Significant Virus Replication in Langerhans Cells following
Application of HIV to Abraded Skin: Relevance to
Occupational Transmission of HIV1
Tatsuyoshi Kawamura,* Yoshio Koyanagi,‡Yuumi Nakamura,* Youichi Ogawa,*
Atsuya Yamashita,†Taku Iwamoto,* Masahiko Ito,†Andrew Blauvelt,§¶and Shinji Shimada2*
The cellular events that occur following occupational percutaneous exposure to HIV have not been defined. In this study, we
studied relevant host cellular and molecular targets used for acquisition of HIV infection using split-thickness human skin
explants. Blockade of CD4 or CCR5 before R5 HIV application to the epithelial surface of skin explants completely blocked
subsequent HIV transmission from skin emigrants to allogeneic T cells, whereas preincubation with C-type lectin receptor in-
hibitors did not. Immunomagnetic bead depletion studies demonstrated that epithelial Langerhans cells (LC) accounted for >95%
of HIV dissemination. When skin explants were exposed to HIV variants engineered to express GFP during productive infection,
GFP?T cells were found adjacent to GFP?LC. In three distinct dendritic cell (DC) subsets identified among skin emigrants
(CD1a?langerin?DC-specific intercellular adhesion molecule grabbing non-integrin (SIGN)?LC, CD1a?langerin?DC-SIGN?dermal
DC, and CD1a?langerin?DC-SIGN?dermal macrophages), HIV infection was detected only in LC. These results suggest that pro-
ductive HIV infection of LC plays a critical role in virus dissemination from epithelium to cells located within subepithelial tissue. Thus,
but may prevent or limit subsequent LC-mediated infection of T cells. The Journal of Immunology, 2008, 180: 3297–3304.
contact with nonintact skin (e.g., exposed skin that is chapped,
abraded, or dermatitic) (1). In prospective studies of HCP, the
average risk of HIV transmission after a single percutaneous ex-
posure to HIV-infected blood has been estimated to be 0.3% (2).
Although episodes of HIV transmission after exposure to nonintact
skin have been documented (3), the average risk for transmission
by this route has not been precisely quantified (1). Epidemiologic
and laboratory studies suggest that several factors increase the risk
of HIV transmission after an occupational exposure, including
contact with a device visibly contaminated with the patient’s
blood, contact with a needle that was in a vein or artery, exposure
ccupational exposures place health-care personnel
(HCP)3at risk for infection with blood-borne pathogens
via sharps injuries, exposure of mucous membranes, or
to hollow-bore needles, a deep injury, and exposure to R5 strains
of HIV that use CCR5 for cell entry (1).
Genetic studies have shown that individuals homozygous for a
32-nt deletion in the chemokine receptor CCR5, CCR5? 32, are
protected from primary HIV infection despite numerous exposures
(4–7). The importance of CCR5 as a critical coreceptor involved
in the sexual transmission of HIV is also supported by the obser-
vation that the majority of HIV strains isolated from patients
shortly after primary infection are R5 viruses (8–10). In addition,
topical application of high doses of the N terminus-modified che-
mokine Na-nonanoyl[thioproline2, cyclohexylglycine3]RANTES
(PSC-RANTES) provided full protection against intravaginal chi-
meric SIV/HIV challenge in female rhesus macaques, suggesting a
critical role for CCR5-mediated infection-dependent pathways in
HIV entry (11).
In a primate model of SIV infection, there is controversy regarding
which cells in the genital mucosa are initially infected with SIV. Stud-
ies have demonstrated that the primary infected cells present in the
lamina propria of the cervicovaginal mucosa 48–72 h after intravag-
inal exposure to SIV are T cells or submucosal dendritic cells (DC),
but not epithelial Langerhans cells (LC) (12, 13). When vaginal tissue
was examined within 18 h following vaginal inoculation, however, up
to 90% of the SIV-infected cells were LC (14). These conflicting
observations may be the result of SIV-infected LC emigrating from
epithelium relatively soon after viral exposure.
DC-specific intercellular adhesion molecule grabbing non-inte-
grin (DC-SIGN), a C-type lectin receptor (CLR) expressed on der-
mal macrophages and monocyte-derived DC (MDDC) (15, 16),
has been shown to bind HIV gp120 and to facilitate HIV infection
of T cells in trans (16, 17). Although results from other studies
indicate a minor contribution by DC-SIGN in the transmission of
HIV from MDDC to T cells (18, 19), DC-SIGN may be involved
in viral dissemination. In addition, langerin, an LC-specific CLR,
and the mannose receptor, which is expressed on dermal DC, have
*Departments of Dermatology and†Microbiology, Faculty of Medicine, University of
Yamanashi, Yamanashi, Japan;‡Laboratory of Viral Pathogenesis, Research Center
for AIDS, Institute for Virus Research, Kyoto University, Kyoto, Japan;§Depart-
ments of Dermatology and Molecular Microbiology and Immunology, Oregon Health
& Science University, Portland, OR 97239; and¶Dermatology Service, Veterans
Administration Medical Center, Portland, OR 97239
Received for publication November 6, 2006. Accepted for publication December
The costs of publication of this article were defrayed in part by the payment of page
charges. This article must therefore be hereby marked advertisement in accordance
with 18 U.S.C. Section 1734 solely to indicate this fact.
