IgG glycosylation has been shown to play a key role in modulating antibody binding to FcγRs [24,25]. The Fc domain of IgG harbors a sugar moiety, consisting of a conserved biantennary core structure with additional fucose and sialic acid residues [26]. Glycosylation of IgG has been shown to be essential for binding to FcγRs (whether activating or inhibitory) (Table 1). While removal of the whole sugar moiety from the Fc part will change its structural integrity [27], resulting in impaired binding IgG to FcγRs [28], but variations in Fc glycosylation may affect FcγR binding in different ways [29]. For example, low levels of fucose specifically increase the affinity of IgG for activating FcγRIIIa [30], a receptor involved in triggering antibody-dependent cell cytotoxicity (ADCC). Galactose, another residue in the sugar moiety, has also been implicated in IgG activity. Indeed, some autoimmune disorders are associated with increased level of IgG without terminal galactose and sialic acid [28]. Conversely, highly sialylated IgG glycoforms display low FcγRs binding capacity. Thus, IgG enriched with sialic acid had a diminished cytotoxic activity in vivo, consistent with their reduced affinity for FcγRs. It was demonstrated that sialic acid confers enhanced anti-inflammatory activity to IgG via upregulation of inhibitory FcγRIIb expression [31]. This receptor has been described to be mostly implicated in regulatory function of innate and adaptive immunity [25]. An indirect mechanism has been proposed, suggesting that other unknown receptors exist and are able to sense sialic-acid-rich IgG [24]. Variations in IgG glycoforms in vivo have been reported upon immunization [32]. IgG fucosylation increases in response to repeated immunization with ovalbumin, suggesting that changes in IgG fucosylation may be of biological significances. These findings are consistent with the notion that antigen-specific antibodies generated in response to immunization acquire the ability to mediate a protective inflammatory response through switching to an IgG population with lower levels of sialylation. These data open up new possibilities for research aiming to induce the production of specific IgG subsets by immunization against HIV. For example, it would be interesting to analyze the association of IgG subclasses and Fc domain glycosylation with the HIV inhibitory activities of IgG in HIV controllers. In vaccinated HIV individuals, such associations need also to be determined. The role of the Fcγ portion of such antibodies in the immune function need to be investigate and clarify in order to design further HIV vaccine candidates that are able to elicit antibodies with optimal FcγR engagements.

The antigen-specific IgG specialize in the recognition of pathogenic agents, including HIV-1, and trigger various immune functions, such as neutralization, aggregation, phagocytosis, degranulation, cellular cytotoxicity (ADCC), virus inhibition (ADCVI or antibody-dependent cell-mediated virus inhibition) and the release of pro-inflammatory cytokines or chemokines. These antibodies may mediate either pro- or anti- inflammatory effects, by binding to activating or inhibitory FcγRs. In vivo, immune cell activations or functions are triggered by the engagement of specific FcγRs (balanced between activating or inhibitory FcγRs). These activating and inhibitory FcγRs are differentially expressed on a wide range of innate immune effector cells, including basophils, mast cells, neutrophils, monocytes, macrophages, dendritic cells, eosinophils, neutrophils, NK cells, γδ T and B lymphocytes (reviewed in [33]). The binding of immune complexes to FcγRs on dendritic cells or macrophages, for example, has been shown to result in the phagocytosis, degradation and presentation of antigenic peptide on MHC class I and II molecules (leading to the activation of the other antigen-specific immune cells such as CTLs, CD4 T-helper cells, Treg cells, etc.) [34]. Other FcγR effector functions of have been also described, such as ADCC and ADCVI for instance. As part of humoral immune responses, ADCC is a mechanism whereby a FcγR-bearing effector cell lysed a target cell that expressed foreign antigens, which have been recognized and bound by specific antibodies. Similar to ADCC, ADCVI will measure both cytolytic and noncytolytic killing of infected cells by FcγR-bearing effector cells. NK cells are widely believed to be the major mediators of ADCC in vivo [35,36], but others cells of the immunity, in particular monocytes, macrophages [37], neutrophils, eosinophils and γδ T cells have also been described to mediate ADCC [38]. As the large majority of these cells are present in different sites, more often in peripheral tissues, they can act early during the initial events of the infection. ADCC activity has mainly been attributed to FcγRIIIa and IgG1 and IgG3 isotypes. FcγRIIIa presents at the cell membrane of a subset of NK cells is able to recognize Fc part of IgG which its Fab portion will bound to HIV antigen present at the cell membrane of infected target cells. Once bound to FcγRIII, NK cells released cytokines such as IFN-γ, and cytotoxic granules containing perforin and granzymes that promote cell death by triggering apoptosis of the targeted cells. FcεRI of eosinophils and monocytes can also induce cell death by recognizing IgE-bound cancer cells [39,40].

