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Ellis RJ, Pal S, Achim CL, Sundermann E, Moore DJ, Soontornniyomkij V, Feldman H. Alzheimer-Type Cerebral Amyloidosis in the Context of HIV Infection: Implications for a Proposed New Treatment Approach. J Neuroimmune Pharmacol 2024; 19:27. [PMID: 38829507 PMCID: PMC11147830 DOI: 10.1007/s11481-024-10126-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
Reverse transcriptase inhibitors (RTIs) are currently broadly prescribed for the treatment of HIV infection but are also thought to prevent Alzheimer's disease (AD) progression by protecting against amyloidosis. Our study evaluates the hypothesis that reverse transcriptase inhibitors protect against Alzheimer-type brain amyloidogenesis in the context of HIV infection. We compiled a case series of participants from a prospective study of the neurological consequences of HIV infection at the HIV Neurobehavioral Research Program (HNRP) who had serial neuropsychological and neurological assessments and were on RTIs. Two participants had gross and microscopic examination and immunohistochemistry of the brain at autopsy; one was assessed clinically for Alzheimer's disease by cerebrospinal fluid (CSF) analysis of phosphorylated-Tau, Total-Tau and Aβ42. Additionally, a larger cohort of 250 autopsied individuals was evaluated for presence of amyloid plaques, Tau, and related pathologies. Three older, virally suppressed individuals with HIV who had long-term treatment with RTIs were included in analyses. Two cases demonstrated substantial cerebral amyloid deposition at autopsy. The third case met clinical criteria for AD based on a typical clinical course and CSF biomarker profile. In the larger cohort of autopsied individuals, the prevalence of cerebral amyloidosis among people with HIV (PWH) was greater for those on RTIs. Our study showed that long-term RTI therapy did not protect against Alzheimer-type brain amyloidogenesis in the context of HIV infection in these patients. Given the known toxicities of RTIs, it is premature to recommend them to individuals at risk or with Alzheimer's disease who do not have HIV infection.
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Affiliation(s)
- Ronald J Ellis
- Department of Neuroscience, University of California, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego, CA, USA.
| | - Shibangi Pal
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Cristian L Achim
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, CA, USA
| | | | - Howard Feldman
- Department of Neuroscience, University of California, San Diego, CA, USA
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2
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Kanmogne GD. HIV Infection, Antiretroviral Drugs, and the Vascular Endothelium. Cells 2024; 13:672. [PMID: 38667287 PMCID: PMC11048826 DOI: 10.3390/cells13080672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Endothelial cell activation, injury, and dysfunction underlies the pathophysiology of vascular diseases and infections associated with vascular dysfunction, including human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome. Despite viral suppression with combination antiretroviral therapy (ART), people living with HIV (PLWH) are prone to many comorbidities, including neurological and neuropsychiatric complications, cardiovascular and metabolic diseases, premature aging, and malignancies. HIV and viral proteins can directly contribute to the development of these comorbidities. However, with the continued high prevalence of these comorbidities despite viral suppression, it is likely that ART or some antiretroviral (ARVs) drugs contribute to the development and persistence of comorbid diseases in PLWH. These comorbid diseases often involve vascular activation, injury, and dysfunction. The purpose of this manuscript is to review the current literature on ARVs and the vascular endothelium in PLWH, animal models, and in vitro studies. I also summarize evidence of an association or lack thereof between ARV drugs or drug classes and the protection or injury/dysfunction of the vascular endothelium and vascular diseases.
