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Endothelial Dysfunction, HMGB1, and Dengue: An Enigma to Solve. Viruses 2022; 14:v14081765. [PMID: 36016387 PMCID: PMC9414358 DOI: 10.3390/v14081765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Dengue is a viral infection caused by dengue virus (DENV), which has a significant impact on public health worldwide. Although most infections are asymptomatic, a series of severe clinical manifestations such as hemorrhage and plasma leakage can occur during the severe presentation of the disease. This suggests that the virus or host immune response may affect the protective function of endothelial barriers, ultimately being considered the most relevant event in severe and fatal dengue pathogenesis. The mechanisms that induce these alterations are diverse. It has been suggested that the high mobility group box 1 protein (HMGB1) may be involved in endothelial dysfunction. This non-histone nuclear protein has different immunomodulatory activities and belongs to the alarmin group. High concentrations of HMGB1 have been detected in patients with several infectious diseases, including dengue, and it could be considered as a biomarker for the early diagnosis of dengue and a predictor of complications of the disease. This review summarizes the main features of dengue infection and describes the known causes associated with endothelial dysfunction, highlighting the involvement and possible relationship between HMGB1 and DENV.
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Tasca KI, Fagundes Vidal VVM, Martinez Manfio V, Naime Barbosa A, de Souza LDR. Contributory role of ART in the development of non-AIDS comorbidities in asymptomatic PLWHA. J Appl Biomed 2021; 19:73-82. [PMID: 34907718 DOI: 10.32725/jab.2021.002] [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: 04/27/2020] [Accepted: 01/21/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite the many benefits that follow antiretroviral therapy (ART) initiation, its chronic use contributes to the early aging of people living with HIV/AIDS (PLWHA). The aim of this cross-sectional study was to trace the prevalence of and investigate possible renal, bone and metabolic changes, as well as cardiovascular risk in 94 asymptomatic PLWHA, relating them to the duration of ART use. METHODS Four groups were evaluated according to ART use: G1 (n = 21), ART-naïve individuals; G2 (n = 17), <2 years; G3 (n = 40), 2-10 years; and G4 (n = 16) on ART for more than 10 years. RESULTS Our results showed a high prevalence of dyslipidemic individuals (64%), especially in those under ART. Lower creatine phosphokinase levels were observed in G1 as compared to the others (p < 0.05). Regarding the Framingham score, 12.1% of PLWHA showed moderate and high risk, and the highest proportion (38.5%) occurred in G4 (p = 0.003). A decrease in glomerular filtration rates occurred in 20% of patients, which was also more significant in G3 and G4 (p = 0.007). High prevalences of osteopenia and osteoporosis (53.2%) were found, especially in G1 and G4; however, G1 showed the lowest means for alkaline phosphatases (AP, p = 0.04 and BAP, p = 0.005) and osteocalcin (p = 0.005), in addition to higher vitamin-D concentrations (p = 0.04). CONCLUSIONS Our study showed the possible contributory role of ART in these changes, which leads us to reflect on the need for specific conducts and patient care, pointing out the importance of individualized care in an attempt to increase life expectancy.
