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Copyright © 1999, The National Academy of Sciences Medical Sciences Quantification of CD4, CCR5, and CXCR4 levels on lymphocyte subsets, dendritic cells, and differentially conditioned monocyte-derived macrophages *Department of Pathology and Laboratory Medicine, and ‡Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104; and †The Wistar Institute, 3601 Spruce Street, Philadelphia, PA §To whom reprint requests should be addressed at: Department of Pathology and Laboratory Medicine, 807 Abramson, 34th and Civic Center Boulevard, Philadelphia, PA 19104. e-mail: doms/at/mail.med.upenn.edu. Edited by Anthony S. Fauci, National Institute of Allergy and Infectious Diseases, Bethesda, MD, and approved February 24, 1999 Received January 12, 1999. This article has been cited by other articles in PMC.Abstract CCR5 and CXCR4 are the major HIV-1 coreceptors for R5 and X4 HIV-1 strains, respectively, and a threshold number of CD4 and chemokine receptor molecules is required to support virus infection. Therefore, we used a quantitative fluorescence-activated cell sorting assay to determine the number of CD4, CCR5, and CXCR4 antibody-binding sites (ABS) on various T cell lines, T cell subsets, peripheral blood dendritic cells (PBDC), and monocyte-derived macrophages by using four-color fluorescence-activated cell sorting analysis on fresh whole blood. Receptor levels varied dramatically among the various subsets examined and typically varied from 2- to 5-fold between individuals. CCR5 was expressed at much higher levels in CD4+/CD45RO+/CD62L-true memory cells compared with CD4+/CD45RO+/CD62L+ cells. Fresh PBDC had the highest number of CCR5 ABS among the leukocyte subsets examined but had few CXCR4 ABS, affording a strategy for sort-purifying PBDC. In vitro maturation of PBDC resulted in median 3- and 41-fold increases in CCR5 and CXCR4 ABS, respectively. We found that macrophage colony-stimulating factor caused the greatest up-regulation of both CCR5 and CXCR4 on macrophage maturation (from ≈5,000 to ≈50,000 ABS) whereas granulocyte-macrophage colony-stimulating factor caused a marked decrease of CXCR4 (from ≈5,000 ABS to <500) while up-regulating CCR5 expression (from ≈5,000 to ≈20,000 ABS). Absolute ABS for CD4 and the major HIV-1 coreceptors serve as a more quantitative measure of cell surface expression, and we propose that this be used for future studies looking at the modulation of CD4 or chemokine receptor expression by cytokines, HIV-1 infection, or receptor polymorphisms. HIV-1 entry into cells requires sequential interactions between envelope (Env), CD4, and a coreceptor (1–3). Epidemiological and experimental evidence indicates that CD4 and coreceptor levels affect the efficiency of viral entry and that this may have consequences for the pathogenesis of HIV disease. Individuals homozygous for the Δ32-ccr5 allele have no surface expression of CCR5 and are highly protected against HIV-1 infection, whereas Δ32-ccr5 heterozygotes have lower CCR5 expression levels and progress to AIDS more slowly than individuals without this allele (reviewed in ref. 4). Individuals homozygous for a mutation in the SDF-1 gene also progress more slowly to clinical AIDS (5), perhaps because of increased expression of SDF-1 and modulation of CXCR4 expression. Indeed, in vitro studies have shown that CD4, CCR5, and CXCR4 expression levels impact the efficiency of viral entry (6–8). Chemokine receptor expression in both peripheral blood lymphocytes and monocyte-derived macrophages (MDM) is sensitive to cytokine-mediated modulation (reviewed in ref. 9). Because the presence of CD4 and either CCR5 and/or CXCR4 on specific leukocytes and MDMs designates these cells as potentially susceptible targets for viral infection, it is important to determine quantitatively the amount of CD4 and the major coreceptors present on various leukocyte and monocyte subpopulations to help clarify the roles these cells may play in the dynamics of viral replication in vivo and to rigorously address the effects of cytokines on coreceptor expression. In this report, we used a quantitative fluorescence-activated cell sorting (QFACS) assay that relies on a series of precalibrated beads that can bind a fixed number of mouse IgG molecules to determine the absolute number of CD4 and coreceptor molecules on the surface of numerous leukocyte subsets, MDMs, and peripheral blood dendritic cells (PBDC). By using this approach, we found great variation in chemokine receptor expression in