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Since the advent of antiretroviral therapy, there has been a substantial decrease in deaths related to HIV-1 monoinfection. However, liver disease has emerged as a common cause of morbidity in HIV-infected patients1,2. Coinfections of hepatitis viruses with HIV-1 infection are more common, accounting for 10% - 30% of HIV-infected persons in the United States3,4,5.
The host-specificity of HIV-1 and hepatitis viruses limits the utility of small animal models to study human-specific infectious diseases or to investigate multiple aspects of HIV-1-associated liver pathogenesis. Immunodeficient mice that permit the engraftment of human cells and/or tissues (termed humanized mouse models) are acceptable animal models for preclinical studies6,7,8. Since the introduction of humanized mice in the early 2000s, multiple preclinical studies of cholestatic human liver toxicity, human-specific pathogens, including HIV-1 and HIV-associated neurocognitive disorders, Epstein Barr virus, hepatitis, and other infectious diseases, have been investigated in these mice6,9,10,11. Multiple mouse models for CD34+ HSPCs and/or human hepatocyte transplantation have long been developed and have improved over time to study the disease pathogenesis of Hepatitis B virus (HBV)-associated liver disease12,13,14. Several models for HSPC and human hepatocyte (HEP) transplantation are based on strains, known as NOG (NOD.Cg-Prkdcscid Il2rgtm1Sug/JicTac)8,13, NSG (NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ)15, Balb/C-Rag2-/- γc-/- (Rag2tm1.1Flv Il2rgtm1.1Flv/J)12, and fah-/- NOD rag1-/-il2rγnull mouse16. However, each model has its own advantages and limitations; for example, AFC8 dual humanized mice for HEPs and human stem cells (HSCs) on a Balb/C-Rag2-/- γc-/- background enables the successful engraftment of immune cells and HSCs, but there is an absence of an antigen-specific T- and B-cell response in this model12. The major concerns in reconstituting double humanized mice include suboptimal engraftment, a lack of suitable models to support different tissues, mismatched conditions, immune rejection, or graft-versus-host disease (GVHD), and technical difficulties, such as risky manipulations with newborns and high mortality rates due to metabolic abnormalities13.
Although humanized mice have been used for HIV research for many years17,18,19, the use of humanized mice to study liver damage caused by HIV-1 has been limited20. We previously reported the establishment of a dual humanized TK-NOG mouse model and its application in HIV-associated liver disease8. This model shows the robust engraftment of liver and immune cells and recapitulates HIV infection pathogenesis. This discussion presents a detailed protocol, including the most critical steps in the transplantation of human hepatocytes. A description of the HSPCs required for a successful engraftment of HEPs and the establishment of a functional immune system in TK-NOG mice is also presented. The use of these mice to study HIV-associated liver immunopathogenesis is detailed. TK-NOG male mice carrying a liver-specific herpes simplex virus type 1 thymidine kinase (HSV-TK) transgene are used. Mouse liver cells expressing this transgene can easily be ablated after a brief exposure to a nontoxic dose of GCV. Transplanted human liver cells are stably maintained within the mouse liver without exogenous drugs21. The mice are also preconditioned with nonmyeloablative doses of treosulfan to create a niche in the mouse bone marrow for human cells8. Immunodeficient TK-NOG mice are intrasplenically injected with HEPs and multipotent HSPCs. The mice are then regularly monitored for blood and liver reconstitution by blood immunophenotyping and measurements of serum human-albumin levels, respectively. Mice with a successful reconstitution of more than 15% for both human immune cells and HEPs are intraperitoneally injected with HIV-1. The effect of HIV on the liver can be assessed as early as 4 - 5 weeks postinfection. It is critical to note that, because HIV-1 is used, all necessary precautions must be taken while handling the virus and injecting it into mice.