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Rodríguez‐Santiago MA, Wojna V, Miranda‐Valentín E, Arnold S, Sepúlveda‐Rivera V. Diagnosing Alzheimer's disease: Which dementia screening test to use in elderly Puerto Ricans with mild cognitive impairment and early Alzheimer's disease? Alzheimers Dement (Amst) 2024; 16:e12554. [PMID: 38454965 PMCID: PMC10918733 DOI: 10.1002/dad2.12554] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 03/09/2024]
Abstract
Typically, Alzheimer's disease (AD) diagnosis is not made at its earliest period, for instance, at mild cognitive impairment (MCI) and early AD (E-AD). Our study aims to demonstrate a correlation between the screening tools, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Clinical Dementia Rating (CDR), and the biological biomarkers in the cerebrospinal fluid (CSF) amyloid beta 1-42 (Aβ42), phosphorylated tau (p-tau) proteins and total tau (t-tau)/Aβ42 ratio in Puerto Ricans > 55 years old with MCI and E-AD. We evaluated 30 participants, including demographics, memory scales, and CSF biomarkers. Twenty-eight CSF biomarkers (Aβ42, p-tau protein, and t-tau/Aβ42 ratio) were analyzed using the Meso Scale Discovery Platform (MSD). Associations between memory scales (MoCA, MMSE, CDR) and CSF markers were performed using Spearman rho correlation. Our study revealed a statistical association favoring a direct relationship between MMSE and MoCA with t-tau/Aβ42 ratio in CSF (P = 0.022, P = 0.035, respectively). We found a trend toward significance with an inverse relationship with MMSE and Aβ42 (P = 0.069) and a direct relationship with MMSE and p-tau (P = 0.098). MMSE and MoCA screening tests were identified with a statistically significant association with the CSF biomarkers, specifically t-tau/Aβ42 ratio, in elderly Puerto Ricans with MCI and E-AD. Puerto Ricans > 55 years old with MCI and E-AD could be screened confidently with MMSE and MoCA for a higher likelihood of earlier detection and, thus, initiation of disease-modifying treatment and prompt non-pharmacological interventions.
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Affiliation(s)
- María A. Rodríguez‐Santiago
- Medical Sciences CampusSchool of MedicineDepartment of Internal MedicineUniversity of Puerto RicoSan JuanPuerto RicoUSA
| | - Valerie Wojna
- Medical Sciences CampusSchool of MedicineDepartment of Internal MedicineUniversity of Puerto RicoSan JuanPuerto RicoUSA
- Medical Sciences CampusSchool of MedicineDepartment of NeurologyUniversity of Puerto RicoSan JuanPuerto RicoUSA
| | - Eric Miranda‐Valentín
- Medical Sciences CampusSchool of MedicineDepartment of Internal MedicineUniversity of Puerto RicoSan JuanPuerto RicoUSA
| | - Steven Arnold
- Department of NeurologyMassachusetts General HospitalWang Ambulatory Care CenterBostonMassachusettsUSA
| | - Vanessa Sepúlveda‐Rivera
- Medical Sciences CampusSchool of MedicineDepartment of Internal MedicineUniversity of Puerto RicoSan JuanPuerto RicoUSA
- Medical Sciences CampusSchool of MedicineDepartment of Internal MedicineGeriatrics DivisionUniversity of Puerto RicoSan JuanPuerto RicoUSA
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Shikuma CM, Wojna V, De Gruttola V, Siriwardhana C, Souza SA, Rodriguez-Benitez RJ, Turner EH, Kallianpur K, Bolzenius J, Chow D, Matos M, Shiramizu B, Clements DM, Premeaux TA, Ndhlovu LC, Paul R. Impact of antiretroviral therapy intensification with C-C motif chemokine receptor 5 antagonist maraviroc on HIV-associated neurocognitive impairment. AIDS 2023; 37:1987-1995. [PMID: 37418541 PMCID: PMC10538417 DOI: 10.1097/qad.0000000000003650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 12/07/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES Chemokine receptor CCR5 is the principal co-receptor for entry of M-tropic HIV virus into immune cells. It is expressed in the central nervous system and may contribute to neuro-inflammation. The CCR5 antagonist maraviroc (MVC) has been suggested to improve HIV-associated neurocognitive impairment (NCI). DESIGN A double-blind, placebo-controlled, 48-week, randomized study of MVC vs. placebo in people with HIV (PWH) on stable antiretroviral therapy (ART) for more than one year in Hawaii and Puerto Rico with plasma HIV RNA less than 50 copies/ml and at least mild NCI defined as an overall or domain-specific neuropsychological z (NPZ) score less than -0.5. METHODS Study participants were randomized 2 : 1 to intensification of ART with MVC vs. placebo. The primary endpoint was change in global and domain-specific NPZ modeled from study entry to week 48. Covariate adjusted treatment comparisons of average changes in cognitive outcome were performed using winsorized NPZ data. Monocyte subset frequencies and chemokine expression as well as plasma biomarker levels were assessed. RESULTS Forty-nine participants were enrolled with 32 individuals randomized to MVC intensification and 17 to placebo. At baseline, worse NPZ scores were seen in the MVC arm. Comparison of 48-week NPZ change by arm revealed no differences except for a modest improvement in the Learning and Memory domain in the MVC arm, which did not survive multiplicity correction. No significant changes between arms were seen in immunologic parameters. CONCLUSION This randomized controlled study found no definitive evidence in favor of MVC intensification among PWH with mild cognitive difficulties.
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Affiliation(s)
- Cecilia M. Shikuma
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Valerie Wojna
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Victor De Gruttola
- Wertheim School of Public Health, University of California San Diego, California
| | | | - Scott A. Souza
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | | | - Emilee H. Turner
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Kalpana Kallianpur
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
- Kamehameha Schools - Kapalama, Honolulu, Hawaii
| | - Jacob Bolzenius
- Missouri Institute of Mental Health, University of Missouri – St. Louis, St. Louis, Missouri
| | - Dominic Chow
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Miriam Matos
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Bruce Shiramizu
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | - Danielle M. Clements
- John A. Burns School of Medicine, University of Hawaii – Manoa, Honolulu, Hawaii
| | | | | | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri – St. Louis, St. Louis, Missouri
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Rodriguez‐Santiago MA, Sepulveda V, Valentin EM, Arnold SE, Jiménez‐Velázquez IZ, Wojna V. Diagnosing Alzheimer Disease: Which Dementia Screening Tool to Use in Elderly Puerto Ricans with Mild Cognitive Impairment and Early Alzheimer Disease? Alzheimers Dement 2022. [DOI: 10.1002/alz.062560] [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: 12/24/2022]
Affiliation(s)
| | | | | | - Steven E. Arnold
- MassGeneral Institute for Neurodegenerative Diseases Charlestown MA USA
| | | | - Valerie Wojna
- University of Puerto Rico, School of Medicine San Juan PR USA
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Wojna V. Neuroinflammation and HIV-Associated Cognitive Impairment: Can They Be Eradicated? Neurology 2022; 99:499-500. [PMID: 35918171 DOI: 10.1212/wnl.0000000000201095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Valerie Wojna
- Division of Neurology, Department of Internal Medicine, University of Puerto Rico, Medical Sciences Campus
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Cantres-Rosario YM, Wojna V, Ruiz R, Diaz B, Matos M, Rodriguez-Benitez RJ, Rodriguez E, Skolasky RL, Gerena Y. Soluble Insulin Receptor Levels in Plasma, Exosomes, and Urine and Its Association With HIV-Associated Neurocognitive Disorders. Front Neurol 2022; 13:809956. [PMID: 35720083 PMCID: PMC9202317 DOI: 10.3389/fneur.2022.809956] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background HIV-associated neurocognitive disorders (HAND) are one of the HIV-associated comorbidities affecting 20-50% of the people with HIV (PWH) infection. We found that the soluble insulin receptor (sIR) levels in plasma and cerebrospinal fluid (CSF) were significantly higher in HIV-infected women. The mechanism of sIR release into the plasma remains unknown, but the detection of the sIR in exosomes may uncover novel mechanisms of sIR secretion from HIV-infected cells and its contribution to HIV disease progression and HAND development. Quantification of sIR in urine may represent a less invasive and more accessible diagnostic tool. Our objective was to quantify sIR levels in plasma, plasma-derived exosomes, and urine, and evaluate their association with HAND and renal function. Methods We measured full-length sIR in the plasma and urine of 38 controls and 76 HIV-infected women by ELISA, and sIR, HIV-1 Tat, and reactive oxygen species (ROS) in exosomes by flow cytometry. Results Plasma and exosomes with sIR were significantly higher in HIV-infected women when compared with controls and HAND. Exosomal sIR positively correlated with exosomal ROS and exosomal HIV-1 Tat in HIV-infected women. Exosomal ROS was significantly higher in HIV-infected women with more symptomatic cognitive impairment. Plasma-derived exosomes exhibited significantly higher levels of astrocyte (GFAP) and neuronal (L1CAM) markers in HIV-infected women, confirming the presence of circulating CNS-derived exosomes in the blood of HIV-infected women. Urine sIR positively correlated with eGFR in controls, but not in HIV-infected women, regardless there was no significant difference in renal function as determined by the estimated glomerular filtration rate (eGFR, p = 0.762). In HIV-infected women, higher plasma sIR correlated with lower urine sIR that could suggest sIR retention in blood or decreased renal filtration. Discussion Higher plasma sIR levels and their correlation with ROS in plasma-derived exosomes with HAND suggest a combined role of metabolic disturbances, oxidative stress, exosome release, and cognitive decline. Communication between CNS and periphery is compromised in PWH, thus plasma-derived exosomes may shed light on disrupted cellular mechanisms in the brain of PWH. High plasma and low urine sIR levels could suggest sIR retention in blood or decreased renal filtration.
