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Rodriguez-Irizarry VJ, Schneider AC, Ahle D, Smith JM, Suarez-Martinez EB, Salazar EA, McDaniel Mims B, Rasha F, Moussa H, Moustaïd-Moussa N, Pruitt K, Fonseca M, Henriquez M, Clauss MA, Grisham MB, Almodovar S. Mice with humanized immune system as novel models to study HIV-associated pulmonary hypertension. Front Immunol 2022; 13:936164. [PMID: 35990658 PMCID: PMC9390008 DOI: 10.3389/fimmu.2022.936164] [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: 05/04/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
People living with HIV and who receive antiretroviral therapy have a significantly improved lifespan, compared to the early days without therapy. Unfortunately, persisting viral replication in the lungs sustains chronic inflammation, which may cause pulmonary vascular dysfunction and ultimate life-threatening Pulmonary Hypertension (PH). The mechanisms involved in the progression of HIV and PH remain unclear. The study of HIV-PH is limited due to the lack of tractable animal models that recapitulate infection and pathobiological aspects of PH. On one hand, mice with humanized immune systems (hu-mice) are highly relevant to HIV research but their suitability for HIV-PH research deserves investigation. On another hand, the Hypoxia-Sugen is a well-established model for experimental PH that combines hypoxia with the VEGF antagonist SU5416. To test the suitability of hu-mice, we combined HIV with either SU5416 or hypoxia. Using right heart catheterization, we found that combining HIV+SU5416 exacerbated PH. HIV infection increases human pro-inflammatory cytokines in the lungs, compared to uninfected mice. Histopathological examinations showed pulmonary vascular inflammation with arterial muscularization in HIV-PH. We also found an increase in endothelial-monocyte activating polypeptide II (EMAP II) when combining HIV+SU5416. Therefore, combinations of HIV with SU5416 or hypoxia recapitulate PH in hu-mice, creating well-suited models for infectious mechanistic pulmonary vascular research in small animals.
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Affiliation(s)
- Valerie J. Rodriguez-Irizarry
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, United States,Department of Biology, University of Puerto Rico in Ponce, Ponce, PR, United States
| | - Alina C. Schneider
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Daniel Ahle
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Justin M. Smith
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Ethan A. Salazar
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Brianyell McDaniel Mims
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Fahmida Rasha
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Hanna Moussa
- Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, United States
| | - Naima Moustaïd-Moussa
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Kevin Pruitt
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Marcelo Fonseca
- Program of Physiology and Biophysics, University of Chile, Santiago, Chile
| | - Mauricio Henriquez
- Program of Physiology and Biophysics, University of Chile, Santiago, Chile
| | - Matthias A. Clauss
- Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University, Indianapolis, IN, United States
| | - Matthew B. Grisham
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Sharilyn Almodovar
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, United States,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,*Correspondence: Sharilyn Almodovar,
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Abstract
Pulmonary hypertension (PH) describes heterogeneous population of patients with a mean pulmonary arterial pressure >20 mm Hg. Rarely, PH presents as a primary disorder but is more commonly part of a complex phenotype associated with comorbidities. Regardless of the cause, PH reduces life expectancy and impacts quality of life. The current clinical classification divides PH into 1 of 5 diagnostic groups to assign treatment. There are currently no pharmacological cures for any form of PH. Animal models are essential to help decipher the molecular mechanisms underlying the disease, to assign genotype-phenotype relationships to help identify new therapeutic targets, and for clinical translation to assess the mechanism of action and putative efficacy of new therapies. However, limitations inherent of all animal models of disease limit the ability of any single model to fully recapitulate complex human disease. Within the PH community, we are often critical of animal models due to the perceived low success upon clinical translation of new drugs. In this review, we describe the characteristics, advantages, and disadvantages of existing animal models developed to gain insight into the molecular and pathological mechanisms and test new therapeutics, focusing on adult forms of PH from groups 1 to 3. We also discuss areas of improvement for animal models with approaches combining several hits to better reflect the clinical situation and elevate their translational value.
