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Martin SL, Cardel MI, Carson TL, Hill JO, Stanley T, Grinspoon S, Steger F, Blackman Carr LT, Ashby-Thompson M, Stewart D, Ard J, Stanford FC. Increasing diversity, equity, and inclusion in the fields of nutrition and obesity: A road map to equity in academia. Obesity (Silver Spring) 2023; 31:1240-1254. [PMID: 36896568 PMCID: PMC10191885 DOI: 10.1002/oby.23704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 03/11/2023]
Abstract
Research shows that a diverse faculty improves academic, clinical, and research outcomes in higher education. Despite that, persons in minority groups, usually categorized by race or ethnicity, are underrepresented in academia (URiA). The Nutrition Obesity Research Centers (NORCs), supported by the National Institute of Diabetes and Digestive and Kidney Diseases, hosted workshops on five separate days in September and October 2020. NORCs convened these workshops to identify barriers and facilitators for diversity, equity, and inclusion (DEI) and provide specific recommendations to improve DEI within obesity and nutrition for individuals from URiA groups. Recognized experts on DEI presented each day, after which the NORCs conducted breakout sessions with key stakeholders who engage in nutrition and obesity research. The breakout session groups included early-career investigators, professional societies, and academic leadership. The consensus from the breakout sessions was that glaring inequities affect URiA in nutrition and obesity, particularly related to recruitment, retention, and advancement. Recommendations from the breakout sessions to improve DEI across academia focused on six themes: (1) recruitment, (2) retention, (3) advancement, (4) intersectionality of multiple challenges (e.g., being Black and a woman), (5) funding agencies, and (6) implementation of strategies to address problems related to DEI.
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Affiliation(s)
- Samantha L. Martin
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham AL
| | - Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida
- WW International, Inc., New York, NY
| | - Tiffany L. Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - James O. Hill
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Takara Stanley
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital, and Harvard School, Boston, MA
- Pediatric Endocrinology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
- Nutrition Obesity Research Center at Harvard (NORCH), Harvard Medical School, Boston, MA
| | - Steven Grinspoon
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital, and Harvard School, Boston, MA
- Nutrition Obesity Research Center at Harvard (NORCH), Harvard Medical School, Boston, MA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston Salem
| | - Felicia Steger
- Department of Nutrition, University of Alabama at Birmingham, Birmingham AL
| | - Loneke T. Blackman Carr
- Department of Nutritional Sciences, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT
| | | | - Delisha Stewart
- Department of Nutrition, University of North Carolina Chapel Hill, Nutrition Research Institute, Kannapolis NC
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem NC
| | | | - Fatima Cody Stanford
- Pediatric Endocrinology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
- Nutrition Obesity Research Center at Harvard (NORCH), Harvard Medical School, Boston, MA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston Salem
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Martin SL, Cardel MI, Carson TL, Hill JO, Stanley T, Grinspoon S, Steger F, Blackman Carr LT, Ashby-Thompson M, Stewart D, Ard J, Stanford FC. Increasing diversity, equity, and inclusion in the fields of nutrition and obesity: A roadmap to equity in academia. Am J Clin Nutr 2023; 117:659-671. [PMID: 36907515 PMCID: PMC10273076 DOI: 10.1016/j.ajcnut.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Research shows that a diverse faculty improves academic, clinical, and research outcomes in higher education. Despite that, persons in minority groups, usually categorized by race or ethnicity, are underrepresented in academia (URiA). The Nutrition Obesity Research Centers (NORCs), supported by the NIDDK, hosted workshops on five separate days in September and October 2020. NORCs convened these workshops to identify barriers and facilitators for diversity, equity, and inclusion (DEI) and provide specific recommendations to improve DEI within obesity and nutrition for individuals from URiA groups. Recognized experts on DEI presented each day, after which the NORCs conducted breakout sessions with key stakeholders who engage in nutrition and obesity research. The breakout session groups included early-career investigators, professional societies, and academic leadership. The consensus from the breakout sessions was that glaring inequities affect URiA in nutrition and obesity, particularly related to recruitment, retention, and advancement. Recommendations from the breakout sessions to improve DEI across the academe focused on six themes: (1) recruitment, (2) retention, (3) advancement, (4) intersectionality of multiple challenges (e.g., being Black and a woman), (5) funding agencies, and (6) implementation of strategies to address problems related to DEI.
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Affiliation(s)
- Samantha L Martin
- Department of Obstetrics and Gynecology University of Alabama at Birmingham Birmingham, Alabama, USA; Center for Women's Reproductive Health University of Alabama at Birmingham Birmingham, Alabama, USA.
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida Gainesville, Florida, USA; Center for Integrative Cardiovascular and Metabolic Diseases University of Florida, Gainesville, Florida, USA; WW International, Inc. New York, New York, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior Moffitt Cancer Center Tampa, Florida, USA
| | - James O Hill
- Nutrition Obesity Research Center University of Alabama at Birmingham Birmingham, Alabama, USA
| | - Takara Stanley
- Department of Medicine, Metabolism Unit Massachusetts General Hospital, and Harvard School Boston, Massachusetts, USA; Pediatric Endocrinology Massachusetts General Hospital, and Harvard Medical School Boston, Massachusetts, USA; Nutrition Obesity Research Center at Harvard (NORCH) Harvard Medical School Boston, Massachusetts, USA
| | - Steven Grinspoon
- Department of Medicine, Metabolism Unit Massachusetts General Hospital, and Harvard School Boston, Massachusetts, USA; Nutrition Obesity Research Center at Harvard (NORCH) Harvard Medical School Boston, Massachusetts, USA; Department of Epidemiology and Prevention Wake Forest School of Medicine, Wake Forest Baptist Medical Center Winston-Salem, North Carolina USA
| | - Felicia Steger
- Department of Nutrition University of Alabama at Birmingham Birmingham, Alabama, USA
| | - Loneke T Blackman Carr
- Department of Nutritional Sciences, College of Agriculture, Health and Natural Resources University of Connecticut Storrs, Connecticut, USA
| | - Maxine Ashby-Thompson
- Department of Pediatrics Columbia University, New York Obesity Research Center New York, New York, USA
| | - Delisha Stewart
- Department of Nutrition University of North Carolina Chapel Hill, Nutrition Research Institute Kannapolis, North Carolina, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention Wake Forest University Winston-Salem, North Carolina, USA
| | - Fatima Cody Stanford
- Pediatric Endocrinology Massachusetts General Hospital, and Harvard Medical School Boston, Massachusetts, USA; Nutrition Obesity Research Center at Harvard (NORCH) Harvard Medical School Boston, Massachusetts, USA; Department of Epidemiology and Prevention Wake Forest School of Medicine, Wake Forest Baptist Medical Center Winston-Salem, North Carolina USA
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DiCarli M, Grinspoon S, Iyengar S, Shen G, Srinivasa S, Thomas T, Walpert A, Huck DM. OR02-5 Coronary Microvascular Dysfunction is Present Among Well-Treated Asymptomatic Persons with HIV, Similar to Those with Diabetes. J Endocr Soc 2022. [PMCID: PMC9624646 DOI: 10.1210/jendso/bvac150.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Persons with HIV (PWH) who are well-treated on antiretroviral therapies (ART) have a 1.5-2.0 fold increased risk of cardiovascular disease (CVD) compared to persons without HIV (PWOH). A unique cardiovascular phenotype is seen in HIV such that traditional cardiovascular risk factors alone to do not account for this excess CVD risk. Coronary microvascular dysfunction may promote subendocardial ischemia and cardiomyocyte injury and provide a potential underlying mechanism for the atherosclerotic and myocardial disease prevalent in HIV. We assessed coronary microvascular function among those with HIV, comparing to those without HIV and with diabetes (DM). 39 PWH with no known history of CVD or DM, required to be on stable ART and virologically controlled (HIV viral load <200 copies/mL), underwent coronary 13N-ammonia PET/CT to evaluate coronary flow reserve (CFR)—a measure of microvascular dysfunction calculated by the ratio of peak coronary flow during regadenoson stress to rest. CFR was corrected using the rate pressure product, which integrates resting blood pressure and heart rate. A 0.1 unit reduction in CFR is associated with a 8% increase in hazard of CV events. Comparisons of CFR were made to PWOH from a database of higher risk clinical referrals who were matched approximately 2: 1 based on demographics and traditional risk factors and to those with diabetes and no known history of CVD recruited as part of a prior study evaluating CFR. Overall group comparisons for CFR were analyzed with the Wilcoxon/Kruskal-Wallis test, and if significant, the Mann-Whitney U test was employed for two-group comparisons. PWH(74% male, age 55±7years, BMI 32±6kg/m2, duration HIV 20±8years, duration ART 16±7years, CD4+ count 801±333cells/ul) were similar to PWOH(n=69, 74% male, age 55±8years, BMI 32±6kg/m2) and persons with DM(n=63, 63% male, age 55±8years, BMI 32±5kg/m2). CFR was significantly different among groups: PWOH 2.76(2.37,3.36), PWH 2.47(1.92,2.93), DM 2.31(1.98,2.84), overall P=.003. CFR was significantly reduced when comparing to PWH to PWOH(P=.02) as was DM to PWOH(P=.001) and did not differ when comparing PWH to DM(P=.68). Total cholesterol 182(168,205)mg/dL, LDL 108(77,127)mg/dL, triglycerides 159(88,219)mg/dL, and current tobacco use 23% were overall significantly higher among PWH (overall P<.03 for each comparison). Controlling for group status (PWH vs. PWOH) and either total cholesterol or current tobacco use, only group status remained significantly and independently related to CFR (group status P=.02 and .01, respectively). Subclinical coronary microvascular dysfunction is present among asymptomatic, chronically infected PWH on ART who demonstrate good immunological control. This study demonstrates for the first time CFR is reduced compared to higher risk PWOH and comparable to those with DM, regardless of traditional CVD risk factors, and further highlights well-treated HIV as a CVD-risk enhancing factor similar to diabetes. The implications of reduced CFR in HIV warrants further investigation. Presentation: Saturday, June 11, 2022 12:30 p.m. - 12:45 p.m.
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Thomas TS, Iyengar S, Shen G, Walpert A, Adler G, Grinspoon S, Srinivasa S. RF12 | PSUN104 Visceral adiposity index as a measure of cardiometabolic disease in persons living with HIV. J Endocr Soc 2022. [PMCID: PMC9626851 DOI: 10.1210/jendso/bvac150.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Well-treated persons living with HIV (PLWH) are predisposed to fat redistribution/visceral adiposity, potentially due to anti-retroviral therapy (ART) use and/or the virus itself, and demonstrate a 2-fold higher risk of cardiovascular disease (CVD) compared to those without HIV. Visceral adipose tissue (VAT) is a metabolically unfavorable ectopic fat depot, which is highly inflamed and dysfunctional. Fat redistribution leading to VAT accumulation is related to increased CVD risk. Current gold standard measures of VAT are obtained using CT and MRI, but are not used clinically. The visceral adiposity index (VAI) is a simple tool combining biochemical measures with anthropometrics that can be easily evaluated by the clinician. VAI may be a surrogate measure of VAT and indeed has been shown to relate to insulin resistance, type 2 diabetes mellitus, metabolic syndrome and CVD among the general population. In this study, we evaluated VAI in PLWH and its relation to VAT, anthropometric measures and other cardiometabolic parameters. 45 PLWH on stable ART with no known CVD were recruited as part of a clinical trial to evaluate CVD indices and were included if they were virologically controlled (HIV viral load <200 copies/mL) and demonstrated increased abdominal VAT (VAT area>110cm2) on CT. For purposes of this study, baseline fasting biochemical, radiologic and anthropometric data were used. VAI was calculated using the standard sex-specific formulas which incorporate waist circumference (WC), BMI, triglycerides and HDL. Presence of coronary plaque was assessed using coronary CT angiography or coronary PET scans. Linear regression was performed to assess relationships with VAI. Non-normally distributed variables were log-transformed for analyses. Participants were predominantly male (73%), Caucasian (53%), and non-Hispanic (84%) with mean age 55 ± 7 years. Participants had a long duration of HIV and ART use (20 ± 8 and 15 [12,19] years, respectively). The majority of PLWH were obese (BMI 31.9 ± 5.8 kg/m2) with VAT 189 [127,267]cm2 and VAI 4.9 [2.8,7.3]. VAI correlated strongly with VAT (r=0.59, P<0.0001), anthropometric measures (BMI r=0.36, P=0.02; WC r=0.43, P=0.004; WHR r=0.33, P=0.03) and ALT (r=0.32, P=0.03), and did not relate to HIV-specific parameters and other metabolic parameters (blood pressure, HbA1c). Participants with coronary plaque tended to have a higher VAI compared to those without coronary plaque (log VAI 0.7 ± 0.3 vs. 0.5 ± 0.3, P=0.056). These data show VAI, an easily obtained measure, is strongly correlated with abdominal VAT area measured by CT and may be a useful biomarker for visceral adiposity in HIV. Furthermore, VAI may be related to ALT and coronary plaque, which could help identify those PLWH at risk for fatty liver disease (another ectopic fat depot) and heart disease, respectively. Further studies are needed to assess the utility of VAI in evaluating metabolic disease in HIV. Presentation: Saturday, June 11, 2022 1:24 p.m. - 1:29 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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Kolossváry M, deFilippi C, Lu M, Zanni M, Fulda E, Foldyna B, Ribaudo H, Mayrhofer T, Collier A, Bloomfield G, Fichtenbaum C, Overton E, Aberg J, Currier J, Fitch K, Douglas P, Grinspoon S. 463 Proteomic Signature Of Early Coronary Artery Disease In People With Hiv: Analysis Of The Reprieve Mechanistic Substudy. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Carson TL, Cardel MI, Stanley TL, Grinspoon S, Hill JO, Ard J, Mayer-Davis E, Stanford FC. Racial and ethnic representation among a sample of nutrition- and obesity-focused professional organizations in the United States. Obesity (Silver Spring) 2022; 30:292-296. [PMID: 34658155 PMCID: PMC9708392 DOI: 10.1002/oby.23310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Obesity is a chronic disease that disproportionately affects individuals from nonmajority racial/ethnic groups in the United States. Research shows that individuals from minority racial/ethnic backgrounds consider it important to have access to providers from diverse backgrounds. Health care providers and scientists from minority racial/ethnic groups are more likely than their non-Hispanic White counterparts to treat or conduct research on patients from underrepresented groups. The objective of this study was to characterize the racial/ethnic diversity of nutrition- and obesity-focused professional organizations in the United States. METHODS This study assessed race/ethnicity data from several obesity-focused national organizations including The Obesity Society, the Academy of Nutrition and Dietetics (AND), the American Society for Nutrition, and the American Board of Obesity Medicine (ABOM). Each organization was queried via emailed survey to provide data on racial/ethnic representation among their membership in the past 5 years and among elected presidents from 2010 to 2020. RESULTS Two of the three professional societies queried did not systematically track race/ethnicity data at the time of query. Limited tracking data available from AND show underrepresentation of Black (2.6%), Asian (3.9%), Latinx (3.1%), Native Hawaiian or Pacific Islander (1.3%), or indigenous (American Indian or Alaskan Native: 0.3%) individuals compared with the US population. Underrepresentation of racial/ethnic minorities was also reported for ABOM diplomates (Black: 6.0%, Latinx: 5.0%, Native American: 0.2%). Only AND reported having racial/ethnic diversity (20%) among the organization's presidents within the previous decade (2010-2020). CONCLUSIONS Findings suggest that (1) standardized tracking of race and ethnicity data is needed to fully assess diversity, equity, and inclusion, and (2) work is needed to increase the diversity of membership and leadership at the presidential level within obesity- and nutrition-focused professional organizations. A diverse cadre of obesity- and nutrition-focused health care professionals is needed to further improve nutrition-related health outcomes, including obesity, cardiovascular disease, diabetes, and undernutrition, in this country.
