1
|
Naimo E, Zischke J, Schulz TF. Recent Advances in Developing Treatments of Kaposi's Sarcoma Herpesvirus-Related Diseases. Viruses 2021; 13:1797. [PMID: 34578378 PMCID: PMC8473310 DOI: 10.3390/v13091797] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/27/2022] Open
Abstract
Kaposi-sarcoma-associated herpesvirus (KSHV) or human herpesvirus 8 (HHV-8) is the causative agent of several malignancies, including Kaposi's sarcoma (KS), primary effusion lymphoma (PEL), and multicentric Castleman's disease (MCD). Active KSHV replication has also been associated with a pathological condition called KSHV inflammatory cytokine syndrome (KICS), and KSHV may play a role in rare cases of post-transplant polyclonal lymphoproliferative disorders. Several commonly used herpesviral DNA polymerase inhibitors are active against KSHV in tissue culture. Unfortunately, they are not always efficacious against KSHV-induced diseases. To improve the outcome for the patients, new therapeutics need to be developed, including treatment strategies that target either viral proteins or cellular pathways involved in tumor growth and/or supporting the viral life cycle. In this review, we summarize the most commonly established treatments against KSHV-related diseases and review recent developments and promising new compounds that are currently under investigation or on the way to clinical use.
Collapse
Affiliation(s)
- Eleonora Naimo
- Institute of Virology, Hannover Medical School, 30625 Hannover, Germany; (E.N.); (J.Z.)
- German Centre for Infection Research, Hannover-Braunschweig Site, 38023 Braunschweig, Germany
| | - Jasmin Zischke
- Institute of Virology, Hannover Medical School, 30625 Hannover, Germany; (E.N.); (J.Z.)
- German Centre for Infection Research, Hannover-Braunschweig Site, 38023 Braunschweig, Germany
| | - Thomas F. Schulz
- Institute of Virology, Hannover Medical School, 30625 Hannover, Germany; (E.N.); (J.Z.)
- German Centre for Infection Research, Hannover-Braunschweig Site, 38023 Braunschweig, Germany
- Cluster of Excellence 2155 RESIST, Institute of Virology, Hannover Medical School, 30625 Hannover, Germany
| |
Collapse
|
2
|
Herrera-Ortíz A, Meng W, Gao SJ. Nitric oxide is induced and required for efficient Kaposi's sarcoma-associated herpesvirus lytic replication. J Med Virol 2021; 93:6323-6332. [PMID: 34297418 DOI: 10.1002/jmv.27228] [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] [Received: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/08/2022]
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) is an oncogenic virus associated with several human malignancies. KSHV lytic replication promotes the spread of infection and progression of KSHV-associated malignancies; however, the mechanism regulating KSHV lytic replication remains unclear. In this study, we investigated the role of nitric oxide (NO) in KSHV lytic replication. In the TREx BCBL1-RTA KSHV lytic replication cell system, induction of KSHV lytic replication increased intracellular and extracellular NO. Chemical inhibition of NO production resulted in a lower level of KSHV lytic replication as shown by a reduced level of infectious virions, and decreased levels of viral lytic transcripts and proteins. In a second KSHV lytic replication system of iSLK-RGB-BAC16 cells, we confirmed that KSHV lytic replication increased NO production. Chemical inhibition of NO production resulted in reduced numbers of cells expressing enhanced green fluorescent protein and blue fluorescent protein, two reporters that closely track the expression of KSHV early and late genes, respectively. Consistent with these results, inhibition of NO production resulted in reduced levels of infectious virions, and viral lytic transcripts and proteins. Importantly, exogenous addition of a NO donor was sufficient to enhance the full KSHV lytic replication program. These results demonstrate that NO is required for efficient KSHV lytic replication, and NO plays a crucial role in the KSHV life cycle and KSHV-induced malignancies.
Collapse
Affiliation(s)
- Antonia Herrera-Ortíz
- Department of Immunology and Molecular Microbiology, University of Southern California Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Centro de Investigaciones sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Wen Meng
- Department of Microbiology and Molecular Genetics, Cancer Virology Program, UPMC Hillman Caner Center, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shou-Jiang Gao
- Department of Immunology and Molecular Microbiology, University of Southern California Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Microbiology and Molecular Genetics, Cancer Virology Program, UPMC Hillman Caner Center, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
3
|
Nalwoga A, Webb EL, Chihota B, Miley W, Walusimbi B, Nassuuna J, Sanya RE, Nkurunungi G, Labo N, Elliott AM, Cose S, Whitby D, Newton R. Kaposi's sarcoma-associated herpesvirus seropositivity is associated with parasite infections in Ugandan fishing communities on Lake Victoria islands. PLoS Negl Trop Dis 2019; 13:e0007776. [PMID: 31618208 PMCID: PMC6816576 DOI: 10.1371/journal.pntd.0007776] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 10/28/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022] Open
Abstract
We investigated the impact of helminths and malaria infection on Kaposi's sarcoma associated herpesvirus (KSHV) seropositivity, using samples and data collected from a cluster-randomised trial of intensive versus standard anthelminthic treatment. The trial was carried out in 2012 to 2016 among fishing communities on Lake Victoria islands in Uganda. Plasma samples from 2881 participants from two household surveys, the baseline (1310 participants) and the final (1571 participants) surveys were tested for KSHV IgG antibody responses to K8.1 and ORF73 recombinant proteins using ELISA. The baseline survey was carried out before the trial intervention while the final survey was carried out after three years of the trial intervention. Additionally, a subset sample of 372 participants from the final survey was tested for IgE, IgG and IgG4 antibody concentrations to S. mansoni adults worm antigen (SWA) and S. mansoni egg antigen (SEA) using ELISA. Infection by helminths (S. mansoni, N. americanus, T. trichiura and S. stercoralis) was diagnosed using real-time PCR, urine circulating cathodic antigen (CCA) and stool microscopy (Kato-Katz method) while malaria infection was diagnosed using microscopy. We analysed the relationship between helminth and malaria infections and KSHV seropositivity using regression modelling, allowing for survey design. At baseline, 56% of the participants were male while 48% of the participants were male in the final survey. The most prevalent helminth infection was S. mansoni (at baseline 52% and 34% in the final survey by microscopy, 86% by CCA and 50% by PCR in the final survey). KSHV seropositivity was 66% (baseline) and 56% (final survey) among those 1-12 years and >80% in those 13+ years in both surveys; malaria parasitaemia prevalence was 7% (baseline) and 4% (final survey). At baseline, individuals infected with S. mansoni (detected by microscopy) were more likely to be KSHV seropositive (aOR = 1.86 (1.16, 2.99) p = 0.012) and had higher anti-K8.1 antibody levels (acoefficient = 0.03 (0.01, 0.06) p = 0.02). In the final survey, S. mansoni (by microscopy, adjusted Odds Ratio (aOR = 1.43 (1.04-1.95), p = 0.028) and malaria parasitaemia (aOR = 3.49 (1.08-11.28), p = 0.038) were positively associated with KSHV seropositivity. Additionally, KSHV seropositive participants had higher S. mansoni-specific IgE and IgG antibody concentrations in plasma. Furthermore, HIV infected individuals on cART were less likely to be KSHV seropositive compared to HIV negative individuals (aOR = 0.46 (0.30, 0.71) p = 0.002). Schistosoma species skew the immune response towards Th2 and regulatory responses, which could impact on KSHV reactivation if co-infected with both organisms.
Collapse
Affiliation(s)
- Angela Nalwoga
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily L. Webb
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Belinda Chihota
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | | | | | - Richard E. Sanya
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gyaviira Nkurunungi
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Alison M. Elliott
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen Cose
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York; United Kingdom
| |
Collapse
|
4
|
Franco JB, Maureira Pena LJ, Martins E Martins F, de Oliveira MA, Ortega KL. Regression of human immunodeficiency virus-associated oral Kaposi sarcoma with combined antiretroviral therapy: A case report and literature review. Head Neck 2018; 41:E21-E25. [PMID: 30552825 DOI: 10.1002/hed.25446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/15/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is the most prevalent malignant neoplasia in human immunodeficiency virus positive (HIV+) patients for which the primary mode of management was chemotherapy. METHODS We have presented the case of a newly diagnosed HIV+ male patient who was diagnosed with a pedunculated nodule in the anterior region of the hard palate, measuring 3.5 cm in diameter and with 2 months of evolution. RESULTS Histopathological examination confirmed the clinical hypothesis of KS. Soon after the diagnosis, the patient started using combined antiretroviral therapy (Biovir and Kaletra), presenting a significant reduction of the lesion after 4 weeks. With 1.5 cm in diameter, the lesion was surgically removed. The patient was followed-up for 10 years without any recurrence. CONCLUSION In antiretroviral-naive patients with a well-preserved immune system, the use of cART may be efficient in reducing the progression of the KS lesions, thus avoiding the use of chemotherapeutic agents.
Collapse
Affiliation(s)
- Juliana Bertoldi Franco
- Oral Pathology, Department of Stomatology, University of Sao Paulo School of Dentistry, Sao Paulo, Brazil.,Division of Dentistry, Hospital of Clinics of the University of São Paulo School of Medicine, São Paulo, Brazil
| | - Loreto José Maureira Pena
- Special Care Dentistry Centre, Department of Stomatology, University of Sao Paulo School of Dentistry, Sao Paulo, Brazil
| | - Fabiana Martins E Martins
- Special Care Dentistry Centre, Department of Stomatology, University of Sao Paulo School of Dentistry, Sao Paulo, Brazil.,School of Dentistry, Santo Amaro University, São Paulo, Brazil
| | - Marcio Augusto de Oliveira
- Special Care Dentistry Centre, Department of Stomatology, University of Sao Paulo School of Dentistry, Sao Paulo, Brazil
| | - Karem L Ortega
- Oral Pathology, Department of Stomatology, University of Sao Paulo School of Dentistry, Sao Paulo, Brazil.,Special Care Dentistry Centre, Department of Stomatology, University of Sao Paulo School of Dentistry, Sao Paulo, Brazil
| |
Collapse
|
5
|
McAllister SC, Hanson RL, Grissom KN, Botto S, Moses AV. An In Vitro Model for Studying Cellular Transformation by Kaposi Sarcoma Herpesvirus. J Vis Exp 2017. [PMID: 28872106 DOI: 10.3791/54828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Kaposi sarcoma (KS) is an unusual tumor composed of proliferating spindle cells that is initiated by infection of endothelial cells (EC) with KSHV, and develops most often in the setting of immunosuppression. Despite decades of research, optimal treatment of KS remains poorly defined and clinical outcomes are especially unfavorable in resource-limited settings. KS lesions are driven by pathological angiogenesis, chronic inflammation, and oncogenesis, and various in vitro cell culture models have been developed to study these processes. KS arises from KSHV-infected cells of endothelial origin, so EC-lineage cells provide the most appropriate in vitro surrogates of the spindle cell precursor. However, because EC have a limited in vitro lifespan, and as the oncogenic mechanisms employed by KSHV are less efficient than those of other tumorigenic viruses, it has been difficult to assess the processes of transformation in primary or telomerase-immortalized EC. Therefore, a novel EC-based culture model was developed that readily supports transformation following infection with KSHV. Ectopic expression of the E6 and E7 genes of human papillomavirus type 16 allows for extended culture of age- and passage-matched mock- and KSHV-infected EC and supports the development of a truly transformed (i.e., tumorigenic) phenotype in infected cell cultures. This tractable and highly reproducible model of KS has facilitated the discovery of several essential signaling pathways with high potential for translation into clinical settings.