1This work was supported in part by a grant from the Ministry of Education and
Science of the Japanese government.
2Address correspondence and reprint requests to Dr. Shinji Shimada, 1110 Shi-
mokato, Chuo, Yamanashi 409-3898, Japan. E-mail address: sshimada@
3Abbreviations used in this paper: HCP, health-care personnel; CLR, C-type lectin
receptor; DC, dendritic cell; EGFP, enhanced GFP; IRES, internal ribosome entry
site; LC, Langerhans cell; MDDC, monocyte-derived DC; PEP, postexposure pro-
phylaxis; PSC-RANTES, Na-nonanoyl[thioproline2, cyclohexylglycine3]RANTES;
DC-SIGN, DC-specific intercellular adhesion molecule grabbing non-integrin;
TCID50, 50% tissue culture infecting dose.
Copyright © 2008 by The American Association of Immunologists, Inc. 0022-1767/08/$2.00
The Journal of Immunology
been shown to bind HIV gp120 (20), suggesting their participation
in virus transmission from DC to T cells. In addition, CLR may
also enhance de novo CD4/coreceptor-dependent infection of DC
(21). The cooperation of CLR and CD4/HIV coreceptors in facil-
itating de novo infection of DC has been termed cis infection
To understand how HIV traverses the skin and genital mucosa,
we recently developed an ex vivo model in which epithelial tissue
explants obtained from suction blister roofs were exposed to HIV
(22). By contrast to the studies using MDDC, results from this
model indicated that resident LC transmit HIV to T cells via a
CD4/CCR5-mediated infection-dependent pathway, and not by
CLR-mediated capture pathways (23, 24). LC infection levels in
this model correlated with host CCR5 genotype (e.g., CCR5? 32),
and the genetic susceptibility of LC to HIV infection paralleled
genetic susceptibility to HIV in cohorts of HIV-infected individ-
uals (23). These results, along with the finding that immature res-
ident LC express surface CCR5, but not surface CXCR4 (25),
suggest that selective R5 HIV transmission observed in epidemi-
ologic studies most likely occurs at the level of the LC. This has
been referred to as the primary gatekeeper model.
In our current study, we have modified our previous explant
model to focus more on the cellular mechanisms that may be in-
volved following occupational HIV exposure to nonintact skin.
HIV was applied to the abraded epithelial surfaces of split-thick-
ness skin explants, and infection of all the possible cell types
present in skin was studied in detail.
Materials and Methods
Reagents and Abs
All mAbs were purchased from BD Biosciences, except for anti-p24 mAb
and anti-langerin mAb (Beckman Coulter), and anti-DC-SIGN mAb (R&D
Systems). Mannan and mannose were purchased from Sigma-Aldrich.
R. Offord (University of Geneva, Geneva, Switzerland) provided PSC-
RANTES (a newer, more potent analog of RANTES) (26). N. Yamamoto
(Tokyo Medical and Dental University, Tokyo, Japan) provided
KRH-1636, a small molecule CXCR4 antagonist that blocks X4 HIV-1
entry into target cells (27).
Purified, pelleted, and titered HIVBa-L, an R5 HIV laboratory isolate, stock
containing 107.17median tissue culture infectious doses (TCID50)/ml was
purchased from Advanced Biotechnologies. rHIV-1 expressing GFP (X4
HIV: NL-EGFP; R5 HIV: NLCSFV3EGFP and JRFL-EGFP) were pre-
pared, as previously described (28, 29). Briefly, the X4 HIV-1 expressing
GFP (NL-EGFP) was constructed from pNL4-3 by inserting an enhanced
GFP (EGFP) gene and an internal ribosome entry site (IRES) sequence
between gp41 and the nef sequence by PCR-based subcloning. The ATG
codon of EGFP was placed 2 bp downstream of gp41 termination codon,
and nef expression was rescued from insertion of the IRES sequence. The
R5 HIV-1 expressing GFP (NLCSFV3EGFP) was constructed by replacing
the V3 sequence in the NL-EGFP with the V3 sequence from JRCSF.
