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      Broad Neutralization as a Byproduct of Antibody Maturation during HIV-1 Infection: a Personal Perspective


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          Broadly neutralizing antibodies (bnAbs) may be key for an effective HIV-1 vaccine. Although bnAbs can be detected in a small percentage of HIV-1-infected individuals, they have not been successfully elicited by any vaccines. Germline ancestors of bnAbs generally do not neutralize HIV-1, but they can gradually gain potency and breadth for neutralization of heterologous HIV-1 strains when they become more mature through accumulation of high levels of somatic mutations after a few years of infection. Since bnAbs develop in the absence of diverse heterologous HIV-1 variants in an infected individual, one plausible hypothesis is that broad neutralization of diverse heterologous viruses is a byproduct of the antibody maturation process. This hypothesis is supported by observations that bnAbs continuously evolve to gain neutralization breadth and potency, even after all autologous plasma viruses become resistant to bnAbs in infected individuals. Importantly, those individuals do not benefit from the development of continuously more matured bnAbs because autologous viruses have completely escaped from these bnAbs. This theory may have significant implication in AIDS vaccine development.

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          Therapeutic Efficacy of Potent Neutralizing HIV-1-Specific Monoclonal Antibodies in SHIV-Infected Rhesus Monkeys

          HIV-1-specific monoclonal antibodies (mAbs) with extraordinary potency and breadth have recently been described. In humanized mice, combinations of mAbs have been shown to suppress viremia, but the therapeutic potential of these mAbs has not yet been evaluated in primates with an intact immune system. Here we show that administration of a cocktail of HIV-1-specific mAbs, as well as the single glycan-dependent mAb PGT121, resulted in a rapid and precipitous decline of plasma viremia to undetectable levels in rhesus monkeys chronically infected with the pathogenic virus SHIV-SF162P3. A single mAb infusion afforded up to a 3.1 log decline of plasma viral RNA in 7 days and also reduced proviral DNA in peripheral blood, gastrointestinal mucosa, and lymph nodes without the development of viral resistance. Moreover, following mAb administration, host Gag-specific T lymphocyte responses exhibited improved functionality. Virus rebounded in the majority of animals after a median of 56 days when serum mAb titers had declined to undetectable levels, although a subset of animals maintained long-term virologic control in the absence of further mAb infusions. These data demonstrate a profound therapeutic effect of potent neutralizing HIV-1-specific mAbs in SHIV-infected rhesus monkeys as well as an impact on host immune responses. Our findings strongly encourage the investigation of mAb therapy for HIV-1 in humans.
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            Antibodies in HIV-1 vaccine development and therapy.

            Despite 30 years of study, there is no HIV-1 vaccine and, until recently, there was little hope for a protective immunization. Renewed optimism in this area of research comes in part from the results of a recent vaccine trial and the use of single-cell antibody-cloning techniques that uncovered naturally arising, broad and potent HIV-1-neutralizing antibodies (bNAbs). These antibodies can protect against infection and suppress established HIV-1 infection in animal models. The finding that these antibodies develop in a fraction of infected individuals supports the idea that new approaches to vaccination might be developed by adapting the natural immune strategies or by structure-based immunogen design. Moreover, the success of passive immunotherapy in small-animal models suggests that bNAbs may become a valuable addition to the armamentarium of drugs that work against HIV-1.
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              Antibody-mediated immunotherapy of macaques chronically infected with SHIV suppresses viraemia.

              Neutralizing antibodies can confer immunity to primate lentiviruses by blocking infection in macaque models of AIDS. However, earlier studies of anti-human immunodeficiency virus type 1 (HIV-1) neutralizing antibodies administered to infected individuals or humanized mice reported poor control of virus replication and the rapid emergence of resistant variants. A new generation of anti-HIV-1 monoclonal antibodies, possessing extraordinary potency and breadth of neutralizing activity, has recently been isolated from infected individuals. These neutralizing antibodies target different regions of the HIV-1 envelope glycoprotein including the CD4-binding site, glycans located in the V1/V2, V3 and V4 regions, and the membrane proximal external region of gp41 (refs 9-14). Here we have examined two of the new antibodies, directed to the CD4-binding site and the V3 region (3BNC117 and 10-1074, respectively), for their ability to block infection and suppress viraemia in macaques infected with the R5 tropic simian-human immunodeficiency virus (SHIV)-AD8, which emulates many of the pathogenic and immunogenic properties of HIV-1 during infections of rhesus macaques. Either antibody alone can potently block virus acquisition. When administered individually to recently infected macaques, the 10-1074 antibody caused a rapid decline in virus load to undetectable levels for 4-7 days, followed by virus rebound during which neutralization-resistant variants became detectable. When administered together, a single treatment rapidly suppressed plasma viraemia for 3-5 weeks in some long-term chronically SHIV-infected animals with low CD4(+) T-cell levels. A second cycle of anti-HIV-1 monoclonal antibody therapy, administered to two previously treated animals, successfully controlled virus rebound. These results indicate that immunotherapy or a combination of immunotherapy plus conventional antiretroviral drugs might be useful as a treatment for chronically HIV-1-infected individuals experiencing immune dysfunction.

                Author and article information

                Infectious Diseases and Translational Medicine
                Infect. Dis. Transl. Med.
                Infect. Dis. Transl. Med.
                International Biological and Medical Journals Publishing House Co., Limited (Room E16, 3/f, Yongda Commercial Building, No.97, Bonham Stand (Sheung Wan), HongKong )
                10 July 2016
                10 July 2016
                : 2
                : 2
                : 60-68
                From Duke University Medical Center, Durham, NC 27710, USA; School of Life Sciences and National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, Jilin 130012, China
                Author notes
                Correspondence to: Feng Gao, MD. Duke University Medical Center, 303 Research Drive, 244 Sands Bldg, DUMC 102359, Durham, NC 27710. Phone: 1-919-668-6433; Email: fgao@ 123456duke.edu .

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                Page count
                Figures: 0, Tables: 0, References: 102, Pages: 9

                Medicine,Infectious disease & Microbiology
                Neutralization breadth,Escape,Broadly neutralizing antibody,Byproduct,Antibody maturation,HIV-1


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