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High-mobility group box 1 protein induces HIV-1 expression from persistently infected cells

Thierry, Sylvaina; Gozlan, Joëla,c; Jaulmes, Amandinea; Boniface, Rachela; Nasreddine, Nadineb; Strauss, Françoisa; Maréchal, Vincenta

doi: 10.1097/QAD.0b013e3280115b50
Basic Science

Background: Necrosis is a frequent condition during AIDS, notably in organs targetted by opportunistic infections. Soluble factors released by necrotic cells are important for signalling cell damage, but little is known concerning their effect on HIV-1 replication. We focused on HMGB1, an abundant component of the chromatin that is released from necrotic cells and can act as a pro-inflammatory mediator.

Materials and methods: A native form of HMGB1 was obtained from necrotic Hela cells, whereas a purified recombinant HMGB1 was generated in Escherichia coli. ACH-2 and U1 cells were used as models of persistent HIV-1 infection in lymphocytes and monocytes. Reactivation from latency was also investigated ex vivo using peripheral blood mononuclear cells (PBMC) collected from HIV-1-infected patients controlled by HAART. HIV-1 expression was quantified by enzyme-linked immunosorbent assay, real-time reverse transcription–polymerase chain reaction and branched DNA techniques. Flow cytometry and blocking experiments were used to identify the receptor used by HMGB1. Chromatin immunoprecipitation was used to investigate long-terminal repeat activation upon stimulation by HMGB1.

Results: HMGB1 increased HIV-1 transcription in chronically infected cells, a process that did not require de-novo protein synthesis. HIV-1 induction relied on HMGB1 interaction with the receptor for advanced glycation end-products. The activation pathway involved p38 and extracellular signal-related kinase as well as nuclear factor kappa B binding to the HIV-1 promoter. Finally, HMGB1 reactivated HIV-1 from latently infected PBMC collected in aviraemic HIV-infected patients.

Conclusion: This work establishes for the first time a link between necrosis and HIV-1 replication, which involves HMGB1, a soluble mediator released by damaged cells.

From the aUMR 7079, Université Pierre et Marie Curie, France

bINSERM U743, Centre de Recherches Biomédicales des Cordeliers, Paris, France

cLaboratoire de Virologie, Hôpital Saint-Antoine, Paris, France.

Received 10 March, 2006

Revised 28 July, 2006

Accepted 5 September, 2006

Correspondence to Joël Gozlan, UMR 7079, Centre de Recherches Biomédicales des Cordeliers, 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France. Tel: +33 1 49 28 29 36; fax: +33 1 49 28 24 72; e-mail:

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In HIV-infected patients, HAART is effective at halting HIV-1 replication and delaying the progression of AIDS [1]. However, HAART is unable to eradicate HIV totally, because replication-competent viruses persist under therapy in an integrated latent form in several cell types and anatomical sites [2,3]. Resting memory CD4 T lymphocytes are considered to be the main long-term reservoir of HIV in patients controlled by HAART. These cells do not usually release virus unless they are exposed ex vivo to various stimuli, including mitogens [4–6], cytokines [7–9] or phorbol ester [10,11].

The factors that induce HIV reactivation from latently infected cells have yet to be fully identified in vivo. Several pro-inflammatory cytokines that can be produced notably in the context of opportunistic infections are known to promote HIV-1 expression. These include IL-1, IL-6, IL-12 or TNF-α. In addition, soluble factors released by necrotic cells can reach high local concentrations and are thought to be important for immune activation in response to cell damage [12]. However, little is known about their direct effects on HIV replication. This is of particular relevance in the context of AIDS because necrosis is a frequent condition in organs that are targeted by devastating opportunistic diseases. Furthermore, necrosis stimulates the production of pro-inflammatory signals [12] that may in turn increase HIV replication in infected cells [13].