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Affiliation(s)
- Karen Ingrid Tasca
- Sao Paulo State University - UNESP, Institute of Biosciences of Botucatu, Department of Microbiology and Immunology, Botucatu, Sao Paulo State, Brazil
| | - Vania V M Fagundes Vidal
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil
| | - Vanessa Martinez Manfio
- Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Alexandre Naime Barbosa
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Lenice do Rosario de Souza
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
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El Kamari V, Thomas A, Shan L, Sattar A, Monnier V, Howell SK, Beisswenger PJ, McComsey GA. Advanced Glycation End Products Are Associated With Inflammation and Endothelial Dysfunction in HIV. J Acquir Immune Defic Syndr 2019; 81:e55-e62. [PMID: 31095008 DOI: 10.1097/qai.0000000000002030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare levels of advanced glycation end products (AGEs) between HIV-infected patients and uninfected controls and assess the relationship between AGEs, HIV, inflammation, and endothelial dysfunction. DESIGN Cross-sectional study involving 90 individuals (68 HIV+ and 22 healthy controls matched by age and sex). METHODS AGE levels were assessed using 3 different modalities: free AGEs were measured in the serum, skin autofluorescence (AF) was determined with a noninvasive reader, and dietary AGEs were estimated using 24-hour dietary recalls. Markers of inflammation, immune activation, and endothelial dysfunction were also measured. Wilcoxon rank-sum and χ tests were used to compare AGEs between groups. Spearman correlations were used to explore relationships between variables while adjusting for different covariates. RESULTS Overall, 71% were men and 68% were African American, with a median age of 53 years. Among HIV-infected individuals, all participants were on antiretroviral therapy by design, and most participants (78%) had an undetectable HIV-1 RNA level (≤20 copies/mL). Skin AF and serum AGEs were significantly higher in HIV-infected participants compared with uninfected controls (P < 0.01), whereas no differences in dietary AGEs were found between groups (P = 0.2). In the HIV-infected group, but not in controls, skin AF and circulating AGEs were significantly associated with inflammatory and oxidative markers, and with markers of endothelial dysfunction. CONCLUSIONS These results suggest intrinsic production of AGE in HIV-infected individuals. The relationship between serum/skin AGE and inflammatory, oxidative, and cardiovascular markers highlights the potential implications of AGEs in chronic inflammation and endothelial dysfunction in HIV, suggesting a new potential target for HIV-associated heightened inflammation and cardiovascular risk.
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Affiliation(s)
- Vanessa El Kamari
- Case Western Reserve University, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Alicia Thomas
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | | | | | - Scott K Howell
- Geisel School of Medicine at Dartmouth, Prevent AGE Healthcare LLC, Lebanon, NH
| | - Paul J Beisswenger
- Geisel School of Medicine at Dartmouth, Prevent AGE Healthcare LLC, Lebanon, NH
| | - Grace A McComsey
- Case Western Reserve University, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
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Carr DF, Wang CW, Bellón T, Ressel L, Nwikue G, Shrivastava V, Bergfeld W, Jorgensen AL, Chung WH, Pirmohamed M. Serum and blister-fluid elevation and decreased epidermal content of high-mobility group box 1 protein in drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis. Br J Dermatol 2019; 181:166-174. [PMID: 30613954 PMCID: PMC6617791 DOI: 10.1111/bjd.17610] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND High-mobility group box 1 (HMGB1) is a damage-associated molecular-pattern protein. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) are serious, immune-mediated skin-blistering conditions. OBJECTIVES To determine serum and/or blister-fluid total HMGB1 levels in SJS/TEN cohorts, and HMGB1 expression in formalin-fixed, paraffin-embedded (FFPE) SJS/TEN skin vs. healthy and maculopapular exanthema (MPE) skin. Methods Serum HMGB1 was quantified in Malawian nevirapine-induced hypersensitivity, Taiwanese SJS/TEN and Spanish SJS/TEN cohorts. FFPE skin (healthy skin, MPE, SJS/TEN) was stained and assessed for HMGB1 expression. RESULTS Serum total HMGB1 was not significantly elevated in patients with nevirapine-induced SJS/TEN (3·98 ± 2·17 ng mL-1 ), MPE (3·92 ± 2·75 ng mL-1 ) or drug reaction with eosinophilia and systemic symptoms (4·73 ± 3·00 ng mL-1 ) vs. tolerant controls (2·97 ± 3·00 ng mL-1 ). HMGB1 was significantly elevated in Taiwanese patients with SJS/TEN, highest during the acute phase (32·6 ± 26·6 ng mL-1 ) vs. the maximal (19·7 ± 23·2 ng mL-1 ; P = 0·007) and recovery (24·6 ± 25·3 ng mL-1 ; P = 0·027) phases. In blister fluid from Spanish patients with SJS/TEN, HMGB1 (486·8 ± 687·9 ng mL-1 ) was significantly higher than in serum (8·8 ± 7·6 ng mL-1 ; P <0·001). Preblistered SJS/TEN skin showed decreased epidermal nuclear HMGB1 expression in upper epidermis vs. healthy or MPE skin but retained basal/suprabasal expression. CONCLUSIONS Epidermal HMGB1 expression was decreased in SJS/TEN skin. Retained basal/suprabasal epidermal HMGB1 expression may exacerbate localized injury in SJS/TEN.