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Affiliation(s)
- Tiffany L. Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
- WW International, Inc., New York City, New York, USA
| | - Takara L. Stanley
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Steven Grinspoon
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James O. Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Fatima Cody Stanford
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Bick AG, Popadin K, Thorball CW, Uddin MM, Zanni MV, Yu B, Cavassini M, Rauch A, Tarr P, Schmid P, Bernasconi E, Günthard HF, Libby P, Boerwinkle E, McLaren PJ, Ballantyne CM, Grinspoon S, Natarajan P, Fellay J. Increased prevalence of clonal hematopoiesis of indeterminate potential amongst people living with HIV. Sci Rep 2022; 12:577. [PMID: 35022435 PMCID: PMC8755790 DOI: 10.1038/s41598-021-04308-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023] Open
Abstract
People living with human immunodeficiency virus (PLWH) have significantly increased risk for cardiovascular disease in part due to inflammation and immune dysregulation. Clonal hematopoiesis of indeterminate potential (CHIP), the age-related acquisition and expansion of hematopoietic stem cells due to leukemogenic driver mutations, increases risk for both hematologic malignancy and coronary artery disease (CAD). Since increased inflammation is hypothesized to be both a cause and consequence of CHIP, we hypothesized that PLWH have a greater prevalence of CHIP. We searched for CHIP in multi-ethnic cases from the Swiss HIV Cohort Study (SHCS, n = 600) and controls from the Atherosclerosis Risk in the Communities study (ARIC, n = 8111) from blood DNA-derived exome sequences. We observed that HIV is associated with a twofold increase in CHIP prevalence, both in the whole study population and in a subset of 230 cases and 1002 matched controls selected by propensity matching to control for demographic imbalances (SHCS 7%, ARIC 3%, p = 0.005). We also observed that ASXL1 is the most commonly mutated CHIP-associated gene in PLWH. Our results suggest that CHIP may contribute to the excess cardiovascular risk observed in PLWH.
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Affiliation(s)
- Alexander G Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Konstantin Popadin
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Station 19, 1015, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Christian W Thorball
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Station 19, 1015, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Markella V Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bing Yu
- Human Genetics Center, Baylor College of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philip Tarr
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital of Lugano, Lugano, Switzerland
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric Boerwinkle
- Human Genetics Center, Baylor College of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Paul J McLaren
- JC Wilt Infectious Diseases Research Centre, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | | | - Steven Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pradeep Natarajan
- Broad Institute of MIT and Harvard, Cambridge, MA, USA. .,Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street, CPZN 3.184, Boston, MA, 02114, USA.
| | - Jacques Fellay
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Station 19, 1015, Lausanne, Switzerland. .,Swiss Institute of Bioinformatics, Lausanne, Switzerland. .,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Carson TL, Cardel MI, Stanley TL, Grinspoon S, Hill JO, Ard J, Mayer-Davis E, Stanford FC. Racial and ethnic representation among a sample of nutrition- and obesity-focused professional organizations in the United States. Am J Clin Nutr 2021; 114:1869-1872. [PMID: 34718383 PMCID: PMC8634609 DOI: 10.1093/ajcn/nqab284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity is a chronic disease that disproportionately affects individuals from nonmajority racial/ethnic groups in the United States. Research shows that individuals from minority racial/ethnic backgrounds consider it important to have access to providers from diverse backgrounds. Health care providers and scientists from minority racial/ethnic groups are more likely than non-Hispanic whites to treat or conduct research on patients from underrepresented groups. OBJECTIVES To characterize the racial/ethnic diversity of nutrition- and obesity-focused professional organizations in the United States. METHODS This study assessed race/ethnicity data from several obesity-focused national organizations including The Obesity Society, the Academy of Nutrition and Dietetics (AND), the American Society for Nutrition, and the American Board of Obesity Medicine (ABOM). Each organization was queried via emailed survey to provide data on racial/ethnic representation among their membership in the past 5 y and among elected presidents from 2010 to 2020. RESULTS Two of the 3 professional societies queried did not systematically track race/ethnicity data at the time of query. Limited tracking data available from AND show underrepresentation of black (2.6%), Asian (3.9%), Latinx (3.1%), Native Hawaiian or Pacific Islander: (1.3%), or indigenous (American Indian or Alaskan Native: 0.3%) individuals compared with the US population. Underrepresentation of racial/ethnic minorities was also reported for ABOM diplomates (black: 6.0%, Latinx: 5.0%, Native American: 0.2%). Only AND reported having racial/ethnic diversity (20%) among the organization's presidents within the previous decade (2010-2020). CONCLUSIONS Findings suggest that 1) standardized tracking of race and ethnicity data is needed to fully assess diversity, equity, and inclusion, and 2) work is needed to increase the diversity of membership and leadership at the presidential level within obesity- and nutrition-focused professional organizations. A diverse cadre of obesity- and nutrition-focused health care professionals is needed to further improve nutrition-related health outcomes, including obesity, cardiovascular disease, diabetes, and undernutrition, in this country.
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Affiliation(s)
- Tiffany L Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida; Gainesville, FL, USA
- WW International, Inc., New York City, NY, USA
| | - Takara L Stanley
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven Grinspoon
- Department of Medicine, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James O Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham AL, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fatima Cody Stanford
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medicine, Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Fanzo J, Rudie C, Sigman I, Grinspoon S, Benton TG, Brown ME, Covic N, Fitch K, Golden CD, Grace D, Hivert MF, Huybers P, Jaacks LM, Masters WA, Nisbett N, Richardson RA, Singleton CR, Webb P, Willett WC. Sustainable food systems and nutrition in the 21st century: a report from the 22nd annual Harvard Nutrition Obesity Symposium. Am J Clin Nutr 2021; 115:18-33. [PMID: 34523669 PMCID: PMC8755053 DOI: 10.1093/ajcn/nqab315] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/10/2021] [Indexed: 01/02/2023] Open
Abstract
Food systems are at the center of a brewing storm consisting of a rapidly changing climate, rising hunger and malnutrition, and significant social inequities. At the same time, there are vast opportunities to ensure that food systems produce healthy and safe food in equitable ways that promote environmental sustainability, especially if the world can come together at the UN Food Systems Summit in late 2021 and make strong and binding commitments toward food system transformation. The NIH-funded Nutrition Obesity Research Center at Harvard and the Harvard Medical School Division of Nutrition held their 22nd annual Harvard Nutrition Obesity Symposium entitled "Global Food Systems and Sustainable Nutrition in the 21st Century" in June 2021. This article presents a synthesis of this symposium and highlights the importance of food systems to addressing the burden of malnutrition and noncommunicable diseases, climate change, and the related economic and social inequities. Transformation of food systems is possible, and the nutrition and health communities have a significant role to play in this transformative process.
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Affiliation(s)
| | - Coral Rudie
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Iman Sigman
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tim G Benton
- Energy, Environment and Resources Programme, Chatham House, London, United Kingdom
| | - Molly E Brown
- Department of Geographical Sciences, University of Maryland College Park, College Park, MD, USA
| | - Namukolo Covic
- International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Kathleen Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christopher D Golden
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Delia Grace
- Natural Resources Institute, University of Greenwich, Chatham Maritime, United Kingdom,Animal and Human Health, International Livestock Research Institute, Nairobi, Kenya
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
| | - Peter Huybers
- Department of Earth and Planetary Sciences, Harvard University, Boston, MA, USA
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Security, The University of Edinburgh, Edinburgh, United Kingdom
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Nicholas Nisbett
- Health and Nutrition Cluster, Institute of Development Studies, Falmer, United Kingdom
| | | | - Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Walter C Willett
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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10
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Lake JE, La K, Erlandson KM, Adrian S, Yenokyan G, Scherzinger A, Dubé MP, Stanley T, Grinspoon S, Falutz J, Mamputu JC, Marsolais C, McComsey GA, Brown TT. Tesamorelin improves fat quality independent of changes in fat quantity. AIDS 2021; 35:1395-1402. [PMID: 33756511 PMCID: PMC8243807 DOI: 10.1097/qad.0000000000002897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fat quality and quantity may affect health similarly or differently. Fat quality can be assessed by measuring fat density on CT scan (greater density = smaller, higher quality adipocytes). We assessed the effects of tesamorelin, a growth hormone-releasing hormone analogue that reduces visceral fat (VAT) quantity in some people living with HIV (PWH), on fat density. DESIGN Participants from two completed, placebo-controlled, randomized trials of tesamorelin for central adiposity treatment in PWH were included if they had either a clinical response to tesamorelin (VAT decrease ≥8%, ≈70% of participants) or were placebo-treated. METHODS CT VAT and subcutaneous fat (SAT) density (Hounsfield Units, HU) were measured by a central blinded reader. RESULTS Participants (193 responders, 148 placebo) were 87% male and 83% white. Baseline characteristics were similar across arms, including VAT (-91 HU both arms, P = 0.80) and SAT density (-94 HU tesamorelin, -95 HU placebo, P = 0.29). Over 26 weeks, mean (SD) VAT and SAT density increased in tesamorelin-treated participants only [VAT: +6.2 (8.7) HU tesamorelin, +0.3 (4.2) HU placebo, P < 0.0001; SAT: +4.0 (8.7) HU tesamorelin, +0.3 (4.8) HU placebo, P < 0.0001]. The tesamorelin effects persisted after controlling for baseline VAT or SAT HU and area, and VAT [+2.3 HU, 95% confidence interval (4.5-7.3), P = 0.001) or SAT (+3.5 HU, 95% confidence interval (2.3-4.7), P < 0.001] area change. CONCLUSION In PWH with central adiposity who experienced VAT quantity reductions on tesamorelin, VAT and SAT density increased independent of changes in fat quantity, suggesting that tesamorelin also improves VAT and SAT quality in this group.