Collapse
Affiliation(s)
- Shane C McAllister
- Division of Pediatric Infectious Diseases, University of Minnesota Medical School;
| | - Ryan L Hanson
- Division of Pediatric Infectious Diseases, University of Minnesota Medical School
| | - Kyleen N Grissom
- Division of Pediatric Infectious Diseases, University of Minnesota Medical School
| | - Sara Botto
- Vaccine and Gene Therapy Institute, Oregon Health and Science University
| | - Ashlee V Moses
- Vaccine and Gene Therapy Institute, Oregon Health and Science University;
| |
Collapse
|
6
|
Ferraz da Silva AP, Giron LB, Ramos da Silva S, Naime Barbosa A, Almeida RAMDB, Elgui de Oliveira D. Human gammaherpesviruses viraemia in HIV infected patients. J Clin Pathol 2015; 68:726-32. [PMID: 25979989 DOI: 10.1136/jclinpath-2014-202840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/26/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Epstein-Barr virus (EBV) and Kaposi's sarcoma associated herpesvirus (KSHV) are consistently associated with lymphoproliferative diseases and cancers in humans, notably in patients with HIV. AIMS Our aim was to evaluate whether EBV and/or KSHV viral loads regularly assessed in peripheral blood mononuclear cells (PBMC) correlate with clinical or laboratorial parameters retrieved for patients living with HIV. METHODS This was a longitudinal study with a cohort of 157 HIV positive patients attending an academic HIV outpatient clinic in São Paulo State, Brazil. For each patient, up to four blood samples were collected over a 1 year clinical follow-up: on enrolment into the study, and after 4, 8 and 12 months. Total DNA was extracted from PBMC, and EBV and KSHV viral loads were assessed by real time quantitative PCR. RESULTS Higher viral loads for EBV were significantly associated with high HIV viraemia, a greater number of circulating T CD8+ cells and lack of virological response to the antiretroviral treatment. KSHV viral load was undetectable in virtually all samples. CONCLUSIONS EBV viral load in PBMC correlated with the number of circulating T CD8+ lymphocytes and the response to the antiretroviral therapy in HIV infected patients. In contrast, KSHV was undetectable in PBMC, presumably an effect of the antiretroviral treatment. Therefore, either KSHV infection in the population studied was absent or viral load in PBMC was beyond the analytical limit of the assay.
Collapse
Affiliation(s)
- Ana Paula Ferraz da Silva
- Pathology Department at Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Leila Bertoni Giron
- Pathology Department at Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Suzane Ramos da Silva
- Pathology Department at Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Alexandre Naime Barbosa
- Tropical Diseases and Diagnostic Imaging Department at Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | | | - Deilson Elgui de Oliveira
- Pathology Department at Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil Biotechnology Institute (IBTEC), São Paulo State University (UNESP), Botucatu, SP, Brazil
| |
Collapse
|
7
|
Pria AD, Hayward K, Bower M. Do we still need chemotherapy for AIDS-associated Kaposi’s sarcoma? Expert Rev Anticancer Ther 2014; 13:203-9. [DOI: 10.1586/era.12.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
8
|
Bower M, Dalla Pria A, Coyle C, Andrews E, Tittle V, Dhoot S, Nelson M. Prospective stage-stratified approach to AIDS-related Kaposi's sarcoma. J Clin Oncol 2013; 32:409-14. [PMID: 24378415 DOI: 10.1200/jco.2013.51.6757] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Combination antiretroviral therapy (cART) is standard of care for patients with HIV diagnosed with Kaposi's sarcoma (KS), but the current role of systemic chemotherapy is undefined. PATIENTS AND METHODS Since 1998, a prospective stage-stratified approach has been adopted for 469 patients with HIV with KS. Patients with early-stage (T0) KS are treated with cART alone; patients with advanced-stage (T1) KS receive cART plus liposomal anthracycline chemotherapy. Clinical characteristics, overall survival, and KS progression-free survival were analyzed according to stage at presentation and treatment received. RESULTS A total of 303 patients presented with T0 stage KS, including 237 who were not receiving cART, and 166 patients had T1 stage KS. Patients with T0 KS had higher CD4 cell counts (P < .001); 90% of patients with T0 KS who were not receiving cART and 84% of those with T1 KS were treated in accordance with the stage-stratified approach. Median follow-up was 4.6 years, and 5-year overall survival was 89%; 54 patients have died, 15 as a result of KS. Overall 5-year survival was 92% for T0 KS and 83% to T1 KS (P = .0024). On-treatment analysis of 213 cART-naive patients with T0 KS treated with cART alone revealed 5-year overall survival of 95% and progression-free survival of 77%. For 140 patients with T1 disease treated with cART and liposomal anthracycline chemotherapy, 5-year overall survival was 85%. CONCLUSION This stage-stratified approach to the management of KS achieves high survival in patients with advanced KS and reduces exposure to chemotherapy in patients with early-stage KS.
Collapse
Affiliation(s)
- Mark Bower
- All authors: Chelsea and Westminster Hospital, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
9
|
Ameen M. The impact of human immunodeficiency virus-related diseases on pigmented skin types. Br J Dermatol 2013; 169 Suppl 3:11-8. [PMID: 24098897 DOI: 10.1111/bjd.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 11/28/2022]
Abstract
Infection with human immunodeficiency virus (HIV) remains a significant problem globally. Early diagnosis and treatment with antiretroviral drugs has considerably improved health outcomes and decreased disease-related morbidity. HIV infection is associated with a wide range of skin disorders enabling dermatologists to diagnose HIV as well as associated opportunistic infections early in the course of disease. Despite concerted efforts by international health organizations to limit disease incidence, the prevalence of HIV infection remains high and is highest in sub-Saharan Africa. The diagnosis of HIV-related skin diseases is challenging as immunosuppression often results in atypical disease presentation. In addition, the clinical presentation will vary in pigmented skin types. The aim of this article is to describe disease variation in pigmented skin types.
Collapse
Affiliation(s)
- M Ameen
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, U.K
| |
Collapse
|
10
|
Petrara MR, Freguja R, Gianesin K, Zanchetta M, De Rossi A. Epstein-Barr virus-driven lymphomagenesis in the context of human immunodeficiency virus type 1 infection. Front Microbiol 2013; 4:311. [PMID: 24151490 PMCID: PMC3799006 DOI: 10.3389/fmicb.2013.00311] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 09/28/2013] [Indexed: 12/12/2022] Open
Abstract
Epstein-Barr virus (EBV) is a ubiquitous human γ-herpes virus which establishes a life-long asymptomatic infection in immunocompetent hosts. In human immunodeficiency virus type 1 (HIV-1) infected patients, the impaired immunosurveillance against EBV may favor the development of EBV-related diseases, ranging from lymphoproliferative disorders to B cell non-Hodgkin's lymphomas (NHL). Antiretroviral therapy (ART) has significantly modified the natural course of HIV-1 infection, resulting in decreased HIV-1 plasmaviremia, increased CD4 lymphocytes, and decreased opportunistic infections, indicating a restoration of immune functions. However, the impact of ART appears to be less favorable on EBV-related malignancies than on other AIDS-defining tumors, such as Kaposi's sarcoma, and NHL remains the most common cancer during the ART era. EBV-driven tumors are associated with selective expression of latent oncogenic proteins, but uncontrolled lytic cycle with virus replication and/or reactivation may favor cell transformation, at least in the early phases. Several host's factors may promote EBV reactivation and replication; besides immunodepression, inflammation/chronic immune stimulation may play an important role. Microbial pathogen-associated molecular patterns and endogenous damage-associated molecular patterns, through Toll-like receptors, activate the immune system and may promote EBV reactivation and/or polyclonal expansion of EBV-infected cells. A body of evidence suggests that chronic immune stimulation is a hallmark of HIV-1 pathogenesis and may persist even in ART-treated patients. This review focuses on lymphomagenesis driven by EBV both in the context of the natural history of HIV-1 infection and in ART-treated patients. Understanding the mechanisms involved in the expansion of EBV-infected cells is a premise for the identification of prognostic markers of EBV-associated malignancies.
Collapse
Affiliation(s)
- Maria R Petrara
- Viral Oncology Unit and AIDS Reference Center, Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova Padova, Italy
| | | | | | | | | |
Collapse
|
11
|
Speicher DJ, Sehu MM, Johnson NW, Shaw DR. Successful treatment of an HIV-positive patient with unmasking Kaposi's sarcoma immune reconstitution inflammatory syndrome. J Clin Virol 2013; 57:282-5. [PMID: 23578530 DOI: 10.1016/j.jcv.2013.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/06/2013] [Accepted: 03/10/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Kaposi's sarcoma (KS) continues to be the most common human immunodeficiency virus (HIV)-associated neoplasm with considerable morbidity and mortality. While lesions normally resolve upon initiation of antiretroviral therapy (ART), recrudescence or unmasking of KS lesions may occur as part of immune reconstitution inflammatory syndrome (IRIS). Treatment of unmasking KS-IRIS is not yet standardised. OBJECTIVES To report the successful treatment of a patient with fulminating mucocutaneous unmasking KS-IRIS by maintaining ART and using pegylated liposomal doxorubicin (PLD). STUDY DESIGN The patient, a 39-year-old HIV-positive male with no previous history of KS presented with a 2-week history of cutaneous and oral KS lesions that had disseminated rapidly over the preceding 4 days. The KS lesions appeared 8 weeks after recommencing ART. At the time of this presentation, his CD4+ count was 742 cells/mm(3) with a HIV viral load <400 copies/ml. ART was maintained and treatment with PLD commenced. RESULTS Despite the rapid dissemination of KS lesions, virus was undetectable in plasma. In a late-stage vasoformative lesion, immunohistochemistry (IHC) for human herpesvirus 8 (HHV-8) antigen was light and diffuse, with stippled deposits within endothelial cell nuclei. Virus extracted from the lesion was HHV-8 subtype A. The patient responded well to PLD, relapsed a year later, but after further PLD, has remained well for the following 5 years. CONCLUSION Despite the absence of HHV-8 viraemia, this is clearly a case of unmasking KS-IRIS. It demonstrates that this entity can be successfully treated by maintaining ART and administering PLD.
