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Mehraj V, Chen J, Routy JP. Effects of statins beyond lipid-lowering agents in ART-treated HIV infection. Front Immunol 2024; 15:1339338. [PMID: 38655259 PMCID: PMC11035727 DOI: 10.3389/fimmu.2024.1339338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Antiretroviral therapies (ART) have reduced human immunodeficiency virus (HIV) infection-associated morbidity and mortality improving the life of people with HIV (PWH). However, ART lead to residual HIV production, which in conjunction with microbial translocation and immune dysfunction contributes to chronic inflammation and immune activation. PWH on ART remain at an increased risk for cardiovascular diseases (CVDs) including myocardial infarction and stroke; which in part is explained by chronic inflammation and immune activation. Lifestyle factors and certain ART are associated with dyslipidemia characterized by an increase of low-density lipoprotein (LDL), which further contributes in the increased risk for CVDs. Lipid-lowering agents like statins are emerging as immune modulators in decreasing inflammation in a variety of conditions including HIV. The international randomized clinical trial REPRIEVE has shed light on the reduction of CVDs with statin therapy among PWH. Such reports indicate a more than expected benefit of statins beyond their lipid-lowering effects. Bempedoic acid, a first-in-class non-statin LDL-lowering drug with immune modulatory effects, may further aid PWH in combination with statins. Herein, we critically reviewed studies aimed at lipid-lowering and immune-modulating roles of statins that may benefit aging PWH.
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Affiliation(s)
- Vikram Mehraj
- Research Centre McGill University Health Centre, Montreal, QC, Canada
| | - Jun Chen
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jean-Pierre Routy
- Research Centre McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service and Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
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Anaraki KT, Zahed Z, Javid RN, Shafiei S, Beiranvandi F, Kahrizsangi NG, Golafshan F, Arzhangzade A, Kojuri J, Almassian S, Hadi R, Gholizadeh P, Kazeminava F. Immune response following transcatheter aortic valve procedure. Vascul Pharmacol 2024; 154:107283. [PMID: 38340884 DOI: 10.1016/j.vph.2024.107283] [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] [Received: 11/27/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
Aortic valve stenosis is the most common type of heart valve disease in the United States and Europe and calcific aortic stenosis (AS) affects 2-7% of people aged 65 years and older. Aortic valve replacement (AVR) is the only effective treatment for individuals with this condition. Transcatheter Aortic Valve Replacement (TAVR) has been widely accepted as a minimally invasive therapeutic approach for addressing symptomatic AS in patients who are considered to have a high risk for traditional surgical intervention. TAVR procedure may have a paradoxical effect on the immune system and inflammatory status. A major portion of these immune responses is regulated by activating or inhibiting inflammatory monocytes and the complement system with subsequent changes in inflammatory cytokines. TAVR has the potential to induce various concurrent exposures, including disruption of the native valve, hemodynamic changes, antigenicity of the bioprosthesis, and vascular damage, which finally lead to the development of inflammation. On the other hand, it is important to acknowledge that TAVR may also have anti-inflammatory effects by helping in the resolution of stenosis.The inflammation and immune response following TAVR are complex processes that significantly impact procedural outcomes and patient well-being. Understanding the underlying mechanisms, identifying biomarkers of inflammation, and exploring therapeutic interventions to modulate these responses are crucial for optimizing TAVR outcomes. Further research is warranted to elucidate the precise immunological dynamics and develop tailored strategies to attenuate inflammation and enhance post-TAVR healing while minimizing complications.
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Affiliation(s)
- Kasra Talebi Anaraki
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zahed
- Department of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Sasan Shafiei
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Beiranvandi
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Faraz Golafshan
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Arzhangzade
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samin Almassian
- Heart Valve Disease Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Raha Hadi
- Department of Chemistry, Faculty of Basic Science, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Pourya Gholizadeh
- Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil, Iran; Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Fahimeh Kazeminava
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Alles M, Gunasena M, Kettelhut A, Ailstock K, Musiime V, Kityo C, Richardson B, Mulhern W, Tamilselvan B, Rubsamen M, Kasturiratna D, Demberg T, Cameron CM, Cameron MJ, Dirajlal-Fargo S, Funderburg NT, Liyanage NPM. Activated NK Cells with Pro-inflammatory Features are Associated with Atherogenesis in Perinatally HIV-Acquired Adolescents. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.06.23297580. [PMID: 37986784 PMCID: PMC10659511 DOI: 10.1101/2023.11.06.23297580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Human immunodeficiency virus (HIV) is associated with persistent immune activation and dysfunction in people with HIV despite treatment with antiretroviral therapy (ART). Modulation of the immune system may be driven by: low-level HIV replication, co-pathogens, gut dysbiosis /translocation, altered lipid profiles, and ART toxicities. In addition, perinatally acquired HIV (PHIV) and lifelong ART may alter the development and function of the immune system. Our preliminary data and published literature suggest reprogramming innate immune cells may accelerate aging and increase the risk for future end-organ complications, including cardiovascular disease (CVD). The exact mechanisms, however, are currently unknown. Natural killer (NK) cells are a highly heterogeneous cell population with divergent functions. They play a critical role in HIV transmission and disease progression in adults. Recent studies suggest the important role of NK cells in CVDs; however, little is known about NK cells and their role in HIV-associated cardiovascular risk in PHIV adolescents. Here, we investigated NK cell subsets and their potential role in atherogenesis in PHIV adolescents compared to HIV-negative adolescents in Uganda. Our data suggest, for the first time, that activated NK subsets in PHIV adolescents may contribute to atherogenesis by promoting plasma oxidized low-density lipoprotein (Ox-LDL) uptake by vascular macrophages.
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Vemulapalli AC, Elias AA, Yerramsetti MD, Olanisa OO, Jain P, Khan QS, Butt SR. The Impact of Contemporary Antiretroviral Drugs on Atherosclerosis and Its Complications in People Living With HIV: A Systematic Review. Cureus 2023; 15:e47730. [PMID: 38021858 PMCID: PMC10676193 DOI: 10.7759/cureus.47730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
With the advent of modern antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection has been modified into a chronic manageable condition, prolonging the lifespan of people living with HIV (PLHIV). This has resulted in an increased non-AIDS-related morbidity in the HIV-infected population. Our aim is to study the role of contemporary ART in tackling the risk of atherosclerosis and cardiovascular disease (CVD) in PLHIV. We searched through the databases of PubMed, PubMed Central, and Cochrane Library for pertinent articles using the medical subject headings (MeSH) "HIV infection", "Atherosclerosis", and "Antiretroviral agents". The articles published in the past five years were retrieved, screened for relevance, and assessed for quality before being included in the review. This review was performed following the PRISMA 2020 guidelines. The results indicate that the incidence of dyslipidemia with integrase strand transfer inhibitors (INSTIs) is greater than with non-nucleoside reverse transcriptase inhibitors (NNRTIs) and lesser than with protease inhibitors (PIs). INSTIs are indispensably associated with weight gain and obesity. High triglyceride (TG) and oxidized low-density lipoproteins to low-density lipoproteins (oxLDL/LDL) ratio levels and low high-density lipoprotein (HDL) levels are seen in patients taking PIs. A higher incidence of hypertension and metabolic syndrome (MetS) was noticed with INSTIs compared to NNRTIs. PI intake for >5 years increases the risk of subclinical atherosclerosis. Increased risk of myocardial infarction with INSTIs was observed in a study, while another study reported decreased risk. HIV infection independently increases the risk for atherosclerosis and CVD. Although contemporary ART decreases this enhanced risk, it inherently increases the risk for abnormal lipid profile, MetS, weight gain, and obesity. Further research into the risk of atherosclerosis and CVD with newer ART drugs is essential for decoding the underlying mechanisms and preventing adverse cardiac outcomes in PLHIV.
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Affiliation(s)
- Abhijith C Vemulapalli
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abanob A Elias
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Monica D Yerramsetti
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Olawale O Olanisa
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Payal Jain
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Qasim S Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Samia R Butt
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Zidar DA, Al-Kindi S, Longenecker CT, Parikh SA, Gillombardo CB, Funderburg NT, Juchnowski S, Huntington L, Jenkins T, Nmai C, Osnard M, Shishebhor M, Filby S, Tatsuoka C, Lederman MM, Blackstone E, Attizzani G, Simon DI. Platelet and Monocyte Activation After Transcatheter Aortic Valve Replacement (POTENT-TAVR): A Mechanistic Randomized Trial of Ticagrelor Versus Clopidogrel. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100182. [PMID: 37520136 PMCID: PMC10382989 DOI: 10.1016/j.shj.2023.100182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 08/01/2023]
Abstract
Background Inflammation and thrombosis are often linked mechanistically and are associated with adverse events after transcatheter aortic valve replacement (TAVR). High residual platelet reactivity (HRPR) is especially common when clopidogrel is used in this setting, but its relevance to immune activation is unknown. We sought to determine whether residual activity at the purinergic receptor P2Y12 (P2Y12) promotes prothrombotic immune activation in the setting of TAVR. Methods This was a randomized trial of 60 patients (enrolled July 2015 through December 2018) assigned to clopidogrel (300mg load, 75mg daily) or ticagrelor (180mg load, 90 mg twice daily) before and for 30 days following TAVR. Co-primary endpoints were P2Y12-dependent platelet activity (Platelet Reactivity Units; VerifyNow) and the proportion of inflammatory (cluster of differentiation [CD] 14+/CD16+) monocytes 1 day after TAVR. Results Compared to clopidogrel, those randomized to ticagrelor had greater platelet inhibition (median Platelet Reactivity Unit [interquartile range]: (234 [170.0-282.3] vs. 128.5 [86.5-156.5], p < 0.001), but similar inflammatory monocyte proportions (22.2% [18.0%-30.2%] vs. 25.1% [22.1%-31.0%], p = 0.201) 1 day after TAVR. Circulating monocyte-platelet aggregates, soluble CD14 levels, interleukin 6 and 8 levels, and D-dimers were also similar across treatment groups. HRPR was observed in 63% of the clopidogrel arm and was associated with higher inflammatory monocyte proportions. Major bleeding events, pacemaker placement, and mortality did not differ by treatment assignment. Conclusions Residual P2Y12 activity after TAVR is common in those treated with clopidogrel but ticagrelor does not significantly alter biomarkers of prothrombotic immune activation. HRPR appears to be an indicator (not a cause) of innate immune activation in this setting.
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Affiliation(s)
- David A. Zidar
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Chris T. Longenecker
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sahil A. Parikh
- Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, New York, USA
| | - Carl B. Gillombardo
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nicholas T. Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitations Sciences, Ohio State University, Columbus, Ohio, USA
| | - Steven Juchnowski
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lauren Huntington
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Trevor Jenkins
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Christopher Nmai
- New York University Grossman School of Medicine, New York, New York, USA
| | - Michael Osnard
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mehdi Shishebhor
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven Filby
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Curtis Tatsuoka
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael M. Lederman
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Eugene Blackstone
- Department of Population Health and Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Guilherme Attizzani
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Daniel I. Simon
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Singh TK, Zidar DA, McCrae K, Highland KB, Englund K, Cameron SJ, Chung MK. A Post-Pandemic Enigma: The Cardiovascular Impact of Post-Acute Sequelae of SARS-CoV-2. Circ Res 2023; 132:1358-1373. [PMID: 37167358 PMCID: PMC10171306 DOI: 10.1161/circresaha.122.322228] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
COVID-19 has become the first modern-day pandemic of historic proportion, affecting >600 million individuals worldwide and causing >6.5 million deaths. While acute infection has had devastating consequences, postacute sequelae of SARS-CoV-2 infection appears to be a pandemic of its own, impacting up to one-third of survivors and often causing symptoms suggestive of cardiovascular phenomena. This review will highlight the suspected pathophysiology of postacute sequelae of SARS-CoV-2, its influence on the cardiovascular system, and potential treatment strategies.
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Affiliation(s)
- Tamanna K Singh
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (TKS, MC, SJC)
- Cleveland Clinic Lerner College of Medicine, OH (T.K.S., K.M., K.B.H., K.E., S.J.C., M.K.C.)
- Case Western Reserve University School of Medicine, Cleveland, OH (T.K.S., D.A.Z., K.M., K.B.H., K.E., S.J.C., M.K.C.)
| | - David A Zidar
- Case Western Reserve University School of Medicine, Cleveland, OH (T.K.S., D.A.Z., K.M., K.B.H., K.E., S.J.C., M.K.C.)
- Louise Stokes Cleveland Veterans Affairs Medical Center, Department of Cardiovascular Medicine, Cleveland, OH (D.A.Z.)
| | - Keith McCrae
- Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH (KM)
- Cleveland Clinic Lerner College of Medicine, OH (T.K.S., K.M., K.B.H., K.E., S.J.C., M.K.C.)
- Case Western Reserve University School of Medicine, Cleveland, OH (T.K.S., D.A.Z., K.M., K.B.H., K.E., S.J.C., M.K.C.)
| | - Kristin B Highland
- Pulmonary Medicine, Cleveland Clinic, Cleveland, OH (KBH)
- Cleveland Clinic Lerner College of Medicine, OH (T.K.S., K.M., K.B.H., K.E., S.J.C., M.K.C.)
- Case Western Reserve University School of Medicine, Cleveland, OH (T.K.S., D.A.Z., K.M., K.B.H., K.E., S.J.C., M.K.C.)
| | - Kristin Englund
- Infectious Disease, Cleveland Clinic, Cleveland, OH (KE)
- Cleveland Clinic Lerner College of Medicine, OH (T.K.S., K.M., K.B.H., K.E., S.J.C., M.K.C.)
- Case Western Reserve University School of Medicine, Cleveland, OH (T.K.S., D.A.Z., K.M., K.B.H., K.E., S.J.C., M.K.C.)
| | - Scott J Cameron
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (TKS, MC, SJC)
- Cleveland Clinic Lerner College of Medicine, OH (T.K.S., K.M., K.B.H., K.E., S.J.C., M.K.C.)
- Case Western Reserve University School of Medicine, Cleveland, OH (T.K.S., D.A.Z., K.M., K.B.H., K.E., S.J.C., M.K.C.)
| | - Mina K Chung
- Cleveland Clinic Lerner College of Medicine, OH (T.K.S., K.M., K.B.H., K.E., S.J.C., M.K.C.)
- Case Western Reserve University School of Medicine, Cleveland, OH (T.K.S., D.A.Z., K.M., K.B.H., K.E., S.J.C., M.K.C.)