In the case of HIV vaccine development, optimizing HIV-specific antibody activities by enhancing their interaction with FcγRs would likely to improve the viral fate and disease outcome. It might be useful for example to enhance HIV-specific IgG reactions such as antibody-mediated destruction of virus-infected cells at mucosal site of viral entry. Moreover, improving HIV antigen presentation by using antibody as targeting molecule for the delivery of antigen to specialized APCs via FcγRs would not only enhance viral degradation but also boost specific antiviral immunity. All these points will need to be addressed during the development of an effective HIV vaccine.

IgG1 b12 was the first neutralizing antibody to be identified. This antibody recognizes the CD4 receptor-binding site on gp120, which is conserved between various HIV subtypes [39]. IgG1 b12 showed an unusual protuberance of his paratope that confers such specificity, in particular, to plunge in the cavity of the gp120 responsible for the attachment to CD4, inhibiting by this fact the binding of HIV to its host receptor. Many other antibodies recognizing epitopes in the vicinity of the CD4 binding site have been found in HIV-infected individuals, but none of them exhibited potent neutralizing activity [49]. 2G12 recognizes an epitope based on the C4/V4 region of gp120 [50-53]. Conserved mannose residues on the distal end of the oligomannose glycan located around the base of the V3 and V4 loops in the outer and “silent” face of gp120 are required for 2G12 binding. This epitope is located on carbohydrate residues, which are generally poorly immunogenic or even tolerogenic, as HIV used host glycosylation machinery. 2G12 is a very interesting and unique antibody, as its structure is unconventional and differs from the classical “Y”-shaped form of IgG antibodies in that the two heavy structures of the arms are vertically adjacent. This specific configuration enables this antibody to display neutralizing activity against many HIV clades [54]. Thus, consistent with the apparently unique nature of 2G12, such neutralizing antibodies are difficult to elicit. It has been proposed that this antibody may prevent HIV attachment to the CD4 receptor and to alternative receptors, such as DC-SIGN (by competing with 2G12 for binding to gp120) [50,55], thereby inhibiting non-specific HIV fusion.

447-52D recognizes 14 amino acids, including the conserved stretch of four amino acids - GPGR - core sequence at the tip of the hypervariable V3 loop [50]. The conservation of this sequence at the tip of the V3 loop is directly related to the function of this loop in binding to the HIV coreceptor. 447-52D neutralizes primary isolates bearing the GPGR V3 motif, regardless of whether these viruses belong to clades A, B, F, or H. However, this sequence is more highly conserved among subtype B viruses. Independently of the CXCR4 and CCR5 coreceptor usage, this neutralizing antibody is able to neutralize both R5- and X4-HIV strains. The interaction of 447-52D with the V3 loop seems to be unique, as it is not observed with other anti-V3 antibodies. The V3 region of some HIV primary isolates is somewhat inaccessible to 447-52D, due to the presence of glycan moieties or V1/V2 regions, often rendering these viruses resistant to neutralization. Some resistant viruses become sensitive to 447-52D neutralization after binding to their receptors. Thus, conformational changes may expose critical epitopes, making them accessible for antibody recognition. Such observation has also been made for neutralizing CD4 induced antibodies that need HIV binding to its receptor for recognizing other neutralizing masked epitopes.