Collapse
Affiliation(s)
- David J Speicher
- School of Dentistry and Oral Health, Griffith University, Queensland, Australia.
| | | | | | | |
Collapse
|
12
|
Galleu A, Fozza C, Simula MP, Contini S, Virdis P, Corda G, Pardini S, Cottoni F, Pruneddu S, Angeloni A, Ceccarelli S, Longinotti M. CD4+ and CD8+ T-cell skewness in classic Kaposi sarcoma. Neoplasia 2012; 14:487-94. [PMID: 22787430 PMCID: PMC3394191 DOI: 10.1596/neo.11646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 11/17/2022]
Abstract
It is widely accepted that a deranged immune system plays a key role in the onset and evolution of classic Kaposi sarcoma (CKS). Nevertheless, the usage of the T-cell receptor (TCR) β-variable (BV) chain repertoire expressed by peripheral blood lymphocytes in patients with CKS is still unknown. With the aim of providing some further insights into the complex role of the immune system in CKS pathogenesis, we performed an extensive analysis of the TCR BV repertoire in both CD4(+) and CD8(+) T cells in 30 human herpesvirus 8-positive Sardinian patients with CKS and an equal number of age-matched healthy controls. We used a panel of monoclonal antibodies covering approximately 70% of human BV subfamilies and third complementarity determining region (CDR3) spectratyping. Patients with CKS showed an increased frequency of BV expansions in both CD4(+) and CD8(+) lymphocytes, with no prevalent clones. On spectratyping analysis, most of the 720 BV CDR3 profiles obtained from both CD4(+) and CD8(+) T cells in patients with CKS were skewed. In particular, the surprising increase of BV skewing observed in CD4(+) lymphocytes mimics the pattern of progressive TCR BV narrowing described in responses to persistent viral antigen stimulations. Our findings support the hypothesis that CKS evolution is associated with inadequate activation rather than impairment of the immune system.
Collapse
Affiliation(s)
- Antonio Galleu
- Haematology Section, Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Petrara MR, Cattelan AM, Zanchetta M, Sasset L, Freguja R, Gianesin K, Cecchetto MG, Carmona F, De Rossi A. Epstein-Barr virus load and immune activation in human immunodeficiency virus type 1-infected patients. J Clin Virol 2011; 53:195-200. [PMID: 22209290 DOI: 10.1016/j.jcv.2011.12.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 12/06/2011] [Accepted: 12/09/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients infected with HIV-1 are at high risk of developing Epstein-Barr Virus (EBV)-related diseases. Chronic immune activation is a hallmark of HIV-1 pathogenesis and may play a role in B-cell stimulation and expansion of EBV-infected cells. OBJECTIVES The aim of the study was to define the relationship between parameters of immune activation and EBV load in HIV-1-infected subjects. STUDY DESIGN A total of 156 HIV-1-infected patients were studied. EBV types 1 and 2 were quantified on peripheral blood mononuclear cells by multiplex real-time PCR. Plasma levels of cytokines and lipopolysaccharide (LPS) were determined by immunoenzymatic assays. B-cell activation was analyzed by flow cytometry. RESULTS EBV-DNA was detected in 114 patients, and in all but 3 was EBV type 1. The median [interquartile] EBV-DNA load was 43[1-151] copies/10(5) PBMC. EBV-DNA load was higher in patients with detectable HIV-1 plasma viremia, despite good immunological status (CD4>500 cells/μl), than in patients with undetectable HIV-1 plasma viremia regardless of immunological status (46[5-136] copies/10(5) cells vs 17[1-56] copies/10(5) cells, p=0.008). Patients with high EBV-DNA load (>median value) had higher levels of LPS and proinflammatory cytokines (IL-6, IL-10 and TNF-α) than patients with low EBV load. Furthermore, percentages of activated B-cells correlated with EBV-DNA load (r(s)=0.754; p<0.001). CONCLUSIONS Overall, these findings indicate a strong association between HIV-1 viremia, markers of immune activation and EBV load and suggest that persistence of HIV-1 viremia and immune activation, regardless of peripheral CD4 cell depletion/repopulation, may favor expansion of EBV-infected cells and onset of EBV-related malignancies.
Collapse
Affiliation(s)
- Maria Raffaella Petrara
- Department of Oncology and Surgical Sciences, Section of Oncology, AIDS Reference Centre, University of Padova, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Asiimwe F, Moore D, Were W, Nakityo R, Campbell J, Barasa A, Mermin J, Kaharuza F. Clinical outcomes of HIV-infected patients with Kaposi's sarcoma receiving nonnucleoside reverse transcriptase inhibitor-based antiretroviral therapy in Uganda. HIV Med 2011; 13:166-71. [PMID: 22112164 DOI: 10.1111/j.1468-1293.2011.00955.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical outcomes for patients with Kaposi's sarcoma (KS) using nonnucleoside reverse transcriptase inhibitor (NNRTI)-based highly active antiretroviral therapy (HAART) in resource-limited settings have not previously been described. METHODS We evaluated HIV-infected patients aged ≥ 18 years, who initiated HAART in the Home-Based AIDS Care (HBAC) project in Tororo, Uganda, between May 2003 and February 2008 and were diagnosed with KS at baseline or during follow-up. We examined independent risk factors for having either prevalent or incident KS and risk factors for death among patients with KS. RESULTS Of 1121 study subjects, 17 (1.5%) were diagnosed with prevalent KS and 18 (1.6%) with incident KS over a median of 56.1 months of follow-up. KS was associated with male sex [adjusted odds ratio (AOR) 2.41; 95% confidence interval (CI) 1.20-4.86] and baseline CD4 cell count < 50 cells/μL (AOR 3.25; 95% CI 1.03-10.3). Eleven (65%) of 17 patients with prevalent KS and 13 (72%) of 18 patients with incident KS experienced complete regression (P = 0.137). Eighteen (64%) of 28 patients who remained on NNRTI-based HAART experienced regression of their KS and six (86%) of seven patients who were switched to protease inhibitor-containing HAART regimens had regression of their KS (P = 0.23). Mortality among those with KS was significantly associated with visceral disease (hazard ratio 19.22; 95% CI 2.42-152). CONCLUSION Prevalent or incident KS was associated with 30% mortality. The resolution of KS lesions among individuals who initiated HAART with NNRTI-based regimens was similar to that found in studies using only protease inhibitor-based HAART.
Collapse
Affiliation(s)
- Fm Asiimwe
- Global AIDS Program, US Centers for Disease Control and Prevention (CDC) Uganda, Entebbe, Uganda
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Ramos da Silva S, Elgui de Oliveira D. HIV, EBV and KSHV: Viral cooperation in the pathogenesis of human malignancies. Cancer Lett 2011; 305:175-85. [DOI: 10.1016/j.canlet.2011.02.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 02/09/2011] [Indexed: 01/26/2023]
|
16
|
Reactive oxygen species hydrogen peroxide mediates Kaposi's sarcoma-associated herpesvirus reactivation from latency. PLoS Pathog 2011; 7:e1002054. [PMID: 21625536 PMCID: PMC3098240 DOI: 10.1371/journal.ppat.1002054] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 03/16/2011] [Indexed: 01/17/2023] Open
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) establishes a latent
infection in the host following an acute infection. Reactivation from latency
contributes to the development of KSHV-induced malignancies, which include
Kaposi's sarcoma (KS), the most common cancer in untreated AIDS patients,
primary effusion lymphoma and multicentric Castleman's disease. However,
the physiological cues that trigger KSHV reactivation remain unclear. Here, we
show that the reactive oxygen species (ROS) hydrogen peroxide
(H2O2) induces KSHV reactivation from latency through
both autocrine and paracrine signaling. Furthermore, KSHV spontaneous lytic
replication, and KSHV reactivation from latency induced by oxidative stress,
hypoxia, and proinflammatory and proangiogenic cytokines are mediated by
H2O2. Mechanistically, H2O2
induction of KSHV reactivation depends on the activation of mitogen-activated
protein kinase ERK1/2, JNK, and p38 pathways. Significantly,
H2O2 scavengers N-acetyl-L-cysteine (NAC), catalase
and glutathione inhibit KSHV lytic replication in culture. In a mouse model of
KSHV-induced lymphoma, NAC effectively inhibits KSHV lytic replication and
significantly prolongs the lifespan of the mice. These results directly relate
KSHV reactivation to oxidative stress and inflammation, which are physiological
hallmarks of KS patients. The discovery of this novel mechanism of KSHV
reactivation indicates that antioxidants and anti-inflammation drugs could be
promising preventive and therapeutic agents for effectively targeting KSHV
replication and KSHV-related malignancies. Kaposi's sarcoma-associated herpesvirus (KSHV) is the etiologic agent of all
clinical forms of Kaposi's sarcoma (KS) and several other malignancies. The
life cycle of KSHV consists of latent and lytic phases. While establishment of
viral latency is essential for KSHV to evade host immune surveillances, viral
lytic replication promotes KSHV-induced malignancies. In this study, we show
that the reactive oxygen species (ROS) hydrogen peroxide
(H2O2) induces KSHV reactivation from latency.
Furthermore, induction of KSHV reactivation by oxidative stress, hypoxia, and
proinflammatory and proangiogenic cytokines, which are physiological hallmarks
in all clinical forms of KS patients, is mediated by H2O2.
Significantly, antioxidants inhibit H2O2-induced KSHV
lytic replication in culture and in a mouse model of KSHV-induced lymphoma.
These results show that ROS is likely an important physiological cue that
triggers KSHV replication. The discovery of this novel mechanism of KSHV
reactivation indicates that antioxidants and anti-inflammation drugs might be
promising preventive and therapeutic agents for effectively targeting KSHV
replication and KSHV-related malignancies.
