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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] [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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Sénécal V, Barat C, Tremblay MJ. The delicate balance between neurotoxicity and neuroprotection in the context of HIV-1 infection. Glia 2020; 69:255-280. [PMID: 32910482 DOI: 10.1002/glia.23904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 12/17/2022]
Abstract
Human immunodeficiency virus type-1 (HIV-1) causes a spectrum of neurological impairments, termed HIV-associated neurocognitive disorder (HAND), following the infiltration of infected cells into the brain. Even though the implementation of antiretroviral therapy reduced the systemic viral load, the prevalence of HAND remains unchanged and infected patients develop persisting neurological disturbances affecting their quality of life. As a result, HAND have gained importance in basic and clinical researches, warranting the need of developing new adjunctive treatments. Nonetheless, a better understanding of the molecular and cellular mechanisms remains necessary. Several studies consolidated their efforts into elucidating the neurotoxic signaling leading to HAND including the deleterious actions of HIV-1 viral proteins and inflammatory mediators. However, the scope of these studies is not sufficient to address all the complexity related to HAND development. Fewer studies focused on an altered neuroprotective capacity of the brain to respond to HIV-1 infection. Neurotrophic factors are endogenous polyproteins involved in neuronal survival, synaptic plasticity, and neurogenesis. Any defects in the processing or production of these crucial factors might compose a risk factor rendering the brain more vulnerable to neuronal damages. Due to their essential roles, they have been investigated for their diverse interplays with HIV-1 infection. In this review, we present a complete description of the neurotrophic factors involved in HAND. We discuss emerging concepts for their therapeutic applications and summarize the complex mechanisms that down-regulate their production in favor of a neurotoxic environment. For certain factors, we finally address opposing roles that rather lead to increased inflammation.
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Affiliation(s)
- Vincent Sénécal
- Axe des Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, Québec, Quebec, Canada
| | - Corinne Barat
- Axe des Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, Québec, Quebec, Canada
| | - Michel J Tremblay
- Axe des Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Pavillon CHUL, Québec, Quebec, Canada.,Département de Microbiologie-infectiologie et immunologie, Faculté de Médecine, Université Laval, Québec, Quebec, Canada
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Abstract
PURPOSE OF REVIEW Widespread use of antiretroviral therapy (ART) has led to near-normal life expectancy in people with human immunodeficiency virus (HIV) infection. However, neurologic complications of HIV remain common; can affect any part of the neuraxis; and are due to direct effects of the virus, immunosuppression because of untreated HIV infection, aberrant immune responses in the setting of ART initiation, and ART toxicities. RECENT FINDINGS HIV-associated neurocognitive disorder (HAND) remains one of the most common neurologic complications of HIV encountered today, but milder forms predominate in people on ART. No specific treatments for HAND exist, but small trials and epidemiologic evidence suggest paroxetine, intranasal insulin, and maraviroc may have utility in its treatment; further trials of these agents are ongoing. Widespread ART use has decreased the incidence of central nervous system opportunistic infections, but prognosis often remains poor in those who develop opportunistic infections. High-titer positive serum cryptococcal antigen is strongly predictive of cryptococcal meningitis and provides a tool to enhance diagnosis in areas with limited resources. HIV is an independent risk factor for stroke, and accelerated aging associated with HIV infection results in neurologic diseases of older age occurring at much younger ages in individuals infected with HIV. Ongoing HIV replication in the CSF despite peripheral virologic suppression may contribute to the development of HAND and may not improve despite adjusting the ART regimen to increase central nervous system penetrance. SUMMARY Neurologists are likely to encounter patients infected with HIV in clinical practice. This article reviews the presentation, diagnosis, and management of the most common neurologic conditions associated with HIV infection and ART.