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Affiliation(s)
- Georgette D Kanmogne
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5800, USA
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3
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Ellis RJ, Pal S, Achim CL, Sundermann E, Moore DJ, Soontornniyomkij V, Feldman H. Alzheimer-type cerebral amyloidosis in the context of HIV infection: implications for a proposed new treatment approach. RESEARCH SQUARE 2023:rs.3.rs-3040756. [PMID: 37398361 PMCID: PMC10312930 DOI: 10.21203/rs.3.rs-3040756/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Reverse transcriptase inhibitors (RTIs) are currently broadly prescribed for the treatment of HIV infection but are also thought to prevent Alzheimer's Disease (AD) progression by protecting against amyloidosis. Our study evaluates the hypothesis that reverse transcriptase inhibitors protect against Alzheimer-type brain amyloidogenesis in the context of HIV infection. We compiled a case series of participants from a prospective study of the neurological consequences of HIV infection at the HIV Neurobehavioral Research Program (HNRP) who had serial neuropsychological and neurological assessments and were on RTIs. Two participants had gross and microscopic examination and immunohistochemistry of the brain at autopsy; one was assessed clinically for Alzheimer's Disease by cerebrospinal fluid (CSF) analysis of phosphorylated-Tau, Total-Tau and Aβ42. Additionally, a larger cohort of autopsied individuals was evaluated for presence of amyloid plaques, Tau, and related pathologies. Three older, virally suppressed individuals with HIV who had long-term treatment with RTIs were included in analyses. Two cases demonstrated substantial cerebral amyloid deposition at autopsy. The third case met clinical criteria for AD based on a typical clinical course and CSF biomarker profile. In the larger cohort of autopsied individuals, the prevalence of cerebral amyloidosis among people with HIV (PWH) was greater for those on RTIs. Our study showed that long-term RTI therapy did not protect against Alzheimer-type brain amyloidogenesis in the context of HIV infection in these patients. Given the known toxicities of RTIs, it is premature to recommend them to individuals at risk or with Alzheimer's disease who do not have HIV infection.
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4
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Hanley S, Moodley D, Naidoo M. Obesity in young South African women living with HIV: A cross-sectional analysis of risk factors for cardiovascular disease. PLoS One 2021; 16:e0255652. [PMID: 34780476 PMCID: PMC8592426 DOI: 10.1371/journal.pone.0255652] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Young South African women are faced with a dual epidemic of HIV and obesity, placing them at a high risk of developing atherosclerotic cardiovascular disease (CVD). We sought to determine the prevalence of CVD risk factors in a cohort of reproductive-aged South African women living with HIV (WLHIV). METHODS While the main purpose of an ongoing intervention study is the reduction of cardiovascular disease through the integration of CVD screening and prevention in the HIV management plan for women of reproductive age (ISCHeMiA trial), we present the prevalence of risk factors for CVD in this cohort of young women at baseline. Sociodemographic, conventional CVD risk factors, HIV-related factors and self body image perception were assessed through study questionnaires and standardized clinical and laboratory procedures. RESULTS Of the 372 WLHIV enrolled from November 2018 to May 2019, 97% had received efavirenz-based antiretroviral treatment (ART) for at least 1 year and 67.5% (248/367) of women were overweight or obese at the time of enrolment. The prevalence of metabolic syndrome was 17.6% (95%CI 11.6-22.8) at a median age of 35 years (IQR 30.5-40.5). A significant proportion of women had abnormally low levels of high-density lipoprotein (43.2%, 80/185) and elevated levels of high sensitivity C-reactive protein (59.5%, 110/185). Seventy five percent of overweight women with an increased waist circumference reported to be satisfied with their body image. CONCLUSIONS The high prevalence of metabolic syndrome, obesity and elevated markers of inflammation in young South African WLHIV, underscores the need for a proactive integrated management approach to prevent atherosclerotic cardiovascular disease in low and middle income settings.
