Microbial Function and Genital Inflammation in Young South African Women at High Risk of HIV
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bioRxiv preprint doi: https://doi.org/10.1101/2020.03.10.986646; this version posted September 27, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. 1 Microbial function and genital inflammation in young South African women at high risk of HIV 2 infection 3 4 Arghavan Alisoltani1,2, Monalisa T. Manhanzva1, Matthys Potgieter3,4, Christina Balle5, Liam Bell6, 5 Elizabeth Ross6, Arash Iranzadeh3, Michelle du Plessis6, Nina Radzey1, Zac McDonald6, Bridget 6 Calder4, Imane Allali3,7, Nicola Mulder3,8,9, Smritee Dabee1,10, Shaun Barnabas1, Hoyam Gamieldien1, 7 Adam Godzik2, Jonathan M. Blackburn4,8, David L. Tabb8,11,12, Linda-Gail Bekker8,13, Heather B. 8 Jaspan5,8,10, Jo-Ann S. Passmore1,8,14,15, Lindi Masson1,8,14,16, 17* 9 10 1Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town 7925, South 11 Africa; 2Division of Biomedical Sciences, University of California Riverside School of Medicine, Riverside, CA 12 92521, USA; 3Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape 13 Town, Cape Town 7925, South Africa; 4Division of Chemical and Systems Biology, Department of Integrative 14 Biomedical Sciences, University of Cape Town, Cape Town 7925, South Africa. 5Division of Immunology, 15 Department of Pathology, University of Cape Town, Cape Town 7925, South Africa; 6Centre for Proteomic and 16 Genomic Research, Cape Town 7925, South Africa; 7Laboratory of Human Pathologies Biology, Department of 17 Biology and Genomic Center of Human Pathologies, Mohammed V University in Rabat, Morocco; 8Institute of 18 Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town 7925, South Africa; 19 9Centre for Infectious Diseases Research (CIDRI) in Africa Wellcome Trust Centre, University of Cape Town, 20 Cape Town 7925, South Africa; 10Seattle Children’s Research Institute, University of Washington, WA 98101, 21 USA; 11Bioinformatics Unit, South African Tuberculosis Bioinformatics Initiative, Stellenbosch University, 22 Stellenbosch 7602, South Africa; 12DST–NRF Centre of Excellence for Biomedical Tuberculosis Research, 23 Stellenbosch University, Stellenbosch 7602, South Africa; 13Desmond Tutu HIV Centre, Cape Town 7925, 24 University of Cape Town, South Africa; 14Centre for the AIDS Programme of Research in South Africa, Durban 25 4013, South Africa; 15National Health Laboratory Service, Cape Town 7925, South Africa; 16Disease Elimination 26 Program, Life Sciences Discipline, Burnet Institute, Melbourne 3004, Australia; 17Central Clinical School, Monash 27 University, Melbourne 3004, Australia 28 29 *Corresponding author: Dr Lindi Masson; 85 Commercial Road, Melbourne, Victoria, Australia 3004; GPO Box 30 2284, Melbourne, Victoria, Australia 3001; Email: [email protected] 1 bioRxiv preprint doi: https://doi.org/10.1101/2020.03.10.986646; this version posted September 27, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. 1 Abstract 2 Background: Female genital tract (FGT) inflammation is an important risk factor for HIV acquisition. 3 The FGT microbiome is closely associated with inflammatory profile, however, the relative importance 4 of microbial activities has not been established. Since proteins are key elements representing actual 5 microbial functions, this study utilized metaproteomics to evaluate the relationship between FGT 6 microbial function and inflammation in 113 young and adolescent South African women at high risk of 7 HIV infection. Women were grouped as having low, medium or high FGT inflammation by K-means 8 clustering according to pro-inflammatory cytokine concentrations. 9 Results: A total of 3,186 microbial and human proteins were identified in lateral vaginal wall swabs 10 using liquid chromatography-tandem mass spectrometry, while 94 microbial taxa were included in the 11 taxonomic analysis. Both metaproteomics and 16S rRNA gene sequencing analyses showed 12 increased non-optimal bacteria and decreased lactobacilli in women with FGT inflammatory profiles. 