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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] [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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Abstract
: Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the central nervous system (CNS) may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Although there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain. In many resource-limited settings, antiretrovirals considered second or third line in the United States, which carry substantial neurotoxicity, remain mainstays of treatment, and patients continue to present with severe immunosuppression and CNS opportunistic infections. Despite this, increased global access to cART has coincided with an aging HIV-positive population with cognitive sequelae, cerebrovascular disease, and peripheral neuropathy. Further neurological research in low-income and middle-income countries (LMICs) is needed to address the burden of neurological complications in HIV-positive patients, particularly regarding CNS viral reservoirs and their effects on eradication.
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Rubin LH, Maki PM. Neurocognitive Complications of HIV Infection in Women: Insights from the WIHS Cohort. Curr Top Behav Neurosci 2019; 50:175-191. [PMID: 31396894 DOI: 10.1007/7854_2019_101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Although sex differences in brain function and brain disorders are well documented, very few studies have had adequate number of women to address sex-related factors contributing to HIV-associated brain dysfunction. Compared to men living with HIV (MLWH), women living with HIV (WLWH) may be at greater risk for cognitive dysfunction and decline due to biological factors (e.g., hormonal, immunologic) and issues common in underserved communities including poverty, low literacy levels, mental health and substance abuse, barriers to health-care services, and environmental exposures. To address this issue, we review relevant cross-sectional and longitudinal findings from the Women's Interagency HIV Study (WIHS), the largest study of the natural and treated history of WLWH, as well as other studies focusing on cognitive complications of HIV in women. We provide evidence that WLWH are more cognitively vulnerable than MLWH and that there are differences in the pattern of cognitive impairment. We next discuss factors that contribute to these differences, including biological factors (e.g., inflammation, hormonal, genetic) as well as common comorbidities (mental health, substance use, vascular and metabolic risk factors, coinfections and liver function, non-antiretroviral medications, and genetic markers). These findings demonstrate the importance of considering sex as a biological factor in studies of cognitive dysfunction and suggest avenues for future research.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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Abstract
Combined antiretroviral therapy (CART) has turned HIV-infection to a treatable chronic disease during which many patients survive to middle and older age. However, they prematurely develop non-AIDS comorbidities such as cardiovascular disease, metabolic syndrome, diabetes, and HIV-associated neurocognitive disorders (HAND). Microcirculatory changes and endothelial dysfunction occur early both in HIV-infected and in aging patients, in whom they usually precede cardiovascular and neurocognitive impairments. Also, mild cognitive involvement has been reported in women during the menopausal transition. Disruption of the blood-brain barrier, as well as microvascular and cerebral blood flow changes, has been reported in HIV patients with HAND, including postmenopausal women. However, most studies addressing this issue included women aged less than 50 years. Whether HIV-infected women growing older with CART would be subsequently exposed to an increased progression of cognitive impairment overtime remains unknown.
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Affiliation(s)
- Jean-Jacques Monsuez
- AP-HP, Cardiology, Hôpital René Muret, Hôpitaux universitaires de Paris Seine Saint-Denis, Avenue du docteur Schaeffner, F-93270, Sevran, France.
| | - Catherine Belin
- AP-HP, Neurology, Hôpital Avicenne, Hôpitaux universitaires de Paris Seine Saint-Denis, Bobigny, France
| | - Olivier Bouchaud
- AP-HP, Infectious diseases, Hôpital Avicenne, Hôpitaux universitaires de Paris Seine Saint-Denis, Bobigny, France
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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] [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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Abstract
An overview of the detection, mechanism of formation and clinical function of hormone binding proteins shedded from the membrane receptor and detected in the last twenty years is presented. The representatives of such binding proteins are restricted only to human soluble receptors that have been already detected in blood or other intravasal fluids such as soluble receptors for LH/hCG, prolactin, TSH, erythropoietin, insulin and IGF-I. The clinical or diagnostic significance of these putative-detectable or indeed circulating proteins often remains largely unclear.
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Affiliation(s)
- Juergen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List Strasse 13-15, D-04103 Leipzig, Germany.
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