Collapse
|
17
|
Guadalupe M, Pollock BH, Westbrook S, Redding S, Bullock D, Anstead G, Agan BK, Marconi VC, Barbieri S, Sankar V, Rebeles J, Flahive Y, Schoolfield J, Wang L, Lei X, Dow D, Yeh CK, Dang H, Infante AJ, Gao SJ. Risk factors influencing antibody responses to Kaposi's sarcoma-associated herpesvirus latent and lytic antigens in patients under antiretroviral therapy. J Acquir Immune Defic Syndr 2011; 56:83-90. [PMID: 21084997 PMCID: PMC3051282 DOI: 10.1097/qai.0b013e3181fdc928] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Kaposi's sarcoma-associated herpesvirus (KSHV) seropositivity and lytic antibody titer are predictors for Kaposi's sarcoma. METHODS We examined demographic, viral, and immunologic factors that influence KSHV latent and lytic antibodies in HIV-infected patients. RESULTS Detection rate of KSHV latent but not lytic antibodies was lower in patients with CD4 cells/mm3 less than 200 than greater than 200 (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.11-0.61) and CD8 cells/mm3 less than 400 than greater than 400 (OR, 0.26; 95% CI, 0.07-0.67). Overall seropositivity rate was higher in patients with CD4 cells/mm3 less than 200 than greater than 200 (OR, 2.34; 95% CI, 1.37-4.02) and HIV copies/mL greater than 400 than less than 400 (OR, 1.70; 95% CI, 1.09-2.65). Lytic antibody level was inversely correlated with CD4 count (P < 0.001). Lytic seropositivity (OR, 2.47; 95% CI, 1.35-4.50) and antibody level (adjusted difference mean optical density, 0.324; 95% CI, 0.16-0.46) were higher in patients with HIV infection greater than 15 than less than 15 years. Hispanics had higher lytic seropositivity rate (OR, 1.71; 95% CI, 1.07-2.73) and antibody level (adjusted difference mean optical density, 0.111; 95% CI, 0.03-0.18) than non-Hispanics. CONCLUSIONS Lower CD4 and CD8 counts impair antibody response to KSHV latent antigens. Immune deterioration, long-term HIV infection, and Hispanic status are risk factors for Kaposi's sarcoma predictors.
Collapse
Affiliation(s)
- Moraima Guadalupe
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, San Antonio, Texas
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Brad H. Pollock
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Steven Westbrook
- Department of Dental Diagnostic Science, University of Texas Health Science Center, San Antonio, San Antonio, Texas
- South Texas Veterans Healthcare System, San Antonio, Texas
| | - Spencer Redding
- Department of Dental Diagnostic Science, University of Texas Health Science Center, San Antonio, San Antonio, Texas
- South Texas Veterans Healthcare System, San Antonio, Texas
| | - Delia Bullock
- Department of Medicine, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Gregory Anstead
- Department of Medicine, University of Texas Health Science Center, San Antonio, San Antonio, Texas
- South Texas Veterans Healthcare System, San Antonio, Texas
| | - Brian K. Agan
- Infectious Disease Clinical Research Program Uniformed Services, University of the Health Sciences, Bethesda, Maryland
- San Antonio Military Medical Center, San Antonio, Texas
| | - Vincent C. Marconi
- Infectious Disease Clinical Research Program Uniformed Services, University of the Health Sciences, Bethesda, Maryland
- San Antonio Military Medical Center, San Antonio, Texas
| | - Sharon Barbieri
- Department of Dental Hygiene, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Vidya Sankar
- Department of Dental Diagnostic Science, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Jennifer Rebeles
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Yvette Flahive
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - John Schoolfield
- Department of Academic Technology Services, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Linding Wang
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, San Antonio, Texas
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Xiufen Lei
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, San Antonio, Texas
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Dorothy Dow
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Chih-Ko Yeh
- Department of Dental Diagnostic Science, University of Texas Health Science Center, San Antonio, San Antonio, Texas
- South Texas Veterans Healthcare System, San Antonio, Texas
| | - Howard Dang
- Department of Community Dentistry, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Anthony J. Infante
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Shou-Jiang Gao
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, San Antonio, Texas
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, San Antonio, Texas
- Department of Medicine, University of Texas Health Science Center, San Antonio, San Antonio, Texas
| |
Collapse
|
18
|
Toschi E, Sgadari C, Malavasi L, Bacigalupo I, Chiozzini C, Carlei D, Compagnoni D, Bellino S, Bugarini R, Falchi M, Palladino C, Leone P, Barillari G, Monini P, Ensoli B. Human immunodeficiency virus protease inhibitors reduce the growth of human tumors via a proteasome-independent block of angiogenesis and matrix metalloproteinases. Int J Cancer 2010; 128:82-93. [DOI: 10.1002/ijc.25550] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
19
|
Mani D, Neil N, Israel R, Aboulafia DM. A Retrospective Analysis of AIDS-Associated Kaposi’s Sarcoma in Patients With Undetectable HIV Viral Loads and CD4 Counts Greater Than 300 cells/mm3. ACTA ACUST UNITED AC 2009; 8:279-85. [DOI: 10.1177/1545109709341852] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the clinical course of patients with AIDS-related Kaposi’s sarcoma (KS) with CD4 counts >300 cells/mm3 and undetectable HIV viral loads (VLs) to patients with AIDS-KS with lesser CD4 counts and detectable HIV VLs. Methods: We retrospectively analyzed a cohort of 91 patients with AIDS-KS in a multispeciality clinic. We used χ2 and Student t tests to analyze intragroup differences; survival was determined by Kaplan-Meier analysis. Results: Twenty (22%) of the 91 patients had newly diagnosed, persistent or progressive KS despite CD4 counts >300 cells/mm3 and undetectable HIV VLs. Age, gender, ethnicity, mode and duration of HIV acquisition, type of antiretroviral therapy (ART), and KS therapy did not differ significantly (P ≤ .005) between this group and the remaining 71 patients. Although tumor stage and response to KS therapy were similar, there was a significantly greater risk of death among the patients with CD4 counts <300 cells/mm3 and detectable HIV VLs (P = .048). Conclusions: In the highly active antiretroviral (HAART) era, a substantial proportion of patients with KS had undetectable HIV VLs and CD4 counts greater than the level typically associated with opportunistic diseases. They required systemic therapy to control their KS but were significantly less likely to die and demonstrated a trend toward better 15-year survival than patients having KS with lesser CD4 counts and detectable HIV VLs.
Collapse
Affiliation(s)
- Deepthi Mani
- Division of Internal Medicine, Spokane Medical Centers, Spokane, Washington
| | - Nancy Neil
- School of Public Health, University of Washington, Seattle, Washington
| | - Rebecca Israel
- Division of Hematology and Oncology, Virginia Mason Medical Center. Seattle, Washington
| | - David M. Aboulafia
- Division of Hematology and Oncology, Virginia Mason Medical Center. Seattle, Washington,
| |
Collapse
|
20
|
Abstract
OBJECTIVE A prospective cohort study was performed to evaluate the clinical outcomes of patients with histologically confirmed AIDS-related Kaposi's sarcoma diagnosed since the introduction of HAART. METHODS Two hundred and fifty-four consecutive patients (96% men) diagnosed with Kaposi's sarcoma between 1996 and 2008 are included. Clinicopathological and treatment details were prospectively collected. The median follow-up is over 4 years and maximum 12 years. RESULTS The mean age at Kaposi's sarcoma diagnosis was 39 years and average duration of known HIV seropositivity was 4 years. At Kaposi's sarcoma diagnosis, only 19% patients were on HAART and only 7% patients had an undetectable plasma HIV viral load. Seventy-nine (31%) patients had AIDS clinical Trial Group stage T1 disease at Kaposi's sarcoma diagnosis and 122 (48%) had AIDS clinical Trial Group stage I1 disease (CD4 cell count < 150 cells/microl). Nodular grade Kaposi's sarcoma represented 28% of the tumours and was significantly associated with black African ethnicity and AIDS clinical Trial Group T1 stage disease. The overall 5-year survival is 89% (95% confidence interval 84-93). One hundred and sixty-three patients were treated with HAART alone for T0 stage Kaposi's sarcoma; only one died of Kaposi's sarcoma and only 37 (22%) required chemotherapy, giving a systemic treatment-free survival at 5 years of 74% (95% confidence interval 67-82) and the overall survival at 5 years is 91% (95% confidence interval 87-95). CONCLUSION The high success rate of HAART in a large cohort of AIDS-Kaposi's sarcoma patients over a prolonged period of follow-up will reassure patients and clinicians that this is a well tolerated and effective approach to stage T0 Kaposi's sarcoma.
Collapse
|
21
|
Robey RC, Lagos D, Gratrix F, Henderson S, Matthews NC, Vart RJ, Bower M, Boshoff C, Gotch FM. The CD8 and CD4 T-cell response against Kaposi's sarcoma-associated herpesvirus is skewed towards early and late lytic antigens. PLoS One 2009; 4:e5890. [PMID: 19536280 PMCID: PMC2691989 DOI: 10.1371/journal.pone.0005890] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 04/30/2009] [Indexed: 01/06/2023] Open
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) is causally related to Kaposi's sarcoma (KS), the most common malignancy in untreated individuals with HIV/AIDS. The adaptive T-cell immune response against KSHV has not been fully characterized. To achieve a better understanding of the antigenic repertoire of the CD8 and CD4 T-cell responses against KSHV, we constructed a library of lentiviral expression vectors each coding for one of 31 individual KSHV open reading frames (ORFs). We used these to transduce monocyte-derived dendritic cells (moDCs) isolated from 14 KSHV-seropositive (12 HIV-positive) and 7 KSHV-seronegative (4 HIV-positive) individuals. moDCs were transduced with up to 3 KSHV ORFs simultaneously (ORFs grouped according to their expression during the viral life cycle). Transduced moDCs naturally process the KSHV genes and present the resulting antigens in the context of MHC class I and II. Transduced moDCs were cultured with purified autologous T cells and the CD8 and CD4 T-cell proliferative responses to each KSHV ORF (or group) was assessed using a CFSE dye-based assay. Two pools of early lytic KSHV genes ([ORF8/ORF49/ORF61] and [ORF59/ORF65/K4.1]) were frequently-recognized targets of both CD8 and CD4 T cells from KSHV seropositive individuals. One pool of late lytic KSHV genes ([ORF28/ORF36/ORF37]) was a frequently-recognized CD8 target and another pool of late genes ([ORF33/K1/K8.1]) was a frequently-recognized CD4 target. We report that both the CD8 and CD4 T-cell responses against KSHV are skewed towards genes expressed in the early and late phases of the viral lytic cycle, and identify some previously unknown targets of these responses. This knowledge will be important to future immunological investigations into KSHV and may eventually lead to the development of better immunotherapies for KSHV-related diseases.
