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Jankowski CM, Mawhinney S, Wilson MP, Campbell TB, Kohrt WM, Schwartz RS, Brown TT, Erlandson KM. Body Composition Changes in Response to Moderate- or High-Intensity Exercise Among Older Adults With or Without HIV Infection. J Acquir Immune Defic Syndr 2020; 85:340-345. [PMID: 32701826 PMCID: PMC8040534 DOI: 10.1097/qai.0000000000002443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND People with HIV (PWH) are at an increased risk for adiposity and sarcopenia, despite effective antiretroviral therapy. Our objective was to compare the effects of prescribed exercise on body composition in older PWH and uninfected controls. SETTING Academic medical center. METHODS Sedentary PWH (n = 27) and uninfected controls (n = 28) aged 50-75 years completed 24 weeks of cardiovascular and resistance exercise. Participants completed 12 weeks of moderate-intensity exercise and then were randomized to moderate- or high-intensity exercise for 12 additional weeks. Total lean (LEAN) and fat mass (FAT), and visceral adipose tissue area (VAT) were measured using dual-energy x-ray absorptiometry at baseline and 24 weeks; baseline and intervention differences were compared by HIV serostatus using multivariable regression analyses adjusted for baseline values, age, and exercise adherence. RESULTS At baseline, PWH had significantly lower FAT (P = 0.003), but no significant differences in LEAN or VAT compared with controls (P > 0.20). Changes over 24 weeks were not significantly different by HIV serostatus, although controls tended to gain more LEAN (0.8 kg; range, 0-1.6 kg; P = 0.04] than PWH (0.6 kg; range, -0.2 to 1.4 kg; P = 0.12) and lose less FAT and VAT (controls: (-0.9 kg; range, -1.8 to 0.0 kg and -10.3 cm; range, -19.6, 1.0) cm; both P = 0.03 vs PWH: -2.0 kg; range, -2.9 to -1.1 kg and -17.7 cm; range, -27.1 to -8.2 cm; both P < 0.001). Exercise intensity differences were not apparent for LEAN, FAT, or VAT. CONCLUSIONS Exercise reduced total and visceral fat in older PWH and controls. Minimal gains in lean mass suggest that greater emphasis on resistance exercise may be needed to more effectively increase muscle in PWH.
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Affiliation(s)
| | - Samantha Mawhinney
- Department of Biostatistics, University of Colorado Anschutz Medical Campus, School of Public Health, Aurora, CO
| | - Melissa P Wilson
- Department of Biostatistics, University of Colorado Anschutz Medical Campus, School of Public Health, Aurora, CO
| | - Thomas B Campbell
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Wendy M Kohrt
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Eastern Colorado VA Geriatric Research, Education and Clinical Center, Denver, CO; and
| | - Robert S Schwartz
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Eastern Colorado VA Geriatric Research, Education and Clinical Center, Denver, CO; and
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University, Baltimore, MD
| | - Kristine M Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Abstract
PURPOSE OF REVIEW HIV-infected individuals have improved access to antiretroviral therapy. This has resulted in a shift in causes of mortality from infectious diseases to noncommunicable diseases including cardiovascular disease, chronic kidney disease (CKD) and malignancies. This review will look at the epidemiological shift, risk factors for the development of these diseases and examine some of the supporting laboratory diagnostic testing, which may be required. RECENT FINDINGS Risk factors for the development of these diseases in HIV-infected patients include underlying genetic predisposition, lifestyle risk factors, chronic inflammation as a consequence of HIV infection, the presence and persistence of opportunistic infections and in some cases, highly active antiretroviral therapy, itself. Morbidity and mortality from HIV-associated conditions are increasing in low-income and middle-income countries (LMICs) with increased prevalence of HIV-associated cancers, cardiovascular disease and CKD. SUMMARY Management of these conditions in LMICs requires an integrated pathology solution that will enable early screening, diagnosis and monitoring.
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Vuda M, Kamath A. Drug induced mitochondrial dysfunction: Mechanisms and adverse clinical consequences. Mitochondrion 2016; 31:63-74. [PMID: 27771494 DOI: 10.1016/j.mito.2016.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/24/2016] [Accepted: 10/17/2016] [Indexed: 01/12/2023]
Abstract
Several commonly used medications impair mitochondrial function resulting in adverse effects or toxicities. Drug induced mitochondrial dysfunction may be a consequence of increased production of reactive oxygen species, altered mitochondrial permeability transition, impaired mitochondrial respiration, mitochondrial DNA damage or inhibition of beta-oxidation of fatty acids. The clinical manifestation depends on the specific drug and its effect on mitochondria. Given the ubiquitous presence of mitochondria and its central role in cellular metabolism, drug-mitochondrial interactions may manifest clinically as hepatotoxicity, enteropathy, myelosuppression, lipodystrophy syndrome or neuropsychiatric adverse effects, to name a few. The current review focuses on specific drug groups which adversely affect mitochondria, the mechanisms involved and the clinical consequences based on the data available from experimental and clinical studies. Knowledge of these adverse drug-mitochondrial interactions may help the clinicians foresee potential issues in individual patients, prevent adverse drug reactions or alter drug regimens to enhance patient safety.