Another R5 HIV-1 expressing GFP (JRFL-EGFP) was generated through
insertion of the EGFP/IRES fragment in pJRFL DNA. Virus stock was
made via transfection into 293T cells, and its p24Gag levels in the culture
supernatant were measured by ELISA (ZeptoMetrix). The p24Gag
amounts for NL43-EGFP, NLCSFV3EGFP, and JRFL-EGFP were 540,
305, and 113 ng/ml, respectively. The TCID50was determined by a sen-
sitive 14-day endpoint titration assay using PHA-stimulated PBMC from
HIV-seronegative healthy donors. The infectious titers of NL43EGFP,
NLCSFV3EGFP, and JRFLEGFP were 1.8 ? 105, 5.3 ? 104, and 1.5 ? 104
Virus infection of skin explants ex vivo
Split skin was obtained from HIV-negative healthy donors undergoing
plastic or corrective surgery (written consent was obtained from all tissue
donors, according to the Local Research Ethics Committee). The epidermal
surface of skin was abraded with a wire brush to remove the corneal layer.
The skin was stored at 4°C and used within 2 h of collection. Skin explants
were prepared by cutting abraded skin into 8.0-mm circular pieces. For
infection, skin explants were placed in wells of 24-well plastic plates, and,
as previously described (30), 3% agarose was added to confine the inoc-
ulates to the epidermis by sealing the surrounding area. Virus was added to
the epidermal surface, and the plates were incubated at 37°C for 2 h. In
other experiments, virus was added directly to culture medium, and entire
skin plants were floated on the culture medium. For some experiments, skin
explants were preincubated for 20 min at 37°C with various inhibitors, and
then HIVBa-Lat 1/100 final dilution was added before incubation for an
additional 2 h at 37°C. After incubation, skin explants were extensively
washed to remove unbound virus and inhibitors. After a wash step, three to
five infected skin explants were floated on culture medium, RPMI 1640
(Invitrogen Life Technologies) supplemented with heat-inactivated 10%
FCS (Sigma-Aldrich), 2 mM L-glutamine, 10 mM nonessential amino ac-
ids, 1? penicillin/streptomycin, 10 mM sodium pyruvate, and 25 mM
HEPES, in 6-well plates, with each experimental condition performed in
duplicate. In some experiments, skin explants were incubated with Dis-
pase II (2.5 mg/ml; Roche Diagnostics) in RPMI 1640 at 4°C. After
4–6 h, the skin was washed to remove dispase, and using fine forceps,
the epidermis was separated from the dermis. Epidermal sheets were
then exposed to 100-?l droplets containing NLCSFV3EGFP at 10,000
TCID50/ml for 2 h at 37°C, washed to remove unbound virus, and then
floated on culture medium to allow migration of LC from the explants.
The emigrating cells from epidermal sheets were collected 3 days fol-
lowing HIV exposure.
Assessment of HIV transmission to CD4?T cells
PBMC were isolated by density centrifugation and enriched for CD4?T
cells by negative selection using a commercially prepared mAb mixture/
complement reagent (Lympho-Kwik; One Lambda), according to manu-
facturer’s guidelines. The emigrating cells from explants were collected
3–4 days after HIV exposure, and then cocultured with 2.5 ? 106resting
allogeneic CD4?T cells in an approximate skin cell emigrant/T cell ratio
of 1:100. In some experiments, HIV-exposed skin explants were incubated
with Dispase II (2.5 mg/ml) in RPMI 1640 at 4°C. After 6 h, the epidermis
was separated from the dermis, and both layers were washed in PBS.
Epidermal and dermal sheets were floated on culture medium for 3–4
days to allow migration of cells from the separated sheets. Cells emi-
grating from three epidermal or dermal sheets were collected and
washed before adding to CD4?T cells in coculture. In some experi-
ments, the emigrant cells from HIV-exposed skin explants were incu-
bated with control IgG or mAbs against CD3, HLA-DR, or langerin,
followed by sheep anti-mouse Ig-coated magnetic beads (Dynal Bio-
tech), according to the manufacturer’s protocol. Negative populations
were cocultured with CD4?T cells, respectively. For detection of se-
creted HIV p24 protein, supernatants were examined for p24 protein
content by ELISA (Beckman Coulter).
Assessment of HIV infection
To quantify numbers of infected cells, cells that spontaneously emigrated
from skin explants were collected 3–4 days following HIV exposure, as
described above, and analyzed by flow cytometry, as previously described
(23). Briefly, skin emigrants were preincubated with mouse anti-CD16
mAb and anti-CD32 mAb in staining buffer (2% mouse serum in HBSS)
for 10 min at room temperature to block nonspecific staining. After wash-
ing twice with staining buffer, cells were incubated with 10 ?g/ml mouse
anti-human mAbs against surface molecules for 30 min at 4°C, fixed, and
permeabilized with Cytofix/Cytoperm reagents (BD Biosciences) for 20
min at 4°C, and incubated with 10 ?g/ml FITC-conjugated rat anti-p24
mAb or isotype control Ab diluted in Perm/Wash (BD Biosciences) con-
taining 2% rat serum for 30 min at 4°C. Cells were then examined by flow
cytometry using a FACScan (BD Biosciences). HIV-1 p24 mAb staining of
the emigrant cells from uninfected skin showed occasional low positive
staining (0–0.08%), confirming the specificity of the HIV-1 p24 staining.