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Affiliation(s)
- Jordan E Lake
- University of Texas Health Science Center, Houston, Texas
| | - Kristen La
- University of Texas Health Science Center, Houston, Texas
| | | | | | | | | | - Michael P Dubé
- University of Southern California, Los Angeles, California
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11
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Douglas PS, Umbleja T, Bloomfield GS, Fichtenbaum CJ, Zanni MV, Overton ET, Fitch KV, Kileel EM, Aberg JA, Currier J, Sponseller CA, Melbourne K, Avihingsanon A, Bustorff F, Estrada V, Ruxrungtham K, Saumoy M, Navar AM, Hoffmann U, Ribaudo HJ, Grinspoon S. Cardiovascular Risk and Health Among People With HIV Eligible for Primary Prevention: Insights From the REPRIEVE Trial. Clin Infect Dis 2021; 73:2009-2022. [PMID: 34134131 PMCID: PMC8664454 DOI: 10.1093/cid/ciab552] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background In addition to traditional cardiovascular (CV) risk factors, antiretroviral therapy, lifestyle, and human immunodeficiency virus (HIV)-related factors may contribute to future CV events in persons with HIV (PWH). Methods Among participants in the global REPRIEVE randomized trial, we characterized demographics and HIV characteristics relative to ACC/AHA pooled cohort equations (PCE) for atherosclerotic CV disease predicted risk and CV health evaluated by Life’s Simple 7 (LS7; includes smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and glucose). Results Among 7382 REPRIEVE participants (31% women, 45% Black), the median PCE risk score was 4.5% (lower and upper quartiles Q1, Q3: 2.2, 7.2); 29% had a PCE score <2.5%, and 9% scored above 10%. PCE score was related closely to known CV risk factors and modestly (<1% difference in risk score) to immune function and HIV parameters. The median LS7 score was 9 (Q1, Q3: 7, 10) of a possible 14. Only 24 participants (0.3%) had 7/7 ideal components, and 36% had ≤2 ideal components; 90% had <5 ideal components. The distribution of LS7 did not vary by age or natal sex, although ideal health was more common in low sociodemographic index countries and among Asians. Poor dietary and physical activity patterns on LS7 were seen across all PCE scores, including the lowest risk categories. Conclusions Poor CV health by LS7 was common among REPRIEVE participants, regardless of PCE. This suggests a critical and independent role for lifestyle interventions in conjunction with conventional treatment to improve CV outcomes in PWH. Clinical Trials Registration: NCT02344290. AIDS Clinical Trials Group study number: A5332.
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Affiliation(s)
- Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | | | | | | | | | - Judith Currier
- University of California at Los Angeles, Los Angeles, CA
| | | | | | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre and TB RU; Faculty of Medicine, Chulalongkorn University, Thailand
| | | | | | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre and TB RU; Faculty of Medicine, Chulalongkorn University, Thailand
| | - Maria Saumoy
- Hospital de Bellvitge, l'Hospitalet de Llobregat, Spain
| | | | | | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
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12
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Bick AG, Popadin K, Thorball CW, Uddin MM, Zanni M, Yu B, Cavassini M, Rauch A, Tarr P, Schmid P, Bernasconi E, Günthard HF, Libby P, Boerwinkle E, McLaren PJ, Ballantyne CM, Grinspoon S, Natarajan P, Fellay J. Increased CHIP Prevalence Amongst People Living with HIV. medRxiv 2020:2020.11.06.20225607. [PMID: 33173934 PMCID: PMC7654930 DOI: 10.1101/2020.11.06.20225607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
People living with human immunodeficiency virus (PLWH) have significantly increased risk for cardiovascular disease in part due to inflammation and immune dysregulation. Clonal hematopoiesis of indeterminate potential (CHIP), the age-related acquisition and expansion of hematopoietic stem cells due to leukemogenic driver mutations, increases risk for both hematologic malignancy and coronary artery disease (CAD). Since increased inflammation is hypothesized to be both a cause and consequence of CHIP, we hypothesized that PLWH have a greater prevalence of CHIP. We searched for CHIP in multi-ethnic cases from the Swiss HIV Cohort Study (SHCS, n=600) and controls from the Atherosclerosis Risk in the Communities study (ARIC, n=8,111) from blood DNA-derived exome sequences. We observed that HIV is associated with increased CHIP prevalence, both in the whole study population and in a subset of 230 cases and 1002 matched controls selected by propensity matching to control for demographic imbalances (SHCS 7%, ARIC 3%, p=0.005). Additionally, unlike in ARIC, ASXL1 was the most commonly implicated mutated CHIP gene. We propose that CHIP may be one mechanism through which PLWH are at increased risk for CAD. Larger prospective studies should evaluate the hypothesis that CHIP contributes to the excess cardiovascular risk in PLWH.
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Affiliation(s)
- Alexander G. Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Konstantin Popadin
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Christian W. Thorball
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Markella Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bing Yu
- Human Genetics Center, University of Texas Health Science Center, Houston, TX, USA Baylor College of Medicine, Houston, Texas, USA
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Philip Tarr
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital of Lugano, Lugano, Switzerland
| | - Huldrych F. Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center, Houston, TX, USA Baylor College of Medicine, Houston, Texas, USA
| | - Paul J. McLaren
- JC Wilt Infectious Diseases Research Centre, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | | | - Steven Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pradeep Natarajan
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jacques Fellay
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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13
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Kearns AC, Liu F, Dai S, Robinson JA, Kiernan E, Tesfaye Cheru L, Peng X, Gordon J, Morgello S, Abuova A, Lo J, Zanni MV, Grinspoon S, Burdo TH, Qin X. Caspase-1 Activation Is Related With HIV-Associated Atherosclerosis in an HIV Transgenic Mouse Model and HIV Patient Cohort. Arterioscler Thromb Vasc Biol 2019; 39:1762-1775. [PMID: 31315440 PMCID: PMC6703939 DOI: 10.1161/atvbaha.119.312603] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Atherosclerotic cardiovascular disease (ASCVD) is an increasing cause of morbidity and mortality in people with HIV since the introduction of combination antiretroviral therapy. Despite recent advances in our understanding of HIV ASCVD, controversy still exists on whether this increased risk of ASCVD is due to chronic HIV infection or other risk factors. Mounting biomarker studies indicate a role of monocyte/macrophage activation in HIV ASCVD; however, little is known about the mechanisms through which HIV infection mediates monocyte/macrophage activation in such a way as to engender accelerated atherogenesis. Here, we experimentally investigated whether HIV expression is sufficient to accelerate atherosclerosis and evaluated the role of caspase-1 activation in monocytes/macrophages in HIV ASCVD. Approach and Results: We crossed a well-characterized HIV mouse model, Tg26 mice, which transgenically expresses HIV-1, with ApoE-/- mice to promote atherogenic conditions (Tg26+/-/ApoE-/-). Tg26+/-/ApoE-/- have accelerated atherosclerosis with increased caspase-1 pathway activation in inflammatory monocytes and atherosclerotic vasculature compared with ApoE-/-. Using a well-characterized cohort of people with HIV and tissue-banked aortic plaques, we documented that serum IL (interleukin)-18 was higher in people with HIV compared with non-HIV-infected controls, and in patients with plaques, IL-18 levels correlated with monocyte/macrophage activation markers and noncalcified inflammatory plaques. In autopsy-derived aortic plaques, caspase-1+ cells and CD (clusters of differentiation) 163+ macrophages correlated. CONCLUSIONS These data demonstrate that expression of HIV is sufficient to accelerate atherogenesis. Further, it highlights the importance of caspase-1 and monocyte/macrophage activation in HIV atherogenesis and the potential of Tg26+/-/ApoE-/- as a tool for mechanistic studies of HIV ASCVD.
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Affiliation(s)
- Alison C. Kearns
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140
- Co-first author, these authors contributed equally to this work
| | - Fengming Liu
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140
- Division of Pathology, Tulane National Primate Research Center, 18703 Three Rivers Road, Covington, LA 70433
- Co-first author, these authors contributed equally to this work
| | - Shen Dai
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140
| | - Jake A. Robinson
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140
| | - Elizabeth Kiernan
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140
| | - Lediya Tesfaye Cheru
- Program in Nutritional Metabolism, Mass General Hospital and Harvard Medical School, Boston, MA
| | - Xiao Peng
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140
| | - Jennifer Gordon
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140
| | - Susan Morgello
- Departments of Neurology, Neuroscience, and Pathology, Mount Sinai Medical Center, New York, NY
| | - Aishazhan Abuova
- Departments of Neurology, Neuroscience, and Pathology, Mount Sinai Medical Center, New York, NY
| | - Janet Lo
- Program in Nutritional Metabolism, Mass General Hospital and Harvard Medical School, Boston, MA
| | - Markella V. Zanni
- Program in Nutritional Metabolism, Mass General Hospital and Harvard Medical School, Boston, MA
| | - Steven Grinspoon
- Program in Nutritional Metabolism, Mass General Hospital and Harvard Medical School, Boston, MA
| | - Tricia H. Burdo
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140
| | - Xuebin Qin
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140
- Division of Pathology, Tulane National Primate Research Center, 18703 Three Rivers Road, Covington, LA 70433
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14
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Adrian S, Scherzinger A, Sanyal A, Lake JE, Falutz J, Dubé MP, Stanley T, Grinspoon S, Mamputu JC, Marsolais C, Brown TT, Erlandson KM. The Growth Hormone Releasing Hormone Analogue, Tesamorelin, Decreases Muscle Fat and Increases Muscle Area in Adults with HIV. J Frailty Aging 2019; 8:154-159. [PMID: 31237318 DOI: 10.14283/jfa.2018.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tesamorelin, a growth hormone-releasing hormone analogue, decreases visceral adipose tissue in people living with HIV, however, the effects on skeletal muscle fat and area are unknown. OBJECTIVES The goals of this exploratory secondary analysis were to determine the effects of tesamorelin on muscle quality (density) and quantity (area). DESIGN Secondary, exploratory analysis of two previously completed randomized (2:1), clinical trials. SETTING U.S. and Canadian sites. PARTICIPANTS People living with HIV and with abdominal obesity. Tesamorelin participants were restricted to responders (visceral adipose tissue decrease ≥8%). INTERVENTION Tesamorelin or placebo. MEASUREMENTS Computed tomography scans (at L4-L5) were used to quantify total and lean density (Hounsfield Units, HU) and area (centimeters2) of four trunk muscle groups using a semi-automatic segmentation image analysis program. Differences between muscle area and density before and after 26 weeks of tesamorelin or placebo treatment were compared and linear regression models were adjusted for baseline and treatment arm. RESULTS Tesamorelin responders (n=193) and placebo (n=148) participants with available images were similar at baseline; most were Caucasian (83%) and male (87%). In models adjusted for baseline differences and treatment arm, tesamorelin was associated with significantly greater increases in density of four truncal muscle groups (coefficient 1.56-4.86 Hounsfield units; all p<0.005), and the lean anterolateral/abdominal and rectus muscles (1.39 and 1.78 Hounsfield units; both p<0.005) compared to placebo. Significant increases were also seen in total area of the rectus and psoas muscles (0.44 and 0.46 centimeters2; p<0.005), and in the lean muscle area of all four truncal muscle groups (0.64-1.08 centimeters2; p<0.005). CONCLUSIONS Among those with clinically significant decrease in visceral adipose tissue on treatment, tesamorelin was effective in increasing skeletal muscle area and density. Long term effectiveness of tesamorelin among people with and without HIV, and the impact of these changes in daily life should be further studied.
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Affiliation(s)
- S Adrian
- Kristine M. Erlandson, MD, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO 80045, ; 303-724-4941 (p); 303-724-4926 (f)
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15
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Godfrey C, Bremer A, Alba D, Apovian C, Koethe JR, Koliwad S, Lewis D, Lo J, McComsey GA, Eckard A, Srinivasa S, Trevillyan J, Palmer C, Grinspoon S. Obesity and Fat Metabolism in Human Immunodeficiency Virus-Infected Individuals: Immunopathogenic Mechanisms and Clinical Implications. J Infect Dis 2019; 220:420-431. [PMID: 30893434 PMCID: PMC6941618 DOI: 10.1093/infdis/jiz118] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/22/2019] [Indexed: 01/07/2023] Open
Abstract
Metabolic complications relating to complex effects of viral and immune-mediated mechanisms are now a focus of clinical care among persons living with human immunodeficiency virus (PLHIV), and obesity is emerging as a critical problem. To address knowledge gaps, the US National Institutes of Health sponsored a symposium in May 2018 entitled "Obesity and Fat Metabolism in HIV-infected Individuals." Mechanisms relating to adipose dysfunction and fibrosis, immune function, inflammation, and gastrointestinal integrity were highlighted as contributors to obesity among PLHIV. Fibrotic subcutaneous adipose tissue is metabolically dysfunctional and loses its capacity to expand, leading to fat redistribution, including visceral obesity and ectopic fat accumulation, promoting insulin resistance. Viral proteins, including viral protein R and negative regulatory factor, have effects on adipogenic pathways and cellular metabolism in resident macrophages and T cells. HIV also affects immune cell trafficking into the adipose compartments, with effects on adipogenesis, lipolysis, and ectopic fat accumulation. Key cellular metabolic functions are likely to be affected in PLHIV by gut-derived cytokines and altered microbiota. There are limited strategies to reduce obesity specifically in PLHIV. Enhancing our understanding of critical pathogenic mechanisms will enable the development of novel therapeutics that may normalize adipose tissue function and distribution, reduce inflammation, and improve insulin sensitivity in PLHIV.