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Affiliation(s)
| | - Ashwin Kamath
- Department of Pharmacology, Kasturba Medical College, Manipal University, Mangalore, India.
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4
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Ortmeyer HK, Ryan AS, Hafer-Macko C, Oursler KK. Skeletal muscle cellular metabolism in older HIV-infected men. Physiol Rep 2016; 4:4/9/e12794. [PMID: 27166139 PMCID: PMC4873639 DOI: 10.14814/phy2.12794] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/20/2016] [Indexed: 02/07/2023] Open
Abstract
Skeletal muscle mitochondrial dysfunction may contribute to low aerobic capacity. We previously reported 40% lower aerobic capacity in HIV-infected men compared to noninfected age-matched men. The objective of this study was to compare skeletal muscle mitochondrial enzyme activities in HIV-infected men on antiretroviral therapy (55 ± 1 years of age, n = 10 African American men) with age-matched controls (55 ± 1 years of age, n = 8 Caucasian men), and determine their relationship with aerobic capacity. Activity assays for mitochondrial function including enzymes involved in fatty acid activation and oxidation, and oxidative phosphorylation, were performed in homogenates prepared from vastus lateralis muscle. Hydrogen peroxide (H2O2), cardiolipin, and oxidized cardiolipin were also measured. β-hydroxy acyl-CoA dehydrogenase (β-HAD) (38%) and citrate synthase (77%) activities were significantly lower, and H2O2 (1.4-fold) and oxidized cardiolipin (1.8-fold) were significantly higher in HIV-infected men. VO2peak (mL/kg FFM/min) was 33% lower in HIV-infected men and was directly related to β-HAD and citrate synthase activity and inversely related to H2O2 and oxidized cardiolipin. Older HIV-infected men have reduced oxidative enzyme activity and increased oxidative stress compared to age-matched controls. Further research is crucial to determine whether an increase in aerobic capacity by exercise training will be sufficient to restore mitochondrial function in older HIV-infected individuals.
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Affiliation(s)
- Heidi K Ortmeyer
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland
| | - Alice S Ryan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland Veterans Affairs Research Service, Veterans Affairs Maryland Health Care System, Baltimore, Maryland
| | - Charlene Hafer-Macko
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland Departments of Neurology, University of Maryland School of Medicine, Baltimore, Maryland Department of Physical Therapy Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - KrisAnn K Oursler
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland
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Haugaard SB. Alteration in pancreatic islet function in human immunodeficiency virus. Endocrinol Metab Clin North Am 2014; 43:697-708. [PMID: 25169562 DOI: 10.1016/j.ecl.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Molecular mechanisms behind the defects in insulin production and secretion associated with antihuman immunodeficiency virus (anti-HIV) therapy and the development of HIV-associated lipodystrophy syndrome (HALS) are discussed in this article. Data suggesting insulin resistance on the beta cell and defects in first-phase insulin release of HALS patients are presented. Hepatic extraction of insulin, nonglucose insulin secretagogues and insulin-like growth factor release may exert influence on the demand of circulating insulin and on insulin secretion in HIV-infected patients. Finally, the paucity in understanding the incretin effects in HIV and HIV therapy in relation to insulin secretion is highlighted.
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Affiliation(s)
- Steen B Haugaard
- Department of Internal Medicine and the Clinical Research Centre, University of Copenhagen Amager Hvidovre Hospitals, Italiensvej 1, DK-2300 Copenhagen S, Denmark.
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6
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Payne BAI, Gardner K, Chinnery PF. Mitochondrial DNA mutations in ageing and disease: implications for HIV? Antivir Ther 2014; 20:109-20. [PMID: 25032944 DOI: 10.3851/imp2824] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
Abstract
Mitochondrial DNA (mtDNA) mutations cause neurological and multisystem disease. Somatic (acquired) mtDNA mutations are also associated with degenerative diseases and with normal human ageing. It is well established that certain nucleoside reverse transcriptase inhibitor (NRTI) antiretroviral drugs cause inhibition of the mtDNA polymerase, pol γ, leading to a reduction in mtDNA content (depletion). Given this effect of NRTI therapy on mtDNA replication, it is plausible that NRTI treatment may also lead to increased mtDNA mutations. Here we review recent evidence for an effect of HIV infection or NRTI therapy on mtDNA mutations, as well as discussing the methodological challenges in addressing this question. Finally, we discuss the possible implications for HIV-infected persons, with particular reference to ageing.
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Affiliation(s)
- Brendan A I Payne
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK.