In some experiments, HIV-1 expressing GFP was added to the epidermal
surface of the skin explants or epidermal sheets, and emigrated cells or
coculture with CD4?T cells were examined under fluorescence micro-
scope using IX70 (Olympus) or processed for flow cytometry. Micro-
scopic images were taken using charge-coupled device camera
(VB7000; KEYENCE) and VH-Analyzer (H1A5; KEYENCE). In some
experiments, the emigrating cells were labeled with PKH67 Red
(Sigma-Aldrich), according to manufacturer’s instructions, before adding
to CD4?T cells in coculture.
3298SIGNIFICANT HIV REPLICATION IN LC
After epidermal and dermal exposure to HIV, DC and T cells
that have emigrated from HIV-exposed skin explants transmit
virus to CD4?T cells
During ex vivo culture of skin explants, resident LC, dermal DC,
and T cells spontaneously emigrated from explants into surround-
ing medium in 1–3 days. In experiments in which the numbers of
cells emigrating from individual skin explants were determined,
the mean cell yield ? SD was 8.4 ? 1.7 ? 103(n ? 5). The
number of cells recovered from the skin explants was similar to
that obtained by others (31, 32). We next characterized DC/mac-
rophage subsets migrating from skin explants. HLA-DR?migra-
dermal DC, and CD1a?langerin?DC-SIGN?dermal macro-
phages, and each subset exhibited comparable surface expression
levels of CD4 and CCR5 (Fig. 1A).
In initial experiments, HIVBa-L(an R5 virus) was added to the
entire skin explants, and the emigrating cells from the explants
were collected 3–4 days following HIV exposure. As shown in
Fig. 1, emigrating cells from HIV-exposed skin explants induced
high levels of HIV infection when cocultured with resting alloge-
distinct subsets,as follows:
neic CD4?T cells. We could not detect p24 protein in culture
supernatants of emigrating cells cultured alone (data not shown),
suggesting that the main source of secreted p24 protein in the
cocultures was T cells. When anti-CD4 mAb was preincubated
with skin explants before HIV exposure, HIV p24 production in
the supernatants was substantially inhibited (Fig. 1B). By contrast,
mannan, a known inhibitor of CLR binding, partially, but signif-
icantly inhibited HIV p24 production in the supernatants, and
when combined with CD4 mAb did not increase its inhibition pro-
vided by CD4 mAb alone (Fig. 1B). These data suggest that, after
spontaneous epidermal and dermal exposure, transmission of R5
HIV from skin emigrants to T cells is dependent upon a CD4- and
CLR-dependent infection process. We then investigated the cell
type or types responsible for transmission of virus to T cells. As
shown in Fig. 1C, HLA-DR?cells accounted for as much as 95%
of HIV-1 dissemination, whereas CD3?cells contributed partially.
These results suggest that HIV-1 dissemination by migratory cells
is largely mediated by DC subsets, and DC-T cell conjugates also
contribute to the dissemination.
After epidermal exposure to HIV, HIV-infected LC that have
emigrated from HIV-exposed skin explants transmit virus to
We next tested whether CLR were involved in HIV transmission
from skin emigrants to CD4?T cells after epidermal exposure to
HIV. HIVBa-Lwas applied to the surface of abraded skin explants,
and the emigrating cells from the explants were collected 3–4 days
following HIV exposure. Consistent with previous report (31),
abrasion of the epidermal surface had no detectable effect on the
phenotype of the emigrant cells (data not shown). As shown in Fig.
2, emigrating cells from HIV-exposed skin explants induced high
levels of HIV infection when cocultured with allogeneic CD4?T
cells. We could not detect p24 protein in culture supernatants of
emigrating cells cultured alone (data not shown). Interestingly,
when PSC-RANTES, a chemically modified RANTES analog and
potent CCR5 inhibitor, was preincubated with skin explants before
HIV exposure, HIV p24 production in the supernatants was clearly
inhibited (Fig. 2, A and B). By contrast, mannan did not affect HIV
p24 production in the supernatants (Fig. 2, A and B). No cellular
toxicity was observed for PSC-RANTES at the doses used in these
experiments (24). HIV transmission mediated by skin emigrants
was also not affected by preincubation of skin explants with man-
nose or KRH-1636, a small molecule CXCR4 antagonist (Fig. 2B
and data not shown). Preincubation of skin explants with CD4
mAb blocked subsequent transmission of HIVBa-Lto cocultured
CD4?T cells, whereas preincubation with either DC-SIGN mAb
or langerin mAb did not affect HIV p24 production in coculture
supernatants (Fig. 2A). These data suggest that, after epidermal
exposure, transmission of R5 HIV from skin emigrants to T cells
is totally dependent upon a CD4- and CCR5-dependent and CLR-
independent infection process.
