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Chemparathy DT, Ray S, Ochs C, Ferguson N, Gawande DY, Dravid SM, Callen S, Sil S, Buch S. Neuropathogenic role of astrocyte-derived extracellular vesicles in HIV-associated neurocognitive disorders. J Extracell Vesicles 2024; 13:e12439. [PMID: 38647111 PMCID: PMC11034007 DOI: 10.1002/jev2.12439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
Our previous findings demonstrated that astrocytic HIF-1α plays a major role in HIV-1 Tat-mediated amyloidosis which can lead to Alzheimer's-like pathology-a comorbidity of HIV-Associated Neurocognitive Disorders (HAND). These amyloids can be shuttled in extracellular vesicles, and we sought to assess whether HIV-1 Tat stimulated astrocyte-derived EVs (ADEVs) containing the toxic amyloids could result in neuronal injury in vitro and in vivo. We thus hypothesized that blocking HIF-1α could likely mitigate HIV-1 Tat-ADEV-mediated neuronal injury. Rat hippocampal neurons when exposed to HIV-1 Tat-ADEVs carrying the toxic amyloids exhibited amyloid accumulation and synaptodendritic injury, leading to functional loss as evidenced by alterations in miniature excitatory post synaptic currents. The silencing of astrocytic HIF-1α not only reduced the biogenesis of ADEVs, as well as amyloid cargos, but also ameliorated neuronal synaptodegeneration. Next, we determined the effect of HIV-1 Tat-ADEVs carrying amyloids in the hippocampus of naive mice brains. Naive mice receiving the HIV-1 Tat-ADEVs, exhibited behavioural changes, and Alzheimer's 's-like pathology accompanied by synaptodegeneration. This impairment(s) was not observed in mice injected with HIF-1α silenced ADEVs. This is the first report demonstrating the role of amyloid-carrying ADEVs in mediating synaptodegeneration leading to behavioural changes associated with HAND and highlights the protective role of HIF-1α.
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Affiliation(s)
- Divya T. Chemparathy
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Sudipta Ray
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Chase Ochs
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Natasha Ferguson
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Dinesh Y. Gawande
- Department of Pharmacology and NeuroscienceCreighton UniversityOmahaNebraskaUSA
| | - Shashank M. Dravid
- Department of Pharmacology and NeuroscienceCreighton UniversityOmahaNebraskaUSA
| | - Shannon Callen
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Susmita Sil
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Shilpa Buch
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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Sundermann EE, Campbell LM, Villers O, Bondi MW, Gouaux B, Salmon DP, Galasko D, Soontornniyomkij V, Ellis RJ, Moore DJ. Alzheimer's Disease Pathology in Middle Aged and Older People with HIV: Comparisons with Non-HIV Controls on a Healthy Aging and Alzheimer's Disease Trajectory and Relationships with Cognitive Function. Viruses 2023; 15:1319. [PMID: 37376619 PMCID: PMC10305373 DOI: 10.3390/v15061319] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
We determined the prevalence of Alzheimer's disease (AD) pathological hallmarks, amyloid-β and phosphorylated-Tau, in autopsied brains of 49 people with HIV (PWH) (ages: 50-68; mean age = 57.0) from the National NeuroAIDS Tissue Consortium and in a comparative cohort of 55 people without HIV (PWoH) from the UC San Diego Alzheimer's Disease Research Center (17 controls, 14 mild cognitive impairment, 24 AD; ages: 70-102, mean age = 88.7). We examined how AD pathology relates to domain-specific cognitive functions in PWH overall and in sex-stratified samples. Amyloid-β and phosphorylated-Tau positivity (presence of pathology of any type/density) was determined via immunohistochemistry in AD-sensitive brain regions. Among PWH, amyloid-β positivity ranged from 19% (hippocampus) to 41% (frontal neocortex), and phosphorylated-Tau positivity ranged from 47% (entorhinal cortex) to 73% (transentorhinal cortex). Generally, AD pathology was significantly less prevalent, and less severe when present, in PWH versus PWoH regardless of cognitive status. Among PWH, positivity for AD pathology related most consistently to memory-related domains. Positivity for p-Tau pathology related to memory-related domains in women with HIV only, although the sample size of women with HIV was small (n = 10). Results indicate that AD pathology is present in a sizable portion of middle aged and older PWH, although not to the extent in older PWoH. Studies with better age-matched PWoH are needed to examine the effect of HIV status on AD pathology.
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Affiliation(s)
- Erin E. Sundermann
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - Laura M. Campbell
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Olivia Villers
- School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA
| | - Ben Gouaux
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - David P. Salmon
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - Virawudh Soontornniyomkij
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
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Cooley SA, Nelson B, Boerwinkle A, Yarasheski KE, Kirmess KM, Meyer MR, Schindler SE, Morris JC, Fagan A, Ances BM, O’Halloran JA. Plasma Aβ42/Aβ40 Ratios in Older People With Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:1776-1783. [PMID: 36610788 PMCID: PMC10209437 DOI: 10.1093/cid/ciad001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND As people with human immunodeficiency virus (HIV) (PWH) age, it remains unclear whether they are at higher risk for age-related neurodegenerative disorders-for example, Alzheimer disease (AD)-and, if so, how to differentiate HIV-associated neurocognitive impairment from AD. We examined a clinically available blood biomarker test for AD (plasma amyloid-β [Aβ] 42/Aβ40 ratio) in PWH who were cognitively normal (PWH_CN) or cognitively impaired (PWH_CI) and people without HIV (PWoH) who were cognitively normal (PWoH_CN) or had symptomatic AD (PWoH_AD). METHODS A total of 66 PWH (age >40 years) (HIV RNA <50 copies/mL) and 195 PWoH provided blood samples, underwent magnetic resonance imaging, and completed a neuropsychological battery or clinical dementia rating scale. Participants were categorized by impairment (PWH_CN, n = 43; PWH_CI, n = 23; PWoH_CN, n = 138; PWoH_AD, n = 57). Plasma Aβ42 and Aβ40 concentrations were obtained using a liquid chromatography-tandem mass spectrometry method to calculate the PrecivityAD amyloid probability score (APS). The APS incorporates age and apolipoprotein E proteotype into a risk score for brain amyloidosis. Plasma Aβ42/Aβ40 ratios and APSs were compared between groups and assessed for relationships with hippocampal volumes or cognition and HIV clinical characteristics (PWH only). RESULTS The plasma Aβ42/Aβ40 ratio was significantly lower, and the APS higher, in PWoH_AD than in other groups. A lower Aβ42/Aβ40 ratio and higher APS was associated with smaller hippocampal volumes for PWoH_AD. The Aβ42/Aβ40 ratio and APS were not associated with cognition or HIV clinical measures for PWH. CONCLUSIONS The plasma Aβ42/Aβ40 ratio can serve as a screening tool for AD and may help differentiate effects of HIV from AD within PWH, but larger studies with older PWH are needed.
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Affiliation(s)
- Sarah A Cooley
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Brittany Nelson
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Anna Boerwinkle
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | | | | | | | - Suzanne E Schindler
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - John C Morris
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Radiology, Washington University in St Louis, St Louis, Missouri, USA
| | - Anne Fagan
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - Beau M Ances
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Jane A O’Halloran
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
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Trunfio M, Atzori C, Pasquero M, Di Stefano A, Vai D, Nigra M, Imperiale D, Bonora S, Di Perri G, Calcagno A. Patterns of Cerebrospinal Fluid Alzheimer’s Dementia Biomarkers in People Living with HIV: Cross-Sectional Study on Associated Factors According to Viral Control, Neurological Confounders and Neurocognition. Viruses 2022; 14:v14040753. [PMID: 35458483 PMCID: PMC9031633 DOI: 10.3390/v14040753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 12/11/2022] Open
Abstract
People living with HIV (PLWH) age with an excess burden of comorbidities that may increase the incidence of age-related complications. There is controversy surrounding the hypothesis that HIV can accelerate neurodegeneration and Alzheimer’s dementia (AD). We performed a retrospective study to analyze the distribution of cerebrospinal fluid (CSF) AD biomarkers (beta amyloid 1–42 fragment, tau, and phosphorylated tau) in adult PLWH (on cART with undetectable viremia, n = 136, with detectable viremia, n = 121, and with central nervous system CNS disorders regardless of viremia, n = 72) who underwent a lumbar puncture between 2008 to 2018; HIV-negative controls with AD were included (n = 84). Five subjects (1.5%) presented CSF biomarkers that were compatible with AD: one was diagnosed with AD, whereas the others showed HIV encephalitis, multiple sclerosis, cryptococcal meningitis, and neurotoxoplasmosis. Regardless of confounders, 79.6% of study participants presented normal CSF AD biomarkers. Isolated abnormalities in CSF beta amyloid 1–42 (7.9%) and tau (10.9%) were associated with age, biomarkers of intrathecal injury, and inflammation, although no HIV-specific feature was associated with abnormal CSF patterns. CSF levels of AD biomarkers very poorly overlapped between HIV-positive clinical categories and AD controls. Despite the correlations with neurocognitive performance, the inter-relationship between amyloid and tau proteins in PLWH seem to differ from that observed in AD subjects; the main driver of the isolated increase in tau seems represented by non-specific CNS inflammation, whereas the mechanisms underlying isolated amyloid consumption remain unclear.