Collapse
Affiliation(s)
- Rebecca C. Robey
- Department of Immunology, Imperial College London, London, United Kingdom
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Dimitrios Lagos
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Fiona Gratrix
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Stephen Henderson
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Nick C. Matthews
- Department of Immunology, Imperial College London, London, United Kingdom
| | - Richard J. Vart
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Mark Bower
- Department of Immunology, Imperial College London, London, United Kingdom
| | - Chris Boshoff
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Frances M. Gotch
- Department of Immunology, Imperial College London, London, United Kingdom
| |
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW There is an increasing burden of non-AIDS-defining malignancies (NADMs) in the antiretroviral therapy (ART) era. The recent literature is reviewed with respect to NADM risk, ART use, and immune function. RECENT FINDINGS Recent studies have increasingly focused on individual ART use, CD4 T-cell counts, and the risk of NADMs. Certain NADMs have been shown to have a reduced risk with ART use including liver, breast, colorectal, and lung cancers. NADMs associated with immunosuppression included Hodgkin's lymphoma, oral/pharynx, lung, anal, and colorectal cancers. Despite the potential protective effect of ART on some NADMs, recent studies evaluating calendar era trends have noted an increased risk of Hodgkin's lymphoma and anal cancer and no change in risk for lung cancer in the ART era. SUMMARY Successful ART use and improvements in immune function for HIV-infected persons may reduce the risk of certain NADMs. However, a continued high risk in the ART era for certain cancers have been observed, including Hodgkin's lymphoma and anal cancers. Future studies should monitor trends in NADMs in HIV-infected persons in the ART era, as well as changes in the prevalence of risk factors, coinfections, and screening practices in this population.
Collapse
Affiliation(s)
- Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA.
| | | |
Collapse
|
23
|
Nguyen HQ, Magaret AS, Kitahata MM, Van Rompaey SE, Wald A, Casper C. Persistent Kaposi sarcoma in the era of highly active antiretroviral therapy: characterizing the predictors of clinical response. AIDS 2008; 22:937-45. [PMID: 18453853 PMCID: PMC2730951 DOI: 10.1097/qad.0b013e3282ff6275] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate the role of highly active antiretroviral therapy and chemotherapy on tumor response among persons with AIDS-related Kaposi sarcoma and identify factors associated with response in a clinic setting. DESIGN Retrospective cohort. METHODS One hundred and fourteen patients from two HIV clinics with a diagnosis of Kaposi sarcoma were identified via a clinical database. Records were reviewed to confirm Kaposi sarcoma diagnosis and abstract clinical and chemotherapy information. Demographics, laboratory values, and highly active antiretroviral therapy use were abstracted electronically. Cox's proportional hazards models identified predictors of Kaposi sarcoma improvement and resolution. RESULTS Thirty-six months following Kaposi sarcoma diagnosis, the rate of improvement among 64 patients with confirmed Kaposi sarcoma was 77% and that of complete resolution was 51%. In univariate analyses, recent chemotherapy was associated with Kaposi sarcoma improvement, and recent HIV viral load and highly active antiretroviral therapy were associated with both improvement and resolution. No measured baseline characteristics (tumor stage, diagnosis year, CD4 T-cell count, HIV viral load, or prior highly active antiretroviral therapy history) or recent CD4 T-cell counts predicted improvement or resolution. In multivariate analyses, recent chemotherapy (hazard ratio 5.5, 95% confidence interval: 2.7-11.2, P < 0.001) and highly active antiretroviral therapy (hazard ratio 4.1, 95% confidence interval: 1.4-12.6, P = 0.01) were predictors of improvement; only recent highly active antiretroviral therapy was associated with resolution (hazard ratio 6.2, 95% confidence interval: 1.5-26.4, P = 0.01). Response was not associated with type of highly active antiretroviral therapy regimen (non nucleoside reverse transcriptase inhibitor based, protease inhibitor based, or ritonavir-boosted protease inhibitor based). CONCLUSION Highly active antiretroviral therapy and chemotherapy are important in clinical Kaposi sarcoma response. Despite widespread availability of these therapies, Kaposi sarcoma continues to be a clinical problem; only half the patients achieved complete resolution of disease. New therapeutic approaches are needed.
Collapse
Affiliation(s)
| | - Amalia S Magaret
- Department of Laboratory Medicine, University of Washington
- Program in Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Anna Wald
- Department of Epidemiology, University of Washington
- Department of Laboratory Medicine, University of Washington
- Department of Medicine, University of Washington
| | - Corey Casper
- Department of Epidemiology, University of Washington
- Department of Medicine, University of Washington
- Program in Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
24
|
Feller L, Lemmer J. Insights into pathogenic events of HIV-associated Kaposi sarcoma and immune reconstitution syndrome related Kaposi sarcoma. Infect Agent Cancer 2008; 3:1. [PMID: 18208585 PMCID: PMC2265259 DOI: 10.1186/1750-9378-3-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 01/21/2008] [Indexed: 11/27/2022] Open
Abstract
A decrease in the incidence of human immune deficiency virus-associated Kaposi sarcoma (HIV-KS) and regression of some established HIV-KS lesions is evident after the introduction of highly active anti-retroviral treatment (HAART), and is attributed to generalized immune restoration, to the reconstitution of human herpesvirus (HHV)-8 specific cellular immune responses, and to the decrease in HIV Tat protein and HHV-8 loads following HAART. However, a small subset of HIV-seropositive subjects with a low CD4+ T cell count at the time of introduction of HAART, may develop HIV-KS as immune reconstitution inflammatory syndrome (IRIS) within 8 weeks thereafter.
Collapse
Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, Box D26 School of Dentistry, University of Limpopo Medunsa Campus, Pretoria, South Africa.
| | | |
Collapse
|
25
|
Silverberg MJ, Abrams DI. AIDS-defining and non-AIDS-defining malignancies: cancer occurrence in the antiretroviral therapy era. Curr Opin Oncol 2007; 19:446-51. [PMID: 17762569 DOI: 10.1097/cco.0b013e3282c8c90d] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Effective antiretroviral therapy use has resulted in a large number of older individuals living with HIV. Recent literature is reviewed with respect to the incidence and risk factors for cancer in HIV patients. RECENT FINDINGS Previous studies have demonstrated substantial declines in AIDS-defining malignancies in the era of antiretroviral therapy, with clear links to better immune function. Increases in non-AIDS-defining malignancies such as Hodgkin's disease, skin, lung, anal, and kidney cancers have been noted by some but not all authors. Certain non-AIDS-defining malignancies may be related to immunodeficiency, although data are conflicting. Recent studies have indicated that confounding by traditional risk factors, including cigarette use, may account for some of the increased risk of lung and other cancers in HIV patients. SUMMARY Non-AIDS-defining malignancies account for more morbidity and mortality than AIDS-defining malignancies in the antiretroviral therapy era. Traditional risk factors play a significant role in the increased risk of non-AIDS-defining malignancies for HIV-infected individuals, but do not entirely explain the excess cancer risk. Unanswered questions remain including the relationship of immunodeficiency and the risk of site-specific non-AIDS-defining malignancies, and the effect of antiretroviral therapy duration and drug class on cancer risk.
Collapse
Affiliation(s)
- Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland 94612, USA.
| | | |
Collapse
|
26
|
Ramaswamy M, Geretti AM. Interactions and management issues in HSV and HIV coinfection. Expert Rev Anti Infect Ther 2007; 5:231-43. [PMID: 17402838 DOI: 10.1586/14787210.5.2.231] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Significant synergistic interactions have been observed between HIV and herpes simplex virus (HSV). HIV-induced immune compromise can cause frequent and persistent HSV disease, while poorly controlled HSV replication may influence HIV pathogenicity and transmission. HSV-2 seroprevalence is high in HIV-infected cohorts worldwide, with rates of over 80% for HSV-1 and ranging from 33% to more than 80% for HSV-2. As seen in HIV-negative individuals, HSV-2 coinfection is associated with female gender, older age and black ethnicity. HSV infection is commonly under-diagnosed in HIV-infected individuals, although the use of PCR for HSV detection in mucocutaneous swabs and HSV type-specific serology can improve the diagnostic yield. In HIV-1-infected patients with frequent clinical episodes of HSV reactivation, suppressive antiviral therapy may prove beneficial in controlling HSV disease while also reducing HSV-mediated promotion of HIV replication. Antiretroviral therapy leads to a gradual recovery of HSV-specific T-cell responses and a reduction in HSV-related morbidity, indicating that successful management of coinfection should target both HIV and HSV replication. The aim of this review is to address the more speculative issues surrounding the management of HSV/HIV coinfection and to summarize the data that inform them.
Collapse
Affiliation(s)
- Meghna Ramaswamy
- Royal Free Hospital and Royal Free & University College Medical School, Department of Virology, Pond Street, London NW3 2QG, UK.
| | | |
Collapse
|
27
|
Chan SY, Madan V, Lear JT, Helbert M. Highly active antiretroviral therapy-induced regression of basal cell carcinomas in a patient with acquired immunodeficiency and Gorlin syndrome. Br J Dermatol 2007; 155:1079-80. [PMID: 17034550 DOI: 10.1111/j.1365-2133.2006.07479.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
Di Lorenzo G, Konstantinopoulos PA, Pantanowitz L, Di Trolio R, De Placido S, Dezube BJ. Management of AIDS-related Kaposi's sarcoma. Lancet Oncol 2007; 8:167-76. [PMID: 17267331 DOI: 10.1016/s1470-2045(07)70036-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The advent of highly active antiretroviral therapy (HAART) has lead to a substantial reduction in the prevalence, morbidity, and mortality associated with AIDS-related Kaposi's sarcoma. Similarly, concomitant advances in chemotherapy and supportive-care protocols have allowed for Kaposi's sarcoma to be managed more effectively in comparison with the pre-HAART era. Furthermore, developments in our understanding of the pathogenesis of Kaposi's sarcoma have identified several molecular targets that can potentially provide new therapeutic strategies. This Review discusses the role of conventional chemotherapeutic and immunomodulatory agents in the treatment of Kaposi's sarcoma and summarises the current status and future prospects of novel molecularly targeted agents in the treatment of this disease.