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Dirajlal-Fargo S, Strah M, Ailstock K, Sattar A, Karungi C, Nazzinda R, Kityo C, Musiime V, Funderburg N, McComsey GA. Persistent immune activation and altered gut integrity over time in a longitudinal study of Ugandan youth with perinatally acquired HIV. Front Immunol 2023; 14:1165964. [PMID: 37056779 PMCID: PMC10086119 DOI: 10.3389/fimmu.2023.1165964] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction Perinatally acquired HIV infection (PHIV) occurs during a critical window of immune development. We investigated changes in systemic inflammation and immune activation in adolescents with PHIV and those without HIV (HIV-) in Uganda. Methods A prospective observational cohort study was performed in 2017-2021 in Uganda. All participants were between 10-18 years of age and without active co-infections. PHIVs were on ART with HIV-1 RNA level ≤400 copies/mL. We measured plasma and cellular markers of monocyte activation, T-cell activation (expression of CD38 and HLA-DR on CD4+ and CD8+), oxidized LDL, markers of gut integrity and fungal translocation. Groups were compared using Wilcoxon rank sum tests. Changes from baseline were examined with 97.5% confidence intervals on relative fold change. P values were adjusted for false discovery rate. Results We enrolled 101 PHIV and 96 HIV-; among these, 89 PHIV and 79 HIV- also had measurements at 96 weeks. At baseline, median (Q1, Q3) age was 13 yrs (11,15), and 52% were females. In PHIV, median CD4+ cell counts were 988 cells/µL (638, 1308), ART duration was 10 yrs (8, 11), and 85% had viral load <50 copies/mL throughout the study, 53% of participants had a regimen switch between visits, 85% of whom switched to 3TC, TDF and DTG. Over 96 weeks, while hsCRP decreased by 40% in PHIV (p=0.12), I-FABP and BDG both increased by 19 and 38% respectively (p=0.08 and ≤0.01) and did not change in HIV- (p≥0.33). At baseline, PHIVs had higher monocyte activation (sCD14) (p=0.01) and elevated frequencies of non-classical monocytes (p<0.01) compared to HIV- which remained stable over time in PHIV but increased by 34% and 80% respectively in HIV-. At both time points, PHIVs had higher T cell activation (p ≤ 0.03: CD4+/CD8+ T cells expressing HLA-DR and CD38). Only in PHIV, at both timepoints, oxidized LDL was inversely associated with activated T cells(p<0.01). Switching to dolutegravir at week 96 was significantly associated an elevated level of sCD163 (β=0.4, 95% CI=0.14,0.57, p<0.01), without changes in other markers. Conclusion Ugandan PHIV with viral suppression have some improvement in markers of inflammation over time, however T-cell activation remains elevated. Gut integrity and translocation worsened only in PHIV over time. A deeper understanding of the mechanisms causing immune activation in ART treated African PHIV is crucial.
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Affiliation(s)
- Sahera Dirajlal-Fargo
- Division of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Division of Infectious Diseases, Rainbow Babies and Children’s Hospital, Cleveland, OH, United States
- School of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Monika Strah
- School of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Kate Ailstock
- School of Health and Rehabilitation Sciences, Ohio State University School of Health and Rehabilitation Sciences, Columbus, OH, United States
| | - Abdus Sattar
- School of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
| | | | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Victor Musiime
- Joint Clinical Research Centre, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | - Nicholas Funderburg
- School of Health and Rehabilitation Sciences, Ohio State University School of Health and Rehabilitation Sciences, Columbus, OH, United States
| | - Grace A. McComsey
- Division of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Division of Infectious Diseases, Rainbow Babies and Children’s Hospital, Cleveland, OH, United States
- School of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
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8
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Uysal P, Yüksel A, Durmus S, Cuhadaroglu Ç, Gelisgen R, Uzun H. Can circulating oxidative stress-related biomarkers be used as an early prognostic marker for COVID-19? Front Med (Lausanne) 2023; 10:1041115. [PMID: 36844214 PMCID: PMC9948026 DOI: 10.3389/fmed.2023.1041115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Background Oxidative stress plays an important role in the pathogenesis of many diseases. This study aimed to investigate the relationship between nuclear factor kappa B (NF-κB) and oxidative stress and the severity of the disease in new COVID-19 patients, and, to compare the levels of NF-κB, oxidized LDL (oxLDL), and lectin-like oxidized-LDL receptor-1 (LOX-1) with oxygen saturation, which is an indicator of the severity parameters of the disease in COVID-19 patients. Methods In this prospective study, 100 COVID-19 patients and 100 healthy subjects were selected. Results LOX-1, NF-κB, and oxLDL were found to be higher in COVID-19 patients compared to the healthy subjects (p < 0.001 for all). According to the results of correlation analysis, it was found that there was no significant relationship between oxygen saturation and LOX-1, NF-κB and oxLDL parameters. There was significant relationship between oxLDL with LOX-1 and NF-κB in patients with COVID-19 disease. ROC analysis results of the highest discrimination power were oxLDL (AUC: 0.955, CI: 0.904-1.000; sensitivity: 77%, and specificity: 100%, for cutoff: 127.944 ng/l) indicating COVID-19. Conclusion Oxidative stress plays an essential role in COVID-19. NF-κB, oxLDL, and LOX-1 seem to represent good markers in COVID-19. Our study also showed that oxLDL has the highest power in distinguishing patients with COVID-19 from the healthy subjects.
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Affiliation(s)
- Pelin Uysal
- Department of Chest Diseases, Acibadem Mehmet Ali Aydinlar University Faculty of Medicine, Maslak Hospital, Istanbul, Turkey
| | - Arzu Yüksel
- Department of Biochemistry, Acibadem Mehmet Ali Aydinlar University Faculty of Medicine, Atakent Hospital, Istanbul, Turkey
| | - Sinem Durmus
- Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Çaglar Cuhadaroglu
- Department of Chest Diseases, Acibadem University Faculty of Medicine, Altunizade Hospital, Istanbul, Turkey
| | - Remise Gelisgen
- Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hafize Uzun
- Department of Medical Biochemistry, Faculty of Medicine, İstanbul Atlas University, Istanbul, Turkey,*Correspondence: Hafize Uzun, ✉
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Hileman CO, Durieux JC, Janus SE, Bowman E, Kettelhut A, Nguyen TT, Avery AK, Funderburg N, Sullivan C, McComsey GA. Heroin Use Is Associated With Vascular Inflammation in Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:375-381. [PMID: 36208157 PMCID: PMC10169434 DOI: 10.1093/cid/ciac812] [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: 05/10/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heroin use may work synergistically with human immunodeficiency virus (HIV) infection to cause greater immune dysregulation than either factor alone. Unraveling how this affects end-organ disease is key as it may play a role in the excess mortality seen in people with HIV (PWH) who use heroin despite access to care and antiretroviral therapy. METHODS This is a prospectively enrolled, cross-sectional study of adults with and without HIV who use and do not use heroin using (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to compare tissue-specific inflammation including aortic (target-to-background ratio [TBR]), splenic, and bone marrow (standardized uptake value [SUV]). RESULTS A total of 120 participants were enrolled. The unadjusted mean difference in aortic TBR was 0.43 between HIV-positive [HIV+] heroin+ and HIV+ heroin-negative [heroin-] (P = .02); however, among HIV-, aortic TBR was similar regardless of heroin-use status. Further, HIV-by-heroin-use status interaction was significant (P = .02), indicating that the relationship between heroin use and higher aortic TBR depended on HIV status. On the other hand, both HIV (1.54 vs 1.68; P = .04, unadjusted estimated means for HIV+ vs HIV-) and heroin use were associated with lower bone marrow SUV, although the effect of heroin depended on sex (heroin-use-by-sex interaction, P = .03). HIV-by-heroin-use interaction was not significant for splenic or bone marrow SUV. CONCLUSIONS Aortic inflammation was greatest in PWH who use heroin, but paradoxically, bone marrow activity was the least in this group, suggesting complex and possibly divergent pathophysiology within these different end organs.
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Affiliation(s)
- Corrilynn O Hileman
- Department of Medicine, Division of Infectious Disease, MetroHealth Medical Center, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jared C Durieux
- Department of Medicine and Pediatrics, Division of Infectious Disease, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Scott E Janus
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Emily Bowman
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, The Ohio State University, Columbus, Ohio, USA
| | - Aaren Kettelhut
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, The Ohio State University, Columbus, Ohio, USA
| | - Trong-Tuong Nguyen
- Department of Medicine, Division of Infectious Disease, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Ann K Avery
- Department of Medicine, Division of Infectious Disease, MetroHealth Medical Center, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nicholas Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, The Ohio State University, Columbus, Ohio, USA
| | - Claire Sullivan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Grace A McComsey
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Medicine and Pediatrics, Division of Infectious Disease, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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10
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Ahmed D, Al-Daraawi M, Cassol E. Innate sensing and cellular metabolism: role in fine tuning antiviral immune responses. J Leukoc Biol 2023; 113:164-190. [PMID: 36822175 DOI: 10.1093/jleuko/qiac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Indexed: 01/19/2023] Open
Abstract
Several studies over the last decade have identified intimate links between cellular metabolism and macrophage function. Metabolism has been shown to both drive and regulate macrophage function by producing bioenergetic and biosynthetic precursors as well as metabolites (and other bioactive molecules) that regulate gene expression and signal transduction. Many studies have focused on lipopolysaccharide-induced reprogramming, assuming that it is representative of most inflammatory responses. However, emerging evidence suggests that diverse pathogen-associated molecular patterns (PAMPs) are associated with unique metabolic profiles, which may drive pathogen specific immune responses. Further, these metabolic pathways and processes may act as a rheostat to regulate the magnitude of an inflammatory response based on the biochemical features of the local microenvironment. In this review, we will discuss recent work examining the relationship between cellular metabolism and macrophage responses to viral PAMPs and describe how these processes differ from lipopolysaccharide-associated responses. We will also discuss how an improved understanding of the specificity of these processes may offer new insights to fine-tune macrophage function during viral infections or when using viral PAMPs as therapeutics.
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Affiliation(s)
- Duale Ahmed
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada.,Department of Biology, Carleton University, Ottawa, Ontario, Canada
| | - Malak Al-Daraawi
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Edana Cassol
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada.,Centre for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, Ontario, Canada
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11
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Looby SE, Kantor A, Burdo TH, Currier JS, Fichtenbaum CJ, Overton ET, Aberg JA, Malvestutto CD, Bloomfield GS, Erlandson KM, Cespedes M, Kallas EG, Masiá M, Thornton AC, Smith MD, Flynn JM, Kileel EM, Fulda E, Fitch KV, Lu MT, Douglas PS, Grinspoon SK, Ribaudo HJ, Zanni MV. Factors Associated With Systemic Immune Activation Indices in a Global Primary Cardiovascular Disease Prevention Cohort of People With Human Immunodeficiency Virus on Antiretroviral Therapy. Clin Infect Dis 2022; 75:1324-1333. [PMID: 35235653 PMCID: PMC9555837 DOI: 10.1093/cid/ciac166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Among antiretroviral therapy (ART)-treated people with human immunodeficiency virus (PWH), persistent systemic immune activation contributes to atherogenesis atherosclerotic, cardiovascular disease (CVD) events, and mortality. Factors associated with key immune activation indices have not previously been characterized among a global primary CVD prevention cohort of PWH. METHODS Leveraging baseline Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) data, we evaluated factors associated with soluble CD14 (sCD14) and oxidized low-density lipoprotein (oxLDL). RESULTS The primary analysis cohort included 4907 participants from 5 global-burden-of-disease regions (38% female, 48% Black, median age 50 years). In fully adjusted models for sCD14, female sex and White race (among those in high-income regions) were associated with higher sCD14 levels, while higher body mass index (BMI) and current use of nucleoside reverse transcriptase inhibitor + integrase strand transfer inhibitor ART were associated with lower sCD14 levels. In fully adjusted models for oxLDL, male sex, residence in high-income regions, White race (among those in high-income regions), and higher BMI were associated with higher oxLDL levels. In a subanalysis cohort of 1396 women with HIV, increased reproductive age was associated with higher sCD14 levels but not with higher oxLDL levels. CONCLUSIONS Factors associated with sCD14 and oxLDL, 2 key indices of immune-mediated CVD risk, differ. Future studies will elucidate ways in which medications (eg, statins) and behavioral modifications influence sCD14 and oxLDL and the extent to which dampening of these markers mediates CVD-protective effects. CLINICAL TRIALS REGISTRATION NCT0234429.
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Affiliation(s)
- Sara E Looby
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Kantor
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tricia H Burdo
- Department of Microbiology, Immunology, and Inflammation and Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Judith S Currier
- Division of Infectious Diseases, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Carl J Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Edgar T Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carlos D Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Gerald S Bloomfield
- Department of Medicine, Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Kristine M Erlandson
- Department of Medicine, Division of Infectious Disease, University of Colorado–nschutz Medical Campus, Aurora, Colorado, USA
| | - Michelle Cespedes
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Esper G Kallas
- Departmento de Molestias Infecciosas e Parasitárias, University of Sao Paulo, Sao Paulo, Brazil
| | - Mar Masiá
- Department of Infectious Diseases, Hospital General Universitario de Elche, Alicante, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Spain
| | - Alice C Thornton
- Division of Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Mandy D Smith
- Department of Microbiology, Immunology, and Inflammation and Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jacqueline M Flynn
- Department of Microbiology, Immunology, and Inflammation and Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emma M Kileel
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Evelynne Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen V Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela S Douglas
- Duke University Research Institute, Duke University School of Medicine, Durham North Carolina, USA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Markella V Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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12
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Qrareya AN, Wise NS, Hodges ER, Mahdi F, Stewart JA, Paris JJ. HIV-1 Tat Upregulates the Receptor for Advanced Glycation End Products and Superoxide Dismutase-2 in the Heart of Transgenic Mice. Viruses 2022; 14:v14102191. [PMID: 36298745 PMCID: PMC9607872 DOI: 10.3390/v14102191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
Abstract
Cardiovascular disorder (CVD) is a common comorbidity in people living with HIV (PLWH). Although the underlying mechanisms are unknown, virotoxic HIV proteins, such as the trans-activator of transcription (Tat), likely contribute to CVD pathogenesis. Tat expression in mouse myocardium has been found to induce cardiac dysfunction and increase markers of endothelial toxicity. However, the role that Tat may play in the development of CVD pathogenesis is unclear. The capacity for Tat to impact cardiac function was assessed using AC16 human cardiomyocyte cells and adult male and female transgenic mice that conditionally expressed Tat [Tat(+)], or did not [Tat(-)]. In AC16 cardiomyocytes, Tat increased intracellular calcium. In Tat(+) mice, Tat expression was detected in both atrial and ventricular heart tissue. Tat(+) mice demonstrated an increased expression of the receptor for advanced glycation end products and superoxide dismutase-2 (SOD-2) in ventricular tissues compared to Tat(-) controls. No changes in SOD-1 or α-smooth muscle actin were observed. Despite Tat-mediated changes at the cellular level, no changes in echocardiographic measures were detected. Tat(+) mice had a greater proportion of ventricular mast cells and collagen; however, doxycycline exposure offset the latter effect. These data suggest that Tat exposure promotes cellular changes that can precede progression to CVD.
