf4Cre/+R26Dta/+ mice, and thus a substantial pathogenic component is removed.
Collectively, our results support a model for HIV pathogenesis in which immune deficiency and activation originate from virus-mediated killing of memory and regulatory CD4+ T cells, respectively. According to the proposed model, generalized immune activation is a consequence, rather that the cause, of accelerated CD4+ T cell turnover. Nevertheless, once instigated, immune activation will also contribute to the progressive loss of CD4+ T cells by completing the cycle of cell activation and death. Defining the precise balance between CD4+ T cell killing and immune activation and deficiency will be vital to our understanding of the pathogenesis of immune deficiency virus infection and to any effort to influence its outcome in favor of the host.