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Persistent enterovirus B infection has been proposed as an important contributor to the etiology of type 1 diabetes. We leveraged extensive bulk RNA-sequencing (RNA-seq) data from α-, β-, and exocrine cells, as well as islet single-cell RNA-seq data from the Human Pancreas Analysis Program (HPAP), to evaluate the presence of enterovirus B sequences in the pancreas of patients with type 1 diabetes and prediabetes (no diabetes but positive for autoantibodies). We examined all available HPAP data for either assay type, including donors without diabetes and with type 1 and type 2 diabetes. To assess the presence of viral reads, we analyzed all reads not mapping to the human genome with the taxonomic classification system Kraken2 and its full viral database augmented to encompass representatives for all 28 enterovirus B serotypes for which a complete genome is available. As a secondary approach, we input the same sequence reads into the STAR aligner using these 28 enterovirus B genomes as the reference. No enterovirus B sequences were detected by either approach in any of the 243 bulk RNA libraries or in any of the 79 single-cell RNA libraries. While we cannot rule out the possibility of a very-low-grade persistent enterovirus B infection in the donors analyzed, our data do not support the notion of chronic viral infection by these viruses as a major driver of type 1 diabetes. Article Highlights: Persistent enterovirus B infections of pancreatic islets have been suggested as a trigger for autoimmunity leading to type 1 diabetes in genetically susceptible individuals. Unbiased sequence-based analysis of bulk and single-cell RNA sequencing data from the Human Pancreas Analysis Program found no evidence for the presence of enterovirus B sequences in the human pancreas. While our findings do not rule out the possibility of a very-low-grade persistent enterovirus B infection, our data do not support the notion of chronic viral infection by these viruses. [ABSTRACT FROM AUTHOR]

BACKGROUND. Idiopathic multicentric Castleman disease (iMCD) is a hematologic illness involving cytokine-induced lymphoproliferation, systemic inflammation, cytopenias, and life-threatening multi-organ dysfunction. The molecular underpinnings of interleukin-6 (IL-6) blockade-refractory patients remain unknown; no targeted therapies exist. In this study, we searched for therapeutic targets in IL-6 blockade-refractory iMCD patients with the thrombocytopenia, anasarca, fever/elevated C-reactive protein, reticulin myelofibrosis, renal dysfunction, organomegaly (TAFRO) clinical subtype. METHODS. We analyzed tissues and blood samples from 3 IL-6 blockade-refractory iMCD-TAFRO patients. Cytokine panels, quantitative serum proteomics, flow cytometry of PBMCs, and pathway analyses were employed to identify novel therapeutic targets. To confirm elevated mTOR signaling, a candidate therapeutic target from the above assays, immunohistochemistry was performed for phosphorylated S6, a read-out of mTOR activation, in 3 iMCD lymph node tissue samples and controls. Proteomic, immunophenotypic, and clinical response assessments were performed to quantify the effects of administration of the mTOR inhibitor sirolimus. RESULTS. Studies of 3 IL-6 blockade-refractory iMCD cases revealed increased [CD8.sup.+] T cell activation, VEGF-A, and PI3K/Akt/mTOR pathway activity. Administration of sirolimus substantially attenuated [CD8.sup.+] T cell activation and decreased VEGF-A levels. Sirolimus induced clinical benefit responses in all 3 patients with durable and ongoing remissions of 66, 19, and 19 months. CONCLUSION. This precision medicine approach identifies PI3K/Akt/mTOR signaling as the first pharmacologically targetable pathogenic process in IL-6 blockade-refractory iMCD. Prospective evaluation of sirolimus in treatment- refractory iMCD is planned (NCT03933904). FUNDING. This study was supported by the Castleman's Awareness & Research Effort/Castleman Disease Collaborative Network, Penn Center for Precision Medicine, University Research Foundation, Intramural NIH funding, and the National Heart Lung and Blood Institute., Introduction Multicentric Castleman disease (MCD) is characterized by polyclonal lymphoproliferation, hypervascularized lymph nodes containing dysmorphic germinal centers, cytokine-driven systemic inflammation, cytopenias, and multi-organ dysfunction. The estimated annual incidence of MCD [...]