Monoclonal neutralizing 2F5 and 4E10 recognize a conserved epitope of the HIV gp41 that has been directly implicated in viral fusion. 2F5 binds to an epitope involving a linear amino acid motif ELDKWA on the gp41. These antibodies cannot prevent HIV attachment to the cells, but a later phenomenon of virus-host cell membrane fusion [41]. They were obtained from EBV-immortalized B-cell clones generated from PBMCs from various HIV-infected subjects [42]. These antibodies have been described to have lipid polyreactivity and CDR3 motifs suggestive of autoimmune antibodies [56,57]. Their neutralizing activity is mediated by the long CDR3 H3 loop that penetrates deeply into the antigen cleft [49]. This has led to the suggestion that immune dysregulation may contribute to the development of these MPER antibodies [56,57], accounting for the rarity of 2F5- and 4E10-like antibodies in HIV patients.

By examining neutralization breadth in sera or plasma samples from large cohorts of infected individuals, new broadly cross-neutralizing antibodies have been recently discovered [46-48]. Using a single round of infection of TZM-bl cells with pseudo-virus particles, as the main neutralization assay for the detection of neutralizing antibodies, the group of Lynn Moris has demonstrated that various subclasses of IgG directed against a novel epitope within the gp41 MPER have potent heterologous neutralizing activity. These antibodies detected in three broadly neutralizing plasma of chronically infected individuals, and for one (BB34) of them, were mainly from the IgG3 subclass. Originally, 4E10, 2F5 and neutralizing fraction of a HIVIG were all of the IgG3 subclass [58,59]. IgG3 antibodies appear early in infection and have a very flexible hinge region that is thought to render the MPER region highly accessible to these antibodies. However, class switching from IgG3 to IgG1 did not affect the neutralizing activity of the well-known neutralizing 2F5 and 4E10 antibodies, indicating a lack of requirement of the IgG subclass for MPER-mediated neutralization. Interestingly, like 2F5 and 4E10, the anti-MPER neutralizing activity detected in BB34 was potentiated by the presence of FcγRI on TZM-bl, indicating that these new recognized epitopes within the MPER region may confirm the relevance of such immunogens for rational vaccine design [60], as FcγRs have been shown to play a crucial role in the mechanism of protection by neutralizing antibodies in macaques [61]. Further evaluations are required to determine whether the subclass (IgG1 or IgG3) of these neutralizing antibodies affects their potency in vivo, due to differences in Fcγ affinity for the corresponding FcγRs. Although, it has been proposed that such anti-MPER antibodies are autoreactive and therefore eliminated through B-cell tolerance mechanisms [56], these data showed that neutralizing anti-MPER antibodies are seldom detected in HIV-infected individuals. The presence of anti-MPER antibodies in broadly neutralizing blood samples has also been reported [62,63]. These neutralizing antibodies that target MPER epitopes overlapping the 2F5 epitope were not produced during the acute phase of infection but rather 12 to 27 months following HIV transmission and coincident with the development of auto-antibodies. Indeed, others have concluded that the time period following HIV exposure is an important parameter that could influence neutralization breadth and antibody avidity [64]. The antibody activity or potency to neutralize HIV may also depend of the maturation of its Fab domain [65]. Others may assume that post-translational changes in antibody structure would turn a non-neutralizing antibody into a broadly neutralizing one or enhance the cross-neutralizing activity of weak neutralizing antibody. Due to poor immunogenicity of these neutralizing epitopes, we need to identify new cross-neutralizing antibodies that would recognize immunogenic epitopes, which are more accessible on HIV envelope to facilitate vaccine design.