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Affiliation(s)
- Yisel M. Cantres-Rosario
- NeuroHIV Research Program, School of Medicine, University of Puerto Rico, San Juan, PR, United States
| | - Valerie Wojna
- Division of Neurology, Internal Medicine Department and NeuroHIV Research Program, School of Medicine, University of Puerto Rico, San Juan, PR, United States
| | - Rafael Ruiz
- NeuroHIV Research Program, School of Medicine, University of Puerto Rico, San Juan, PR, United States
| | - Bexaida Diaz
- NeuroHIV Research Program, School of Medicine, University of Puerto Rico, San Juan, PR, United States
| | - Miriam Matos
- NeuroHIV Research Program, School of Medicine, University of Puerto Rico, San Juan, PR, United States
| | | | - Elaine Rodriguez
- NeuroHIV Research Program, School of Medicine, University of Puerto Rico, San Juan, PR, United States
| | - Richard L. Skolasky
- Orthopaedic Surgery and Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Yamil Gerena
- Department of Pharmacology and Toxicology, School of Medicine, NeuroHIV Research Program, Pharmacology Department, University of Puerto Rico, San Juan, PR, United States
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González-Feliciano JA, Akamine P, Capó-Vélez CM, Delgado-Vélez M, Dussupt V, Krebs SJ, Wojna V, Polonis VR, Baerga-Ortiz A, Lasalde-Dominicci JA. A recombinant gp145 Env glycoprotein from HIV-1 expressed in two different cell lines: Effects on glycosylation and antigenicity. PLoS One 2020; 15:e0231679. [PMID: 32559193 PMCID: PMC7304579 DOI: 10.1371/journal.pone.0231679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/04/2020] [Indexed: 11/18/2022] Open
Abstract
The envelope glycoprotein (Env) of the human immunodeficiency virus (HIV), has been the primary target for the development of a protective vaccine against infection. The extensive N-linked glycosylation on Env is an important consideration as it may affect efficacy, stability, and expression yields. The expression host has been shown to influence the extent and type of glycosylation that decorates the protein target. Here, we report the glycosylation profile of the candidate subtype C immunogen CO6980v0c22 gp145, which is currently in Phase I clinical trials, produced in two different host cells: CHO-K1 and Expi293F. The amino acid sequence for both glycoproteins was confirmed to be identical by peptide mass fingerprinting. However, the isoelectric point of the proteins differed; 4.5–5.5 and 6.0–7.0 for gp145 produced in CHO-K1 and Expi293F, respectively. These differences in pI were eliminated by enzymatic treatment with sialidase, indicating a large difference in the incorporation of sialic acid between hosts. This dramatic difference in the number of sialylated glycans between hosts was confirmed by analysis of PNGase F-released glycans using MALDI-ToF MS. These differences in glycosylation, however, did not greatly translate into differences in antibody recognition. Biosensor assays showed that gp145 produced in CHO-K1 had similar affinity toward the broadly neutralizing antibodies, 2G12 and PG16, as the gp145 produced in Expi293F. Additionally, both immunogens showed the same reactivity against plasma of HIV-infected patients. Taken together, these results support the notion that there are sizeable differences in the glycosylation of Env depending on the expression host. How these differences translate to vaccine efficacy remains unknown.
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Affiliation(s)
| | - Pearl Akamine
- Molecular Sciences Research Center Inc., University of Puerto Rico, San Juan, Puerto Rico
| | - Coral M. Capó-Vélez
- Molecular Sciences Research Center Inc., University of Puerto Rico, San Juan, Puerto Rico
| | - Manuel Delgado-Vélez
- Molecular Sciences Research Center Inc., University of Puerto Rico, San Juan, Puerto Rico
| | - Vincent Dussupt
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Shelly J. Krebs
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Valerie Wojna
- Division of Neurology, Internal Medicine Department and NeuroHIV Research Program, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Victoria R. Polonis
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Abel Baerga-Ortiz
- Molecular Sciences Research Center Inc., University of Puerto Rico, San Juan, Puerto Rico
- Department of Biochemistry, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- * E-mail: (ABO); (JALD)
| | - José A. Lasalde-Dominicci
- Molecular Sciences Research Center Inc., University of Puerto Rico, San Juan, Puerto Rico
- Department of Biology, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico
- * E-mail: (ABO); (JALD)
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Rodriguez-Benitez RJ, Muriel F, Rivera-Aviles A, Matos M, Wojna V. Preliminary Neuropsychological Normative Data in a Healthy Sample of Puerto Rican Women. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.39] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Accurate diagnosis of neuropsychological (NP) impairment in Spanish-speaking Latinx women is limited by a lack of appropriate norms. While multiple normative datasets have emerged for Mexican/Mexican-American populations, there is a particular dearth of normative options for Puerto Rican women. This study collected normative data in a sample of Spanish-speaking healthy women in Puerto Rico (PR).
Participants and Method
The sample consisted of 63 healthy, HIV-seronegative women recruited as comparison participants in a longitudinal HIV-seropositive Latinx Women Cohort study at the University of Puerto Rico during 2002-2017. The NP battery included measures from seven cognitive domains: verbal fluency, executive functioning, processing speed, learning, memory, sensory, perceptual, and motor skills.
Results
The sample’s age ranged from 20-77 years (M = 42.14; SD = 12.71) and education ranged from 9-18 years (M = 13.74; SD = 2.09). The NP test M and SD raw score results were: Trail Making A (M = 41.29; SD = 14.87), Trail Making B (M = 105.14; SD = 49.77), Grooved Pegs Dominant Hand (M = 78.49; SD = 31.91), Stroop Word/Color (M = 47.86; SD = 23.66), Rey Verbal Learning Test Total (M = 42.0; SD = 9.36), Verbal Fluency FAS-F (M = 11.27; SD = 4.20), FAS-A (M = 12.05; SD=4.34), FAS-S (M = 10.67; SD = 4.19), Digit Span (M = 12.16; SD = 3.28), Spatial Span (M = 10.95; SD = 3.62), Benton Judgment of Line Orientation Test (M = 18.10; SD = 5.54), Finger Tapping Left (M = 50.58; SD = 7.78), Finger Tapping Right (M = 53.87; SD = 8.83), Seashore Rhythm Test (M = 23.38; SD = 3.99), and Rey Complex Figure Test Immediate (M = 13.17; SD = 6.99) and Delay (M = 13.58; SD = 7.21). The NP norms were stratified by age (10-year increments and 60+) and education (< 12 years and 12+ years).
Conclusions
This preliminary study provides initial normative data from a sample of healthy women living in PR, which can improve NP diagnostic accuracy for this population. This is particularly important given that this population experiences worse health outcomes compared to other Latinx subpopulations.
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Ramirez-Marrero FA, Amalbert-Birriel MA, Santana-Bagur JL, Wojna V, Frontera W. Mechanical Efficiency After High Intensity Interval Training In Hiv+ Hispanic Women. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562104.95940.de] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gerena Y, Menéndez-Delmestre R, Delgado-Nieves A, Vélez J, Méndez-Álvarez J, Sierra-Pagan JE, Skolasky RL, Henderson L, Nath A, Wojna V. Release of Soluble Insulin Receptor From Neurons by Cerebrospinal Fluid From Patients With Neurocognitive Dysfunction and HIV Infection. Front Neurol 2019; 10:285. [PMID: 30972014 PMCID: PMC6443904 DOI: 10.3389/fneur.2019.00285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/20/2018] [Accepted: 03/05/2019] [Indexed: 01/03/2023] Open
Abstract
Previously, we found that high levels of soluble insulin receptor (sIR) in the cerebrospinal fluid (CSF) of an HIV-infected women cohort were associated with the presence and severity of HIV-associated neurocognitive disorders (HAND). In this study we investigated if CSF from this population, HIV-1 Tat, and selected cytokines induces sIR secretion from human neuronal cells. Twenty-three (23) HIV-seropositive women stratified by cognitive status and five HIV- seronegative women were evaluated. Soluble IR levels were measured in the extracellular medium of neuronal cells (SH-SY5Y) that were exposed (for 24 h) to the CSF of patients. The levels of sIR, HIV-1 Tat, and cytokine levels (IL-2, IL4, IL-6, IFNγ, TNFα, and IL-10) were quantified in the CSF of participants by ELISA and flow cytometry. Neuronal secretion of sIR was measured after exposure (24 h) to HIV-1 Tat (0.5–250 nM), or specific cytokines. The effects of TNFα and HIV-1 Tat on sIR secretion were also evaluated in the presence of R7050 (TNFα antagonist; 10 nM). Neurons exposed to the CSF of HIV-infected women had higher sIR levels according to the severity of neurocognitive impairment of the participant. Increased CSF sIR levels were associated with the presence and severity of HAND and were positively correlated with CSF HIV-1 Tat levels in HIV-infected women with cognitive impairment. CSF levels of IL-2, IFNγ, and TNFα were significantly increased with HAND. However, only TNFα (5 pg/mL) and HIV-1 Tat (100 nM) induced a significant increase in neuronal sIR secretion after 24 h exposure, an effect that was antagonized when each were combined with R7050. Our data suggests that TNFα and HIV-1 Tat from the CSF of HIV-infected women may regulate the secretion of sIR from neuronal cells and that the effect of HIV-1 Tat on sIR secretion may depend on TNFα receptor activation.
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Affiliation(s)
- Yamil Gerena
- NeuroHIV Research Program, Department of Pharmacology and Toxicology, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | - Raissa Menéndez-Delmestre
- NeuroHIV Research Program, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | - Andrea Delgado-Nieves
- NeuroHIV Research Program, Department of Pharmacology and Toxicology, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | - Joyce Vélez
- NeuroHIV Research Program, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | | | - Javier E Sierra-Pagan
- NeuroHIV Research Program, Department of Pharmacology and Toxicology, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Lisa Henderson
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Valerie Wojna
- NeuroHIV Research Program, Division of Neurology, Internal Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
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Wojna V. ZIKA VIRUS - The Puerto Rican Experience. P R Health Sci J 2018; 37:S3-S4. [PMID: 30576571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Zika has been one of the most devastating new emerging viruses epidemic due to its effects on the nervous system mostly newborns. It was an unexpected epidemic that jeopardized our population and those with the appropriate environment for the virus to replicate, the tropics. It took us by surprise and challenged our health system. When it arrived in Puerto Rico in December 2015 many questions were raised regarding how the clinical manifestations of the infection will affect our population. Although most of infections go on asymptomatic it was not clear how our population heavily infected with other arboviruses such as dengue and chikungunya will alter the clinical and neurological manifestations of Zika. Other questions regarding our health system preparedness to attend to such an epidemic was questioned. We hope that these experiences will aid in the establishment of procedures to deal with similar epidemics in the future and help to gain a better understanding of the acute and chronic effects of the infection in the clinical manifestations and possible management of the infection in a clinical and public health manner. Puerto Rico possess a special position in the Caribbean and can serve to spearhead the establishment of procedures to detect, treat, and study the effects of these new emerging virus epidemics. Thereby establishing the needed programs to attend to other similar epidemics.