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Affiliation(s)
- Alaa N. Qrareya
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Nason S. Wise
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Emmanuel R. Hodges
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Fakhri Mahdi
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - James A. Stewart
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
- Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
- Correspondence: (J.A.S.J.); (J.J.P.); Tel.: +1-662-915-2309 (J.A.S.J.); +1-662-915-3096 (J.J.P.)
| | - Jason J. Paris
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
- Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
- Correspondence: (J.A.S.J.); (J.J.P.); Tel.: +1-662-915-2309 (J.A.S.J.); +1-662-915-3096 (J.J.P.)
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13
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Kowalska K, Sabatowska Z, Forycka J, Młynarska E, Franczyk B, Rysz J. The Influence of SARS-CoV-2 Infection on Lipid Metabolism—The Potential Use of Lipid-Lowering Agents in COVID-19 Management. Biomedicines 2022; 10:biomedicines10092320. [PMID: 36140421 PMCID: PMC9496398 DOI: 10.3390/biomedicines10092320] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 12/15/2022] Open
Abstract
Several studies have indicated lipid metabolism alterations during COVID-19 infection, specifically a decrease in high-density lipoprotein (HDL) and low-density lipoprotein (LDL) concentrations and an increase in triglyceride (TG) levels during the infection. However, a decline in triglycerides can also be observed in critical cases. A direct correlation can be observed between a decrease in serum cholesterol, HDL-C, LDL-C and TGs, and the severity of the disease; these laboratory findings can serve as potential markers for patient outcomes. The transmission of coronavirus increases proportionally with rising levels of cholesterol in the cell membrane. This is due to the fact that cholesterol increases the number of viral entry spots and the concentration of angiotensin-converting enzyme 2 (ACE2) receptor, crucial for viral penetration. Studies have found that lower HDL-C levels correspond with a higher susceptibility to SARS-CoV-2 infection and infections in general, while higher HDL-C levels were related to a lower risk of developing them. However, extremely high HDL-C levels in serum increase the risk of infectious diseases and is associated with a higher risk of cardiovascular events. Low HDL-C levels are already accepted as a marker for risk stratification in critical illnesses, and higher HDL-C levels prior to the infection is associated with a lower risk of death in older patients. The correlation between LDL-C levels and disease severity is still unclear. However, TG levels were significantly higher in non-surviving severe patients compared to those that survived; therefore, elevated TG-C levels in COVID-19 patients may be considered an indicator of uncontrolled inflammation and an increased risk of death.
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14
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Al-Kindi S, Zidar DA. COVID-lateral damage: cardiovascular manifestations of SARS-CoV-2 infection. Transl Res 2022; 241:25-40. [PMID: 34780967 PMCID: PMC8588575 DOI: 10.1016/j.trsl.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 02/07/2023]
Abstract
Early in the pandemic, concern that cardiovascular effects would accompany COVID-19 was fueled by lessons from the first SARS epidemic, knowledge that the SARS-COV2 entry receptor (Angiotensin-converting enzyme 2, ACE2) is highly expressed in the heart, early reports of myocarditis, and first-hand accounts by physicians caring for those with severe COVID-19. Over 18 months, our understanding of the cardiovascular manifestations has expanded greatly, leaving more new questions than those conclusively answered. Cardiac involvement is common (∼20%) but not uniformly observed in those who require treatment in a hospitalized setting. Cardiac MRI studies raise the possibility of manifestations in those with minimal symptoms. Some appear to experience protracted cardiovascular symptoms as part of a larger syndrome of post-acute sequelae of COVID-19. Instances of vaccine induced thrombosis and myocarditis are exceedingly rare but illustrate the need to monitor the cardiovascular safety of interventions that induce inflammation. Here, we will summarize the current understanding of potential cardiovascular manifestations of SARS-COV2. To provide proper context, paradigms of cardiovascular injury due to other inflammatory processes will also be discussed. Ongoing research and a deeper understanding COVID-19 may ultimately reveal new insight into the mechanistic underpinnings of cardiovascular disease. Thus, in this time of unprecedented suffering and risk to global health, there exists the opportunity that well conducted translational research of SARS-COV2 may provide health dividends that outlast the current pandemic.
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Key Words
- ace2, angiotensin-converting enzyme 2
- pasc, post-acute sequelae of covid-19
- cvd, cardiovascular disease
- tnf, tumor necrosis factor
- pamp, pathogen associated molecular patterns
- damps, damage associated molecular patterns
- car-t, chimeric antigen receptor therapy
- dvt, deep venous thrombosis
- tf, tissue factor
- psgl, p-selectin glycoprotein ligand
- nets, neutrophil extracellular traps
- lv, left ventricular
- crp, c-reactive protein
- lge, late gadolinium enhancement
- cbv, coxsackie virus b
- b19v, parvovirus b12
- car, coxsackievirus and adenovirus receptor
- ns1, nonstructural protein 1
- ec, endothelial cells
- scrnaseq, single cell rna sequencing
- embx, endomyocardial biopsy
- tte, transthoracic echocardiograms
- rv, right ventricular
- gls, global longitudinal strain
- hscrp, high sensitivity c-reative protein
- vitt, vaccine-induced immune thrombotic thrombocytopenia
- dtap, diphtheria, tetanus, and polio
- vaers, vaccine adverse event reporting system
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Affiliation(s)
- Sadeer Al-Kindi
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - David A Zidar
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Louis Stokes VA Medical Center, Cleveland, Ohio.
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15
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Daskou M, Mu W, Sharma M, Vasilopoulos H, Heymans R, Ritou E, Rezek V, Hamid P, Kossyvakis A, Sen Roy S, Grijalva V, Chattopadhyay A, Kitchen SG, Fogelman AM, Reddy ST, Kelesidis T. ApoA-I mimetics reduce systemic and gut inflammation in chronic treated HIV. PLoS Pathog 2022; 18:e1010160. [PMID: 34995311 PMCID: PMC8740974 DOI: 10.1371/journal.ppat.1010160] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/30/2021] [Indexed: 12/31/2022] Open
Abstract
Novel therapeutic strategies are needed to attenuate increased systemic and gut inflammation that contribute to morbidity and mortality in chronic HIV infection despite potent antiretroviral therapy (ART). The goal of this study is to use preclinical models of chronic treated HIV to determine whether the antioxidant and anti-inflammatory apoA-I mimetic peptides 6F and 4F attenuate systemic and gut inflammation in chronic HIV. We used two humanized murine models of HIV infection and gut explants from 10 uninfected and 10 HIV infected persons on potent ART, to determine the in vivo and ex vivo impact of apoA-I mimetics on systemic and intestinal inflammation in HIV. When compared to HIV infected humanized mice treated with ART alone, mice on oral apoA-I mimetic peptide 6F with ART had consistently reduced plasma and gut tissue cytokines (TNF-α, IL-6) and chemokines (CX3CL1) that are products of ADAM17 sheddase activity. Oral 6F attenuated gut protein levels of ADAM17 that were increased in HIV-1 infected mice on potent ART compared to uninfected mice. Adding oxidized lipoproteins and endotoxin (LPS) ex vivo to gut explants from HIV infected persons increased levels of ADAM17 in myeloid and intestinal cells, which increased TNF-α and CX3CL1. Both 4F and 6F attenuated these changes. Our preclinical data suggest that apoA-I mimetic peptides provide a novel therapeutic strategy that can target increased protein levels of ADAM17 and its sheddase activity that contribute to intestinal and systemic inflammation in treated HIV. The large repertoire of inflammatory mediators involved in ADAM17 sheddase activity places it as a pivotal orchestrator of several inflammatory pathways associated with morbidity in chronic treated HIV that make it an attractive therapeutic target.
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Affiliation(s)
- Maria Daskou
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - William Mu
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Madhav Sharma
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Hariclea Vasilopoulos
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Rachel Heymans
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Eleni Ritou
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Valerie Rezek
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Philip Hamid
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Athanasios Kossyvakis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Shubhendu Sen Roy
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Victor Grijalva
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Arnab Chattopadhyay
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Scott G. Kitchen
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Alan M. Fogelman
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Srinivasa T. Reddy
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, California, United States of America
- Molecular Toxicology Interdepartmental Degree Program, University of California Los Angeles, Los Angeles, California, United States of America
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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16
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Bavaro DF, Laghetti P, Poliseno M, De Gennaro N, Di Gennaro F, Saracino A. A Step Closer to the "Fourth 90": A Practical Narrative Review of Diagnosis and Management of Nutritional Issues of People Living with HIV. Diagnostics (Basel) 2021; 11:diagnostics11112047. [PMID: 34829394 PMCID: PMC8618448 DOI: 10.3390/diagnostics11112047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 12/02/2022] Open
Abstract
The quality of life of people living with HIV (PLWH) has remarkably increased thanks to the introduction of combined antiretroviral therapy. Still, PLWH are exposed to an increased risk of cardiovascular diseases, diabetes, chronic kidney disease, and liver disease. Hence, the purpose of this review is to summarize the current knowledge about diagnosis and nutritional management with specific indication of macro and micronutrients intake for the main comorbidities of PLWH. In fact, a prompt diagnosis and management of lifestyle behaviors are fundamental steps to reach the “fourth 90”. To achieve an early diagnosis of these comorbidities, clinicians have at their disposal algorithms such as the Framingham Score to assess cardiovascular risk; transient elastography and liver biopsy to detect NAFLD and NASH; and markers such as the oral glucose tolerance test and GFR to identify glucose impairment and renal failure, respectively. Furthermore, maintenance of ideal body weight is the goal for reducing cardiovascular risk and to improve diabetes, steatosis and fibrosis; while Mediterranean and low-carbohydrate diets are the dietetic approaches proposed for cardioprotective effects and for glycemic control, respectively. Conversely, diet management of chronic kidney disease requires different nutritional assessment, especially regarding protein intake, according to disease stage and eventually concomitant diabetes.
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Affiliation(s)
- Davide Fiore Bavaro
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
- Correspondence: ; Tel.: +39-080-559-2477; Fax: +39-080-559-230
| | - Paola Laghetti
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
| | | | - Nicolò De Gennaro
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University Hospital Policlinico, University of Bari, 70124 Bari, Italy; (P.L.); (N.D.G.); (F.D.G.); (A.S.)
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17
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Mahat RK, Rathore V, Singh N, Singh N, Singh SK, Shah RK, Garg C. Lipid profile as an indicator of COVID-19 severity: A systematic review and meta-analysis. Clin Nutr ESPEN 2021; 45:91-101. [PMID: 34620375 PMCID: PMC8325550 DOI: 10.1016/j.clnesp.2021.07.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023]
Abstract
Background Coronavirus disease-2019 (COVID-19) is a global pandemic. Studies reported dyslipidemia in patients with COVID-19. Herein, we conducted a systematic review and meta-analysis of published articles to evaluate the association of the lipid profile with the severity and mortality in COVID-19 patients. Methods PubMed/Medline, Europe PMC, and Google Scholar were searched for studies published between January 1, 2020 and January 13, 2021. Random or Fixed effects models were used to calculate the mean difference (MD) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using Cochran's Q test and I2 statistics. Results This meta-analysis included 19 studies. Of which, 12 studies were categorized by severity, 04 studies by mortality, and 03 studies by both severity and mortality. Our findings revealed significantly decreased levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) in the severe group when compared with the non-severe group in a random effect model. Similarly, random effect model results demonstrated significantly lower levels of HDL-C and LDL-C in the non-survivor group when compared with the survivor group. The level of TC was also found to be decreased in the non-survivor group when compared to the survivor group in a fixed-effect model. Conclusion In conclusion, the lipid profile is associated with both the severity and mortality in COVID-19 patients. Hence, the lipid profile may be used for assessing the severity and prognosis of COVID-19. Prospero registration number CRD42021216316.
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Affiliation(s)
- Roshan Kumar Mahat
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India.
| | - Vedika Rathore
- Department of Biochemistry, Shyam Shah Medical College, Rewa, Madhya Pradesh, 486001, India.
| | | | - Nivedita Singh
- Department of Biochemistry, Gajra Raja Medical College, Gwalior, Madhya Pradesh, 474009, India
| | - Sanjeev Kumar Singh
- Department of Biochemistry, Gajra Raja Medical College, Gwalior, Madhya Pradesh, 474009, India
| | - Rakesh Kumar Shah
- Department of Biochemistry, Gajra Raja Medical College, Gwalior, Madhya Pradesh, 474009, India
| | - Chanchal Garg
- Department of Biochemistry, Gajra Raja Medical College, Gwalior, Madhya Pradesh, 474009, India
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18
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D’Ardes D, Rossi I, Bucciarelli B, Allegra M, Bianco F, Sinjari B, Marchioni M, Di Nicola M, Santilli F, Guagnano MT, Cipollone F, Bucci M. Metabolic Changes in SARS-CoV-2 Infection: Clinical Data and Molecular Hypothesis to Explain Alterations of Lipid Profile and Thyroid Function Observed in COVID-19 Patients. Life (Basel) 2021; 11:life11080860. [PMID: 34440605 PMCID: PMC8400261 DOI: 10.3390/life11080860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/08/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022] Open
Abstract
It seems that during SARS-CoV-2 infection, total cholesterol, LDL-C, and HDL-C values decrease and lipids could play a fundamental role in viral replication. Moreover, it has been shown that SARS-CoV-2 infection could influence thyroid function. We performed a retrospective analysis of 118 hospitalized patients with COVID-19, comparing pre-infection lipid profile (53 patients) and thyroid-stimulating hormone (TSH) values (45 patients) to those measured on admission. Our aim was to evaluate whether SARS-CoV-2 infection could be involved in thyroid and lipid profile alterations and study possible correlations with disease severity and clinical outcome. Median baseline values at the admission time were: total cholesterol at 136.89 ± 42.73 mg/dL, LDL-C 81.53 ± 30.35 mg/dL, and HDL-C 32.36 ± 15.13 mg/dL; and triglycerides at 115.00 ± 40.45 mg/dL, non-HDL-C 104.53 ± 32.63 md/dL, and TSH 1.15 ± 1.08 μUI/mL. Median values of pre-infection total cholesterol, HDL-C, and TSH were significantly higher than those measured at the admission time (p value < 0.05). The C-reactive protein (CRP) negatively correlated with LDL-C (p = 0.013) and HDL-C (p = 0.05). Our data underline a possible impact of SARS-CoV-2 infection on thyroid function. Moreover it suggests a possible relation between COVID-19 and the lipid profile with a negative correlation between CRP, LDL-C, and HDL-C values, proposing the hypothesis that lipid lowering could follow the rising of the COVID-19 inflammatory state.