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Affiliation(s)
- D F Carr
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, U.K
| | - C-W Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Linkou, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - T Bellón
- La Paz University Hospital Health Research Institute (IdiPAZ), Madrid, Spain
| | - L Ressel
- Departments of Veterinary Pathology and Public Health, University of Liverpool, Liverpool, U.K
| | - G Nwikue
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, U.K
| | - V Shrivastava
- Naval Medical Center Portsmouth, Portsmouth, VA, U.S.A
| | - W Bergfeld
- Department of Dermatology and Dermatopathology, Cleveland Clinic Foundation, Cleveland, OH, U.S.A
| | - A L Jorgensen
- Departments of Biostatistics, University of Liverpool, Liverpool, U.K
| | - W-H Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Linkou, Taipei, Taiwan
| | - M Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, U.K
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Rodrigues KL, Borges JP, Lopes GDO, Pereira ENGDS, Mediano MFF, Farinatti P, Tibiriça E, Daliry A. Influence of Physical Exercise on Advanced Glycation End Products Levels in Patients Living With the Human Immunodeficiency Virus. Front Physiol 2018; 9:1641. [PMID: 30574090 PMCID: PMC6291474 DOI: 10.3389/fphys.2018.01641] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/30/2018] [Indexed: 01/17/2023] Open
Abstract
Introduction: Combined antiretroviral therapy (cART) used to treat acquired immunodeficiency virus (HIV) induces a number of adverse effects, such as insulin resistance and dyslipidemia, which ultimately increases the cardiovascular risk. Advanced glycation end products (AGEs) have been implicated in the etiology of cardiovascular diseases, diabetes and other chronic diseases. It is known that physical exercise improves the lipid profile, insulin resistance and reduces the risk of cardiovascular diseases. However, the impact of physical exercise on AGE levels in HIV-infected patients has not been so far investigated. Therefore, this study compared AGEs levels in people with and without HIV and verified the effect of physical training on serum AGE levels. Methods: Participants were initially assigned into three groups: healthy control (CTL, n = 35), physically inactive HIV-infected (In-HIV, n = 33) and physically active HIV-infected (Ac-HIV, n = 19). The In-HIV group underwent physical training for 3 months, consisting of 60-min sessions of multimodal supervised exercise (aerobic, resistance and flexibility) with moderate intensity (50–80% heart rate reserve), performed 3 times/week. AGEs were measured in serum by fluorescence spectrometry. Results: At baseline, serum AGEs fluorescence level was significantly higher in inactive HIV-patients when compared to controls or active HIV-patients (In-HIV: 0.93 ± 0.08 vs. controls: 0.68 ± 0.13 and Ac-HIV: 0.59 ± 0.04 A.U.; P < 0.001). Triglycerides were also higher in In-HIV than CTL (182.8 ± 102 vs. 132.8 ± 52.3 mg/dL; P < 0.05). Waist circumference was lower in Ac-HIV, compared to In-HIV and controls (83.9 ± 10.4 vs. 92.9 ± 13.5 and 98.3 ± 12.4, respectively; P < 0.05). Body mass, fasting blood glucose, LDL, HDL, and total cholesterol were similar between groups. After training, AGE levels decreased (Baseline: 0.93 ± 0.08 vs. 3 months follow-up: 0.59 ± 0.04 AU; P < 0.001), no further difference being detected vs. CTL or Ac-HIV. Conclusion: HIV-infected patients under cART exhibited elevated AGEs levels compared to healthy individuals and physically active patients. Short-term aerobic training of moderate intensity counteracted this condition.