Of a number of molecules released by necrotic cells, we were most interested in high-mobility group box 1 (HMGB1) protein for several reasons. Although HMGB1 was initially purified from calf thymus as an abundant component of the chromatin, it is now recognized as an important pro-inflammatory mediator. Most particularly, HMGB1 can be secreted by macrophages and monocytes stimulated by bacterial lipopolysaccharide, TNF-α or IL-1β. In this form, HMGB1 acts as a delayed pro-inflammatory molecule that plays a central role during lethal endotoxaemia and sepsis [14]. Extracellular HMGB1 induces a large panel of cellular responses, including the production of several pro-inflammatory molecules such as TNF-α, IL-1β and HMGB1 itself. A large amount of HMGB1 can also be passively released from necrotic cells, but not from apoptotic cells [15]. This form of HMGB1 also acts as a soluble mediator because it activates inflammation in response to cell injury [16]. A convergent set of data suggests that HMGB1 could directly affect HIV replication or reactivation in latently infected cells. First, the three known receptors for HMGB1, namely the receptor for advanced glycation end-products (RAGE) [17], and Toll-like receptor (TLR) 2 and 4 [18] are expressed on cells targeted by HIV, such as monocytes/macrophages [18–20], memory and activated CD4 T cells [21], and dendritic cells [22]. Second, the binding of HMGB1 to its receptors induces the activation of mitogen-activated protein kinases (MAPK) in some cells [23–26], which results in the nuclear translocation of nuclear factor kappa B (NF-κB), a major transcriptional activator of HIV-1 [27].

Persistently infected cell lines of monocytic (U1) or lymphocytic (ACH-2) lineages have been used to investigate the molecular mechanisms that control postintegration latency and viral reactivation [28]. We show here for the first time that a soluble extract derived from necrotic cells efficiently stimulates HIV-1 replication in U1 and ACH-2 cells, an effect that is mainly the result of HMGB1. Using a purified recombinant form of HMGB1, we demonstrate that HIV-1 reactivation is a direct consequence of RAGE–HMGB1 interaction and does not require de-novo production of secondary mediators. HIV-1 induction by HMGB1 requires activation of p38 and extracellular signal-related kinase (ERK) MAPK, as well as NF-κB. Finally, HMGB1 was effective at reactivating HIV ex vivo from primary peripheral blood mononuclear cells (PBMC) obtained from HIV-infected patients controlled by HAART for more than 4 years. Altogether, these results target HMGB1 as a potent inducer of HIV-1 reactivation, notably in the context of cell injury.

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Materials and methods

Cells and reagents

ACH-2 and U1 were obtained from the AIDS Research and Reference Reagent Programme. Monocytes were isolated from healthy donors' PBMC after Ficoll–Paque gradient centrifugation, sheep red blood cells rosetting [29] and adhesion. Monocyte-derived macrophages were obtained by growing monocytes for 7 days in the presence of 10 ng/ml macrophage–colony-stimulating factor. Monocytes, monocyte-derived macrophages, U1 and ACH-2 cells were maintained in RPMI medium (Gibco, Eragny, France) supplemented with 10% fetal calf serum, glutamine and antibiotics. Lipopolysaccharide, IL-1β and cycloheximide were obtained from Sigma (Lyon, France). Specific inhibitors of JNK (JNK-i: SP600125, 100 nmol), p38 (p38-i: SB203580, 1 μmol), ERK (ERK-i: PD98059, 10 μmol) and NF-κB (aurin-tricarboxylic acid; ATA, 200 μmol) were purchased from Sigma. HMGB1 immune serum S004 was obtained after rabbit immunization against the peptide PDAAKKGVVKAEK (167–180).

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Necrotic cell extracts

HeLa cells (ATCC CCL2) were lysed by three cycles of freezing and thawing in phosphate-buffered saline (10 million cells per ml) [15]. Cell debris was pelleted by centrifugation and the supernatant was passed through a 0.2 μm membrane filter. The amount of HMGB1 in necrotic extracts, assessed by immunoblot was 7 μg per ml (or per 107 cells). HMGB1 depletion was performed by incubating 0.5 ml of necrotic cell supernatant with 100 μl anti-HMGB1 serum for 16 h at 4°C. Pre-immune serum was used as a control. Immune complexes were removed by incubation in the presence of 75 μl protein G sepharose for 1 h at 4°C under agitation.

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HIV-1 monitoring

p24 antigen and viral genomic RNA were respectively measured by enzyme-linked immunosorbent assay (ELISA; HIV-1 p24 Innogenetics ELISA Kit; Ingen, Rungis, France) and the branched DNA technique (Versant HIV-1 RNA 3.0 assay; Bayer, Puteaux, France), according to the manufacturer's procedure. A real-time reverse transcription–polymerase chain reaction (PCR) assay was used to quantify multiply spliced and unspliced viral RNA, as previously described [30].