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Affiliation(s)
- Valerie Wojna
- Editor-in-Chief, Professor of Neurology, PI NeuroAIDS Program, University of Puerto Rico Medical Sciences Campus
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Oda R, Shiramizu B, Agsalda-Garcia M, Kettlewell J, Wojna V. In Vitro Blood-Brain Barrier Modeling adapted for Peripheral Blood Mononuclear Cell Transmigration from HIV-Positive Patients for Clinical Research on Therapeutic Drug Intervention. P R Health Sci J 2018; 37:155-159. [PMID: 30188559 PMCID: PMC6129984] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE HIV-associated cognitive impairment (HACI) continues to persist for HIV-seropositive individuals who are on antiretroviral therapy (ART). HACI develops in part when HIV-infected monocytes (MOs) transmigrate through the blood-brain barrier (BBB) and secrete pro-inflammatory cytokines and chemokines, which leads to neuronal damage. In vitro BBB models are important tools that can elucidate mechanisms of MO transmigration. Previously described in vitro BBB models relied on pathology specimens, resulting in potentially variable and inconsistent results. This project reports on a reliable and consistent alternative in vitro BBB model that has the potential to be used in clinical research intervention studies analyzing the effects of ART on the BBB and on MO transmigration. METHODS A bilayer BBB model was established with commercially available astrocytes and endothelial cells on a 3μm PET membrane insert to allow the contact of astrocytic foot processes with endothelial cells. Inserts were cultured in growth medium for 7 days before exposure to HIV- or HIV+ peripheral blood mononuclear cells (PBMCs). PBMCs were allowed to transmigrate across the BBB for 24 hours. RESULTS Confluency and integrity measurements by trans-endothelial electrical resistance (TEER) (136.7 ± 18.3Ω/cm2) and permeability (5.64 ± 2.20%) verified the integrity of the in vitro BBB model. Transmigrated MOs and non-MOs were collected and counted (6.0x104 MOs; 1.1x105 non-MOs). Markers indicative of glial fibrillary acidic protein (GFAP), von Willebrand factor (vWF), and p-glycoprotein (Pgp) were revealed in immunofluorescence staining (IF), indicating BBB phenotype and functionality. CONCLUSION Potential applications for this model include assessing the HIV DNA copy numbers of transmigrated cells (pre- and post-targeted ART) and understanding the role of oxidative stress related to HIV DNA and HACI.
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Affiliation(s)
- Robert Oda
- Department of Molecular Biosciences & Bioengineering, College of Tropical Agriculture and Human Resources, Honolulu, Hawaii
| | - Bruce Shiramizu
- Department of Tropical Medicine, Medical Microbiology & Pharmacology; John A. Burns School of Medicine; University of Hawaii, Honolulu, Hawaii
| | - Melissa Agsalda-Garcia
- Department of Tropical Medicine, Medical Microbiology & Pharmacology; John A. Burns School of Medicine; University of Hawaii, Honolulu, Hawaii
| | - Joanna Kettlewell
- Department of Tropical Medicine, Medical Microbiology & Pharmacology; John A. Burns School of Medicine; University of Hawaii, Honolulu, Hawaii
| | - Valerie Wojna
- Department of Medicine, Neurology Division, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Romero-Reyes A, Ramirez-Marrero FA, Amalbert-Birriel M, Medina-Encarnacion A, Santana-Bagur J, Frontera W, Wojna V. Feasibility Of A Low Volume HIIT Intervention In HIV+ Hispanic Women With Neurocognitive Impairment. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536663.83324.d9] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ramirez-Marrero FA, Frontera W, Santana-Bagur J, Wojna V. Considering Cardiorespiratory Fitness Relative to Lean Body Mass in HIV+ compared with HIV- Hispanic Women. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536258.35964.46] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cantres-Rosario YM, Acevedo-Mariani FM, Pérez-Laspiur J, Haskins WE, Plaud M, Cantres-Rosario YM, Skolasky R, Méndez-Bermúdez I, Wojna V, Meléndez LM. Microwave & magnetic proteomics of macrophages from patients with HIV-associated cognitive impairment. PLoS One 2017; 12:e0181779. [PMID: 28746408 PMCID: PMC5528838 DOI: 10.1371/journal.pone.0181779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 07/06/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE HIV-infected monocytes can infiltrate the blood brain barrier as differentiated macrophages to the central nervous system, becoming the primary source of viral and cellular neurotoxins. The final outcome is HIV-associated cognitive impairment (HACI), which remain prevalent today, possibly due to the longer life-span of the patients treated with combined anti-retroviral therapy. Our main goal was to characterize the proteome of monocyte-derived macrophages (MDM) from HACI patients, and its association with their cognitive status, to find novel targets for therapy. METHODS MDM were isolated from the peripheral blood of 14 HIV-seropositive women characterized for neurocognitive function, including: four normal cognition (NC), five asymptomatic (A), and five with cognitive impaired (CI). Proteins from macrophage lysates were isobaric-labeled with the microwave and magnetic (M2) sample preparation method followed by liquid chromatography-tandem mass spectrometry-based protein identification and quantification. Differences in protein abundance across groups classified by HACI status were determined using analysis of variance. RESULTS A total of 2,519 proteins were identified with 2 or more peptides and 28 proteins were quantified as differentially expressed. Statistical analysis revealed increased abundance of 17 proteins in patients with HACI (p<0.05), including several enzymes associated to the glucose metabolism. Western blot confirmed increased expression of 6-Phosphogluconate dehydrogenase and L-Plastin in A and CI patients over NC and HIV seronegatives. CONCLUSIONS This is the first quantitative proteomics study exploring the changes in protein abundance of macrophages isolated from patients with HACI. Further studies are warranted to determine if these proteins may be target candidates for therapy development against HACI.
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Affiliation(s)
- Yisel M. Cantres-Rosario
- Department of Microbiology and Medical Zoology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Juliana Pérez-Laspiur
- RCMI Translational Proteomics Center, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Marines Plaud
- RCMI Translational Proteomics Center, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Yadira M. Cantres-Rosario
- RCMI Translational Proteomics Center, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Richard Skolasky
- John Hopkins University, Department of Orthopedic Surgery, Baltimore, Maryland, United States of America
| | - Israel Méndez-Bermúdez
- Department of Biostatistics and Epidemiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Valerie Wojna
- Department of Medicine, Neurology Division, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Loyda M. Meléndez
- Department of Microbiology and Medical Zoology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- RCMI Translational Proteomics Center, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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15
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Jimenez-Torres GJ, Wojna V, Rosario E, Hechevarría R, Alemán-Batista AM, Matos MR, Madan A, Skolasky RL, Acevedo SF. Assessing health-related resiliency in HIV+ Latin women: Preliminary psychometric findings. PLoS One 2017; 12:e0181253. [PMID: 28723939 PMCID: PMC5517021 DOI: 10.1371/journal.pone.0181253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 06/28/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV-associated vulnerabilities-especially those linked to psychological issues-and limited mental health-treatment resources have the potential to adversely affect the health statuses of individuals. The concept of resilience has been introduced in the literature to shift the emphasis from vulnerability to protective factors. Resilience, however, is an evolving construct and is measured in various ways, though rarely among underserved, minority populations. Herein, we present the preliminary psychometric properties of a sample of HIV-seropositive Puerto Rican women, measured using a newly developed health-related resilience scale. METHODS AND DESIGN The Resilience Scales for Children and Adolescents, an instrument with solid test construction properties, acted as a model in the development (in both English and Spanish) of the HRRS, providing the same dimensions and most of the same subscales. The present sample was nested within the Hispanic-Latino longitudinal cohort of women (HLLC), that is part of the NeuroAIDS Research Program at the University of Puerto Rico (UPR), Medical Sciences Campus (MSC). Forty-five consecutively recruited, HIV+ women from the HLLC completed a demographic survey, the HRRS, and the Beck Depression Inventory-I, Spanish version. RESULTS The results demonstrate excellent overall internal consistency for the total HRRS score (α = 0.95). Each of the dimensional scores also evidenced acceptable internal consistency (α ≥ 0.88). All the dimensional and subscale content validity indices were above the 0.42 cut-off. Analysis revealed a significant negative correlation between the HRRS total score and BDI-I-S (r(45) = -0.453, p < 0.003). CONCLUSION Albeit preliminary in nature, the present study provides support for the HRRS as a measure to assess resilience among individuals living with chronic medical conditions. Minority populations, especially non-English speaking ones, are understudied across the field of medicine, and when efforts are made to include these patient groups, measurement is rarely tailored to their unique cultural and linguistic experiences. The HRRS is a measure that addresses these notable voids in the medical literature.
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Affiliation(s)
- Gladys J. Jimenez-Torres
- The Menninger Clinic, Houston, TX, United States of America
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States of America
- Psychology Department, Ponce School of Medicine and Health Sciences, Ponce, PR, United States of America
| | - Valerie Wojna
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
- Department of Internal Medicine, Neurology Division, University of Puerto Rico, San Juan, PR, United States of America
| | - Ernesto Rosario
- Psychology Department, Ponce School of Medicine and Health Sciences, Ponce, PR, United States of America
| | - Rosa Hechevarría
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
- Physical Medicine and Rehabilitation, University of Puerto Rico, San Juan, PR, United States of America
| | - Ada M. Alemán-Batista
- School of Health Professions, University of Puerto Rico, San Juan, PR, United States of America
| | - Miriam Ríos Matos
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
| | - Alok Madan
- The Menninger Clinic, Houston, TX, United States of America
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States of America
| | - Richard L. Skolasky
- School of Health Professions, University of Puerto Rico, San Juan, PR, United States of America
- Department of Orthopedic Surgery and Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, United States of America
| | - Summer F. Acevedo
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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16
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Sepulveda V, Arnold SE, Jimenez‐Velazquez IZ, Wojna V. [P4–477]: ARE INSULIN RESISTANCE AND CEREBROSPINAL FLUID BIOMARKERS CORRELATED IN PUERTO RICANS WITH MINIMAL COGNITIVE IMPAIRMENT AND EARLY ALZHEIMER's DISEASE? Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.638] [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: 10/18/2022]
Affiliation(s)
- Vanessa Sepulveda
- University of Puerto Rico, School of MedicineSan JuanPuerto RicoUSA
- Massachusetts General HospitalCharlestownMAUSA
| | - Steven E. Arnold
- University of Puerto Rico, School of MedicineSan JuanPuerto RicoUSA
| | | | - Valerie Wojna
- University of Puerto Rico, School of MedicineSan JuanPuerto RicoUSA
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17
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Salinas JL, Major CG, Pastula DM, Dirlikov E, Styczynski A, Luciano CA, Wojna V, Sharp TM, Sejvar JJ, Rivera-Garcia B. Incidence and clinical characteristics of Guillain-Barré syndrome before the introduction of Zika virus in Puerto Rico. J Neurol Sci 2017; 377:102-106. [PMID: 28477675 DOI: 10.1016/j.jns.2017.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Zika virus has been associated with increases in Guillain-Barré syndrome (GBS) incidence. A GBS incidence estimation and clinical description was performed to assess baseline GBS epidemiology before the introduction of Zika virus in Puerto Rico. METHODS Hospitalization administrative data from an island-wide insurance claims database and U.S. Census Bureau population estimates provided a crude GBS incidence for 2013. This estimate was adjusted using the proportion of GBS cases meeting Brighton criteria for confirmed GBS from nine reference hospitals. Characteristics of confirmed GBS cases in the same nine hospitals during 2012-2015 are described. RESULTS A total of 136 GBS hospitalization claims were filed in 2013 (crude GBS incidence was 3.8 per 100,000 population). The adjusted GBS incidence was 1.7 per 100,000 population. Of 67 confirmed GBS cases during 2012-2015, 66% had an antecedent illness. Median time from antecedent illness to GBS onset was 7days. Most cases (67%) occurred during July-September. CONCLUSIONS Puerto Rico's GBS incidence for 2013 was estimated using a combination of administrative data and medical records review; this method could be employed in other regions to monitor GBS incidence before and after the introduction of GBS infectious triggers.