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Affiliation(s)
- Karine Lino Rodrigues
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Juliana Pereira Borges
- Laboratory of Physical Activity and Health Promotion, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gabriella de Oliveira Lopes
- Laboratory of Physical Activity and Health Promotion, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,National Institute of Cardiology, Ministry of Health, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Laboratory of Physical Activity and Health Promotion, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Tibiriça
- National Institute of Cardiology, Ministry of Health, Rio de Janeiro, Brazil
| | - Anissa Daliry
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Guariglia DA, Pedro RE, Deminice R, Rosa FT, Peres SB, Franzói De Moraes SM. Effect of combined training on body composition and metabolic variables in people living with HIV: A randomized clinical trial. Cytokine 2018; 111:505-510. [PMID: 29903591 DOI: 10.1016/j.cyto.2018.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of this study was to conduct a randomized clinical trial to assess the effects of 16 weeks of combined training on body composition, lipid profile, adiponectin, C-reactive protein (CRP), and leptin levels in people living with HIV/AIDS (PLWHA). METHODS Fifty-eight HIV-infected individuals were randomized into a training group (T) or a control group (C). Combined training consisted of aerobic and resistance exercises performed at the same training session, applied at a frequency of three times a week for a total of 16 weeks. Waist circumference, body mass, body fat percentage (%fat), fat mass, lipid profile, adiponectin, CRP, and leptin levels were measured pre- and post-training in both groups. RESULTS Sixteen weeks of combined training decreased (P < 0.05) body fat in different body segments in PLWHA. Lipodystrophic PLWHA experienced greater reduction in body fat in the android region than non-lipodystrophic PLWHA after combined training. Lipid profile and circulating levels of adiponectin, leptin, and CRP remained unchanged. CONCLUSIONS Sixteen weeks of combined training was effective to reduce body fat in different body segments, without altering plasma lipid and cytokine levels.
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Affiliation(s)
| | - Rafael Evangelista Pedro
- Adipose Tissue Study Group - Department of Physiological Sciences, State University of Maringá, Maringá, Brazil.
| | - Rafael Deminice
- Department of Physical Education, State University of Londrina, Londrina, Brazil.
| | | | - Sidney Barnabé Peres
- Department of Physiological Sciences, State University of Maringá, Maringá, Brazil.
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Antiretroviral Therapy Initiation Alters the Redox System of Asymptomatic HIV-Infected Individuals: A Longitudinal Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:9834803. [PMID: 28421130 PMCID: PMC5379093 DOI: 10.1155/2017/9834803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 01/11/2023]
Abstract
Background. The combination antiretroviral therapy (cART) increases the oxidative stress in HIV-infected people, which in turn favors the onset and aggravation of non-AIDS comorbidities, a common situation affecting these individuals. We aimed to evaluate the influence of cART initiation on oxidative stress parameters. This is a longitudinal study including 30 asymptomatic patients divided according to their CD4+ T cell count (G1: <500 cell/mL; G2: >500 cell/mL) before (M0) and after (M1) cART initiation. We analyzed total antioxidant capacity (TAC), fat-soluble vitamins, malondialdehyde, 8-isoprostane, and DNA damage. Results. Results showed a decrease in TAC, retinol, α-tocopherol, and some carotenoids, in addition to a significant increase in DNA damage at M1. These changes were more evident in G2 subjects. Moreover, there was a significant 8-isoprostane increase at M1 in individuals belonging to G1. Conclusion. The results indicate that cART interfered in the redox system, mainly by reducing the antioxidant defenses. In addition, patients who had CD4+ T counts higher than 500 cells/mm3 showed more susceptibility to genotoxicity, while patients with less CD4+ T counts displayed more damage triggered by lipoperoxidation. Considering the early beginning of cART, its chronic use, and its capacity to alter the redox status, further long-term studies on larger cohorts are needed to define the best time to initiate therapy and to investigate new strategies to delay the development of non-AIDS diseases.
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