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Khawaja AA, Taylor KA, Lovell AO, Nelson M, Gazzard B, Boffito M, Emerson M. HIV Antivirals Affect Endothelial Activation and Endothelial-Platelet Crosstalk. Circ Res 2020; 127:1365-1380. [PMID: 32998637 DOI: 10.1161/circresaha.119.316477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
RATIONALE People living with HIV on effective antiretroviral therapy are at increased risk of cardiovascular complications, possibly due to off-target drug effects. Some studies have associated antiretroviral therapy with increased risk of myocardial infarction and endothelial dysfunction, but a link between endothelial function and antiretrovirals has not been established. OBJECTIVE To determine the effects of antiretrovirals in common clinical use upon in vitro endothelial function to better understand cardiovascular risk in people living with HIV. METHODS AND RESULTS Human umbilical cord vein endothelial cells or human coronary artery endothelial cells were pretreated with the antiretrovirals abacavir sulphate (ABC), tenofovir disoproxil fumarate, or tenofovir alafenamide. Expression of adhesion molecules, ectonucleotidases (CD39 and CD73), tissue factor (TF), endothelial-derived microparticle (EMP) numbers and phenotype, and platelet activation were evaluated by flow cytometry. TF and ectonucleotidase activities were measured using colourimetric plate-based assays. ABC-treated endothelial cells had higher levels of ICAM (intercellular adhesion molecule)-1 and TF expression following TNF (tumor necrosis factor)-α stimulation. In contrast, tenofovir disoproxil fumarate and tenofovir alafenamide treatment gave rise to greater populations of CD39+CD73+ cells. These cell surface differences were also observed within EMP repertoires. ABC-treated cells and EMP had greater TF activity, while tenofovir disoproxil fumarate- and tenofovir alafenamide-treated cells and EMP displayed higher ectonucleotidase activity. Finally, EMP isolated from ABC-treated cells enhanced collagen-evoked platelet integrin activation and α-granule release. CONCLUSIONS We report differential effects of antiretrovirals used in the treatment of HIV upon endothelial function. ABC treatment led to an inflammatory, prothrombotic endothelial phenotype that promoted platelet activation. In contrast, tenofovir disoproxil fumarate and tenofovir alafenamide conferred potentially cardioprotective properties associated with ectonucleotidase activity. These observations establish a link between antiretrovirals and specific functional effects that provide insight into cardiovascular disease in people living with HIV.
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Affiliation(s)
- Akif A Khawaja
- National Heart and Lung Institute (A.A.K., K.A.T., M.E.), Imperial College London, London, United Kingdom
| | - Kirk A Taylor
- National Heart and Lung Institute (A.A.K., K.A.T., M.E.), Imperial College London, London, United Kingdom
| | - Andrew O Lovell
- Department of Infectious Disease (A.O.L., M.N., B.G., M.B.), Imperial College London, London, United Kingdom
| | - Mark Nelson
- National Heart and Lung Institute (A.A.K., K.A.T., M.E.), Imperial College London, London, United Kingdom.,Department of Infectious Disease (A.O.L., M.N., B.G., M.B.), Imperial College London, London, United Kingdom.,Chelsea and Westminster NHS Foundation Trust, London, United Kingdom (M.N., B.G., M.B.)
| | - Brian Gazzard
- Department of Infectious Disease (A.O.L., M.N., B.G., M.B.), Imperial College London, London, United Kingdom.,Chelsea and Westminster NHS Foundation Trust, London, United Kingdom (M.N., B.G., M.B.)
| | - Marta Boffito
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom (M.N., B.G., M.B.)
| | - Michael Emerson
- Department of Infectious Disease (A.O.L., M.N., B.G., M.B.), Imperial College London, London, United Kingdom
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