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Affiliation(s)
- Catherine Godfrey
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Andrew Bremer
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Diana Alba
- University of California, San Francisco School of Medicine
| | - Caroline Apovian
- Boston Medical Center and Boston University School of Medicine, Massachusetts
| | | | - Suneil Koliwad
- University of California, San Francisco School of Medicine
| | - Dorothy Lewis
- McGovern Medical School, University of Texas Health Science Center at Houston
| | - Janet Lo
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - Grace A McComsey
- University Hospitals Cleveland Medical Center and Case Western Reserve, Ohio
| | | | - Suman Srinivasa
- Massachusetts General Hospital and Harvard Medical School, Boston
| | | | | | - Steven Grinspoon
- Massachusetts General Hospital and Harvard Medical School, Boston
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16
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Srinivasa S, Garcia R, Torriani M, Fitch K, Maehler P, Feldpausch M, Cypess A, Kahn C, Grinspoon S. MON-100 Unique miRNA Signature in HIV Lipodystrophy with Reduced Adipose Dicer Expression. J Endocr Soc 2019. [PMCID: PMC6550730 DOI: 10.1210/js.2019-mon-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Suppression of Dicer, an endoribonuclease that regulates microRNAs(miRNA), has evolved as a viral mechanism to enhance host HIV infectivity and may have unintended metabolic consequences. Animal knockout models of adipose-specific dicer(ADicer) acquire lipodystrophy accompanied by severe metabolic abnormalities. Data show adipose is a source of exosomal miRNAs, functioning as adipokines influencing metabolic homeostasis. We hypothesized a unique miRNA profile among individuals well-phenotyped for HIV lipodystrophy and reduced ADicer expression. We evaluated >1000 miRNAs from exosomes derived from sera among the 27 male individuals [9 HIV lipodystrophy(HIV/lipo), 9 HIV without lipodystrophy(HIV/non-lipo), 9 non-HIV] whom we previously showed variations in ADicer: most suppressed among HIV lipo, followed by HIV non-lipo and non-HIV (2.49[0.02,4.88] vs. 11.20[4.83,21.45] vs. 17.69[10.72,47.91],P=.002). To estimate miRNA abundance, data was normalized using the geomean of expressed Ct values. A false discovery rate analysis(FDR) was applied. We investigated whether significant exosomal miRNAs demonstrated a similar pattern in corresponding subcutaneous adipose tissue(SAT) samples. Using target prediction databases (TargetScan, miRDB, Diana), we identified genes related to fat biology (target score ≥85%) with clinical relevance to lipodystrophic phenotypes and further evaluated these in the adipose depot. HIV/lipo individuals(age 56±3years, BMI 30±1kg/m2, duration HIV 24±2years, duration ART 20±2years, CD4+ count 482±90cells/μl, undetectable VL 67%) were similar to HIV/non-lipo(age 52±3 years, BMI 30±1 kg/m2) and non-HIV(age 55±3years, BMI 30±1kg/m2) individuals. Reduced ADicer expression was significantly related to reduced CD4+ count(r=0.55,P=.02), duration ART use(r=-0.70,P=.001) and tended to be related to duration HIV(r=-0.44,P=.07) and reduced CD8+ count(r=0.42,P=.08). Applying FDR, we detected exosomal miRNA-20a-3p(P=.0026), 324-5p(P=.0059), and 186-5p(P=.0977) were expressed differentially in HIV/lipo vs. non-HIV and 324-5p(P=.0348) in HIV/lipo vs. HIV/non-lipo. We further confirmed that miRNA-20a-3p was significantly and differentially expressed in the SAT, expressed highest in HIV lipo followed by HIV non-lipo and non-HIV [9.73±12.38 vs. 2.24±1.84 vs. 1.02±0.19, P<0.05] in a pattern similar to the exosomal profiles. Relevant miRNA and their target genes which tended to be differentially expressed in the SAT of HIV lipo vs. HIV non-lipo include: 20a-3p (TDG, P=0.07) and 186-5p (PDE10A, PID1; P<0.05). Altered ADicer expression and specific exosomal miRNAs may affect gene expression of regulators important to fat biology and metabolic homeostasis in HIV. In particular, miRNA-20a-3p may function as an adipokine demonstrating similar expression profiles in exosomes and adipose tissue of individuals with HIV lipodystrophy.
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Affiliation(s)
- Suman Srinivasa
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Ruben Garcia
- Joslin Diabetes Center, Boston, MA, United States
| | - Martin Torriani
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Kathleen Fitch
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Patrick Maehler
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | - Meghan Feldpausch
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | | | - Carl Kahn
- Rsrch Div, Dept of Med, Joslin Diabetes Center, Boston, MA, United States
| | - Steven Grinspoon
- Medicine/Neuroendocrine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
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17
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Fourman L, Gerard M, Pan C, Zheng I, Sheehab A, Triant V, Stanley T, Grinspoon S. SAT-256 Obesity and Reactive Airway Disease Are Increased Among HIV-Exposed Uninfected Adolescents. J Endocr Soc 2019. [PMCID: PMC6552223 DOI: 10.1210/js.2019-sat-256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Worldwide, over 1 million babies are born to mothers with HIV each year. With the advent of prenatal antiretroviral therapy (ART), the vast majority of these individuals are HIV-exposed but uninfected (HEU). HEU infants and children exhibit impaired growth, mitochondrial toxicity, and immune activation compared to HIV-unexposed peers. Nonetheless, the long-term sequelae of in utero HIV and ART exposure have never before been examined. We hypothesized that in utero HIV/ART exposure may condition fetal development in a manner that predisposes to obesity and reactive airway disease (RAD) later in life. Methods: We leveraged a patient database registry at a U.S. academic health system to compare long-term health outcomes among HEU adolescents and matched controls, and to determine maternal factors associated with adverse HEU outcomes. HEU individuals born since 1990 with medical records available at age ≥ 13 y were identified. Over 200,000 controls also were retrieved from RPDR and matched up to 3:1 on birthdate (±5 y), age of last encounter (±2 y), sex, race, and zip code (SAS 9.4). Charts were manually reviewed to confirm HEU status and to extract health information. BMI was adjusted for age and sex per CDC growth charts. Obesity was defined as BMI ≥ 30 kg/m2 or ≥ 95 percentile. RAD was by clinical report. Results: 50 HEU adolescents (18 [15, 20] y, 54% male) and 141 matched controls (19 [16, 21] y, 55% male) were compared. Mothers of HEU adolescents were 30 ± 4 years old with BMI 26 [24, 30] kg/m2. Mothers had HIV for 4 [1, 7] years with CD4 count 405 [222, 615]/mm3, and 93% received prenatal ART. Obesity was seen in 42% of HEU adolescents compared to 25% of controls (P = 0.04). The prevalence of RAD also was higher among HEU than controls (40% vs. 24%, P = 0.04). Within the HEU group, there was a strong inverse correlation between maternal third trimester CD4 count and adolescent BMI z-score (r = -0.47, P = 0.01). This relationship persisted upon adjustment for prenatal maternal factors including age, BMI, ART, and HIV duration as well as median household income (P < 0.05). Lower third trimester CD4 count also was strongly associated with higher birth weight (r = -0.56, P = 0.006) and placental weight (r = -0.58, P = 0.006). Prenatal maternal CD4 nadir, peak HIV viral load, HIV duration, and ART were not associated with adolescent BMI z-score. Unlike obesity, maternal factors did not relate to RAD among HEU. Conclusions: In utero exposure to HIV/ART may predispose to obesity and RAD in adolescence. Lower prenatal maternal CD4 count – indicative of more severe immune dysfunction – was associated with higher adolescent BMI. Prospective studies are needed to further characterize metabolic and immune dysregulation among the aging and expanding HEU population. Insights learned from these individuals may have implications for other groups exposed to maternal inflammation in utero, including individuals born to obese mothers.
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Affiliation(s)
| | - Marisa Gerard
- Massachusetts General Hospital, Boston, MA, United States
| | - Chelsea Pan
- Massachusetts General Hospital, Boston, MA, United States
| | - Isabel Zheng
- Massachusetts General Hospital, Boston, MA, United States
| | - Asia Sheehab
- Massachusetts General Hospital, Boston, MA, United States
| | - Virginia Triant
- INFECTIOUS DISEASES, Massachusetts General Hospital, Boston, MA, United States
| | - Takara Stanley
- Program in Nutrition Metabolism, Massachusetts General Hospital, Boston, MA, United States
| | - Steven Grinspoon
- Medicine/Neuroendocrine, Massachusetts General Hospital, Boston, MA, United States
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18
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Teague HL, Ahlman MA, Alavi A, Wagner DD, Lichtman AH, Nahrendorf M, Swirski FK, Nestle F, Gelfand JM, Kaplan MJ, Grinspoon S, Ridker PM, Newby DE, Tawakol A, Fayad ZA, Mehta NN. Unraveling Vascular Inflammation: From Immunology to Imaging. J Am Coll Cardiol 2017; 70:1403-1412. [PMID: 28882238 DOI: 10.1016/j.jacc.2017.07.750] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 12/17/2022]
Abstract
Inflammation is a critical factor in early atherosclerosis and its progression to myocardial infarction. The search for valid surrogate markers of arterial vascular inflammation led to the increasing use of positron emission tomography/computed tomography. Indeed, vascular inflammation is associated with future risk for myocardial infarction and can be modulated with short-term therapies, such as statins, that mitigate cardiovascular risk. However, to better understand vascular inflammation and its mechanisms, a panel was recently convened of world experts in immunology, human translational research, and positron emission tomographic vascular imaging. This contemporary review first strives to understand the diverse roles of immune cells implicated in atherogenesis. Next, the authors describe human chronic inflammatory disease models that can help elucidate the pathophysiology of vascular inflammation. Finally, the authors review positron emission tomography-based imaging techniques to characterize the vessel wall in vivo.
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Affiliation(s)
- Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark A Ahlman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Abass Alavi
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Andrew H Lichtman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Filip K Swirski
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Mariana J Kaplan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Steven Grinspoon
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul M Ridker
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ahmed Tawakol
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zahi A Fayad
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nehal N Mehta
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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Zanni MV, Fitch K, Rivard C, Sanchez L, Douglas PS, Grinspoon S, Smeaton L, Currier JS, Looby SE. Follow YOUR Heart: development of an evidence-based campaign empowering older women with HIV to participate in a large-scale cardiovascular disease prevention trial. HIV Clin Trials 2017; 18:83-91. [PMID: 28277924 DOI: 10.1080/15284336.2017.1297551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Women's under-representation in HIV and cardiovascular disease (CVD) research suggests a need for novel strategies to ensure robust representation of women in HIV-associated CVD research. OBJECTIVE To elicit perspectives on CVD research participation among a community-sample of women with or at risk for HIV, and to apply acquired insights toward the development of an evidence-based campaign empowering older women with HIV to participate in a large-scale CVD prevention trial. METHODS In a community-based setting, we surveyed 40 women with or at risk for HIV about factors which might facilitate or impede engagement in CVD research. We applied insights derived from these surveys into the development of the Follow YOUR Heart campaign, educating women about HIV-associated CVD and empowering them to learn more about a multi-site HIV-associated CVD prevention trial: REPRIEVE. RESULTS Endorsed best methods for learning about a CVD research study included peer-to-peer communication (54%), provider communication (46%) and video-based communication (39%). Top endorsed non-monetary reasons for participating in research related to gaining information (63%) and helping others (47%). Top endorsed reasons for not participating related to lack of knowledge about studies (29%) and lack of request to participate (29%). Based on survey results, the REPRIEVE Follow YOUR Heart campaign was developed. Interwoven campaign components (print materials, video, web presence) offer provider-based information/knowledge, peer-to-peer communication, and empowerment to learn more. Campaign components reflect women's self-identified motivations for research participation - education and altruism. CONCLUSIONS Investigation of factors influencing women's participation in HIV-associated CVD research may be usefully applied to develop evidence-based strategies for enhancing women's enrollment in disease-specific large-scale trials. If proven efficacious, such strategies may enhance conduct of large-scale research studies across disciplines.
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Affiliation(s)
- Markella V Zanni
- a Program in Nutritional Metabolism , Mass General Hospital and Harvard Medical School , Boston , MA , USA
| | - Kathleen Fitch
- a Program in Nutritional Metabolism , Mass General Hospital and Harvard Medical School , Boston , MA , USA
| | - Corinne Rivard
- a Program in Nutritional Metabolism , Mass General Hospital and Harvard Medical School , Boston , MA , USA
| | - Laura Sanchez
- a Program in Nutritional Metabolism , Mass General Hospital and Harvard Medical School , Boston , MA , USA
| | - Pamela S Douglas
- b Cardiology Division and Duke Clinical Research Institute , Duke University School of Medicine, Duke University Hospital , Durham , NC , USA
| | - Steven Grinspoon
- a Program in Nutritional Metabolism , Mass General Hospital and Harvard Medical School , Boston , MA , USA
| | - Laura Smeaton
- c Harvard T.H. Chan School of Public Health , Center for Biostatistics in AIDS Research , Boston , MA , USA
| | - Judith S Currier
- d Division of Infectious Diseases , University of California, Los Angeles CARE Hospital and University of California, Los Angeles Medical School , Los Angeles , CA , USA
| | - Sara E Looby
- a Program in Nutritional Metabolism , Mass General Hospital and Harvard Medical School , Boston , MA , USA.,e Yvonne L. Munn Center for Nursing Research , Mass General Hospital , Boston , MA , USA
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20
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Affiliation(s)
- Steven Grinspoon
- From the Program in Nutritional Metabolism (S.G.) and Cardiac MR PET CT Program (U.H.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Udo Hoffmann
- From the Program in Nutritional Metabolism (S.G.) and Cardiac MR PET CT Program (U.H.), Massachusetts General Hospital and Harvard Medical School, Boston
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21
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Foldyna B, Lo J, Grinspoon S, Lu M, Hoffmann U. Statine beeinflussen die Zusammensetzung und reduzieren die Änderungsvariabilität von Koronarplaques: Subanalyse einer randomisierten, kontrollierten Studie von Atorvastatin in HIV Patienten. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- B Foldyna
- Massachusetts General Hospital, Radiology – Cardiac MR PET CT Program, Boston
| | - J Lo
- Massachusetts General Hospital – Harvard Medical School, Department of Medicine, Endocrine Division, Program in Nutritional Metabolism, Boston
| | - S Grinspoon
- Massachusetts General Hospital – Harvard Medical School, Department of Medicine, Endocrine Division, Program in Nutritional Metabolism, Boston
| | - M Lu
- Massachusetts General Hospital – Harvard Medical School, Department of Radiology, Cardiac PET MR CT Program, Bosoton
| | - U Hoffmann
- Massachusetts General Hospital – Harvard Medical School, Department of Radiology, Cardiac PET MR CT Program, Boston
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22
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Ishai A, Tung B, Mamdani N, Shin L, Pitman R, Grinspoon S, Tawakol A. RESTING AMYGDALAR ACTIVITY ASSOCIATES WITH FUTURE CHANGES IN ADIPOSITY: IMPLICATIONS FOR ATHEROSCLEROTIC DISEASE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Since the publication of the first issue of this journal in November 2005, our understanding of the endocrine system has evolved, with the identification of novel hormones and novel endocrine roles for previously identified molecules. Here, we have asked six of our Advisory Board Members to comment on how these insights have led to the recognition that many organs and tissues that were not widely considered part of the classic endocrine system in the past have important endocrine functions.