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Affiliation(s)
- Sherika Hanley
- Umlazi Clinical Research Unit, Centre for the AIDS Programme of Research of South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Dhayendre Moodley
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
| | - Mergan Naidoo
- Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa
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5
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Ellis RJ, Peterson S, Cherner M, Morgan E, Schrier R, Tang B, Hoenigl M, Letendre S, Iudicello J. Beneficial Effects of Cannabis on Blood-Brain Barrier Function in Human Immunodeficiency Virus. Clin Infect Dis 2021; 73:124-129. [PMID: 32296832 DOI: 10.1093/cid/ciaa437] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/14/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection leads to blood-brain barrier (BBB) dysfunction that does not resolve despite viral suppression on antiretroviral therapy (ART) and is associated with adverse clinical outcomes. In preclinical models, cannabis restores BBB integrity. METHODS We studied persons with HIV (PWH) and HIV-negative (HIV-) individuals who had used cannabis recently. We assessed 2 biomarkers of BBB permeability: the cerebrospinal fluid (CSF) to serum albumin ratio (CSAR) and CSF levels of soluble urokinase plasminogen activator receptor (suPAR), a receptor for uPA, a matrix-degrading proteolytic enzyme that disrupts the BBB. A composite index of the BBB markers was created using principal components analysis. Neural injury was assessed using neurofilament light (NFL) in CSF by immunoassay. RESULTS Participants were 45 PWH and 30 HIV- individuals of similar age and ethnicity. Among PWH, higher CSF suPAR levels correlated with higher CSAR values (r = 0.47, P < .001). PWH had higher (more abnormal) BBB index values than HIV- individuals (mean ± SD, 0.361 ± 1.20 vs -0.501 ± 1.11; P = .0214). HIV serostatus interacted with cannabis use frequency, such that more frequent use of cannabis was associated with lower BBB index values in PWH but not in HIV- individuals. Worse BBB index values were associated with higher NFL in CSF (r = 0.380, P = .0169). CONCLUSIONS Cannabis may have a beneficial impact on HIV-associated BBB injury. Since BBB disruption may permit increased entry of toxins such as microbial antigens and inflammatory mediators, with consequent CNS injury, these results support a potential therapeutic role of cannabis among PWH and may have important treatment implications for ART effectiveness and toxicity.
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Affiliation(s)
- Ronald J Ellis
- University of California, San Diego, San Diego, California, USA
| | - Scott Peterson
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California, USA
| | - Mariana Cherner
- University of California, San Diego, San Diego, California, USA
| | - Erin Morgan
- University of California, San Diego, San Diego, California, USA
| | - Rachel Schrier
- University of California, San Diego, San Diego, California, USA
| | - Bin Tang
- University of California, San Diego, San Diego, California, USA
| | - Martin Hoenigl
- University of California, San Diego, San Diego, California, USA
| | - Scott Letendre
- University of California, San Diego, San Diego, California, USA
| | - Jenny Iudicello
- University of California, San Diego, San Diego, California, USA
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6
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Sico JJ, Kundu S, So-Armah K, Gupta SK, Chang CCH, Butt AA, Gibert CL, Marconi VC, Crystal S, Tindle HA, Freiberg MS, Stewart JC. Depression as a Risk Factor for Incident Ischemic Stroke Among HIV-Positive Veterans in the Veterans Aging Cohort Study. J Am Heart Assoc 2021; 10:e017637. [PMID: 34169726 PMCID: PMC8403311 DOI: 10.1161/jaha.119.017637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background HIV infection and depression are each associated with increased ischemic stroke risk. Whether depression is a risk factor for stroke within the HIV population is unknown. Methods and Results We analyzed data on 106 333 (33 528 HIV‐positive; 72 805 HIV‐negative) people who were free of baseline cardiovascular disease from an observational cohort of HIV‐positive people and matched uninfected veterans in care from April 1, 2003 through December 31, 2014. International Classification of Diseases, Ninth Revision (ICD‐9) codes from medical records were used to determine baseline depression and incident stroke. Depression occurred in 19.5% of HIV‐positive people. After a median of 9.2 years of follow‐up, stroke rates were highest among people with both HIV and depression and lowest among those with neither condition. In Cox proportional hazard models, depression was associated with an increased risk of stroke for HIV‐positive people after adjusting for sociodemographic characteristics and cerebrovascular risk factors (hazard ratio [HR], 1.18; 95% CI: 1.03–1.34; 0.014). The depression‐stroke relationship was attenuated by alcohol use disorders, cocaine use, and baseline antidepressant use, and unaffected by combined antiretroviral therapy use or individual antiretroviral agents. A numerically higher HR of depression on stroke was found among those younger than 60 years. Conclusions Depression is associated with an increased risk of stroke among HIV‐positive people after adjusting for sociodemographic characteristics, traditional cerebrovascular risk factors, and HIV‐specific factors. Alcohol use disorders, cocaine use, and baseline antidepressant use accounted for some of the observed stroke risk. Depression may be a novel, independent risk factor for ischemic stroke in HIV, particularly among younger people.