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Affiliation(s)
- Olivier Boucherat
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
| | - Vineet Agrawal
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allan Lawrie
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK & Insigneo institute for in silico medicine, Sheffield, UK
| | - Sebastien Bonnet
- Pulmonary Hypertension Research Group, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
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3
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Important Functions and Molecular Mechanisms of Mitochondrial Redox Signaling in Pulmonary Hypertension. Antioxidants (Basel) 2022; 11:antiox11030473. [PMID: 35326123 PMCID: PMC8944689 DOI: 10.3390/antiox11030473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/13/2022] Open
Abstract
Mitochondria are important organelles that act as a primary site to produce reactive oxygen species (ROS). Additionally, mitochondria play a pivotal role in the regulation of Ca2+ signaling, fatty acid oxidation, and ketone synthesis. Dysfunction of these signaling molecules leads to the development of pulmonary hypertension (PH), atherosclerosis, and other vascular diseases. Features of PH include vasoconstriction and pulmonary artery (PA) remodeling, which can result from abnormal proliferation, apoptosis, and migration of PA smooth muscle cells (PASMCs). These responses are mediated by increased Rieske iron–sulfur protein (RISP)-dependent mitochondrial ROS production and increased mitochondrial Ca2+ levels. Mitochondrial ROS and Ca2+ can both synergistically activate nuclear factor κB (NF-κB) to trigger inflammatory responses leading to PH, right ventricular failure, and death. Evidence suggests that increased mitochondrial ROS and Ca2+ signaling leads to abnormal synthesis of ketones, which play a critical role in the development of PH. In this review, we discuss some of the recent findings on the important interactive role and molecular mechanisms of mitochondrial ROS and Ca2+ in the development and progression of PH. We also address the contributions of NF-κB-dependent inflammatory responses and ketone-mediated oxidative stress due to abnormal regulation of mitochondrial ROS and Ca2+ signaling in PH.
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Wencheng H, Zhang W, An Y, Huang L, Luo H. Impact of Pulmonary Arterial Hypertension on Systemic Inflammation, Cardiac Injury and Hemodynamics in Sepsis: A retrospective study from MIMIC-III. Am J Med Sci 2022; 363:311-321. [PMID: 35038420 DOI: 10.1016/j.amjms.2021.12.009] [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: 01/08/2021] [Revised: 08/27/2021] [Accepted: 12/07/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sepsis and pulmonary arterial hypertension (PAH) may both present in a single patient in the intensive care unit. The impact of PAH on the sepsis process is not well understood. Here we assess the effect of PAH in patients with sepsis from multiple perspectives. METHODS Patients with sepsis with or without PAH underwent propensity score matching according to age, sex and ethnicity. Clinical complications, hemodynamics, and laboratory examinations, including heart injury and inflammation, were compared between the 2 groups. We aimed to model the relationship between the severity of PAH and systemic inflammation levels using linear regression analysis. Factors associated with 28-day and one-year mortality in patients with sepsis with PAH were also analyzed using binary logistic regression. RESULTS A total of 285 pairs of patients with sepsis with or without PAH were included in the analysis. There were no significant differences in the C-reactive protein (CRP), white blood cell (WBC), or lactate levels or neutrophil percentage between the 2 groups, and the mean pulmonary arterial pressure and N-terminal pro b-type natriuretic peptide (NTproBNP) level did not correlate with CRP, WBC or lactate. The cardiac injury indexes were significantly higher in the PAH group. Lower mean arterial pressure was found in patients with PAH. Longer ventilation duration was a risk factor for, while obesity was protective against, both short- and long-term mortality in patients with sepsis with PAH. CONCLUSIONS PAH had little effect on the inflammation profile in sepsis, but it may worsen the sepsis outcome by impairing cardiac function and subsequent hemodynamic stability.
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Affiliation(s)
- He Wencheng
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen Peking University - The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China; Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Weixing Zhang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Youzhong An
- Department of Intensive Care Unit, Peking University People's Hospital, Beijing, China
| | - Lei Huang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Hua Luo
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
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Bai Y, Lockett AD, Gomes MT, Stearman RS, Machado RF. Sphingosine Kinase 1 Regulates the Pulmonary Vascular Immune Response. Cell Biochem Biophys 2021; 79:517-529. [PMID: 34133010 PMCID: PMC8206894 DOI: 10.1007/s12013-021-01006-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 12/13/2022]
Abstract
The aberrant proliferation of pulmonary artery smooth muscle (PASMCs) cells is a defining characteristic of pulmonary arterial hypertension (PAH) and leads to increased vascular resistance, elevated pulmonary pressure, and right heart failure. The sphingosine kinase 1 (SPHK1)/sphingosine-1 phosphate/sphingosine-1 phosphate receptor 2 pathway promotes vascular remodeling and induces PAH. The aim of this study was to identify genes and cellular processes that are modulated by over-expression of SPHK1 in human PASMCs (hPASMCs). RNA was purified and submitted for RNA sequencing to identify differentially expressed genes. Using a corrected p-value threshold of <0.05, there were 294 genes significantly up-regulated while 179 were significantly down-regulated. Predicted effects of these differentially expressed genes were evaluated using the freeware tool Enrichr to assess general gene set over-representation (enrichment) and ingenuity pathway analysis (IPA™) for upstream regulator predictions. We found a strong change in genes that regulated the cellular immune response. IL6, STAT1, and PARP9 were elevated in response to SPHK1 over-expression in hPASMCs. The gene set enrichment mapped to a few immune-modulatory signaling networks, including IFNG. Furthermore, PARP9 and STAT1 protein were elevated in primary hPASMCs isolated from PAH patients. In conclusion, these data suggest a role of Sphk1 regulates pulmonary vascular immune response in PAH.