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Poulsen MM, Larsen JØ, Hamilton-Dutoit S, Clasen BF, Jessen N, Paulsen SK, Kjær TN, Richelsen B, Pedersen SB. Resveratrol up-regulates hepatic uncoupling protein 2 and prevents development of nonalcoholic fatty liver disease in rats fed a high-fat diet. Nutr Res 2012; 32:701-8. [PMID: 23084643 DOI: 10.1016/j.nutres.2012.08.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/18/2012] [Accepted: 08/06/2012] [Indexed: 12/13/2022]
Abstract
Obesity is associated with a markedly increased risk of nonalcoholic fatty liver disease. The anti-inflammatory polyphenol resveratrol possess promising properties in preventing this metabolic condition by dampening the pathological inflammatory reaction in the hepatic tissue. However, in the current study, we hypothesize that the beneficial effect of resveratrol is not solely attributable to its anti-inflammatory potential. Eight-week-old male Wistar rats were randomly distributed into 3 groups of 12 animals each: control diet (C), high-fat diet (HF), and HF supplemented with 100 mg resveratrol daily (HFR). After 8 weeks of dietary treatment, the rats were euthanized and relevant tissues were prepared for subsequent analysis. Resveratrol prevented the high fat-induced steatosis assessed by semiquantitative grading, which furthermore corresponded with a complete normalization of the hepatic triglyceride content (P < .001), despite no change in total body fat. In HFR, the hepatic uncoupling protein 2 expression was significantly increased by 76% and 298% as compared with HF and C, respectively. Moreover, the hepatic mitochondria content in HFR was significantly higher as compared with both C and HF (P < .001 and P = .004, respectively). We found no signs of hepatic inflammation, hereby demonstrating that resveratrol protects against fatty liver disease independently of its proposed anti-inflammatory potential. Our data might indicate that an increased number of mitochondria and, particularly, an increase in hepatic uncoupling protein 2 expression are involved in normalizing the hepatic fat content due to resveratrol supplementation in rodents fed a high-fat diet.
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Affiliation(s)
- Morten Møller Poulsen
- Department of Endocrinology and Internal Medicine MEA, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Århus C, Denmark.
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Christophersen OA. Should autism be considered a canary bird telling that Homo sapiens may be on its way to extinction? MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2012; 23:19008. [PMID: 23990819 PMCID: PMC3747741 DOI: 10.3402/mehd.v23i0.19008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There has been a dramatic enhancement of the reported incidence of autism in different parts of the world over the last 30 years. This can apparently not be explained only as a result of improved diagnosis and reporting, but may also reflect a real change. The causes of this change are unknown, but if we shall follow T.C. Chamberlin's principle of multiple working hypotheses, we need to take into consideration the possibility that it partly may reflect an enhancement of the average frequency of responsible alleles in large populations. If this hypothesis is correct, it means that the average germline mutation rate must now be much higher in the populations concerned, compared with the natural mutation rate in hominid ancestors before the agricultural and industrial revolutions. This is compatible with the high prevalence of impaired human semen quality in several countries and also with what is known about high levels of total exposure to several different unnatural chemical mutagens, plus some natural ones at unnaturally high levels. Moreover, dietary deficiency conditions that may lead to enhancement of mutation rates are also very widespread, affecting billions of people. However, the natural mutation rate in hominids has been found to be so high that there is apparently no tolerance for further enhancement of the germline mutation rate before the Eigen error threshold will be exceeded and our species will go extinct because of mutational meltdown. This threat, if real, should be considered far more serious than any disease causing the death only of individual patients. It should therefore be considered the first and highest priority of the best biomedical scientists in the world, of research-funding agencies and of all medical doctors to try to stop the express train carrying all humankind as passengers on board before it arrives at the end station of our civilization.
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Tang YW, Ou CY. Past, present and future molecular diagnosis and characterization of human immunodeficiency virus infections. Emerg Microbes Infect 2012; 1:e19. [PMID: 26038427 PMCID: PMC3630918 DOI: 10.1038/emi.2012.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/08/2012] [Accepted: 05/21/2012] [Indexed: 12/31/2022]
Abstract
Substantive and significant advances have been made in the last two decades in the characterization of human immunodeficiency virus (HIV) infections using molecular techniques. These advances include the use of real-time measurements, isothermal amplification, the inclusion of internal quality assurance protocols, device miniaturization and the automation of specimen processing. The result has been a significant increase in the availability of results to a high level of accuracy and quality. Molecular assays are currently widely used for diagnostics, antiretroviral monitoring and drug resistance characterization in developed countries. Simple and cost-effective point-of-care versions are also being vigorously developed with the eventual goal of providing timely healthcare services to patients residing in remote areas and those in resource-constrained countries. In this review, we discuss the evolution of these molecular technologies, not only in the context of the virus, but also in the context of tests focused on human genomics and transcriptomics.
