Understanding mechanisms underlying the pathology of immune reconstitution inflammatory syndrome (IRIS) by using animal models

Abstract

Purpose of review: Despite the increasing number of clinical reports on immune reconstitution inflammatory syndrome (IRIS), mechanistic understanding of IRIS is still largely limited. The main focus of this review is to summarize animal studies, which were performed to better understand the cellular and molecular mechanisms underlying the pathology of IRIS.

Recent findings: Three IRIS animal models have been reported. They are Mycobacterial IRIS (M-IRIS), cryptococcal IRIS (C-IRIS) and Pneumocystis-IRIS. M-IRIS animal model suggested that, rather than lymphopenia itself, the failure to clear the pathogen by T cells results in excessive priming of the innate immune system. If this happens before T cell reconstitution, hosts likely suffer IRIS upon T cell reconstitution. Interestingly, T cells specific to self-antigens, not only pathogen-specific, could drive IRIS as well.

Summary: The mechanism to develop IRIS is quite complicated, including multiple layers of host immune responses; the innate immune system that detects pathogens and prime host immunity, and the adaptive immune system that is reconstituted but hyper-activated particularly through CD4⁺ T cells. Animal models of IRIS, although there are still small numbers of studies available, have already provided significant insights on the mechanistic understanding of IRIS.

Keywords: Cryptococcus neoformans; IRIS; Immune reconstitution; Mycobacterium avium; Opportunistic infection; Pneumocystis.

Figure 1

Protocols and outcomes of three mouse IRIS models. The upper panel indicates experimental protocols of mouse IRIS. The bottom panel shows results from M-IRIS [56, 57], C-IRIS [59], Pneumocystis-IRIS [66].