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Affiliation(s)
- Roger Bouillon
- Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49 ON1, Box 902, 3000 Leuven, Belgium
| | - Daniel J Drucker
- Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, 600 University Avenue, TCP5-1004 MailBox 39, Toronto, ON M5G 1X5, Canada
| | - Ele Ferrannini
- University of Pisa, Department of Internal Medicine, Via Roma 67, Pisa, PI 56100, Italy
| | - Steven Grinspoon
- Harvard Medical School, MGH Program in Nutritional Metabolism, 5 Longfellow Place, Room 207, Boston, MA 02114, USA
| | - Clifford J Rosen
- Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME 04074, USA
| | - Paul Zimmet
- Baker IDI Heart and Diabetes Institute, Epidemiology &Clinical Diabetes, 99 Commercial Road, Melbourne, VIC 3004, Australia
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24
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Li JZ, Arnold KB, Lo J, Dugast AS, Plants J, Ribaudo HJ, Cesa K, Heisey A, Kuritzkes DR, Lauffenburger DA, Alter G, Landay A, Grinspoon S, Pereyra F. Differential levels of soluble inflammatory markers by human immunodeficiency virus controller status and demographics. Open Forum Infect Dis 2015; 2:ofu117. [PMID: 25884005 PMCID: PMC4396431 DOI: 10.1093/ofid/ofu117] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/10/2014] [Indexed: 11/29/2022] Open
Abstract
Background. Human immunodeficiency virus (HIV)-1 elite controllers (ECs) represent an ideal population to study the effects of HIV persistence on chronic inflammation in the absence of antiretroviral therapy (ART). Methods. Twenty inflammatory markers measured in cohorts of ECs, HIV suppressed noncontrollers, and HIV-uninfected controls were compared using rank-based tests and partial least squares discriminant analysis (PLSDA). Spearman correlations were determined among the inflammatory markers, residual viremia by the single-copy assay, and CD4+ T cell slope. Results. Significant differences were seen between cohorts in 15 of the soluble inflammatory markers. Human immunodeficiency virus-1 ECs were found to have the highest levels for all of the markers with the exception of RANTES. In particular, median levels of 7 inflammatory markers (soluble CD14 [sCD14], interferon [IFN]-γ, IFN-γ-inducible protein [IP]-10, interleukin [IL]-4, IL-10, sCD40L, and granulocyte-macrophage colony-stimulating factor) were twice as high in the HIV-1 ECs compared with either of the HIV-suppressed or uninfected groups. Multivariate PLSDA analysis of inflammatory markers improved differentiation between the patient cohorts, discerning gender differences in inflammatory profile amongst individuals on suppressive ART. Soluble markers of inflammation in ECs were not associated with either levels of residual HIV-1 viremia or CD4+ T cell decline. Conclusions. Despite maintaining relatively low levels of viremia, HIV-1 ECs had elevated levels of a set of key inflammatory markers. Additional studies are needed to determine whether ECs may benefit from ART and to further evaluate the observed gender differences.
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Affiliation(s)
- Jonathan Z Li
- Brigham and Women's Hospital , Harvard Medical School , Cambridge, Massachusetts
| | | | - Janet Lo
- Massachusetts General Hospital , Boston
| | | | - Jill Plants
- Rush University Medical Center , Chicago, Illinois
| | | | | | - Andrea Heisey
- Brigham and Women's Hospital , Harvard Medical School , Cambridge, Massachusetts
| | - Daniel R Kuritzkes
- Brigham and Women's Hospital , Harvard Medical School , Cambridge, Massachusetts
| | | | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard , Cambridge, Massachusetts
| | - Alan Landay
- Rush University Medical Center , Chicago, Illinois
| | | | - Florencia Pereyra
- Brigham and Women's Hospital , Harvard Medical School , Cambridge, Massachusetts ; Massachusetts General Hospital , Boston
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25
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McKibben RA, Margolick JB, Grinspoon S, Li X, Palella FJ, Kingsley LA, Witt MD, George RT, Jacobson LP, Budoff M, Tracy RP, Brown TT, Post WS. Elevated levels of monocyte activation markers are associated with subclinical atherosclerosis in men with and those without HIV infection. J Infect Dis 2014; 211:1219-28. [PMID: 25362192 DOI: 10.1093/infdis/jiu594] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heightened immune activation among human immunodeficiency virus (HIV)-infected persons may contribute to atherosclerosis. We assessed associations of serologic markers of monocyte activation, soluble CD163 (sCD163) and soluble CD14 (sCD14), and monocyte chemoattractant protein 1 (CCL2) with subclinical atherosclerosis among men with and those without HIV infection in the Multicenter AIDS Cohort Study. METHODS We performed noncontrast computed tomography on 906 men (566 HIV-infected men and 340 HIV-uninfected men), 709 of whom also underwent coronary computed tomographic angiography. Associations between each biomarker and the prevalence of coronary plaque, the prevalence of stenosis of ≥50%, and the extent of plaque were assessed by logistic and linear regression, adjusting for age, race, HIV serostatus, and cardiovascular risk factors. RESULTS Levels of all biomarkers were higher among HIV-infected men, of whom 81% had undetectable HIV RNA, and were associated with lower CD4(+) T-cell counts. In the entire population and among HIV-infected men, higher biomarker levels were associated with a greater prevalence of coronary artery stenosis of ≥50%. Higher sCD163 levels were also associated with greater prevalences of coronary artery calcium, mixed plaque, and calcified plaque; higher CCL2 levels were associated with a greater extent of noncalcified plaque. CONCLUSIONS sCD163, sCD14, and CCL2 levels were elevated in treated HIV-infected men and associated with atherosclerosis. Monocyte activation may increase the risk for cardiovascular disease in individuals with HIV infection.
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Affiliation(s)
| | | | | | - Xiuhong Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Mallory D Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | | | - Lisa P Jacobson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | | | | | - Wendy S Post
- Johns Hopkins University School of Medicine Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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26
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Torriani M, Zanni MV, Fitch K, Stavrou E, Bredella MA, Lim R, Cypess AM, Grinspoon S. Increased FDG uptake in association with reduced extremity fat in HIV patients. Antivir Ther 2012; 18:243-8. [PMID: 23041595 DOI: 10.3851/imp2420] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND HIV lipodystrophy - characterized by peripheral lipoatrophy, with or without central fat accumulation - confers increased metabolic risk. However, the functional activity of HIV lipodystrophic tissue in relation to metabolic risk has yet to be fully explored in vivo through the use of non-invasive imaging techniques. This study assesses the relationship between FDG uptake in various fat depots and metabolic/immune parameters among subjects with HIV lipodystrophy. METHODS Lipodystrophic men on antiretroviral therapy underwent whole-body (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography scans and detailed metabolic/immune phenotyping. RESULTS FDG uptake in the subcutaneous adipose tissue (SAT) of the extremities (mean standardized uptake value [SUV] of the arm and leg SAT) was found to correlate with the degree of peripheral lipoatrophy (r=0.7; P=0.01). Extremity SAT FDG uptake was positively associated with homeostasis model assessment of insulin resistance (HOMA-IR; r=0.6; P=0.02) and fasting hyperinsulinaemia (r=0.7; P=0.01), while fat percentage of extremities was not. Furthermore, extremity SAT FDG uptake was significantly associated with CD4(+) T-cell count (r=0.6; P=0.05). In multivariate modelling for HOMA-IR, extremity SAT FDG uptake remained significant after controlling for body mass index and tumour necrosis factor-α (R(2) for model =0.71, P=0.02; SUV in the extremity SAT β-estimate 12.3, P=0.009). CONCLUSIONS In HIV lipodystrophic patients, extremity SAT FDG uptake is increased in association with reduced extremity fat and may contribute to insulin resistance. Non-invasive assessments of in situ inflammation using FDG-PET may usefully complement histological and gene expression analyses of metabolic dysregulation in peripheral fat among HIV-positive patients.
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Affiliation(s)
- Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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27
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Torriani M, Fitch K, Stavrou E, Bredella MA, Lim R, Sass CA, Cypess AM, Grinspoon S. Deiodinase 2 expression is increased in dorsocervical fat of patients with HIV-associated lipohypertrophy syndrome. J Clin Endocrinol Metab 2012; 97:E602-7. [PMID: 22259052 PMCID: PMC3319185 DOI: 10.1210/jc.2011-2951] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 12/20/2011] [Indexed: 01/13/2023]
Abstract
CONTEXT The pathogenesis and function of dorsocervical sc adipose tissue (DSAT) accumulation in HIV-infected patients is not known. Previous investigations using either UCP-1 expression or positron emission tomography have been inconclusive as to whether this depot represents brown adipose tissue (BAT). We investigated DSAT gene expression, including DIO2, a deiodinase that contributes to increased thermogenesis in brown fat, and simultaneously determined [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) uptake in lipodystrophic HIV and healthy control subjects. DESIGN Thirteen HIV-infected and three non-HIV-infected men were recruited. HIV-infected subjects had evidence of significant lipodystrophy, including fat atrophy of the face, arms, and legs, and/or fat accumulation of the neck and abdomen. Subjects were cooled, followed by [¹⁸F]FDG positron emission tomography/computed tomography, fat biopsy of DSAT, and measurement of resting energy expenditure (REE). HIV-infected subjects were characterized as lipohypertrophic and lipoatrophic and compared. RESULTS Mean standardized uptake value of [¹⁸F]FDG and UCP-1 expression were not significantly different in DSAT among the groups. However, lipohypertrophic subjects demonstrated increased expression of DIO2 in DSAT compared with lipoatrophic subjects (P = 0.03). Among HIV-infected patients, DIO2 expression was strongly related to REE (r = 0.78, P = 0.002) and was a predictor of REE in multivariate modeling controlling for age, TSH, and lean body mass (r² = 0.79, P = 0.008). One control subject demonstrated typical BAT in the supraclavicular area. CONCLUSIONS Adipose tissue accumulating in the dorsocervical area in HIV lipodystrophy does not appear to be classical BAT. However, DIO2 expression is increased in DSAT among patients with HIV lipodystrophy, particularly those with increased visceral adiposity, and is positively associated with energy expenditure.
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Affiliation(s)
- Martin Torriani
- Division of Musculoskeletal Imaging and Intervention and Program in Nutritional Metabolism, Massachusetts General Hospital Longfellow 207, Boston, Massachusetts 02114, USA
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28
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Burdo TH, Lo J, Abbara S, Wei J, DeLelys ME, Preffer F, Rosenberg ES, Williams KC, Grinspoon S. Soluble CD163, a novel marker of activated macrophages, is elevated and associated with noncalcified coronary plaque in HIV-infected patients. J Infect Dis 2011; 204:1227-36. [PMID: 21917896 DOI: 10.1093/infdis/jir520] [Citation(s) in RCA: 332] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pro-inflammatory monocytes/macrophages may contribute to increased atherosclerosis in human immunodeficiency virus (HIV)-infected patients. We investigate--to our knowledge, for the first time--sCD163 and other markers of monocyte activation in relationship to atherosclerotic plaque in HIV-infected patients. METHODS One hundred two HIV-infected and 41 HIV-seronegative men with equivalent cardiovascular risk factors and without history of coronary artery disease were prospectively recruited and underwent computed tomography coronary angiography. RESULTS sCD163 levels and presence of plaque were significantly higher among antiretroviral-treated subjects with undetectable HIV RNA levels, compared with seronegative controls (1172 ± 646 vs. 883 ± 561 ng/mL [P = .02] for sCD163 and 61% vs. 39% [P = .03] for presence of plaque). After adjusting for age, race, lipids, blood pressure, glucose, smoking, sCD14, and HIV infection, sCD163 remained independently associated with noncalcified plaque (P = .008). Among HIV-infected patients, sCD163 was associated with coronary segments with noncalcified plaque (r = 0.21; P = .04), but not with calcium score. In contrast, markers of generalized inflammation, including C-reactive protein level, and D-dimer were not associated with sCD163 or plaque among HIV-infected patients. CONCLUSIONS sCD163, a monocyte/macrophage activation marker, is increased in association with noncalcified coronary plaque in men with chronic HIV infection and low or undetectable viremia. These data suggest a potentially important role of chronic monocyte/macrophage activation in the development of noncalcified vulnerable plaque. CLINICAL TRIAL REGISTRATION NCT00455793.