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Affiliation(s)
- Jason J Sico
- Neurology Service VA Connecticut Healthcare System West Haven CT.,Department of Neurology Yale School of Medicine New Haven CT.,Center for NeuroEpidemiological and Clinical Neurological Research Yale School of Medicine New Haven CT.,Department of Internal Medicine Yale School of Medicine New Haven CT.,Clinical Epidemiology Research Center (CERC) VA Connecticut Healthcare System West Haven CT.,Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center VA Connecticut Healthcare System West Haven CT.,Vanderbilt Center for Clinical Cardiovascular Outcomes Research and Trials Evaluation (V-CREATE) Vanderbilt University School of Medicine Nashville TN
| | - Suman Kundu
- Vanderbilt Center for Clinical Cardiovascular Outcomes Research and Trials Evaluation (V-CREATE) Vanderbilt University School of Medicine Nashville TN.,Tennessee Valley Geriatrics Research Education and Clinical Centers (GRECC) VA Tennessee Valley Healthcare System Nashville TN
| | | | - Samir K Gupta
- Department of Medicine Indiana University School of Medicine Indianapolis IN
| | | | - Adeel A Butt
- VA Pittsburgh Healthcare System Pittsburgh PA.,Weill Cornell Medical College New York NY.,Weill Cornell Medical College Doha Qatar.,Hamad Medical Corporation Doha Qatar
| | - Cynthia L Gibert
- Washington DC Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences Washington DC
| | - Vincent C Marconi
- Emory University School of Medicine and Rollins School of Public Health Emory Center for AIDS Research, and the Atlanta VA Medical Center Atlanta GA
| | - Stephen Crystal
- Center for Health Services Research Institute for Health Rutgers University New Brunswick NJ
| | - Hilary A Tindle
- Tennessee Valley Geriatrics Research Education and Clinical Centers (GRECC) VA Tennessee Valley Healthcare System Nashville TN.,Vanderbilt University Medical Center Nashville TN
| | - Matthew S Freiberg
- Vanderbilt Center for Clinical Cardiovascular Outcomes Research and Trials Evaluation (V-CREATE) Vanderbilt University School of Medicine Nashville TN.,Tennessee Valley Geriatrics Research Education and Clinical Centers (GRECC) VA Tennessee Valley Healthcare System Nashville TN
| | - Jesse C Stewart
- Department of Psychology Indianapolis University-Purdue University Indianapolis (IUPUI) Indianapolis IN
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7
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Huang Q, Sun Y, Huang Q, Zeng Y, Lin S, Huang S, Cai Y, Xu X, Kang D, Li H, Wu S. Association Between Circular RNAs and Intracranial Aneurysm Rupture Under the Synergistic Effect of Individual Environmental Factors. Front Neurol 2021; 12:594835. [PMID: 33746870 PMCID: PMC7969784 DOI: 10.3389/fneur.2021.594835] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/04/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction: To study the association between specific circular RNAs and rupture of intracranial aneurysm. To explore its clinical diagnostic significance and synergistic effects with individual environmental influencing factors. Methods: Three hundred and forty seven cases and controls were included in this study. Multivariate analysis was used to explore the main individual environmental factors. Intracranial aneurysm rupture related circular RNAs screened based on sequencing was verified in peripheral blood by PCR. ROC curve, logistic regression model and fork analysis were used to study the association, diagnostic values, and synergistic effects of circular RNA with intracranial aneurysms and individual environmental factors. Results: Smoking, hair dyeing, sitting time ≥6 h/day, single animal oil intake and hypertension are the main risk factors for intracranial aneurysm rupture; People with higher education, sleeping time ≥7 h/day, tea drinking, diabetes, higher levels of (hemoglobin, low density lipoprotein, serum calcium, and apolipoprotein-A1) have a low risk of intracranial aneurysm rupture. Hsa_circ_0008433 and hsa_circ_0001946 are closely related to intracranial aneurysm rupture and have certain clinical diagnostic significance (AUC = 0.726; 95% CI: 0.668~0.784). Hsa_circ_0008433 (OR = 0.497, 95% CI: 0.338~0.731), hsa_circ_0001946 (OR = 0.682, 95% CI: 0.509~0.914) were independent epigenetic factors affecting intracranial aneurysm rupture, and have a multiplicative interaction with age (OR = 3.052, 95% CI: 1.006~9.258). Conclusions: Low expressions of hsa_circ_0008433 and hsa_circ_0001946 are risk factors for intracranial aneurysms rupture and have good clinical diagnostic value. There was a multiplicative interaction between epigenetic score and age. The older and the higher the epigenetic score was, the more likely to have intracranial aneurysm rupture.