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Affiliation(s)
- Yi-Wei Tang
- Memorial Sloan-Kettering Cancer Center , New York, NY 10065, USA
| | - Chin-Yih Ou
- Centers for Disease Control and Prevention , Atlanta, GA 30333, USA
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10
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Morse CG, Voss JG, Rakocevic G, McLaughlin M, Vinton CL, Huber C, Hu X, Yang J, Huang DW, Logun C, Danner RL, Rangel ZG, Munson PJ, Orenstein JM, Rushing EJ, Lempicki RA, Dalakas MC, Kovacs JA. HIV infection and antiretroviral therapy have divergent effects on mitochondria in adipose tissue. J Infect Dis 2012; 205:1778-87. [PMID: 22476717 PMCID: PMC3357134 DOI: 10.1093/infdis/jis101] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 06/28/2011] [Accepted: 07/05/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) affect mitochondrial DNA (mtDNA) content and function, comprehensive evaluations of their effects on mitochondria in muscle, adipose tissue, and blood cells are limited. METHODS Mitochondrial DNA quantification, mitochondrial genome sequencing, and gene expression analysis were performed on muscle, adipose tissue, and peripheral blood mononuclear cell (PBMC) samples from untreated HIV-positive patients, HIV-positive patients receiving nucleoside reverse transcriptase inhibitor (NRTI)-based ART, and HIV-negative controls. RESULTS The adipose tissue mtDNA/nuclear DNA (nDNA) ratio was increased in untreated HIV-infected patients (ratio, 353) and decreased in those receiving ART (ratio, 162) compared with controls (ratio, 255; P < .05 for both comparisons); the difference between the 2 HIV-infected groups was also significant (P = .002). In HIV-infected participants, mtDNA/nDNA in adipose tissue correlated with the level of activation (CD38+ /HLA-DR+) for CD4+ and CD8+ lymphocytes. No significant differences in mtDNA content were noted in muscle or PMBCs among groups. Exploratory DNA microarray analysis identified differential gene expression between patient groups, including a subset of adipose tissue genes. CONCLUSIONS HIV infection and ART have opposing effects on mtDNA content in adipose tissue; immune activation may mediate the effects of HIV, whereas NRTIs likely mediate the effects of ART.
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Affiliation(s)
- Caryn G Morse
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1403, USA.
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Chapplain JM, Tattevin P, Guyader D, Begue JM, Beillot J, Turlin B, Souala F, Arvieux C, Rochcongar P, Michelet C. Mitochondrial abnormalities in patients with HIV-HCV co-infection as compared to patients with HCV mono-infection. HIV CLINICAL TRIALS 2011; 12:54-60. [PMID: 21388941 DOI: 10.1310/hct1201-54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Mitochondrial dysfunction is a classic complication of HIV infection and its treatment and has also been reported in hepatitis C virus (HCV)-infected patients. Little is known about interactions between both viruses on mitochondrial metabolism. METHODS We performed a cross-sectional study of HCV-infected patients who underwent liver biopsy as part of their routine care. Mitochondrial function was assessed by (a) liver morphological (histology) and functional (spectro-photometry) studies, and (b) serum lactate kinetics, oxygen uptake, and anaerobic threshold measurement during standardized incremental exercise. Three predefined groups of patients were compared. RESULTS Thirty-eight HCV-infected patients were included: 13 not HIV infected (group 1), 7 with HIV co-infection and low nucleoside reverse transcriptase inhibitor (NRTI) exposure (none over the last 2 years; group 2), and 18 with HIV co-infection and high NRTI exposure (group 3). On liver biopsies, respiratory chain complex IV activity was impaired, at 5 (2-7) nmol/min/mg substrates in group 1, 5 (3-8) in group 2, and 8 (2-13) in group 3 (normal values, 20-56). Maximal power output was diminished and anaerobic threshold occurred earlier in HIV-infected patients, regardless of NRTI exposure. CONCLUSION HCV has deleterious effects on liver mitochondrial metabolism, notably on respiratory chain complex IV. No significant interaction with HIV was observed.
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Banasch M, Frank J, Serova K, Knyhala K, Kollar S, Potthoff A, Brockmeyer NH, Goetze O. Impact of antiretroviral treatment on (13) C-methionine metabolism as a marker of hepatic mitochondrial function: a longitudinal study. HIV Med 2011; 12:40-5. [PMID: 20500232 DOI: 10.1111/j.1468-1293.2010.00847.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Uncontrolled viral replication and antiretroviral treatment (ART) may independently contribute to hepatic mitochondrial toxicity. The present study was designed to explore the longitudinal effects of treatment modifications on hepatic mitochondrial function by means of noninvasive (13) C-methionine breath test (MeBT) diagnostics. METHODS A total of 113 HIV-infected patients underwent two consecutive MeBTs over an interval of 11.8±3.5 months. Forty-nine patients remained on stable ART or no therapy; 28 participants switched ART; 27 patients (re)initiated ART, and nine individuals underwent a structured treatment interruption (STI) of ART between MeBTs 1 and 2. Breath test results were expressed as cumulative percentage dose of (13) CO(2) recovered after 1.5 h test time (cPDR(1.5h) ). RESULTS Initiation of ART in treatment-naïve individuals and patients on STI was associated with a significant improvement of hepatic mitochondrial function (P<0.05). Cessation of ART or a prolonged delay in initiating therapy in treatment-naïve patients in turn led to a significant decline of (13) C-exhalation compared with baseline (P<0.05). A marked increase in (13) C-exhalation was observed in individuals who switched from stavudine or ddI to tenofovir or abacavir (+170%; P<0.001), while no differences between MeBTs 1 and 2 were found in individuals on ART who had remained on stable regimens or in those who changed a protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI) component. CONCLUSION The present data suggest that hepatic mitochondrial function in HIV disease is a dynamic process with a high regenerative capacity and highlight the pathogenic relevance of HIV replication. Our findings suggest that modern ART per se does not negatively impact hepatic mitochondrial function.