Collapse
Affiliation(s)
- Giuseppe Di Lorenzo
- Department of Molecular and Clinical Endocrinology and Oncology, University of Federico II, Naples, Italy
| | | | | | | | | | | |
Collapse
|
29
|
Lehloenya R, Meintjes G. Dermatologic Manifestations of the Immune Reconstitution Inflammatory Syndrome. Dermatol Clin 2006; 24:549-70, vii. [PMID: 17010783 DOI: 10.1016/j.det.2006.06.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The immune reconstitution inflammatory syndrome (IRIS) represents a diverse range of immunopathologic reactions resulting in clinical deterioration that may occur as immune function is partially restored in HIV-infected patients receiving highly active antiretroviral therapy. Approximately half of IRIS events are dermatologic, and dermatologic IRIS is described in relation to a wide range of conditions, the commonest being herpes zoster and herpes simplex. Most cases of IRIS result in mild and moderate symptoms, but non-dermatologic manifestations related to IRIS have resulted in death. This article covers certain general issues related to IRIS and then focuses on the spectrum of dermatologic manifestations.
Collapse
Affiliation(s)
- Rannakoe Lehloenya
- Division of Dermatology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, 7925, South Africa
| | | |
Collapse
|
30
|
Mastrolorenzo A, Rusconi S, Scozzafava A, Supuran CT. Inhibitors of HIV-1 protease: 10 years after. Expert Opin Ther Pat 2006. [DOI: 10.1517/13543776.16.8.1067] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
31
|
Vanni T, Sprinz E, Machado MW, Santana RDC, Fonseca BAL, Schwartsmann G. Systemic treatment of AIDS-related Kaposi sarcoma: current status and perspectives. Cancer Treat Rev 2006; 32:445-55. [PMID: 16860939 DOI: 10.1016/j.ctrv.2006.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 06/01/2006] [Accepted: 06/07/2006] [Indexed: 12/16/2022]
Abstract
Kaposi's sarcoma (KS) is the most frequent type of cancer in patients with Acquired Immune Deficiency Syndrome (AIDS). In the western world, its incidence decreased dramatically in the era of highly active anti-retroviral therapy (HAART). In contrast, the incidence of KS has been steadily climbing in parallel with the AIDS epidemic in Africa over the past 10-15 years, being the most common cancer in adult men in countries like Uganda and Zimbabwe. AIDS-KS can be diagnosed at any stage of HIV infection, although it more commonly occurs in the setting of severe immune suppression, especially with an elevated viral load. Up to now, AIDS-KS is still an incurable disease. Its clinical course is variable, ranging from very indolent cases, requiring no or minimal therapy, to a rapidly progressive disease. Various local therapies are available to control small and asymptomatic lesions, while cytotoxic, immunological and biological therapies can be considered for more aggressive disease. The primary goal of therapy in most of the cases is to provide safe and effective palliation, in order to quality of life. Optimal anti-retroviral therapy is a key component of AIDS-KS management. There are still many questions to be answered in the management of patients with AIDS-KS, such as (1) What are the therapeutic agents that should be used in this disease, and in which sequence? and (2) What are the benefits and risks expected with each treatment option? The aim of this review is to discuss the systemic management of AIDS-KS, with special focus on the above mentioned questions.
Collapse
Affiliation(s)
- Tazio Vanni
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | | | |
Collapse
|
32
|
Martinez V, Caumes E, Gambotti L, Ittah H, Morini JP, Deleuze J, Gorin I, Katlama C, Bricaire F, Dupin N. Remission from Kaposi's sarcoma on HAART is associated with suppression of HIV replication and is independent of protease inhibitor therapy. Br J Cancer 2006; 94:1000-6. [PMID: 16570046 PMCID: PMC2361239 DOI: 10.1038/sj.bjc.6603056] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Highly active antiretroviral therapy (HAART) reduces the incidence and improves the prognosis of Kaposi's sarcoma (KS). This study was designed to identify factors associated with KS clinical responses in HIV-infected patients during HAART. We reviewed the files of 138 HIV-1-infected patients with KS. Epidemiologic and HIV-related clinical and biological parameters were recorded at KS diagnosis (baseline) and every 6 months thereafter. In a subset of 73 antiretroviral-naive patients, we compared the clinical outcome of KS according to the use or nonuse of protease inhibitors (PI). After 6 months of follow-up, KS remission was more frequent in patients who were naive of HAART and who were at ACTG stage S0 at baseline (P=0.03 and 0.02). Undetectable HIV viral load was strongly associated with KS remission (P⩽0.004 at all time points), while CD4 cell count was not. Among the 73 antiretroviral-naive patients at baseline, and who were studied for 24 months, KS outcome did not differ between patients who were prescribed PI-containing and PI-sparing regimens. Intercurrent multicentric Castleman's disease was associated with poor outcome after 60 months of follow-up (P⩽0.0001). Fourteen deaths occurred after a median follow-up of 37.5 months, eight of which were KS related. Suppression of HIV replication appears to be crucial to control KS. Non-PI-based regimens were equivalent to PI-based regimens as regards the clinical and virological outcome of antiretroviral-naive HIV-infected patients with KS.
Collapse
Affiliation(s)
- V Martinez
- Service de Dermatologie, Hôpital Tarnier-Cochin, AP-HP, UPRES 1833, Université Paris V 89, rue d'Assas, Paris 75006, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Esposito V, Palescandolo E, Spugnini EP, Montesarchio V, De Luca A, Cardillo I, Cortese G, Baldi A, Chirianni A. Evaluation of Antitumoral Properties of the Protease Inhibitor Indinavir in a Murine Model of Hepatocarcinoma. Clin Cancer Res 2006; 12:2634-9. [PMID: 16638877 DOI: 10.1158/1078-0432.ccr-05-2188] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Accumulating evidences show a higher incidence of hepatic neoplasm in HIV/hepatitis C virus (HCV)-coinfected individuals compared with HCV-monoinfected patients. Treatment with HIV-1 protease inhibitors inhibited cancer-promoted angiogenesis in HIV-infected patients affected by Kaposi sarcoma. We aimed to evaluate the antineoplastic potential activities of the protease inhibitor indinavir (Crixivan) in in vitro and in vivo hepatocarcinoma models. EXPERIMENTAL DESIGN We analyzed effects of indinavir on cell growth and invasiveness in Huh7 and SK-HEP-1 hepatocarcinoma cell lines and on in vivo tumor growth of the same cells in nude mice. Morphologic and molecular analyses on explanted tumors were carried out to evaluate vascularization and apoptosis. RESULTS We observed a reduced ability to invade an in vitro extracellular matrix for both cell lines treated with indinavir compared with controls (P = 0,001). Moreover, indinavir treatment was able to inhibit matrix metalloproteinase-2 proteolytic activation, whereas there was no effect on cell proliferation. The drug was also able to delay in vivo tumor growth. The inhibition of tumor growth was statistically significant from days 6 to 21 (P = 0.004 and P = 0.003, respectively). Moreover, the drug showed antiangiogenic and proapoptotic actions, as revealed by vessel count and apoptotic index by terminal deoxynucleotide transferase-mediated nick end labeling in explanted tumors. Finally, treatment with indinavir did not block the production of vascular endothelial growth factor in the tumors. CONCLUSION Indinavir could be helpful to prevent the development of hepatocarcinomas in HIV/HCV-coinfected individuals. In view of the current trend to substitute protease inhibitors with other antiretroviral agents, this information may have clinical implications.
Collapse
MESH Headings
- Angiogenesis Inhibitors/pharmacology
- Angiogenesis Inhibitors/therapeutic use
- Animals
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Apoptosis/drug effects
- Blotting, Western
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/pathology
- Cell Line, Tumor
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Drug Evaluation, Preclinical
- Enzyme Activation/drug effects
- HIV Protease Inhibitors/pharmacology
- HIV Protease Inhibitors/therapeutic use
- Humans
- In Situ Nick-End Labeling
- Indinavir/pharmacology
- Indinavir/therapeutic use
- Liver Neoplasms, Experimental/blood supply
- Liver Neoplasms, Experimental/drug therapy
- Liver Neoplasms, Experimental/pathology
- Male
- Matrix Metalloproteinase 2/metabolism
- Mice
- Mice, Nude
- Vascular Endothelial Growth Factor A/metabolism
- Xenograft Model Antitumor Assays
Collapse
|
34
|
Vaccher E, di Gennaro G, Simonelli C, Schioppa O, Tirelli U. Evidence of activity of Irinotecan in patients with advanced AIDS-related Kaposi's sarcoma. AIDS 2005; 19:1915-6. [PMID: 16227802 DOI: 10.1097/01.aids.0000189855.06194.ce] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fourteen HIV-infected patients with advanced Kaposi's sarcoma (KS) received Irinotecan 150 mg/m intravenously on days 1 and 10. All patients were relapsed/progressed during highly active antiretroviral therapy, administered as primary antineoplastic therapy. An objective response, all partial remissions, occurred in 75% of patients. Irinotecan was well tolerated, severe leukopenia occurred in only 33% of patients. In HIV-infected patients with advanced KS, irinotecan is active and well tolerated.
Collapse
Affiliation(s)
- Emanuela Vaccher
- Division of Medical Oncology A, Aviano Cancer Institute, Aviano, PN, Italy
| | | | | | | | | |
Collapse
|
35
|
Abstract
HIV infection affects residents of all countries of the world, but the greater majority of affected individuals reside in the developing world. In the past decade there have been substantial changes in the management of HIV disease, particularly the introduction of highly active antiretroviral therapy (HAART). Such agents have reduced significantly the morbidity and mortality associated with HIV disease, however, they are not available for most HIV-infected individuals in the developing world. There is now considerable understanding of the molecular epidemiology, transmission and therapy of the common opportunistic oral infections of HIV disease, and as a consequence of improved anti-HIV strategies, the frequency and severity of oral disease associated with HIV infection have reduced considerably, although HAART may predispose to human papilloma virus infection of the mouth and potentially increase the risk of later oral squamous cell carcinoma. Despite advances in clinical care the majority of individuals with HIV disease worldwide will continue to develop oral disease, as they are resident in the developing world and do not have ready access to even simple therapies.