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Affiliation(s)
- Qing Huang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yi Sun
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Qiuyu Huang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yile Zeng
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shaowei Lin
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Shuna Huang
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yingying Cai
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xingyan Xu
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huangyuan Li
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Siying Wu
- School of Public Health, Fujian Medical University, Fuzhou, China
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8
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Bertrand L, Velichkovska M, Toborek M. Cerebral Vascular Toxicity of Antiretroviral Therapy. J Neuroimmune Pharmacol 2021; 16:74-89. [PMID: 31209776 PMCID: PMC7952282 DOI: 10.1007/s11481-019-09858-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/27/2019] [Indexed: 01/14/2023]
Abstract
HIV infection is associated with comorbidities that are likely to be driven not only by HIV itself, but also by the toxicity of long-term use of antiretroviral therapy (ART). Indeed, increasing evidence demonstrates that the antiretroviral drugs used for HIV treatment have toxic effects resulting in various cellular and tissue pathologies. The blood-brain barrier (BBB) is a modulated anatomophysiological interface which separates and controls substance exchange between the blood and the brain parenchyma; therefore, it is particularly exposed to ART-induced toxicity. Balancing the health risks and gains of ART has to be considered in order to maximize the positive effects of therapy. The current review discusses the cerebrovascular toxicity of ART, with the focus on mitochondrial dysfunction. Graphical Abstract Graphical representation of the interactions between HIV, antiretroviral therapy (ART), and the blood-brain barrier (BBB).
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Affiliation(s)
- Luc Bertrand
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Gautier Bldg., Room 528, 1011 NW 15th Street, Miami, FL, 33136, USA
| | - Martina Velichkovska
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Gautier Bldg., Room 528, 1011 NW 15th Street, Miami, FL, 33136, USA
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Gautier Bldg., Room 528, 1011 NW 15th Street, Miami, FL, 33136, USA.
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9
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Lazalde-Ramos BP, Zamora-Perez AL, Ortega-Guerrero AI, Quintero-Fraire SZ, Palacios-Lara O, Quirarte-Báez SM, Galaviz-Hernández C, Sosa-Macías M, Ortiz-García YM, Morales-Velazquez G. Genomic Instability Decreases in HIV Patient by Complementary Therapy with Rosmarinus officinalis Extracts. J Med Food 2020; 23:1070-1076. [PMID: 32125929 DOI: 10.1089/jmf.2019.0199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Genomic instability is associated with increased oxidative stress in patients with human immunodeficiency virus (HIV). The aim of this study was to determine the effect of intake of methanolic and aqueous extracts of Rosmarinus officinalis on genomic instability in HIV patients. We studied 67 HIV patients under pharmacological treatment with ATRIPLA who were divided into three groups: group 1, patients under ATRIPLA antiretroviral therapy; group 2, patients with ATRIPLA and rosemary aqueous extract (4 g/L per day); and group 3, patients with ATRIPLA and rosemary methanolic extract (400 mg/day). The genomic instability was evaluated through the buccal micronucleus cytome assay. Oral epithelial cells were taken at the beginning and 1 and 4 months later. The groups that received the pharmacological therapy with ATRIPLA and the complementary therapy with R. officinalis extracts showed a decrease in the number of cells with micronuclei and nuclear abnormalities compared with the group that only received ATRIPLA. The complementary therapy with R. officinalis decreased the genomic instability in HIV patients.
