Transmembrane P-glycoprotein (P-gp/P-170) in HIV infection: Analysis of lymphocyte surface expression and drug-unrelated function

P-glycoprotein (P-gp/P-170), a transmembrane efflux pump known to be one of the mechanisms responsible for multidrug resistance in cancer therapy, is constitutively expressed in several solid human tissues as well as in normal peripheral blood lymphocytes and bone marrow cells. In particular, this molecule has been associated with the transport of perforin and other cytolysins in natural killer (NK) and T cytotoxic lymphocytes. In the present study, we analyzed peripheral blood lymphocytes (PBLs) from controls and HIV⁺ patients for phenotypic expression and function of the P-gp/P-170 molecule. We found that 90% of all PBL subsets (i.e., CD4⁺, CD8⁺, CD56⁺, and CD19⁺ cells) expressed surface P-gp/P-170 both in controls and HIV⁺ patients. However, a significant decrease in CD4⁺/P-170⁺ and CD19⁺/P- 170⁺ cells was observed in HIV⁺ individuals with respect to controls. PHA and IL-2 stimulation of PBLs was unable to increase the expression of P- gp/P-170 both in controls and HIV⁺ patients, despite the increased detection of the CD25 molecule. On the other hand, stimulation with anti-CD3 determined a significant increase in lymphocyte P-gp/P-170. The function of P-gp/P-170, assessed by a flow cytometric assay for rhodamine-123 (Rh123) efflux, was significantly reduced in CD16⁺ NK cells and CD19⁺ B cells from HIV⁺ patients. The Rh123 efflux by NK cells correlated (p < 0.01) with the NK cytotoxicity against the ⁵¹Cr-labeled K562 cell line. Last, the effect of the antiretroviral drugs AZT, ddI, and ddC on P-gp expression and function was evaluated. The dideoxynucleoside compounds did not inhibit P-gp/P-170 function of normal mononuclear cells in vitro, and did not increase P-gp/P- 170 expression in vivo, in patients undergoing antiretroviral therapy with AZT. These findings provide further evidence of a possible involvement of the P-gp/P-170 system in specific immunological lymphocyte functions, and especially in cytotoxic-type functions. In addition, it is possible to suggest, on the basis of our experimental data, that the dideoxynucleoside class of antiretroviral agents does not contribute to the phenotypic and functional alterations related to P-glycoprotein during HIV infection.