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Affiliation(s)
- Damiano D’Ardes
- “Clinica Medica” Institute, Department of “Medicine and Science of Aging”, “G. d’Annunzio” University, 66100 Chieti, Italy; (B.B.); (M.A.); (F.S.); (M.T.G.); (F.C.); (M.B.)
- Azienda Sanitaria Locale n° 2 Abruzzo Lanciano-Vasto-Chieti, 66100 Chieti, Italy
- Correspondence: (D.D.); (I.R.)
| | - Ilaria Rossi
- “Clinica Medica” Institute, Department of “Medicine and Science of Aging”, “G. d’Annunzio” University, 66100 Chieti, Italy; (B.B.); (M.A.); (F.S.); (M.T.G.); (F.C.); (M.B.)
- Correspondence: (D.D.); (I.R.)
| | - Benedetta Bucciarelli
- “Clinica Medica” Institute, Department of “Medicine and Science of Aging”, “G. d’Annunzio” University, 66100 Chieti, Italy; (B.B.); (M.A.); (F.S.); (M.T.G.); (F.C.); (M.B.)
| | - Marco Allegra
- “Clinica Medica” Institute, Department of “Medicine and Science of Aging”, “G. d’Annunzio” University, 66100 Chieti, Italy; (B.B.); (M.A.); (F.S.); (M.T.G.); (F.C.); (M.B.)
| | - Francesco Bianco
- Pediatric Cardiology and Adult Congenital Heart Disease, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” of Ancona, 60126 Ancona, Italy;
| | - Bruna Sinjari
- Department of Innovative Technologies in Medicine and Dentistry, “G. d’Annunzio” University, Chieti-Pescara, 66100 Chieti, Italy;
| | - Michele Marchioni
- Laboratory of Biostatistics, Department of “Medical, Oral and Biotechnological Sciences”, “G. d’Annunzio” University, Chieti-Pescara, 66100 Chieti, Italy; (M.M.); (M.D.N.)
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of “Medical, Oral and Biotechnological Sciences”, “G. d’Annunzio” University, Chieti-Pescara, 66100 Chieti, Italy; (M.M.); (M.D.N.)
| | - Francesca Santilli
- “Clinica Medica” Institute, Department of “Medicine and Science of Aging”, “G. d’Annunzio” University, 66100 Chieti, Italy; (B.B.); (M.A.); (F.S.); (M.T.G.); (F.C.); (M.B.)
- Azienda Sanitaria Locale n° 2 Abruzzo Lanciano-Vasto-Chieti, 66100 Chieti, Italy
| | - Maria Teresa Guagnano
- “Clinica Medica” Institute, Department of “Medicine and Science of Aging”, “G. d’Annunzio” University, 66100 Chieti, Italy; (B.B.); (M.A.); (F.S.); (M.T.G.); (F.C.); (M.B.)
- Azienda Sanitaria Locale n° 2 Abruzzo Lanciano-Vasto-Chieti, 66100 Chieti, Italy
| | - Francesco Cipollone
- “Clinica Medica” Institute, Department of “Medicine and Science of Aging”, “G. d’Annunzio” University, 66100 Chieti, Italy; (B.B.); (M.A.); (F.S.); (M.T.G.); (F.C.); (M.B.)
- Azienda Sanitaria Locale n° 2 Abruzzo Lanciano-Vasto-Chieti, 66100 Chieti, Italy
| | - Marco Bucci
- “Clinica Medica” Institute, Department of “Medicine and Science of Aging”, “G. d’Annunzio” University, 66100 Chieti, Italy; (B.B.); (M.A.); (F.S.); (M.T.G.); (F.C.); (M.B.)
- Azienda Sanitaria Locale n° 2 Abruzzo Lanciano-Vasto-Chieti, 66100 Chieti, Italy
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19
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Su X, Zhang G, Cheng Y, Wang B. New insights into the emerging effects of inflammatory response on HDL particles structure and function. Mol Biol Rep 2021; 48:5723-5733. [PMID: 34319542 DOI: 10.1007/s11033-021-06553-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022]
Abstract
According to the increasing results, it has been well-demonstrated that the chronic inflammatory response, including systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel disease are associated with an increased risk of atherosclerotic cardiovascular disease. The mechanism whereby inflammatory response up-regulates the risk of cardio-metabolic disorder disease is multifactorial; furthermore, the alterations in high density lipoprotein (HDL) structure and function which occur under the inflammatory response could play an important modulatory function. On the other hand, the serum concentrations of HDL cholesterol (HDL-C) have been shown to be reduced significantly under inflammatory status with remarked alterations in HDL particles. Nevertheless, the potential mechanism whereby the inflammatory response reduces serum HDL-C levels is not simply defined but reduces apolipoprotein A1 production. The alterations in HDL structure mediated by the inflammatory response has been also confirmed to decrease the ability of HDL particle to play an important role in reverse cholesterol transport and protect the LDL particles from oxidation. Recently, it has been shown that under the inflammatory condition, diverse alterations in HDL structure could be observed which lead to changes in HDL function. In the current review, the emerging effects of inflammatory response on HDL particles structure and function are well-summarized to elucidate the potential mechanism whereby different inflammatory status modulates the pathogenic development of dyslipidemia.
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Affiliation(s)
- Xin Su
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China
| | - Guoming Zhang
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China
| | - Ye Cheng
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China.
| | - Bin Wang
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China.
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20
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Mu W, Sharma M, Heymans R, Ritou E, Rezek V, Hamid P, Kossyvakis A, Sen Roy S, Grijalva V, Chattopadhyay A, Papesh J, Meriwether D, Kitchen SG, Fogelman AM, Reddy ST, Kelesidis T. Apolipoprotein A-I mimetics attenuate macrophage activation in chronic treated HIV. AIDS 2021; 35:543-553. [PMID: 33306550 PMCID: PMC8010648 DOI: 10.1097/qad.0000000000002785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Despite antiretroviral therapy (ART), there is an unmet need for therapies to mitigate immune activation in HIV infection. The goal of this study is to determine whether the apoA-I mimetics 6F and 4F attenuate macrophage activation in chronic HIV. DESIGN Preclinical assessment of the in-vivo impact of Tg6F and the ex-vivo impact of apoA-I mimetics on biomarkers of immune activation and gut barrier dysfunction in treated HIV. METHODS We used two humanized murine models of HIV infection to determine the impact of oral Tg6F with ART (HIV+ART+Tg6F+) on innate immune activation (plasma human sCD14, sCD163) and gut barrier dysfunction [murine I-FABP, endotoxin (LPS), LPS-binding protein (LBP), murine sCD14]. We also used gut explants from 10 uninfected and 10 HIV-infected men on potent ART and no morbidity, to determine the impact of ex-vivo treatment with 4F for 72 h on secretion of sCD14, sCD163, and I-FABP from gut explants. RESULTS When compared with mice treated with ART alone (HIV+ART+), HIV+ART+Tg6F+ mice attenuated macrophage activation (h-sCD14, h-sCD163), gut barrier dysfunction (m-IFABP, LPS, LBP, and m-sCD14), plasma and gut tissue oxidized lipoproteins. The results were consistent with independent mouse models and ART regimens. Both 4F and 6F attenuated shedding of I-FABP and sCD14 from gut explants from HIV-infected and uninfected participants. CONCLUSION Given that gut barrier dysfunction and macrophage activation are contributors to comorbidities like cardiovascular disease in HIV, apoA-I mimetics should be tested as therapy for morbidity in chronic treated HIV.
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Affiliation(s)
- William Mu
- Division of Infectious Diseases
- Division of Hematology and Oncology
| | | | | | | | | | - Philip Hamid
- Division of Infectious Diseases
- Division of Hematology and Oncology
| | | | | | - Victor Grijalva
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Arnab Chattopadhyay
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Jeremy Papesh
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - David Meriwether
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | | | - Alan M Fogelman
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Srinivasa T Reddy
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
- Department of Molecular and Medical Pharmacology
- Molecular Toxicology Interdepartmental Degree Program, University of California Los Angeles
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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21
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Abstract
PURPOSE OF REVIEW Systemic inflammation increases as a consequence of aging (inflammaging) and contributes to age-related morbidities. Inflammation in people living with HIV is elevated compared with the general population even after prolonged suppression of viremia with anti-retroviral therapy. Mechanisms that contribute to inflammation during aging and in treated HIV disease are potentially interactive, leading to an exaggerated inflammatory phenotype in people with HIV. RECENT FINDINGS Recent studies highlight roles for anti-retroviral therapy, co-infections, immune system alterations, and microbiome perturbations as important contributors to HIV-associated inflammation. These factors likely contribute to increased risk of age-related morbidities in people living with HIV. Understanding mechanisms that exaggerate the inflammaging process in people with HIV may lead to improved intervention strategies, ultimately, extending both lifespan and healthspan.
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22
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Abstract
Lipids are biologically active molecules involved in a variety of cellular processes and immunological functions, including inflammation. It was recently shown that phospholipids and their derivatives, lysophospholipids, can reactivate latent (dormant) tumor cells, causing cancer recurrence. However, the potential link between lipids and HIV latency, persistence, and viral rebound after cessation of antiretroviral therapy (ART) has never been investigated. We explored the links between plasma lipids and the burden of HIV during ART. We profiled the circulating lipidome from plasma samples from 24 chronically HIV-infected individuals on suppressive ART who subsequently underwent an analytic treatment interruption (ATI) without concurrent immunotherapies. The pre-ATI viral burden was estimated as time-to-viral-rebound and viral load set points post-ATI. We found that higher pre-ATI levels of lysophospholipids, including the proinflammatory lysophosphatidylcholine, were associated with faster time-to-viral-rebound and higher viral set points upon ART cessation. Furthermore, higher pre-ATI levels of the proinflammatory by-product of intestinal lysophosphatidylcholine metabolism, trimethylamine-N-oxide (TMAO), were also linked to faster viral rebound post-ART. Finally, pre-ATI levels of several phosphatidylcholine species (lysophosphatidylcholine precursors) correlated strongly with higher pre-ATI levels of HIV DNA in peripheral CD4+ T cells. Our proof-of-concept data point to phospholipids and lysophospholipids as plausible proinflammatory contributors to HIV persistence and rapid post-ART HIV rebound. The potential interplay between phospholipid metabolism and both the establishment and maintenance of HIV latent reservoirs during and after ART warrants further investigation.
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23
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Cornwell A, Palli R, Singh MV, Benoodt L, Tyrell A, Abe JI, Schifitto G, Maggirwar SB, Thakar J. Molecular characterization of atherosclerosis in HIV positive persons. Sci Rep 2021; 11:3232. [PMID: 33547350 PMCID: PMC7865026 DOI: 10.1038/s41598-021-82429-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 12/30/2020] [Indexed: 01/30/2023] Open
Abstract
People living with HIV are at higher risk of atherosclerosis (AS). The pathogenesis of this risk is not fully understood. To assess the regulatory networks involved in AS we sequenced mRNA of the peripheral blood mononuclear cells (PBMCs) and measured cytokine and chemokine levels in the plasma of 13 persons living with HIV and 12 matched HIV-negative persons with and without AS. microRNAs (miRNAs) are known to play a role in HIV infection and may modulate gene regulation to drive AS. Hence, we further assessed miRNA expression in PBMCs of a subset of 12 HIV+ people with and without atherosclerosis. We identified 12 miRNAs differentially expressed between HIV+ AS+ and HIV+ , and validated 5 of those by RT-qPCR. While a few of these miRNAs have been implicated in HIV and atherosclerosis, others are novel. Integrating miRNA measurements with mRNA, we identified 27 target genes including SLC4A7, a critical sodium and bicarbonate transporter, that are potentially dysregulated during atherosclerosis. Additionally, we uncovered that levels of plasma cytokines were associated with transcription factor activity and miRNA expression in PBMCs. For example, BACH2 activity was associated with IL-1β, IL-15, and MIP-1α. IP10 and TNFα levels were associated with miR-124-3p. Finally, integration of all data types into a single network revealed increased importance of miRNAs in network regulation of the HIV+ group in contrast with increased importance of cytokines in the HIV+ AS+ group.
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Affiliation(s)
- Adam Cornwell
- Department of Biomedical Genetics, University of Rochester, Rochester, NY, USA
| | - Rohith Palli
- Medical Scientist Training Program, University of Rochester, Rochester, NY, USA
- Biophysics, Structural, and Computational Biology PhD Program, University of Rochester, Rochester, NY, USA
| | - Meera V Singh
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA
| | - Lauren Benoodt
- Biophysics, Structural, and Computational Biology PhD Program, University of Rochester, Rochester, NY, USA
| | - Alicia Tyrell
- Department of Neurology, General Neurology, University of Rochester, Rochester, NY, USA
- Department of Imaging Sciences, University of Rochester, Rochester, NY, USA
| | - Jun-Ichi Abe
- Department of Cardiology-Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M Health Science Center Institute of Biosciences and Technology, Houston, TX, USA
| | - Giovanni Schifitto
- Department of Neurology, General Neurology, University of Rochester, Rochester, NY, USA
- Department of Imaging Sciences, University of Rochester, Rochester, NY, USA
| | - Sanjay B Maggirwar
- Department of Microbiology, Immunology, and Tropical Medicine, George Washing University, Washington, DC, USA
| | - Juilee Thakar
- Department of Biomedical Genetics, University of Rochester, Rochester, NY, USA.