T cell lines and lymphocyte subsets, in immature versus mature dendritic cells (DC), and in MDM depending on culture conditions. These results provide insight into the types of cells most susceptible to infection by R5 and X4 viruses and an understanding of the discrepancies in the literature regarding CD4 and coreceptor expression in cultured MDM. MATERIALS AND METHODS Cell Lines and Infection Studies. All cell lines were obtained from the American Type Culture Collection or the National Institutes of Health AIDS Reference and Reagent Program (GHOST cells). All cell lines were maintained according to the supplier’s recommendations. Pseudotyped luciferase reporter viruses were used for infection studies as described (10). Antibodies. Phycoerythrin-conjugated anti-CD4 (Q4120) was obtained from Sigma. Allophycocyanin-conjugated anti-CD4 (S3.5), anti-CD8 (3B5), anti-HLA-DR (TU36), FITC-conjugated anti-CD11c, and tricolor-conjugated anti-CD3, anti-CD14 (Tuk4), anti-CD16 (3G8), anti-CD19 (SJ35-C1), anti-CD45RA (MEM56), anti-CD45RO (UCHL1), anti-CD56 (NKI-nbl-1), anti-CD62L (DREG-56), anti-CD83 (HB15), and anti-HLA-DR (TU36) were obtained from Caltag (South San Francisco, CA). Cychrome-conjugated anti-CD26, phycoerythrin-conjugated anti-CCR5 (2D7), and anti-CXCR4 (12G5) were obtained from PharMingen. FITC-conjugated CD1a (B-B5) was obtained from BioSource International (Camarillo, CA). FACS Strategy. We used phycoerythrin (PE)- and allophycocyanin (APC)-conjugated mAbs for quantification because they do not self-quench at high density (11, 12). Tricolor (Tri) and FITC were the two other fluorochromes used in our four-color FACS analysis. For peripheral blood mononuclear cells (PBMCs), the following panels were used for each donor: (i) CD62L-FITC, CCR5-PE, CD45RO-Tri, CD4-APC; (ii) CD62L-FITC, CXCR4-PE, CD45RA-Tri, CD4-APC; (iii) CD19-FITC, CCR5-PE, CD56-Tri, CD4-APC; (iv) CD19-FITC, CXCR4-PE, CD56-Tri, CD8-APC; (v) CD4-FITC, CCR5-PE, CD26-Tri, HLA-DR-APC; and (vi) CD8-FITC, CXCR4-PE, CD26-Tri, HLA-DR-APC. The strategy for identifying PBDC is illustrated in Fig. Fig.3.3
QFACS. QFACS was performed by converting the mean channel fluorescence into antibody-binding sites (ABS) by using a standardized microbeads kit (Sigma). This is a mixture of five microbead populations of uniform size, coated with goat anti-mouse antibodies, that have differing abilities to bind mouse antibodies (one population does not bind mouse IgG and is used as a control). Q4120, PE-conjugated anti-CD4 (7 μl); 2D7, PE-conjugated anti-CCR5 (12.5 μl); and 12G5, PE-conjugated anti-CXCR4 (10 μl), were added at saturating amounts to ≈100,000 beads. Beads were incubated with the same concentration of mAb for 1 hour and processed identically as the samples being quantitated. The binding capacities of the stained microbeads were then regressed against the corresponding geometric mean of each bead population, and the MFI of the antigen analyzed on the sample cells was converted to ABS per cell by comparison with the regression curve generated. The MFI of the isotype control for each experiment was converted to ABS and subtracted from the ABS value obtained with the experimental sample. The parameters of the regression curve permit a determination of the linear deviation and hence provide an estimate of the degree of confidence one should have in the values generated. Regression curves were only acceptable if r2 >0.995 and the deviation from linearity was <5%. Additional details on the relationship between ABS and mean fluorescence intensity values can be obtained from the manufacturer (Sigma). Statistics. Student’s t test was used to determine any significant differences between expression levels among the various cell types. The simultaneous analysis of multiple markers on the same donor allowed a paired t test two-tailed distribution analysis to be applied on analysis of the leukocyte subsets. For analysis of expression levels on macrophages, an unpaired t test (two-sample unequal variance) was used because data on time points from six to eight different donors from five independent experiments were combined in the analysis. RESULTS Choice of Antibodies Used for Quantitative Studies. Seven transmembrane domain receptors may exist in multiple conformational states, which can affect exposure of specific antigenic epitopes (16). Because QFACS determines the number of ABS on a cell rather than the physical number of cell surface molecules, we selected mAbs that efficiently block Env–receptor interactions. mAb Q4120 competes with gp120 binding on CD4 (13) whereas the epitopes recognized by 2D7 and 12G5 overlap with both the chemokine and HIV-1 gp120 binding sites on CCR5 and CXCR4, respectively (14, 15). Furthermore, in our recent analysis of the antigenic structure of CCR5, we found that 2D7 reacts with CCR5 more efficiently than any of the 18 mAbs examined (16). Quantification of CD4, CCR5, and CXCR4 on T Cell Lines. There was marked variation of CD4 and CXCR4 levels among T cell lines commonly used to propagate HIV-1 (Fig. (Fig.1).1