We then investigated the cell type or types responsible for trans-
mission of virus to T cells after epidermal exposure to HIV. We
first examined the relative contributions of emigrating cells from
the epidermis and from the dermis to HIV dissemination. The sur-
face of abraded skin explants was exposed to HIVBa-Lfor 2 h, and
the epidermis was then separated from the dermis using dispase.
The emigrating cells from the epidermis or dermis were examined
for virus carriage to cocultured allogeneic CD4?T cells. Interest-
ingly, emigrating cells from epidermal, but not dermal, sheets
carry HIV (Fig. 2C). Consistent with this finding, LC-depleted
emigrating cells from HIV-exposed skin explants failed to transmit
infection to cocultured T cells (Fig. 2D). These results indicate that
cells from HIV-exposed skin transmit infection to T cells. A, Emigrating
cells from skin explants were stained for the surface Ags shown in com-
bination with HLA-DR staining. Representative data show staining of elec-
tronically gated HLA-DR?cells. An electronic gate was further set on the
indicated cell populations in the upper left panel, and the expression levels
of CD4 and CCR5 in each population are shown (bold line) along with
isotype control staining (thin line) (lower panels). B, Entire skin explants
were preincubated with mannan (200 ?g/ml) or indicated Abs (40 ?g/ml)
before exposure to HIV-1Ba-L, and emigrant cells were cocultured with
allogeneic CD4?T cells. ?, p ? 0.05 compared with the control IgG-
preincubated explants. C, Emigrating cells from HIV-exposed skin ex-
plants were collected, and the emigrants were depleted of CD3?cells or
HLA-DR?cells by immunomagnetic bead separation. Nondepleted or
each negative population was cocultured with allogeneic T cells. HIV p24
levels in coculture supernatants (SN) were assessed by ELISA. Data shown
represent at least two separate experiments derived from separate donors.
After epidermal and dermal exposure to HIV, emigrant
3299The Journal of Immunology
LC play a critical role in virus dissemination from skin emigrants
to T cells.
HIV-infected cells were detected in LC, but not in dermal DC or
macrophages, emigrating from R5 HIV-exposed skin explants
Others have shown that emigrating cells from skin explants con-
tain three main populations of cells, as follows: HLA-DR?CD3?
LC/DC, CD3?HLA-DR?T cells, and HLA-DR?CD3?LC/DC-T
cell conjugates (31, 33). To determine which populations are in-
fected by R5 HIV using our new model, HIVBa-Lwas applied to
the surface of abraded skin explants and the emigrating cells from
the explants were stained with intracellular HIV p24. The number
of LC/DC and T cells emigrating from the explants was variable,
depending on the donor. In a series of five experiments, analysis of
the emigrant cells showed a mean ? SD of 22.9 ? 8.3% T cells,
17.7 ? 9.5% LC/DC-T cell conjugates, and 35.1 ? 14.5% LC/DC.
HIV p24?cells were detected in HLA-DR?populations: LC/DC
and LC/DC-T cell conjugates, but not in HLA-DR-negative pop-
ulations (Fig. 3A). To determine which DC/macrophage subsets
SIGN?dermal DC, and CD1a?langerin?DC-SIGN?dermal
macrophages observed in Fig. 1A) are infected by HIV, HLA-DR?
cells migrating from HIV-exposed skin were further analyzed for
infection. Interestingly, we could detect HIV p24?cells in lange-
rin?LC (R2), whereas langerin?DC/macrophages (R1) demon-
strated ?1% HIV-infected cells (Fig. 3B). In three experiments in
which HIV-infected emigrant cells were characterized, the results
for percentage of HIV p24?cells in LC vs dermal DC/macro-
phages were 9.4 vs 0.0%, 5.6 vs 0.8%, and 12.2 vs 0.1%, respec-
tively. These results suggest that LC are the major target for HIV
infection when the epidermal surface of abraded skin is exposed to
virus. Variability in LC infection levels may be due to CCR5 het-
erogeneity in skin donors, as documented by previous findings
(23). In this model, disruption of the corneal layer of the epidermis
was necessary for infection, because no HIV-infected cells were
detected in the migrating cells when virus was applied to the sur-
face of nonabraded skin (data not shown).