T follicular helper cells (Tfh), a subset of [CD4.sup.+] T cells, provide requisite help to B cells in the germinal centers (GC) of lymphoid tissue. GC Tfh are identified by high expression of the chemokine receptor CXCR5 and the inhibitory molecule PD-1. Although more accessible, blood contains lower frequencies of [CXCR5.sup.+] and [PD-1.sup.+] cells that have been termed circulating Tfh (cTfh). However, it remains unclear whether GC Tfh exit lymphoid tissues and populate this cTfh pool. To examine exiting cells, we assessed the phenotype of Tfh present within the major conduit of efferent lymph from lymphoid tissues into blood, the human thoracic duct. Unlike what was found in blood, we consistently identified a CXCR5-bright PD-1-bright ([CXCR5.sup.Br][PD-1.sup.Br]) Tfh population in thoracic duct lymph (TDL). These [CXCR5.sup.Br][PD-1.sup.Br] TDL Tfh shared phenotypic and transcriptional similarities with GC Tfh. Moreover, components of the epigenetic profile of GC Tfh could be detected in [CXCR5.sup.Br][PD-1.sup.Br] TDL Tfh and the transcriptional imprint of this epigenetic signature was enriched in an activated cTfh subset known to contain vaccine-responding cells. Together with data showing shared TCR sequences between the [CXCR5.sup.Br][PD-1.sup.Br] TDL Tfh and cTfh, these studies identify a population in TDL as a circulatory intermediate connecting the biology of Tfh in blood to Tfh in lymphoid tissue., Introduction T follicular helper cells (Tfh) are a subset of [CD4.sup.+] T cells that provide B cell help within the follicles of secondary lymphoid tissues. Tfh promote B cell class [...]

HIV rapidly rebounds after interruption of antiretroviral therapy (ART). HIV-specific CD8+ T cells may act to prevent early events in viral reactivation. However, the presence of viral immune escape mutations may limit the effect of CD8+ T cells on viral rebound. Here, we studied the impact of CD8 immune pressure on post-treatment rebound of barcoded SIVmac293M in 14 Mamu-A*01 positive rhesus macaques that initiated ART on day 14, and subsequently underwent two analytic treatment interruptions (ATIs). Rebound following the first ATI (seven months after ART initiation) was dominated by virus that retained the wild-type sequence at the Mamu-A*01 restricted Tat-SL8 epitope. By the end of the two-month treatment interruption, the replicating virus was predominantly escaped at the Tat-SL8 epitope. Animals reinitiated ART for 3 months prior to a second treatment interruption. Time-to-rebound and viral reactivation rate were significantly slower during the second treatment interruption compared to the first. Tat-SL8 escape mutants dominated early rebound during the second treatment interruption, despite the dominance of wild-type virus in the proviral reservoir. Furthermore, the escape mutations detected early in the second treatment interruption were well predicted by those replicating at the end of the first, indicating that escape mutant virus in the second interruption originated from the latent reservoir as opposed to evolving de novo post rebound. SL8-specific CD8+ T cell levels in blood prior to the second interruption were marginally, but significantly, higher (median 0.73% vs 0.60%, p = 0.016). CD8+ T cell depletion approximately 95 days after the second treatment interruption led to the reappearance of wild-type virus. This work suggests that CD8+ T cells can actively suppress the rebound of wild-type virus, leading to the dominance of escape mutant virus after treatment interruption. Author summary: During untreated HIV infection, CD8+ ('killer') T cells target and apply selective pressure on the HIV virus. Unfortunately, immune escape mutation may occur, allowing HIV to evade immune recognition. HIV may be more susceptible to immune pressure when there are low levels of virus, such as during initial viral rebound following treatment interruption. However, it is unknown if the immune system can target and suppress the growth of rebounding virus. In this study, we demonstrate that CD8+ T cells can inhibit the reactivation of susceptible virus following treatment interruption. However, escaped virus can circumvent CD8 pressure and reactivate if it is present in the latent viral reservoir. [ABSTRACT FROM AUTHOR]

One approach to 'functional cure' of HIV infection is to induce durable control of HIV replication after the interruption of antiretroviral therapy (ART). However, the major factors that determine the viral 'setpoint' level after treatment interruption are not well understood. Here we combine data on ART interruption following SIV infection for 124 total animals from 10 independent studies across 3 institutional cohorts to understand the dynamics and predictors of post-treatment viral control. We find that the timing of treatment initiation is an important determinant of both the peak and early setpoint viral levels after treatment interruption. During the first 3 weeks of infection, every day of delay in treatment initiation is associated with a 0.22 log10 copies/ml decrease in post-rebound peak and setpoint viral levels. However, delay in initiation of ART beyond 3 weeks of infection is associated with higher post-rebound setpoint viral levels. For animals treated beyond 3 weeks post-infection, viral load at ART initiation was the primary predictor of post-rebound setpoint viral levels. Potential alternative predictors of post-rebound setpoint viral loads including cell-associated DNA or RNA, time from treatment interruption to rebound, and pre-interruption CD8+ T cell responses were also examined in the studies where these data were available. This analysis suggests that optimal timing of treatment initiation may be an important determinant of post-treatment control of HIV. Author summary: HIV infection can be effectively treated with antiretroviral therapy. However, the virus persists in a latent form despite treatment, and 'rebounds' to high levels if treatment is stopped. A number of approaches are now being investigated that might reduce the level of viral rebound following treatment interruption. However, little is known about how variation in infection history (e.g., timing of treatment initiation) influences rebound and may bias observed effects of trial treatments. Here, we aggregated data across multiple studies of SIV infection (a non-human primate model of HIV) to investigate what factors determined the level of viral rebound after treatment interruption. We found that the time from infection to when antiretroviral therapy was initiated was a major factor influencing average viral levels in the first months post treatment. Over the first three weeks of SIV infection, delaying treatment reduced levels of viral rebound when treatment was stopped. This is assumed to occur because increased exposure to the virus induces a more potent immune response. However, after three weeks, later initiation of antiretroviral therapy was associated with higher SIV levels after stopping treatment. Future work is needed to investigate whether the same patterns of viral rebound are seen in HIV infection. [ABSTRACT FROM AUTHOR]