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Affiliation(s)
- Tricia H Burdo
- Department of Biology, Boston College, Chestnut Hill, Massachusetts, USA
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Abstract
The treatment of HIV infection has dramatically reduced the incidence of AIDS-related illnesses. At the same time, non-AIDS-related illnesses such as cardiovascular and bone disease are becoming more prevalent in this population. The mechanisms of these illnesses are complex and are related in part to the HIV virus, antiretroviral medications prescribed for HIV infection, traditional risk factors exacerbated by HIV, and lifestyle and nutritional factors. Further prospective research is needed to clarify the mechanisms by which HIV, antiretroviral medications, and nutritional abnormalities contribute to bone and cardiovascular disease in the HIV population. Increasingly, it is being recognized that optimizing the treatment of HIV infection to improve immune function and reduce viral load may also benefit the development of non-AIDS-related illnesses such as cardiovascular and bone disease.
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Affiliation(s)
- Kathleen Fitch
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, USA
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30
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Grinspoon S, Fitch K. Therapy: HIV-associated dyslipidemia: the heart positive study. Nat Rev Endocrinol 2011; 7:443-4. [PMID: 21691307 DOI: 10.1038/nrendo.2011.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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31
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Falutz J, Mamputu JC, Potvin D, Moyle G, Soulban G, Loughrey H, Marsolais C, Turner R, Grinspoon S. Effects of tesamorelin (TH9507), a growth hormone-releasing factor analog, in human immunodeficiency virus-infected patients with excess abdominal fat: a pooled analysis of two multicenter, double-blind placebo-controlled phase 3 trials with safety extension data. J Clin Endocrinol Metab 2010; 95:4291-304. [PMID: 20554713 DOI: 10.1210/jc.2010-0490] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
CONTEXT HIV patients treated with antiretroviral therapy (ART) often develop increased visceral adipose tissue (VAT). OBJECTIVE Our objective was to perform a pooled analysis of two phase-3 studies of tesamorelin in ART-treated HIV patients with excess abdominal fat. DESIGN AND SETTING Two multicenter, international studies were conducted; a 26-wk randomized, placebo-controlled primary intervention phase was followed by a 26-wk safety extension. PATIENTS A total of 806 ART-treated HIV patients with excess abdominal fat were randomized in a 2:1 fashion to receive tesamorelin 2 mg (n = 543) or placebo (n = 263) sc daily. At wk 26, patients initially on tesamorelin were rerandomized to 2 mg tesamorelin (T-T group, n = 246) or placebo (T-P, n = 135) for an additional 26 wk, whereas patients on placebo were switched to tesamorelin (P-T, n = 197). INTERVENTIONS Tesamorelin (GHRH(1-44)) at a dose of 2 mg or identical placebo, sc, was given daily. MAIN OUTCOME MEASURE We evaluated percent change in VAT by computed tomography scan at wk 26. RESULTS At wk 26, VAT decreased significantly in tesamorelin-treated patients (-24 +/- 41 vs. 2 +/- 35 cm(2), tesamorelin vs. placebo, P < 0.001; treatment effect, -15.4%). No significant changes were observed in abdominal sc adipose tissue (-2 +/- 32 vs. 2 +/- 29 cm(2), P = 0.08; treatment effect, -0.6%). Treatment with tesamorelin resulted in significant decreases in triglycerides (-37 +/- 139 vs. 6 +/- 112 mg/dl, P < 0.001; treatment effect, -12.3%) and cholesterol to high-density lipoprotein ratio (-0.18 +/- 1.00 vs. 0.18 +/- 0.94, P < 0.001; treatment effect, -7.2%) vs. placebo. Tesamorelin improved body image [belly appearance distress (P = 0.002)], patient rating of belly profile (P = 0.003), and physician rating of belly profile (P < 0.001). Mean IGF-I increased 108 +/- 112 vs.-7 +/- 64 ng/ml (P < 0.001 vs. placebo). At wk 52, decreases in VAT [-35 +/- 50 cm(2) (-17.5 +/- 23.3%)], waist circumference (-3.4 +/- 6.0 cm), triglycerides (-48 +/- 182 mg/dl), cholesterol (-8 +/- 38 mg/dl), and non-high-density lipoprotein (-7 +/- 38 mg/dl) were maintained (all P < 0.001 vs. original baseline) in the T-T group. Treatment with tesamorelin was generally well tolerated. No clinically meaningful differences were observed between groups in glucose parameters at wk 26 and 52. CONCLUSIONS Treatment with tesamorelin reduces VAT and maintains the reduction for up to 52 wk, preserves abdominal sc adipose tissue, improves body image and lipids, and is overall well tolerated without clinically meaningful changes in glucose parameters.
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Affiliation(s)
- Julian Falutz
- Montreal General Hospital, McGill University Health Centre, Montreal H3G 1A4, Canada
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Affiliation(s)
- Janet Lo
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston
| | - Sung Min You
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston
| | - James Liebau
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital
| | - Steven Grinspoon
- Program in Nutritional Metabolism, Massachusetts General Hospital
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Raboud JM, Diong C, Carr A, Grinspoon S, Mulligan K, Sutinen J, Rozenbaum W, Cavalcanti RB, Wand H, Costagliola D, Walmsley S. A meta-analysis of six placebo-controlled trials of thiazolidinedione therapy for HIV lipoatrophy. HIV Clin Trials 2010; 11:39-50. [PMID: 20400410 DOI: 10.1310/hct1101-39] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the impact of thiazolidinediones (TZD) on changes in limb fat mass in HIV-infected individuals, particularly in those not receiving a thymidine analogue. METHODS Individual patient data from placebo-controlled, randomized trials of rosiglitazone (n = 5) or pioglitazone (n = 1) were combined. Generalized estimating equation (GEE) models were used to estimate the treatment effect on changes in limb fat mass. RESULTS In the combined dataset of 427 patients, the baseline median age was 45 years, 86% were male, 80% were Caucasian, 63% were receiving stavudine (d4T) or zidovudine (AZT), 66% were on protease inhibitors, and median body mass index was 23 kg/m(2). In a univariate GEE model, TZD was associated with an increase in limb fat mass (coeff = 0.14 kg vs placebo, P = .04). In a multivariable GEE model, patients receiving pioglitazone had significantly higher limb fat mass gains (coeff = 0.35 kg, P < or = .01) compared to patients receiving placebo, while patients on rosiglitazone did not (coeff = 0.05 kg, P = .48). Interactions between thymidine analogue use and rosiglitazone and pioglitazone were not significant. CONCLUSIONS In this meta-analysis, pioglitazone therapy was more effective than placebo to increase limb fat mass whereas rosiglitazone was not significantly better than placebo. The effectiveness of these drugs did not vary according to whether the patients were receiving thymidine analogues.
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Nachtigall LB, Valassi E, Lo J, McCarty D, Passeri J, Biller BMK, Miller KK, Utz A, Grinspoon S, Lawson EA, Klibanski A. Gender effects on cardiac valvular function in hyperprolactinaemic patients receiving cabergoline: a retrospective study. Clin Endocrinol (Oxf) 2010; 72:53-8. [PMID: 19508591 DOI: 10.1111/j.1365-2265.2009.03608.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ergot-derived dopamine agonists are associated with increased risk of valvular dysfunction in Parkinson's disease. The risk of valvular disease associated with lower doses of cabergoline used to treat prolactinomas remains controversial. OBJECTIVE To determine whether there is an association of cabergoline and valvular function in patients with hyperprolactinaemia according to gender. DESIGN Case-record retrospective study. SETTING Outpatient neuroendocrine clinical centre at a tertiary care hospital. STUDY PARTICIPANTS One hundred patients (48 men and 52 women) with hyperprolactinaemia who had an echocardiogram while receiving cabergoline for at least 6 months. CONTROLS One hundred controls (48 men and 52 women) selected from Massachusetts general hospital (MGH) database of echocardiograms without clinically significant findings, matched to patients for age, gender, body mass index (BMI) and hypertension. MAIN OUTCOME MEASURE Echocardiogram. RESULTS There were no significant differences in valvular function in patients compared with controls. However, women patients had a higher prevalence of mild tricuspid regurgitation (TR) than female controls (15.4%vs. 1.9%, P = 0.03). Among men only, patients had more trace TR than controls (68.8%vs. 45.8%, P = 0.02). The mild valvular regurgitation in patients was not clinically significant and did not correlate with dose, duration or cumulative dose. CONCLUSIONS Overall cabergoline was not associated with valvulopathy. However, subdivided by gender, hyperprolactinaemic men and women had higher prevalence of trace or mild TR, respectively, compared with gender matched controls. There may be gender differences in valvular dysfunction associated with cabergoline. Longer term, larger studies are necessary to evaluate definitively an effect of cabergoline on valvular function in hyperprolactinaemic patients.
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Affiliation(s)
- Lisa B Nachtigall
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Lo J, You SM, Wei J, Canavan B, Grinspoon S. Relationship of peak growth hormone to cardiovascular parameters, waist circumference, lipids and glucose in HIV-infected patients and healthy adults. Clin Endocrinol (Oxf) 2009; 71:815-22. [PMID: 19508594 PMCID: PMC2889024 DOI: 10.1111/j.1365-2265.2009.03603.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Relative growth hormone (GH) deficiency is highly prevalent in patients with HIV. The purpose of this study was to investigate relationships of GH to metabolic and anthropometric parameters in HIV patients and non-HIV controls. DESIGN Peak GH and metabolic parameters were assessed in a cross-sectional study of 191 HIV patients and 62 age and BMI-matched healthy controls. METHODS Peak GH was assessed by GHRH/arginine stimulation testing. RESULTS HIV patients demonstrated similar BMI, but increased waist circumference (WC) and reduced peak GH to GHRH/arginine compared with control subjects [median = 12.4 (interquartile range: 6.3-24.8) vs. 21.3 (8.8, 34.5) μg/l, P = 0.006, HIV vs. control]. Among HIV and non-HIV groups, peak GH was inversely associated with WC (rho = -0.44, P < 0.0001; rho = -0.63, P < 0.0001; HIV patients and controls, respectively), blood pressure (rho = -0.17, P = 0.02; rho = -0.36, P = 0.004), triglycerides (rho = -0.37, P < 0.0001; rho = -0.43, P = 0.001), glucose (rho = -0.34, P < 0.0001; rho = -0.30, P = 0.02), insulin (rho = -0.43, P < 0.0001; rho = -0.60, P < 0.0001) and CRP (rho= -0.29, P < 0.0001; rho = -0.59, P < 0.0001). Among HIV patients, the inverse association between peak GH and fasting glucose remained significant (β = -0.006 mmol/l change in glucose per μg/l change in GH, P = 0.004) controlling for age, gender, race, BMI, WC, protease inhibitor (PI) and nucleoside reverse transcriptase inhibitors. Similarly, the inverse association between peak GH and triglycerides remained significant (β = -0.01 mmol/l change in triglycerides per μg/l change in GH, P = 0.02) controlling for age, gender, race, BMI, WC, PI and lipid-lowering medications. HIV men with peak GH < 7.5 μg/l demonstrated higher BMI, WC, SBP, triglycerides, glucose and CRP. CONCLUSIONS Reduced GH secretion is independently associated with dyslipidaemia and higher glucose, among HIV patients with abdominal fat accumulation.
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Affiliation(s)
- Janet Lo
- Massachusetts General Hospital, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Makimura H, Wei J, Dolan-Looby SE, Ricchiuti V, Grinspoon S. Retinol-binding protein levels are increased in association with gonadotropin levels in healthy women. Metabolism 2009; 58:479-87. [PMID: 19303967 PMCID: PMC2727279 DOI: 10.1016/j.metabol.2008.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 11/13/2008] [Indexed: 10/21/2022]
Abstract
Recent studies have demonstrated an association between retinol-binding protein (RBP4) and insulin resistance. Retinol-binding protein is decreased in women and elevated in polycystic ovary syndrome. However, prior studies have not investigated the relationship between RBP4, gonadal steroids, and gonadotropins in healthy women. The aim of this study was to determine the RBP4 levels in a cohort of healthy women with a range of body mass indices and glucose tolerances to investigate the relationship between RBP4, gonadotropin levels, and menopausal status. Serum RBP4 levels were measured by enzyme-linked immunosorbent assay and quantitative Western blot in 88 healthy women (aged 24-59 years) from the general community in a cross-sectional study. Retinol-binding protein was higher in postmenopausal compared with premenopausal women (26.1 +/- 2.1 vs 19.3 +/- 0.5 mug/mL, P = .001). In univariate analysis, RBP4 was associated with follicle-stimulating hormone (r = 0.37, P = .0004), luteinizing hormone (r = 0.3, P = .005), and sex hormone-binding globulin (r = -0.24, P = .03) and trended to significance with estradiol (P = .09) but not with free testosterone or dehydroepiandrosterone sulfate. Retinol-binding protein was also associated with insulin at 2 hours during an oral glucose tolerance test (r = 0.24, P = .03) and the area under the curve for insulin during the oral glucose tolerance test (r = 0.26, P = .02). In multivariate regression modeling, both follicle-stimulating hormone (P = .03) and luteinizing hormone (P = .04) remained significantly associated with RBP4 after controlling for estradiol, sex hormone-binding globulin, insulin area under the curve, cholesterol, triglycerides, waist-to-hip ratio, and tumor necrosis factor alpha. Retinol-binding protein was not associated with inflammatory markers or with carotid intima-media thickness. Therefore, RBP4 is higher in postmenopausal women and is associated with gonadotropin concentrations in healthy women.
