Cellular immune activation in cerebrospinal fluid from ugandans with cryptococcal meningitis and immune reconstitution inflammatory syndrome

David B. Meya, Samuel Okurut, Godfrey Zziwa, Melissa A. Rolfes, Melander Kelsey, Steve Cose, Moses Joloba, Prossy Naluyima, Brent E. Palmer, Andrew Kambugu, Harriet Mayanja-Kizza, Paul R. Bohjanen, Michael A. Eller, Sharon M. Wahl, David R. Boulware, Yuka C. Manabe, Edward N. Janoff

Research output: Contribution to journalArticle

Abstract

Background. Human immunodeficiency virus (HIV)-associated cryptococcal meningitis (CM) is characterized by high fungal burden and limited leukocyte trafficking to cerebrospinal fluid (CSF). The immunopathogenesis of CM immune reconstitution inflammatory syndrome (IRIS) after initiation of antiretroviral therapy at the site of infection is poorly understood. Methods. We characterized the lineage and activation status of mononuclear cells in blood and CSF of HIV-infected patients with noncryptococcal meningitis (NCM) (n = 10), those with CM at day 0 (n = 40) or day 14 (n = 21) of antifungal therapy, and those with CM-IRIS (n = 10). Results. At diagnosis, highly activated CD8+ T cells predominated in CSF in both CM and NCM. CM-IRIS was associated with an increasing frequency of CSF CD4+ T cells (increased from 2.2% to 23%; P =. 06), a shift in monocyte phenotype from classic to an intermediate/proinflammatory, and increased programmed death ligand 1 expression on natural killer cells (increased from 11.9% to 61.6%, P =. 03). CSF cellular responses were distinct from responses in peripheral blood. Conclusions. After CM, T cells in CSF tend to evolve with the development of IRIS, with increasing proportions of activated CD4+ T cells, migration of intermediate monocytes to the CSF, and declining fungal burden. These changes provide insight into IRIS pathogenesis and could be exploited to more effectively treat CM and prevent CM-IRIS.

Original languageEnglish (US)
Pages (from-to)1597-1606
Number of pages10
JournalJournal of Infectious Diseases
Volume211
Issue number10
DOIs
StatePublished - May 15 2015

Keywords

  • Cell activation
  • Cerebrospinal fluid
  • Cryptococcal meningitis
  • Cryptococcus
  • HIV
  • Immune responses

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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  • Cite this

    Meya, D. B., Okurut, S., Zziwa, G., Rolfes, M. A., Kelsey, M., Cose, S., Joloba, M., Naluyima, P., Palmer, B. E., Kambugu, A., Mayanja-Kizza, H., Bohjanen, P. R., Eller, M. A., Wahl, S. M., Boulware, D. R., Manabe, Y. C., & Janoff, E. N. (2015). Cellular immune activation in cerebrospinal fluid from ugandans with cryptococcal meningitis and immune reconstitution inflammatory syndrome. Journal of Infectious Diseases, 211(10), 1597-1606. https://doi.org/10.1093/infdis/jiu664