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Affiliation(s)
- Blanca Patricia Lazalde-Ramos
- Master of Science and Chemical Technology, Chemistry Department, Autonomous University of Zacatecas, Zacatecas, Mexico
| | - Ana Lourdes Zamora-Perez
- Institute of Dental Research, University Center for Health Science, University of Guadalajara, Mexico
| | - Aymée Ileana Ortega-Guerrero
- Pharmaceutical-Biological Chemistry Program, Chemistry Department, Autonomous University of Zacatecas, Zacatecas, Mexico
| | - Saira Zulema Quintero-Fraire
- Pharmaceutical-Biological Chemistry Program, Chemistry Department, Autonomous University of Zacatecas, Zacatecas, Mexico
| | - Omar Palacios-Lara
- Outpatient Centers for the Prevention and Care of AIDS and Sexually Transmitted Infections and Care Services Integral Hospital, Secretary of Health, Zacatecas, Zacatecas, Mexico.,Mexican Institute of Social Security, Zacatecas Delegation, Mexico
| | | | | | - Martha Sosa-Macías
- National Polytechnic Institute, CIIDIR-Durango, Academy of Genomics, Durango, Mexico
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10
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Brain microstructural changes support cognitive deficits in HIV uninfected children born to HIV infected mothers. Brain Behav Immun Health 2020; 2:100039. [PMID: 34589830 PMCID: PMC8474176 DOI: 10.1016/j.bbih.2020.100039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Antiretroviral therapy (ART) is considered the most effective way to prevent perinatal transmission of human immunodeficiency virus (HIV). However, there is little knowledge about the effect of ART on the brain of HIV uninfected children born to HIV infected mothers (HUC). The current study evaluated the brain's microstructural integrity, and cognitive function in HUC compared to healthy children born to normal mothers (CHNM) and HIV infected children born to HIV infected mothers (HIC) to investigate the effect of in-utero exposure of ART on cerebral gray and white matter. Materials and methods Forty nine HIC, 12 HUC and 18 CHNM underwent neuropsychological (NP) assessment and a brain MRI. Diffusion tensor imaging (DTI) data was used to generate fractional anisotropy (FA) and mean diffusivity (MD) maps. Voxel wise comparison for FA and MD was performed between three groups using an analysis of covariance (ANCOVA) including age and sex as covariates, and correction for multiple comparisons (false discovery rate (FDR), p < 0.05 with minimum extended cluster size, 150 voxels). NP test scores were also compared between three groups using ANOVA with Post Hoc Bonferroni multiple comparison corrections (p < 0.05). Significantly changed FA and MD values in different brain regions in HIC and HUC compared to CHNM were used for correlation analysis with NP test scores using Pearson's correlation. Results HIC and HUC groups showed significantly decreased NP test scores in various domain compared to CHNM. Significantly lower NP test scores was observed in HIC than those of HUC. HIC showed decreased FA and increased MD in multiple brain sites as compared to both CHNM and HUC. Decreased FA along with both increased and decreased MD in different brain regions was present in HUC compared to CHNM. Both positive and negative correlation of altered FA and MD values from different brain regions in HIC and HUC with NP test scores was observed. Conclusion The presence of brain tissue changes and neurocognitive function deficit in absence of HIV infection in HUC indicates that ART may have a detrimental impact on the developing brain. The findings of the current study underscore the need for screening of ART exposed children for neurodevelopment and cognitive abnormalities at an early stage and call for access to early interventions, and nutritional and care programs.