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Affiliation(s)
- Hideo Makimura
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Grinspoon S. Strategies to augment growth-hormone secretion in obesity. Nat Rev Endocrinol 2009; 5:123. [PMID: 19229227 DOI: 10.1038/ncpendmet1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Makimura H, Stanley T, Mun D, You SM, Grinspoon S. The effects of central adiposity on growth hormone (GH) response to GH-releasing hormone-arginine stimulation testing in men. J Clin Endocrinol Metab 2008; 93:4254-60. [PMID: 18765508 PMCID: PMC2582562 DOI: 10.1210/jc.2008-1333] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The relative contribution of central adiposity vs. weight on GH response to stimulation testing in obesity is not known. OBJECTIVE We aimed to assess the contribution of weight and specific measures of central and peripheral adiposity to GH response to GHRH-arginine testing in lean, overweight, and obese men. DESIGN A total of 75 men [mean age, 44.3+/-1.1 yr; body mass index (BMI), 28.8+/-0.7 kg/m2] were investigated. Subjects were classified as lean (BMI<25 kg/m2; n=23), overweight (BMI>or=25 and <30 kg/m2; n=28), or obese (BMI>or=30 kg/m2; n=24). Subjects were also stratified by waist circumference (WC) (<102 cm, n=47; >or=102 cm, n=28). Body composition and regional adiposity were assessed by anthropometrics, dual-energy x-ray absorptiometry (DEXA), and abdominal computed tomography (CT) scans. RESULTS Peak stimulated GH was 36.4+/-5.4, 16.6+/-2.9, and 7.6+/-0.9 microg/liter among lean, overweight, and obese subjects, respectively (P<0.001 for all comparisons). Peak stimulated GH was 26.9+/-3.4 microg/liter among subjects with WC less than 102 cm compared to 7.9+/-0.9 microg/liter among subjects with WC of 102 cm or greater (P<0.0001). Separate multivariate models using anthropometric, DEXA, and CT-derived measures of central adiposity demonstrated strong associations between peak stimulated GH and measures of central adiposity including WC, trunk fat by DEXA, and visceral adiposity by CT, controlling for age, BMI, and more general measures of adiposity. WC was independently associated with peak GH response to GHRH-arginine in a model including age, BMI, and hip circumference. In this model, BMI was no longer significant, and peak GH was reduced 1.02 microg/liter for each 1 cm increase in WC (P=0.02). CONCLUSIONS GH response to GHRH-arginine testing is reduced in both overweight and obese subjects and negatively associated with indices of central abdominal obesity including WC, trunk fat, and visceral adipose tissue. The use of waist circumference, as a surrogate for central adiposity, adds predictive information to the determination of GH response, independent of BMI.
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Affiliation(s)
- Hideo Makimura
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, LON 211, Boston, Massachusetts 02114, USA.
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Lo J, You SM, Canavan B, Liebau J, Beltrani G, Koutkia P, Hemphill L, Lee H, Grinspoon S. Low-dose physiological growth hormone in patients with HIV and abdominal fat accumulation: a randomized controlled trial. JAMA 2008; 300:509-19. [PMID: 18677023 PMCID: PMC2532757 DOI: 10.1001/jama.300.5.509] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Antiretroviral therapy can be associated with visceral adiposity and metabolic complications, increasing cardiovascular risk, and reduced growth hormone (GH) secretion may be a contributing factor. OBJECTIVE To investigate the effects of low-dose physiological GH administration on body composition, glucose, and cardiovascular parameters in patients with human immunodeficiency virus (HIV) having abdominal fat accumulation and relative GH deficiency. DESIGN, SETTING, AND PATIENTS A randomized, double-blind, placebo-controlled trial of 56 patients with HIV, abdominal fat accumulation, and reduced GH secretion (peak GH <7.5 ng/mL) conducted at a US academic medical center between November 2003 and October 2007. INTERVENTION Patients were randomly assigned to receive either subcutaneous GH or matching placebo titrated to the upper quartile of normal insulinlike growth factor 1 (IGF-1) range for 18 months. Starting dose was 2 microg/kg/d and increased to maximum dose of 6 microg/kg/d (average dose, 0.33 mg/d). MAIN OUTCOME MEASURES Change in body composition assessed by computed tomographic scan and dual-energy x-ray absorptiometry. Secondary outcomes included glucose, IGF-1, blood pressure (BP), and lipids. Treatment effect was the difference in the change between GH and placebo groups, using all available data. RESULTS Fifty-five patients (26 with GH and 29 with placebo) were included in the safety analyses and 52 patients (25 with GH and 27 with placebo) were included in the efficacy analyses. Visceral adipose tissue area (treatment effect [last-value-carried-forward analysis {n = 56}, -19 cm(2); 95% confidence interval {CI}, -37 to -0.3 cm(2)], -19 cm(2); 95% CI, -38 to -0.5 cm(2); P = .049); trunk fat (-0.8 kg; 95% CI, -1.5 to -0.04 kg; P = .04); diastolic BP (-7 mm Hg; 95% CI, -11 to -2 mm Hg; P = .006); and triglycerides (-7 mg/dL, P = .002) improved but 2-hour glucose levels on glucose tolerance testing increased in the GH group vs the placebo group (treatment effect, 22 mg/dL; 95% CI, 6-37 mg/dL; P = .009). The IGF-1 levels increased (treatment effect, 129 ng/mL; 95% CI, 95-164 ng/mL; P < .001). Adverse events were not increased for GH vs placebo (23%; 95% CI, 9%-44% vs 28%; 95% CI, 13%-47%; P = .70). CONCLUSIONS In HIV-associated abdominal fat accumulation and relative GH deficiency, low-dose GH received for 18 months resulted in significantly reduced visceral fat and truncal obesity, triglycerides, and diastolic BP, but 2-hour glucose levels on glucose tolerance testing were increased. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00100698.
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Affiliation(s)
- Janet Lo
- Program in Nutritional Metabolism, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
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Hulgan T, Tebas P, Canter JA, Mulligan K, Haas DW, Dubé M, Grinspoon S, Robbins GK, Motsinger AA, Kallianpur AR. Hemochromatosis gene polymorphisms, mitochondrial haplogroups, and peripheral lipoatrophy during antiretroviral therapy. J Infect Dis 2008; 197:858-66. [PMID: 18419350 DOI: 10.1086/528697] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART)-associated lipoatrophy involves mitochondrial dysfunction. Iron metabolism impacts mitochondrial function and oxidative stress. Mitochondrial haplogroups and hemochromatosis gene (HFE) polymorphisms have been associated with ART-induced neuropathy. We assessed relationships between these variants and lipoatrophy. METHODS The AIDS Clinical Trials Group 384 study randomized ART-naive individuals to receive didanosine-stavudine or zidovudine-lamivudine, combined with efavirenz and/or nelfinavir. Substudy A5005s evaluated fat distribution by dual-energy X-ray absorptiometry (DEXA). We characterized HFE polymorphisms 845G>A and 187C>G and European mitochondrial haplogroups in A5005s participants who consented to genetic analyses. RESULTS Among 96 participants (58% were white, and 10% were female) with baseline and 48 or 64 week DEXA data, the median limb fat change was -8.8% (interquartile range, -28.7% to +15.6%). HFE 187C/G heterozygotes (n = 23) had less limb fat loss than 187C/C homozygotes (n = 71) (+6.1% vs. -12.5%; P = .02) and were less likely to develop lipoatrophy after adjustment for age, sex, race, and ART randomization (odds ratio, 0.31; 95% confidence interval, 0.10-0.95; P = .04). Among non-Hispanic white participants, median limb fat change was +26.1% among 5 participants with mitochondrial haplogroup J, compared with -9.7% among 49 participants with other mitochondrial haplogroups (P = .07). CONCLUSIONS HFE 187C>G and, possibly, mitochondrial haplogroup J gave relative protection against lipoatrophy during ART in A5005s. These associations should be replicated in other studies.
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Affiliation(s)
- Todd Hulgan
- Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee 37203, USA.
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Falutz J, Allas S, Blot K, Potvin D, Kotler D, Somero M, Berger D, Brown S, Richmond G, Fessel J, Turner R, Grinspoon S. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med 2007; 357:2359-70. [PMID: 18057338 DOI: 10.1056/nejmoa072375] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Visceral adipose tissue accumulates during antiretroviral therapy in many patients who are infected with the human immunodeficiency virus (HIV); this process is associated with an increased cardiovascular risk. We assessed the use of a growth hormone-releasing factor analogue, tesamorelin, to decrease visceral adiposity. METHODS We randomly assigned 412 patients with HIV (86% of whom were men) who had an accumulation of abdominal fat to receive a daily subcutaneous injection of either 2 mg of tesamorelin or placebo for 26 weeks. The primary end point was the percent change from baseline in visceral adipose tissue as shown on computed tomography. Secondary end points included triglyceride levels, the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol, the level of insulin-like growth factor I (IGF-I), and self-assessed body image. Glycemic measures included glucose and insulin levels. RESULTS The measure of visceral adipose tissue decreased by 15.2% in the tesamorelin group and increased by 5.0% in the placebo group; the levels of triglycerides decreased by 50 mg per deciliter and increased by 9 mg per deciliter, respectively, and the ratio of total cholesterol to HDL cholesterol decreased by 0.31 and increased by 0.21, respectively (P<0.001 for all comparisons). Levels of total cholesterol and HDL cholesterol also improved significantly in the tesamorelin group. Levels of IGF-I increased by 81.0% in the tesamorelin group and decreased by 5.0% in the placebo group (P<0.001). Adverse events did not differ significantly between the two study groups, but more patients in the tesamorelin group withdrew from the study because of an adverse event. No significant differences were observed in glycemic measures. CONCLUSIONS Daily tesamorelin for 26 weeks decreased visceral fat and improved lipid profiles, effects that might be useful in HIV-infected patients who have treatment-associated central fat accumulation. (ClinicalTrials.gov number, NCT00123253 [ClinicalTrials.gov] .).
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Affiliation(s)
- Julian Falutz
- Montreal General Hospital, McGill University Health Centre, Montreal
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Joy T, Keogh HM, Hadigan C, Lee H, Dolan SE, Fitch K, Liebau J, Lo J, Johnsen S, Hubbard J, Anderson EJ, Grinspoon S. Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era. AIDS 2007; 21:1591-600. [PMID: 17630554 PMCID: PMC4393713 DOI: 10.1097/qad.0b013e32823644ff] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate dietary intake and its relationship to lipid parameters in HIV-infected patients with metabolic abnormalities. METHOD We prospectively determined dietary intake (4-day food records or 24-h recall) in 356 HIV-infected patients and 162 community-derived HIV-negative controls evaluated for metabolic studies between 1998-2005. Differences in dietary intake between HIV-infected patients and non-HIV-infected controls, in relation to the established 2005 USDA (United States Department of Agriculture) Recommended Dietary Guidelines, were determined. The relationship between dietary fat intake and serum lipid levels among HIV-infected individuals was also evaluated. RESULTS Assessment of dietary intake in this group of HIV-infected patients demonstrated increased intake of total dietary fat (P < 0.05), saturated fat (P = 0.006), and cholesterol (P = 0.006) as well as a greater percentage of calories from saturated fat (P = 0.002) and from trans fat (P = 0.02), despite similar caloric intake to the control individuals. A significantly higher percentage of HIV-infected patients were above the 2005 USDA Recommended Dietary Guidelines for saturated fat (> 10%/day) (76.0% HIV vs. 60.9% controls, P = 0.003), and cholesterol (> 300 mg/day) (49.7% HIV vs. 37.9% controls, P = 0.04). Saturated fat intake was strongly associated with triglyceride level [triglyceride level increased 8.7 mg/dl (parameter estimate) per gram of increased saturated fat intake, P = 0.005] whereas total fat was inversely associated with triglyceride level [triglyceride level decreased 3.0 mg/dl (parameter estimate) per gram of increased total fat intake, P = 0.02] among HIV-infected individuals. CONCLUSIONS Increased intake of saturated fat is seen and contributes to hypertriglyceridemia among HIV-infected patients who have developed metabolic abnormalities. Increased saturated fat intake should be targeted for dietary modification in this population.