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Purification of the recombinant human HMGB1 protein

Recombinant human HMGB1 was purified from Escherichia coli BL21(DE3) pLysS transformed with pET15b-6His-HMGB1. The expression vector encoded for the full-length human HMGB1 fused to a polyhistidine tag at its N-terminus. Protein expression and purification were performed as previously described [31]. The removal of contaminanting bacterial lipopolysaccharide was performed using Triton X-114, as described [31]. Residual lipopolysaccharide, quantified using the E-toxate assay (Sigma) was less than 100 fg per microgram rhHMGB1.

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Immunoblotting assays

Total proteins were separated by 12% SDS-PAGE and transferred onto a nitrocellulose membrane (Hybond nitrocellulose; Amersham Biosciences, Saclay, France). Membranes were incubated for 1 h with blocking buffer (Tris-buffered saline, 0.2% Tween, 5% milk), washed and incubated for 1 h with a 1: 2000 dilution of anti-HMGB1 serum or a 1: 400 dilution of anti-RAGE antibodies (Santa Cruz, Heidelberg, Germany). Detection of the primary antibodies was performed using a 1: 2000 dilution of a donkey anti-rabbit immunoglobulin-horseradish peroxidase conjugate (Amersham). Immune complexes were detected using ECL detection reagents (Amersham).

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Measurement of TNF-α production

TNF-α release was measured using the human TNF-α ELISA kit (Peprotech, London,UK) according to the manufacturer's procedure.

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Fluorescence-activated cell sorter analysis of HMGB1 membrane receptors

Direct immunofluorescence was performed using phycoerythrin-conjugated anti-TLR-2 and FITC-conjugated anti-TLR-4. RAGE detection was performed using a rabbit-anti-RAGE and an FITC-conjugated goat-anti-rabbit antibody. All antibodies were purchased from Santa Cruz. The expression of cell surface molecules was analysed by flow cytometry (FACSCalibur; Becton Dickinson, Le Pont de Claix, France).

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Chromatin immunoprecipitation assay and nuc-1 analysis

The chromatin immunoprecipitation assay was described previously [30], using an antibody against NF-κB p50 (Santa Cruz SC114X). A non-immune rabbit IgG was used as a negative control. The immunoprecipitated as well as the input DNA were subjected to quantification by real-time PCR in the nuc-1 region of the HIV-1 long-terminal repeat (LTR) [30]. Results are expressed as the fraction of immunoprecipitated DNA for each condition.

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Patients and ex-vivo experiments

Six HIV-1-infected volunteers under antiretroviral therapy were selected for good treatment compliance and a viral load of less than 50 copies/ml for more than 4 years. These patients had received HAART for at least 5 years, a treatment that was unmodified for more than one year. The antiretroviral therapy associates two nucleoside analogue reverse-transcriptase inhibitors and either a non-nucleoside analogue reverse-transcriptase inhibitor or a protease inhibitor. The median CD4 T-cell count of the volunteers was 723 cells/μl (minimum 419; maximum 961). After informed consent, 50 ml peripheral blood were drawn and PBMC were isolated by Ficoll gradient centrifugation. HIV-1 cultures were performed from 2.106 CD8 depleted (Miltenyi Biotec, Paris, France) PBMC, in the presence or absence of recombinant HMGB1. Cultures were maintained for 35 days in RPMI medium supplemented with 10% fetal calf serum, glutamine and antibiotics, with or without IL-2 (50 ng/ml; Roche, Meylan, France). Half medium was renewed every week. Cells activated by phytohaemagglutinin A (PHA) (2.5 μg/ml; Sigma) and IL-2 were used as a positive control for HIV-1 outgrowth. HIV-1 reactivation was monitored every week by quantification of HIV RNA in cell culture supernatants, using the bDNA technique.

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Statistical evaluation

Unless specified, values are expressed as the mean of at least three independent experiments. Confidence intervals are presented in the figures, with a P value of less than 0.05 or less than 0.01 as indicated.

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HMGB1 released from necrotic cells activates HIV-1 expression

To determine the impact of an endogenous signal associated with cell injury on HIV-1 expression, we generated soluble necrotic extracts from HeLa cells. Western blot analysis confirmed the presence of large amounts of HMGB1 in these extracts (Fig. 1a). HMGB1-depleted extracts were obtained by two rounds of immunodepletion using specific anti-HMGB1 antibodies.