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Affiliation(s)
- Mattia Trunfio
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
- Correspondence: ; Tel.: +39-0114393884
| | | | - Marta Pasquero
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
| | - Alessandro Di Stefano
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
| | - Daniela Vai
- Neurology Unit, Maria Vittoria Hospital, 10144 Torino, Italy
| | - Marco Nigra
- Laboratory Medicine, Maria Vittoria Hospital, 10144 Torino, Italy
| | | | - Stefano Bonora
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
| | - Giovanni Di Perri
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
| | - Andrea Calcagno
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
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Mechanisms of immune aging in HIV. Clin Sci (Lond) 2022; 136:61-80. [PMID: 34985109 DOI: 10.1042/cs20210344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022]
Abstract
Massive CD4+ T-cell depletion as well as sustained immune activation and inflammation are hallmarks of Human Immunodeficiency Virus (HIV)-1 infection. In recent years, an emerging concept draws an intriguing parallel between HIV-1 infection and aging. Indeed, many of the alterations that affect innate and adaptive immune subsets in HIV-infected individuals are reminiscent of the process of immune aging, characteristic of old age. These changes, of which the presumed cause is the systemic immune activation established in patients, likely participate in the immuno-incompetence described with HIV progression. With the success of antiretroviral therapy (ART), HIV-seropositive patients can now live for many years despite chronic viral infection. However, acquired immunodeficiency syndrome (AIDS)-related opportunistic infections have given way to chronic diseases as the leading cause of death since HIV infection. Therefore, the comparison between HIV-1 infected patients and uninfected elderly individuals goes beyond the sole onset of immunosenescence and extends to the deterioration of several physiological functions related to inflammation and systemic aging. In light of this observation, it is interesting to understand the precise link between immune activation and aging in HIV-1 infection to figure out how to best care for people living with HIV (PLWH).
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Vera JH, Eftychiou N, Schuerer M, Rullmann M, Barthel H, Sabri O, Gisslen M, Zetterberg H, Blennow K, O'Brien C, Banerjee S, Dizdarevic S. Clinical Utility of β-Amyloid PET Imaging in People Living With HIV With Cognitive Symptoms. J Acquir Immune Defic Syndr 2021; 87:826-833. [PMID: 33587503 DOI: 10.1097/qai.0000000000002648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Imaging with β-amyloid (Aβ) positron emission tomography (PET) has the potential to aid the diagnosis of the cause of cognitive impairment affecting people living with HIV (PLWH) when neurodegenerative disorders are considered. We evaluated the clinical utility of [18F]Florbetaben (FBB) in PLWH with cognitive symptoms. METHODS Imaging with FBB PET was performed in 20 patients with cognitive concerns about dementia. Neuropsychological testing, plasma neurofilament light protein, plasma Aβ40, Aβ42, and cerebrospinal fluid Aβ42, tau, and HIV RNA were obtained. FBB PET images were assessed visually by 3 readers blinded to the clinical diagnosis and quantitatively by obtaining a composite cortical to cerebellar cortex standardized uptake value ratio (SUVR). FBB SUVR from 10 age-matched healthy controls was compared with SUVR of PLWH. RESULTS Most participants were men (90%) of white ethnicity (90%) with a median age (interquartile range) of 59 (43-79) years. Median CD4 count was 682 (74-1056). All patients were on combination antiretroviral therapy with plasma and cerebrospinal fluid HIV RNA <40 copies/mL. Fourteen patients had objective cognitive impairment including 2 who met clinical criteria for a diagnosis of dementia. No significant differences in composite SUVRs between PLWH and controls [mean (SD): 1.18 (0.03) vs. 1.16 (0.09); P = 0.37] were observed. Four patients were FBB+ with the highest SUVR in the posterior cingulate, superior temporal, and frontal superior lobe. Amyloid PET results contributed to a change in diagnosis and treatment for 10 patients. CONCLUSION [18F]Florbetaben PET has potential as an adjunctive tool in the diagnosis of PLWH with cognitive impairment, increasing diagnostic certainty and optimizing management.
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Affiliation(s)
- Jaime H Vera
- Centre for Global Health Research, Brighton and Sussex Med School, United Kingdom
| | - Nicholas Eftychiou
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals, United Kingdom
| | - Matti Schuerer
- Department of Nuclear Medicine, University of Leipzig, Germany
| | | | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Germany
| | - Magnus Gisslen
- Department of Infectious Diseases, University of Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Sweden
| | - Clara O'Brien
- Department of Neuropsychology, Brighton and Sussex University Hospitals, United Kingdom ; and
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, United Kingdom
| | - Sabina Dizdarevic
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals, United Kingdom
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Irollo E, Luchetta J, Ho C, Nash B, Meucci O. Mechanisms of neuronal dysfunction in HIV-associated neurocognitive disorders. Cell Mol Life Sci 2021; 78:4283-4303. [PMID: 33585975 PMCID: PMC8164580 DOI: 10.1007/s00018-021-03785-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
HIV-associated neurocognitive disorder (HAND) is characterized by cognitive and behavioral deficits in people living with HIV. HAND is still common in patients that take antiretroviral therapies, although they tend to present with less severe symptoms. The continued prevalence of HAND in treated patients is a major therapeutic challenge, as even minor cognitive impairment decreases patient’s quality of life. Therefore, modern HAND research aims to broaden our understanding of the mechanisms that drive cognitive impairment in people with HIV and identify promising molecular pathways and targets that could be exploited therapeutically. Recent studies suggest that HAND in treated patients is at least partially induced by subtle synaptodendritic damage and disruption of neuronal networks in brain areas that mediate learning, memory, and executive functions. Although the causes of subtle neuronal dysfunction are varied, reversing synaptodendritic damage in animal models restores cognitive function and thus highlights a promising therapeutic approach. In this review, we examine evidence of synaptodendritic damage and disrupted neuronal connectivity in HAND from clinical neuroimaging and neuropathology studies and discuss studies in HAND models that define structural and functional impairment of neurotransmission. Then, we report molecular pathways, mechanisms, and comorbidities involved in this neuronal dysfunction, discuss new approaches to reverse neuronal damage, and highlight current gaps in knowledge. Continued research on the manifestation and mechanisms of synaptic injury and network dysfunction in HAND patients and experimental models will be critical if we are to develop safe and effective therapies that reverse subtle neuropathology and cognitive impairment.
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Affiliation(s)
- Elena Irollo
- Department of Pharmacology and Physiology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Jared Luchetta
- Department of Pharmacology and Physiology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Chunta Ho
- Department of Pharmacology and Physiology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Bradley Nash
- Department of Pharmacology and Physiology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Olimpia Meucci
- Department of Pharmacology and Physiology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA. .,Department of Microbiology and Immunology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA. .,Center for Neuroimmunology and CNS Therapeutics, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.
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Chang L, Liang H, Kandel SR, He JJ. Independent and Combined Effects of Nicotine or Chronic Tobacco Smoking and HIV on the Brain: A Review of Preclinical and Clinical Studies. J Neuroimmune Pharmacol 2020; 15:658-693. [PMID: 33108618 DOI: 10.1007/s11481-020-09963-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023]
Abstract
Tobacco smoking is highly prevalent among HIV-infected individuals. Chronic smokers with HIV showed greater cognitive deficits and impulsivity, and had more psychopathological symptoms and greater neuroinflammation than HIV non-smokers or smokers without HIV infection. However, preclinical studies that evaluated the combined effects of HIV-infection and tobacco smoking are scare. The preclinical models typically used cell cultures or animal models that involved specific HIV viral proteins or the administration of nicotine to rodents. These preclinical models consistently demonstrated that nicotine had neuroprotective and anti-inflammatory effects, leading to cognitive enhancement. Although the major addictive ingredient in tobacco smoking is nicotine, chronic smoking does not lead to improved cognitive function in humans. Therefore, preclinical studies designed to unravel the interactive effects of chronic tobacco smoking and HIV infection are needed. In this review, we summarized the preclinical studies that demonstrated the neuroprotective effects of nicotine, the neurotoxic effects of the HIV viral proteins, and the scant literature on nicotine or tobacco smoke in HIV transgenic rat models. We also reviewed the clinical studies that evaluated the neurotoxic effects of tobacco smoking, HIV infection and their combined effects on the brain, including studies that evaluated the cognitive and behavioral assessments, as well as neuroimaging measures. Lastly, we compared the different approaches between preclinical and clinical studies, identified some gaps and proposed some future directions. Graphical abstract Independent and combined effects of HIV and tobacco/nicotine. Left top and bottom panels: Both clinical studies of HIV infected persons and preclinical studies using viral proteins in vitro or in vivo in animal models showed that HIV infection could lead to neurotoxicity and neuroinflammation. Right top and bottom panels: While clinical studies of tobacco smoking consistently showed deleterious effects of smoking, clinical and preclinical studies that used nicotine show mild cognitive enhancement, neuroprotective and possibly anti-inflammatory effects. In the developing brain, however, nicotine is neurotoxic. Middle overlapping panels: Clinical studies of persons with HIV who were smokers typically showed additive deleterious effects of HIV and tobacco smoking. However, in the preclinical studies, when nicotine was administered to the HIV-1 Tg rats, the neurotoxic effects of HIV were attenuated, but tobacco smoke worsened the inflammatory cascade.