CD4, CCR5, and CXCR4 Levels on Fresh Peripheral Blood Leukocytes. Various cytokines and cell purification protocols can affect coreceptor expression levels. Therefore, we determined the number of CD4, CCR5, and CXCR4 ABS on fresh unstimulated PBMC from healthy donors (wild-type for CCR5) to determine the basal levels of coreceptor expression before any exogenous treatment. Four-color FACS analysis was performed on stained whole blood after selective red blood cell lysis, thus avoiding Ficoll purification, which can acutely affect chemokine receptor expression (10). Table 1 shows the mean percent CCR5/CXCR4-positive cells and the median CCR5/CXCR4 ABS on each leukocyte subset. In general, CCR5 and CXCR4 levels varied from 2- to 5-fold between donors, depending on the subset examined. In the lymphocyte gate and its various subsets, CCR5 could usually be gated into distinctly positive and negative populations. In contrast, the expression of CXCR4 was heterogenously spread through the lymphocyte gate and many of its subsets. Therefore, the ABS values for CCR5 and CXCR4 on both total lymphocytes and on the CXCR4- or CCR5-positive gates are shown (CXCR4+ or CCR5+, see Fig. Fig.22
We confirmed that CCR5 and CXCR4 were expressed predominantly on CD4+/CD45RO+ and CD4+/CD45RA+ cells, respectively (refs. 18 and 19; Fig. Fig.22 Significant amounts of CXCR4 were expressed on CD19+ B cells (≈7,500 ABS) with almost undetectable levels present on CD56+ NK cells (<250 ABS). The converse was true for CCR5 on B cells (≈250 ABS) and NK cells (≈7,000 ABS). CD26 and HLA-DR, considered as markers for acute activation (20), were used to determine whether coreceptor expression differed depending on the activation status of the cell. Although CD26 is not a specific marker for T cell activation, our results show that both CCR5 and CXCR4 were expressed at significantly higher levels in CD26+ vs. CD26− lymphocytes (P < 0.0001 for both). CCR5 and CXCR4 also were differentially expressed on HLA-DR+ and HLA-DR− cells, with CCR5 being lower and CXCR4 higher on HLA-DR+ cells (P < 0.0001 for both cases). However, because HLA-DR and CD26 expression may coincide with CD45 isoform expression (memory vs. naive), in addition to being markers of different activation states (i.e., expression of HLA-DR and CD26 are almost mutually exclusive), the relevance of these subset differences in CCR5 and CXCR4 expression awaits further refined analysis. CD4 levels were uniform among lymphocyte subsets that were CD4+. Of interest, CD4 ABS were higher on CCR5+ than CCR5− lymphocytes from all 12 donors (P < 0.001). The mean lymphocyte CD4 ABS value (65,339 ± 6,049) was equivalent to that reported in the literature with the same whole blood lysis protocol (21). Fresh PBDC Can Be Identified by High CCR5 Expression. There is evidence that mucosal DC are one of the initial targets of HIV-1 infection and that they help transmit the virus to the T lymphocyte pool (reviewed in ref. 22). Although there have been numerous studies on chemokine receptor expression in cultured monocyte-derived DC or explanted, skin-derived DC (23–26), it is also important to determine the levels of CD4 and coreceptor expression on fresh unstimulated PBDC, generally known to be immature DC (27, 28) that may serve as the initial targets of infection when they target the mucosa, or the responsible agent for transmitting virus when they retarget the lymph node. The strategy for phenotypically defining PBDC was modified from published protocols (ref. 28; Fig. Fig.3).3 Because CCR5 was so highly expressed on PBDC, we asked whether CCR5 in combination with lineage markers could be used to correctly identify PBDCs. Fig. Fig.33 Modulation of CD4, CCR5 and CXCR4 Levels on MDM. MDM are usually generated by culturing monocytes in the presence of human sera or with the addition of macrophage colony-stimulating factor (M-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF). There have been a multitude of studies examining the effects of these cytokines on the