IntroductionThe pathogenesis of HIV-1 infection is linked to dysfunction and depletion of CD4 ϩ T lymphocytes. [1][2][3] The virus persists and disseminates over years, despite an apparently intact host immune response. The inability to eliminate HIV-1 suggests that negativeregulatory (tolerogenic) signals may shield HIV-1 from adaptive immune clearance. 4,5 However, the specific mechanisms by which the virus might protect itself from clearance remain unresolved.HIV-1 is known to persist at low levels within the central nervous system (CNS) during most of the disease course. 6 Significant productive HIV-1 replication occurs in brain mononuclear phagocytes (MPs; perivascular macrophages and microglia) during late stages of infection only in a subset of individuals with severe immune suppression and high peripheral viral loads. Secretory viral and cellular products from HIV-1-infected and immune competent brain MPs are known to induce neuronal dysfunction and injury. [7][8][9] These include virotoxins such as Tat, Nef, and gp120 and cellular toxins such as proinflammatory cytokines, chemokines, arachidonic acid and its metabolites, platelet activating factor, nitric oxide, and quinolinic acid. Indoleamine 2,3-dioxygenase (IDO) is the first and the rate-limiting enzyme in the generation of quinolinic acid from tryptophan via the kynurenine pathway. 10 An increase of functional IDO enzymatic activity in the brain could lead to enhanced production of neurotoxins, resulting in neurocognitive dysfunction and HIV-1-associated dementia (HAD). 11-13 Signs of increased IDO activity correlate with tryptophan depletion, progression of systemic and brain HIV-1 infection, and HAD. 14,15 Accumulating evidence suggests that IDO serves immunoregulatory and tolerogenic functions. [16][17][18][19][20][21] It appears that certain antigen presenting cells (APCs) may regulate T-cell responses through the expression of IDO. 22 A number of studies indicate that IDO overexpression by APCs may result in immune suppression and reduced T-cell responses. 17,18,20,[23][24][25] Therefore, HIV-induced IDO activity in the brain may participate not only in local neurotoxicity, but also in the failure of the immune system to clear HIV from this reservoir.A strong association between HAD and profound immunodeficiency supports the notion that a lack of effective adaptive immune responses is associated with ongoing viral replication in the brain. One plausible explanation is that circulating HIV-1-specific CD8 ϩ cells could be partially anergic and may be unable to eliminate HIV-1-infected cells in vivo in the setting of functionally impaired helper CD4 ϩ T cells during late stages of infection. 26,27 Based on these observations, we hypothesize that IDOexpressing APCs (specifically, HIV-1-infected macrophages) might help to create a protected reservoir for HIV-1 persistence in the brain. To test this idea we used a mouse model of HIV-1 For personal use only. on June 19, 2019. by guest www.bloodjournal.org From encephalitis (HIVE) in which nonobese di...