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Affiliation(s)
- Yang Bai
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Angelia D Lockett
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marta T Gomes
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert S Stearman
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Roberto F Machado
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Sibomana JP, Campeche A, Carvalho-Filho RJ, Correa RA, Duani H, Pacheco Guimaraes V, Hilton JF, Kassa B, Kumar R, Lee MH, Loureiro CMC, Mazimba S, Mickael C, Oliveira RKF, Ota-Arakaki JS, Rezende CF, Silva LCS, Sinkala E, Ahmed HY, Graham BB. Schistosomiasis Pulmonary Arterial Hypertension. Front Immunol 2020; 11:608883. [PMID: 33362796 PMCID: PMC7758287 DOI: 10.3389/fimmu.2020.608883] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a disease of the lung blood vessels that results in right heart failure. PAH is thought to occur in about 5% to 10% of patients with hepatosplenic schistosomiasis, particularly due to S. mansoni. The lung blood vessel injury may result from a combination of embolization of eggs through portocaval shunts into the lungs causing localized Type 2 inflammatory response and vessel remodeling, triggering of autonomous pathology that becomes independent of the antigen, and high cardiac output as seen in portopulmonary hypertension. The condition is likely underdiagnosed as there is little systematic screening, and risk factors for developing PAH are not known. Screening is done by echocardiography, and formal diagnosis requires invasive right heart catheterization. Patients with Schistosoma-associated PAH show reduced functional capacity and can be treated with pulmonary vasodilators, which improves symptoms and may improve survival. There are animal models of this disease that might help in understanding disease pathogenesis and identify novel targets to screen and treatment. Pathogenic mechanisms include Type 2 immunity and activation and signaling in the TGF-β pathway. There are still major uncertainties regarding Schistosoma-associated PAH development, course and treatment.
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Affiliation(s)
- Jean Pierre Sibomana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tikur Anbessa Specialized Hospital, College of Health Sciences, University of Addis Ababa, Addis Ababa, Ethiopia
- Department of Medicine, Butare University Teaching Hospital, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aloma Campeche
- Division of Gastroenterology, Department of Medicine, Santa Casa Hospital, Salvador, Bahia, Brazil
| | - Roberto J. Carvalho-Filho
- Division of Gastroenterology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo Amorim Correa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Duani
- Internal Medicine/Infectious Diseases Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Virginia Pacheco Guimaraes
- Pulmonary Department, Hospital Júlia Kubistchek, Fundação Hospitalar of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Biruk Kassa
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Rahul Kumar
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Michael H. Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | | | - Sula Mazimba
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Claudia Mickael
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rudolf K. F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jaquelina S. Ota-Arakaki
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Camila Farnese Rezende
- Pulmonary Medicine, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luciana C. S. Silva
- Internal Medicine Department, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Edford Sinkala
- Hepatology Clinic, Department of Medicine, University of Zambia Teaching Hospital, Lusaka, Zambia
| | - Hanan Yusuf Ahmed
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tikur Anbessa Specialized Hospital, College of Health Sciences, University of Addis Ababa, Addis Ababa, Ethiopia
| | - Brian B. Graham
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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7
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Krishnan M, Barnett CF. Advances in the diagnosis and treatment of HIV-associated pulmonary arterial hypertension. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1770080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mrinalini Krishnan
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Department of Cardiology, Division of Advanced Heart Failure, Washington, D.C, USA
| | - Christopher F. Barnett
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Department of Cardiology, Division of Advanced Heart Failure, Washington, D.C, USA
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Statin treatment prevents the development of pulmonary arterial hypertension in a nonhuman primate model of HIV-associated PAH. Sci Rep 2019; 9:19832. [PMID: 31882598 PMCID: PMC6934837 DOI: 10.1038/s41598-019-55301-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by pulmonary vascular remodeling, elevated pulmonary arterial pressure, and right heart failure. Human immunodeficiency virus (HIV)-infected individuals have a higher incidence of PAH than the non-HIV infected population and evidence suggests a role for systemic and pulmonary inflammation in the pathogenesis of HIV-associated PAH. Due to their pleiotropic effects, including immune-modulatory and anti-inflammatory effects, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) have been considered for the treatment of PAH, with conflicting results. The effects of statins on HIV-associated PAH have not been specifically evaluated. We have developed a non-human primate (NHP) model of HIV-associated PAH that closely mimics HIV-PAH using simian immunodeficiency virus (SIV)-infected rhesus macaques (Macaca mulatta). We determined that treatment of healthy macaques with atorvastatin prior to and throughout SIV infection prevented the development of SIV-associated PAH. Additionally, SIV-infected macaques that initiated atorvastatin treatment during the early chronic disease stage had reduced incidence of PAH compared to untreated animals. Statin treatment reduced inflammatory mediators TGF-β, MIP-1α, and TNF-α and the numbers of CD14dimCD16+ non-classical monocytes, and CD14+CCR7−CD163−CD206+ alveolar macrophages previously shown to be associated with SIV-PAH. These results support the concept that statins reduce inflammatory processes that contribute to PAH and may provide a safe and effective prophylactic strategy for the prevention of PAH in HIV-infected individuals.