replication of HIV and on the expression of CCR5 and CXCR4 (refs. 9, 31, and 32, and refs. therein). However, donor variability and greatly increased autofluorescence of MDM complicates interpretation of any studies regarding the variation in coreceptor levels as MDM mature. However, the QFACS assay is relatively immune to the problem of increasing autofluoresence because the background at every stage always is converted to an ABS value that is subtracted from the value obtained with the cognate antibody. MDM were matured for 7 days in the presence of human serum alone or with the addition of M-CSF or GM-CSF. ABS were determined over time for CD4, CCR5, and CXCR4. Although there was considerable donor variability (Fig. (Fig.4),4
DISCUSSION In vitro studies indicate that R5 and X4 viral strains can have differential requirements for CD4 and coreceptor levels (6, 7). Platt et al. (8) determined that, where CD4 levels were “limiting” (≈104), levels of CCR5 below a threshold of 1–2 × 104 molecules significantly affected the efficiency of infection. However, when CD4 levels were high (≈4.5 × 105), minimal levels of CCR5 (2 × 103) supported maximal viral infectivity. In addition, primary X4-viruses appear more dependent on CD4 levels than lab-adapted strains (7, 8). Considering that CD4 antigen density on PBMC is <105 molecules per cell (ref. 21; Fig. Fig.2),2 We confirmed that CCR5 and CXCR4 were differentially expressed on memory vs. naive T cells (18, 19), but we also discovered significant differences in coreceptor expression when CD62L was used to define precisely the true naive (RA+/62L+) and memory (RO+/62L−) subsets (see Table 1) (33–35). Specifically, whereas CCR5 was expressed only on CD45RO+ memory cells, the order of mean CXCR4 ABS was RA+/62L+ > RA+/62L− ≈ RO+/62L+ > RO+/62L− (Table 1). Memory T cells are the main responders to B-chemokines (36), and the high expression of CCR5 on true quiescent memory cells (RO+/62L−) is consistent with their role in being highly responsive to chemokine gradients generated at sites of immune and inflammatory reactions (37). Although there are reports indicating that CD45RA+ naive T cells are less susceptible to virus infection in vitro (33, 38), it remains to be determined whether these subpopulations in vivo differ in their susceptibility to infection by either R5 or X4-viruses. We also found that, for most peripheral blood lymphocytes subsets, CCR5 and CXCR4 levels varied by 2- to 5-fold between donors. Immature DC in blood (PBDC) that migrate to body mucosa have been posited to be the initial targets of HIV-1 infection (39), preferentially via R5 viruses (24, 40). Although there have been reports describing the expression of chemokine receptors on in vitro cultured DC or explanted Langerhans cells (23–26), the expression of chemokine receptors on fresh uncultured PBDC has received scant attention. Our findings that PBDC have the highest number of CCR5 ABS among all leukocyte subsets examined is consistent with the putative role of DC as being the sentinel targets of HIV infection and may contribute to the preferential transmission of R5 viruses. However, the vanishingly small number of PBDC has made it difficult to determine whether these cells are infected with HIV in vivo. In addition, whether this level of CCR5 is maintained on DC interdigitation in the mucosa is unknown. However, on in vitro maturation in media with 10% FCS, the number of CXCR4 ABS increased by ≈40-fold with a 2- to 3-fold increase in CCR5 ABS. This pattern of CXCR4 up-regulation on DC maturation is similar to that seen with in vitro cultured MDDC (data not shown). However, the moderate increase in CCR5 seen in our mature PBDC is contrary to what has been reported in the literature (26). This discrepancy may be due to the culture systems employed. Indeed, we also saw down-regulation of CCR5 with maturation of our MDDC (30,603 ± 1,224 to 18,023 ± 720 ABS). But our fresh PBDC were matured in the presence of all of the leukocyte subsets present in peripheral blood, as opposed to cytokine-cultured MDDC and explanted skin-derived Langerhan cells. These mature PBDC may represent a novel subset of DC that warrants further characterization. The small but significant differences in CCR5 expression between the CD11c+ and CD11c− subgroups of PBDC (P = 0.008) also lends credence to the hypothesis that CD11c (+) or (−) DC constitute functionally different subsets of DC (28). We also suggest that the high expression of CCR5 on fresh PBDC allows an alternative way for