Fig. 1

Fig. 1

HMGB1 has previously been shown to activate TNF-α secretion from macrophages and monocytes [32]. To evaluate the cytokine activity of HMGB1 derived from necrotic extracts, HMGB1-depleted and mock-depleted necrotic extracts were assayed for their ability to induce TNF-α release from human primary monocytes. As shown in Figure 1b, necrotic extracts exhibited a strong activity that was dramatically reduced, but not totally abrogated, after immunodepletion with anti-HMGB1 antibodies. These experiments confirmed that necrotic extracts contained an active, pro-inflammatory form of HMGB1, as well as other pro-inflammatory molecules.

ACH-2 and U1 cells are widely used to investigate HIV-1 postintegration latency in T and monocytic cells, respectively. They both exhibit a low level of basal HIV-1 expression that can be increased by various chemical or biological agents. ACH-2 and U1 cells were cultivated in the presence of HMGB1-depleted or undepleted necrotic extracts. As indicated in Figure 1c a strong increase in p24 antigen production was observed when these cells were exposed to undepleted necrotic extracts. Again, this effect was dramatically reduced, but not totally abrogated, when the extracts were first immunodepleted with specific anti-HMGB1 antibodies. Therefore our results demonstrated that HMGB1 derived from necrotic extracts activated HIV-1 expression in ACH-2 and U1 cells, although other cellular components may also contribute to viral reactivation.

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Activation of HIV-1 by HMGB1 is mediated by RAGE

To confirm that HMGB1 alone was able to induce HIV-1 in ACH-2 and U1 cells, a recombinant form of human HMGB1 (rhHMGB1) was produced and purified from E. coli. rhHMGB1 was biologically active as it could stimulate TNF-α release from primary human monocytes as previously described (data not shown) [31,32].

To test whether purified HMGB1 could activate HIV-1 expression in U1 and ACH-2, these cells were incubated for 24 or 72 h with increasing amounts of rhHMGB1, and viral expression was quantified by measuring intra and extracellular p24 antigen. A dose-dependent increase in the production of p24 antigen was observed in both U1 and ACH2 cells with HMGB1 concentrations ranging from 100 ng/ml to 10 μg/ml (Fig. 2a), demonstrating that a recombinant purified form of HMGB1 was able to activate HIV-1 replication in these cells. Importantly, similar concentrations are known to be active on monocytes/macrophages [31,32], dendritic cells [33,34], smooth muscle cells [35,36], endothelial cells [26] or enterocytic cells [24].

Fig. 2

Fig. 2

Three receptors for HMGB1 have been described, namely RAGE, TLR-2 and TLR-4 [17,18]. Their presence at the surface of ACH-2 and U1 cells was first investigated by flow cytometry analysis (Fig. 2b). RAGE was the only receptor to be significantly expressed at the surface of U1 and ACH-2 cells (72.5 and 45.2% of the cells, respectively). Western blot analysis confirmed that anti-RAGE antibodies recognized a single polypeptide of the expected mobility (Fig. 2c).

To confirm that the HMGB1-dependent activation of HIV-1 was mediated through RAGE, ACH-2 and U1 cells were incubated with anti-RAGE or irrelevant antibodies before being exposed to rhHMGB1. As shown in Figure 2d, the activation of HIV-1 by HMGB1 was inhibited by anti-RAGE antibodies, which demonstrated that the HMGB1-dependent activation of HIV-1 was mainly, if not exclusively, caused by its interaction with RAGE in U1 and ACH-2 cells.

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HMGB1 activates HIV-1 transcription without de-novo protein synthesis

In macrophages and monocytes, HMGB1 stimulates the release of pro-inflammatory cytokines, such as TNF-α or IL-1β, that are known to induce HIV replication [32]. Therefore, we wondered whether the activation of HIV-1 expression by HMGB1 was direct or if it was part of an autocrine/paracrine loop mediated by cytokines produced in response to HMGB1.

We first quantified TNF-α release from ACH-2 and U1 cells exposed to HMGB1. Whereas ACH-2 cells did not secrete detectable amount of TNF-α, U1 cells exhibited a time-dependent release of TNF-α in response to HMGB1. Importantly, the addition of the protein synthesis inhibitor cycloheximide completely abrogated the production of TNF-α, whether or not the cells were treated with HMGB1 (Fig. 3a). Then, we quantified the transcription of multiply spliced and unspliced viral RNA in cells incubated with HMGB1 in the presence or in the absence of cycloheximide. A dramatic increase of both RNA species was observed from 2 to 8 h after the addition of rhHMGB1 (Fig. 3b). Once again, this transcription pattern was not modified by cycloheximide, which demonstrated that the transcriptional activation of HIV-1 by HMGB1 did not require the synthesis of cellular cytokines and therefore occurred through a direct activation pathway.