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11
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Marincowitz C, Genis A, Goswami N, De Boever P, Nawrot TS, Strijdom H. Vascular endothelial dysfunction in the wake of HIV and ART. FEBS J 2018; 286:1256-1270. [PMID: 30220106 DOI: 10.1111/febs.14657] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 01/18/2023]
Abstract
Mounting evidence points to increased rates of cardiovascular disease (CVD) among people living with HIV/AIDS (PLWHA). Endothelial dysfunction (loss of endothelium-dependent vascular relaxation in response to provasodilatory stimuli) constitutes an early pathophysiological event in atherogenesis and CVD. Both HIV-1 infection and antiretroviral therapy (ART) are implicated in the development of endothelial dysfunction; however, conclusions are frequently drawn from associations shown in epidemiological studies. In this narrative review of mainly in vitro and animal studies, we report on the current understanding of how various HIV-1 proteins, HIV-1-induced proinflammatory cytokines and common antiretroviral drugs directly impact vascular endothelial cells. Proposed cellular mechanisms underlying the switch to a dysfunctional state are discussed, including oxidative stress, impaired expression and regulation of endothelial nitric oxide (NO) synthase (eNOS) and increased expression of vascular adhesion molecules. From the literature, it appears that increased reactive oxygen species (ROS) production, linked to decreased NO bioavailability and ensuing endothelial dysfunction, may be proposed as a putative final common pathway afflicting the vascular endothelium in PLWHA. The HIV-1-proteins Tat, Gp120 and Nef in particular, the proinflammatory cytokine, TNF-α, and the antiretroviral drugs Efavirenz and Lopinavir, most commonly postulated to be primary causal agents of endothelial dysfunction, are also discussed. We conclude that, despite existing evidence from basic research papers, a significant gap remains in terms of the exact underlying cellular mechanisms involved in HIV-1 and ART induced endothelial dysfunction. Bridging this gap could help pave the way for future strategies to prevent and treat early cardiovascular changes in PLWHA.
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Affiliation(s)
- Clara Marincowitz
- Division of Medical Physiology, Stellenbosch University, Cape Town, South Africa
| | - Amanda Genis
- Division of Medical Physiology, Stellenbosch University, Cape Town, South Africa
| | - Nandu Goswami
- Department of Physiology and Otto Loewi Research Centre, Medical University of Graz, Austria
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Centre for Environment and Health, Department for Public Health and Primary Care, KU Leuven, Belgium
| | - Hans Strijdom
- Division of Medical Physiology, Stellenbosch University, Cape Town, South Africa
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12
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Mu Y, Kodidela S, Wang Y, Kumar S, Cory TJ. The dawn of precision medicine in HIV: state of the art of pharmacotherapy. Expert Opin Pharmacother 2018; 19:1581-1595. [PMID: 30234392 DOI: 10.1080/14656566.2018.1515916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Combination antiretroviral therapy (ART) reduces viral load to under the limit of detection, successfully decreasing HIV-related morbidity and mortality. Due to viral mutations, complex drug combinations and different patient response, there is an increasing demand for individualized treatment options for patients. AREAS COVERED This review first summarizes the pharmacokinetic and pharmacodynamic profile of clinical first-line drugs, which serves as guidance for antiretroviral precision medicine. Factors which have influential effects on drug efficacy and thus precision medicine are discussed: patients' pharmacogenetic information, virus mutations, comorbidities, and immune recovery. Furthermore, strategies to improve the application of precision medicine are discussed. EXPERT OPINION Precision medicine for ART requires comprehensive information on the drug, virus, and clinical data from the patients. The clinically available genetic tests are a good starting point. To better apply precision medicine, deeper knowledge of drug concentrations, HIV reservoirs, and efficacy associated genes, such as polymorphisms of drug transporters and metabolizing enzymes, are required. With advanced computer-based prediction systems which integrate more comprehensive information on pharmacokinetics, pharmacodynamics, pharmacogenomics, and the clinically relevant information of the patients, precision medicine will lead to better treatment choices and improved disease outcomes.