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Affiliation(s)
- Tisha Joy
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Abstract
Recent studies suggest that bone loss occurs among HIV-infected women. This study examined the effects of reduced androgen levels, changes in weight, body composition, and menstrual dysfunction on bone mineral density (BMD) among 152 HIV-infected women characterized by normal weight (>90% ideal body weight [IBW], n = 124) and low weight (<or=90% IBW, n = 28) compared with 100 non-HIV-infected control subjects. BMD was assessed by dual x-ray absorptiometry, and free testosterone was assessed by equilibrium dialysis. Abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were determined by computed tomography scan. A significant difference was seen in BMD between groups at the lumbar spine (0.92 +/- 0.02 g/cm vs. 1.01 +/- 0.01 g/cm vs. 1.07 +/- 0.01 g/cm; P < 0.0001), total hip (0.84 +/- 0.03 g/cm vs. 0.94 +/- 0.01 g/cm vs. 0.98 +/- 0.01 g/cm; P < 0.0001), and femoral neck (0.73 +/- 0.03 g/cm vs. 0.83 +/- 0.01 g/cm vs. 0.87 +/- 0.01 g/cm; P < 0.0001) (HIV-infected low-weight group, HIV-infected normal-weight group, and non-HIV-infected control subjects, respectively, for each comparison; mean +/- SEM). Among the HIV-infected subjects, lumbar BMD correlated with percent IBW (r = 0.37, P < 0.0001), total body lean mass (r = 0.43, P < 0.0001), total body fat mass (r = 0.35, P < 0.0001), and SAT (r = 0.41, P < 0.0001), but not VAT (r = 0.07, P = 0.417). Clinical risk factors for osteopenia and osteoporosis in the HIV population identified in univariate analysis included low free testosterone (<1.1 pg/mL [lower limit of the normal range of free testosterone for women] or 3.8 pmol/L; P = 0.0007), low weight (P = 0.014), and oligomenorrhea (P = 0.0006). In multivariate regression analysis, lean body mass was most significantly associated with BMD among those with HIV. These data demonstrate that BMD is reduced among HIV-infected women in association with low weight, reduced lean mass, reduced androgen levels, and abnormal menstrual function.
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Affiliation(s)
- Sara E Dolan
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Grinspoon S. Use of thiazolidinediones in HIV-infected patients: what have we learned? J Infect Dis 2007; 195:1731-3. [PMID: 17492586 DOI: 10.1086/518008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 01/09/2007] [Indexed: 11/03/2022] Open
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Mulligan K, Yang Y, Wininger DA, Koletar SL, Parker RA, Alston-Smith BL, Schouten JT, Fielding RA, Basar MT, Grinspoon S. Effects of metformin and rosiglitazone in HIV-infected patients with hyperinsulinemia and elevated waist/hip ratio. AIDS 2007; 21:47-57. [PMID: 17148967 DOI: 10.1097/qad.0b013e328011220e] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effects of metformin and rosiglitazone, alone or in combination, on fat distribution, insulin sensitivity, and lipids in HIV-infected patients with insulin resistance and changes in fat distribution. METHODS A total of 105 subjects were randomly assigned to receive metformin (500 mg twice a day increasing to 1000 mg twice a day after 2 weeks) with rosiglitazone placebo (Met/P, N = 26); rosiglitazone (4 mg/day) with metformin placebo (Rosi/P, N = 27); rosiglitazone (4 mg/day) plus metformin (500 mg twice a day increasing to 1000 mg twice a day after 2 weeks; Met/Rosi, N = 25); or dual placebo (P/P, N = 27) for 16 weeks. Efficacy assessments included oral glucose tolerance testing, abdominal computed tomography, whole-body dual-energy X-ray absorptiometry, and the measurement of fasting lipids and other biochemical indices. Safety was monitored throughout. Intent-to-treat analyses were performed using non-parametric methods. RESULTS The median insulin area under the curve (AUC) decreased significantly compared with baseline in both groups randomly assigned to rosiglitazone (Rosi/P -25.7 microIU/ml, P = 0.012; Met/Rosi -17.7 microIU/ml, P = 0.002); and tended to decrease in the Met/P group (-11.1 microIU/ml, P = 0.058). The change in AUC with combination therapy was significant compared with placebo (P = 0.032). No treatment was associated with significant changes in visceral or subcutaneous abdominal fat. Leg fat increased in subjects on Rosi/P compared with placebo (+4.8 versus -8.3%, P = 0.034). Rosiglitazone, but not metformin, increased adiponectin but also increased LDL-cholesterol and decreased HDL-cholesterol. Gastrointestinal effects occurred frequently in subjects on metformin. CONCLUSION Both treatments improved insulin sensitivity, but neither reduced visceral fat. Rosiglitazone may increase subcutaneous fat in some individuals.
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Affiliation(s)
- Kathleen Mulligan
- University of California at San Francisco, San Francisco General Hospital, San Francisco, California, USA.
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Hadigan C, Liebau J, Torriani M, Andersen R, Grinspoon S. Improved triglycerides and insulin sensitivity with 3 months of acipimox in human immunodeficiency virus-infected patients with hypertriglyceridemia. J Clin Endocrinol Metab 2006; 91:4438-44. [PMID: 16940448 PMCID: PMC3196527 DOI: 10.1210/jc.2006-1174] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Metabolic abnormalities such as hypertriglyceridemia remain a challenge for optimizing long-term health in HIV-infected patients. OBJECTIVE Elevation of free fatty acids (FFAs) may contribute to hyperlipidemia and insulin resistance in HIV. We evaluated the efficacy and safety of chronic inhibition of lipolysis in HIV-infected men and women with hypertrigyceridemia. We hypothesized that acipimox would lead to significant reductions in triglycerides and improved insulin sensitivity, compared with placebo. DESIGN A 3-month, randomized, double-blind, controlled trial of acipimox (250 mg thrice daily) vs. placebo was conducted in 23 HIV-infected men and women with hypertriglyceridemia (>150 mg/dl), abnormal fat distribution, and no current lipid-lowering therapy. The primary outcome variable was triglyceride concentration, and insulin sensitivity measured by hyperinsulinemic euglycemic clamp was a secondary outcome. SETTING The study was conducted at an academic medical center. RESULTS Acipimox resulted in significant reductions in FFAs [mean change -0.38 (0.06) vs. 0.08 (0.06) mEq/liter with placebo, -68 vs. +17% change from mean baseline, P < 0.0001], decreased rates of lipolysis (P < 0.0001), and a median triglyceride decrease from 238 mg/dl at baseline to 190 mg/dl, compared with an increase from 290 to 348 mg/dl in the placebo group (P = 0.01). Acipimox improved insulin sensitivity [acipimox +2.31 (0.74) vs. placebo -0.21 (0.90) mg glucose per kilogram lean body mass per minute, or +31 vs. -2% change from mean baseline values, P = 0.04]. Improvements in insulin sensitivity were significantly correlated with reductions in FFAs (r = -0.62, P = 0.003) and lipolysis (r = -0.59, P = 0.005). CONCLUSIONS Acipimox resulted in significant sustained reductions in lipolysis, improved glucose homeostasis, and significant but modest reductions in triglycerides in HIV-infected individuals with abnormal fat distribution and hypertriglyceridemia. Improvement in overall metabolic profile with acipimox suggests a potential clinical utility for this agent that requires further investigation.
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Affiliation(s)
- Colleen Hadigan
- Program in Nutritional Metabolism, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Dolan SE, Frontera W, Librizzi J, Ljungquist K, Juan S, Dorman R, Cole ME, Kanter JR, Grinspoon S. Effects of a supervised home-based aerobic and progressive resistance training regimen in women infected with human immunodeficiency virus: a randomized trial. ACTA ACUST UNITED AC 2006; 166:1225-31. [PMID: 16772251 PMCID: PMC3205443 DOI: 10.1001/archinte.166.11.1225] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Women infected with human immunodeficiency virus (HIV) increasingly demonstrate abnormalities in fat distribution and metabolism; however, the effects of a home-based exercise regimen in this group have not been investigated. METHODS We conducted a 16-week randomized intervention study of a supervised home-based progressive resistance training and aerobic exercise program in 40 HIV-infected women with increased waist-hip ratio and self-reported fat redistribution. Cross-sectional muscle area and muscle attenuation were measured by computed tomography. Cardiorespiratory fitness was determined by calculated maximum oxygen consumption (VO2max) and strength by 1-repetition maximum. RESULTS Cardiorespiratory fitness (VO2max) was markedly lower at baseline (median [95% confidence interval], 15.4 [8.3-25.2] mL x kg(-1) x min(-1)) than reported values for healthy female subjects (26-35 mL x kg(-1) x min(-1)). Subjects randomized to exercise had significant improvement in mean +/- SEM VO2max (1.5 +/- 0.8 vs -2.5 +/- 1.6 mL x kg(-1) x min(-1); P<.001) and endurance (1.0 +/- 0.3 vs -0.6 +/- 0.3 minute; P<.001). Strength increased at the knee extensors, pectoralis, knee flexors, shoulder abductors, ankle plantar flexors, and elbow flexors (all P<.001). Total muscle area (6 +/- 1 vs 2 +/- 1 cm2; P = .02) and attenuation (2 +/- 1 vs -1 +/- 1 Hounsfield unit; P = .03) increased in the exercise group. No significant difference was seen in lipid levels, blood pressure, or abdominal visceral fat between the groups, but subjects randomized to exercise reported improved energy and appearance. CONCLUSIONS A 16-week, supervised, home-based exercise regimen improved measures of physical fitness in HIV-infected women. The effects on strength were most significant, but improvements in cardiorespiratory fitness, endurance, and body composition were also seen.
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Affiliation(s)
- Sara E Dolan
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital, Boston 02114, USA
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Abstract
OBJECTIVES The objective of the study was to investigate change in bone mineral density (BMD) over time in HIV-infected women in comparison with healthy control subjects similar in age, race, and body mass index (BMI). DESIGN This was a prospective cohort study. METHODS BMD was measured by dual-energy x-ray absorptiometry in 100 HIV-infected females and 100 healthy controls similar in age (41 +/- 1 vs. 41 +/- 1 yr, P = 0.57), BMI (26.1 +/- 0.5 vs. 27.2 +/- 0.4 kg/m(2), P = 0.12), and race (60 vs. 65% non-Caucasian, P = 0.47, HIV-infected vs. controls). Changes in BMD were determined every 6 months over 24 months. RESULTS At baseline, HIV-infected subjects had lower BMD at the lumbar spine (1.01 +/- 0.01 vs. 1.07 +/- 0.01 g/cm(2), P = 0.001), hip (0.94 +/- 0.01 vs. 0.98 +/- 0.01 g/cm(2), P = 0.02), and femoral neck (0.83 +/- 0.01 vs. 0.87 +/- 0.01 g/cm(2), P = 0.02). Historical low weight, duration of nucleoside reverse transcriptase inhibitor use, and FSH were significantly associated with lumbar BMD, whereas duration of HIV, BMI, historical low weight, smoking pack-years, N-telopeptide of type 1 collagen, viral load, 25 hydroxyvitamin D, and osteocalcin were associated with hip BMD at baseline. In mixed model longitudinal analyses, BMD remained lower in HIV-infected subjects than in controls over 24 months of follow-up (P = 0.001 for the spine, P = 0.04 for the hip, and P = 0.02 for the femoral neck). These differences remained significant controlling for age, race, BMI, and menstrual function. In contrast, rates of change for the spine (P = 0.79), hip (P = 0.44), and femoral neck (P = 0.34) were not different between the HIV and control groups over 2 yr. In the HIV group, longitudinal changes in BMD were not associated with current protease inhibitor, nucleoside reverse transcriptase inhibitor, or non-nucleoside reverse transcriptase inhibitor use but were associated with CD4 count, weight, FSH, N-telopeptide of type 1 collagen, and baseline BMD. CONCLUSIONS BMD is reduced at the spine, hip, and femoral neck among women with HIV in relationship to low weight, duration of HIV, smoking, and increased bone turnover. Over 2 yr of follow-up, BMD remained stable but lower in HIV-infected women, compared with control subjects.
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Affiliation(s)
- Sara E Dolan
- Program in Nutritional Metabolism, Massachusetts General Hospital, 55 Fruit Street, LON207, Boston, MA 02114, USA
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Abstract
Adrenal androgen production is reduced in association with disease severity in HIV-infected women. This response may be maladaptive in terms of maintenance of lean body mass, functional status, and immune function. The aim of this study was to assess whether the use of an adrenal enzyme inhibitor of 11beta-hydroxylase might increase androgen production in this population. We conducted a randomized, double-blind, placebo-controlled study of metyrapone (500 mg p.o. qid) or placebo for 2 wk in 10 HIV-infected women with AIDS wasting [weight <90% ideal body weight (IBW) or weight loss >10%] and reduced androgen levels. Basal and ACTH-stimulated androgen, mineralocorticoid, and glucocorticoid levels were measured at baseline and after 14 days of treatment. Subjects were similar in age (40.9 +/- 0.9 yr), weight (91.7 +/- 3.5% IBW) and hormone concentrations at study entry. Total testosterone (84 +/- 54 vs. -0.4 +/- 2 ng/dl, P = 0.024), free testosterone (6.5 +/- 2.8 vs. 0.1 +/- 0.1 pg/ml, P = 0.024), DHEA (5.0 +/- 3.2 vs. -0.6 +/- 0.5 microg/l, P = 0.024), and 11-deoxycortisol (2,145 +/- 820 vs. -14 +/- 22 ng/dl, P = 0.024) levels increased in response to metyrapone compared with placebo treatment. In response to ACTH, significant increases in the DHEA/cortisol ratio (174 +/- 48 vs. 3 +/- 3, P = 0.008) were seen in the metyrapone group compared with placebo. Blood pressure and electrolytes did not change, and signs of adrenal insufficiency were not apparent. These data demonstrate that inhibition of 11beta-hydroxylase with metyrapone increases adrenal androgen secretion in HIV-infected women. Further studies are needed to assess the physiological effects of this strategy to increase anabolic hormone levels in severe stress, including detailed testing to rule out the potential risk of concomitant adrenal insufficiency.
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Affiliation(s)
- Polyxeni Koutkia
- Program in Nutritional Metabolism and Neuroendocrine Unit, Mass General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA
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