sort-purifying PBDC for analysis of uncultured blood-derived DC. The use of one (CCR5) versus two (HLA-DR and CD11c) positive markers may have advantages of preserving more of the native DC phenotype for in vitro studies. Macrophages are also important targets for HIV-1 infection, although the literature is inconsistent about whether CD4 is down- (41–43) or up-regulated (44–46) on macrophage maturation and whether CXCR4 can be used for viral entry in a macrophage context (41, 43, 46–48). Part of the difficulty in monitoring CD4 and coreceptor expression is due to the inconsistent accounting for the increased autofluoresence on macrophage maturation and the fact that MDMs can be obtained in several ways. We found that M-CSF was the most potent inducer of CD4, CCR5, and CXCR4 expression, whereas GM-CSF was the most effective suppressor of CXCR4 expression. Human sera alone had intermediate effects on CD4 and coreceptor expression. We also determined that absolute CD4 ABS actually increased with macrophage maturation (M-CSF > GM-CSF ≈ no treatment). The significant donor variability present in MDM may also explain some of the inconsistent results in the literature regarding the restrictive tropism of X4 viruses for MDM (47–50). Quantifying the levels of CD4 and CXCR4 under defined culture conditions would be useful when revisiting the issue of X4 viral restriction in MDM. In conclusion, we have obtained baseline values for absolute CD4, CCR5, and CXCR4 ABS on various subsets of peripheral blood lymphocytes, PBDC, and differentially conditioned MDM. Most peripheral blood lymphocytes and DC subsets examined had CD4 levels close to the threshold (≈104) number of molecules where CCR5 levels become important for determining the efficiency of viral entry (8). However, examination of peripheral blood may not reflect changes that occur within secondary lymphoid tissues, where the bulk of active viral replication takes place. Therefore, the same QFACS assay should be used to examine leukocyte populations from lymph nodes and tonsillar tissues. In addition, reexamining coreceptor levels in HIV disease states using this technique, especially in light of the various promoter polymorphisms in ccr5 known to be correlated with disease progression (51, 52), would increase our understanding of the role of coreceptor regulation in HIV-1 pathogenesis. Acknowledgments We thank Joe Rucker and Ben Doranz for helpful comments. B.L. was supported by a Measey Foundation Fellowship for Clinicians (Wistar Institute) and by National Institutes of Health Grant K08 HL03923-01. L.J.M. was supported in part by National Institutes of Health Grants AI43206 and AI 44304. D.W. was supported by a grant from the W. W. Smith Charitable Trust. R.W.D. was supported by National Institutes of Health Grant R01 40880. ABBREVIATIONS Footnotes This paper was submitted directly (Track II) to the Proceedings Office. References 1. 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Curr Opin Immunol. 1997 Aug; 9(4):551-62.
[Curr Opin Immunol. 1997]Emerg Infect Dis. 1997 Jul-Sep; 3(3):261-71.
[Emerg Infect Dis. 1997]Science. 1998 Jan 16; 279(5349):389-93.
[Science. 1998]J Virol. 1994 Apr; 68(4):2570-7.
[J Virol. 1994]J Virol. 1998 Apr; 72(4):2855-64.
[J Virol. 1998]J Virol. 1998 Sep; 72(9):7450-8.
[J Virol. 1998]Cytometry. 1996 Nov 1; 25(3):271-9.
[Cytometry. 1996]J Biol Chem. 1999 Apr 2; 274(14):9617-26.
[J Biol Chem. 1999]J Exp Med. 1990 Oct 1; 172(4):1233-42.
[J Exp Med. 1990]J Virol. 1999 Apr; 73(4):2752-61.
[J Virol. 1999]J Exp Med. 1997 Oct 20; 186(8):1373-81.
[J Exp Med. 1997]J Immunol. 1998 Jan 15; 160(2):877-83.
[J Immunol. 1998]J Virol. 1998 Sep; 72(9):7450-8.
[J Virol. 1998]Proc Natl Acad Sci U S A. 1997 Mar 4; 94(5):1925-30.
[Proc Natl Acad Sci U S A. 1997]J Exp Med. 1997 May 5; 185(9):1681-91.
[J Exp Med. 1997]J Immunol Methods. 1995 Jun 28; 183(2):267-77.
[J Immunol Methods. 1995]Immunobiology. 1998 Mar; 198(5):490-500.
[Immunobiology. 1998]Nat Med. 1997 Dec; 3(12):1369-75.
[Nat Med. 1997]Proc Natl Acad Sci U S A. 1995 Jan 31; 92(3):826-30.
[Proc Natl Acad Sci U S A. 1995]Immunology. 1994 Jul; 82(3):487-93.
[Immunology. 1994]J Immunol. 1995 Oct 15; 155(8):4111-7.
[J Immunol. 1995]J Virol. 1998 Sep; 72(9):7642-7.
[J Virol. 1998]Immunol Rev. 1997 Oct; 159():31-48.
[Immunol Rev. 1997]J Virol. 1994 Apr; 68(4):2570-7.
[J Virol. 1994]J Virol. 1997 Feb; 71(2):873-82.
[J Virol. 1997]J Virol. 1998 Apr; 72(4):2855-64.
[J Virol. 1998]J Immunol Methods. 1995 Jun 28; 183(2):267-77.
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