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Gaff J, Octaviana F, Jackaman C, Kamerman P, Papadimitriou J, Lee S, Mountford J, Price P. Expression in skin biopsies supports genetic evidence linking CAMKK2, P2X7R and P2X4R with HIV-associated sensory neuropathy. J Neurovirol 2023; 29:241-251. [PMID: 37166584 PMCID: PMC10404215 DOI: 10.1007/s13365-023-01134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/12/2023]
Abstract
HIV-associated sensory neuropathy (HIV-SN) affects 14-38% of HIV+ individuals stable on therapy with no neurotoxic drugs. Polymorphisms in CAMKK2, P2X7R and P2X4R associated with altered risk of HIV-SN in Indonesian and South African patients. The role of CaMKK2 in neuronal repair makes this an attractive candidate, but a direct role for any protein is predicated on expression in affected tissues. Here, we describe expression of CaMKK2, P2X7R and P2X4R proteins in skin biopsies from the lower legs of HIV+ Indonesians with and without HIV-SN, and healthy controls (HC). HIV-SN was diagnosed using the Brief Peripheral Neuropathy Screen. Biopsies were stained to detect protein gene product 9.5 on nerve fibres and CaMKK2, P2X7R or P2X4R, and were examined using 3-colour sequential scanning confocal microscopy. Intraepidermal nerve fibre densities (IENFD) were lower in HIV+ donors than HC and correlated directly with nadir CD4 T-cell counts (r = 0.69, p = 0.004). However, IENFD counts were similar in HIV-SN+ and HIV-SN- donors (p = 0.19) and so did not define neuropathy. CaMKK2+ cells were located close to dermal and epidermal nerve fibres and were rare in HC and HIV-SN- donors, consistent with a role for the protein in nerve damage and/or repair. P2X7R was expressed by cells in blood vessels of HIV-SN- donors, but rarely in HC or HIV-SN+ donors. P2X4R expression by cells in the epidermal basal layer appeared greatest in HIV-SN+ donors. Overall, the differential expression of CaMKK2, P2X7R and P2X4R supports the genetic evidence of a role for these proteins in HIV-SN.
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Affiliation(s)
- Jessica Gaff
- Curtin Medical School, Curtin University, Bentley, 6102, Australia
| | - Fitri Octaviana
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Neurology Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Connie Jackaman
- Curtin Medical School, Curtin University, Bentley, 6102, Australia
- Curtin Health Innovation Research Institute, Bentley, Australia
| | - Peter Kamerman
- School of Physiology, University of Witwatersrand, Johannesburg, South Africa
| | | | - Silvia Lee
- Curtin Medical School, Curtin University, Bentley, 6102, Australia
- Department of Microbiology, Pathwest Laboratory Medicine, Perth, Australia
| | | | - Patricia Price
- Curtin Medical School, Curtin University, Bentley, 6102, Australia.
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
- Curtin Health Innovation Research Institute, Bentley, Australia.
- School of Physiology, University of Witwatersrand, Johannesburg, South Africa.
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Gaff J, Estiasari R, Diafiri D, Halstrom S, Kamerman P, Price P. Brief Report: Polymorphisms in CAMKK2 may Influence Domain-Specific Neurocognitive Function in HIV+ Indonesians Receiving ART. J Acquir Immune Defic Syndr 2022; 89:115-119. [PMID: 34878439 DOI: 10.1097/qai.0000000000002819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite effective antiretroviral therapy (ART), milder forms of HIV-associated neurocognitive disorders remain prevalent and are characterized by neuroinflammation, synaptic dysfunction, and neuronal loss. METHODS We explore associations between neurocognitive impairment in HIV+ Indonesians and 17 polymorphisms in adjacent genes involved in inflammation and neuronal growth/repair pathways, P2X4R and CAMKK2. HIV+ Indonesians (n = 59) who had received ART for 12 months were assessed to derive Z-scores for the attention, fluency, memory, executive, and motor speed domains relative to local control subjects. These were used to determine total cognitive scores. RESULTS No alleles of P2X4R displayed significant associations with neurocognition in bivariate or multivariable analyses. In CAMKK2, rs2686344 influenced total cognitive scores in bivariate analyses (P = 0.04). Multivariable linear regression modeling independently associated rs2686344 with higher executive function Z-scores (P = 0.05) after adjusting for CD4 T-cell counts (adjusted R2 = 0.103, model P = 0.034), whereas rs1653588 associated with lower and rs1718120 (P = 0.05) with higher fluency Z-scores (P = 0.05) after adjusting for education and log10 HIV RNA copies/mL (adjusted R2 = 0.268, model P = 0.001). CONCLUSIONS Polymorphisms in CAMKK2 may influence neurocognitive outcomes in specific domains in HIV+ Indonesians receiving ART for 12 months.