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA.
- Department of Biostatistics and Computational Biology, University of Rochester, 601 Elmwood Avenue, , Box 672, Rochester, NY, 14642, USA.
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24
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Yue J, Xu H, Zhou Y, Liu W, Han X, Mao Q, Li S, Tam LS, Ma J, Liu W. Dyslipidemia Is Related to Mortality in Critical Patients With Coronavirus Disease 2019: A Retrospective Study. Front Endocrinol (Lausanne) 2021; 12:611526. [PMID: 34248834 PMCID: PMC8261125 DOI: 10.3389/fendo.2021.611526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/10/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND It has been reported that dyslipidemia is related to coronavirus-related diseases. Critical patients with coronavirus disease 2019 (COVID-19) who suffered from multiple organ dysfunctions were treated in the intensive care unit (ICU) in Wuhan, China. Whether the lipids profile was associated with the prognosis of COVID-19 in critical patients remained unclear. METHODS A retrospective study was performed in critical patients (N=48) with coronavirus disease 2019 in Leishenshan hospital between February and April 2020 in Wuhan. The parameters including lipid profiles, liver function, and renal function were collected on admission day, 2-3days after the admission, and the day before the achievement of clinical outcome. RESULTS Albumin value and creatine kinase (ck) value were statistically decreased at 2-3 days after admission compared with those on admission day (P<0.05). Low density lipoprotein (LDL-c), high density lipoprotein (HDL-c), apolipoprotein A (ApoA), and apolipoprotein A (Apo B) levels were statistically decreased after admission (P<0.05). Logistic regression showed that HDL-c level both on admission day and the day before the achievement of clinical outcome were negatively associated with mortality in critical patients with COVID-19. Total cholesterol (TC) level at 2-3days after admission was related to mortality in critical patients with COVID-19. CONCLUSIONS There were lipid metabolic disorders in the critical patients with COVID-19. Lower levels of HDL-c and TC were related to the progression of critical COVID-19.
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Affiliation(s)
- Jiang Yue
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Xu
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Zhou
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Liu
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaofeng Han
- Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Mao
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shengxian Li
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jing Ma
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Jing Ma, ; Wei Liu,
| | - Wei Liu
- Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Jing Ma, ; Wei Liu,
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25
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Blanco JR, Negredo E, Bernal E, Blanco J. Impact of HIV infection on aging and immune status. Expert Rev Anti Infect Ther 2020; 19:719-731. [PMID: 33167724 DOI: 10.1080/14787210.2021.1848546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Thanks to antiretroviral therapy (ART), persons living with HIV (PLWH), have a longer life expectancy. However, immune activation and inflammation remain elevated, even after viral suppression, and contribute to morbidity and mortality in these individuals.Areas covered: We review aspects related to immune activation and inflammation in PLWH, their consequences, and the potential strategies to reduce immune activation in HIV-infected individuals on ART.Expert opinion: When addressing a problem, it is necessary to thoroughly understand the topic. This is the main limitation faced when dealing with immune activation and inflammation in PLWH since there is no consensus on the ideal markers to evaluate immune activation or inflammation. To date, the different interventions that have addressed this problem by targeting specific mediators have not been able to significantly reduce immune activation or its consequences. Given that there is currently no curative intervention for HIV infection, more studies are necessary to understand the mechanism underlying immune activation and help to identify potential therapeutic targets that contribute to improving the life expectancy of HIV-infected individuals.
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Affiliation(s)
- Jose-Ramon Blanco
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Pedro- Centro De Investigación Biomédica De La Rioja (CIBIR), La Rioja, Spain
| | - Eugenia Negredo
- Lluita Contra La Sida Foundation, Germans Trias I Pujol University Hospital, Badalona, Spain. Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (Uvic - UCC), Catalonia, Spain
| | - Enrique Bernal
- Unidad De Enfermedades Infecciosas, Hospital General Universitario Reina Sofía, Universidad De Murcia, Murcia, Spain
| | - Juliá Blanco
- AIDS Research Institute-IrsiCaixa, Badalona, Barcelona, Spain.,Universitat De Vic-Central De Catalunya (UVIC-UCC), Vic, Spain
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26
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Lin L, Zhong C, Rao S, Lin H, Huang R, Chen F. Clinical characteristics of 78 cases of patients infected with coronavirus disease 2019 in Wuhan, China. Exp Ther Med 2020; 21:7. [PMID: 33235616 PMCID: PMC7678631 DOI: 10.3892/etm.2020.9439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout the world in December 2019. The present study aimed to describe the clinical characteristics and laboratory findings of 78 patients with COVID-19 in order to enhance the understanding of the disease. Medical records and data of 78 patients with COVID-19, including demographics, clinical features, laboratory findings and radiological characteristics, were collected and analyzed. Of the 78 hospitalized patients with COVID-19, the median age was 66.5 years and 48.7% of patients were male. Hypertension and diabetes were the most common chronic underlying diseases, and the most common symptoms were a cough and a fever. Furthermore, the most common findings on the chest CT were extensive ground-glass opacity and bilateral shadowing. Anemia and lymphocytopenia were the most common abnormalities identified during routine blood tests. COVID-19 caused early liver renal damage, with 52.9% of patients displaying elevated D-dimer levels, 98.7% of patients displaying elevated IL-6 levels and 80.8% of patients displaying a reduced level of low-density lipoprotein cholesterol (LDL-C). In the present single-center case study of 78 patients with COVID-19 in Wuhan, China, the patients displayed abnormal routine blood tests, liver function, renal function and levels of D-dimer, LDL-C and IL-6. Therefore, the development of drugs and vaccines that can be used to prevent and treat infections of COVID-19 is urgently required.
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Affiliation(s)
- Liying Lin
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350000, P.R. China
| | - Canmei Zhong
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350000, P.R. China
| | - Shanshan Rao
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian 350000, P.R. China
| | - Hongguang Lin
- Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian 350000, P.R. China
| | - Rongfeng Huang
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350000, P.R. China
| | - Fenglin Chen
- Department of Gastroenterology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350000, P.R. China
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27
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Bloch M, John M, Smith D, Rasmussen TA, Wright E. Managing HIV-associated inflammation and ageing in the era of modern ART. HIV Med 2020; 21 Suppl 3:2-16. [PMID: 33022087 DOI: 10.1111/hiv.12952] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This paper aims to address the concerns around ongoing immune activation, inflammation, and resistance in those ageing with HIV that represent current challenges for clinicians. METHODS Presentations at a symposium addressing issues of ageing with HIV infection were reviewed and synthesised. RESULTS The changing natural history and demographics of human immunodeficiency virus (HIV)-infected individuals means new challenges in contemporary management. In the early years of the epidemic,management was focussed on acute, potentially life-threatening AIDS-related complications. From initial monotherapy with first-generation antiretroviral therapy (ART), the development of combination highly active ART (HAART) allowed HIV control but ART toxicities, treatment adherence and drug resistance emerged as major issues. Today, the availability of potent and tolerable ART has made viral suppression achievable in most people living with HIV (PLHIV), and clinicians are confronted with managing a chronic condition among an ageing population. The combination of diseases of ageing and the co-morbidities associated with HIV-infection, even when well controlled, results in a complex set of challenges for many older PLHIV. There is a growing appreciation that many non-AIDS-related co-morbidities are caused, at least in part, by persistent, low-grade immune activation, inflammation, and hypercoagulability, despite suppressive ART. CONCLUSIONS In order to further improve HIV management, it is important to understand the enduring effects of chronically suppressed HIV infection, the potential contribution of these factors to the ageing process, the possibility of drug resistance, and the impact of different treatment strategies, including early ART initiation.
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Affiliation(s)
- M Bloch
- Holdsworth House Medical Practice, Sydney, NSW, Australia.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M John
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Royal Perth Hospital, Perth, WA, Australia.,Institute of Immunology and Infectious Disease, Perth, WA, Australia
| | - D Smith
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.,The Albion Centre, Sydney, NSW, Australia
| | - T A Rasmussen
- Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia.,University of Melbourne, Melbourne, Vic., Australia
| | - E Wright
- The Alfred Hospital, Melbourne, Vic., Australia.,Centre for Inflammatory Diseases, Monash University, Melbourne, Vic., Australia.,The Burnett Institute, Melbourne, Vic., Australia
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Schnittman SR, Deitchman AN, Beck-Engeser G, Ahn H, York VA, Hartig H, Hecht FM, Martin JN, Deeks SG, Aweeka FT, Hunt PW. Abnormal Levels of Some Biomarkers of Immune Activation Despite Very Early Treatment of Human Immunodeficiency Virus. J Infect Dis 2020; 223:1621-1630. [PMID: 32915986 DOI: 10.1093/infdis/jiaa580] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite early antiretroviral therapy (ART), ART-suppressed people with human immunodeficiency virus (HIV) (PWH) remain at higher risk for infections and infection-related cancers than the general population. The immunologic pathways that remain abnormal in this setting, potentially contributing to these complications, are unclear. METHODS ART-suppressed PWH and HIV-negative controls, all cytomegalovirus seropositive and enriched for HIV risk factors, were sampled from an influenza vaccine responsiveness study. PWH were stratified by timing of ART initiation (within 6 months of infection [early ART] vs later) and nadir CD4+ T-cell count among later initiators. Between-group differences in kynurenine-tryptophan (KT) ratio, interferon-inducible protein 10, soluble CD14 and CD163, soluble tumor necrosis factor receptor 2, interleukin 6, and soluble urokinase plasminogen activator receptor were assessed after confounder adjustment. RESULTS Most participants (92%) were male, reflecting the demographics of early-ART initiators in San Francisco. Most biomarkers were higher among later-ART initiators. Participants in the early-ART group achieved near-normal soluble tumor necrosis factor receptor 2, interleukin 6, and soluble urokinase plasminogen activator receptor levels, but substantially higher KT ratio than those without HIV after confounder adjustment (P = .008). Soluble CD14, soluble CD163, and interferon-inducible protein 10 trended similarly. CONCLUSIONS While early-ART initiators restore near-normal levels of many inflammatory markers, the kynurenine pathway of tryptophan catabolism remains abnormally high. Because this pathway confers adaptive immune defects and predicts tuberculosis and cancer progression, this it may contribute to persistent risks of these complications in this setting.
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Affiliation(s)
- Samuel R Schnittman
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Amelia N Deitchman
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, California, USA
| | - Gabriele Beck-Engeser
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - HaeLee Ahn
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Vanessa A York
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Heather Hartig
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Frederick M Hecht
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Steven G Deeks
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Francesca T Aweeka
- Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, California, USA
| | - Peter W Hunt
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Monocyte activation and gut barrier dysfunction in South African youth on antiretroviral therapy and their associations with endothelial dysfunction. AIDS 2020; 34:1615-1623. [PMID: 32769763 DOI: 10.1097/qad.0000000000002615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is evidence for endothelial dysfunction in youth living with perinatally acquired HIV (YLPHIV). However, little data exist on its mechanisms. METHODS YLPHIV and age-matched HIV-uninfected (HIV-) youth enrolled in the Cape Town Adolescent Antiretroviral Cohort in South Africa between 9 and 14 years of age were included. YLPHIV were on antiretroviral therapy more than 6 months with viral load less than 400 copies/ml at baseline and 24 months. Serum biomarkers of systemic inflammation, monocyte activation, intestinal integrity, and oxidized LDL-cholesterol were measured at baseline and after 24 months. Endothelial function was measured at 24 months using reactive hyperemic index (RHI); endothelial dysfunction was defined as RHI less than 1.35. Spearman correlation coefficient and quantile regression were used to examine associations between RHI and different biomarkers. RESULTS We included 266 YLPHIV and 69 HIV- participants. At baseline, median (Q1, Q3) age was 12 (11, 13) years and 53% were females. YLPHIV had poorer endothelial function compared with HIV- youth (RHI = 1.36 vs. 1.52, P < 0.01). At baseline and 24 months, YLPHIV had higher markers of monocyte activation (soluble CD14), gut barrier dysfunction (intestinal fatty acid binding protein) and oxidized LDL-cholesterol (P ≤ 0.04) compared with HIV- youth. Among YLPHIV, soluble CD14 remained associated with endothelial dysfunction after adjusting for age, sex, Tanner stage, and antiretroviral therapy duration (β: -0.05, P = 0.01). CONCLUSION Despite viral suppression, South African YLPHIV have poor endothelial function and persistent evidence of monocyte activation and gut barrier dysfunction compared with HIV- youth. The long-term clinical significance of gut integrity and monocyte activation needs to be further assessed in YLPHIV.
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Di Yacovo S, Saumoy M, Sánchez-Quesada JL, Navarro A, Sviridov D, Javaloyas M, Vila R, Vernet A, Low H, Peñafiel J, García B, Ordoñez-Llanos J, Podzamczer D. Lipids, biomarkers, and subclinical atherosclerosis in treatment-naive HIV patients starting or not starting antiretroviral therapy: Comparison with a healthy control group in a 2-year prospective study. PLoS One 2020; 15:e0237739. [PMID: 32817629 PMCID: PMC7446923 DOI: 10.1371/journal.pone.0237739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/31/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To assess the effect of HIV infection and combined antiretroviral therapy (c-ART) on various proatherogenic biomarkers and lipids and to investigate their relationship with subclinical atherosclerosis in a cohort of treatment-naive HIV-infected patients. Methods We performed a prospective, comparative, multicenter study of 2 groups of treatment-naive HIV-infected patients (group A, CD4>500 cells/μL, not starting c-ART; and group B, CD4<500 cells/μL, starting c-ART at baseline) and a healthy control group. Laboratory analyses and carotid ultrasound were performed at baseline and at months 12 and 24. The parameters measured were low-density lipoprotein (LDL) particle phenotype, lipoprotein-associated phospholipase A2 (Lp-PLA2), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), sCD14, sCD163, monocyte chemoattractant protein-1(MCP-1), and asymmetric dimethylarginine (ADMA). A linear mixed model based on patient clusters was used to assess differences in biomarkers between the study groups and over time. Results The study population comprised 62 HIV-infected patients (group A, n = 31; group B, n = 31) and 22 controls. Age was 37 (30–43) years, and 81% were men. At baseline, the HIV-infected patients had a worse LDL particle phenotype and higher plasma concentration of sCD14, sCD163, hs-CRP, and LDL-Lp-PLA2 than the controls. At month 12, there was an increase in total cholesterol (p = 0.002), HDL-c (p = 0.003), and Apo A-I (p = 0.049) and a decrease in sCD14 (p = <0.001) and sCD163 (p<0.001), although only in group B. LDL particle size increased in group B at month 24 (p = 0.038). No changes were observed in group A or in the healthy controls. Common carotid intima-media thickness increased in HIV-infected patients at month 24 (Group A p = 0.053; group B p = 0.048). Plasma levels of sCD14, sCD163, and hs-CRP correlated with lipid values. Conclusions In treatment-naive HIV-infected patients, initiation of c-ART was associated with an improvement in LDL particle phenotype and inflammatory/immune biomarkers, reaching values similar to those of the controls. HIV infection was associated with progression of carotid intima-media thickness.