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Cribbs SK, Crothers K, Morris A. Pathogenesis of HIV-Related Lung Disease: Immunity, Infection, and Inflammation. Physiol Rev 2019; 100:603-632. [PMID: 31600121 DOI: 10.1152/physrev.00039.2018] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Despite anti-retroviral therapy (ART), human immunodeficiency virus-1 (HIV)-related pulmonary disease continues to be a major cause of morbidity and mortality for people living with HIV (PLWH). The spectrum of lung diseases has changed from acute opportunistic infections resulting in death to chronic lung diseases for those with access to ART. Chronic immune activation and suppression can result in impairment of innate immunity and progressive loss of T cell and B cell functionality with aberrant cytokine and chemokine responses systemically as well as in the lung. HIV can be detected in the lungs of PLWH and has profound effects on cellular immune functions. In addition, HIV-related lung injury and disease can occur secondary to a number of mechanisms including altered pulmonary and systemic inflammatory pathways, viral persistence in the lung, oxidative stress with additive effects of smoke exposure, microbial translocation, and alterations in the lung and gut microbiome. Although ART has had profound effects on systemic viral suppression in HIV, the impact of ART on lung immunology still needs to be fully elucidated. Understanding of the mechanisms by which HIV-related lung diseases continue to occur is critical to the development of new preventive and therapeutic strategies to improve lung health in PLWH.
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Affiliation(s)
- Sushma K Cribbs
- Pulmonary Medicine, Department of Veterans Affairs, Atlanta, Georgia; Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University, Atlanta, Georgia; Department of Medicine, Veterans Affairs Puget Sound Health Care System and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; and Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kristina Crothers
- Pulmonary Medicine, Department of Veterans Affairs, Atlanta, Georgia; Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University, Atlanta, Georgia; Department of Medicine, Veterans Affairs Puget Sound Health Care System and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; and Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alison Morris
- Pulmonary Medicine, Department of Veterans Affairs, Atlanta, Georgia; Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University, Atlanta, Georgia; Department of Medicine, Veterans Affairs Puget Sound Health Care System and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington; and Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Provencher S, Archer SL, Ramirez FD, Hibbert B, Paulin R, Boucherat O, Lacasse Y, Bonnet S. Standards and Methodological Rigor in Pulmonary Arterial Hypertension Preclinical and Translational Research. Circ Res 2019; 122:1021-1032. [PMID: 29599278 DOI: 10.1161/circresaha.117.312579] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite advances in our understanding of the pathophysiology and the management of pulmonary arterial hypertension (PAH), significant therapeutic gaps remain for this devastating disease. Yet, few innovative therapies beyond the traditional pathways of endothelial dysfunction have reached clinical trial phases in PAH. Although there are inherent limitations of the currently available models of PAH, the leaky pipeline of innovative therapies relates, in part, to flawed preclinical research methodology, including lack of rigour in trial design, incomplete invasive hemodynamic assessment, and lack of careful translational studies that replicate randomized controlled trials in humans with attention to adverse effects and benefits. Rigorous methodology should include the use of prespecified eligibility criteria, sample sizes that permit valid statistical analysis, randomization, blinded assessment of standardized outcomes, and transparent reporting of results. Better design and implementation of preclinical studies can minimize inherent flaws in the models of PAH, reduce the risk of bias, and enhance external validity and our ability to distinguish truly promising therapies form many false-positive or overstated leads. Ideally, preclinical studies should use advanced imaging, study several preclinical pulmonary hypertension models, or correlate rodent and human findings and consider the fate of the right ventricle, which is the major determinant of prognosis in human PAH. Although these principles are widely endorsed, empirical evidence suggests that such rigor is often lacking in pulmonary hypertension preclinical research. The present article discusses the pitfalls in the design of preclinical pulmonary hypertension trials and discusses opportunities to create preclinical trials with improved predictive value in guiding early-phase drug development in patients with PAH, which will need support not only from researchers, peer reviewers, and editors but also from academic institutions, funding agencies, and animal ethics authorities.