The group of Dennis Burton has recently isolated, from an African donor, two potent monoclonal antibodies (PG9 and PG16). These antibodies were unable to bind monomeric gp120 and gp41 while they neutralize native viral particles. They recognized a new cross-neutralizing epitope expressed on the quaternary envelope structure of the conserved region of V2/V3 loops [48]. Their gene analysis revealed that these broadly neutralizing antibodies had a long CDR3 loop, typical of polyreactive antibody. The reactivity of these antibodies against several antigens was tested and no polyreactivity was found. Interestingly, these neutralizing antibodies display different neutralizing activities against any given virus. These neutralization data undoubtedly reflect the capacity of the immune system to evolve with viral envelope mutations. As these new neutralizing antibodies display broad neutralization activities, particularly, against non-clade B HIV primary isolates, they would provide protection against the most prevalent HIV variants worldwide if they could be induced by vaccination.

A recent study has demonstrated that the in vivo administration of an adeno-associated virus (AAV) vector carrying the gene encoding an engineered neutralizing antibody (distinct from IgG1 b12 and 2G12) can induce the production of the biologically active neutralizing antibody in the serum of macaques and maintained a long-term memory immunity [66]. In the vaccinated monkeys, neutralizing antibodies produced in vivo can protect them from an intravenous SIV challenge, at virus inoculum concentrations known to infect 100% of the macaques [66]. Such systems have been previously been used to generate cross-neutralizing IgG1 b12 production in mouse serum, as a proof-of-concept [67]. In addition, memory antibody responses to HIV have recently been characterized, in particular from infected patients with low viral loads and broadly neutralizing antibodies [68], suggesting that HIV-specific humoral immune responses can achieve such neutralizing antibody production. These results pave the way for innovative new approaches for the cloning of neutralizing antibodies from HIV individuals. Altogether, these data provide new hope for the rational design of new vaccine candidates for eliciting broad-range cross-neutralizing antibodies.

Now, there is widespread acceptance that eliciting neutralizing antibodies is likely to be an important component of an effective HIV-1 vaccine [73]. The neutralizing activity of antibodies is largely considered as the mainstay of antiviral immune protection mediated by Ig. It is well known that in vitro HIV-1 neutralization by monoclonal IgG is correlated with in vivo protection against HIV-1 in macaque model [12,13,61,74-76]. Several years ago, it was clearly demonstrated that the passive administration of a mixture of neutralizing antibodies prevents the vaginal transmission of pathogenic chimeric virus (SHIV) in rhesus macaques [12]. Mascola et al., have reported that high-doses of broadly neutralizing antibodies provided an effective protection against mucosal HIV transmission [12]. Following the passive transfer of neutralizing antibodies, an analysis of mucosal secretions showed that these antibodies were able to transudate in the mucosal compartments (nasal, oral and vaginal mucosa), suggesting greater protective activity against the infection of macaques via the vaginal route [12]. Baba et al., also showed that the passive transfer of neutralizing IgG to new-born primates protects against oral SHIV transmission, suggesting a role for these neutralizing IgG in the inhibition of vertical HIV transmission from mothers to infants [11]. Another report showed that the passive transfer of the monoclonal neutralizing antibodies 2F5 and 2G12, which have broad neutralizing activity against primary HIV isolates [77], together with a purified polyclonal IgG obtained from the plasma of HIV patients, prevented intravenous SHIV infection in macaques [13]. Several other studies have also described that the passive administration of neutralizing monoclonal antibodies to non-human primates before or after viral challenge can protect the animals against infection [78]. Nishimura et al., showed that the passive transfer of neutralizing antibodies one hour following the infection of the primates, rather than 24 hours, conferred an increased effectiveness of protection [15]. The presence of these neutralizing antibodies before the establishment of infection seems to be the key determinant of the efficacy of antibodies. The initial studies in macaques highlighted the role of such neutralizing IgG in mucosal protection, but the use of progesterone to thin the cervico-vaginal surfaces may improve the transudation of these antibodies into mucosal fluid, thereby conferring a higher level of infection. Therefore, it has been speculated that, in the absence of hormone treatment, higher concentrations of systemic neutralizing IgG may be needed for efficient mucosal protection. However, this notion has been recently reconsidered, following the report from Ann Hessell et al., that low doses of neutralizing 2G12 antibodies protected rhesus macaques against experimental mucosal challenge [55]. This protection does not seem to be due to higher levels of 2G12 transudation or transport from blood to the vaginal mucosal surface following intravenous antibody administration in macaques. The authors also determined the capacity of 2G12 to induce ADCVI and showed that 2G12 promoted ADCVI less efficient than IgG1 b12. Nevertheless, Fcγ-mediated inhibitory activities, other than ADCVI or ADCC, including phagocytosis and the clearance of immune complexes, were not evaluated. It therefore remains possible that 2G12 may compensate its neutralizing activity by other “extra-neutralizing activities”. Taken together, these data strongly suggest that higher doses of neutralizing antibodies are not necessary to confer a sterilizing protection in macaques and that other mechanisms of HIV protection, different from the neutralization, are certainly involved [79]. On the other hand, it has been suggested that the vaginal inoculation of macaques with large amounts of virus is not representative of the physiopathological conditions underlying sexually transmitted infection. Mostly, sexual HIV infection in human has occurred after multiple exposures to the virus, suggesting that repeated administration of low doses of virus inoculum in non-human primates may be the most appropriate model for studying the capacity of HIV-specific antibodies to prevent mucosal infection. Another recent report from the group of Dennis Burton suggested that the repeated passive administration of low levels of monoclonal neutralizing IgG1 b12 antibodies was sufficient to protect macaques against the repeated low-dose exposure of SHIV to the mucosal surfaces of the vaginal walls [76].

