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However, the therapeutic benefits of these substances remain ambiguous. To date, little is known about the effects of these plant extracts on chronic CD4\u2009+\u2009T-cell activation and exhaustion which is partly driven by HIV-1 associated microbial translocation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Effects of <jats:italic>Azadirachta indica, Momordica foetida and Moringa oleifera<\/jats:italic> ethanol: water mixtures on cell viability were evaluated using the Guava PCA system. Then, an in-vitro cell culture model was developed to mimic CD4+ T cell exposures to antigens following HIV-1 microbial translocation. In this, peripheral blood mononuclear cells (PBMCs) isolated from HIV negative (<jats:italic>n<\/jats:italic>\u2009=\u200913), viral load &lt;\u20091000 copies per mL (<jats:italic>n<\/jats:italic>\u2009=\u200910) and viral load &gt;\u20091000 copies per mL (<jats:italic>n<\/jats:italic>\u2009=\u20096) study participants from rural Uganda were treated with Staphylococcus enterotoxin B (SEB). Then, the candidate plant extract (<jats:italic>A. indica<\/jats:italic>) was added to test the potential to inhibit corresponding CD4+ T cell activation. Following BD Facs Canto II event acquisition, variations in %CD38, %CD69, Human Leukocyte Antigen -DR (HLA-DR), Programmed cell death protein 1 (PD-1), T-cell immunoglobulin and mucin domain-containing protein 3 (Tim-3), interferon gamma (IFN \u03b3) and interleukin 2 (IL-2) CD4\u2009+\u2009T cell expression were evaluated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Following exposure to SEB, only <jats:italic>A. indica<\/jats:italic> demonstrated a concentration-dependent ability to downregulate the levels of CD4\u2009+\u2009T cell activation. At the final concentration of 0.500\u2009\u03bcg\/mL of <jats:italic>A. indica,<\/jats:italic> a significant downregulation of CD4\u2009+\u2009CD38\u2009+\u2009HLA-DR+ expression was observed in HIV negative (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and both HIV infected groups (<jats:italic>P<\/jats:italic>\u2009=\u20090.0313). This plant extract also significantly lowered SEB induced % CD4+ T cell HLADR, PD-1 and Tim-3 levels. PD-1 and CD69 markers were only significantly downmodulated in only the HIV negative ((<jats:italic>p<\/jats:italic>\u2009=\u20090.0001 and <jats:italic>p<\/jats:italic>\u2009=\u20090.0078 respectively) and viral load&lt;\u20091000 copies per ml (p\u2009=\u20090.0078) groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p><jats:italic>A. indica<\/jats:italic> exhibited the in-vitro immunomodulatory potential to inhibit the continuum of SEB induced CD4+ T-cell activation\/ exhaustion without impacting general T-cell specific functions such as cytokine secretion. Additional studies are needed to confirm <jats:italic>A. indica<\/jats:italic> as a source of natural products for targeting persistent immune activation and inflammation during ART.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12906-021-03288-0","type":"journal-article","created":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T10:03:40Z","timestamp":1617962620000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["In-vitro Immunomodulatory activity of Azadirachta indica A.Juss. 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