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Affiliation(s)
- Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 670 W. Baltimore Street, HSF III, Baltimore, MD, 21201, USA.
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.
| | - Huajun Liang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 670 W. Baltimore Street, HSF III, Baltimore, MD, 21201, USA
| | - Suresh R Kandel
- Department of Microbiology and Immunology, Chicago Medical School, Center for Cancer Cell Biology, Immunology and Infection, Rosalind Franklin University, 3333 Green Bay Road, Basic Science Building 2.300, North Chicago, IL, 60064, USA
| | - Johnny J He
- Department of Microbiology and Immunology, Chicago Medical School, Center for Cancer Cell Biology, Immunology and Infection, Rosalind Franklin University, 3333 Green Bay Road, Basic Science Building 2.300, North Chicago, IL, 60064, USA.
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9
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Yoshino Y, Koga I, Kitazawa T, Oba H, Furui S, Matsuda H, Ota Y. Magnetic resonance imaging changes in Asian people living with HIV. Infect Dis (Lond) 2020; 53:89-93. [PMID: 32988259 DOI: 10.1080/23744235.2020.1825797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Previous studies have reported a significant increase in age-related magnetic resonance imaging (MRI) changes in relatively younger people living with HIV (PLWH). However, there is little data available for brain changes in Asian PLWH. The data to differentiate HIV specific brain change from usual aging change was also sparse. To clarify them, we assessed the presence of leukoaraiosis and brain atrophic changes on MRI in young and middle-aged Japanese PLWH. METHODS We reviewed data from well-controlled PLWH (age: 20-64 years) and coeval controls. We evaluated the presence of leukoaraiosis, as well as the extent of whole-brain grey matter (GM) atrophy and parahippocampal atrophy on brain MRI and determined between-group differences. Moreover, we evaluated the severity of parahippocampal atrophy based on the voxel-based specific regional analysis system for Alzheimer's disease. RESULTS We enrolled 40 PLWH and 33 controls (median age: 40.15 and 48.00 years, respectively, [p = .3585]). Leukoaraiosis was significantly more prevalent among the PLWH (20 cases [50%]) than in the controls (9 cases [27.3%]) (univariate: p = .0483, multivariate: p = .0206). The extent of whole-brain GM atrophy was significantly greater in the PLWH than in the controls (univariate: p < .001, multivariate: p = .0012). Contrastingly, there was no significant between-group difference in the extent and severity of parahippocampal atrophy. CONCLUSIONS Aging changes in the brain were significantly more prevalent in well-controlled Japanese PLWH. However, the process of atrophic brain changes might differ between HIV and one of age-related diseases, Alzheimer's disease.
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Affiliation(s)
- Yusuke Yoshino
- Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Japan
| | - Ichiro Koga
- Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Japan
| | - Takatoshi Kitazawa
- Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Japan
| | - Hiroshi Oba
- Department of Radiology, Teikyo University School of Medicine, Itabashi, Japan
| | - Shigeru Furui
- Department of Radiology, Teikyo University School of Medicine, Itabashi, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center (IBIC), National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yasuo Ota
- Department of Internal Medicine, Teikyo University School of Medicine, Itabashi, Japan.,Department of Internal Medicine, National Hospital Organization Higashi Saitama Hospital, Hasuda, Japan
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10
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Sil S, Hu G, Liao K, Niu F, Callen S, Periyasamy P, Fox HS, Buch S. HIV-1 Tat-mediated astrocytic amyloidosis involves the HIF-1α/lncRNA BACE1-AS axis. PLoS Biol 2020; 18:e3000660. [PMID: 32453744 PMCID: PMC7274476 DOI: 10.1371/journal.pbio.3000660] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 06/05/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022] Open
Abstract
Increased life expectancy of patients diagnosed with HIV in the current era of antiretroviral therapy is unfortunately accompanied with the prevalence of HIV-associated neurocognitive disorders (HANDs) and risk of comorbidities such as Alzheimer-like pathology. HIV-1 transactivator of transcription (Tat) protein has been shown to induce the production of toxic neuronal amyloid protein and also enhance neurotoxicity. The contribution of astrocytes in Tat-mediated amyloidosis remains an enigma. We report here, in simian immunodeficiency virus (SIV)+ rhesus macaques and patients diagnosed with HIV, brain region-specific up-regulation of amyloid precursor protein (APP) and Aβ (40 and 42) in astrocytes. In addition, we find increased expression of β-site cleaving enzyme (BACE1), APP, and Aβ in human primary astrocytes (HPAs) exposed to Tat. Mechanisms involved up-regulation of hypoxia-inducible factor (HIF-1α), its translocation and binding to the long noncoding RNA (lncRNA) BACE1-antisense transcript (BACE1-AS), resulting, in turn, in the formation of the BACE1-AS/BACE1 RNA complex, subsequently leading to increased BACE1 protein, and activity and generation of Aβ-42. Gene silencing approaches confirmed the regulatory role of HIF-1α in BACE1-AS/BACE1 in Tat-mediated amyloidosis. This is the first report implicating the role of the HIF-1α/lncRNABACE1-AS/BACE1 axis in Tat-mediated induction of astrocytic amyloidosis, which could be targeted as adjunctive therapies for HAND-associated Alzheimer-like comorbidity.
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Affiliation(s)
- Susmita Sil
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Guoku Hu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Ke Liao
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Fang Niu
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Shannon Callen
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Palsamy Periyasamy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Howard S. Fox
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Shilpa Buch
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
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11
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Howdle GC, Quidé Y, Kassem MS, Johnson K, Rae CD, Brew BJ, Cysique LA. Brain amyloid in virally suppressed HIV-associated neurocognitive disorder. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/4/e739. [PMID: 32393651 PMCID: PMC7238897 DOI: 10.1212/nxi.0000000000000739] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/06/2020] [Indexed: 01/23/2023]
Abstract
Objective To determine whether virally suppressed HIV neuropathogenesis, a chronic neuroinflammatory state, promotes abnormal brain amyloid deposition. Methods A total of 10 men with virally suppressed HIV-associated neurocognitive disorder (HAND), aged 46–68 years, underwent 11C-labeled Pittsburgh compound B PET. Data from the Australian Imaging, Biomarkers and Lifestyle (AIBL), including 39 cognitively normal individuals (aged 60–74 years), 7 individuals with mild cognitive impairment (MCI) (aged 64–71 years), and 11 individuals with Alzheimer disease (AD) (aged 55–74 years), were used as reference. Apart from more women, the AIBL cohort was demographically comparable with the HIV sample. Also, the AIBL PET data did not differ by sex. Cerebellum standardized uptake value ratio amyloid values within 22 regions of interest were estimated. In the HIV sample, apolipoprotein E (APOE) was available in 80%, CSF biomarkers in 60%, and 8–10 years of long-term health outcomes in 100%. Results HAND and the AIBL group with no cognitive deficits had similar amyloid deposition, which was lower than that in both the MCI and AD groups. At the individual level, one HAND case showed high amyloid deposition consistent with AD. This case also had a CSF-AD–like profile and an E4/E4 for APOE. Clinically, this case declined over 18 years with mild HAND symptoms first, followed by progressive memory decline 8–9 years after the study PET, then progression to severe dementia within 2–3 years, and lived a further 6 years. Another HAND case showed increased amyloid deposition restricted to the hippocampi. Two other HAND cases showed abnormally decreased amyloid in subcortical areas. Conclusions Relative to cognitively normal older controls, brain amyloid burden does not differ in virally suppressed HAND at the group level. However, individual analyses show that abnormally high and low amyloid burden occur.
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Affiliation(s)
- Gemma C Howdle
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Yann Quidé
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Mustafa S Kassem
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Kate Johnson
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Caroline D Rae
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Bruce J Brew
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia
| | - Lucette A Cysique
- From the Neuroscience Research Australia (G.C.H., Y.Q., M.S.K., C.D.R., L.A.C.), Randwick; School of Psychiatry (Y.Q.), UNSW Sydney; School of Medical Sciences (M.S.K., C.D.R, B.J.B), UNSW Sydney; Peter Duncan Neuroscience Research Unit (K.J., B.J.B, L.A.C), St. Vincent's Centre for Applied Medical Research; Departments of Neurology and Immunology (K.J., B.J.B.), St. Vincent's Hospital, Darlinghurst, Australia; and School of Psychology (L.A.C.), UNSW Sydney, NSW, Australia.