Fig. 3

Fig. 3

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HMGB1-mediated induction of HIV-1 involves p38 and extracellular signal-related kinase, and nuclear factor kappa B activation

The HMGB1–RAGE interaction has previously been shown to activate a transduction pathway involving several MAPK and NF-κB [23,25]. To evaluate the relative contribution of three important MAPK, respectively JNK, p38 and ERK, U1 and ACH-2 cells were exposed to rhHMGB1 in the presence of specific inhibitors [37,38], respectively, JNK-i, p38-i and ERK-i. As shown in Fig. 4a, p38-i and ERK-i completely abrogated the induction of HIV by rhHMGB1, whereas JNK-i only induced a partial reduction in HIV-1 activation. A similar pattern was observed when the viral activation was induced by IL-1β, a known activator of MAPK (51–52). In contrast, the direct activation of HIV-1 LTR by the histone deacetylase inhibitor trichostatin A [39] was unaffected by the MAPK inhibitors.

Fig. 4

Fig. 4

We subsequently analysed NF-κB binding to the HIV-1 promoter LTR upon cell stimulation by HMGB1. Two NF-κB binding sites have been mapped in the LTR close to nuc-1, a nucleosome that plays a central role in the control of LTR-dependent transcription [30,40,41]. We previously designed a chromatin immunoprecipitation assay to investigate the binding of NF-κB p50 to this region [30]. As shown in Figure 4b, a four to eightfold increase in NF-κB binding to nuc-1 was observed in cells treated with HMGB1 compared with controls. The recruitment of NF-κB was directly associated with HMGB1 activity because it was also observed in the presence of cycloheximide.

To confirm the involvement of NF-κB in the proviral activation induced by HMGB1, ACH-2 and U1 cells were exposed to rhHMGB1 in the presence of ATA, a chemical inhibitor of NF-κB [42]. IL-1β was used as a positive control because it is known to activate HIV-1 expression through a NF-κB-dependent pathway [40]. As illustrated in Figure 4c, ATA greatly reduced the activation of HIV by IL-1β and totally abrogated HIV induction in rhHMGB1-treated cells.

Altogether these experiments demonstrated that ERK, p38 and NF-κB play a crucial role in the molecular events that promote provirus expression in U1 and ACH-2 cells after exposure to HMGB1.

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HMGB1 induces HIV-1 outgrowth from peripheral blood mononuclear cells collected in aviraemic HIV-infected patients controlled by HAART

The ability of HMGB1 to induce the replication of quiescent HIV was finally analysed ex vivo in PBMC from HIV-infected individuals efficiently controlled by HAART. Six patients were selected because they had been aviraemic for more than 4 years under unmodified HAART. Two million CD8-depleted PBMC were cultured in various conditions for a 5-week period (Fig. 5). In the absence of PHA or HMGB1, no viral outgrowth was detected, except in one case (patient 4) in which a moderate HIV production was observed (less than 200 copies/ml) after 4 weeks of culture in the presence of IL-2. Stimulation with PHA induced the recovery of replication-competent virus for five out of six patients' PBMC. Importantly, HMGB1 was at least as efficient as PHA at reactivating HIV because it induced virus outgrowth for five out of six PBMC cultures, with a viral production similar (patients 4, 5 and 6) or even higher (patients 2 and 3) than that observed with PHA-treated cells. Interestingly, HMGB1 could also reactivate HIV-1 in the absence of IL-2 (patients 2, 3, 5 and 6).

Fig. 5

Fig. 5

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Cell necrosis delivers endogenous danger signals that are critical for initiating the pro-inflammatory process as well as stimulating immune response. We show here that signals associated with cell injury also efficiently activate HIV-1 expression in persistently infected cells. This effect was largely, although not exclusively, a result of the release of HMGB1 protein by necrotic cells. HMGB1 is secreted by various cells in response to lipopolysaccharide or pro-inflammatory cytokines, but its passive release by necrotic cells could provide a far larger source for its activity in vivo. The minimal concentration (100 ng/ml) required to activate HIV-1 expression in U1 and ACH-2 cells is in the upper range of the concentrations of HMGB1 that have been measured in the serum during sepsis [43]. However, much higher concentrations can be reached in the context of local inflammation or in damaged tissues, as recently reported in the lung (20 μg/ml in epithelial lining fluid) [44].