Dennis Burton and his group have recently demonstrated that neutralizing monoclonal IgG1 b12, in the absence of Fc-FcγR functions, cannot efficiently protect macaques from vaginal infection, indicating that FcγRs are crucially involved in the mechanism of antibody protection against vaginal SHIV challenge [61]. Given to these data, it is the most evidence that FcγRs are important in the mechanism of protection-mediated by neutralizing antibodies. When analyzing HIV neutralization on monocyte-derived macrophages and dendritic cells, an enhancement of the neutralizing activity was also detected for the five well-known monoclonal neutralizing IgG [21], but not for their corresponding neutralizing Fab fragments [21,60], indicating that the Fc portion of the these IgG as well as the FcγRs are strongly implicated in this increased neutralization [21,22]. Of note under these conditions, a higher neutralizing or inhibitory activity of neutralizing 2F5 and 4E10 than of IgG1 b12 was detected, suggesting that the conserved epitopes on gp41 are more relevant than the CD4 binding site epitope for neutralization of macrophages infection. Much like these findings, recently Perez et al., also observed that the neutralization activities of both monoclonal neutralizing 2F5 and 4E10, and, other plasma samples from chronically HIV-infected blood donors containing gp41 MPER-specific antibodies were potentiated by FcγRI and, to a lesser extent, by FcγRIIb [60]. In vitro, these recent data have also emphasized the role of FcγRs in the mechanism of HIV inhibition by neutralizing IgG. As another example, previous studies have also confirmed that the passive transfer of monoclonal antibodies directed against West Nile virus cell surface-associated proteins triggers Fcγ receptor-mediated phagocytosis and the clearance of infected cells and thus protection [80-82]. Altogether, these previous studies highlight the potent role of the Fc moiety of the IgG in the in vivo protection and in vitro inhibition afforded by the neutralizing antibody and raise questions about the effector functions induced by their cognate FcγRs present at the cell surface of specific immune cells.

As proof-of-concept, all these numerous passive transfer studies of neutralizing monoclonal antibodies have shown that administration of broadly reactive antibodies in non-human primates can afford sterilizing protection from vaginal or systemic infection [11-13,15,61,74,75,83], demonstrating the potential role of virus-specific humoral immunity [78]. In an important way, the recent studies in non-human primates also emphazised that FcγRs play a crucial role in the mucosal protection against infection by neutralizing antibodies [61].

