Book Description

The expansive global diversity of HIV-1 Env presents significant hurdles in developing a broadly protective vaccine. This diversity is a result of HIV Env’s exceptional evolutionary capacity, which allows it to evade the extraordinary diversity of the humoral immune system during infection. However, the evolutionary arms race between Env and humoral immunity occasionally drives the development of broadly neutralizing antibodies (bnAbs) capable of neutralizing diverse strains. Mapping the epitope specificity of bnAbs has revealed conserved regions of Env, which are promising targets for structure-based vaccine design. Additionally, bnAbs’ broad activity and potential to direct the killing of infected cells make them promising antiviral immunotherapeutic drugs for HIV prevention, therapy, and cure strategies. Translating bnAbs into vaccines and therapies will require both a detailed understanding of how bnAbs interact with Env as well as assessing their potential for viral escape. While structural studies provide atomic-level views of HIV-antibody interactions, they fail to reveal the functional interactions necessary for neutralization and the viral mutations that disrupt these interactions. Neutralization and binding assays using mutants can provide such information for specific mutations, but even the largest studies employing one-at-a-time mutagenesis can only assay a small fraction of all possible Env mutations. To overcome these shortcomings, we have developed mutational antigenic profiling, a deep mutational scanning approach that completely maps the functional interface between HIV and an antibody in a single massively parallel experiment. This involves generating libraries of HIV that carry all possible amino-acid mutations to Env (12,730 amino-acid mutations), incubating these viral libraries with or without an antibody, infecting T cells, and using deep sequencing to quantify the enrichment of each mutation in the antibody selected versus non-selected libraries. Profiling escape from bnAb PGT151 identified all previously known and revealed numerous additional escape mutations. Benchmarking these data against traditional neutralization assays further validated that we accurately quantified the effect of all amino-acid mutations to Env. Additionally, evaluating the effect of each amino acid at each site elucidated the biochemical mechanisms of escape throughout the epitope, highlighting the previously unappreciated role for charge-charge repulsions. To gain a broad view of HIV antibody escape, we mapped escape from a panel of nine bnAbs targeting the five best-characterized Env epitopes. Importantly, many of these bnAbs are being clinically developed as immunotherapeutics. While prior studies had defined each of these bnAbs’ structural epitope, our unbiased mapping defined their functional epitopes, or the sites at which mutations mediated escape in the context of replication competent viruses, for the first time. For most bnAbs, mutations at only a small fraction of structurally defined contact sites mediated escape, and escape often occurred at sites that are near but do not directly contact the antibody. Further, these data helped to interpret viral mutations observed in immunotherapy clinical trials—in vivo escape occurred in the functional epitope, some of which was previously missed since it was far from the structural epitope. Additionally, this data allowed for an unbiased quantification of the ease of viral escape for each bnAb, which we found is distinct from antibody breadth. We also mapped escape from a pool of two bnAbs; we found that there were no mutations that robustly escaped both antibodies, agreeing with the results of two recently completed clinical trials that administered this combination. Further, we profiled escape from two antibodies across multiple viral strains, providing the first unbiased quantifications of strain-specific differences in antibody escape. Next, we leveraged mutational antigenic profiling to directly refine structure-based vaccine design. We contrasted escape from bnAb VRC34.01 with escape from two murine antibodies that were elicited with immunogens based on the VRC34.01 epitope. This revealed distinct differences in the recognition of natural and vaccine-elicited antibodies, and provide a template to guide the iterative rounds of vaccine design. We then adapted this approach to better delineate the genotypic determinants of resistance to the only clinically approved HIV fusion inhibitor, enfuvirtide. Again, we identified both previously characterized and novel resistance mutations. Many resistance mutations were allosteric to the drug’s binding site, which shed light on diverse mechanisms of resistance. Further, this complete map of resistance may be of use in the clinical monitoring of resistance during therapy and the genotypic prediction of enfuvirtide sensitivity prior to treatment. Few protein-protein interfaces have been as heavily studied as those between bnAbs and Env, as these interactions provide the motivation for many HIV treatment and prevention efforts. Mutational antigenic profiling yields an unprecedented view of these interfaces, redefining out understanding of an antibody’s functional epitope. The complete maps of viral escape detailed in this thesis provide a mutation-level antigenic atlas for understanding viral immune escape and guiding the development of antibody immunotherapies and vaccines.