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Affiliation(s)
- Silvana Di Yacovo
- HIV and STD Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
| | - Maria Saumoy
- HIV and STD Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
- * E-mail:
| | - José Luís Sánchez-Quesada
- Biomedical Research Institute IIB Sant Pau, Barcelona, Spain, Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain
| | - Antonio Navarro
- HIV and STD Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
| | - Dmitri Sviridov
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Manuel Javaloyas
- Internal Medicine Service, Hospital de Viladecans, Viladecans, Spain
| | - Ramon Vila
- Vascular Surgery Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Anton Vernet
- Department of Mechanical Engineering, Universitat Rovira i Virgili, Tarragona, Spain
| | - Hann Low
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Judith Peñafiel
- Biostatistics Unit, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
- University of Barcelona, Barcelona, Spain
| | - Benito García
- HIV and STD Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
| | - Jordi Ordoñez-Llanos
- Biomedical Research Institute IIB Sant Pau, Barcelona, Spain, Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain
| | - Daniel Podzamczer
- HIV and STD Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
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Increased monocyte and T-cell activation in treated HIV+ Ugandan children: associations with gut alteration and HIV factors. AIDS 2020; 34:1009-1018. [PMID: 32073452 DOI: 10.1097/qad.0000000000002505] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The pathophysiology of immune activation and its mechanisms in children living with perinatally acquired HIV (PHIV) in sub-Saharan Africa has been understudied. METHODS We enrolled 101 children living with PHIV and 96 HIV-negative controls (HIV-). All participants were between 10 and 18 years of age with no known active infections. PHIVs were on ART with HIV-1 RNA level 400 copies/ml or less. We measured plasma and cellular markers of monocyte activation, T-cell activation (expression of CD38 and HLA-DR on CD4 and CD8), oxidized lipids, markers of gut integrity and fungal translocation. Spearman correlations and linear regression models were used. RESULTS Overall median (Q1; Q3) age was 13 years (11; 15) and 52% were girls. Groups were similar by age, sex and BMI. Median ART duration was 10 years (8; 11). PHIVs had higher monocyte and T-cell activation; higher sCD14 (P = 0.01) and elevated frequencies of nonclassical monocytes (P < 0.001 for both). Markers of systemic inflammation (hsCRP), fungal translocation (BDG), intestinal permeability (zonulin) and oxidized lipids (ox LDL) correlated with monocyte and T-cell activation in PHIV (≤0.05). After adjusting for age, sex, ART duration, protease inhibitor and nonnucleoside reverse transcriptase inhibitor use, a modest association between BDG and activated CD4 T cells was observed (β=0.65, P < 0.01). Oxidized LDL was inversely associated with activated T cells, inflammatory and nonclassical monocytes (P < 0.01). CONCLUSION Ugandan children with perinatally acquired HIV with viral suppression have evidence of ongoing immune activation. Intestinal barrier dysfunction and fungal translocation may be involved in chronic immune dysfunction.
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Wei X, Zeng W, Su J, Wan H, Yu X, Cao X, Tan W, Wang H. Hypolipidemia is associated with the severity of COVID-19. J Clin Lipidol 2020; 14:297-304. [PMID: 32430154 PMCID: PMC7192140 DOI: 10.1016/j.jacl.2020.04.008] [Citation(s) in RCA: 223] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023]
Abstract
Background Many patients with coronavirus disease 2019 (COVID-19) suffer multiple organ dysfunctions. However, whether patients develop dyslipidemia is unknown. Objective In this study, we aimed to investigate the pathological alterations of low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and total cholesterol (TC) in COVID-19 patients and their relationships with the disease severity. Methods A retrospective study was performed to examine serum levels of LDL-c, HDL-c, and TC on 597 COVID-19 patients (mild: 394; severe, 171; critical: 32) who were hospitalized in our center between February 1 and March 3, 2020. Age- and gender-matched normal subjects (n = 50) who had routine laboratory lipid tests between October 1 and November 1, 2019 in our center were included as the control group. Results LDL-c and TC levels were significantly lower in COVID-19 patients as compared with normal subjects (P < .001). There were significant and gradual decreases in levels of LDL-c (median (IQR) in mg/dL, mild: 91 (76, 104); severe: 86 (69, 102); critical: 69 (48, 81); P < .02) and TC (mild: 173 (148, 203); severe: 167 (138, 197); critical: 125 (95, 162); P < .05) across all three groups. HDL-c levels only decreased significantly in critical cases as compared with levels in mild and severe cases. LDL-c and TC levels inversely correlated with C-reactive protein and interleukin-6, and positively correlated with the number of lymphocytes in patients. Conclusions Development of hypolipidemia begins in patients with mild symptoms. It progressively becomes worse in an association with the disease severity. SARS-COV-2 causes multiple types of pathophysiologies including hypolipidemia. Decrease in LDL-c is observed as early as in patients with mild symptoms. Hypolipidemia positively correlates with the disease severity in patients. Hypolipidemia raises awareness to frontline physicians against this pandemic.
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Affiliation(s)
- Xiuqi Wei
- Department of Laboratory Medicine, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Wenjuan Zeng
- Department of Laboratory Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Jingyu Su
- Department of Laboratory Medicine, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Huimin Wan
- Department of Laboratory Medicine, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xinqin Yu
- Department of Laboratory Medicine, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xiaoling Cao
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC, USA; Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, SC, USA.
| | - Hui Wang
- Department of Laboratory Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
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Abstract
PURPOSE OF REVIEW People infected with HIV through injection drug use are more likely to experience progression to AIDS, death due to AIDS, and all-cause mortality even when controlling for access to care and antiretroviral therapy. While high-risk behavior and concurrent infections most certainly are contributors, chronic immune activation, downstream metabolic comorbidities may play an important role. RECENT FINDINGS Altered intestinal integrity plays a major role in HIV-related immune activation and microbial translocation markers are heightened in active heroin users. Additionally, greater injection frequency drives systemic inflammation and is associated with HIV viral rebound. Finally, important systemic inflammation markers have been linked with frailty and mortality in people who inject drugs with and without concurrent HIV infection. Heroin use may work synergistically with HIV infection to cause greater immune activation than either factor alone. Further research is needed to understand the impact on downstream metabolic comorbidities including cardiovascular disease. Medication-assisted treatment for opioid use disorder with methadone or buprenorphine may ameliorate some of this risk; however, there is presently limited research in humans, including in non-HIV populations, describing changes in immune activation on these treatments which is of paramount importance for those with HIV infection.
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Sieg SF, Bazdar DA, Zidar D, Freeman M, Lederman MM, Funderburg NT. Highly oxidized low-density lipoprotein mediates activation of monocytes but does not confer interleukin-1β secretion nor interleukin-15 transpresentation function. Immunology 2019; 159:221-230. [PMID: 31663113 DOI: 10.1111/imm.13142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/16/2019] [Accepted: 10/27/2019] [Indexed: 12/27/2022] Open
Abstract
Oxidized low-density lipoprotein (LDL) contributes to cardiovascular disease in part by mediating activation and maturation of monocytes and macrophages. Furthermore, co-localization studies using histochemical approaches have implicated a potential role for oxidized LDL as a mediator of interleukin-15 (IL-15) expression in myeloid cells of atherosclerotic plaque. The latter activity could be an important pro-inflammatory mechanism that mediates myeloid cell/T-cell crosstalk. Here, we examined the responses of primary human monocytes to highly oxidized LDL molecules. Oxidized LDL readily induced secretion of chemokines MCP-1 (CCL2) and GRO-α (CXCL1) but unlike lipopolysaccharide (LPS), has limited capacity to induce a variety of other cytokines including tumor necrosis factor-α, IL-6, IL-1β and interferon-γ-induced protein-10 and also displayed a poor capacity to induce p-Akt or P-S6 signaling. Failure of oxidized LDL to induce IL-1β secretion was associated with limited induction of caspase-1 activation. Furthermore, despite finding evidence that oxidized LDL could enhance the expression of IL-15 and IL-15 receptor expression in monocytes, we found no evidence that it could confer IL-15 transpresentation capability to these cells. This observation contrasted with induction of IL-15 transpresentation in lipopolysaccharide-stimulated monocytes. Overall, our data suggest that highly oxidized LDL is a selective inducer of monocyte activation. Sterile inflammatory mediators, particularly those implicated in Toll-like receptor 4 signaling, may play a role in vascular pathology but the activities of these agents are not uniform.
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Affiliation(s)
- Scott F Sieg
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Douglas A Bazdar
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Zidar
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Michael Freeman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael M Lederman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas T Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
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Jia S, Yang S, Du P, Gao K, Cao Y, Yao B, Guo R, Zhao M. Regulatory Factor X1 Downregulation Contributes to Monocyte Chemoattractant Protein-1 Overexpression in CD14+ Monocytes via Epigenetic Mechanisms in Coronary Heart Disease. Front Genet 2019; 10:1098. [PMID: 31737059 PMCID: PMC6838212 DOI: 10.3389/fgene.2019.01098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/11/2019] [Indexed: 01/09/2023] Open
Abstract
Monocyte chemoattractant protein 1 (MCP1) affects the chemotaxis of monocytes and is a key chemokine closely related to the development of atherosclerosis (AS). Compared with healthy controls, coronary heart disease (CAD) patients show significantly upregulated plasma concentrations and mRNA expression of MCP1 in CD14+ monocytes. However, the specific regulatory mechanism of MCP1 overexpression in AS is still unclear. Our previous research indicated that there was no significant difference in the H3K4 and H3K27 tri-methylation of the MCP1 promoter in CD14+ monocytes from CAD versus non-CAD patients, but the H3 and H4 acetylation of the MCP1 promoter was increased in CD14+ monocytes from CAD patients. We further found that the H3K9 tri-methylation of the MCP1 promoter in CD14+ monocytes from CAD patients was decreased, but the DNA methylation levels did not differ markedly from those in non-CAD patients. Our previous work showed that the level of regulatory factor X1 (RFX1) was markedly reduced in CD14+ monocytes from CAD patients and played an important role in the progression of AS by regulating epigenetic modification. In this study, we investigated whether RFX1 and epigenetic modifications mediated by RFX1 contribute to the overexpression of MCP1 in activated monocytes in CAD patients. We found that the enrichment of RFX1, histone deacetylase 1 (HDAC1), and suppressor of variegation 3–9 homolog 1 (SUV39H1) in the MCP1 gene promoter region were decreased in CD14+ monocytes from CAD patients and in healthy CD14+ monocytes treated with low-density lipoprotein (LDL). Chromatin immunoprecipitation (ChIP) assays identified MCP1 as a target gene of RFX1. Overexpression of RFX1 increased the recruitments of HDAC1 and SUV39H1 and inhibited the expression of MCP1 in CD14+ monocytes. In contrast, knockdown of RFX1 in CD14+ monocytes reduced the recruitments of HDAC1 and SUV39H1 in the MCP1 promoter region, thereby facilitating H3 and H4 acetylation and H3K9 tri-methylation in this region. In conclusion, our results indicated that RFX1 expression deficiency in CD14+ monocytes from CAD patients contributed to MCP1 overexpression via a deficiency of recruitments of HDAC1 and SUV39H1 in the MCP1 promoter, which highlighted the vital role of RFX1 in the pathogenesis of CAD.
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Affiliation(s)
- Sujie Jia
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China.,Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuang Yang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Pei Du
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Keqin Gao
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China.,Department of Pharmacy, Weifang People's Hospital, Weifang, China
| | - Yu Cao
- Dapartment of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Baige Yao
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ren Guo
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhao
- Dapartment of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China
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Lombardi F, Belmonti S, Borghetti A, Ciccullo A, Baldin G, Cauda R, Fabbiani M, Di Giambenedetto S. Reduced soluble CD14 levels after switching from a dual regimen with lamivudine plus boosted protease inhibitors to lamivudine plus dolutegravir in virologically suppressed HIV-infected patients. HIV Res Clin Pract 2019; 20:92-98. [PMID: 31478469 DOI: 10.1080/25787489.2019.1653512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: HIV-induced systemic immune activation and inflammation have been associated with morbidity and mortality in virologically suppressed patients. Objective: To evaluate the impact of treatment switch from a dual regimen with lamivudine (3TC) plus ritonavir-boosted protease inhibitors (PI/r) to 3TC plus dolutegravir (DTG) on the monocyte activation marker soluble CD14 (sCD14) and other inflammatory biomarkers, interleukin-6 (IL-6), C-reactive protein (CRP), intestinal fatty acid-binding protein (I-FABP) and D-dimer. Methods: We performed a retrospective case-crossover study on integrase inhibitors-naïve virologically suppressed patients while on 3TC + PI/r dual maintenance therapy for ≥48 weeks who switched to 3TC + DTG and maintained this regimen for ≥48 weeks. Biomarkers plasma levels were tested by ELISA assays on stored samples at three time points: at switch (BL), 48 weeks before (-48 W) and 48 weeks after switch (+48 W). Results: A total of 67 patients were included. Median sCD14 levels were stable from -48 W to BL (from 6.07 to 6.04 log10 pg/mL, p = 0.235) but showed a statistically significant decrease after switch: from 6.04 (IQR 5.92-6.12) at BL to 5.95 (IQR 5.84-6.07) log10 pg/mL at + W48 (p < 0.001). Concurrently, an improvement in lipid profile was observed, even thought it was not correlated to the change in sCD14. The levels of IL-6, CRP, I-FABP and D-dimer remained stable before and after the switch to 3TC + DTG. Conclusions: In virologically suppressed HIV-infected patients on a 3TC + PI/r dual therapy, switching to 3TC + DTG was associated with a significant decline in sCD14. These data suggest reduced monocyte activation following substitution of boosted PI with DTG, which could have important clinical implications.