Unlike neutralizing antibodies, non-neutralizing antibodies, which are found in many HIV patients, are induced during the acute phase of HIV infection and generally before the induction of cross-neutralizing antibodies. They may be generated by immunization or vaccination. Their role in HIV infection in vitro and in vivo was poorly understood or is somewhat controversial. Conversely, several groups have reported an FcγRs-mediated antibody-dependent enhancement (ADE) of infection in vitro, which they attributed to the action of non-neutralizing antibodies [84-89]. Takeda et al., showed that subneutralizing concentrations of antibody-positive sera increased HIV replication in the U937 human monocytic cell line [84], whereas optimal antibody concentrations did not. Others have shown that by blocking FcγRIII, but not FcγRI or FcγRII, inhibit the enhancement of HIV infection in peripheral blood macrophages [85,86]. By contrast, FcγR-independent ADE of HIV infection in MT2-CD4⁺ T lymphoblastoid cells has been detected in a small proportion of serum samples from HIV-seropositive individuals [90], suggesting that there may be several modes of ADE. One paper to date has described the ADE of HIV infection in FcαR-expressing cells [91]. Complement-dependent ADE has also been observed in certain types of dendritic cells (reviewed in [92]).

Preliminary studies have reported that the neutralizing activities of polyclonal IgG purified from the plasma or sera of SIV-infected macaques or HIV-infected patients are increased by a factor of 100 to 1,000-fold when monocyte-derived macrophages instead of blood mononuclear cells are used as target cells of virus [16,17]. Interestingly, they have reported that some purified IgG samples from the sera of recently infected individuals (a few months after seroconversion) or from recently infected macaques (six months after SIV inoculation) have potent neutralizing or inhibitory activities on macrophages and not on PBMCs. This suggests that non-neutralizing antibodies, which are produced before neutralizing antibodies, may play a role in the early stages of infection. More recently, it has been reported that non-neutralizing antibody activities were correlated with the reduction of acute viremia in vaccinated macaques [93], demonstrating that non-neutralizing antibodies-elicited by immunization could play an important role in the control of the acute phase of infection mediated, at least in part, by ADCVI activity and transcytosis inhibition.

Although a role of the FcγRIII in the mechanism of HIV inhibition by antibodies, independently of the CD4 receptor, has been described in macrophages [86], we [21] and, more recently, the group of David Montefiori [60], have definitively demonstrated that human FcγRs are involved in the inhibition of HIV replication by some HIV-specific IgG in human blood monocyte-derived macrophages and in transformed TZM-bl cells expressing various FcγRs, respectively. Others have shown that the activation of human macrophages, through FcγRs cross-linking, can contribute to the natural protection against HIV infection observed in some HIV-exposed uninfected individuals by inhibiting mucosal virus transmission [94]. Some time ago, the team of Michael Fanger evaluated the role of FcγRs in the infectivity of monocytes and macrophages, using bispecific antibodies to target HIV particles to various FcγR-bearing cells; they found that these FcγRs were not involved in the ADE of HIV infection in these cells [95].

In vitro some non-neutralizing IgG (monoclonal or polyclonal antibodies from HIV-1 patients) strongly inhibit HIV replication in macrophages or dendritic cells generated from human blood monocytes [21-23]. In addition, it has also been demonstrated that HIV infection and provirus formation are impaired in immature dendritic cells in the presence of HIV-specific IgG and complement [96]. The long-term transfer of HIV from dendritic cells to CD4 T cells also seems to be impeded by these HIV-specific IgG, whereas the addition of these antibodies and/or complement to activated PBMC did not protect them from HIV infection. It has thus been concluded that unconventional mechanisms of HIV inhibition by such antiviral antibodies may take place in dendritic cells but not in PBMC, leading to the suggestion that the lower levels of infection mediated by HIV-IgG immune complexes may result from interactions of virus-bound IgG with FcγRIIb expressed on DCs [96].