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Affiliation(s)
- M Banasch
- Department of Internal Medicine, St Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany.
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13
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Sutinen J, Laaksonen MS, Walker UA, Setzer B, Kemppainen J, Nuutila P, Yki-Jarvinen H. Skeletal muscle mitochondrial DNA content and aerobic metabolism in patients with antiretroviral therapy-associated lipoatrophy. J Antimicrob Chemother 2010; 65:1497-504. [DOI: 10.1093/jac/dkq138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Maggiolo F, Roat E, Pinti M, Nasi M, Gibellini L, De Biasi S, Airoldi M, Ravasio V, Mussini C, Suter F, Cossarizza A. Mitochondrial changes during D-drug-containing once-daily therapy in HIV-positive treatment-naive patients. Antivir Ther 2010; 15:51-9. [DOI: 10.3851/imp1483] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
PURPOSE OF REVIEW To discuss novel developments related to the mechanisms of antiretroviral therapy-related mitochondrial toxicity, describe some apparent paradoxes in the current understanding of this field, and present questions that should be addressed by future research. RECENT FINDINGS The early polymerase gamma hypothesis states that nucleoside reverse transcriptase inhibitors can inhibit mitochondrial DNA replication and cause mitochondrial toxicity through mtDNA depletion. This mechanism is supported by a large body of evidence. Clinical manifestations of mitochondrial dysfunction are not always associated with mtDNA depletion. Increased mtDNA levels after nucleoside reverse transcriptase inhibitor exposure, as well as seemingly severe mtDNA depletion in individuals who show no clinical toxicity, have been reported. These and other observations suggest that additional mechanisms are involved in antiretroviral therapy toxicity, a notion supported by recent studies. Individuals given the same antiretroviral regimen can differ vastly with respect to the development of mitochondrial toxicity symptoms, reflecting interindividual variability. Some factors that may modulate this variability will be discussed. SUMMARY Mitochondrial toxicity induced by nucleoside reverse transcriptase inhibitors and their metabolic intermediates is probably mediated through many direct and indirect mechanisms. Depending on the mechanisms at play, the long-term health consequences of this toxicity may vary.
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Maagaard A, Kvale D. Long term adverse effects related to nucleoside reverse transcriptase inhibitors: Clinical impact of mitochondrial toxicity. ACTA ACUST UNITED AC 2009; 41:808-17. [DOI: 10.3109/00365540903186181] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Maagaard A, Kvale D. Mitochondrial toxicity in HIV-infected patients both off and on antiretroviral treatment: a continuum or distinct underlying mechanisms? J Antimicrob Chemother 2009; 64:901-9. [DOI: 10.1093/jac/dkp316] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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18
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Lin CH, Sloan DD, Dang CH, Wagner T, Cabrera AJE, Tobin NH, Frenkel LM, Jerome KR. Assessment of mitochondrial toxicity by analysis of mitochondrial protein expression in mononuclear cells. CYTOMETRY PART B-CLINICAL CYTOMETRY 2009; 76:181-90. [PMID: 18823003 DOI: 10.1002/cyto.b.20458] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Real-time PCR has quantified decreased mitochondrial DNA levels in association with nucleoside reverse transcriptase inhibitor (NRTI) therapy of HIV-infected populations. However, real-time PCR is best suited to distinguish log differences in an analyte. In an effort to monitor individuals in more detail, we developed a flow cytometric assay to gauge mitochondrial function. METHODS Flow cytometric quantification of a mitochondrial DNA-encoded mitochondrial protein (cytochrome c oxidase subunit I (COX-I)) and a nuclear DNA-encoded mitochondrial protein [ATP synthase subunit D (Sub-D)] was optimized and validated. RESULTS Intra-assay and interassay variability was low using peripheral blood mononuclear cells (PBMCs) (CV of 6.15% for COX-I and 7.11% Sub-D, and 9.38% and 9.83% for COX-I and Sub-D, respectively). Mitochondrial protein depletion was evident with in vitro treatment of cells with ethidium bromide (EtBr) and zalcitabine (ddC). Mitochondrial protein expression in 40 healthy adults clustered tightly. Depletion of mitochondrial protein, however, was neither detected in cryopreserved PBMC from NRTI-treated children (n = 9) nor in adults with a history of symptoms consistent with mitochondrial toxicity or ongoing treatment with didanosine (ddI) or stavudine (d4T) (n = 51). CONCLUSIONS A validated flow cytometric assay allows simultaneous detection of mitochondrial DNA and nuclear DNA encoded proteins at the single cell level, offering a method to monitor for mitochondrial function. Prospective studies are required to evaluate whether mitochondrial protein loss is observed in at-risk patients prior to the onset of symptoms from mitochondrial dysfunction.