Nowak and colleagues [45] recently reported that HMGB1 reactivated HIV-1 in U1 but not in ACH-2 cells. This apparent discrepancy could partly be explained by the high basal level of HIV-1 expression in the ACH-2 clone used in their study compared with U1 cells.

Using fluorescence-activated cell sorter analysis and blocking experiments, we demonstrated that HIV-1 activation by HMGB1 was mediated by RAGE in U1 and ACH-2 cells. However, the activation of TLR-2-dependent pathways by HMGB1 may also be important in vivo, because many target cells for HIV, including monocytes [46] and memory CD4 T lymphocytes [21], express this receptor. The activation of TLR-2 by HMGB1 is likely to induce HIV-1 because stimulation of this receptor with bacterial antigens activates HIV-1 replication [47].

Previous studies have provided evidence that HIV-1 expression induced by phorbol myristate acetate in ACH-2 and U1 cells resulted at least partly from the stimulation of TNF-α release by phorbol myristate acetate [48,49]. Similarly, it was important to determine whether HMGB1 activity resulted from the direct activation of RAGE-dependent pathways or whether it relied on the production of secondary cytokines, including TNF-α. Although TNF-α was secreted in response to HMGB1, at least in U1 cells, HIV-1 transcriptional activation was unaffected by cycloheximide in HMGB1-stimulated cells. These experiments indicate that the de-novo synthesis of TNF-α or other cytokines is not required, at least in these cells. Nonetheless, the ability of HMGB1 to induce various pro-inflammatory cytokines may also contribute to activate HIV-1 replication in vivo. Notably, nanogram concentrations of HMGB1 can act synergistically with IL-1β and IL-2 to drive IFN-γ production from human PBMC and natural killer cells [16].

We analysed the molecular pathways that lead to HIV activation and proved that the MAPK p38 and ERK play a crucial role in HIV-1 activation by HMGB1. We also demonstrated that HMGB1 activation was associated with the recruitment of NF-κB to the LTR. The nuclear translocation of NF-κB could follow the activation of MAPK p38 or ERK through the HMGB1–RAGE interaction, which is strongly reminiscent of activation pathways that have been described in macrophages and endothelial cells exposed to HMGB1 [26,32]. The complete reversion of the HMGB1-induced activation of HIV-1 by ATA, a known inhibitor of NF-κB, confirms the key role of NF-κB in the process that links HMGB1 exposure and HIV-1 reactivation.

We finally performed preliminary experiments to evaluate whether HMGB1 could reactivate HIV from latently infected PBMC. Our results indicate that HMGB1 is at least as efficient as PHA in activating provirus expression, alone or in combination with IL-2. Whether this activity is directly linked to HMGB1, as suggested by the constitutive expression of TLR-2 on memory (CD45RO+) CD4 T lymphocytes [21], or results from its ability to induce various cytokines is currently under investigation.

This work demonstrates that HMGB1 is a potent activator of HIV expression that may play an important role by increasing viral replication when necrosis occurs. This may be especially relevant during AIDS, in which cell injury is frequent in organs targetted by opportunistic diseases. Furthermore, HIV itself could participate in cell injury because both necrosis and apoptosis were observed during HIV-mediated cell killing [50,51]. The effective contribution of HMGB1 in HIV replication in vivo is currently under investigation in our laboratory. In that respect, a recent report correlated increased levels of circulating HMGB1 in HIV patients [52] with high viral loads and T-cell depletion, which strengthens the hypothesis that HMGB1 might contribute significantly to AIDS pathogenesis.

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The authors would like to thank C. Gaillard, C. Tinsley and P.M. Girard for their help. They also wish to thank the patients who volunteered for this study and the Laboratoire Commun de Génétique et Biologie Moléculaire (Hôpital Saint-Antoine) for its technical support.

Sponsorship: This research programme was supported by the Université Pierre et Marie Curie (Bonus Qualité Recherche 2003), Sidaction and ANRS. S.T. and A.J. are recipients of a fellowship from the Ministère de l'Education Nationale, de la Recherche et des Technologies. S.T. and N.N. were supported by the Fondation pour la Recherche Médicale.

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HIV-1; HMGB1; latency; necrosis; reactivation

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