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Affiliation(s)
- Jessica Gaff
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia
| | - Riwanti Estiasari
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Neurology Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dinda Diafiri
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Neurology Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Samuel Halstrom
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia
- School of Medical and Biomedical Science, University of Queensland, Brisbane, Australia ; and
| | - Peter Kamerman
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia
- Brain Function Research Group, School of Physiology, University of Witwatersrand, Johannesburg, South Africa
| | - Patricia Price
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Brain Function Research Group, School of Physiology, University of Witwatersrand, Johannesburg, South Africa
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Gaff J, Estiasari R, Diafiri D, Halstrom S, Kamerman P, Price P. Neurocognitive outcomes in indonesians living with HIV are influenced by polymorphisms in the gene encoding purinergic P2X receptor 7. Brain Behav Immun Health 2021; 13:100220. [PMID: 34589739 PMCID: PMC8474153 DOI: 10.1016/j.bbih.2021.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/05/2022] Open
Abstract
The advent of effective antiretroviral therapy (ART) has decreased the prevalence and severity of HIV-associated neurocognitive disorders (HAND), but milder forms of HAND remain despite optimal treatment. Neuronal injury and loss due to inflammation may mediate HAND. P2X7R encodes purinergic P2X receptor 7 which influences neuroinflammatory pathways and carries polymorphisms associated with sensory neuropathy in HIV patients. We assessed associations between P2X7R polymorphisms and neurocognitive outcomes in Indonesian patients (n = 59) as they commenced ART and after 3, 6 and 12 months. Z-scores were calculated over 5 domains using local controls and evaluated as continuous variables. Optimal linear regression models identified polymorphisms influencing attention, memory, executive function, motor speed and total cognitive function at each time point. rs504677 was associated with lower executive and motor speed Z-scores at 0, 3, 6, and 12 months, and with memory at 0 and 12 months. Memory was positively influenced by carriage of the rs208296 minor allele at 0, 3 and 6 months and by carriage of the rs208307 minor allele at 0 and 12 months. Higher attention Z-scores associated with carriage of minor alleles of rs1653598 after 0 and 12 months. These also positively influenced executive function and motor speed after 0–6 months. This study identifies polymorphisms in P2X7R which influence domain-specific neurocognitive outcomes in HIV+ Indonesians prior to and shortly after commencing ART. This implicates purinergic P2X receptor 7 in the pathogenesis of HAND. Neurocognitive outcomes in HIV+ Indonesians were assessed over one year on ART. Overall scores were influenced by age, education and CD4 T-cell counts. Five intronic polymorphisms in P2X7R affected scores of selected domains. The influence of P2X7R polymorphisms varied over time on ART. P2X7R may influence neurocognitive changes on ART.
