The present results document the potential of the antiviral agent
PMPA to activate production of several cytokines. The concentrations of
IL-1
, IL-10, and TNF-
and the chemokines RANTES and MIP-1
have
been found to be substantially increased in supernatants of mouse
macrophages cultured 5 h in the presence of PMPA (Fig. 2). Their secretion was enhanced in a
dose-dependent manner, the stimulatory effects being apparent starting
with 25 µM PMPA. This concentration equals 7.2 µg/ml, which is very
close to the maximum concentration of drug in serum determined in
HIV-infected humans after the infusion of 3 mg/kg/day
(17). Incidentally, similar maximum concentrations of drug
in serum have been observed after intravenous dosing of other acyclic
nucleotide analogues such as cidofovir and adefovir applied in doses of
3 mg/kg (15). It may be presumed that even higher in vitro
concentrations of PMPA (up to 100 µM) are relevant to expected peak
serum levels that can be generated by substantially enhanced doses (20 to 30 mg/kg) given to SIV-infected macaques (50, 51, 54).
Production of IL-12 p70, IL-13, and IFN-
remained uninfluenced. The
stimulatory effects PMPA are characterized by a dose-dependent mode of
action and rapid onset. Enhanced levels of IL-10 and TNF-
are
detectable as early as 2 h following the 50 µM PMPA exposure
(Fig. 3). Other cytokines, stimulated by
PMPA, occurred at the 5-h interval. The peak concentrations differed
greatly among cytokines, however. They were reached at 5 h (IL-10
and MIP-1
), 12 h (IL-1
and RANTES), or 24 h (TNF-
).
While IL-1
, IL-10, and MIP-1
declined rapidly thereafter,
elevated concentration of TNF-
and RANTES persisted for the whole
observation period of 48 h. Rapid appearance of PMPA-induced IL-10
is in contrast with its delayed secretion with respect to secretion of
many other cytokines, including TNF-
, that are induced by various
immune stimuli like lipopolysaccharide (39). It has been
found that 30- to 60-min pulsing of macrophages with PMPA is sufficient
to trigger the production of cytokines (TNF-
and RANTES). The longer
the prewash (i.e., pulsing) cultivation period was, the higher the
secretion of cytokines achieved during the consecutive postwash 5 h later was (Fig. 4). This pattern of the action might reflect the ability of PMPA to cross the cell membrane and reach a critical intracellular concentration. Whether or
not PMPA has to be phosphorylated to acquire immunomodulatory properties remains unclear, however.
In response to in vitro PMPA exposure, splenocytes could be activated
as well, as shown by increased production of chemokines RANTES and
MIP-1
(but not of other test cytokines, including IL-2) at
intervals of 24 and 48 h (Fig. 5).
Importantly, RANTES also was augmented in the human promonocyte cell
line U937 (Fig. 6). Furthermore, PMPA was
found to be effective under in vivo conditions in mice. Applied as a
single dose or repeatedly on 5 consecutive days (5 mg/kg,
subcutaneously), it increased concentration of RANTES and TNF-
in
serum. Also, the levels of IL-10 were greatly enhanced, but only after
the single dose of PMPA (Fig. 7).
The transduction pathways and transcriptional mechanisms underlying the
immunostimulatory effects of PMPA are presently under investigation.
Herein, we have focused on discussing the possible relevance of the
cytokine- and especially chemokine-enhancing potential to the
established antiviral effectiveness of PMPA. It should be stressed that
all cytokines that have been found to be stimulated by PMPA are known
to influence viral immunity, including defense mechanisms against
retroviruses, notably HIV.
The major role in therapeutic approaches against HIV is generally
considered to be played by
-chemokines. The data accumulated so far
suggest that RANTES and MIP-1
and -1
are prominent inhibitors of
HIV infection of both T cells (11, 22, 62) and macrophages (8, 18, 63). Another antiviral agent, very efficient in many viral infections, is TNF-
. However, it has been found either to
stimulate (23, 45) or inhibit (38, 60) HIV
infection. Anti-HIV activity of TNF-
may be related to the chemokine
system, because TNF-
can delay and down-modulate expression of CCR5
receptor in human monocytic cells (38) and in peripheral
blood lymphocytes, particularly in synergism with IL-13
(2). This action may be at least partially mediated by
RANTES and MIP-1
and -1
themselves (33). Most
reports support the view on the inhibitory effects of IL-10 upon HIV
infection (35, 48, 49, 59), though it occasionally exerts
the opposite effect. Namely, IL-10 was found to reduce the ability of
CD8+ from HIV-infected patients to suppress HIV
replication (4) and to enhance cytokine-induced HIV-1
expression in monocytes (58) and in T cells
(46). The data on the effects of IL-1 suggest that it
rather up-regulates HIV infection (13, 44). With
respect to the ability of IL-1
to stimulate secretion of RANTES and
MIP-1
and -1
(41), the possibility that under some conditions this cytokine also could suppress entry of HIV in cells cannot be excluded.
Obviously, the interference of certain cytokines with replication of
viruses, notably with HIV, is ambiguous. The ultimate direction of the
action may be governed by multiple functional interactions among them.
Noteworthy, anti-inflammatory IL-10 and pro-inflammatory TNF-
are
frequently produced concomitantly upon various immune stimuli, and they
can reciprocally influence secretion of each other, as well as
secretion of many other cytokines. Thus, TNF-
enhances expression of
IL-10 (57) and IL-1
(21), while IL-10 in
turn inhibits production of both TNF-
and IL-1
(19). TNF-
also is a potent activator of secretion of chemokines RANTES and MIP-1
/
(61). Synthesis of them has been found
either uninfluenced (61) or inhibited by IL-10
(34). Biological actions of TNF-
are influenced by the
capability of IL-10 to modify both negatively and positively expression
of TNF-
receptor (37). Furthermore, IL-10 enhances
expression of a natural antagonist of IL-1, i.e., IL-1Ra
(9), which has been suggested to have a perspective in
treatment of HIV infection (13).
Altogether, the ability of cytokines to regulate virus infectivity
and/or disease progression depends primarily on the mode of their
intrinsic immune potential. Cytokines such as TNF-
and IL-10 reduce
HIV infection at the stage of virus replication. Chemokines, e.g.,
RANTES and MIP-1
mainly function as inhibitors of the virus entry,
though some of them, namely macrophage-derived chemokine may suppress
HIV replication as well (14). The ultimate effect results
undoubtedly from an integration of synergistic and antagonistic actions
of individual cytokines.
Herein we document that PMPA (tenofovir) stimulates production of
several cytokines that interfere with HIV replication (TNF-
, IL-10,
and IL-1
) and chemokines (RANTES and MIP-1
) that inhibit entry of
HIV in cells. The data provide new insights contributing to a more
complex understanding of mechanisms of PMPA protective effects against
immunodeficiency virus infection. Ancillary to the antimetabolic
activity, which is the main mode of antiviral effectiveness of various
acyclic nucleoside phosphonates, immunomodulatory potential, especially
chemokine-stimulatory potential, of the drug could be of therapeutic
importance. The present findings favor the view that PMPA could
become a promising candidate for therapeutic exploitation in anti-HIV
preventive medicine.
This work was supported by grant 305/00/0048 and 203/96/K001 from
the Grant Agency of the Czech Republic, and by Gilead Sciences (Foster
City, Calif.).
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