The Fab domain and the Fc constant domain of IgG and FcγRs present at the membrane of these APCs are involved in the efficient inhibition of HIV-1 replication in these immune cells by monoclonal and polyclonal non-neutralizing inhibitory IgG. More interestingly, we have reported that some monoclonal non-neutralizing IgG recognized specific epitopes on the viral gp, particularly in the V3 loop regions of gp120 and certain domains of gp41 (e.g., the immunogenic principal immuno-dominant domain) [23]. For some of them, their inhibitory concentrations that reduced 90% of infection are of similar magnitude that those of monoclonal neutralizing antibodies when these FcγR-bearing immune cells are used as HIV targets cells. These non-neutralizing inhibitory antibodies possess unconventional antiviral activities on FcγR-bearing immune cells. Such antibodies (some non-neutralizing inhibitory IgG as well as the monoclonal neutralizing IgG1 b12 for example) are not detected in the new neutralization assay performed with FcγR-expressing TZM-bl cells [60], undoubtedly due to differences in viral epitope-antibody recognition or host-cell susceptibility to HIV infection (high levels of expression of CCR5) or that these cell lines express only one of each FcγR subtype and not a combination of multiple FcγRs.

For example, it has been reported that the level of CCR5 expression, but not of CD4, on cell surface of HeLa cells may modify the neutralization efficiency of certain 4E10-like neutralizing antibodies [97]. These unconventional inhibitory IgG, despite being unable to neutralize free viral particles in the conventional neutralization assay, display potent FcγR-mediated HIV inhibition in other unconventional assays [20]. Effectively, the Fcγ portion of these anti-HIV antibodies may bind to the corresponding FcγRI or II on the cell surface of these APCs, thereby mediating HIV inhibition by a mechanism involving the phagocytosis and clearance of HIV-IgG immune complexes. This mechanism of HIV inhibition, distinct from the neutralization of the infectious viral particles by the Fab part of the antibody, exploits FcγR functions induced by IgG.

Other non-neutralizing antibodies recognizing epitopes present on the V2 loop, the C5 constant region or the CD4 binding site of HIV cannot prevent HIV replication in APCs [23]. Recently, using cord blood CD34-derived Langerhans and interstitial dendritic cells as HIV target cells, we confirmed that FcγRs are involved in HIV inhibition by neutralizing as well as non-neutralizing inhibitory antibodies (personal communication, unpublished results). No antibody-dependent enhancement of HIV replication has been detected in this in vitro inhibitory assay when macrophages or dendritic cells are used as HIV target cells. These data support the view that other types of HIV inhibition mechanism are implicated, and, point out that new assays need to be set up to understand the underlying mechanism of action.

Moreover, Donald Forthal and teammates have shown that NK cells and the Fc part of polyclonal IgG are required for the enhanced HIV-1 inhibition in PBMCs [98]. They also recently published that recombinant gp120 vaccination can elicit antibodies with antiviral activity against clinical strains of HIV-1, which necessitate the presence of FcγR-bearing effector NK cells [99]. They found that these antibodies inhibited HIV infection in the presence of effector cells, such as NK cells or Fcγ-bearing cells, whereas F(ab’)₂ fragments of these antibodies did not protect permissive cells against infection more effectively than whole IgG. A correlation has been found between the level of ADCVI and the gene polymorphism of FcγRIIa and FcγRIII.

In addition to the neutralizing activity of antibody, Fc-FcγR interactions are essential for in vivo protection against HIV infection. For these reasons, antibody-mediated effector mechanisms other than neutralization are clearly of great importance in protection against HIV [100]. The mechanisms by which FcγRs can enhance the HIV inhibitory activities of such antibodies remain unclear. However, FcγR-bearing immune cells involved in first-line defenses against mucosal HIV transmission are likely to play an important role in the clearance of opsonized virus by specific antibodies (Figure 1). The in vivo relevance of such non-neutralizing inhibitory or antiviral antibodies mediating FcγR effector functions remains to be clarified.

