IL-7 is the key cytokine that regulates the homeostasis of peripheral CD4
+ T cells, through signals that promote both long-term survival and homeostatic proliferation of IL-7R-expressing cells (
2,
30,
52). The present work identifies two steps in the impairment of IL-7-dependent responses in patients with active HIV replication. First, IL-7 binding is altered, due to changes in the expression of functional IL-7R heterodimers. We show for the first time that the combination of an increase in γc expression and a decrease of CD127 results in decreased IL-7 binding within the memory CD4
+ T-cell population. The reduced binding capacity for IL-7 can in turn explain the reduced frequency of memory CD4
+ T cells that respond to IL-7 and contribute to IL-7-dependent functional defects within this population. A second block in IL-7 response at the postreceptor binding stage is needed to account for functional defects within the naive CD4
+ T-cell population. These cells have normal IL-7 binding capacity but show reduced IL-7-dependent prosurvival effects, as measured by Bcl-2 induction, pointing to a signaling defect downstream of the receptor. Since early signaling events, as measured by STAT5 phosphorylation at Y694, are increased, rather than decreased, in naive CD4
+ T cells of viremic patients, the defect likely occurs at a more distal step of the signaling pathway.
Progressive HIV infection exerted two types of effects on STAT5 phosphorylation responses. On the one hand, the percentage of CD4
+ T cells expressing pSTAT5 decreased in conventional and Treg memory CD4
+ T-cell subsets, a finding compatible with a recent study reporting defective IL-7R signaling in memory CD4
+ T cells of patients with active HIV replication (
9). On the other hand, we observed signs of STAT5 hyperactivation, as indicated by (i) an increased level of pSTAT5 induction per cell within the population of CD4
+ T cells that still responded to IL-7 stimulation, (ii) a higher level of pSTAT5 induction for a given level of CD127 expression in CD4
+ T cells of viremic patients than in those of healthy donors, and (iii) increased STAT5 phosphorylation levels at the baseline in both the naive and the memory CD4
+ T-cell compartments of viremic patients. These findings can be reconciled if one considers that HIV perturbs pSTAT5 responses at both receptor binding and postreceptor binding stages. The loss of a population of IL-7 responder cells can be explained by decreased CD127 expression, which limits IL-7 binding capacity and may abrogate pSTAT5 responses under a certain threshold of expression. Since CD127 decrease occurs only within memory CD4
+ T cells, the loss of responder cell remains restricted to the same population. Abnormal activation of the signaling machinery downstream of the IL-7R receptor can in turn explain the increased sensitivity of STAT5 phosphorylation responses. The notion of a chronic activation of the JAK/STAT pathway is in agreement with reports of increased basal phosphorylation levels in several signaling pathways, including those of STAT5 and those downstream of the TCR, in progressive HIV infection (
20,
71). The dysregulation of multiple signaling pathways likely reflects the generalized immune activation that is thought to drive HIV pathogenesis and lead to the progressive exhaustion of the immune system (
25,
32,
76).
A specific reason for the basal activation of STAT5 may lie in the increased levels of circulating IL-7 seen in the plasma of HIV-infected patients with low CD4
+ T-cell counts (
1,
13,
14,
28,
29,
39,
50,
51,
56,
68,
70). However, we did not detect a correlation between circulating IL-7 and basal or induced pSTAT5 levels in our study group, which comprised viremic patients with moderate CD4
+ T-cell depletion (not shown). Also, it is unlikely that the low IL-7 concentrations detected in patients with intermediate CD4 counts can account for the chronic activation of the memory CD4
+ T-cell subsets, which have low IL-7 binding capacity. Rather, other cytokines signaling through STAT5 may be responsible for this chronic activation. In this respect, the increase in γc expression detected in viremic patients was of significant magnitude, with a doubling of the MFI, and persisted to some extent in efficiently treated patients. A possibility is that increased expression of the γc chain renders CD4
+ T cells more susceptible to stimulation by other γc family cytokines that are induced upon chronic immune activation. IL-15 is an intriguing candidate because IL-15 expression is induced in a variety of inflammatory conditions (
18), IL-15 levels are significantly increased in acute and progressive HIV infection (
7,
78), and IL-15 can drive the activation and expansion of CCR5
+ CD4
+ T cells in simian models (
58). In addition, we have found that the two molecules that comprise the minimal IL-15 receptor, namely, γc and CD122/IL-2Rβ, are both increased in CD4
+ T cells of viremic patients (Fig. and data not shown). Thus, the IL-15 system may contribute to persistent STAT5 activation, since both the ligand and the receptor are upregulated in progressive HIV infection.