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12
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Beta-amyloid (Aβ) uptake by PET imaging in older HIV+ and HIV- individuals. J Neurovirol 2020; 26:382-390. [PMID: 32270469 DOI: 10.1007/s13365-020-00836-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
The causes of cognitive impairment among older HIV+ individuals may overlap with causes among elderly HIV seronegative (HIV-) individuals. The objective of this study was to determine if beta-amyloid (Aβ) deposition measured by [18F] AV-45 (florbetapir) positron emission tomography (PET) is increased in older HIV+ individuals compared to HIV- individuals. Forty-eight HIV+ and 25 HIV- individuals underwent [18F] AV-45 PET imaging. [18F] AV-45 binding to Aβ was measured by standardized uptake value ratios (SUVR) relative to the cerebellum in 16 cortical and subcortical regions of interest. Global and regional cortical SUVRs were compared by (1) serostatus, (2) HAND stage, and (3) age decade, comparing individuals in their 50s and > 60s. There were no differences in median global cortical SUVR stratified by HIV serostatus or HAND stage. The proportion of HIV+ participants in their 50s with elevated global amyloid uptake (SUVR > 1.40) was significantly higher than the proportion in HIV- participants (67% versus 25%, p = 0.04), and selected regional SUVR values were also higher (p < 0.05) in HIV+ compared to HIV- participants in their 50s. However, these group differences were not seen in participants in their 60s. In conclusion, PET imaging found no differences in overall global Aβ deposition stratified by HIV serostatus or HAND stage. Although there was some evidence of increased Aβ deposition in HIV+ individuals in their 50s compared to HIV- individuals which might indicate premature aging, the most parsimonious explanation for this is the relatively small sample size in this cross-sectional cohort study.
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13
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Cooley SA, Strain JF, Beaumont H, Boerwinkle AH, Doyle J, Morris JC, Benzinger TL, Ances BM. Tau Positron Emission Tomography Binding Is Not Elevated in HIV-Infected Individuals. J Infect Dis 2020; 220:68-72. [PMID: 30561665 DOI: 10.1093/infdis/jiy663] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/11/2018] [Indexed: 11/14/2022] Open
Abstract
Regional standardized uptake value ratios (SUVRs) for tau positron emission tomography (PET) were compared among 19 cognitively normal human immunodeficiency virus (HIV)-negative control individuals, 20 HIV-negative patients with symptomatic Alzheimer disease, 15 cognitively normal HIV-positive individuals, and 17 cognitively impaired HIV-positive individuals. Among the HIV-positive participants, the correlation between tau PET SUVRs and both HIV loads and CD4+ T-cell counts (recent and nadir). Tau PET SUVRs were similar for HIV-positive individuals and HIV-negative control individuals. Individuals with symptomatic Alzheimer disease had elevated tau PET SUVRs. Tau PET SUVRs did not correlate with impairment or clinical markers in HIV-positive participants. Older HIV-positive individuals are not at increased risk of tau-mediated neurodegeneration.
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Affiliation(s)
- Sarah A Cooley
- Department of Neurology, Washington University in Saint Louis, Missouri
| | - Jeremy F Strain
- Department of Neurology, Washington University in Saint Louis, Missouri
| | - Helen Beaumont
- Department of Neurology, Washington University in Saint Louis, Missouri
| | - Anna H Boerwinkle
- Department of Neurology, Washington University in Saint Louis, Missouri
| | - John Doyle
- Department of Neurology, Washington University in Saint Louis, Missouri
| | - John C Morris
- Department of Neurology, Washington University in Saint Louis, Missouri
| | | | - Beau M Ances
- Department of Neurology, Washington University in Saint Louis, Missouri.,Department of Radiology, Washington University in Saint Louis, Missouri.,Hope Center, Washington University in Saint Louis, Missouri
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14
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Brain PET Imaging: Value for Understanding the Pathophysiology of HIV-associated Neurocognitive Disorder (HAND). Curr HIV/AIDS Rep 2020; 16:66-75. [PMID: 30778853 DOI: 10.1007/s11904-019-00419-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent developments in PET imaging of neuropathologies underlying HIV-associated neurocognitive dysfunction (HAND). We concentrate on the recent post antiretroviral era (ART), highlighting clinical and preclinical brain PET imaging studies. RECENT FINDINGS In the post ART era, PET imaging has been used to better understand perturbations of glucose metabolism, neuroinflammation, the function of neurotransmitter systems, and amyloid/tau protein deposition in the brains of HIV-infected patients and HIV animal models. Preclinical and translational findings from those studies shed a new light on the complex pathophysiology underlying HAND. The molecular imaging capabilities of PET in neuro-HIV are great complements for structural imaging modalities. Recent and future PET imaging studies can improve our understanding of neuro-HIV and provide biomarkers of disease progress that could be used as surrogate endpoints in the evaluation of the effectiveness of potential neuroprotective therapies.
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15
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Henrich TJ, Hsue PY, VanBrocklin H. Seeing Is Believing: Nuclear Imaging of HIV Persistence. Front Immunol 2019; 10:2077. [PMID: 31572355 PMCID: PMC6751256 DOI: 10.3389/fimmu.2019.02077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022] Open
Abstract
A major obstacle to HIV eradication is the presence of infected cells that persist despite suppressive antiretroviral therapy (ART). HIV largely resides outside of the peripheral circulation, and thus, numerous anatomical and lymphoid compartments that have the capacity to harbor HIV are inaccessible to routine sampling. As a result, there is a limited understanding of the tissue burden of HIV infection or anatomical distribution of HIV transcriptional and translational activity. Novel, non-invasive, in vivo methods are urgently needed to address this fundamental gap in knowledge. In this review, we discuss past and current nuclear imaging approaches that have been applied to HIV infection with an emphasis on current strategies to implement positron emission tomography (PET)-based imaging to directly visualize and characterize whole-body HIV burden. These imaging approaches have various limitations, such as the potential for limited PET sensitivity and specificity in the setting of ART suppression or low viral burden. However, recent advances in high-sensitivity, total-body PET imaging platforms and development of new radiotracer technologies that may enhance anatomical penetration of target-specific tracer molecules are discussed. Potential strategies to image non-viral markers of HIV tissue burden or focal immune perturbation are also addressed. Overall, emerging nuclear imaging techniques and platforms may play an important role in the development of novel therapeutic and HIV reservoir eradication strategies.
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Affiliation(s)
- Timothy J Henrich
- Division of Experimental Medicine, Department of Medicine, University of San Francisco, San Francisco, CA, United States
| | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, University of San Francisco, San Francisco, CA, United States
| | - Henry VanBrocklin
- Radiopharmaceutical Research Program, Center for Molecular and Functional Imaging, University of San Francisco, San Francisco, CA, United States
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16
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Chakradhar S. A tale of two diseases: Aging HIV patients inspire a closer look at Alzheimer's disease. Nat Med 2019; 24:376-377. [PMID: 29634694 DOI: 10.1038/nm0418-376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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17
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Rubin LH, Sundermann EE, Moore DJ. The current understanding of overlap between characteristics of HIV-associated neurocognitive disorders and Alzheimer's disease. J Neurovirol 2019; 25:661-672. [PMID: 30671777 DOI: 10.1007/s13365-018-0702-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/04/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022]
Abstract
The advent of effective antiretroviral medications (ARVs) has led to an aging of the HIV population with approximately 50% of people with HIV (PWH) being over the age of 50 years. Neurocognitive complications, typically known as HIV-associated neurocognitive disorders (HAND), persist in the era of ARVs and, in addition to risk of HAND, older PWH are also at risk for age-associated, neurodegenerative disorders including Alzheimer's disease (AD). It has been postulated that risk for AD may be greater among PWH due to potential compounding effects of HIV and aging on mechanisms of neural insult. We are now faced with the challenge of disentangling AD from HAND, which has important prognostic and treatment implications given the more rapidly debilitating trajectory of AD. Herein, we review the evidence to date demonstrating both parallels and differences in the profiles of HAND and AD. We specifically address similarities and difference of AD and HAND as it relates to (1) neuropsychological profiles (cross-sectional/longitudinal), (2) AD-associated neuropathological features as evidenced from neuropathological, cerebrospinal fluid and neuroimaging assessments, (3) biological mechanisms underlying cortical amyloid deposition, (4) parallels in mechanisms of neural insult, and (5) common risk factors. Our current understanding of the similarities and dissimilarities of AD and HAND should be further delineated and leveraged in the development of differential diagnostic methods that will allow for the early identification of AD and more suitable and effective treatment interventions among graying PWH.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego (UCSD) School of Medicine, La Jolla, CA, USA.
| | - David J Moore
- Department of Psychiatry, University of California, San Diego (UCSD) School of Medicine, La Jolla, CA, USA
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19
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Hellmuth J, Milanini B, Masliah E, Tartaglia MC, Dunlop MB, Moore DJ, Javandel S, DeVaughn S, Valcour V. A neuropathologic diagnosis of Alzheimer's disease in an older adult with HIV-associated neurocognitive disorder. Neurocase 2018; 24:213-219. [PMID: 30304986 PMCID: PMC6226354 DOI: 10.1080/13554794.2018.1530362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We discuss the challenges associated with diagnosing neurodegenerative disorders in older adults living with HIV, illustrated through a case report where neurologic co-diagnosis of Alzheimer's disease (AD) and HIV-associated Neurocognitive Disorder (HAND) are considered. The patient was followed and evaluated for over 4 years and underwent post-mortem neuropathologic evaluation. Further work is needed to identify diagnostic tests that can adequately distinguish HAND from early stage neurodegenerative disorders among older adults living with HIV and cognitive changes.