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Affiliation(s)
| | - Chelsea G Major
- Office for State, Tribal, Local, and Territorial Support, CDC, Atlanta, Georgia
| | - Daniel M Pastula
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia; University of Colorado Denver, Aurora, CO, United States
| | - Emilio Dirlikov
- Epidemic Intelligence Service, CDC, Atlanta, Georgia; Puerto Rico Department of Health, San Juan, Puerto Rico
| | | | | | | | - Tyler M Sharp
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - James J Sejvar
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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18
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Joseph J, Cinque P, Colosi D, Dravid A, Ene L, Fox H, Gabuzda D, Gisslen M, Beth Joseph S, Letendre S, Mukerji SS, Nath A, Perez-Valero I, Persaud D, Price RW, Rao VR, Sacktor N, Swanstrom R, Winston A, Wojna V, Wright E, Spudich S. Highlights of the Global HIV-1 CSF Escape Consortium Meeting, 9 June 2016, Bethesda, MD, USA. J Virus Erad 2016; 2:243-250. [PMID: 27781109 PMCID: PMC5075354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
CSF HIV escape is a recently recognised phenomenon that suggests that despite suppressive treatment, HIV RNA may be detected in the CNS compartment in some individuals. In rare cases this is associated with clinical neurological disease, while in most cases, neurological consequences are not apparent. Attempts at characterising the biological substrates of CSF escape and further investigating the neurological consequences need to be made to better understand the implications of this condition for the HIV cure agenda as well as for clinical outcomes. The Global CSF HIV-1 Escape Consortium meeting, convened by the US National Institute of Mental Health, was a first step to gather investigators from diverse sites to discuss opportunities for future collaborative work on this emerging issue. To better understand CSF HIV escape and allow cross-site data reconciliation, it will be useful to reach a consensus set of definitions of the distinct forms of CSF escape, without which concerted cross-site efforts are difficult.
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Affiliation(s)
- Jeymohan Joseph
- Division of AIDS Research,
National Institute of Mental Health, National Institutes of Health,
Bethesda,
MD,
USA,Corresponding author: Jeymohan Joseph, Chief,
HIV Neuropathogenesis, Genetics and Therapeutics Branch, Division of AIDS Research,
National Institute of Mental Health,
Room 9G20, MSC 9831, 5601 Fishers Lane,
Bethesda,
MD20892-9830,
USA.
| | - Paola Cinque
- Department of Infectious Diseases,
IRCCS San Raffaele Scientific Institute,
Milan,
Italy
| | - Deborah Colosi
- Division of AIDS Research,
National Institute of Mental Health, National Institutes of Health,
Bethesda,
MD,
USA
| | - Ameet Dravid
- Department of HIV Medicine,
Ruby Hall Clinic,
Pune,
India
| | - Luminita Ene
- Department of Infectious Diseases,
‘Dr Victor Babes’ Hospital for Infectious and Tropical Diseases,
Bucharest,
Romania
| | - Howard Fox
- Department of Pharmacology and Experimental Neuroscience,
University of Nebraska Medical Center,
Omaha,
NE,
USA
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology,
Dana-Farber Cancer Institute,
Boston,
MA,
USA
| | - Magnus Gisslen
- Department of Infectious Diseases,
Sahlgrenska Academy,
University of Gothenburg,
Gothenburg,
Sweden
| | - Sarah Beth Joseph
- Department of Microbiology and Immunology,
University of North Carolina at Chapel Hill,
Chapel Hill,
NC,
USA
| | - Scott Letendre
- Department of Medicine,
University of California,
San Diego,
CA,
USA
| | - Shibani S. Mukerji
- Department of Cancer Immunology and Virology,
Dana-Farber Cancer Institute,
Boston,
MA,
USA,Department of Neurology,
Massachusetts General Hospital,
Boston,
MA,
USA
| | - Avindra Nath
- Section of Infections of the Nervous System,
National Institute of Neurological Diseases and Stroke,
National Institutes of Health,
Bethesda,
MD,
USA
| | - Ignacio Perez-Valero
- Department of Internal Medicine – HIV Unit,
Hospital La Paz-IdiPAZ,
Madrid,
Spain
| | - Deborah Persaud
- Johns Hopkins University School of Medicine & Bloomberg School of Public Health,
Baltimore,
MD,
USA
| | - Richard W. Price
- Department of Neurology,
University of California,
San Francisco,
CA,
USA
| | - Vasudev R. Rao
- Division of AIDS Research,
National Institute of Mental Health, National Institutes of Health,
Bethesda,
MD,
USA
| | - Ned Sacktor
- Department of Neurology,
Johns Hopkins University,
Baltimore,
MD,
USA
| | - Ronald Swanstrom
- Department of Microbiology and Immunology,
University of North Carolina at Chapel Hill,
Chapel Hill,
NC,
USA
| | - Alan Winston
- Division of Infectious Diseases,
Imperial College London,
London,
UK
| | - Valerie Wojna
- Division of Neurology,
University of Puerto Rico-Medical Sciences Campus,
San Juan,
PR,
USA
| | - Edwina Wright
- Department of Infectious Diseases,
Alfred Health,
Melbourne,
Australia
| | - Serena Spudich
- Department of Neurology,
Yale University,
New Haven,
CT,
USA
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19
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Wojna V. The PRHSJ goes Green: What does it Mean? P R Health Sci J 2015; 34:181. [PMID: 26710363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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20
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Colon K, Perez-Laspiur J, Quiles R, Rodriguez Y, Wojna V, Shaffer SA, Leszyk J, Skolasky RL, Melendez LM. Macrophage secretome from women with HIV-associated neurocognitive disorders. Proteomics Clin Appl 2015. [PMID: 26220577 DOI: 10.1002/prca.201400203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 02/05/2023]
Abstract
PURPOSE Thirty to 50% of HIV patients develop HIV-associated neurocognitive disorders (HANDs) despite combined antiretroviral therapy. HIV-1-infected macrophages release viral and cellular proteins that induce neuronal degeneration and death. We hypothesize that changes in the macrophage secretome of HIV-1 seropositive patients with HAND may dissect proteins related to neurotoxicity. EXPERIMENTAL DESIGN Monocyte-derived macrophages (MDMs) were isolated from the peripheral blood of 12 HIV+ and four HIV- women characterized for neurocognitive function. Serum-free MDM supernatants were collected for protein isolation and quantification with iTRAQ® labeling. Protein identification was performed using a LTQ Orbitrap Velos mass spectrometer and validated in MDM supernatants and in plasma using ELISA. RESULTS Three proteins were different between normal cognition (NC) and asymptomatic neurocognitive disorders (ANI), six between NC and HIV-associated dementia (HAD), and six between NC and HAD. Among these, S100A9 was decreased in plasma from patients with ANI, and metalloproteinase 9 was decreased in the plasma of all HIV+ patients regardless of cognitive status, and was significantly reduced in supernatant of MDM isolated from patients with ANI. CONCLUSIONS AND CLINICAL RELEVANCE S100A9 and metalloproteinase 9 have been associated with inflammation and cognitive impairment, and therefore represent potential targets for HAND treatment.
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Affiliation(s)
- Krystal Colon
- Department of Microbiology, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Juliana Perez-Laspiur
- RCMI Translational Proteomics Center, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Raymond Quiles
- Metropolitan Campus, Interamerican University, San Juan, PR, USA
| | - Yolanda Rodriguez
- Department of Microbiology, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Valerie Wojna
- Division of Neurology, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Scott A Shaffer
- Proteomics and Mass Spectrometry Facility, Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA, USA
| | - John Leszyk
- Proteomics and Mass Spectrometry Facility, Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, John Hopkins University, Baltimore, MD, USA
| | - Loyda M Melendez
- Department of Microbiology, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA.,RCMI Translational Proteomics Center, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
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21
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Gerena Y, Menéndez-Delmestre R, Skolasky RL, Hechavarria RM, Pérez S, Hilera C, González C, Nath A, Wojna V. Soluble insulin receptor as a source of insulin resistance and cognitive impairment in HIV-seropositive women. J Neurovirol 2015; 21:113-9. [PMID: 25604495 DOI: 10.1007/s13365-014-0310-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] [Received: 11/10/2014] [Revised: 12/08/2014] [Accepted: 12/22/2014] [Indexed: 01/06/2023]
Abstract
Insulin resistance occurs in HIV-infected individuals and is associated with HIV-associated neurocognitive disorders (HAND). However, the mechanisms involved are not well understood. Previously, we showed a correlation between soluble insulin receptor (sIR) and HAND. Here, we investigated if binding of free insulin to sIR and soluble insulin-like growth factor-1 receptor (sIGF1-R) levels are associated with sIR in HAND. Thirty-four (34) HIV-seropositive women stratified by cognitive status and five HIV-seronegative women were evaluated. In a subgroup of 20 HIV positive and 5 donors, binding of plasma insulin to sIR was determined by ELISA assay of residual insulin levels in plasma immuno-depleted with anti-IR-monoclonal antibody-Sepharose beads. sIR and sIGF1-R levels were determined by ELISA. Nonparametric statistics were used. Higher percentages of insulin bound to sIR significantly correlated with sIR levels and were associated with HAND status. Higher levels of plasma sIGF1-R had a positive correlation with sIR levels (p = 0.011) and were associated with HAND (p = 0.006). No correlations were observed with age, viral-immune profile, antiretroviral therapy, or TNF. This study suggests that changes in sIGF1-R levels and insulin binding to sIR may contribute to HAND.
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Affiliation(s)
- Yamil Gerena
- Department of Pharmaceutical Sciences, School of Pharmacy and NeuroAIDS Program, Specialized Neuroscience Research Program (SNRP), University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936-5067, USA
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22
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Vázquez-Santiago F, García Y, Rivera-Román I, Noel RJ, Wojna V, Meléndez LM, Rivera-Amill V. Longitudinal Analysis of Cerebrospinal Fluid and Plasma HIV-1 Envelope Sequences Isolated From a Single Donor with HIV Asymptomatic Neurocognitive Impairment. ACTA ACUST UNITED AC 2015; 4. [PMID: 26167513 DOI: 10.4172/2324-8955.1000135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 12/24/2022]
Abstract
OBJECTIVE Combined antiretroviral treatment (cART) has changed the clinical presentation of HIV-associated neurocognitive disorders (HAND) to that of the milder forms of the disease. Asymptomatic neurocognitive impairment (ANI) is now more prevalent and is associated with increased morbidity and mortality risk in HIV-1-infected people. HIV-1 envelope (env) genetic heterogeneity has been detected within the central nervous system (CNS) of individuals with ANI. Changes within env determine co-receptor use, cellular tropism, and neuropathogenesis. We hypothesize that compartmental changes are associated with HIV-1 env C2V4 during ANI and sought to analyze paired HIV-1 env sequences from plasma and cerebrospinal fluid (CSF) of a female subject undergoing long-term cART. METHODS Paired plasma and CSF samples were collected at 12-month intervals and HIV-1 env C2V4 was cloned and sequenced. RESULTS Phylogenetic analysis of paired samples consistently showed genetic variants unique to the CSF. Phenotypic prediction showed CCR5 (R5) variants for all CSF-derived sequences and showed minor X4 variants (or dual-tropic) in the plasma at later time points. Viral compartmentalization was evident throughout the study, suggesting that the occurrence of distinctive env strains may contribute to the neuropathogenesis of HAND. CONCLUSIONS Our study provides new insights about the genetic characteristics within the C2V4 of HIV-1 env that persist after long-term cART and during the course of persistent ANI.