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Affiliation(s)
- Steeve Provencher
- From the Pulmonary Hypertension Research Group, Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., S.B.), Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., Y.L., S.B.), and Department of Medicine (S.P., R.P., O.B., Y.L., S.B.), Université Laval, Québec, Canada; Department of Medicine, Queen's University, Kingston, Canada (S.L.A.); Division of Cardiology (F.D.R., B.H.), CAPITAL Research Group (F.D.R., B.H.), and Vascular Biology and Experimental Medicine Laboratory (B.H.), University of Ottawa Heart Institute, Ontario, Canada; and Department of Cellular and Molecular Medicine (B.H.) and School of Epidemiology and Public Health (F.D.R.) University of Ottawa, Ontario, Canada
| | - Stephen L Archer
- From the Pulmonary Hypertension Research Group, Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., S.B.), Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., Y.L., S.B.), and Department of Medicine (S.P., R.P., O.B., Y.L., S.B.), Université Laval, Québec, Canada; Department of Medicine, Queen's University, Kingston, Canada (S.L.A.); Division of Cardiology (F.D.R., B.H.), CAPITAL Research Group (F.D.R., B.H.), and Vascular Biology and Experimental Medicine Laboratory (B.H.), University of Ottawa Heart Institute, Ontario, Canada; and Department of Cellular and Molecular Medicine (B.H.) and School of Epidemiology and Public Health (F.D.R.) University of Ottawa, Ontario, Canada
| | - F Daniel Ramirez
- From the Pulmonary Hypertension Research Group, Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., S.B.), Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., Y.L., S.B.), and Department of Medicine (S.P., R.P., O.B., Y.L., S.B.), Université Laval, Québec, Canada; Department of Medicine, Queen's University, Kingston, Canada (S.L.A.); Division of Cardiology (F.D.R., B.H.), CAPITAL Research Group (F.D.R., B.H.), and Vascular Biology and Experimental Medicine Laboratory (B.H.), University of Ottawa Heart Institute, Ontario, Canada; and Department of Cellular and Molecular Medicine (B.H.) and School of Epidemiology and Public Health (F.D.R.) University of Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- From the Pulmonary Hypertension Research Group, Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., S.B.), Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., Y.L., S.B.), and Department of Medicine (S.P., R.P., O.B., Y.L., S.B.), Université Laval, Québec, Canada; Department of Medicine, Queen's University, Kingston, Canada (S.L.A.); Division of Cardiology (F.D.R., B.H.), CAPITAL Research Group (F.D.R., B.H.), and Vascular Biology and Experimental Medicine Laboratory (B.H.), University of Ottawa Heart Institute, Ontario, Canada; and Department of Cellular and Molecular Medicine (B.H.) and School of Epidemiology and Public Health (F.D.R.) University of Ottawa, Ontario, Canada
| | - Roxane Paulin
- From the Pulmonary Hypertension Research Group, Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., S.B.), Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., Y.L., S.B.), and Department of Medicine (S.P., R.P., O.B., Y.L., S.B.), Université Laval, Québec, Canada; Department of Medicine, Queen's University, Kingston, Canada (S.L.A.); Division of Cardiology (F.D.R., B.H.), CAPITAL Research Group (F.D.R., B.H.), and Vascular Biology and Experimental Medicine Laboratory (B.H.), University of Ottawa Heart Institute, Ontario, Canada; and Department of Cellular and Molecular Medicine (B.H.) and School of Epidemiology and Public Health (F.D.R.) University of Ottawa, Ontario, Canada
| | - Olivier Boucherat
- From the Pulmonary Hypertension Research Group, Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., S.B.), Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., Y.L., S.B.), and Department of Medicine (S.P., R.P., O.B., Y.L., S.B.), Université Laval, Québec, Canada; Department of Medicine, Queen's University, Kingston, Canada (S.L.A.); Division of Cardiology (F.D.R., B.H.), CAPITAL Research Group (F.D.R., B.H.), and Vascular Biology and Experimental Medicine Laboratory (B.H.), University of Ottawa Heart Institute, Ontario, Canada; and Department of Cellular and Molecular Medicine (B.H.) and School of Epidemiology and Public Health (F.D.R.) University of Ottawa, Ontario, Canada
| | - Yves Lacasse
- From the Pulmonary Hypertension Research Group, Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., S.B.), Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., Y.L., S.B.), and Department of Medicine (S.P., R.P., O.B., Y.L., S.B.), Université Laval, Québec, Canada; Department of Medicine, Queen's University, Kingston, Canada (S.L.A.); Division of Cardiology (F.D.R., B.H.), CAPITAL Research Group (F.D.R., B.H.), and Vascular Biology and Experimental Medicine Laboratory (B.H.), University of Ottawa Heart Institute, Ontario, Canada; and Department of Cellular and Molecular Medicine (B.H.) and School of Epidemiology and Public Health (F.D.R.) University of Ottawa, Ontario, Canada
| | - Sébastien Bonnet
- From the Pulmonary Hypertension Research Group, Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., S.B.), Institut universitaire de cardiologie et de pneumologie de Québec Research Center (S.P., R.P., O.B., Y.L., S.B.), and Department of Medicine (S.P., R.P., O.B., Y.L., S.B.), Université Laval, Québec, Canada; Department of Medicine, Queen's University, Kingston, Canada (S.L.A.); Division of Cardiology (F.D.R., B.H.), CAPITAL Research Group (F.D.R., B.H.), and Vascular Biology and Experimental Medicine Laboratory (B.H.), University of Ottawa Heart Institute, Ontario, Canada; and Department of Cellular and Molecular Medicine (B.H.) and School of Epidemiology and Public Health (F.D.R.) University of Ottawa, Ontario, Canada.