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Affiliation(s)
- Francesca Lombardi
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Simone Belmonti
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italy
| | - Arturo Ciccullo
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Gianmaria Baldin
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Roberto Cauda
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore , Roma , Italy.,UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italy
| | - Massimiliano Fabbiani
- Dipartimento di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Simona Di Giambenedetto
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore , Roma , Italy.,UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italy
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Hoenigl M, Moser CB, Funderburg N, Bosch R, Kantor A, Zhang Y, Eugen-Olsen J, Finkelman M, Reiser J, Landay A, Moisi D, Lederman MM, Gianella S. Soluble Urokinase Plasminogen Activator Receptor Is Predictive of Non-AIDS Events During Antiretroviral Therapy-mediated Viral Suppression. Clin Infect Dis 2019; 69:676-686. [PMID: 30418519 PMCID: PMC6669298 DOI: 10.1093/cid/ciy966] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/08/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite effective antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection remains associated with higher morbidity and mortality, driven, in part, by increased inflammation. Our objective was to identify associations between levels of plasma biomarkers of chronic inflammation, microbial translocation, and monocyte activation, with occurrence of non-AIDS events. METHODS Participants (141 cases, 310 matched controls) were selected from a longitudinal observational trial; all were virally suppressed on ART at year 1 and thereafter. Soluble urokinase plasminogen activator receptor (suPAR), lipopolysaccharide binding protein (LBP), beta-D-glucan (BDG), intestinal fatty-acid binding protein, oxidized low-density lipoproteins, and soluble CD163 were measured pre-ART, after 1-year of ART, and pre-event. At each time point, conditional logistic regression analysis assessed associations of the biomarkers with events and adjusted for relevant covariates to calculate odds ratios (ORs) according to 1 interquartile range (IQR) difference. RESULTS At all time points, higher levels of suPAR were associated with increased risk of non-AIDS events (OR per 1 IQR was 1.7 before ART-initiation, OR per 1 IQR was 2.0 after 1 year of suppressive ART, and OR 2.1 pre-event). Higher levels of BDG and LBP at year 1 and pre-event (but not at baseline) were associated with increased risk of non-AIDS events. No associations were observed for other biomarkers. CONCLUSIONS Elevated levels of suPAR were strongly, consistently, and independently predictive of non-AIDS events at every measured time point. Interventions that target the suPAR pathway should be investigated to explore its role in the pathogenesis of non-AIDS-related outcomes in HIV infection.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, Austria
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Carlee B Moser
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nicholas Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Ronald Bosch
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Amy Kantor
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Denmark
| | | | - Jochen Reiser
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Alan Landay
- Division of Geriatrics and Palliative Care, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Daniela Moisi
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Michael M Lederman
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Sara Gianella
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, Austria
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Jaworowski A, Hearps AC, Angelovich TA, Hoy JF. How Monocytes Contribute to Increased Risk of Atherosclerosis in Virologically-Suppressed HIV-Positive Individuals Receiving Combination Antiretroviral Therapy. Front Immunol 2019; 10:1378. [PMID: 31275317 PMCID: PMC6593090 DOI: 10.3389/fimmu.2019.01378] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/31/2019] [Indexed: 12/27/2022] Open
Abstract
Combination antiretroviral therapy (ART) is effective at suppressing HIV viremia to achieve persistently undetectable levels in peripheral blood in the majority of individuals with access and ability to maintain adherence to treatment. However, evidence suggests that ART is less effective at eliminating HIV-associated inflammation and innate immune activation. To the extent that residual inflammation and immune activation persist, virologically suppressed people living with HIV (PLWH) may have increased risk of inflammatory co-morbidities, and adjunctive therapies may need to be considered to reduce HIV-related inflammation and fully restore the health of virologically suppressed HIV+ individuals. Cardiovascular disease (CVD) is the single leading cause of death in the developed world and is becoming more important in PLWH with access to ART. Arterial disease due to atherosclerosis, leading to acute myocardial infarction (AMI) and stroke, is a major component of CVD. Atherosclerosis is an inflammatory disease, and epidemiological comparisons of atherosclerosis and AMI show a higher prevalence and suggest a greater risk in PLWH compared to the general population. The reasons for greater prevalence of CVD in PLWH can be broadly grouped into four categories: (a) the higher prevalence of traditional risk factors e.g., smoking and hypertension (b) dyslipidemia (also a traditional risk factor) caused by off-target effects of ART drugs (c) HIV-related inflammation and immune activation and (d) other undefined HIV-related factors. Management strategies aimed at reducing the impact of traditional risk factors in PLWH are similar to those for the general population and their effectiveness is currently being evaluated. Together with improvements in ART regimens and guidelines for treatment, and a greater awareness of its impact on CVD, the HIV-related risk of AMI and stroke is decreasing but remains elevated compared to the general community. Monocytes are key effector cells which initiate the formation of atherosclerotic plaques by migrating into the intima of coronary arteries and accumulating as foam cells full of lipid droplets. This review considers the specific role of monocytes as effector cells in atherosclerosis which progresses to AMI and stroke, and explores mechanisms by which HIV may promote an atherogenic phenotype and function independent of traditional risk factors. Altered monocyte function may represent a distinct HIV-related factor which increases risk of CVD in PLWH.
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Affiliation(s)
- Anthony Jaworowski
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.,Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia.,Life Sciences Discipline, Burnet Institute, Melbourne, VIC, Australia
| | - Anna C Hearps
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia.,Life Sciences Discipline, Burnet Institute, Melbourne, VIC, Australia
| | - Thomas A Angelovich
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.,Life Sciences Discipline, Burnet Institute, Melbourne, VIC, Australia
| | - Jennifer F Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
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Abstract
BACKGROUND HIV-exposed-uninfected (HEU) infants have increased infectious morbidity and mortality; little is known about their levels of inflammation and monocyte activation. METHODS Plasma samples obtained at birth and 6 months from 86 HEU mother-infant pairs enrolled in the National Institute of Child Health and Human Development cohorts in Brazil were compared with 88 HIV-unexposed mother-infant pairs. HIV-infected mothers received antiretroviral therapy during pregnancy, their infants received zidovudine prophylaxis and were not breastfed. IL-6, soluble TNFα receptor I (sTNF-RI) and II, soluble CD14, soluble CD163, IFN-γ-induced protein 10 (IP-10), vascular cell adhesion molecule, oxidized LDL, D-dimer and high-sensitivity C-reactive protein were assayed by ELISA at birth and at 6 months. sTNF-RI and IL-6 were considered coprimary endpoints. RESULTS Among HIV-infected mothers, 79% had HIV-RNA less than 400 copies/ml prior to delivery. Compared with HIV-unexposed, HEU infants had a lower mean gestational age (38.7 vs. 39.3 weeks) and weight (3.1 vs. 3.3 kg); and reached lower weight (5.9 vs. 8.5 kg) and height (53.6 vs. 68.8 cm) at 6 months. With the exception of vascular cell adhesion molecule, inflammatory markers were generally higher (P ≤ 0.005) in HEU at birth, but at 6 months only sTNF-RI and IL-6 remained higher. For HEU pairs, only IP-10 was associated with maternal levels at birth (P < 0.001). In HEU, elevated levels of high-sensitivity C-reactive protein and IP-10 at birth were associated with lower weight at birth (P = 0.04) and at 6 months (P = 0.04). CONCLUSION HIV-exposed infants have heightened inflammation and monocyte activation at birth, which for some markers persisted to 6 months of life and was not related to maternal inflammatory status. Inflammation may contribute to the increased HEU infectious morbidity and poor growth.
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Krikke M, Tesselaar K, van den Berk GEL, Otto SA, Freriks LH, van Lelyveld SFL, Visseren FJL, Hoepelman AIM, Arends JE. The effect of switching protease inhibitors to raltegravir on endothelial function, in HIV-infected patients. HIV CLINICAL TRIALS 2019; 19:75-83. [PMID: 29770748 DOI: 10.1080/15284336.2018.1455366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective Lipid management is one of the cornerstones of cardiovascular risk reduction. Treatment of HIV infection with protease inhibitors (PIs) may cause dyslipidaemia, whilst the integrase inhibitor raltegravir (RAL) has a relatively favorable effect on plasma lipids. We examined the effect of switching from PIs to RAL on endothelial function, and its effect on immunological and inflammatory parameters. Methods We performed a 16-week open-label prospective crossover study: 8 weeks intervention (switch PIs to RAL) and 8 weeks control (unchanged cART regimen). Flow-mediated dilatation (FMD), inflammatory plasma, and cellular markers of immune activation were measured at weeks 0, 8, and 16. Results Study participants (n = 22) with a median age of 50 years (IQR 42-60) and known HIV infection of 6.5 years (IQR 5.0-17.3) were on stable cART with undetectable HIV viral loads. After 8 weeks of RAL therapy, a reduction in FMD of -0.81% was seen, compared to +0.54% control (pairwise, p = 0.051), while fasting total cholesterol (-17% versus +10%; p < 0.001), LDL cholesterol (-21% versus -3%; p = 0.026), and triglycerides (-41% versus +18%; p = 0.001) significantly decreased during RAL therapy compared to the control. Furthermore, a relation between the change in percentage of B-1 cells and the change in FMD was found (β 0.40, 95%CI 0.16; 0.64, p = 0.005) during treatment with RAL. Finally, during RAL therapy, 27% of the patients experienced an increased ALT rise. Conclusions We present an overall negative study, where switching from PIs to RAL slightly reduced the endothelial function while decreasing plasma lipids, thus possibly decreasing the CVD risk in the long term. A transient elevation of ALT was seen upon switch to RAL.
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Affiliation(s)
- Maaike Krikke
- a Department of Internal Medicine and Infectious Diseases , University Medical Centre Utrecht , Utrecht , The Netherlands.,c Laboratory of Translational Immunology , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Kiki Tesselaar
- c Laboratory of Translational Immunology , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Guido E L van den Berk
- d Department of Internal Medicine and Infectious Diseases , OLVG , Amsterdam , The Netherlands
| | - Sigrid A Otto
- c Laboratory of Translational Immunology , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Laura H Freriks
- c Laboratory of Translational Immunology , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Steven F L van Lelyveld
- a Department of Internal Medicine and Infectious Diseases , University Medical Centre Utrecht , Utrecht , The Netherlands.,e Department of Internal Medicine & Gastroenterology , Spaarne Gasthuis , Haarlem , The Netherlands
| | - Frank J L Visseren
- b Department of Vascular Medicine , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Andy I M Hoepelman
- a Department of Internal Medicine and Infectious Diseases , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Joop E Arends
- a Department of Internal Medicine and Infectious Diseases , University Medical Centre Utrecht , Utrecht , The Netherlands
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Bastard JP, Couffignal C, Fellahi S, Bard JM, Mentre F, Salmon D, Katlama C, Raffi F, Leport C, Capeau J. Diabetes and dyslipidaemia are associated with oxidative stress independently of inflammation in long-term antiretroviral-treated HIV-infected patients. DIABETES & METABOLISM 2019; 45:573-581. [PMID: 30862472 DOI: 10.1016/j.diabet.2019.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/15/2019] [Accepted: 02/24/2019] [Indexed: 12/31/2022]
Abstract
AIM Ageing HIV-infected patients controlled by antiretroviral therapy (ART) frequently present age-related comorbidities, such as cardiovascular (CV) events, diabetes, dyslipidaemia, hypertension and chronic kidney disease (CKD). The prevalence of these comorbidities was evaluated in a cohort of long-term-monitored ART-controlled HIV-infected patients, then followed by a search into whether oxidative stress, like inflammation, might be associated with metabolic parameters and/or comorbidities. METHODS Included were 352 long-term ART patients who started with protease inhibitors (PIs) in 1997-1999. They were evaluated at their final visit, 11 years later, for previous CV events, prevalence of diabetes, LDL-related and atherogenic (high TG/HDL) dyslipidaemias, hypertension and CKD. Also measured were circulating biomarkers to explore oxidative stress (Lp-PLA2, oxLDL, oxLDL/LDL ratio, paraoxonase and arylesterase activities), inflammation/immune activation (hsCRP, hsIL-6, D dimer, soluble CD14, β2 microglobulin, cystatin C), adipokines and insulin resistance. Levels were compared in patients with and without each comorbidity or condition using non-parametric correlation tests and multivariate adjusted analyses. RESULTS At the final visit, 81.5% of patients were male and were aged (median, IQR) 49 years (45-56); BMI was 23.0 kg/m2 (21.1-25.4), CD4+ lymphocytes were 620 cells/mm3 (453-790) and 91.5% had undetectable HIV-1 viral loads. The prevalence of diabetes was 11%, and LDL-related dyslipidaemia 28%, atherogenic dyslipidaemia 9%, hypertension 28%, CKD 9% and previous CV events 9%. Diabetes and atherogenic dyslipidaemia were associated with increased oxidative stress and independently with inflammation. LDL-related dyslipidaemia and impaired fasting glucose were associated with increased oxidative stress. No association of these biomarkers was detected with hypertension, CKD and previous CV events. CONCLUSION In long-term-treated HIV-infected patients with frequent comorbid conditions, oxidative stress could be contributing to diabetes and LDL-related and atherogenic dyslipidaemias independently of inflammation.
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Affiliation(s)
- J-P Bastard
- Faculty of medicine, Sorbonne université, inserm UMR_S938, ICAN, AP-HP, hôpital Tenon, 27, rue Chaligny, 75571 Paris cedex 12, Paris, France
| | - C Couffignal
- Université Paris Diderot, Sorbonne Paris Cité, inserm UMR_S1137, COREB APHP, 16, rue Henri-Huchard, 75890 Paris cedex 18, France
| | - S Fellahi
- Faculty of medicine, Sorbonne université, inserm UMR_S938, ICAN, AP-HP, hôpital Tenon, 27, rue Chaligny, 75571 Paris cedex 12, Paris, France
| | - J-M Bard
- UFR des sciences pharmaceutiques et biologiques, MMS - EA 2160, IUML FR3473 CNRS, Nantes and institut de cancérologie de l'Ouest, 4, rue Bras France, BP61112, 44035 Nantes cedex 1, France
| | - F Mentre
- Université Paris Diderot, Sorbonne Paris Cité, inserm UMR_S1137, COREB APHP, 16, rue Henri-Huchard, 75890 Paris cedex 18, France
| | - D Salmon
- Service des maladies infectieuses et tropicales, hôpital Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - C Katlama
- Service de maladies infectieuses et tropicales hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Universités, UPMC Université Paris-6, inserm UMR_S1136 IPLESP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Raffi
- Service des maladies infectieuses et tropicales, inserm CIC 1413, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - C Leport
- Université Paris Diderot, Sorbonne Paris Cité, inserm UMR_S1137, COREB APHP, 16, rue Henri-Huchard, 75890 Paris cedex 18, France
| | - J Capeau
- Faculty of medicine, Sorbonne université, inserm UMR_S938, ICAN, AP-HP, hôpital Tenon, 27, rue Chaligny, 75571 Paris cedex 12, Paris, France.