Collapse
Affiliation(s)
- Cristina Frezzini
- Oral Medicine Division of Maxillofacial Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, London, UK
| | | | | |
Collapse
|
36
|
Ng WT, Versace P. Ocular association of HIV infection in the era of highly active antiretroviral therapy and the global perspective. Clin Exp Ophthalmol 2005; 33:317-29. [PMID: 15932540 DOI: 10.1111/j.1442-9071.2005.01001.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ocular involvement is a common complication of HIV infection. Since the late 1990s, widespread use of highly active antiretroviral therapy (HAART) has altered the spectrum, and reduced the incidence of ocular involvement in developed countries. The incidence of the most common ocular opportunistic infection, cytomegalovirus retinitis, has decreased tremendously. However, immune recovery uveitis secondary to HAART has emerged as a frequent visually threatening condition. Early diagnosis and treatment with periocular steroids is helpful in minimizing visual loss. Clinicians should also be aware that certain antimicrobial agents used to treat opportunistic infections in HIV-positive patients are associated with potentially serious ocular side effects. In developing countries, where most of the world's 40 million HIV-positive patients live, the spectrum and incidence of ocular involvement differ from those in developed countries. The lack of HAART availability is among the many causes of these differences, which may include nutritional factors, basic medical care availability and the levels of exposure to different infectious agents. These factors add to the already challenging task of treating ocular complications and preventing blindness in HIV-positive patients in developing countries.
Collapse
Affiliation(s)
- Weng T Ng
- Department of Ophthalmology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
| | | |
Collapse
|
37
|
Aversa SML, Cattelan AM, Salvagno L, Crivellari G, Banna G, Trevenzoli M, Chiarion-Sileni V, Monfardini S. Treatments of AIDS-related Kaposi's sarcoma. Crit Rev Oncol Hematol 2005; 53:253-65. [PMID: 15718150 DOI: 10.1016/j.critrevonc.2004.10.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2004] [Indexed: 11/19/2022] Open
Abstract
Although Kaposi's sarcoma (KS) has decreased in countries where the highly active antiretroviral therapy (HAART) regimen is available, however it remains, after non-Hodgkin's lymphomas, the most common malignancy in HIV+ patients. Advances in the treatment of AIDS-KS have been achieved, even though a gold standard therapy has not been yet defined. With the availability of HAART, a dramatic KS clinical response has been documented, making HAART essential in all patients. In case of aggressive and/or life threatening KS, more complex therapeutic schedules have to be taken into account, including chemotherapy and/or immunotherapy. Liposomal anthracyclines and paclitaxel have been approved by FDA as first line and second line mono-therapy, respectively. Interferon-alpha (INF-alpha) is the only immunomodulant agent to have shown a therapeutic effect. Among the new drugs, many antiangiogenetic agents have produced encouraging responses. Finally, the identification of the HHV-8 as a causative agent and new metalloproteinase inhibitors may offer promising targets for the KS treatment.
Collapse
|
38
|
Cheung TW. AIDS-related cancer in the era of highly active antiretroviral therapy (HAART): a model of the interplay of the immune system, virus, and cancer. "On the offensive--the Trojan Horse is being destroyed"--Part A: Kaposi's sarcoma. Cancer Invest 2004; 22:774-86. [PMID: 15581058 DOI: 10.1081/cnv-200032788] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The introduction of highly active antiretroviral therapy (HAART), aimed at controlling human immunodeficiency virus (HIV), has been associated with a dramatic decrease in the incidence of acquired immunodeficiency syndrome-Kaposi's sarcoma (AIDS-KS) and the clinical manifestations of KS appear to be less aggressive. The pathogenesis of AIDS-related KS is related to a system of cytokines (e.g., interleukin-6) driven by autocrine and paracrine loops. More recently, human herpesvirus 8 (HHV-8), was discovered to be the putative etiological agent of this disease. This virus encodes several unique open reading frames that are homologs of human cellular proteins involved in cellular regulations, cell proliferation, apoptosis, and immune regulation. The treatment of this disease depends on whether it is "limited" disease or "extensive" disease. For "limited" disease, local therapy or non-bone marrow suppressive agents should be used. For "extensive" disease, new chemotherapeutic agents, such as liposomal anthracycline, which are active and have little adverse reactions, are indicated. The control of HIV infection continues to be essential. Knowledge of the pathogenesis of the disease has led to the development of novel treatment strategies, aimed at the inflammatory or angiogenesis cytokines necessary for growth or at HHV-8 as the target of therapy.
Collapse
Affiliation(s)
- Tony W Cheung
- University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| |
Collapse
|
39
|
Aoki Y, Tosato G. Therapeutic options for human herpesvirus-8/Kaposi's sarcoma-associated herpesvirus-related disorders. Expert Rev Anti Infect Ther 2004; 2:213-25. [PMID: 15482187 DOI: 10.1586/14787210.2.2.213] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Human herpesvirus-8/Kaposi's sarcoma-associated herpesvirus infection is associated with three proliferative disorders in immunocompromised patients - Kaposi's sarcoma, primary effusion lymphoma and multicentric Castleman's disease. These disorders often develop in patients with advanced AIDS who present a number of therapeutic challenges, underscoring the importance of continuing efforts dedicated to basic and clinical research in this field. In the era of highly active antiretroviral therapy, the incidence of AIDS and Kaposi's sarcoma has considerably decreased, presumably due to enhanced anti-Kaposi's sarcoma-associated herpesvirus immune responses, whereas the situation with primary effusion lymphoma and multicentric Castleman's disease is more complex. Based on advances in the understanding of Kaposi's sarcoma-associated herpesvirus-related disorders and availability of antiretroviral agents, current and future therapeutic approaches will be discussed.
Collapse
Affiliation(s)
- Yoshiyasu Aoki
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive 12N226, Bethesda, MD 20892-1907, USA.
| | | |
Collapse
|
40
|
van Twillert G, van Eeden S, Nellen FJB, Cornelissen M, Wszolek Z, Westermann AM. Spinal cord compression due to Kaposi's sarcoma. Ann Oncol 2004; 15:1143-4. [PMID: 15205211 DOI: 10.1093/annonc/mdh258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
41
|
Gardner EM, Connick E. Illness of Immune Reconstitution: Recognition and Management. Curr Infect Dis Rep 2004; 6:483-493. [PMID: 15538986 DOI: 10.1007/s11908-004-0068-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Some individuals who initiate highly active antiretroviral therapy (HAART) develop new or worsening opportunistic infections or malignancies despite improvements in surrogate markers of HIV-1 infection. These events of paradoxical clinical worsening, also known as immune reconstitution syndromes (IRS), are increased in individuals with prior opportunistic infections or low CD4+ T-cell nadirs. They are thought to result from reconstitution of the immune system's ability to recognize pathogens or tumor antigens that were previously present, but clinically asymptomatic. There is no consensus regarding the diagnostic criteria or pathogenesis of IRS. Knowledge of their presentation and treatment is largely based on case reports. With the introduction of HAART into resource-limited settings, it is likely that significantly more and distinct forms of IRS will be observed. Prospective studies of the incidence and treatment of IRS in multiple settings are critical to better understand their pathogenesis and optimal management.
Collapse
Affiliation(s)
- Edward M Gardner
- Division of Infectious Diseases, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box B168, Denver, CO 80262, USA.
| | | |
Collapse
|
42
|
Connick E, Kane MA, White IE, Ryder J, Campbell TB. Immune reconstitution inflammatory syndrome associated with Kaposi sarcoma during potent antiretroviral therapy. Clin Infect Dis 2004; 39:1852-5. [PMID: 15578411 DOI: 10.1086/426078] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Accepted: 08/10/2004] [Indexed: 11/03/2022] Open
Abstract
Rapidly progressive Kaposi sarcoma (KS) lesions with lymphadenopathy and tissue swelling occurred in a patient during antiretroviral treatment, despite an increased CD4(+) lymphocyte count and decreased HIV-1 level and KS-associated herpesvirus replication, suggesting immune reconstitution inflammatory syndrome. Inflammation resolved coincident with decreases in the CD4(+) lymphocyte count during paclitaxel treatment, whereas KS cleared only after prolonged antiretroviral therapy and chemotherapy.
Collapse
Affiliation(s)
- Elizabeth Connick
- Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver 80262, USA.
| | | | | | | | | |
Collapse
|
43
|
Martin-Carbonero L, Barrios A, Saballs P, Sirera G, Santos J, Palacios R, Valencia ME, Alegre M, Podzamczer D, González-Lahoz J. Pegylated liposomal doxorubicin plus highly active antiretroviral therapy versus highly active antiretroviral therapy alone in HIV patients with Kaposi's sarcoma. AIDS 2004; 18:1737-40. [PMID: 15280789 DOI: 10.1097/01.aids.0000131385.60974.b9] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Twenty-eight HIV patients either naive or failing highly active antiretroviral therapy (HAART)with moderate-advanced Kaposi's sarcoma (KS)were randomly chosen to initiate a new HAART regimen plus pegylated liposomal doxorubicin(PLD) or the new HAART regimen alone. After 48 weeks, better response rates were observed in the HAART plus PLD group (76% versus 20%). In HIV-infected patients with moderate-advanced KS, HAART alone may not be enough for KS response.
Collapse
|
44
|
Eng W, Cockerell CJ. Histological features of kaposi sarcoma in a patient receiving highly active antiviral therapy. Am J Dermatopathol 2004; 26:127-32. [PMID: 15024195 DOI: 10.1097/00000372-200404000-00008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The introduction of highly active anti-retroviral therapy (HAART) has changed the clinical presentation of skin diseases in patients with the Acquired Immune Deficiency Syndrome (AIDS). This occurs as a consequence of a newly recognized effect of this therapy known as the "Immune Reconstitution Syndrome," which develops with improvement of immunity. One manifestation of this syndrome is alteration of the natural history of Kaposi sarcoma (KS). While there are multiple reports of KS regression during HAART, there is little documentation of the histologic changes that occur. We present the case of a 55-year-old homosexual male with KS for over 4 years who underwent 6 biopsies over a 3-year period before, during, and after HAART. Kaposi sarcoma lesions prior to HAART were multinodular with ill-defined borders clinically and demonstrated typical features of nodular stage KS histologically. After initiation of HAART in this patient, lesions became uninodular, well circumscribed, and histologically were noted to be less cellular and surrounded by a dense fibrotic stroma. Although the mechanisms for these histologic changes are not clear, it may be due to activity of HAART against human herpesvirus type 8 (HHV-8), the causative agent of KS, to reconstitution of immunity due to diminution in HIV viral load, or both.