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11
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Hu HL, Kang Y, Zeng Y, Zhang M, Liao Q, Rong MQ, Zhang Q, Lai R. Region-resolved proteomics profiling of monkey heart. J Cell Physiol 2019; 234:13720-13734. [PMID: 30644093 PMCID: PMC7166496 DOI: 10.1002/jcp.28052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/06/2018] [Indexed: 02/05/2023]
Abstract
Nonhuman primates (NHPs) play an indispensable role in biomedical research because of their similarities in genetics, physiological, and neurological function to humans. Proteomics profiling of monkey heart could reveal significant cardiac biomarkers and help us to gain a better understanding of the pathogenesis of heart disease. However, the proteomic study of monkey heart is relatively lacking. Here, we performed the proteomics profiling of the normal monkey heart by measuring three major anatomical regions (vessels, valves, and chambers) based on iTRAQ‐coupled LC‐MS/MS analysis. Over 3,200 proteins were identified and quantified from three heart tissue samples. Furthermore, multiple bioinformatics analyses such as gene ontology analysis, protein–protein interaction analysis, and gene‐diseases association were used to investigate biological network of those proteins from each area. More than 60 genes in three heart regions are implicated with heart diseases such as hypertrophic cardiomyopathy, heart failure, and myocardial infarction. These genes associated with heart disease are mainly enriched in citrate cycle, amino acid degradation, and glycolysis pathway. At the anatomical level, the revelation of molecular characteristics of the healthy monkey heart would be an important starting point to investigate heart disease. As a unique resource, this study can serve as a reference map for future in‐depth research on cardiac disease‐related NHP model and novel biomarkers of cardiac injury.
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Affiliation(s)
- Hao-Liang Hu
- The National & Local Joint Engineering Laboratory of Animal Peptide Drug Development, College of Life Sciences, Hunan Normal University, Changsha, China
| | - Yu Kang
- Division of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Zeng
- The National & Local Joint Engineering Laboratory of Animal Peptide Drug Development, College of Life Sciences, Hunan Normal University, Changsha, China
| | - Ming Zhang
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences (CAS), Kunming, Yunnan, China
| | - Qiong Liao
- The National & Local Joint Engineering Laboratory of Animal Peptide Drug Development, College of Life Sciences, Hunan Normal University, Changsha, China
| | - Ming-Qiang Rong
- The National & Local Joint Engineering Laboratory of Animal Peptide Drug Development, College of Life Sciences, Hunan Normal University, Changsha, China
| | - Qin Zhang
- Division of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ren Lai
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences (CAS), Kunming, Yunnan, China
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12
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Schweitzer F, Tarantelli R, Rayens E, Kling HM, Mattila JT, Norris KA. Monocyte and Alveolar Macrophage Skewing Is Associated with the Development of Pulmonary Arterial Hypertension in a Primate Model of HIV Infection. AIDS Res Hum Retroviruses 2019; 35:63-74. [PMID: 30229666 DOI: 10.1089/aid.2018.0132] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We investigated the relationship of monocytes, alveolar, and tissue-resident macrophage populations and the development of pulmonary arterial hypertension (PAH) in a nonhuman primate model of HIV infection. A prospective study of simian immunodeficiency virus-associated pulmonary arterial hypertension (SIV-PAH) was done. Rhesus macaques (n = 21) were infected with SIV. Blood, bronchoalveolar lavage fluid (BALF), and lung tissue were analyzed for monocyte and macrophage phenotypes and inflammatory mediators. Serial right heart catheterizations were performed at three time points throughout the study to assess hemodynamic alterations and the development of PAH. All 21 animals showed similar courses of SIV infection with an increasing proinflammatory plasma environment. At 6 months postinfection (mpi), 11 of 21 animals developed SIV-PAH (mPAP ≤25 mmHg; right ventricular systolic pressure [RVSP] ≤36 mmHg). PAH+ animals had an increased frequency of proinflammatory, nonclassical monocytes (CD14dimCD16+) (p = .06) in the peripheral blood and CD14+CCR7-CD163-CD206+ macrophages (p = .04) in BALF compared with PAH- animals at 6 mpi. Increased frequencies of these monocyte and macrophage phenotypes correlated with elevated RVSP (p = .04; p = .03). In addition, PAH+ animals had greater frequencies of tissue resident inflammatory M1-like CD68+STAT1+ (p = .001) and M2a-like CD68+STAT3+ macrophages (p = .003) and a lower frequency of anti-inflammatory M2c-like CD68+STAT6+ macrophages (p = .003) as well as fewer interleukin (IL)-10+ cells (p = .01). The results suggest that HIV-PAH is associated with skewing of monocytes and alveolar macrophages toward a proinflammatory, profibrotic phenotype. Furthermore, PAH+ animals may have diminished capacity to downregulate exaggerated chronic inflammation, as indicated by lower levels of IL-10 in PAH+ animals, contributing to disease progression.