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Affiliation(s)
- Fabián Vázquez-Santiago
- Department of Microbiology, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
| | - Yashira García
- Department of Microbiology, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
| | - Ivelisse Rivera-Román
- Department of Microbiology, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
| | - Richard J Noel
- Department of Biochemistry, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
| | - Valerie Wojna
- Specialized NeuroAIDS Program, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, 00936, USA ; Department of Internal Medicine, Neurology Division, University of Puerto Rico-Medical Sciences Campus, San Juan, PR 00936, USA
| | - Loyda M Meléndez
- Specialized NeuroAIDS Program, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, 00936, USA ; Department of Microbiology and Medical Zoology, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, 00936, USA
| | - Vanessa Rivera-Amill
- Department of Microbiology, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
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23
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Colón K, Vázquez-Santiago F, Rivera-Amill V, Delgado G, Massey SE, Wojna V, Noel RJ, Meléndez LM. HIV gp120 sequence variability associated with HAND in Hispanic Women. J Virol Antivir Res 2015; 4. [PMID: 27358904 DOI: 10.4172/2324-8955.1000143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE HIV-1 variants with different tropisms are associated with various neuropathologies. This study intends to determine if this correlation is determined by unique viral env sequences. We hypothesize that HIV-1 envelope gene sequence changes are associated with cognition status. METHODS Viral RNA was extracted from peripheral blood mononuclear cells (PBMCs) co-cultures derived from HIV-1 infected Hispanic women that had been characterized for HIV associated neurocognitive disorders (HAND). RESULTS Analyses of the C2V4 region of HIV gp120 demonstrated that increased sequence diversity correlates with cognition status as sequences derived from subjects with normal cognition exhibited less diversity than sequences derived from subjects with cognitive impairment. In addition, differences in V3 and V4 loop charges were also noted as well as differences in the N-glycosylation of the V4 region. CONCLUSIONS Our data suggest that the genetic signature within the C2V4 region may contribute to the pathogenesis of HAND. HIV env sequence characteristics for the isolates grouped in milder forms of HAND can provide insightful information of prognostic value to assess neurocognitive status in HIV+ subjects, particularly during the era of highly prevalent milder forms of HAND.
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Affiliation(s)
- Krystal Colón
- Department of Microbiology and Medical Zoology, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - Fabián Vázquez-Santiago
- Department of Basic Sciences, Microbiology Division, Ponce Health Sciences University-School of Medicine, Ponce Research Institute, Ponce PR
| | - Vanessa Rivera-Amill
- Department of Basic Sciences, Microbiology Division, Ponce Health Sciences University-School of Medicine, Ponce Research Institute, Ponce PR
| | | | | | - Valerie Wojna
- Specialized NeuroAIDS Program, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, 00936, USA; Department of Internal Medicine, Neurology Division, University of Puerto Rico-Medical Sciences Campus, San Juan, PR 00936, USA
| | - Richard J Noel
- Department of Basic Sciences, Biochemistry Division, Ponce Health Sciences University-School of Medicine, Ponce Research Institute, Ponce PR
| | - Loyda M Meléndez
- Department of Microbiology and Medical Zoology, University of Puerto Rico Medical Sciences Campus, San Juan, PR
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Agsalda-Garcia M, Shiramizu B, Melendez L, Plaud M, Liang CY, Wojna V. Different levels of HIV DNA copy numbers in cerebrospinal fluid cellular subsets. J Health Care Poor Underserved 2014; 24:8-16. [PMID: 24241256 DOI: 10.1353/hpu.2014.0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Inequities in the incidence of HIV infection and AIDS with continued persistence of HIV-associated neurocognitive disorders (HAND) exist in populations in Hawaii (HI) and Puerto Rico (PR). We previously reported that peripheral monocyte HIV DNA levels are high in patients in Hawaii with HAND and we now hypothesize that similar findings would be observed in the cerebrospinal fluid (CSF) cellular subsets. Cerebrospinal fluid cells were obtained from patients from PR and HI undergoing neurocognitive testing and sorted into monocytes (CD14+) and lymphocytes (CD14-) and HIV DNA was measured. From six PR subjects (three HAND, three normal cognition, NC) and six HI subjects (three HAND, three NC), HIV DNA burden in CD14+ cells was higher in HAND than NC patients; NC patients had higher HIV DNA burden in CD14-cells versus HAND. Differences in HIV DNA burden in particular CSF cellular subsets suggest that HIV DNA burden may play a role in HAND neuropathogenesis.
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Victorson D, Cavazos JE, Holmes GL, Reder AT, Wojna V, Nowinski C, Miller D, Buono S, Mueller A, Moy C, Cella D. Validity of the Neurology Quality-of-Life (Neuro-QoL) measurement system in adult epilepsy. Epilepsy Behav 2014; 31:77-84. [PMID: 24361767 PMCID: PMC3970783 DOI: 10.1016/j.yebeh.2013.11.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/05/2013] [Accepted: 11/09/2013] [Indexed: 11/26/2022]
Abstract
Epilepsy is a chronic neurological disorder that results in recurring seizures and can have a significant adverse effect on health-related quality of life (HRQL). The Neuro-QoL measurement initiative is an NINDS-funded system of patient-reported outcome measures for neurology clinical research, which was designed to provide a precise and standardized way to measure HRQL in epilepsy and other neurological disorders. Using mixed-method and item response theory-based approaches, we developed generic item banks and targeted scales for adults and children with major neurological disorders. This paper provides empirical results from a clinical validation study with a sample of adults diagnosed with epilepsy. One hundred twenty-one people diagnosed with epilepsy participated, the majority of which were male (62%) and Caucasian (95%), with a mean age of 47.3 (SD=16.9). Baseline assessments included Neuro-QoL short forms and general and external validity measures. The Neuro-QoL short forms that are not typically found in other epilepsy-specific HRQL instruments include Stigma, Sleep Disturbance, Emotional and Behavioral Dyscontrol, and Positive Affect and Well-Being. Neurology Quality-of-Life short forms demonstrated adequate reliability (internal consistency range=.86-.96; test-retest range=.57-.89). Pearson correlations (p<.01) between Neuro-QoL forms of emotional distress (anxiety, depression, stigma) and the QOLIE-31 Emotional Well-Being subscale were in the moderate-to-strong range (r's=.66, .71 and .53, respectively), as were relations with the PROMIS Global Mental Health subscale (r's=.59, .74 and .52, respectively). Moderate correlations were observed between Neuro-QoL Social Role Performance and Satisfaction and the QOLIE-31 Social Function (r's=.58 and .52, respectively). In measuring aspects of physical function, the Neuro-QoL Mobility and Upper Extremity forms demonstrated moderate associations with the PROMIS Global Physical Function subscale (r's=.60 and .61, respectively). Neuro-QoL measures of perceived cognitive function (executive function and general concerns) produced moderate-to-strong correlations with the QOLIE-31 Cognition subscale (r's=.65 and .75, respectively) and moderate relations with the Liverpool Adverse Events Profile (r's=.51 and .69, respectively). Finally, the Neuro-QoL Fatigue measure demonstrated moderate associations with the QOLIE-31 Energy/Fatigue subscale (r=-.65), Liverpool Adverse Events Profile (r=.69), and the Liverpool Seizure Severity Scale (r=.50). Five Neuro-QoL short forms demonstrated statistically significant responsiveness to change at 5-7months, including Fatigue, Sleep Disturbance, Depression, Positive Affect and Well-Being, and Emotional and Behavioral Dyscontrol. Overall, Neuro-QoL instruments showed good evidence for internal consistency, test-retest reliability, convergent validity, and responsiveness to change over several months. These results support the validity of Neuro-QoL to measure HRQL in adults with epilepsy.
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Affiliation(s)
- David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jose E Cavazos
- Department of Neurology, University of Texas Health Science Center, San Antonio, TX, USA.
| | - Gregory L Holmes
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA.
| | - Anthony T Reder
- Department of Neurology, University of Chicago, Chicago, IL, USA.
| | - Valerie Wojna
- Division of Neurology, Department of Internal Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA.
| | - Cindy Nowinski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Deborah Miller
- Mellen Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Sarah Buono
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Allison Mueller
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Claudia Moy
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Bandaru VVR, Mielke MM, Sacktor N, McArthur JC, Grant I, Letendre S, Chang L, Wojna V, Pardo C, Calabresi P, Munsaka S, Haughey NJ. A lipid storage-like disorder contributes to cognitive decline in HIV-infected subjects. Neurology 2013; 81:1492-9. [PMID: 24027056 DOI: 10.1212/wnl.0b013e3182a9565e] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE In this multicenter cohort study, we sought to identify prognostic and associative metabolic indicators for HIV-associated neurocognitive disorders (HAND). METHODS A quantitative lipidomic analysis was conducted on 524 longitudinal CSF samples collected from 7 different performance sites across the mainland United States, Hawaii, and Puerto Rico. Subjects included HIV-infected individuals with longitudinal clinical and cognitive testing data and cognitively normal HIV-negative healthy controls. RESULTS At baseline, HIV+ subjects could be differentiated from HIV- controls by reductions in a single ceramide species and increases in multiple forms of cholesterol. Perturbations in cholesterol metabolism and ceramide were influenced by combined antiretroviral therapy (cART) use. There were no cross-sectional baseline differences in any lipid metabolite when HIV+ subjects were grouped according to cognitive status. However, a single sphingolipid metabolite and reduced levels of esterified cholesterols were prognostic indicators of incident cognitive decline. Longitudinal patterns of these disturbances in sphingolipid and sterol metabolism suggest that a progressive disorder of lipid metabolism that is similar to disorders of lipid storage may contribute to the pathogenesis of HAND. CONCLUSIONS These findings suggest that HIV infection and cART are independently associated with a CNS metabolic disturbance, identify surrogate markers that are prognostic for cognitive decline, and implicate a lipid storage-like disorder in the progression of HAND.