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Affiliation(s)
- Chen-Han Lin
- Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA
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Weber J, Mitchell D, Veliotes D, Mitchell B, Kamerman PR. Hyperalgesia induced by oral stavudine administration to rats does not depend on spinal neuronal cell death, or on spinal or systemic inflammatory cytokine secretion, or metabolic dysregulation. Neurotoxicology 2009; 30:423-9. [PMID: 19442827 DOI: 10.1016/j.neuro.2009.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 11/21/2008] [Accepted: 02/09/2009] [Indexed: 11/27/2022]
Abstract
To investigate possible mechanisms of the hyperalgesia induced by the nucleoside reverse transcriptase inhibitor (NRTI) stavudine in rats, we examined neuronal death and inflammatory cytokine secretion in the spinal cord, and cytokine and lactate secretion in the plasma. Stavudine (50 mg kg(-1)) or placebo was administered orally to Sprague-Dawley rats once daily for three or six weeks. In one group, rats' responses to a blunt noxious mechanical stimulus applied to their tails were recorded before and at the end of the period of stavudine or placebo administration. Spinal cords excised from these rats after three and six weeks of stavudine or placebo administration were examined for neuronal necrosis and apoptosis. In a second group of rats, plasma and spinal cord samples collected after three and six weeks of placebo or stavudine administration were examined for changes in CINC-1, IL-6, adiponectin (plasma only) and lactate (plasma only) concentration. Daily stavudine administration induced mechanical hyperalgesia within three weeks, which was sustained until week six, but the hyperalgesia was not associated with neuronal apoptosis or necrosis, or elevated IL-6 concentrations in the spinal cord. The spinal cord concentration of CINC-1 increased, but only after six weeks of stavudine administration, when the hyperalgesia had been established for over three weeks. Stavudine administration did not affect the plasma concentration of IL-6, CINC-1, adiponectin or lactate. Thus, neither peripheral nor central inflammatory cytokine secretion, or neuronal death, or metabolic dysregulation contributed to the development of hyperalgesia in our model of stavudine-induced hyperalgesia in rats.
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Affiliation(s)
- Juliane Weber
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa.
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Wendelsdorf KV, Song Z, Cao Y, Samuels DC. An analysis of enzyme kinetics data for mitochondrial DNA strand termination by nucleoside reverse transcription inhibitors. PLoS Comput Biol 2009; 5:e1000261. [PMID: 19132079 PMCID: PMC2603287 DOI: 10.1371/journal.pcbi.1000261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 11/26/2008] [Indexed: 01/06/2023] Open
Abstract
Nucleoside analogs used in antiretroviral treatment have been associated with mitochondrial toxicity. The polymerase-γ hypothesis states that this toxicity stems from the analogs' inhibition of the mitochondrial DNA polymerase (polymerase-γ) leading to mitochondrial DNA (mtDNA) depletion. We have constructed a computational model of the interaction of polymerase-γ with activated nucleoside and nucleotide analog drugs, based on experimentally measured reaction rates and base excision rates, together with the mtDNA genome size, the human mtDNA sequence, and mitochondrial dNTP concentrations. The model predicts an approximately 1000-fold difference in the activated drug concentration required for a 50% probability of mtDNA strand termination between the activated di-deoxy analogs d4T, ddC, and ddI (activated to ddA) and the activated forms of the analogs 3TC, TDF, AZT, FTC, and ABC. These predictions are supported by experimental and clinical data showing significantly greater mtDNA depletion in cell culture and patient samples caused by the di-deoxy analog drugs. For zidovudine (AZT) we calculated a very low mtDNA replication termination probability, in contrast to its reported mitochondrial toxicity in vitro and clinically. Therefore AZT mitochondrial toxicity is likely due to a mechanism that does not involve strand termination of mtDNA replication. While HIV/AIDS therapy is very successful at controlling HIV infection, the therapy must continue for the remainder of the patient's life. Approximately one-fourth of these patients suffer from serious drug toxicity problems. It is generally believed that the toxicity of these drugs is caused by damage to mitochondria, the “power plants” of every cell. But we do not know exactly how this damage occurs. The most common explanation is that these drugs damage mitochondria in the same way that they control the virus, by interfering with DNA replication. We tested that idea by analyzing data for the interaction of several AIDS drugs with the mitochondrial DNA polymerase, the protein responsible for copying mitochondrial DNA. By using a detailed simulation of the mitochondrial DNA polymerase, we show that some of these drugs do interact well enough with the mitochondrial DNA polymerase to lead to toxic effects. However, many of these drugs, including the commonly used drug AZT, had very little toxic effect in this simulation although AZT often causes toxicity in patients. This indicates that the toxicity of AZT occurs through some other process and not through the direct interruption of mitochondrial DNA replication.