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Affiliation(s)
- Jessica Gaff
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia
| | - Riwanti Estiasari
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Neurology Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dinda Diafiri
- Neurology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Neurology Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sam Halstrom
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia.,School of Medical and Biomedical Science, University of Queensland, Brisbane, Australia
| | - Peter Kamerman
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia.,Brain Function Research Group, School of Physiology, University of Witwatersrand, Johannesburg, South Africa
| | - Patricia Price
- School of Pharmacy and Biomedical Science, Curtin University, Bentley, Australia.,Neurology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Brain Function Research Group, School of Physiology, University of Witwatersrand, Johannesburg, South Africa
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Brief Report: Demographic and Genetic Associations With Markers of Small and Large Fiber Sensory Neuropathy in HIV Patients Treated Without Stavudine. J Acquir Immune Defic Syndr 2021; 85:612-616. [PMID: 32925363 DOI: 10.1097/qai.0000000000002503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Neurotoxic antiretroviral therapy (ART) such as stavudine has been now replaced with safer therapies, reducing the prevalence of neuropathy from 34% to 15% in HIV+ Indonesians. However, it is unclear whether the residual cases display damage to small or large nerve fibers and whether both are influenced by known risk factors, including alleles of CAMKK2 associated with neuropathy in HIV patients. The encoded protein influences the growth and repair of nerve fibers. HIV-positive adults on ART for >12 months without exposure to stavudine were screened for neuropathy using the AIDS Clinical Trials Group Brief Peripheral Neuropathy Screen (BPNS). Large fiber neuropathy was assessed by nerve conduction (NC) and small fiber neuropathy using stimulated skin wrinkling (SSW) applied to the fingers. CAMKK2 alleles were assessed by TaqMan OpenArray technology. Neuropathy diagnoses were more common with SSW than BPNS (49/173 vs 26/185, χ; P = 0.0009), with poor alignment between these outcomes (P = 0.60). NC and BPNS diagnosed neuropathy at similar frequencies (29/151 vs 26/185; P = 0.12) and were aligned (P < 0.0001). In bivariate analyses, all diagnoses were associated with patients' age and persistent HIV replication, with minor effects from CD4 T-cell counts and time on ART. CAMKK2 alleles associated with neuropathy diagnosed with BPNS and SSW but not NC. Multivariable analyses confirmed the importance of age and HIV replication, with distinct CAMKK2 polymorphisms affecting BPNS and SSW. Paradoxically, height was protective against skin wrinkling. Overall the data link CAMKK2 genotypes with small rather than large fiber damage. SSW may reflect pathology distinct from that identified using BPNS.
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Gaff J, Jackaman C, Papadimitriou J, Waters S, McLean C, Price P. Immunohistochemical evidence of P2X7R, P2X4R and CaMKK2 in pyramidal neurons of frontal cortex does not align with Alzheimer's disease. Exp Mol Pathol 2021; 120:104636. [PMID: 33838119 DOI: 10.1016/j.yexmp.2021.104636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/25/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
Alzheimer's disease (AD) is an incurable neurodegenerative condition resulting in progressive cognitive decline. Pathological features include Aβ plaques, neurofibrillary tangles, neuroinflammation and neuronal death. Purinergic receptors 7 and 4 (P2X7R and P2X4R) and calcium/calmodulin-dependent kinase kinase 2 (CaMKK2) are implicated in neuronal death. We used immunohistochemistry to investigate the distribution of these proteins in neurones from frontal cortex of donors (n = 3/group; aged 79-83 years) who died with and without AD. Neurones were identified morphologically and immunoperoxidase staining was achieved using commercial antibodies. Immunoreactive neurones were counted for each protein by 2-3 raters blinded to the diagnoses. We observed no differences in percentages of P2X7R, P2X4R or CaMKK2 positive neurones (p = 0.2-0.99), but sections from individuals with AD had marginally fewer neurones (p = 0.10). Hence P2X7R, P2X4R or CaMKK2 appear to be expressed in neurones from older donors, but expression does not associate with AD.
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Affiliation(s)
- Jessica Gaff
- School of Pharmacy and Biomedical Science, Curtin University, Australia
| | - Connie Jackaman
- School of Pharmacy and Biomedical Science, Curtin University, Australia; Curtin Health Innovation Research Institute, Curtin University, Australia
| | - John Papadimitriou
- Pathology & Laboratory Medicine, University of Western Australia, Australia; Pathwest Laboratories, Western Australia, Australia
| | - Shelley Waters
- School of Pharmacy and Biomedical Science, Curtin University, Australia
| | - Catriona McLean
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia; Victorian Brain Bank, Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Patricia Price
- School of Pharmacy and Biomedical Science, Curtin University, Australia; Curtin Health Innovation Research Institute, Curtin University, Australia.