Some risk factors for severe coronavirus disease 2019 (COVID-19) have been identified, including age, race, and obesity. However, 20%-50% of severe cases occur in the absence of these factors. Cytomegalovirus (CMV) is a herpesvirus that infects about 50% of all individuals worldwide and is among the most significant nongenetic determinants of immune system. We hypothesized that latent CMV infection might influence the severity of COVID-19. Our analyses demonstrate that CMV seropositivity is associated with more than twice the risk of hospitalization due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Immune profiling of blood and CMV DNA quantitative polymerase chain reaction in a subset of patients for whom respiratory tract samples were available revealed altered T-cell activation profiles in absence of extensive CMV replication in the upper respiratory tract. These data suggest a potential role for CMV-driven immune perturbations in affecting the outcome of SARS-CoV-2 infection and may have implications for the discrepancies in COVID-19 severity between different human populations. [ABSTRACT FROM AUTHOR]

We isolated pure, viable populations of tumor-cytolytic T cells directly from patient blood samples using flow cytometric quantification of the surface mobilization of CD107a--an integral membrane protein in cytolytic granules--as a marker for degranulation after tumor stimulation. We show that tumor-cytolytic T cells are indeed elicited in patients after cancer vaccination, and that tumor reactivity is strongly correlated with efficient T-cell recognition of peptide-bearing targets. We combined CD107a mobilization with peptide-major histocompatibility complex (P-MHC) tetramer staining to directly correlate antigen specificity and cytolytic ability on a single-cell level. This showed that tumor-cytolytic T cells with high recognition efficiency represent only a minority of peptide-specific T cells elicited in patients after heteroclitic peptide vaccination. We were also able to expand these cells to high numbers ex vivo while maintaining their cytolytic potential. These techniques will be useful not only for immune monitoring of cancer vaccine trials, but also for adoptive cellular immunotherapy after ex vivo expansion. The ability to rapidly identify and isolate tumor-cytolytic T cells would be very useful in cancer immunotherapy., Author(s): Valerie Rubio [1]; Tor B Stuge [1]; Naileshni Singh [1]; Michael R Betts [2]; Jeffrey S Weber [3]; Mario Roederer [4]; Peter P Lee (corresponding author) [1] A major [...]

2022 marks the 40th anniversary of the Falklands War. This significant milestone will be commemorated with a plethora of events in the Falkland Islands, Argentina, and the UK. One of these, the Falklands Forty Schools Competition, funded by the Falkland Islands Government, will see a national competition for young people (aged 16–18 years) in the UK that will encourage them to consider why the Falkland Islands matter today. With the editorial assistance of Professor Peter Clegg and Dr Kate Matheson, The Round Table gathered several of those involved in organising the competition to discuss remembrance of the Falklands War at this historical juncture. The dialogue below involves three scholars (an historian and two political geographers), two Falkland Islanders of different generations and the Deputy Representative of the Falkland Islands in the UK (FIGO). They conducted their discussion by email over the autumn of 2021. Each of the contributors writes in a personal capacity aside from Michael Betts who writes in his role as Deputy Representative of FIGO. [ABSTRACT FROM AUTHOR]

Author(s): Daniel C. Douek (corresponding author) [1, 2, 3]; Jason M. Brenchley [1, 3]; Michael R. Betts [1]; David R. Ambrozak [1]; Brenna J. Hill [1]; Yukari Okamoto [1]; Joseph [...]

Mycophenolate mofetil may be effective in treating HIV patients who are not responding to AIDS drugs. This drug enhances the activity of some AIDS drugs, including abacavir and didanosine.