Collapse
|
45
|
Stebbing J, Gazzard B, Mandalia S, Teague A, Waterston A, Marvin V, Nelson M, Bower M. Antiretroviral Treatment Regimens and Immune Parameters in the Prevention of Systemic AIDS-Related Non-Hodgkin's Lymphoma. J Clin Oncol 2004; 22:2177-83. [PMID: 15169806 DOI: 10.1200/jco.2004.11.097] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Immunosuppression induced by HIV-1 increases the risk of developing non-Hodgkin's lymphoma (NHL). We measured the influence of immunologic factors and highly active antiretroviral therapy (HAART) on this risk. As there are no data demonstrating that specific antiretroviral regimens are effective at protecting from NHL, we compared different HAART regimens. Patients and Methods The protective effect of HAART regimens, containing protease inhibitors (PI) and/or non-nucleoside reverse transcriptase inhibitors (NNRTIs) on the development of NHL was examined in a prospectively recorded cohort of 9,621 HIV-infected individuals. Lymphocyte and natural killer subset data were also entered in univariate and multivariate analyses to establish and stratify the risk of NHL. Results From this cohort of 9,621 patients, 102 have been diagnosed with systemic AIDS-related NHL since 1996, when HAART became freely available here. By univariate analysis, increased age, higher nadir CD4 and CD8 T-cell counts, CD19 B-cell count, CD16/56 natural killer count and exposure to NNRTI or PI containing HAART conferred significant protection against NHL (P < .05). In a multivariate analysis, age, nadir CD4 and CD8 T-cell counts, and exposure to HAART were independent predictors of risk of NHL (P < .02). NNRTI-based HAART (adjusted rate ratio, 0.4; 95% CI, 0.3 to 0.5) was as protective as PI-based HAART, and these were significantly more protective than nucleoside analogues alone (rate ratio, 0.5; 95% CI, 0.4 to 0.7) or no antiretrovirals (P < .001). Conclusion Effective HAART-induced maintenance of CD4 and CD8 counts protects from systemic AIDS-related NHL.
Collapse
Affiliation(s)
- Justin Stebbing
- Department of Oncology, The Chelsea and Westminster Hospital, 369 Fulham Rd, London SW10 9NH, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Krown SE. Highly Active Antiretroviral Therapy in AIDS-Associated Kaposi's Sarcoma: Implications for the Design of Therapeutic Trials in Patients With Advanced, Symptomatic Kaposi's Sarcoma. J Clin Oncol 2004; 22:399-402. [PMID: 14752065 DOI: 10.1200/jco.2004.08.064] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Susan E Krown
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
47
|
Pantanowitz L, Dezube BJ, Pinkus GS, Tahan SR. Histological characterization of regression in acquired immunodeficiency syndrome-related Kaposi's sarcoma. J Cutan Pathol 2003; 31:26-34. [PMID: 14675282 DOI: 10.1046/j.0303-6987.2004.0132.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Kaposi's sarcoma (KS) is an angioproliferative lesion that may regress or progress. Progression is related to spindle cell proliferation and the expression of human herpes virus-8 latency genes, including latent nuclear antigen-1 (LNA-1), cyclin-D1, and bcl-2. KS regression has not been well characterized histologically. Therefore, this study was undertaken to characterize the histopathology of pharmacologically induced regressed cutaneous KS. METHODS Skin punch biopsies from eight patients with acquired immunodeficiency syndrome (AIDS)-related KS, that regressed following chemotherapy with paclitaxel or the angiogenesis inhibitor Col-3, were investigated by light microscopy. Comparative immunophenotyping on pre- and post-treatment specimens for CD31, LNA-1, cyclin-D1, bcl-2, and CD117 (c-kit) was performed. RESULTS Clinical and histologic features of regression were similar for paclitaxel and Col-3 treatment. On clinical examination, lesions flattened, became smaller, and lost their purple-red appearance, resulting in an orange-brown macule. Histological regression was divided into partial (n = 3) and complete (n = 5) regression. Partially regressed lesions had a significant reduction of spindle cells in the dermal interstitium, with residual spindle cells arranged around superficial and mid-dermal capillaries. Complete regression was characterized by an absence of detectable spindle cells, with a slight increase in capillaries of the superficial plexus. All regressed samples exhibited a prominent, superficial, perivascular, lymphocytic infiltrate and abundant dermal hemosiderin-laden macrophages. This clinicopathologic picture resembled the findings of pigmented purpura. CD31 staining correlated with the reduction of spindle cells. Regression was accompanied by a quantitative and qualitative decrease in LNA-1 and cyclin-D1 immunoreactivity, but no change in bcl-2 or c-kit expression. CONCLUSIONS Pharmacologically induced regression of AIDS-related cutaneous KS is characterized by a complete loss or decrease of spindle cells, increased lymphocytes, and prominent dermal siderophage deposition. Without any prior knowledge of the history of KS regression following therapy, regressed KS lesions may be misdiagnosed clinically and histologically as pigmented purpuric dermatitis.
Collapse
Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Beth Israel Deaconess Medical Center, and Department of Pathology, 330 Brookline Avenue, Boston, MA 02215, USA.
| | | | | | | |
Collapse
|
48
|
Nasti G, Martellotta F, Berretta M, Mena M, Fasan M, Di Perri G, Talamini R, Pagano G, Montroni M, Cinelli R, Vaccher E, D'Arminio Monforte A, Tirelli U. Impact of highly active antiretroviral therapy on the presenting features and outcome of patients with acquired immunodeficiency syndrome-related Kaposi sarcoma. Cancer 2003; 98:2440-6. [PMID: 14635079 DOI: 10.1002/cncr.11816] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objective of the current study was to evaluate the impact of highly active antiretroviral therapy (HAART) on clinical characteristics of presentation and the natural history of Kaposi sarcoma (KS) in patients already receiving HAART at the time of KS diagnosis. METHODS The authors conducted a retrospective cohort study comparing epidemiologic, clinical, and outcome data for 160 patients who were naive to HAART at the time of KS diagnosis (KS-naive) with the corresponding data for 51 patients already receiving HAART at the time of KS diagnosis (KS-HAART). The analysis included all patients with a diagnosis of KS since January 1996 within two Italian cohorts of patients with human immunodeficiency virus. RESULTS Immunologic and virologic status at the time of KS diagnosis were significantly more favorable in the KS-HAART group than in the KS-naive group. The frequency of cutaneous involvement was similar in both groups, but cutaneous disease was more indolent among KS-HAART patients, with 1 anatomic site of involvement in 9 patients (21%) and less than 10 lesions in 26 patients (60%), compared with 16 patients (12%; P = 0.06) and 47 patients (34%; P = 0.01), respectively, in the KS-naive group. A smaller proportion of KS-HAART patients presented with visceral disease (24% vs. 39%; P = 0.06); in particular, gastrointestinal tract involvement was significantly less frequent among KS-HAART patients (14%) compared with KS-naive patients (28%; P = 0.05). Median survival was not reached in either group, and the 3-year survival rates of KS-HAART patients (64%) and KS-naive patients (78%) were not significantly different. CONCLUSIONS The data from the current study indicate that KS exhibits a less aggressive presentation in patients already receiving HAART compared with patients who are naive to HAART at KS diagnosis. Natural history and outcome do not appear to be influenced by the initiation of HAART before development of KS.
Collapse
Affiliation(s)
- Guglielmo Nasti
- Division of Medical Oncology A, Italian National Cancer Institute, Aviano, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Godfrey A, Laman H, Boshoff C. RNA interference: a potential tool against Kaposiʼs sarcoma-associated herpesvirus. Curr Opin Infect Dis 2003; 16:593-600. [PMID: 14624111 DOI: 10.1097/00001432-200312000-00013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW RNA interference is a conserved cellular function that controls viral infection, the expression of transposable elements, repetitive sequences and genes in embryonic development. Originally described as an antiviral mechanism in plants, known as posttranscriptional gene silencing, it is now appreciated that this phenomenon occurs in all living cells. Double-stranded RNA, when acting as part of RNA interference, reduces expression of genes with sequence similarity, but has no effect on the expression of genes of unrelated sequence. Studies of RNA interference in mammalian cells have demonstrated that exogenous genes delivered by DNA transfection as well as endogenous gene expression can be suppressed by the delivery of RNA interference. We discuss here the potential for exploiting this phenomenon to prevent or treat viral infections, in particular Kaposi's sarcoma-associated herpesvirus. RECENT FINDINGS There have been several studies showing that RNA interference can be exploited to target a wide range of human viruses, including HIV-1, human T cell leukaemia virus-1, human papillomavirus, hepatitis B, hepatitis C and the polio virus. RNA interference is effective in mammalian cells and can be delivered by various methods. Double-stranded RNA has been injected into the tail veins of mice to block both virally and chemically induced hepatitis. SUMMARY A greater understanding of RNA interference allows us to exploit this phenomenon in order to study the functions of genes in mammalian cells, and also to target the expression of mutated cellular or viral genes. New delivery techniques should be developed to allow the process to be used as a therapeutic tool against viruses and malignancies in humans.
Collapse
Affiliation(s)
- Andrew Godfrey
- Cancer Research UK Viral Oncology Group, Wolfson Institute for Biomedical Research, University College London, London, UK
| | | | | |
Collapse
|
50
|
Sgadari C, Monini P, Barillari G, Ensoli B. Use of HIV protease inhibitors to block Kaposi's sarcoma and tumour growth. Lancet Oncol 2003; 4:537-47. [PMID: 12965274 DOI: 10.1016/s1470-2045(03)01192-6] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV protease inhibitors are antiretroviral drugs that block the enzyme required for production of infectious viral particles. Although these agents have been designed to selectively bind to the catalytic site of HIV protease, evidence indicates that other cellular and microbial enzymes and pathways are also affected. It has been reported that patients treated with highly active anti-retroviral therapy (HAART) containing a protease inhibitor may be at reduced risk of Kaposi's sarcoma (KS) and some types of non-Hodgkin lymphomas; some disease regressions have also been described. Here we review recent data showing that several widely used protease inhibitors, including indinavir, saquinavir, ritonavir, and nelfinavir, can affect important cellular and tissue processes such as angiogenesis, tumour growth and invasion, inflammation, antigen processing and presentation, cell survival, and tissue remodelling. Most of these non-HIV-related effects of protease inhibitors are due to inhibition of cell invasion and matrix metalloprotease activity, or modulation of the cell proteasome and NFkappaB. These elements are required for development of most tumours. Thus, by direct and indirect activities, protease inhibitors can simultaneously block several pathways involved in tumour growth, invasion, and metastasis. These findings indicate that protease inhibitors can be exploited for the therapy of KS and other tumours that occur in both HIV-infected and non-infected individuals. A multicentre phase II clinical trial with indinavir in non-HIV-associated KS is about to start in Italy.
Collapse
Affiliation(s)
- Cecilia Sgadari
- Senior Investigators at the Laboratory of Virology, Istituto Superiore di Sanità, Rome, Italy
| | | | | | | |
Collapse
|