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Affiliation(s)
- Joanna Hellmuth
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , California, CA , USA
| | - Benedetta Milanini
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , California, CA , USA
| | - Eliezer Masliah
- b Departments of Neurosciences and Pathology , University of California, San Diego , California, CA, USA
| | - Maria Carmela Tartaglia
- c University of Toronto, Tanz Centre for Research in Neurodegenerative Diseases , Toronto , Canada
| | - Miranda B Dunlop
- d Department of Internal Medicine , University of California, San Francisco , California, CA, USA
| | - David J Moore
- e Department of Psychiatry , University of California, San Diego , California, CA,USA
| | - Shireen Javandel
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , California, CA , USA
| | - Saskia DeVaughn
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , California, CA , USA
| | - Victor Valcour
- a Memory and Aging Center, Department of Neurology , University of California, San Francisco , California, CA , USA
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20
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Milanini B, Valcour V. Differentiating HIV-Associated Neurocognitive Disorders From Alzheimer's Disease: an Emerging Issue in Geriatric NeuroHIV. Curr HIV/AIDS Rep 2018; 14:123-132. [PMID: 28779301 DOI: 10.1007/s11904-017-0361-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review was to examine characteristics that may distinguish HIV-associated neurocognitive disorder (HAND) from early Alzheimer's disease (AD). RECENT FINDINGS Cerebrospinal fluid (CSF) AD biomarkers are perturbed in HIV, yet these alterations may be limited to settings of advanced dementia or unsuppressed plasma HIV RNA. Neuropsychological testing will require extensive batteries to maximize utility. Structural imaging is limited for early AD detection in the setting of HIV, but proper studies are absent. While positron-emission tomography (PET) amyloid imaging has altered the landscape of differential diagnosis for age-associated neurodegenerative disorders, costs are prohibitive. Risk for delayed AD diagnosis in the aging HIV-infected population is now among the most pressing issues in geriatric neuroHIV. While clinical, imaging, and biomarker characterizations of AD are extensively defined, fewer data define characteristics of HIV-associated neurocognitive disorder in the setting of suppressed plasma HIV RNA. Data needed to inform the phenotype of AD in the setting of HIV are equally few.
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Affiliation(s)
- Benedetta Milanini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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Abstract
Human immunodeficiency virus (HIV) enters the brain early after infecting humans and may remain in the central nervous system despite successful antiretroviral treatment. Many neuroimaging techniques were used to study HIV+ patients with or without opportunistic infections. These techniques assessed abnormalities in brain structures (using computed tomography, structural magnetic resonance imaging (MRI), diffusion MRI) and function (using functional MRI at rest or during a task, and perfusion MRI with or without a contrast agent). In addition, single-photon emission computed tomography with various tracers (e.g., thallium-201, Tc99-HMPAO) and positron emission tomography with various agents (e.g., [18F]-dexoyglucose, [11C]-PiB, and [11C]-TSPO tracers), were applied to study opportunistic infections or HIV-associated neurocognitive disorders. Neuroimaging provides diagnoses and biomarkers to quantitate the severity of brain injury or to monitor treatment effects, and may yield insights into the pathophysiology of HIV infection. As the majority of antiretroviral-stable HIV+ patients are living longer, age-related comorbid disorders (e.g., additional neuroinflammation, cerebrovascular disorders, or other dementias) will need to be considered. Other highly prevalent conditions, such as substance use disorders, psychiatric illnesses, and the long-term effects of combined antiretroviral therapy, all may lead to additional brain injury. Neuroimaging studies could provide knowledge regarding how these comorbid conditions impact the HIV-infected brain. Lastly, specific molecular imaging agents may be needed to assess the central nervous system viral reservoir.
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Affiliation(s)
- Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Medicine and Department of Neurology, John A. Burns School of Medicine, University of Hawaii, Manoa, United States.
| | - Dinesh K Shukla
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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Wyczechowska D, Lin HY, LaPlante A, Jeansonne D, Lassak A, Parsons CH, Molina PE, Peruzzi F. A miRNA Signature for Cognitive Deficits and Alcohol Use Disorder in Persons Living with HIV/AIDS. Front Mol Neurosci 2017; 10:385. [PMID: 29187813 PMCID: PMC5694774 DOI: 10.3389/fnmol.2017.00385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/06/2017] [Indexed: 01/23/2023] Open
Abstract
HIV-associated neurocognitive disorders (HAND) affects more than half of persons living with HIV-1/AIDS (PLWHA). Identification of biomarkers representing the cognitive status of PLWHA is a critical step for implementation of successful cognitive, behavioral and pharmacological strategies to prevent onset and progression of HAND. However, the presence of co-morbidity factors in PLWHA, the most common being substance abuse, can prevent the identification of such biomarkers. We have optimized a protocol to profile plasma miRNAs using quantitative RT-qPCR and found a miRNA signature with very good discriminatory ability to distinguish PLWHA with cognitive impairment from those without cognitive impairment. Here, we have evaluated this miRNA signature in PLWHA with alcohol use disorder (AUD) at LSU Health Sciences Center (LSUHSC). The results show that AUD is a potential confounding factor for the miRNAs associated with cognitive impairment in PLWHA. Furthermore, we have investigated the miRNA signature associated with cognitive impairment in an independent cohort of PLWHA using plasma samples from the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) program. Despite differences between the two cohorts in socioeconomic status, AUD, and likely misuse of illicit or prescription drugs, we validated a miRNA signature for cognitive deficits found at LSUHSC in the CHARTER samples.
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Affiliation(s)
- Dorota Wyczechowska
- Stanley S. Scott Cancer Center, Louisiana State University, New Orleans, LA, United States
| | - Hui-Yi Lin
- Biostatistics Program, School of Public Health, Louisiana State University, New Orleans, LA, United States
| | - Andrea LaPlante
- Department of Psychiatry, University Medical Center, Louisiana State University, New Orleans, LA, United States
| | - Duane Jeansonne
- Stanley S. Scott Cancer Center, Louisiana State University, New Orleans, LA, United States
| | - Adam Lassak
- Stanley S. Scott Cancer Center, Louisiana State University, New Orleans, LA, United States
| | - Christopher H Parsons
- Stanley S. Scott Cancer Center, Department of Medicine, School of Medicine, Louisiana State University, New Orleans, LA, United States
| | - Patricia E Molina
- Alcohol and Drug Abuse Center of Excellence, Department of Physiology, School of Medicine, Louisiana State University, New Orleans, LA, United States
| | - Francesca Peruzzi
- Stanley S. Scott Cancer Center, Alcohol and Drug Abuse Center of Excellence, Department of Medicine, School of Medicine, Louisiana State University, New Orleans, LA, United States
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PET brain imaging in HIV-associated neurocognitive disorders (HAND) in the era of combination antiretroviral therapy. Eur J Nucl Med Mol Imaging 2017; 44:895-902. [PMID: 28058461 DOI: 10.1007/s00259-016-3602-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
Effective combination antiretroviral therapy (cART) has lead to a significant reduction in the prevalence and incidence of central nervous system (CNS) HIV-associated brain disease, particularly CNS opportunistic infections and HIV encephalitis. Despite this, cognitive deficits in people living with HIV, also known as HIV-associated neurocognitive disorders (HAND) have become more prevalent in recent years. The pathogenesis of HAND is likely to be multifactorial, however recent evidence suggests that brain microglial activation is the most likely pathogenic mechanism. Recent developments in positron emission tomography (PET) brain neuroimaging using novel brain radioligands targeting a variety of physiological changes in the brains of HIV-positive individuals have improved our understanding of the mechanisms associated with the development of HAND. This review will highlight recent PET brain neuroimaging studies in the cART era, focusing on physiological and neurochemical changes associated with HAND in people living with HIV.
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Chen NC, Partridge AT, Sell C, Torres C, Martín-García J. Fate of microglia during HIV-1 infection: From activation to senescence? Glia 2016; 65:431-446. [PMID: 27888531 DOI: 10.1002/glia.23081] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 12/14/2022]
Abstract
Microglia support productive human immunodeficiency virus type 1 (HIV-1) infection and disturbed microglial function could contribute to the development of HIV-associated neurocognitive disorders (HAND). Better understanding of how HIV-1 infection and viral protein exposure modulate microglial function during the course of infection could lead to the identification of novel therapeutic targets for both the eradication of HIV-1 reservoir and treatment of neurocognitive deficits. This review first describes microglial origins and function in the normal central nervous system (CNS), and the changes that occur during aging. We then critically discuss how HIV-1 infection and exposure to viral proteins such as Tat and gp120 affect various aspects of microglial homeostasis including activation, cellular metabolism and cell cycle regulation, through pathways implicated in cellular stress responses including p38 mitogen-activated protein kinase (MAPK) and nuclear factor κB (NF-κB). We thus propose that the functions of human microglia evolve during both healthy and pathological aging. Aging-associated dysfunction of microglia comprises phenotypes resembling cellular senescence, which could contribute to cognitive impairments observed in various neurodegenerative diseases. In addition, microglia seems to develop characteristics that could be related to cellular senescence post-HIV-1 infection and after exposure to HIV-1 viral proteins. However, despite its potential role as a component of HAND and likely other neurocognitive disorders, microglia senescence has not been well characterized and should be the focus of future studies, which could have high translational relevance. GLIA 2017;65:431-446.