13 However, differences in the predicted relative abundance of most bacteria were observed between 14 16S rRNA gene sequencing and metaproteomics analyses. Bacterial protein functional annotations 15 (gene ontology) predicted inflammatory cytokine profiles more accurately than bacterial relative 16 abundance determined by 16S rRNA gene sequence analysis, as well as functional predictions based 17 on 16S rRNA gene sequence data (p<0.0001). The majority of microbial biological processes were 18 underrepresented in women with high inflammation compared to those with low inflammation, 19 including a Lactobacillus-associated signature of reduced cell wall organization and peptidoglycan 20 biosynthesis. This signature remained associated with high FGT inflammation in a subset of 74 21 women nine weeks later, was upheld after adjusting for Lactobacillus relative abundance, and was 22 associated with in vitro inflammatory cytokine responses to Lactobacillus isolates from the same 23 women. Reduced cell wall organization and peptidoglycan biosynthesis were also associated with 24 high FGT inflammation in an independent sample of ten women. 25 Conclusions: Both the presence of specific microbial taxa in the FGT and their properties and 26 activities are critical determinants of FGT inflammation. Our findings support those of previous studies 27 suggesting that peptidoglycan is directly immunosuppressive, and identify a possible avenue for 28 biotherapeutic development to reduce inflammation in the FGT. To facilitate further investigations of 29 microbial activities, we have developed the FGT-METAP application that is available at 30 (http://immunodb.org/FGTMetap/). 2 bioRxiv preprint doi: https://doi.org/10.1101/2020.03.10.986646; this version posted September 27, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. 1 Keywords 2 Metaproteomics; microbiome; microbial function; female genital tract; inflammation; cytokine 3 bioRxiv preprint doi: https://doi.org/10.1101/2020.03.10.986646; this version posted September 27, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. 1 Background 2 Despite the large reduction in AIDS-related deaths as a result of the expansion of HIV antiretroviral 3 programs, global HIV incidence has declined by only 16% since 2010 [1]. Of particular concern are 4 the extremely high rates of HIV infection in young South African women [1]. The behavioral and 5 biological factors underlying this increased risk are not fully understood, however, a key predisposing 6 factor that has been identified in this population is genital inflammation [2–4]. We have previously 7 shown that women with elevated concentrations of pro-inflammatory cytokines and chemokines in 8 their genital tracts were at higher risk of becoming infected with HIV [2]. Furthermore, the protection 9 offered by a topical antiretroviral tenofovir microbicide was compromised in women with evidence of 10 genital inflammation [3]. 11 12 The mechanisms by which female genital tract (FGT) inflammation increases HIV risk are likely 13 multifactorial, and increased genital inflammatory cytokine concentrations may facilitate the 14 establishment of a productive HIV infection by recruiting and activating HIV target cells, directly 15 promoting HIV transcription and reducing epithelial barrier integrity [5–7]. Utilizing proteomics, Arnold, 16 et al. showed that proteins associated with tissue remodeling processes were up-regulated in the 17 FGT, while protein biomarkers of mucosal barrier integrity were down-regulated in individuals with an 18 inflammatory profile [7]. This suggests that inflammation increases tissue remodeling at the expense 19 of mucosal barrier integrity, which may in turn increase HIV acquisition risk [7]. Furthermore, 20 neutrophil-associated proteins, especially certain proteases, were positively associated with 21 inflammation and may be involved in disrupting the mucosal barrier [7]. This theory was further 22 validated by the finding that antiproteases associated with HIV resistance were increased in a cohort 23 of sex workers from Kenya [8]. 24 25 Bacterial vaginosis (BV), non-optimal cervicovaginal bacteria, and sexually transmitted infections 26 (STIs), which are highly prevalent in South African women, are likely important drivers of genital 27 inflammation in this population [9,10]. BV and non-optimal bacteria have been consistently associated 28 with a marked increase in pro-inflammatory cytokine concentrations [9–12]. Conversely, women who 29 have “optimal” vaginal microbiota, primarily consisting of Lactobacillus spp., have low levels of genital 30 inflammation and a reduced risk of acquiring HIV [13]. Lactobacilli and the lactic acid that they 4 bioRxiv preprint doi: https://doi.org/10.1101/2020.03.10.986646; this version posted September 27, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. 1 produce may actively suppress inflammatory responses and thus may play a significant role in 2 modulating