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Affiliation(s)
- Katherine V. Wendelsdorf
- Virginia Bioinformatics Institute, Virginia Polytechnic Institute and State University, Virginia, United States of America
| | - Zhuo Song
- Virginia Bioinformatics Institute, Virginia Polytechnic Institute and State University, Virginia, United States of America
| | - Yang Cao
- Department of Computer Science, Virginia Polytechnic Institute and State University, Virginia, United States of America
| | - David C. Samuels
- Virginia Bioinformatics Institute, Virginia Polytechnic Institute and State University, Virginia, United States of America
- The Center for Human Genetics Research, Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
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Haugaard SB, Andersen O, Madsbad S, Iversen J, Dela F. Glucose production, oxidation and disposal correlate with plasma lactate levels in HIV-infected patients on HAART. J Infect 2007; 54:89-97. [PMID: 16487595 DOI: 10.1016/j.jinf.2006.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 12/21/2005] [Accepted: 01/04/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Hyperlactatemia is prevalent in HIV-infected patients on highly active antiretroviral therapy (HAART) and may be associated with depletion of mitochondrial DNA. However, the correlation between fasting lactate and mitochondrial DNA may be weak or absent, implicating that other factors e.g. glucose turnover may contribute to hyperlactatemia. METHODS HIV-infected patients receiving HAART who had lipodystrophy (LIPO, n=18) or were without lipodystrophy (NONLIPO, n=18) were investigated. Insulin sensitivity (M-value), glucose oxidation rate (GOX) and fasting endogenous glucose production (EGP) were determined by hyperinsulinemic euglycemic clamp, indirect calorimetry and glucose tracer technique, respectively. RESULTS Fasting p-lactate (median 1.2 mmol/L; range 0.6-4.3, n=36) tended to be increased in LIPO (P=0.12); 6 patients (4 LIPO) had lactate > or =2.0 mmol/L. Fasting lactate correlated inversely with M-value (P<0.001) and positively with fasting EGP (P<0.05) and fasting GOX (P<0.05), together explaining 51% (R2, n=36) of the variation in fasting lactate. Lactate increased in NONLIPO (P<0.05) but not in LIPO (P>0.5) during clamp. Incremental (clamp minus fasting value) GOX (P<0.01) was decreased and incremental insulin (P<0.01) was increased in LIPO. CONCLUSIONS Fasting EGP, GOX and insulin resistance may be major determinants of fasting lactate levels in HIV-infected patients on HAART. Insulin levels per se may not determine plasma lactate in such patients.
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Affiliation(s)
- Steen B Haugaard
- Department of Infectious Diseases, Hvidovre University Hospital, DK 2650 Hvidovre, Copenhagen, Denmark.
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Buyse S, Vibert E, Sebagh M, Antonini T, Ichai P, Castaing D, Samuel D, Duclos-Vallée JC. Liver transplantation for fulminant hepatitis related to nevirapine therapy. Liver Transpl 2006; 12:1880-2. [PMID: 17133571 DOI: 10.1002/lt.20985] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Drug-induced hepatotoxicity is an important cause of hepatocellular injury. Non-nucleoside retroviral transcriptase inhibitors are known to cause hepatotoxicity. We describe a detailed case of fulminant hepatitis induced by nevirapine (Viramune) and treated by liver transplantation.
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Affiliation(s)
- Sophie Buyse
- Department of Hepatology and Hepatobiliar Surgery, Centre Hépato-Biliaire and INSERM U785, Hôpital Paul Brousse, 12 avenue Paul Vaillant Couturier, 94800, Villejuif, France
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Oursler KK, Sorkin JD, Smith BA, Katzel LI. Reduced aerobic capacity and physical functioning in older HIV-infected men. AIDS Res Hum Retroviruses 2006; 22:1113-21. [PMID: 17147498 DOI: 10.1089/aid.2006.22.1113] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aerobic capacity and physical functioning decline with age and chronic illness. The extent of physical disability is unknown in older HIV-infected adults, who represent a rapidly growing proportion of HIV/AIDS patients in the United States. We performed functional performance testing including treadmill testing in 32 HIV-infected male veterans aged 40-69 years. Controls were 47 healthy male subjects tested previously in the same exercise laboratory. HIV-infected subjects were classified as younger (40-49 years, n = 12) or older age (50+ years, n = 20). Peak aerobic capacity (VO2peak) was significantly reduced in the older vs. younger HIV subjects [19.1 mL/kg/min +/- 5.7 (mean, SD) vs. 25.2 +/- 4.2, p = 0.01]. VO2peak was reduced 41% +/- 15% (mean, SD) in HIV-infected subjects compared to expected values from age-matched healthy controls. Regression analyses show a similar decline in VO2peak with age in HIV-infected and healthy controls. Mean 6-min walk distance was not significantly different between the HIV-infected age groups, and was reduced only 8% compared to expected values for healthy adults. Current CD4 count and HAART exposure were similar in the two age groups and were not significantly associated with VO2peak. Anemia (HCT <35%) was significantly associated with reduced VO2peak (p = 0.02), but this association was not independent of the effect of age (p = 0.1). We conclude that older HIV-infected adults have markedly impaired aerobic capacity but maintain the capacity to undertake day-to-day activities. Additional physiologic and metabolic testing is needed to measure the effect of HAART toxicity and primary aging on aerobic capacity, and to determine if older HIV-infected adults are at greater risk.