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Affiliation(s)
- Natalie C Chen
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania.,MD/PhD Program, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Molecular and Cell Biology and Genetics Graduate Program, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Andrea T Partridge
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Microbiology and Immunology Graduate Program, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Christian Sell
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Claudio Torres
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Julio Martín-García
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, Pennsylvania
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The Role of Nuclear Medicine in the Staging and Management of Human Immune Deficiency Virus Infection and Associated Diseases. Nucl Med Mol Imaging 2016; 51:127-139. [PMID: 28559937 DOI: 10.1007/s13139-016-0422-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 02/07/2023] Open
Abstract
Human immune deficiency virus (HIV) is a leading cause of death. It attacks the immune system, thereby rendering the infected host susceptible to many HIV-associated infections, malignancies and neurocognitive disorders. The altered immune system affects the way the human host responds to disease, resulting in atypical presentation of these disorders. This presents a diagnostic challenge and the clinician must use all diagnostic avenues available to diagnose and manage these conditions. The advent of highly active antiretroviral therapy (HAART) has markedly reduced the mortality associated with HIV infection but has also brought in its wake problems associated with adverse effects or drug interaction and may even modulate some of the HIV-associated disorders to the detriment of the infected human host. Nuclear medicine techniques allow non-invasive visualisation of tissues in the body. By using this principle, pathophysiology in the body can be targeted and the treatment of diseases can be monitored. Being a functional imaging modality, it is able to detect diseases at the molecular level, and thus it has increased our understanding of the immunological changes in the infected host at different stages of the HIV infection. It also detects pathological changes much earlier than conventional imaging based on anatomical changes. This is important in the immunocompromised host as in some of the associated disorders a delay in diagnosis may have dire consequences. Nuclear medicine has played a huge role in the management of many HIV-associated disorders in the past and continues to help in the diagnosis, prognosis, staging, monitoring and assessing the response to treatment of many HIV-associated disorders. As our understanding of the molecular basis of disease increases nuclear medicine is poised to play an even greater role. In this review we highlight the functional basis of the clinicopathological correlation of HIV from a metabolic view and discuss how the use of nuclear medicine techniques, with particular emphasis of F-18 fluorodeoxyglucose, may have impact in the setting of HIV. We also provide an overview of the role of nuclear medicine techniques in the management of HIV-associated disorders.
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Saylor D, Sacktor N. Cognitive Impairment Among Older Individuals with HIV Infection. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0165-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zwan MD, Rinne JO, Hasselbalch SG, Nordberg A, Lleó A, Herukka SK, Soininen H, Law I, Bahl JMC, Carter SF, Fortea J, Blesa R, Teunissen CE, Bouwman FH, van Berckel BNM, Visser PJ. Use of amyloid-PET to determine cutpoints for CSF markers: A multicenter study. Neurology 2015; 86:50-8. [PMID: 26468410 DOI: 10.1212/wnl.0000000000002081] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 08/28/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To define CSF β-amyloid 1-42 (Aβ42) cutpoints to detect cortical amyloid deposition as assessed by 11C-Pittsburgh compound B ([11C]PiB)-PET and to compare these calculated cutpoints with cutpoints currently used in clinical practice. METHODS We included 433 participants (57 controls, 99 with mild cognitive impairment, 195 with Alzheimer disease [AD] dementia, and 82 with non-AD dementia) from 5 European centers. We calculated for each center and for the pooled cohort CSF Aβ42 and Aβ42/tau ratio cutpoints for cortical amyloid deposition based on visual interpretation of [11C]PiB-PET images. RESULTS Amyloid-PET-based calculated CSF Aβ42 cutpoints ranged from 521 to 616 pg/mL, whereas existing clinical-based cutpoints ranged from 400 to 550 pg/mL. Using the calculated cutpoint from the pooled sample (557 pg/mL), concordance between CSF Aβ42 and amyloid-PET was 84%. Similar concordance was found when using a dichotomized Aβ42/tau ratio. Exploratory analysis showed that participants with a positive amyloid-PET and normal CSF Aβ42 levels had higher CSF tau and phosphorylated tau levels and more often had mild cognitive impairment or AD dementia compared with participants who had negative amyloid-PET and abnormal CSF Aβ42 levels. CONCLUSIONS Amyloid-PET-based CSF Aβ42 cutpoints were higher and tended to reduce intercenter variability compared with clinical-based cutpoints. Discordant participants with normal CSF Aβ42 and a positive amyloid-PET may be more likely to have AD-related amyloid pathology than participants with abnormal CSF Aβ42 and a negative amyloid-PET. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that an amyloid-PET-based CSF Aβ42 cutpoint identifies individuals with amyloid deposition with a sensitivity of 87% and specificity of 80%.
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Affiliation(s)
- Marissa D Zwan
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands.
| | - Juha O Rinne
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Steen G Hasselbalch
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Agneta Nordberg
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Alberto Lleó
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Sanna-Kaisa Herukka
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Hilkka Soininen
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Ian Law
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Justyna M C Bahl
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Stephen F Carter
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Juan Fortea
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Rafael Blesa
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Charlotte E Teunissen
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Femke H Bouwman
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Bart N M van Berckel
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Pieter J Visser
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
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Abstract
PURPOSE OF REVIEW HIV enters the brain after initial infection, and with time can lead to HIV-associated neurocognitive disorders (HAND). Although the introduction of combination antiretroviral therapy has reduced the more severe forms of HAND, milder forms are still highly prevalent. The 'gold standard' for HAND diagnosis remains detailed neuropsychological performance testing but additional biomarkers (including neuroimaging) may assist in early detection of HAND. RECENT FINDINGS We review the application of recently developed noninvasive MRI and PET techniques in HIV+ individuals. In particular, magnetic resonance spectroscopy may be more sensitive than conventional MRI alone in detecting HIV associated changes. Diffusion tensor imaging has become increasingly popular for assessing changes in white matter structural integrity due to HIV. Both functional MRI and PET have been limitedly performed but could provide keys for characterizing neuropathophysiologic changes due to HIV. SUMMARY It is hoped that continued progress will allow novel neuroimaging methods to be included in future HAND management guidelines.
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Abstract
Antiretroviral therapy extends the lifespan of human immunodeficiency virus (HIV)-infected patients, but many survivors develop premature impairments in cognition. These residual cognitive impairments may involve aberrant deposition of amyloid β-peptides (Aβ). By unknown mechanisms, Aβ accumulates in the lysosomal and autophagic compartments of neurons in the HIV-infected brain. Here we identify the molecular events evoked by the HIV coat protein gp120 that facilitate the intraneuronal accumulation of Aβ. We created a triple transgenic gp120/APP/PS1 mouse that recapitulates intraneuronal deposition of Aβ in a manner reminiscent of the HIV-infected brain. In cultured neurons, we found that the HIV coat protein gp120 increased the transcriptional expression of BACE1 through repression of PPARγ, and increased APP expression by promoting interaction of the translation-activating RBP heterogeneous nuclear ribonucleoprotein C with APP mRNA. APP and BACE1 were colocalized into stabilized membrane microdomains, where the β-cleavage of APP and Aβ formation were enhanced. Aβ-peptides became localized to lysosomes that were engorged with sphingomyelin and calcium. Stimulating calcium efflux from lysosomes with a TRPM1 agonist promoted calcium efflux, luminal acidification, and cleared both sphingomyelin and Aβ from lysosomes. These findings suggest that therapeutics targeted to reduce lysosomal pH in neurodegenerative conditions may protect neurons by facilitating the clearance of accumulated sphingolipids and Aβ-peptides.
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Valcour V, Paul R, Chiao S, Wendelken LA, Miller B. Screening for cognitive impairment in human immunodeficiency virus. Clin Infect Dis 2014; 53:836-42. [PMID: 21921226 DOI: 10.1093/cid/cir524] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Recent publications estimate the prevalence of human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) exceeds 50%, and this rate is likely higher among older patients. Cognitive impairment may impact medication adherence, and symptomatic impairment has been linked to all-cause mortality providing some impetus for early detection. There are currently insufficient data to inform solid recommendations on screening methods. Most HIV-specific tools have poor performance characteristics for all but the most severe form of impairment, which accounts for <5% of cases. Reliance on symptoms is likely to miss a substantial proportion of individuals with HAND due to poor insight, confounding mood disturbances, and lack of well-informed proxies. In the aging HIV-positive population, broader screening tools may be required to allow sensitivity for both HIV and neurodegenerative disorders. We describe the clinical presentation of HAND, review existing data related to screening tools, and provide preliminary and practical recommendations in the absence of more definitive studies.