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Affiliation(s)
- Veera Venkata Ratnam Bandaru
- From the Department of Neurology, Division of Neuroimmunology and Neurological Infections (V.V.R.B., N.S., J.C.M., C.P., P.C., N.J.H.), and the Department of Psychiatry (N.J.H.), The Johns Hopkins University, School of Medicine, Baltimore, MD; the Department of Health Sciences Research (M.M.M.), Division of Epidemiology, The Mayo Clinic, Rochester, MN; HIV Neurobehavioral Research Program and Department of Psychiatry (I.G., S.L.), School of Medicine, University of California, San Diego, La Jolla; the Department of Psychiatry (L.C., S.M.), University of Hawaii, John A. Burns School of Medicine, Honolulu; and the Department of Neurology (V.W.), Specialized Neurosciences Research Program, University of Puerto Rico Medical Sciences Campus, San Juan
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Delgado M, Baez C, Gerena Y, Quesada O, Santiago L, Wojna V, Melendez L, Silva W, Lasalde‐Dominicci J. HIV‐1 gp120 confers a pro‐inflammatory phenotype to macrophages changing the role of the alpha7 acetylcholine receptor. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.lb491] [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: 11/11/2022]
Affiliation(s)
- Manuel Delgado
- BiologyUniversity of Puerto RicoRio PiedrasSan JuanPuerto Rico
| | - Carlos Baez
- BiologyUniversity of Puerto RicoRio PiedrasSan JuanPuerto Rico
| | - Yamil Gerena
- School of PharmacyDepartment of Pharmaceutical Sciences Medical Sciences CampusSan JuanPR
| | - Orestes Quesada
- Department of Physical SciencesUniversity of Puerto RicoRio PiedrasSan JuanPuerto Rico
| | - Laura Santiago
- BiologyUniversity of Puerto RicoRio PiedrasSan JuanPuerto Rico
| | - Valerie Wojna
- Department of Internal MedicineUniversity of Puerto Rico, Medical Science CampusSan JuanPuerto Rico
| | - Loyda Melendez
- Department of Microbiology and Medical ZoologyUniversity of Puerto Rico, Medical Sciences CampusSan JuanPuerto Rico
| | - Walter Silva
- Department of PhysiologyUniversity of Puerto Rico, Medical Sciences CampusSan JuanPuerto Rico
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Morales D, Acevedo SF, Skolasky RL, Hechavarria R, Santiago S, De La Torre T, Maldonado E, Wojna V. Translational spatial task and its relationship to HIV-associated neurocognitive disorders and apolipoprotein E in HIV-seropositive women. J Neurovirol 2012; 18:488-502. [PMID: 22972599 DOI: 10.1007/s13365-012-0128-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/26/2012] [Accepted: 08/24/2012] [Indexed: 11/26/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) continue to be a neurological complication of HIV infection in the era of combined antiretroviral therapy. Hippocampal neurodegeneration and dysfunction occurs as a result of HIV infection, but few studies to date have assesses spatial learning and memory function in patients with HAND. We used the Memory Island (MI) test to study the effects of HIV infection, apolipoprotein E (ApoE) allele status, and cerebral spinal fluid (CSF) ApoE protein levels on spatial learning and memory in our cohort of Hispanic women. The MI test is a virtual reality-based computer program that tests spatial learning and memory and was designed to resemble the Morris Water Maze test of hippocampal function widely used in rodent studies. In the current study, HIV-seropositive women (n = 20) and controls (n = 16) were evaluated with neuropsychological (NP) tests, the MI test, ApoE, and CSF ApoE assays. On the MI, the HIV-seropositive group showed significant reduced learning and delayed memory performance compared with HIV-seronegative controls. When stratified by cognitive performance on NP tests, the HIV-seropositive, cognitively impaired group performed worse than HIV-seronegative controls in ability to learn and in the delayed memory trial. Interestingly, differences were observed in the results obtained by the NP tests and the MI test for ε4 carriers and noncarriers: NP tests showed effects of the ε4 allele in HIV-seronegative women but not HIV-seropositive ones, whereas the converse was true for the MI test. Our findings suggest that the MI test is sensitive in detecting spatial deficits in HIV-seropositive women and that these deficits may arise relatively early in the course of HAND.
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Affiliation(s)
- Diana Morales
- Department of Physiology, Pharmacology, and Toxicology, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico
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Gerena Y, Skolasky RL, Velez JM, Toro-Nieves D, Mayo R, Nath A, Wojna V. Soluble and cell-associated insulin receptor dysfunction correlates with severity of HAND in HIV-infected women. PLoS One 2012; 7:e37358. [PMID: 22629383 PMCID: PMC3358319 DOI: 10.1371/journal.pone.0037358] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/19/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Blood sugar metabolism abnormalities have been identified in HIV-infected individuals and associated with HIV-associated neurocognitive disorders (HAND). These abnormalities may occur as a result of chronic HIV infection, long-term use of combined antiretroviral treatment (CART), aging, genetic predisposition, or a combination of these factors, and may increase morbidity and mortality in this population. OBJECTIVE To determine if changes in soluble and cell-associated insulin receptor (IR) levels, IR substrate-1 (IRS-1) levels, and IRS-1 tyrosine phosphorylation are associated with the presence and severity of HAND in a cohort of HIV-seropositive women. METHODS AND RESULTS This is a retrospective cross-sectional study using patient database information and stored samples from 34 HIV-seropositive women and 10 controls without history of diabetes from the Hispanic-Latino Longitudinal Cohort of Women. Soluble IR subunits [sIR, ectodomain (α) and full-length or intact (αβ)] were assayed in plasma and CSF samples by ELISA. Membrane IR levels, IRS-1 levels, and IRS-1 tyrosine phosphorylation were analyzed in CSF white cell pellets (WCP) using flow cytometry. HIV-seropositive women had significantly increased levels of intact or full-length sIR in plasma (p<0.001) and CSF (p<0.005) relative to controls. Stratified by HAND, increased levels of full-length sIR in plasma were associated with the presence (p<0.001) and severity (p<0.005) of HAND. A significant decrease in IRS-1 tyrosine-phosphorylation in the WCP was also associated with the presence (p<0.02) and severity (p<0.02) of HAND. CONCLUSIONS This study provides evidence that IR secretion is increased in HIV-seropositive women, and increased IR secretion is associated with cognitive impairment in these women. Thus, IR dysfunction may have a role in the progression of HAND and could represent a biomarker for the presence and severity of HAND.
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Affiliation(s)
- Yamil Gerena
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
- School of Pharmacy, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Richard L. Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joyce M. Velez
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Dianedis Toro-Nieves
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Raul Mayo
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
- Departments of Physical Medicine and Rehabilitation, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Valerie Wojna
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
- Internal Medicine Neurology Division, University of Puerto Rico, San Juan, Puerto Rico, United States of America
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Cella D, Lai JS, Nowinski CJ, Victorson D, Peterman A, Miller D, Bethoux F, Heinemann A, Rubin S, Cavazos JE, Reder AT, Sufit R, Simuni T, Holmes GL, Siderowf A, Wojna V, Bode R, McKinney N, Podrabsky T, Wortman K, Choi S, Gershon R, Rothrock N, Moy C. Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology. Neurology 2012; 78:1860-7. [PMID: 22573626 DOI: 10.1212/wnl.0b013e318258f744] [Citation(s) in RCA: 429] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To address the need for brief, reliable, valid, and standardized quality of life (QOL) assessment applicable across neurologic conditions. METHODS Drawing from larger calibrated item banks, we developed short measures (8-9 items each) of 13 different QOL domains across physical, mental, and social health and evaluated their validity and reliability. Three samples were utilized during short form development: general population (Internet-based, n = 2,113); clinical panel (Internet-based, n = 553); and clinical outpatient (clinic-based, n = 581). All short forms are expressed as T scores with a mean of 50 and SD of 10. RESULTS Internal consistency (Cronbach α) of the 13 short forms ranged from 0.85 to 0.97. Correlations between short form and full-length item bank scores ranged from 0.88 to 0.99 (0.82-0.96 after removing common items from banks). Online respondents were asked whether they had any of 19 different chronic health conditions, and whether or not those reported conditions interfered with ability to function normally. All short forms, across physical, mental, and social health, were able to separate people who reported no health condition from those who reported 1-2 or 3 or more. In addition, scores on all 13 domains were worse for people who acknowledged being limited by the health conditions they reported, compared to those who reported conditions but were not limited by them. CONCLUSION These 13 brief measures of self-reported QOL are reliable and show preliminary evidence of concurrent validity inasmuch as they differentiate people based upon number of reported health conditions and whether those reported conditions impede normal function.
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Affiliation(s)
- D Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Wojna V, Curry T, Haughey N, Bandaru V, Skolasky R, Hachavarria R, Mayo R, Bryant C, Anderson C, Fernandez M, Velez J, Nath A. Gonadal Hormone Dysfunction Modulates CSF Oxidative Stress Markers in HIV-Seropositive Women with Cognitive Impairment (S37.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s37.002] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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De Jesus-Acosta C, Rosado N, Hechavarria R, San Miguel L, Serrano L, Nath A, Wojna V. Thinning of Retinal Nerve Fiber Layer Is Associated with Neurocognitive Impairment in HIV Infected Women (P01.263). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kraft-Terry S, Gerena Y, Wojna V, Plaud-Valentin M, Rodriguez Y, Ciborowski P, Mayo R, Skolasky R, Gendelman HE, Meléndez LM. Proteomic analyses of monocytes obtained from Hispanic women with HIV-associated dementia show depressed antioxidants. Proteomics Clin Appl 2011; 4:706-14. [PMID: 21137088 DOI: 10.1002/prca.201000010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Monocyte ingress into the brain during progressive human immunodeficiency virus (HIV-1) infection parallels the severity of cognitive impairments. Although activated monocyte phenotypes emerge in disease, the functional correlates of these cells remain unresolved. EXPERIMENTAL DESIGN To this end, we studied the proteome of blood-derived monocytes obtained from Hispanic women with the most severe form of HIV-associated neurocognitive disorders, HIV-associated dementia (HAD). Monocytes isolated from peripheral blood mononuclear cells by CD14+ immunoaffinity column chromatography were >95% pure. Cells were recovered from four patients without evidence of cognitive impairment and five with HAD and analyzed by 2-D DIGE and tandem MS. RESULTS Importantly, ADP ribosylhydrolase, myeloperoxidase, thioredoxin, peroxiredoxin 3, NADPH, and GTPase-activating protein were all downregulated in HAD. In regards to myeloperoxidase, thioredoxin, and peroxiredoxin 3, these changes were validated in an additional cohort of 30 patients by flow cytometry. CONCLUSIONS AND CLINICAL RELEVANCE We conclude that deficits in monocyte antioxidants lead to neuronal damage through the loss of hydrogen peroxide scavenging capabilities; thus exposing neurons to apoptosis-inducing factors. Altered monocyte functions therefore may contribute to the development and progression of cognitive impairment.