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Muscarinic Toxin 7 Signals Via Ca 2+/Calmodulin-Dependent Protein Kinase Kinase β to Augment Mitochondrial Function and Prevent Neurodegeneration. Mol Neurobiol 2020; 57:2521-2538. [PMID: 32198698 PMCID: PMC7253379 DOI: 10.1007/s12035-020-01900-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/09/2020] [Indexed: 12/29/2022]
Abstract
Mitochondrial dysfunction is implicated in a variety of neurodegenerative diseases of the nervous system. Peroxisome proliferator–activated receptor-γ coactivator-1α (PGC-1α) is a regulator of mitochondrial function in multiple cell types. In sensory neurons, AMP-activated protein kinase (AMPK) augments PGC-1α activity and this pathway is depressed in diabetes leading to mitochondrial dysfunction and neurodegeneration. Antimuscarinic drugs targeting the muscarinic acetylcholine type 1 receptor (M1R) prevent/reverse neurodegeneration by inducing nerve regeneration in rodent models of diabetes and chemotherapy-induced peripheral neuropathy (CIPN). Ca2+/calmodulin-dependent protein kinase kinase β (CaMKKβ) is an upstream regulator of AMPK activity. We hypothesized that antimuscarinic drugs modulate CaMKKβ to enhance activity of AMPK, and PGC-1α, increase mitochondrial function and thus protect from neurodegeneration. We used the specific M1R antagonist muscarinic toxin 7 (MT7) to manipulate muscarinic signaling in the dorsal root ganglia (DRG) neurons of normal rats or rats with streptozotocin-induced diabetes. DRG neurons treated with MT7 (100 nM) or a selective muscarinic antagonist, pirenzepine (1 μM), for 24 h showed increased neurite outgrowth that was blocked by the CaMKK inhibitor STO-609 (1 μM) or short hairpin RNA to CaMKKβ. MT7 enhanced AMPK phosphorylation which was blocked by STO-609 (1 μM). PGC-1α reporter activity was augmented up to 2-fold (p < 0.05) by MT7 and blocked by STO-609. Mitochondrial maximal respiration and spare respiratory capacity were elevated after 3 h of exposure to MT7 (p < 0.05). Diabetes and CIPN induced a significant (p < 0.05) decrease in corneal nerve density which was corrected by topical delivery of MT7. We reveal a novel M1R-modulated, CaMKKβ-dependent pathway in neurons that represents a therapeutic target to enhance nerve repair in two of the most common forms of peripheral neuropathy.
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TNF-Block Genotypes Influence Susceptibility to HIV-Associated Sensory Neuropathy in Indonesians and South Africans. Int J Mol Sci 2020; 21:ijms21020380. [PMID: 31936167 PMCID: PMC7014294 DOI: 10.3390/ijms21020380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 11/17/2022] Open
Abstract
HIV-associated sensory neuropathy (HIV-SN) is a disabling complication of HIV disease and antiretroviral therapies (ART). Since stavudine was removed from recommended treatment schedules, the prevalence of HIV-SN has declined and associated risk factors have changed. With stavudine, rs1799964*C (TNF-1031) associated with HIV-SN in Caucasians and Indonesians but not in South Africans. Here, we investigate associations between HIV-SN and rs1799964*C and 12 other polymorphisms spanning TNF and seven neighboring genes (the TNF-block) in Indonesians (n = 202; 34/168 cases) and South Africans (n = 75; 29/75 cases) treated without stavudine. Haplotypes were derived using fastPHASE and haplotype networks built with PopART. There were no associations with rs1799964*C in either population. However, rs9281523*C in intron 10 of BAT1 (alternatively DDX39B) independently associated with HIV-SN in Indonesians after correcting for lower CD4 T-cell counts and >500 copies of HIV RNA/mL (model p = 0.0011, Pseudo R2 = 0.09). rs4947324*T (between NFKBIL1 and LTA) independently associated with reduced risk of HIV-SN and shared haplotype 1 (containing no minor alleles) associated with increased risk of HIV-SN after correcting for greater body weight, a history of tuberculosis and nadir CD4 T-cell counts (model: p = 0.0003, Pseudo R2 = 0.22). These results confirm TNF-block genotypes influence susceptibility of HIV-SN. However, critical genotypes differ between ethnicities and with stavudine use.
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