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Affiliation(s)
- Finja Schweitzer
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia
| | - Rebecca Tarantelli
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia
| | - Emily Rayens
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia
| | - Heather M. Kling
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joshua T. Mattila
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen A. Norris
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia
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13
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Tarantelli RA, Schweitzer F, Simon MA, Vanderpool RR, Christman I, Rayens E, Kling HM, Zullo T, Carney JP, Lopresti BJ, Bertero T, Chan SY, Norris KA. Longitudinal Evaluation of Pulmonary Arterial Hypertension in a Rhesus Macaque ( Macaca mulatta) Model of HIV Infection. Comp Med 2018; 68:461-473. [PMID: 30541636 PMCID: PMC6310202 DOI: 10.30802/aalas-cm-18-000012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/17/2018] [Accepted: 06/30/2018] [Indexed: 02/06/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a life-threatening disease with higher incidence in HIV-infected compared with noninfected patients. SIV-infected NHP develop clinical manifestations of HIV infection, including PAH. To understand the pathogenesis of PAH and determine the relationship between hemodynamic changes and clinical characteristics associated with SIV infection, we performed right heart catheterization and echocardiographic imaging of 21 rhesus macaques before and after SIV infection. Between 6 and 12 mo after infection, 11 of the 21 animals had elevated mean pulmonary arterial pressure (mPAP; greater than 25 mm Hg). RV involvement was evident as increased RV glucose uptake in PAH+ macaques on positron emission tomography-coupled CT compared with uninfected animals. RV and pulmonary vascular collagen deposition were elevated in PAH+ animals. At 12 mo after infection, 6 of the 21 macaques (28.6%) exhibited continued increase in mPAP (progressive PAH), whereas 5 animals (23.8%) had reduced pressure (transient PAH). SIV infection of rhesus macaques led to 3 distinct outcomes with regard to hemodynamic function. Hemodynamic alterations correlated with specific inflammatory profiles and increased RV and pulmonary arterial fibrosis but not with viral load, sex, or CD4+ T-cell levels. This model of a natural cause of PAH provides insight into disease pathways that are important for the development of novel therapeutic targets.
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Key Words
- balf, bronchoalveolar lavage fluid
- ccl, c-c motif chemokine ligand
- cxcl, c-c-c motif chemokine ligand
- fdg, 2-deoxy-2-[18f]-fluoro-d-glucose
- ip, ifnγ-inducible protein
- lv+s, left ventricle plus septum
- mdc, macrophage-derived chemokine
- mip, macrophage inflammatory protein
- mpap, mean pulmonary artery pressure
- nbf, neutral buffered formalin
- rhc, right heart catheterization
- rv, right ventricle
- suv, standard uptake value
- tgf, transforming growth factor
- vegf, vascular endothelial growth factor
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Affiliation(s)
| | - Finja Schweitzer
- Center for Vaccine and Immunology, University of Georgia, Athens, Georgia, USA
| | - Marc A Simon
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca R Vanderpool
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ian Christman
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Emily Rayens
- Center for Vaccine and Immunology, University of Georgia, Athens, Georgia, USA
| | - Heather M Kling
- Departments of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - ToniAnn Zullo
- Departments of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan P Carney
- Departments of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian J Lopresti
- Departments of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas Bertero
- Institute for Research on Cancer and Aging, Université Côte d'Azur, Nice, France
| | - Stephen Y Chan
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karen A Norris
- Center for Vaccine and Immunology, University of Georgia, Athens, Georgia, USA.
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14
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Abstract
: Improved survival among HIV-1-infected individuals with the advent of antiretroviral therapy has clearly led to a greater prevalence of noninfectious complications. One of the most devastating sequelae in these individuals is the development of pulmonary arterial hypertension (PAH). Various epidemiological studies suggest worse survival of HIV-PAH patients when compared with other forms of PAH. Given that only a subset and not all HIV-infected individuals develop HIV-PAH, it is suggested that an additional second-hit of genetic or environmental trigger is needed for the development of PAH. In this context, it has been well documented that HIV patients who abuse illicit drugs such as stimulants, opioids, and the like, are more susceptible to develop PAH. In this review, we highlight the studies that support the significance of a double hit of HIV and drug abuse in the incidence of PAH and focus on the research that has been undertaken to unravel the pathobiology and vascular remodeling mechanisms underlying the deleterious synergy between HIV infection and drugs of abuse in orchestrating the development of PAH.