HIV replicates within LC emigrating from R5 HIV-exposed
Recently, we established an ex vivo model whereby resident LC
within epithelial tissue explants are exposed to R5 HIV and found
productive virus infection of LC, as evidenced by the following
observations: 1) positive staining for HIV p24, 2) virions budding
from cell surfaces, and 3) detection of HIV transcripts (22–24,
34–36). To test directly whether HIV can replicate within LC, skin
explants were exposed to HIV variants that were engineered to
express GFP during productive infection of cells. NLCSFV3EGFP
(an R5 virus) was applied to the surface of abraded skin explants.
Six days following virus exposure, we could detect GFP-positive
large cells with dendritic morphology in emigrant cells (Fig. 4A).
When the emigrants were stained with anti-langerin and anti-CD3
mAb, GFP?cells could be seen in langerin?CD3?LC and lan-
gerin?CD3?LC-T cell conjugates (R1 and R2) (Fig. 4B). Al-
though T cells within the emigrants were never GFP?, more
brightly GFP?LC were occasionally observed in clusters of cells
(Fig. 4A). When NLCSFV3EGFP was added to the entire skin ex-
plants, GFP?cells were detected in LC and in langerin-negative
dermal DC or macrophages (data not shown). To test whether LC
replicate HIV without interaction with T cells, LC within epider-
mal sheets were exposed to NLCSFV3EGFP. Three days following
virus-exposed skin transmit infection to T cells. A and B, The surfaces of
abraded skin were preincubated with PSC-RANTES (200 nM) (●), man-
nose (200 ?g/ml) (?), mannan (200 ?g/ml) (?), no reagents (E), or in-
dicated Abs (40 ?g/ml) before epidermal exposure to HIV-1Ba-L. Emigrant
cells from each experiment were cocultured with allogeneic CD4?T cells.
C, The epidermis and dermis of HIV-exposed skin were separated. Cells
emigrating from epidermal (E) or dermal (●) sheets were cocultured with
allogeneic T cells. D, Emigrating cells from HIV-exposed skin explants
were collected, and half the emigrants were depleted of LC by immuno-
magnetic bead separation. Nondepleted (●) and LC-depleted (E) emi-
grants were cocultured with allogeneic T cells. HIV p24 levels in coculture
supernatants (SN) were assessed by ELISA. Data shown represent at least
two separate experiments derived from separate donors.
After epidermal exposure to HIV, HIV-infected LC from
grating cells from HIVBa-L-exposed skin explants were stained for the sur-
face Ags shown or intracellular HIV p24. HIV p24 staining of each gated
population in emigrating cells (A) or HLA-DR?emigrant cells (B) is
shown. Emigrating cells from control skin explants unexposed to HIV were
always negative for p24 staining (data not shown). Data shown are repre-
sentative of three separate experiments derived from three separate donors.
HIV infection within LC, but not within dermal DC. Emi-
3300SIGNIFICANT HIV REPLICATION IN LC
virus exposure, GFP weakly positive cells with dendritic morphol-
ogy were observed in emigrating cells from epidermal sheets (Fig.
4C). Because CD3?T cells were never detected in the emigrating
cell populations (data not shown), this result indicates that low
levels of productive R5 HIV infection occur in LC without inter-
action with T cells.
Visualization of viral transmission from HIV-infected LC to
To visualize HIV transmission from LC to CD4?T cells,
NLCSFV3EGFP (an R5 virus) or NL43EGFP (an X4 virus) was
applied to the surface of abraded skin explants, and emigrating
cells from HIV-exposed skin were labeled with PKH67 Red before
coculture with allogeneic T cells. In the cocultures of emigrants
from NLCSFV3EGFP-exposed skin and T cells, we could detect
GFP expression within PKH?large cells with dendritic morphol-
ogy (i.e., HIV-replicating LC), and the number of GFP?LC pro-
gressively increased over the first week (Fig. 5, A and B). By
contrast, we could not detect GFP?cells within the coculture of
emigrants from NL43EGFP-exposed skin and T cells (Fig. 5B).
Between day 10 and 12 following coculture of emigrants from
GFP?PKH?small T cells was visible in cocultures (Fig. 5C).
PKH?T cells expressing high levels of GFP were found adjacent
to PKH?GFP?LC, suggesting that HIV-infected LC directly
transmitted HIV to T cells (Fig. 5C). When the cocultures were
stained with anti-langerin and anti-CD3 mAb, GFP?cells were
detected in langerin?LC, CD3?T cells, and langerin?CD3?
LC-T cell conjugates (R1, R2, and R4) (Fig. 5D).