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Affiliation(s)
- Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California–San Francisco, USA.
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31
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Nasi M, Pinti M, De Biasi S, Gibellini L, Ferraro D, Mussini C, Cossarizza A. Aging with HIV infection: a journey to the center of inflammAIDS, immunosenescence and neuroHIV. Immunol Lett 2014; 162:329-33. [PMID: 24996041 DOI: 10.1016/j.imlet.2014.06.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/12/2014] [Accepted: 06/24/2014] [Indexed: 12/31/2022]
Abstract
In the last years, a significant improvement in life expectancy of HIV+ patients has been observed in Western countries. The parallel increase in the mean age of these patients causes a parallel increase in the frequency of non-AIDS related complications (i.e., neurocognitive, cardiovascular, liver and kidney diseases, metabolic syndrome, osteoporosis, non-HIV associated cancers, among others), even when antiviral treatment is successful. Immune activation and persistent inflammation characterizes both HIV infection and physiological aging, and both conditions share common detrimental pathways that lead to early immunosenescence. Furthermore, HIV-associated neurocognitive disorders represent important consequences of the infection. The persistent systemic immune activation, the continuous migration of activated monocytes to the central nervous system and progressive patients' aging contribute to develop neuronal injuries, that are in turn linked to HIV-associated neurocognitive disorders, which can persist despite successful antiretroviral treatment.
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Affiliation(s)
- Milena Nasi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcello Pinti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara De Biasi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lara Gibellini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy; Infectious Diseases Clinics, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Andrea Cossarizza
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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Role of HIV in amyloid metabolism. J Neuroimmune Pharmacol 2014; 9:483-91. [PMID: 24816714 DOI: 10.1007/s11481-014-9546-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
HIV infection has changed from an acute devastating disease to a more chronic illness due to combination anti-retroviral treatment (cART). In the cART era, the life expectancy of HIV-infected (HIV+) individuals has increased. More HIV + individuals are aging with current projections suggesting that 50% of HIV + individuals will be over 50 years old by 2015. With advancing age, HIV + individuals may be at increased risk of developing other potential neurodegenerative disorders [especially Alzheimer's disease (AD)]. Pathology studies have shown that HIV increases intra and possibly extracellular amyloid beta (Aβ42), a hallmark of AD. We review the synthesis and clearance of Aβ42; the effects of HIV on the amyloid pathway; and contrast the impact of AD and HIV on Aβ42 metabolism. Biomarker studies (cerebrospinal fluid AB and amyloid imaging) in HIV + participants have shown mixed results. CSF Aβ42 has been shown to be either normal or diminished in with HIV associated neurocognitive disorders (HAND). Amyloid imaging using [(11)C] PiB has also not demonstrated increased extracellular amyloid fibrillar deposits in HAND. We further demonstrate that Aβ42 deposition is not increased in older HIV + participants using [(11)C] PiB amyloid imaging. Together, these results suggest that HIV and aging each independently affect Aβ42 deposition with no significant interaction present. Older HIV + individuals are probably not at increased risk for developing AD. However, future longitudinal studies of older HIV + individuals using multiple modalities (including the combination of CSF markers and amyloid imaging) are necessary for investigating the effects of HIV on Aβ42 metabolism.
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Efavirenz promotes β-secretase expression and increased Aβ1-40,42 via oxidative stress and reduced microglial phagocytosis: implications for HIV associated neurocognitive disorders (HAND). PLoS One 2014; 9:e95500. [PMID: 24759994 PMCID: PMC3997351 DOI: 10.1371/journal.pone.0095500] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/27/2014] [Indexed: 11/19/2022] Open
Abstract
Efavirenz (EFV) is among the most commonly used antiretroviral drugs globally, causes neurological symptoms that interfere with adherence and reduce tolerability, and may have central nervous system (CNS) effects that contribute in part to HIV associated neurocognitive disorders (HAND) in patients on combination antiretroviral therapy (cART). Thus we evaluated a commonly used EFV containing regimen: EFV/zidovudine (AZT)/lamivudine (3TC) in murine N2a cells transfected with the human “Swedish” mutant form of amyloid precursor protein (SweAPP N2a cells) to assess for promotion of amyloid-beta (Aβ) production. Treatment with EFV or the EFV containing regimen generated significantly increased soluble amyloid beta (Aβ), and promoted increased β-secretase-1 (BACE-1) expression while 3TC, AZT, or, vehicle control did not significantly alter these endpoints. Further, EFV or the EFV containing regimen promoted significantly more mitochondrial stress in SweAPP N2a cells as compared to 3TC, AZT, or vehicle control. We next tested the EFV containing regimen in Aβ - producing Tg2576 mice combined or singly using clinically relevant doses. EFV or the EFV containing regimen promoted significantly more BACE-1 expression and soluble Aβ generation while 3TC, AZT, or vehicle control did not. Finally, microglial Aβ phagocytosis was significantly reduced by EFV or the EFV containing regimen but not by AZT, 3TC, or vehicle control alone. These data suggest the majority of Aβ promoting effects of this cART regimen are dependent upon EFV as it promotes both increased production, and decreased clearance of Aβ peptide.
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Cañizares S, Cherner M, Ellis RJ. HIV and aging: effects on the central nervous system. Semin Neurol 2014; 34:27-34. [PMID: 24715486 DOI: 10.1055/s-0034-1372340] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
With the introduction of combination antiretroviral therapy, many human immunodeficiency virus-positive (HIV+) individuals are reaching advanced age. The proportion of people living with HIV older than 50 years already exceeds 50% in many communities, and is expected to reach this level nationally by 2015. HIV and aging are independently associated with neuropathological changes, but their concurrence may have a more deleterious effect on the central nervous system (CNS). Published data about neurocognitive and neuroimaging markers of HIV and aging are reviewed. Putative factors contributing to neurocognitive impairment and neuroimaging changes in the aging HIV+ brain, such as metabolic disturbances, cardiovascular risk factors, immune senescence, and neuroinflammation, are described. The possible relationship between HIV and some markers of Alzheimer's disease is presented. Current research findings emphasize multiple mechanisms related to HIV and combination antiretroviral therapy that compromise CNS structure and function with advancing age.
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Affiliation(s)
- Silvia Cañizares
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, California
| | - Ronald J Ellis
- Department of Neurosciences, HIV Neurobehavioral Research Center, University of California, San Diego, California
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Valcour VG. HIV, aging, and cognition: emerging issues. TOPICS IN ANTIVIRAL MEDICINE 2013; 21:119-123. [PMID: 23981600 PMCID: PMC6148873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The prevalence of HIV-associated neurocognitive disorder has not changed from the pre- to the potent antiretroviral therapy era, remaining at approximately 50%. In research settings, mild neurocognitive disorder (MND) and so-called asymptomatic neurocognitive impairment (ANI) are now more common than HIV-associated dementia. The diagnosis of ANI is misleading because functional deficits, when tested in a laboratory, and degree of neuropsychologic testing abnormalities are often comparable in patients with ANI and those with symptomatic MND. Age-related comorbidities increase the risk of cognitive impairment in HIV infection. In a cohort of patients aged 60 years or older with excellent antiretroviral therapy adherence, correlates to cognitive impairment were apolipoprotein (Apo) E4 genotype and a novel measure of the effectiveness of antiretroviral drugs in monocytes, the monocyte efficacy (ME) score, with trend associations for diabetes and nadir CD4+ cell count. Management of impairment includes ensuring that patients are on and adhere to antiretroviral therapy and addressing comorbidities. Switching from effective and well-tolerated antiretroviral therapy for patients with mild cognitive impairment is not routinely recommended, but this must still be addressed on a case-by-case basis. This article summarizes a presentation by Victor G. Valcour, MD, at the IAS-USA continuing education program held in Atlanta, Georgia, in April 2013.
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Affiliation(s)
- Victor G Valcour
- Department of Neurology, Division of Geriatric Medicine, University of California San Francisco, San Francisco, CA, USA
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36
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Niven DJ, Berthiaume LR, Fick GH, Laupland KB. Matched case-control studies: a review of reported statistical methodology. Clin Epidemiol 2012; 4:99-110. [PMID: 22570570 PMCID: PMC3346204 DOI: 10.2147/clep.s30816] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Case-control studies are a common and efficient means of studying rare diseases or illnesses with long latency periods. Matching of cases and controls is frequently employed to control the effects of known potential confounding variables. The analysis of matched data requires specific statistical methods. METHODS The objective of this study was to determine the proportion of published, peer-reviewed matched case-control studies that used statistical methods appropriate for matched data. Using a comprehensive set of search criteria we identified 37 matched case-control studies for detailed analysis. RESULTS Among these 37 articles, only 16 studies were analyzed with proper statistical techniques (43%). Studies that were properly analyzed were more likely to have included case patients with cancer and cardiovascular disease compared to those that did not use proper statistics (10/16 or 63%, versus 5/21 or 24%, P = 0.02). They were also more likely to have matched multiple controls for each case (14/16 or 88%, versus 13/21 or 62%, P = 0.08). In addition, studies with properly analyzed data were more likely to have been published in a journal with an impact factor listed in the top 100 according to the Journal Citation Reports index (12/16 or 69%, versus 1/21 or 5%, P ≤ 0.0001). CONCLUSION The findings of this study raise concern that the majority of matched case-control studies report results that are derived from improper statistical analyses. This may lead to errors in estimating the relationship between a disease and exposure, as well as the incorrect adaptation of emerging medical literature.