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Affiliation(s)
- K K Oursler
- University of Maryland School of Medicine, and the Baltimore Veterans Administration Medical Center, Geriatric Research, Education and Clinical Center, Baltimore, Maryland 21201, USA.
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Abstract
Acquired fat redistribution, that is, peripheral fat loss often accompanied by central fat accumulation in patients with HIV infection is the most common form of lipodystrophy in man. Approximately 30 - 50% of HIV-infected individuals after > or = 12 months on highly active antiretroviral therapy (HAART) may encounter the HIV-associated lipodystrophy syndrome (HALS), which attenuates patient compliance to this treatment. HALS is characterised by impaired glucose and lipid metabolism and other risk factors for cardiovascular disease. This review depicts the metabolic abnormalities associated with HAART by describing the key cell and organ systems that are involved, emphasising the role of insulin resistance. An opinion on the remedies available to treat the metabolic abnormalities and phenotype of HALS is provided.
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Affiliation(s)
- Steen B Haugaard
- Clinical Research Unit, Department of Endocrinology and Internal Medicine, Hvidovre University Hospital, DK 2650 Hvidovre, Copenhagen, Denmark.
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Maagaard A, Holberg-Petersen M, Kollberg G, Oldfors A, Sandvik L, Bruun JN. Mitochondrial (Mt)Dna Changes in Tissue May Not be Reflected by Depletion of Mtdna in Peripheral Blood Mononuclear Cells in HIV-Infected Patients. Antivir Ther 2005. [DOI: 10.1177/135965350601100505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Most data on mitochondrial toxicity have been derived from peripheral blood mononuclear cells (PBMCs). However, whether mitochondrial DNA (mtDNA) content in PBMCs reflects the mitochondrial state in tissues remains elusive. We report herein on mitochondrial toxicity in skeletal muscle in HIV-infected patients naive to antiretroviral treatment (ART [HIV+ART-naive]; n=10) patients exposed to nucleoside reverse transcriptase inhibitors (NRTIs [HIV+NRTI+]; n=24) and healthy controls ( n=11), and compare these tissue data with mtDNA in PBMCs. Methods Muscle biopsies were examined for (i) mtDNA and nuclear DNA (nDNA) content using TaqMan realtime PCR system, (ii) mtDNA deletions using long expand PCR with subsequent gel electrophoresis, and (iii) mitochondrial myopathy expressed as cytochrome c oxidase (COX)-deficient muscle fibres. Results The mt/n DNA ratio in muscle from HIV+NRTI+patients was reduced compared with HIV-negative controls ( P=0.028). Moreover, mtDNA deletions were more frequent in HIV+NRTI+ patients than in both HIV-negative controls ( P=0.009) and HIV+ART-naive patients ( P=0.005). HIV+NRTI+ also tended to have more COX-deficient fibres than HIV-negative controls ( P=0.076). COX-deficient fibres were positively correlated with mtDNA deletions in HIV+NRTI+ patients (r=0.83, P<0.001). Patients with current use of didanosine (ddI) had more frequent mtDNA deletions and COX-deficient fibres than HIV+NRTI+ not on current treatment with ddI. It should be noted that mitochondrial alterations were not correlated with mtDNA/cell in PBMCs in any group. Conclusions In skeletal muscle, HIV+NRTI+ had a reduced mt/n DNA ratio, more frequent mtDNA deletions and possibly more COX-deficient muscle fibres than HIV-negative controls. However, the mtDNA/cell in peripheral blood was decreased in both HIV+NRTI+ and HIV+ART-naive patients. Thus, mtDNA in peripheral blood may not be a relevant marker of mitochondrial toxicity in organ-specific tissue.
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Affiliation(s)
- Anne Maagaard
- Department of Infectious Diseases, Ullevaal University Hospital, Oslo, Norway
- Faculty Division, University of Oslo, Oslo, Norway
| | | | - Gittan Kollberg
- Department of Pathology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anders Oldfors
- Department of Pathology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Leiv Sandvik
- Faculty Division, University of Oslo, Oslo, Norway
- Center for Clinical Research, Ullevaal University Hospital, Oslo, Norway
| | - Johan N Bruun
- Department of Infectious Diseases, Ullevaal University Hospital, Oslo, Norway
- Faculty Division, University of Oslo, Oslo, Norway
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