R5 HIV, but not X4 HIV, applied to skin explants induces HIV
infection in T cells cocultured with skin emigrants
To compare the efficiencies of R5 HIV and X4 HIV dissemination
using our new model, viral inoculates containing 10,000 TCID50
epidermal sheets (C) were exposed to NLCSFV3EGFP (R5 HIV), and em-
igrating cells were examined under microscope or by flow cytometry. A,
Microscopic (left) and fluorescence microscopic (middle) images of skin
emigrants were combined (right). Representative EGFP?large DC (ar-
rows) demonstrate expression of EGFP. B, Emigrating cells from skin ex-
plants were processed for flow cytometry following langerin and CD3
staining. GFP?cells of each gated population in emigrating cells are
shown. Images derived with FITC (green: GFP) and rhodamine filters (red:
langerin) were combined (yellow). C, Microscopic (left) and fluorescence
microscopic (right) images of emigrating cells from epidermal sheets were
shown. Emigrating cells from control skin explants or epidermal sheets
unexposed to HIV were always negative for GFP (data not shown). Scale
bar, 10 ?m. Data shown represent at least two separate experiments de-
rived from separate donors.
R5 HIV replicates within LC. Skin explants (A and B) and
NLCSFV3EGFP-exposed skin were labeled with PKH67 Red before being
cocultured with T cells. Images derived with FITC (green) and rhodamine
filters (red) were combined (yellow). Representative HIV-infected
GFP?PKH?LC (arrows, A) and HIV-infected GFP?PKH?T cells (ar-
rows, C) are shown. Insets (A): higher magnifications. B, GFP?cells in
PKH?cells were counted in the cocultures of emigrating cells from
NLCSFV3EGFP (E)- or NL43EGFP (?)-exposed skin. In PKH?cells,
GFP?cells were not detected during the first week. Scale bar: A, 50 ?m;
C, 10 ?m. D, The cocultures were processed for flow cytometry following
langerin and CD3 staining. GFP?cells of each gated population in emi-
grating cells are shown. Data shown represent at least two separate exper-
iments derived from separate donors.
HIV transmission from LC to T cells. Emigrating cells from
3301The Journal of Immunology
of NLCSFV3EGFP (R5 HIV), JRFLEGFP (R5 HIV), or
NL43EGFP (X4 HIV) were applied to the surface of abraded skin
explants, and emigrant cells were cocultured with allogeneic T
cells. Twelve days following coculture, GFP?cells were observed
from NLCSFV3EGFP or JRFLEGFP infections, but not from
NL43EGFP infections (data not shown). To quantify numbers of
HIV-transmitted T cells at the single-cell level, emigrating cells
were labeled with PKH67 Red before coculture with T cells and
then analyzed by flow cytometry. When NLCSFV3EGFP or
JRFLEGFP was applied to skin, a few GFP?PKH?CD3?T cells
(R2) as well as PKH?skin emigrants (R1) were detected (Fig. 6).
By contrast, when NL43EGFP or heat-inactivated NLCSFV3EGFP
was applied to skin, GFP?cells were ?0.2% in both fractions
(Fig. 6). Consistent with CCR5-dependent virus dissemination in
this model (Fig. 1), these findings indicate that LC are preferen-
tially infected with R5 HIV and transmit virus to cocultured T
cells, most likely because of differential cell surface expression of
CCR5 and CXCR4 on LC (25, 35).
Percutaneous injury, usually inflicted by a hollow-bore needle, is
the most common route of occupational HIV transmission. HIV
may be transmitted to an accident victim by direct inoculation of
exogenous virus into recipient blood vessels of the dermis. In ad-
dition, our results suggest that DC subsets that are resident within
skin may also play a role in initial infection and dissemination of
virus. There could be several possible pathways that HIV is trans-
mitted from resident cutaneous DC to T cells, as follows: de novo
or cis infection-dependent pathway or infection-independent path-
ways via CLR (37–39). Following spontaneous epidermal and der-
mal exposure, we found that transmission of HIV from skin em-
igrants to T cells occurs through a CD4- and a CLR-dependent
manner. Blockade of CD4 substantially inhibited subsequent HIV
dissemination, whereas blockade of CLR partially inhibited virus
dissemination (Fig. 1). In addition, combination of CD4 and CLR
blockade did not increase inhibition provided by CD4 mAb alone,
suggesting that de novo infection is predominantly involved in the
uptake of virus by resident skin DC. Of note is that, although HIV
dissemination by migratory cells is largely mediated by DC sub-
sets, T cells within migratory cells also contributed partially. This
suggests that DC-T cell conjugates contribute greatly to viral dis-
semination, as suggested by previous findings that HIV infection is
highest in DC-T cell conjugates when emigrated skin cells were
directly exposed to HIV (33, 40).