Several studies have shown that ADCC is one mechanism through which HIV-specific antibodies can limit or control viremia during HIV infection; such antiviral antibodies are often detected in the plasma of acutely infected patients [101-105], whereas neutralizing antibodies are generally absent. Unlike neutralizing activity, ADCC activity is detectable in most of HIV-infected individuals within a few days after seroconversion, and is correlated with the decline of the viremia [104]. ADCC activity can also be involved in disease progression, as non progressors, unlike rapid progressors, have high levels of ADCC antibodies [106]. Other HIV-infected individuals with undetectable levels of virus also have higher titers of such antibodies than viremic subjects [107]. Similarly, ADCC activity has recently been detected in HIV controllers at significantly higher levels than in viremic individuals [108]. In macaques, ADCC has also been correlated with delayed progression to AIDS, confirming the previous observations in humans [109,110]. Dysfunction NK cell activity has been reported in HIV-infected individuals [111]. The NK cells of infected patients produce IFN-γ but are unable to mediate ADCC in vitro [112]. In infected patients treated by HAART, a subset of blood cells expressing NK markers have been reported to display persistent HIV infection [113], suggesting that NK cells may serve as a reservoir for the virus. Other studies have also reported that HIV may modify the ADCC function of macrophages and neutrophils [114]. To date, various ADCC assays have been developed to analyze more precisely the activity of such antibodies to kill HIV infected cells, as reviewed in [115]. More recently, as HIV-specific ADCC antibodies triggered multiple effector functions of NK cells upon FcγRIII cross-linking (e.g., IFN-γ, TNF-α and β-chemokines production, degranulation of perforin and granzymes, CD107a expression, etc.)[116], new assays have been setup to monitor directly the activation status of the NK cells. According to the literature, all these compounds have antiviral activity and can directly interfere with HIV infection or infected cells.

Several ADCC epitopes on HIV have been identified, some of which are present in many HIV-infected individuals [114]. V3 loop ADCC epitopes appear to be the major determinants for ADCC activity, but ADCC epitopes in the V2 domain of gp120 have also been defined. It seems likely that the presence of ADCC epitopes in a variable region may result in viral variants escaping ADCC responses. Thus, analyzing of viral escape from ADCC activities would identify a subset of conserved ADCC epitopes. No clear correlations between vaccine-induced ADCC responses and in vivo protection have yet been observed, but most of the available evidence suggests that ADCC responses control HIV infection.

The role of ADCC in vaccination has been evaluated. Mucosal prime systemic boost immunization of macaques can elicit both ADCC and neutralizing antibodies, but protection against mucosal SHIV challenge is correlated with the titers of neutralizing antibodies, rather than with those of ADCC antibodies [114,117]. Others studies have reported that titers of human rgp120 vaccine-induced FcγR-dependent antibodies, which inhibit HIV infection in vitro, are inversely correlated with the infection rate [99]. It is thus important to determine which types of HIV-specific ADCC antibodies are required to prevent HIV infection and the likelihood of their induction by vaccination. It is well known that non-neutralizing antibodies, that mediated ADCC responses, can potentially contribute to mucosal defense against HIV, if present in cervico-vaginal secretions [118,119].

Like ADCC, antibody-dependent cell-mediated virus inhibition or ADCVI results from an interaction between an infected target cell, a HIV-specific antibody and an effector cell expressing one or several FcγRs. Unlike ADCC, ADCVI reflects the impact of antibody and effector cells on viral replication [61,99,104,120]. ADCVI encompasses multiple effector function activities related to lytic (e.g., ADCC) and non-cytolytic (e.g. production of β-chemokines, etc.) mechanisms dependent on FcγRs that may interfere with HIV infection and replication. In vivo, the ADCVI activity of non-neutralizing antibodies may help to reduce viral load and is strongly correlated with Fc-FcγR-mediated HIV inhibition by neutralizing antibodies in vitro [55,61]. ADCVI may be a reliable indicator of the antiviral activity of non-neutralizing antibodies that are not detected in conventional neutralization assays.