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Affiliation(s)
- Stephanie Kraft-Terry
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
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Kraft-Terry S, Gerena Y, Wojna V, Plaud-Valentin M, Rodriguez Y, Ciborowski P, Mayo R, Skolasky R, Gendelman HE, Meléndez LM. Erratum: Proteomic analyses of monocytes obtained from Hispanic women with HIV-associated dementia show depressed antioxidants. Proteomics Clin Appl 2010. [DOI: 10.1002/prca.201090096] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Oquendo-Jiménez I, Mena R, Antoun MD, Wojna V. Linguistic adaptation of the clinical dementia rating scale for a Spanish-speaking population: a focus group approach. P R Health Sci J 2010; 29:102-108. [PMID: 20496524 PMCID: PMC3498396] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common form of dementia worldwide. In Hispanic populations there are few validated tests for the accurate identification and diagnosis of AD. The Clinical Dementia Rating (CDR) scale is an internationally recognized questionnaire used to stage dementia. This study's objective was to develop a linguistic adaptation of the CDR for the Puerto Rican population. METHODS The linguistic adaptation consisted of the evaluation of each CDR question (item) and the questionnaire's instructions, for similarities in meaning (semantic equivalence), relevance of content (content equivalence), and appropriateness of the questionnaire's format and measuring technique (technical equivalence). A focus group methodology was used to assess cultural relevance, clarity, and suitability of the measuring technique in the Argentinean version of the CDR for use in a Puerto Rican population. RESULTS A total of 27 semantic equivalence changes were recommended in four categories: higher than 6th grade level of reading, meaning, common use, and word preference. Four content equivalence changes were identified, all focused on improving the applicability of the test questions to the general population's concept of street addresses and common dietary choices. There were no recommendations for changes in the assessment of technical equivalence. CONCLUSIONS We developed a linguistically adapted CDR instrument for the Puerto Rican population, preserving the semantic, content, and technical equivalences of the original version. Further studies are needed to validate the usefulness of the adapted CDR instrument with the staging of Alzheimer's disease in the Puerto Rican population.
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Affiliation(s)
- Ilia Oquendo-Jiménez
- School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan.
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Hidalgo MB, Rodríguez E, Wojna V. Atypical presentation of basilar artery thrombosis due to hypercoagulable state and incidental patent foramen ovale: a case report. Bol Asoc Med P R 2010; 102:54-57. [PMID: 20939207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This is a case presentation of a 31 year old woman without history of any systemic illness and on her second pregnancy. Three days after an elective cesarean delivery without complications presented with neurological deficits mainly difficulty talking that progressed to aphasia, dizziness, and loss of vision. Neuro-images showed several ischemic areas in the brain. A magnetic resonance angiogram revealed a thrombus in the basilar artery. A transesophageal echocardiogram demonstrated a patent foramen ovale (PFO). The early recognition and diagnosis of PFO is crucial in preventing long-term complications.
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Affiliation(s)
- Marie Bernadine Hidalgo
- St. Lukes Episcopal Hospital - Ponce School of Medicine Consortium, P.O. BOX 7004 Ponce, PR 00732.
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Toro-Nieves DM, Rodriguez Y, Plaud M, Ciborowski P, Duan F, Pérez Laspiur J, Wojna V, Meléndez LM. Proteomic analyses of monocyte-derived macrophages infected with human immunodeficiency virus type 1 primary isolates from Hispanic women with and without cognitive impairment. J Neurovirol 2008; 15:36-50. [PMID: 19115125 DOI: 10.1080/13550280802385505] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The signature for human immunodeficiency virus type 1 (HIV-1) neurovirulence remains a subject of intense debate. Macrophage viral tropism is one prerequisite but others, including virus-induced alterations in innate and adaptive immunity, remain under investigation. HIV-1-infected mononuclear phagocytes (MPs; perivascular macrophages and microglia) secrete toxins that affect neurons. The authors hypothesize that neurovirulent HIV-1 variants affect the MP proteome by inducing a signature of neurotoxic proteins and thus affect cognitive function. To test this hypothesis, HIV-1 isolates obtained from peripheral blood of women with normal cognition (NC) were compared to isolates obtained from women with cognitive impairment (CI) and to the laboratory adapted SF162, a spinal fluid R5 isolate from a patient with HIV-1-associated dementia. HIV-1 isolates were used to infect monocyte-derived macrophages (MDMs) and infection monitored by secreted HIV-1 p24 by enzyme-linked immunosorbent assay (ELISA). Cell lysates of uninfected and HIV-1-infected MDMs at 14 days post infection were fractionated by cationic exchange chromatography and analyzed by surface enhanced laser desorption ionization time of flight (SELDI-TOF) using generalized estimating equations statistics. Proteins were separated by one-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis (1D SDS-PAGE) and identified by tandem mass spectrometry. Levels of viral replication were similar amongst the HIV-1 isolates, although higher levels were obtained from one viral strain obtained from a patient with CI. Significant differences were found in protein profiles between virus-infected MDMs with NC, CI, and SF162 isolates (adjusted P value after multiple testing corrections, or q value <.10). The authors identified 6 unique proteins in NC, 7 in SF162, and 20 in CI. Three proteins were common to SF162 and CI strains. The MDM proteins linked to infection with CI strains were related to apoptosis, chemotaxis, inflammation, and redox metabolism. These findings support the hypothesis that the macrophage proteome differ when infected with viral isolates of women with and without CI.
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Affiliation(s)
- D M Toro-Nieves
- Department of Microbiology and Medical Zoology, Specialized Neurosciences Research Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Velázquez I, Plaud M, Wojna V, Skolasky R, Laspiur JP, Meléndez LM. Antioxidant enzyme dysfunction in monocytes and CSF of Hispanic women with HIV-associated cognitive impairment. J Neuroimmunol 2008; 206:106-11. [PMID: 19101040 DOI: 10.1016/j.jneuroim.2008.10.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 10/30/2008] [Accepted: 10/31/2008] [Indexed: 10/21/2022]
Abstract
HIV-associated cognitive neurological disorders (HAND) prevail in the antiretroviral therapy era. Proteomics analysis of CSF revealed expression of Cu/Zn superoxide dismutase (Cu/Zn SOD) in Hispanic women with cognitive impairment (CI). We tested the hypothesis that there is reduced capacity of antioxidant enzymes in CI by measures of expression and activity of Cu/Zn SOD, catalase, and Se-glutathione peroxidase in HAND. Our results showed that the function of these antioxidants was decreased in the CSF and monocytes of women with CI. These findings have important implications regarding their possible contribution to oxidative stress and in the diagnosis and therapy for HAND.
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Affiliation(s)
- Ixane Velázquez
- Department of Microbiology and Medical Zoology, University of Puerto Rico Medical Sciences Campus, Biomedical Building I, Suite 310, San Juan, 00935, Puerto Rico
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Laspiur JP, Anderson ER, Ciborowski P, Wojna V, Rozek W, Duan F, Mayo R, Rodríguez E, Plaud-Valentín M, Rodríguez-Orengo J, Gendelman HE, Meléndez LM. Erratum to “CSF proteomic fingerprints for HIV-associated cognitive impairment”. J Neuroimmunol 2008. [DOI: 10.1016/j.jneuroim.2008.07.009] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wojna V, Robles L, Skolasky RL, Mayo R, Selnes O, de la Torre T, Maldonado E, Nath A, Meléndez LM, Lasalde-Dominicci J. Associations of cigarette smoking with viral immune and cognitive function in human immunodeficiency virus-seropositive women. J Neurovirol 2008; 13:561-8. [PMID: 18097887 DOI: 10.1080/13550280701620747] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cigarette smoking alters the immune system and may improve cognitive deficits in neuropsychiatric disorders. Smoking prevalence is high in human immunodeficiency virus (HIV)-infected patients; however, its effect on HIV-associated cognitive impairment remains unknown in the era of antiretroviral treatment. The authors examined associations of smoking with viral immune profile and cognitive function in a cohort of HIV-seropositive women. This observational cross-sectional study included 56 women (36 HIV-seropositive and 20 HIV-seronegative) surveyed with a tobacco questionnaire: the Fagerström Test for Nicotine Dependency. Viral immune status was obtained 6 to 12 months before questioned. Neurocognitive testing (NP) assessed verbal memory, frontal/executive function, psychomotor speed, and motor speed. A reference group of HIV-seronegative women was used to calculate standardized z-scores. Cognitive impairment was classified using a modified American Academy of Neurology criteria, adding an asymptomatic group based on NP tests. Statistics included parametric and nonparametric tests. HIV-seropositive women were more likely to report a history of smoking (P = 0.028). Among them, current smoking correlated with higher plasma viral load (P = 0.048), and history of smoking correlated with lower CD4 cell count (P = 0.027). The authors observed no associations between cognitive impairment and either current or past history of smoking and no differences in neurocognitive domain scores between HIV-seropositive and -seronegative women or between those with and without a history of smoking. However, restricting analysis to HIV-seropositives showed a significant better performance on the frontal/executive domain in those with history of smoking. In summary, history of smoking correlated with better frontal/executive cognitive domain performance in HIV-seropositive women and with worse viral immune profile.
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Affiliation(s)
- Valerie Wojna
- NeuroAIDS Program, University of Puerto Rico, San Juan, Puerto Rico.
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Wojna V, Skolasky R, McArthur J, Maldonado E, Hechavarria R, Mayo R, Selnes O, Ginebra T, de la Torre T, Garcia H, Kraiselburd E, Melendez-Guerrero L, Zorrilla C, Nath A. Spanish validation of the HIV dementia scale in women. AIDS Patient Care STDS 2007; 21:930-41. [PMID: 18154490 DOI: 10.1089/apc.2006.0180] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV infection is increasing in minority groups, particularly in African American and Hispanic women. Although the incidence of HIV dementia has decreased since the advent of highly active antiretroviral treatment, prevalence of neurocognitive complications has increased as patients are now living longer. This study's purpose was to determine the psychometric properties of the Spanish-language HIV Dementia Scale (HDS) in a group of HIV-infected women. We recruited 96 women: 60 HIV-seropositive and 36 HIV-seronegative. Modification of the HDS into a Spanish-language version consisted of translating the instructions, substituting four words in Spanish (gato, media, azul, piña), increasing 1 second in the psychomotor speed because the Spanish alphabet has more letters than the English alphabet, and not offering clues for memory recall. Cognitive impairment (CI) was defined according to the modified American Academy of Neurology HIV-dementia criteria including an asymptomatic CI group. Statistical analysis consisted of analysis of variance to determine group differences and receiver operator characteristics (ROC) to determine the optimal cutoff point for the screening of CI. HDS-Spanish total score and subscores for psychomotor speed and memory recall showed significant differences between HIV-seronegative and women with HIV-dementia (p < 0.001) and between HIV-seropositive women with normal cognition and those with HIV-dementia (p < 0.001). The optimal cutoff point of 13 or less had performance characteristics of 87% sensitivity and 46% specificity for HIV-associated CI (50.0% positive predictive value, 85.0% negative predictive value). The HDS-Spanish translation offers a useful screening tool with value for the identification of Hispanic women at risk of developing HIV-associated symptomatic neurocognitive disturbances.