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Affiliation(s)
- Ying Mu
- a Department of Clinical Pharmacy and Translational Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
| | - Sunitha Kodidela
- b Department of Pharmaceutical Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
| | - Yujie Wang
- b Department of Pharmaceutical Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
| | - Santosh Kumar
- b Department of Pharmaceutical Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
| | - Theodore J Cory
- a Department of Clinical Pharmacy and Translational Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
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Combination of Tenofovir and Emtricitabine with Efavirenz Does Not Moderate Inhibitory Effect of Efavirenz on Mitochondrial Function and Cholesterol Biosynthesis in Human T Lymphoblastoid Cell Line. Antimicrob Agents Chemother 2018; 62:AAC.00691-18. [PMID: 30012753 DOI: 10.1128/aac.00691-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/07/2018] [Indexed: 01/22/2023] Open
Abstract
Efavirenz (EFV), the most popular nonnucleoside reverse transcriptase inhibitor, has been associated with mitochondrial dysfunction in most in vitro studies. However, in real life the prevalence of EFV-induced mitochondrial toxicity is relatively low. We hypothesized that the agents given in combination with EFV moderate the effect of EFV on mitochondrial function. To test this hypothesis, we cultured a human T lymphoblastoid cell line (CEM cells) with EFV alone and in combination with emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) to investigate the effects on mitochondrial respiration and function and cholesterol biosynthesis. There was a statistically significant concentration- and time-dependent apoptosis, reduction in mitochondrial membrane potential, and increase in production of reactive oxygen species in cells treated with either EVF alone or in combination with TDF plus FTC. Compared to dimethyl sulfoxide-treated cells, EFV-treated cells had significant reduction in oxygen consumption rate contributed by basal mitochondrial respiration and decreased protein expression of electron transport chain complexes (CI, CII, and CIV). Treatment with EFV resulted in a decrease in mitochondrial DNA content and perturbation of more coding genes (n = 13); among these were 11 genes associated with lipid or cholesterol biosynthesis. Our findings support the growing body of knowledge on the effects of EFV on mitochondrial respiration and function and cholesterol biosynthesis. Interestingly, combining TDF and FTC with EFV did not alter the effects of EFV on mitochondrial respiration and function and cholesterol biosynthesis. The gap between the prevalence of EFV-induced mitochondrial toxicity in in vitro and in vivo studies could be due to individual differences in the pharmacokinetics of EFV.
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Apostolova N, Blas-Garcia A, Galindo MJ, Esplugues JV. Efavirenz: What is known about the cellular mechanisms responsible for its adverse effects. Eur J Pharmacol 2017; 812:163-173. [PMID: 28690189 DOI: 10.1016/j.ejphar.2017.07.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 02/08/2023]
Abstract
The HIV infection remains an important health problem worldwide. However, due to the efficacy of combined antiretroviral therapy (cART), it has ceased to be a mortal condition, becoming a chronic disease instead. Efavirenz, the most prescribed non-nucleoside analogue reverse transcriptase inhibitor (NNRTI), has been a key component of cART since its commercialization in 1998. Though still a drug of choice in many countries, its primacy has been challenged by the arrival of newer antiretroviral agents with better toxicity profiles and treatment adherence. The major side effects related to EFV have been widely described in clinical studies, however the mechanisms that participate in their pathogenesis remain largely ununderstood. This review provides an insight into the cellular and molecular mechanisms responsible for the development of the most significant undesired effects induced by efavirenz, both short- and long-term, revealed by in vitro and in vivo experimental pharmacological research. Growing evidence implicates the drug in energy metabolism, mitochondrial function, and other cellular processes involved in stress responses including oxidative stress, inflammation and autophagy.
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Affiliation(s)
- Nadezda Apostolova
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia-Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Valencia, Spain.
| | - Ana Blas-Garcia
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia-Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Valencia, Spain
| | - Maria J Galindo
- Unidad de Enfermedades Infecciosas - Medicina Interna, Hospital Clínico Universitario de Valencia, Spain
| | - Juan V Esplugues
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia-Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Valencia, Spain; FISABIO-Hospital Universitario Dr. Peset, Valencia, Spain
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