The molecular and cellular events that occur following occupa-
tional exposure of nonintact skin to HIV have not been previously
defined. Our data indicate that CD4- and CCR5-mediated produc-
tive HIV infection of LC, and not C-type lectin-mediated capture
of virus by LC or DC, play a major role in virus dissemination
when the epidermal surface of abraded skin is exposed to virus.
Selective infection of epidermal LC within skin resident DC pop-
ulations observed in our model may be due to restricted access to
subepithelial cells conferred by desmosomes and tight junctions
within epithelial tissue (38).
Reece et al. (31) also used skin explants to model early events
of HIV transmission. These investigators exposed HIV to skin
specimens overnight, and, using a PCR-based assay, demonstrated
that R5 HIV was found in both epidermal and dermal emigrant
DC. The conflicting findings regarding infection of dermal DC
may be a result of the duration of virus exposure to the epidermal
surface of abraded skin (overnight vs 2 h). Because similar con-
flicting results were observed in the rhesus macaques studies (12–
14), it is probable that virus-infected LC emigrate from epithelial
surfaces into subepithelial tissues during overnight virus exposure.
Thus, our data suggest that epithelial LC play a critical early role
in transmitting R5 HIV to cells within underlying subepithelial
Unlike effective R5 HIV dissemination by LC, LC emigrating
from X4 HIV-exposed skin explants failed to transmit infection to
cocultured T cells (Fig. 6). In cocultures, R5 viral infection in LC
was much more efficient than X4 virus infection (Figs. 5 and 6),
suggesting LC are preferentially infected with R5 HIV probably
due to differential HIV coreceptor expression on resident LC (25).
In this regard, it has been reported that DC-SIGN, and probably
other CLR (including langerin), bind R5 and X4 viruses equally
well (16), suggesting that these molecules may not be responsible
for the preferential selection of R5 viruses observed in our model.
By contrast, a recent study revealed that langerin on LC prevents
LC infection of HIV and viral dissemination (41). This study
showed that HIV captured by langerin was internalized into Bir-
beck granules and degraded. Nevertheless, our results indicate that
when LC were exposed to HIV at high virus concentrations
(10,000 TCID), significant LC infection of R5 virus and viral
transmission to T cells were observed, suggesting that langerin is
saturated at these concentrations and is not able to protect against
infection. Because CCR5-dependent and CLR-independent virus
dissemination was predominantly observed in our model using
high concentrations of R5 HIV (Fig. 2), we believe that direct HIV
infection of resident LC most likely plays a pivotal role in occu-
pational transmission of HIV following exposure of nonintact skin.
The disruption of the corneal layer of the epidermis before virus
application to the surface of skin was necessary for LC infection of
HIV, indicating that the corneal layer functions as a protective
barrier for intact skin. Alternatively, it is possible the abrasion of
skin might induce LC activation and subsequent down-regulation
of langerin, leading to the enhanced infection of LC in our model.
skin explants exposed to the indicated HIV strains were labeled with
PKH67 Red before coculture with T cells. Cultured cells were stained with
anti-CD3 mAb and analyzed by flow cytometry. PKH?(R1) or PKH?(R2)
cells were gated and further examined for GFP expression in each popu-
lation. Data shown represent at least two separate experiments derived
from separate donors.
Selective R5 HIV dissemination. Emigrating cells from
3302SIGNIFICANT HIV REPLICATION IN LC
Furthermore, HIV replication in cocultures predominantly oc-
curred in LC-T cell conjugates (Fig. 5). Because activated CD34-
derived LC have been recently shown to facilitate the trans infec-
tion of cocultured T cells (42), LC-T cell conjugates may allow for
T cell-mediated activation of LC and subsequent trans infection
from HIV-infected LC to responding T cells.
In the retrospective case-control study of HCP, use of zidovu-
dine as postexposure prophylaxis (PEP) was associated with a re-
duction in the risk of HIV infection (43). Animal studies have
demonstrated the importance of starting PEP soon after an expo-
sure (44, 45), and PEP probably is substantially less effective when
started ?24–36 h postexposure (45, 46). In addition, larger viral
inoculates decreased prophylactic efficacy (47, 48). Our data sup-
port the importance of starting PEP soon after an exposure, be-
cause PEP may prevent systemic infection and larger viral pro-
duction of T cells. Because LC most likely become infected soon
after exposure, PEP is probably not acting upon HIV replication in
these cells, but rather the later step of LC-mediated infection of T
cells. In addition to the timing of starting PEP, our findings suggest
that other factors (e.g., presence of R5 HIV strains in the source
person) may influence the efficacy of PEP. Further studies are now
underway using our model to determine the effects of PEP admin-
istered at various times following HIV exposure.
We thank Naoki Yamamoto, Naotaka Shibagaki, and Hiroyuki Matsue for
helpful discussions, and Izumi Ishikawa for technical assistance.
The authors have no financial conflict of interest.
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