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James Porterfield, MD, PhD

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GHES U.S. Fellow 2018-2019

FELLOWSHIP SITE: AFRICAN HEALTH RESEARCH INSTITUTE UNIVERSITY OF KWAZULU-NATAL IN DURBAN, SOUTH AFRICA
U.S. INSTITUTION: YALE UNIVERSITY

Project Title: Impairment of Oral Mucosal Immunity in Chronic HIV Infection

HIV infected individuals have increased risk of oropharyngeal disease that persists despite successful treatment with anti-retrovirals. However, this mechanism is poorly understood. The oral microbiome is increasingly being recognized for playing a role in both local and systemic disease. Studying the interplay between oropharyngeal disease, the oral microbiome, and innate immunity may offer clues to not only understanding this phenomenon but preventing or treating the resultant disease in both HIV infected and uninfected individuals.

The tonsils form a major component of the oral Mucosa Associated Lymphoid Tissue (MALT), which is critical to the immune response to oral infection. They are exposed to extensive foreign antigens given their location at the inlet of both the gastrointestinal and respiratory tract and, given their accessibility, they are an ideal resource to study both innate and adaptive immunity of the oral mucosa. 

Given his long history of clinical and research work in South Africa and existing research collaborations with ENT surgeon from across the province of KwaZulu-Natal, South Africa, Dr. Porterfield has been able to facilitate access to tonsil tissue from medically-indicated tonsillectomies in both HIV infected and uninfected adults and children. This offers a very unique opportunity to study HIV in a way that likely would be impossible nearly anywhere else in the world given both the prevalence of HIV in the region and the extensive research infrastructure available at AHRI.

Dr. Porterfield will be working with Dr. Aladair Leslie at AHRI better understanding of the role of the tonsil (a secondary lymphoid organ and HIV sanctuary site) on the innate immune response to infection, maintenance of the oral microbiome, and the resultant role in oropharyngeal disease. He will specifically be evaluating changes in Innate Lymphoid Cell frequency and phenotype in the tonsil as well as changes in dysbiosis with HIV infection.