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Affiliation(s)
- Daniel J Niven
- Department of Critical Care Medicine, Peter Lougheed Centre, Calgary
| | - Luc R Berthiaume
- Department of Critical Care Medicine, Peter Lougheed Centre, Calgary
| | - Gordon H Fick
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin B Laupland
- Department of Critical Care Medicine, Peter Lougheed Centre, Calgary
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Ances BM, Benzinger TL, Christensen JJ, Thomas J, Venkat R, Teshome M, Aldea P, Fagan AM, Holtzman DM, Morris JC, Clifford DB. 11C-PiB imaging of human immunodeficiency virus-associated neurocognitive disorder. ACTA ACUST UNITED AC 2012; 69:72-7. [PMID: 22232345 DOI: 10.1001/archneurol.2011.761] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate whether the amyloid-binding agent carbon 11-labeled Pittsburgh Compound B ((11)C-PiB) could differentiate Alzheimer disease (AD) from human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) in middle-aged HIV-positive participants. DESIGN (11)C-PiB scanning, clinical assessment, and cerebrospinal fluid (CSF) analysis were performed. Both χ(2) and t tests assessed differences in clinical and demographic variables between HIV-positive participants and community-living individuals observed at the Knight Alzheimer's Disease Research Center (ADRC). Analysis of variance assessed for regional differences in amyloid-β protein 1-42 (Aβ42) using (11)C-PiB. SETTING An ADRC and HIV clinic. PARTICIPANTS Sixteen HIV-positive participants (11 cognitively normal and 5 with HAND) and 19 ADRC participants (8 cognitively normal and 11 with symptomatic AD). MAIN OUTCOME MEASURES Mean and regional (11)C-PiB binding potentials. RESULTS Participants with symptomatic AD were older (P < .001), had lower CSF Aβ42 levels (P < .001), and had higher CSF tau levels (P < .001) than other groups. Regardless of degree of impairment, HIV-positive participants did not have increased (11)C-PiB levels. Mean and regional binding potentials were elevated for symptomatic AD participants (P < .001). CONCLUSIONS Middle-aged HIV-positive participants, even with HAND, do not exhibit increased (11)C-PiB levels, whereas symptomatic AD individuals have increased fibrillar Aβ42 deposition in cortical and subcortical regions. Observed dissimilarities between HAND and AD may reflect differences in Aβ42 metabolism. (11)C-PiB may provide a diagnostic biomarker for distinguishing symptomatic AD from HAND in middle-aged HIV-positive participants. Future cross-sectional and longitudinal studies are required to assess the utility of (11)C-PiB in older individuals with HAND.
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Affiliation(s)
- Beau M Ances
- Department of Neurology, Washington University in St. Louis, Campus Box 8111, 660 S Euclid Ave, St Louis, MO 63110, USA.
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Iudicello JE, Woods SP, Deutsch R, Grant I. Combined effects of aging and HIV infection on semantic verbal fluency: a view of the cortical hypothesis through the lens of clustering and switching. J Clin Exp Neuropsychol 2012; 34:476-88. [PMID: 22292479 DOI: 10.1080/13803395.2011.651103] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The profile of HIV-associated neurocognitive disorders (HAND) has classically been characterized as "subcortical," but questions have arisen as to whether aging with HIV in the antiretroviral therapy era has subtly shifted the expression of HAND into a more "cortical" disorder (e.g., decay of semantic memory stores). We evaluated this hypothesis by examining semantic fluency and its component processes (i.e., clustering and switching) in 257 individuals across four groups stratified by age (<40 and ≥50 years) and HIV serostatus. Jonckheere-Terpstra tests revealed significant monotonic trends for the combined effects of HIV and aging on overall semantic (and letter) fluency and switching, but not cluster size, with greatest deficits evident in the older adults with HIV infection. Within the older HIV-infected cohort, poorer switching was uniquely associated with self-reported declines in instrumental activities of daily living and deficits in learning and executive functions, but not semantic memory. Results suggest that HIV infection and aging may confer adverse additive effects on the executive components of semantic fluency (i.e., switching), rather than a degradation of semantic memory stores (i.e., cluster size), which is a profile that is most consistent with combined frontostriatal neuropathological burden of these two conditions.
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Affiliation(s)
- Jennifer E Iudicello
- Department of Psychiatry, University of California, San Diego, San Diego, CA 92103, USA.
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39
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Current World Literature. Curr Opin Neurol 2011; 24:300-7. [DOI: 10.1097/wco.0b013e328347b40e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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Abstract
HIV can infect the brain and impair central nervous system (CNS) function. Combination antiretroviral therapy (cART) has not eradicated CNS complications. HIV-associated neurocognitive disorders (HAND) remain common despite cART, although attenuated in severity. This may result from a combination of factors including inadequate treatment of HIV reservoirs such as circulating monocytes and glia, decreased effectiveness of cART in CNS, concurrent illnesses, stimulant use, and factors associated with prescribed drugs, including antiretrovirals. This review highlights recent investigations of HIV-related CNS injury with emphasis on cART-era neuropathological mechanisms in the context of both US and international settings.
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Simioni S, Cavassini M, Annoni JM, Hirschel B, Du Pasquier RA. HIV-associated neurocognitive disorders: a changing pattern. FUTURE NEUROLOGY 2011. [DOI: 10.2217/fnl.10.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Combination antiretroviral therapy has dramatically decreased the incidence of HIV-related mortality and serious opportunistic diseases, among which is HIV-associated dementia. However, minor forms of cognitive dysfunction have not disappeared and may even have increased in frequency. Aging of HIV+ patients, insufficient penetration of antiretroviral drugs into the brain with continuous low-grade viral production and inflammation may play a role. A putative neurotoxicity of combination antiretroviral therapy is controversial. In this article, we will discuss these aspects, as well as clinical and pathophysiological features shared by HIV-associated neurocognitive disorders and other neurodegenerative diseases, especially Alzheimer’s disease. This article will briefly summarize the current clinical trials on neuroprotective agents, and the management of patients with neurocognitive disorders will be discussed.
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Affiliation(s)
- Samanta Simioni
- Division of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Jean-Marie Annoni
- Division of Neurology, Geneva University Hospital, Rue Gabrielle–Perret–Gentil 4, 1211 Geneva 14, Switzerland
| | - Bernard Hirschel
- Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospital, Rue Gabrielle–Perret–Gentil 4, 1211 Geneva 14, Switzerland
| | - Renaud A Du Pasquier
- Department of Immunology, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, 1011 Lausanne, Switzerland
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APOE ε 4 allele and CSF APOE on cognition in HIV-infected subjects. J Neuroimmune Pharmacol 2010; 6:389-98. [PMID: 21184197 DOI: 10.1007/s11481-010-9254-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022]
Abstract
The significance of the cerebrospinal fluid (CSF) Apolipoprotein E (APOE) level and whether it might have differential effects on brain function due to the presence of APOE ε 4 allele(s) in HIV-infected patients are unknown. However, APOE ε 4 allele has been associated with greater incidence of HIV-associated dementia and accelerated progression of HIV infection. Here, we show further evidence for the role of APOE ε 4 in promoting cognitive impairment. We measured the APOE levels in the CSF of HIV-infected individuals. HIV+ subjects showed lower CSF APOE proteins than SN controls (-19%, p= 0.03). While SN subjects with or without ε 4 allele showed no difference in CSF APOE levels, ε 4+ HIV+ subjects had similar levels to the SN subjects but higher levels than ε 4- HIV+ subjects (+34%, p= 0.01). Furthermore, while HIV+ subjects with ε 2 or ε 3 allele(s) showed a positive relationship between their CSF APOE levels and cognitive performance on the speed of processing domain (r= +0.35, p= 0.05), ε 4+ HIV+ subjects, in contrast, exhibited a negative relationship such that those with higher levels of CSF APOE(4) performed worse on the HIV Dementia Scale (r= -0.61, p= 0.02), had lower Global Cognitive Scores (r= -0.57, p= 0.03), and had poorer performance on tests involving learning (ε 4 allele x [APOE] interaction, p = 0.01). Our findings also suggest that the relatively higher levels of CSF APOE in ε 4+ HIV+ (having primarily APOE4 isoforms) may negatively impact the brain and lead to poorer cognitive outcomes, while those individuals without the ε 4 allele (with primarily APOE2 or APOE3 isoforms) may show compensatory responses that lead to better cognitive performance.
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