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Waters DD, Hsue PY. Lipid Abnormalities in Persons Living With HIV Infection. Can J Cardiol 2018; 35:249-259. [PMID: 30704819 DOI: 10.1016/j.cjca.2018.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 01/16/2023] Open
Abstract
Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug-drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.
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Affiliation(s)
- David D Waters
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Zuckerberg San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California, USA
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Dentone C, Di Biagio A, Cozzi Lepri A, Fenoglio D, Filaci G, Lichtner M, Carrara S, Giacometti A, Sighinolfi L, Marchetti G, Antinori A, D'arminio Monforte A. Inflammatory effects of atazanavir/ritonavir versus darunavir/ritonavir in treatment naïve, HIV-1-infected patients. HIV CLINICAL TRIALS 2018; 19:158-162. [PMID: 30422095 DOI: 10.1080/15284336.2018.1488453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Limited studies have compared the impact of different antiretroviral regimens on soluble markers of inflammation with discordant results. METHODS In this prospective study, treatment naïve HIV-1-infected patients were included if they started their current regimen with atazanavir/ritonavir (ATV/r) (N = 73, Group 1) or darunavir/ritonavir (DRV/r) (N = 85, Group 2) plus tenofovir/emtricitabine. The analysis of IL-6, MCP-1, sCD163, VCAM-1, ox-LDL, and adiponectine was performed on two stored plasma samples, the first prior to antiretroviral therapy initiation and the second one year after initiation. RESULTS The results of our analysis show a difference in ox-LDL between the two groups with higher mean (SD) values in ATV/r based group 608.5 ± 137.4 versus 519.1 ± 119.6 in DRV/r group, after controlling for baseline levels of ox-LDL as well as other potential confounding factors controlled by means of matching design or linear regression modelling. CONCLUSIONS Our analysis provides further data examining the association between the modulation of vascular inflammatory and of activation markers with specific protease inhibitors-based treatments over one year of exposure to these drugs. The data show little evidence for an association, supporting the notion that antiretroviral regimens has generally poor efficiency in downregulating these soluble markers.
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Affiliation(s)
- Chiara Dentone
- a Infectious Diseases Unit , Sanremo Hospital , Imperia , Italy
| | - Antonio Di Biagio
- b Infectious Diseases Unit, Department of Internal Medicine , Ospedale Policlinico S. Martino , Genoa , Italy
| | - Alessandro Cozzi Lepri
- c Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME) , Institute for Global Health UCL , Rowland Hill St , London , UK
| | - Daniela Fenoglio
- d Centre of Excellence for Biomedical Research , University of Genoa , Genoa , Italy.,e Department of Internal Medicine (DIMI) , University of Genoa , Ospedale Policlinico San Martino , Genoa , Italy
| | - Gilberto Filaci
- d Centre of Excellence for Biomedical Research , University of Genoa , Genoa , Italy.,e Department of Internal Medicine (DIMI) , University of Genoa , Ospedale Policlinico San Martino , Genoa , Italy
| | - Miriam Lichtner
- f Infectious Diseases Unit , Sapienza University , Latina , Italy
| | - Stefania Carrara
- g National Institute for Infectious Diseases (INMI) L. Spallanzani - IRCCS , Rome , Italy
| | - Andrea Giacometti
- h Clinic of Infectious Diseases , Azienda O.U. Ospedali Riuniti di Ancona , Ancona , Italy
| | - Laura Sighinolfi
- i Clinica Malattie Infettive , Hospital and University of Ferrara , Ferrara , Italy
| | - Giulia Marchetti
- j Clinica di Malattie Infettive , San Paolo Hospital, University of Milan , Milan , Italy
| | - Andrea Antinori
- g National Institute for Infectious Diseases (INMI) L. Spallanzani - IRCCS , Rome , Italy
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Ahmed D, Roy D, Cassol E. Examining Relationships between Metabolism and Persistent Inflammation in HIV Patients on Antiretroviral Therapy. Mediators Inflamm 2018; 2018:6238978. [PMID: 30363715 PMCID: PMC6181007 DOI: 10.1155/2018/6238978] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/06/2018] [Indexed: 12/30/2022] Open
Abstract
With the advent of antiretroviral therapy (ART), HIV-infected individuals are now living longer and healthier lives. However, ART does not completely restore health and treated individuals are experiencing increased rates of noncommunicable diseases such as dyslipidemia, insulin resistance, type 2 diabetes, cardiovascular disease, and nonalcoholic fatty liver disease. While it is well known that persistent immune activation and inflammation contribute to the development of these comorbid diseases, the mechanisms underlying this chronic activation remain incompletely understood. In this review, we will discuss emerging evidence that suggests that alterations in cellular metabolism may play a central role in driving this immune dysfunction in HIV patients on ART.
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Affiliation(s)
- Duale Ahmed
- Department of Biology, Carleton University, Ottawa, Ontario, Canada
| | - David Roy
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Edana Cassol
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
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Teer E, Essop MF. HIV and Cardiovascular Disease: Role of Immunometabolic Perturbations. Physiology (Bethesda) 2018; 33:74-82. [PMID: 29212894 DOI: 10.1152/physiol.00028.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 01/07/2023] Open
Abstract
The successful rollout of anti-retroviral therapy ensured that HIV is increasingly managed as a chronic condition. HIV-positive persons are therefore exhibiting increased cardiovascular complications. This review focuses on the emerging role of "immunometabolism" within the context of HIV-related immune dysregulation and cardiovascular disease onset. Here, persistent immune activation contributes to pathophysiological perturbations during early infection, resulting in immune cell metabolic reprogramming and the activation of coagulation pathways in HIV-positive individuals.
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Affiliation(s)
- Eman Teer
- Department of Physiological Sciences, Cardio-Metabolic Research Group (CMRG), Stellenbosch University, Stellenbosch, South Africa
| | - M Faadiel Essop
- Department of Physiological Sciences, Cardio-Metabolic Research Group (CMRG), Stellenbosch University, Stellenbosch, South Africa
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46
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Sokoya T, Steel HC, Nieuwoudt M, Rossouw TM. HIV as a Cause of Immune Activation and Immunosenescence. Mediators Inflamm 2017; 2017:6825493. [PMID: 29209103 PMCID: PMC5676471 DOI: 10.1155/2017/6825493] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
Systemic immune activation has emerged as an essential component of the immunopathogenesis of HIV. It not only leads to faster disease progression, but also to accelerated decline of overall immune competence. HIV-associated immune activation is characterized by an increase in proinflammatory mediators, dysfunctional T regulatory cells, and a pattern of T-cell-senescent phenotypes similar to those seen in the elderly. These changes predispose HIV-infected persons to comorbid conditions that have been linked to immunosenescence and inflamm-ageing, such as atherosclerosis and cardiovascular disease, neurodegeneration, and cancer. In the antiretroviral treatment era, development of such non-AIDS-defining, age-related comorbidities is a major cause of morbidity and mortality. Treatment strategies aimed at curtailing persistent immune activation and inflammation may help prevent the development of these conditions. At present, the most effective strategy appears to be early antiretroviral treatment initiation. No other treatment interventions have been found effective in large-scale clinical trials, and no adjunctive treatment is currently recommended in international HIV treatment guidelines. This article reviews the role of systemic immune activation in the immunopathogenesis of HIV infection, its causes and the clinical implications linked to immunosenescence in adults, and the therapeutic interventions that have been investigated.
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Affiliation(s)
- T. Sokoya
- Department of Immunology, Faculty of Health Sciences, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria 0001, South Africa
| | - H. C. Steel
- Department of Immunology, Faculty of Health Sciences, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria 0001, South Africa
| | - M. Nieuwoudt
- South African Department of Science and Technology (DST)/National Research Foundation (NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch 7600, South Africa
| | - T. M. Rossouw
- Department of Immunology, Faculty of Health Sciences, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria 0001, South Africa
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Abstract
PURPOSE OF REVIEW This review focuses on the differential effects of contemporary antiretrovirals on systemic inflammation as heightened immune activation is linked to important co-morbidities and mortality with HIV infection. RECENT FINDINGS Antiretroviral therapy (ART) reduces dramatically systemic inflammation and immune activation, but not to levels synchronous with HIV-uninfected populations. In one ART initiation trial, integrase inhibitors appear to reduce inflammation to a greater degree than non-nucleoside reverse transcriptase inhibitors (NNRTIs); however, it is not clear that there are beneficial effects on inflammation resulting from treatment with integrase inhibitors compared to PIs, between PIs and NNRTIs, between specific nucleoside reverse transcriptase inhibitors, or with maraviroc in ART-naïve patients. In ART switch studies, changing to an integrase inhibitor from a PI-, NNRTI-, or enfuvirtide-containing regimen has resulted in improvement in several markers of inflammation. Additional research is needed to conclusively state whether there are clear differences in effects of specific antiretrovirals on inflammation and immune activation in HIV.
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48
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Abstract
Infection with the human immunodeficiency virus (HIV), and subsequent treatment with antiretroviral therapy (ART), is often associated with perturbations in lipid profiles. Furthermore, persistent inflammation, in spite of suppression of viral replication by ART, likely contributes to modifications in lipid composition and function, exacerbating risk for development of cardiovascular disease (CVD). Increased levels of several pro-inflammatory lipid species, including oxidized low-density lipoprotein (LDL) and high-density lipoprotein (HDL), have been measured in HIV-infected persons and are associated with markers of immune activation. The mechanisms linked to this bidirectional relationship in which inflammation increases lipid levels and promotes their modification, and these modified lipid species perpetuate inflammatory processes, require further investigation. Treatment with statins and other lifestyle modifications, including improvement in dietary intake and exercise, are critical to reducing CVD risk. Well-designed clinical trials that take into account the complex relationships among lipids and inflammation within persons infected with HIV need to be considered.
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Affiliation(s)
- Nicholas T Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, 453 W. 10th Ave., 535A Atwell Hall, Columbus, OH, 43210, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, Bethesda, MD, 20892, USA.
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Belury MA, Bowman E, Gabriel J, Snyder B, Kulkarni M, Palettas M, Mo X, Lake JE, Zidar D, Sieg SF, Rodriguez B, Playford MP, Andrade A, Kuritzkes DR, Mehta NN, Lederman MM, Funderburg NT. Prospective Analysis of Lipid Composition Changes with Antiretroviral Therapy and Immune Activation in Persons Living with HIV. Pathog Immun 2017; 2:376-403. [PMID: 29098203 PMCID: PMC5663243 DOI: 10.20411/pai.v2i3.218] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Lipid profiles are altered by HIV infection and antiretroviral therapy (ART). Among HIV-uninfected (HIV-) populations the concentrations of various lipid classes (ie, lyso-phosphatidylcholine, LPC) and their saturated (SaFA), mono-unsaturated (MUFA), and polyunsaturated fatty acid (PUFA) composition are related to cardiometabolic disease risk. Associations between changes in the lipidome and immune activation in HIV-infected (HIV+) individuals beginning ART have not been described. Methods Plasma lipid concentrations and their fatty acid composition were measured by differential mobility spectroscopy in samples from 35 treatment-naive HIV+ participants beginning raltegravir (RAL)-based ART and from HIV- individuals (n = 13) matched for age and sex. Results The levels of SaFA, including palmitic (16:0) and stearic (18:0) acid were enriched in HIV+ participants (pre- and post-ART), and SaFA levels were often positively correlated with levels of immune activation (ie, IL-6, sCD14, and TNFR1) at baseline and week 48. Levels of PUFAs (including 18:3, 20:4, and 20:5) were lower in HIV+ participants at baseline compared to levels in HIV- participants (P < 0.01), and levels of these PUFAs were increased following 48 weeks of ART. Levels of PUFAs were often inversely related to immune activation. Levels of LPC were increased in HIV+ participants, both pre- and post-ART vs HIV- participants, and the composition of LPC was enriched for SaFAs among HIV+ individuals. At week 48, several LPC molecules containing SaFAs were positively correlated with levels of sCD14, D-dimer, and TNFR1 (P < 0.01), and levels of PUFA-containing LPC (18:3, 20:5, 22:5, 22:6) were positively correlated with CD4+ T cell counts and inversely correlated with sCD14 and IL-6 (P < 0.01). Conclusions The composition of the lipidome is altered in HIV infection and changes when ART is administered. Alterations in SaFAs were generally associated with inflammatory markers and may contribute to comorbid disease pathogenesis.
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Affiliation(s)
- Martha A Belury
- Department of Human Sciences, Ohio State University, Columbus, Ohio
| | - Emily Bowman
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
| | - Janelle Gabriel
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
| | - Brandon Snyder
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
| | - Manjusha Kulkarni
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
| | - Marilly Palettas
- Center for Biostatistics, Department of Biomedical Informatics, Ohio State University, Columbus, Ohio
| | - Xiaokui Mo
- Center for Biostatistics, Department of Biomedical Informatics, Ohio State University, Columbus, Ohio
| | - Jordan E Lake
- University of Texas Health Science Center, Houston, Texas
| | - David Zidar
- Case Western Reserve University, Cleveland Ohio
| | | | | | | | | | - Daniel R Kuritzkes
- Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Nehal N Mehta
- National Heart Lung and Blood Institute, Bethesda, Maryland
| | | | - Nicholas T Funderburg
- School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, Ohio
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Gut-homing Δ42PD1+Vδ2 T cells promote innate mucosal damage via TLR4 during acute HIV type 1 infection. Nat Microbiol 2017; 2:1389-1402. [DOI: 10.1038/s41564-017-0006-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/05/2017] [Indexed: 12/13/2022]
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