Importantly, chronic STAT5 activation did not result in more-efficient functional responses to IL-7, as measured by CD25, FoxP3, and Bcl-2 induction. Chronic stimulation may activate negative regulatory mechanisms that tightly control the activity of STAT5, a potentially oncogenic protein (
33). Negative regulators include SLIM proteins, which lead to ubiquitin-dependent degradation of activated STAT (
80), and transcriptional regulators, such as PIAS, which prevent STATs from binding to DNA through sumoylation (
75). Another possible mechanism for the desensitization of IL-7 responses may be linked to the accumulation of truncated forms of STAT5, which appear to be increased in HIV infection (
15), and which were shown to act as dominant-negative mutants of full-length STAT5 (
24). Further studies will be needed to pinpoint the distal step at which STAT5 function is impaired.
STAT5 plays a central role in pathways that control CD4
+ T-cell survival, through the direct induction of antiapoptotic factors, such as Bcl-XL, and through its effects on the phosphatidylinositol 3-kinase/Akt pathway (
37,
52,
63). Phosphatidylinositol 3-kinase activation is required for the increased survival, metabolic rate, and proliferation of IL-7-treated T cells (
6,
43,
61,
79). In primary T cells, the IL-7-dependent Akt response is dependent on prior STAT5 activation (
85). Thus, STAT5 dysfunction may result in poor Akt activation, which would contribute to the inefficient Bcl-2 induction and the propensity to apoptosis detected in CD4
+ T cells from viremic patients. The fact that defective Bcl-2 induction extended to the naive CD4
+ T-cell compartment is bound to have profound consequences on CD4
+ T-cell homeostasis by compromising the regenerative capacity of the CD4
+ T-cell pool.
In designing the study, we chose to analyze conventional and regulatory CD4
+ T-cell subsets separately, given their markedly different responses to IL-7 stimulation. Our findings confirm that IL-7 can signal in Tregs, in spite of the low CD127 expression levels characteristic of these cells (
8,
38,
53,
82). Tregs were able to respond to an IL-7 concentration in the picomolar range, even though STAT5 activation levels remained lower than in conventional CD4
+ T cells. Analyses of IL-2 responses in mouse models have shown that Tregs appear to have a low IL-2R signaling threshold (
87), a finding that may be explained in part by a low concentration of the negative regulator of cytokine signaling SOCS3 (
65). Given that IL-2R and IL-7R share many signaling pathways, it may prove of interest to determine whether IL-7R-dependent signaling is similarly regulated in Tregs. Our analysis of R
e ratios suggests that there may be differences in the efficiency of IL-7R-dependent signaling between Tregs and conventional CD4
+ T cells, which warrants further investigations.
Analyses of IL-7 responses were carried out with two Treg subsets that differ in expression of CD45RA but also in activation markers, such as HLA-DR (
81). The naive subset of Tregs, defined by coexpression of CD45RA, CD25, and FoxP3, predominates in infants and persists in adults, where it represents about one-third to one-fourth of the total Treg pool (
73). Naive Tregs are thought not to have encountered their cognate antigen in the periphery and have low HLA-DR expression levels but can exert bona fide suppressive activity in vitro (
81). We found that within Tregs, the naive subset was clearly the more responsive to IL-7. Indeed, the percentage of NTreg cells that responded to low-dose IL-7 stimulation was doubled compared to the level for MTreg (46% versus 24% pSTAT5
+ cells in the HD group;
P = 0.01), a result likely explained by the higher expression level of CD127 in NTreg. These findings suggest that IL-7 may play a significant role in the homeostasis of the naive subset of Tregs.
HIV infection perturbed Treg responses to IL-7 by inducing a decrease in the frequency of responder pSTAT5
+ cells in the MTreg subset. Signs of abnormal activation of STAT5 were also present within both the NTreg and the MTreg subsets, as indicated by increased pSTAT5 expression levels within the responding population. Thus, the pattern of STAT5 dysfunction appeared similar to that seen in conventional CD4
+ T cells. A particularly deleterious effect of STAT5 dysfunction for Tregs may be the impairment of Foxp3 induction, given the central role of this protein in Treg differentiation and suppressive capacity (
38). Thus, dysfunction of the JAK/STAT pathway may impair the capacity of Tregs to negatively regulate immune responses and thereby contribute to the abnormal immune activation characteristic of progressive HIV infection.
In conclusion, HIV infection perturbs both receptor expression and signal transduction in the IL-7/IL-7R axis, which is bound to have deleterious consequences on CD4+ T-cell homeostatic regulation and may contribute to the progressive CD4+ T-cell loss characteristic of HIV disease. The association between the activation and dysfunction of the JAK/STAT pathway emphasizes the need to devise strategies aimed at controlling abnormal immune activation in HIV infection. In particular, it will be important to ensure efficient control of HIV-induced activation in patients who will receive IL-7 immunotherapy as a means to restore CD4+ T-cell counts.