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Affiliation(s)
- V. Wojna
- NeuroAIDS SNRP, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- Neurology Section, Department of Internal Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - R.L. Skolasky
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, Maryland
| | - J.C. McArthur
- Neurology Department, Johns Hopkins University, Baltimore, Maryland
| | - E. Maldonado
- NeuroAIDS SNRP, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - R. Hechavarria
- NeuroAIDS SNRP, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - R. Mayo
- NeuroAIDS SNRP, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - O. Selnes
- Neurology Department, Johns Hopkins University, Baltimore, Maryland
| | - T. Ginebra
- NeuroAIDS SNRP, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - T. de la Torre
- NeuroAIDS SNRP, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - H. Garcia
- Center of Sexually Transmitted Diseases, San Juan, Puerto Rico
| | - E. Kraiselburd
- NeuroAIDS SNRP, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - L.M. Melendez-Guerrero
- NeuroAIDS SNRP, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - C.D. Zorrilla
- Maternal Infant Studies Center, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - A. Nath
- Neurology Department, Johns Hopkins University, Baltimore, Maryland
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Nieves DMT, Plaud M, Wojna V, Skolasky R, Meléndez LM. Characterization of peripheral blood human immunodeficiency virus isolates from Hispanic women with cognitive impairment. J Neurovirol 2007; 13:315-27. [PMID: 17849315 PMCID: PMC2925199 DOI: 10.1080/13550280701361508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 10/22/2022]
Abstract
Human immunodeficiency virus type 1 (HIV-1) tropism plays an important role in HIV-associated dementia. In this study, aimed at determining if the tropism and coreceptor usage of circulating viruses correlates with cognitive function, the authors isolated and characterized HIV from the peripheral blood of 21 Hispanic women using antiretroviral therapy. Macrophage tropism was determined by inoculation of HIV isolates onto monocyte-derived macrophages and lymphocyte cultures. To define coreceptor usage, the HIV isolates were inoculated onto the U87.CD4 glioma cell lines with specific CCR5 and CXCR4 coreceptors. HIV isolates from cognitively impaired patients showed higher levels of replication in mitogen-stimulated peripheral blood mononuclear cells than did isolates from patients with normal cognition (P < .05). The viral growth of HIV primary isolates in macrophages and lymphocytes did not differ between patients with and those without cognitive impairment. However, isolates from the cognitively impaired women preferentially used the X4 coreceptor (P < .05). These phenotypic studies suggest that cognitively impaired HIV-infected women receiving treatment may have a more highly replicating and more pathogenic X4 virus in the circulation that could contribute to their neuropathogenesis.
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Affiliation(s)
- Dianedis M Toro Nieves
- Department of Microbiology and Medical Zoology, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
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Rozek W, Ricardo-Dukelow M, Holloway S, Gendelman HE, Wojna V, Melendez LM, Ciborowski P. Cerebrospinal fluid proteomic profiling of HIV-1-infected patients with cognitive impairment. J Proteome Res 2007; 6:4189-99. [PMID: 17929958 DOI: 10.1021/pr070220c] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Advanced HIV-1 infection is commonly associated with progressive immune suppression and the development of cognitive, motor, and behavior disturbances. In its most severe form, it is diagnosed as HIV-1 associated dementia (HAD) and can progress to profound functional disability and death. Despite prodigious efforts to uncover biomarkers of HAD, none can adequately reflect disease onset or progression. Thus, we developed a proteomics platform for HAD biomarker discovery and used it to perform a pilot study on cerebrospinal fluid (CSF) from HIV-1-infected people with or without HAD. A 2-dimensional electrophoresis (2-DE) map of a HAD CSF proteome was focused on differentially expressed proteins. 2-DE difference gel electrophoresis (2-D DIGE) analysis showed >90 differences in protein spots of which 20 proteins were identified. Differential expression of 6 proteins was validated by Western blot tests and included vitamin D binding protein, clusterin, gelsolin, complement C3, procollagen C-endopeptidase enhancer 1, and cystatin C. We posit that these proteins, alone or together, are potential HAD biomarkers.
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Affiliation(s)
- Wojciech Rozek
- Center for Neurovirology and Neurodegenerative Disorders, Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska 68198-5800, USA
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Wojna V, Skolasky RL, Hechavarría R, Mayo R, Selnes O, McArthur JC, Meléndez LM, Maldonado E, Zorrilla CD, García H, Kraiselburd E, Nath A. Prevalence of human immunodeficiency virus-associated cognitive impairment in a group of Hispanic women at risk for neurological impairment. J Neurovirol 2007; 12:356-64. [PMID: 17065128 DOI: 10.1080/13550280600964576] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [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: 10/24/2022]
Abstract
Human immunodeficiency virus (HIV)-associated cognitive impairment, a significant cause of morbidity, affects up to 30% of HIV-infected people. Its prevalence doubled as patients began to live longer after the introduction of highly active retroviral therapy. Women are now one of the fastest growing groups with acquired immunodeficiency syndrome (AIDS) in the United States and Puerto Rico, but relatively little is known about the prevalence and characteristics of cognitive dysfunction in HIV-infected women. In this study the authors investigated its prevalence in a group of HIV-1-seropositive Hispanic women in Puerto Rico. Forty-nine women with a nadir CD4 cell count of < or = 500 cells/mm3 were enrolled. Cognitive impairment was defined according to the American Academy of Neurology criteria for HIV dementia as modified to identify an "asymptomatic cognitively impaired" group. Observed prevalence was compared with prevalence in other populations in United States, Europe, and Australia. Differences in clinical markers and neuropsychological test performance among the cohort stratified by cognitive impairment were tested. Cognitive impairment was observed in 77.6% (38/49) of cases; asymptomatic cognitive impairment in 32.7% (16/49); minor cognitive motor disorders in 16.3% (8/49); and HIV-associated dementia (HAD) in 28.6% (14/49). Cognitive impairment did not correlate with age, CD4 cell count, viral load, or treatment modality. The cross-sectional prevalence of HIV-associated cognitive impairment was 77.6% (28.6% for HAD). These findings should enhance awareness of the prevalence of HIV-associated cognitive impairment, both clinically apparent and "asymptomatic," in Hispanic women and lead to improvements in areas such as education and compliance and to reevaluation of treatment interventions.
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Affiliation(s)
- Valerie Wojna
- NeuroAIDS Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
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Wojna V, Nath A. Challenges to the diagnosis and management of HIV dementia. AIDS Read 2006; 16:615-6, 621-4, 626, 629-32. [PMID: 17152649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Although it has been evident since the early days of the HIV epidemic that a dementing illness often accompanies HIV infection and that the virus invades the nervous system soon after systemic infection, the clinical syndrome has evolved with the introduction of antiretroviral therapy. Milder forms of cognitive impairment with a variable course, evident at higher CD4+ cell counts, are now more frequently seen. Furthermore, these patients often have other comorbidities such as drug abuse, hepatitis C virus infection, depression, and those associated with aging as confounding factors. The antiretroviral drugs may themselves be toxic or cause an immune reconstitution syndrome that needs to be distinguished from HIV dementia. The treating physician thus faces several new challenges in the diagnosis and treatment of a patient with HIV infection who presents with cognitive impairment. In this article, we provide a systematic approach to addressing each of these issues and guidelines for management of these patients. We also discuss the latest experimental approaches and the clinical trials being conducted for the better management of this population.
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Affiliation(s)
- Valerie Wojna
- Neurology Section, Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Hechavarría R, Blass D, Ginebra T, Maldonado E, Mayo R, Melendez L, Santiago B, Wojna V. Characterization of Depressive Symptoms and CD4 in a Cohort of Hiv-Positive Hispanic Women in Puerto Rico. J Investig Med 2006. [DOI: 10.1177/108155890605402s107] [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: 01/09/2023]
Affiliation(s)
- R. Hechavarría
- University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - D. Blass
- University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - T. Ginebra
- University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - E. Maldonado
- University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - R. Mayo
- University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - L. Melendez
- University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - B. Santiago
- University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - V. Wojna
- University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
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Hechavarría R, Blass D, Ginebra T, Maldonado E, Mayo R, Melendez L, Santiago B, Wojna V. 28 CHARACTERIZATION OF DEPRESSIVE SYMPTOMS AND CD4 IN A COHORT OF HIV-POSITIVE HISPANIC WOMEN IN PUERTO RICO. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0015.106] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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48
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Wojna V, Carlson KA, Luo X, Mayo R, Meléndez LM, Kraiselburd E, Gendelman HE. Proteomic fingerprinting of human immunodeficiency virus type 1-associated dementia from patient monocyte-derived macrophages: A case study. J Neurovirol 2004; 10 Suppl 1:74-81. [PMID: 14982743 DOI: 10.1080/753312756] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 10/23/2022]
Abstract
The emergence of a subset of circulating monocytes during human immunodeficiency virus type 1 (HIV-1) disease has been shown to correlate with cognitive impairment. Thus, it is hypothesized that diagnostic protein profiles may be obtained from these cells from patients with or at risk for HIV-1-associated dementia (HAD). To address this possibility, we used ProteinChip assays to define a unique monocyte-derived macrophage (MDM) protein fingerprint during HAD and whether it is affected by highly active antiretroviral therapy (HAART). The study included five Hispanic women, one with HAD, two HIV-1-infected without cognitive impairment, and two seronegative controls. All patients were matched by age and immune status. Monocytes were recovered from the peripheral blood leukocytes by Percoll gradient centrifugation and allowed to differentiate in vitro for 7 days. Cell lysates and supernatants were collected from the MDM and analyzed by surface enhanced laser desorption/ionization-time of flight ProteinChip assays. Seven unique protein peaks between 3.0 and 20.0 kDa were found in the HAD MDM sample. Each of these proteins were abrogated after HAART. Additional studies extending this one time point determination would serve to confirm the general utility of MDM protein profiling for the diagnosis and monitoring of HAD.
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Affiliation(s)
- Valerie Wojna
- The Departments of Microbiology and Specialized NeuroSciences Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Abstract
Despite the development and use of effective antiretroviral therapy, HIV dementia persists and has important socio-economic consequences. Significant progress has been made in our current understanding of the neuropathogenesis of HIV infection, and it is clear that adjunctive neuroprotective therapy in addition to antiretroviral therapy are necessary for prevention and treatment of this entity. In this manuscript, we discuss the rationale and the pathophysiological mechanisms that support the development of neuroprotective therapy for HIV dementia. We review all the placebo controlled clinical trials conducted to date with neuromodulatory/neuroprotective therapy in patients with HIV dementia and discuss their outcomes. We also provide a thorough review of potential new treatments for HIV dementia based on the experimental literature. We hope that this manuscript will serve as an important guide for future approaches for clinical trials and drug development for patients with HIV dementia.
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Affiliation(s)
- Jadwiga Turchan
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287, USA
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50
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Wojna V, Carlson K, Luo X, Mayo R, Mel�ndez L, Kraiselburd E, Gendelman H. Proteomic fingerprinting of human immunodeficiency virus type 1?associated dementia from patient monocyte-derived macrophages: A case study. J Neurovirol 2004. [DOI: 10.1080/13550280490270860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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