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15
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Thenappan T, Chan SY, Weir EK. Role of extracellular matrix in the pathogenesis of pulmonary arterial hypertension. Am J Physiol Heart Circ Physiol 2018; 315:H1322-H1331. [PMID: 30141981 PMCID: PMC6297810 DOI: 10.1152/ajpheart.00136.2018] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/06/2018] [Accepted: 08/14/2018] [Indexed: 12/23/2022]
Abstract
Pulmonary arterial hypertension (PAH) is characterized by remodeling of the extracellular matrix (ECM) of the pulmonary arteries with increased collagen deposition, cross-linkage of collagen, and breakdown of elastic laminae. Extracellular matrix remodeling occurs due to an imbalance in the proteolytic enzymes, such as matrix metalloproteinases, elastases, and lysyl oxidases, and tissue inhibitor of matrix metalloproteinases, which, in turn, results from endothelial cell dysfunction, endothelial-to-mesenchymal transition, and inflammation. ECM remodeling and pulmonary vascular stiffness occur early in the disease process, before the onset of the increase in the intimal and medial thickness and pulmonary artery pressure, suggesting that the ECM is a cause rather than a consequence of distal pulmonary vascular remodeling. ECM remodeling and increased pulmonary arterial stiffness promote proliferation of pulmonary vascular cells (endothelial cells, smooth muscle cells, and adventitial fibroblasts) through mechanoactivation of various signaling pathways, including transcriptional cofactors YAP/TAZ, transforming growth factor-β, transient receptor potential channels, Toll-like receptor, and NF-κB. Inhibition of ECM remodeling and mechanotransduction prevents and reverses experimental pulmonary hypertension. These data support a central role for ECM remodeling in the pathogenesis of the PAH, making it an attractive novel therapeutic target.
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Affiliation(s)
- Thenappan Thenappan
- Cardiovascular Division, Department of Medicine, University of Minnesota , Minneapolis, Minnesota
| | - Stephen Y Chan
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania
- University of Pittsburgh Medical Center, Pennsylvania
| | - E Kenneth Weir
- Cardiovascular Division, Department of Medicine, University of Minnesota , Minneapolis, Minnesota
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16
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Kumar R, Graham B. How does inflammation contribute to pulmonary hypertension? Eur Respir J 2018; 51:51/1/1702403. [PMID: 29371392 DOI: 10.1183/13993003.02403-2017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/02/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Rahul Kumar
- Program in Translational Lung Research, Dept of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Brian Graham
- Program in Translational Lung Research, Dept of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
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17
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Almodovar S, Swanson J, Giavedoni LD, Kanthaswamy S, Long CS, Voelkel NF, Edwards MG, Folkvord JM, Connick E, Westmoreland SV, Luciw PA, Flores SC. Lung Vascular Remodeling, Cardiac Hypertrophy, and Inflammatory Cytokines in SHIVnef-Infected Macaques. Viral Immunol 2017; 31:206-222. [PMID: 29256819 DOI: 10.1089/vim.2017.0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fatal pulmonary arterial hypertension (PAH) affects HIV-infected individuals at significantly higher frequencies. We previously showed plexiform-like lesions characterized by recanalized lumenal obliteration, intimal disruption, medial hypertrophy, and thrombosis consistent with PAH in rhesus macaques infected with chimeric SHIVnef but not with the parental SIVmac239, suggesting that Nef is implicated in the pathophysiology of HIV-PAH. However, the current literature on non-human primates as animal models for SIV(HIV)-associated pulmonary disease reports the ultimate pathogenic pulmonary outcomes of the research efforts; however, the variability and features in the actual disease progression remain poorly described, particularly when using different viral sources for infection. We analyzed lung histopathology, performed immunophenotyping of cells in plexogenic lesions pathognomonic of PAH, and measured cardiac hypertrophy biomarkers and cytokine expression in plasma and lung of juvenile SHIVnef-infected macaques. Here, we report significant hematopathologies, changes in cardiac biomarkers consistent with ventricular hypertrophy, significantly increased levels of interleukin-12 and GM-CSF and significantly decreased sCD40 L, CCL-2, and CXCL-1 in plasma of the SHIVnef group. Pathway analysis of inflammatory gene expression predicted activation of NF-κB transcription factor RelB and inhibition of bone morphogenetic protein type-2 in the setting of SHIVnef infection. Our findings highlight the utility of SHIVnef-infected macaques as suitable models of HIV-associated pulmonary vascular remodeling as pathogenetic changes are concordant with features of idiopathic, familial, scleroderma, and HIV-PAH.
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Affiliation(s)
- Sharilyn Almodovar
- 1 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado.,2 Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center , Lubbock, Texas
| | - Jessica Swanson
- 1 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Luis D Giavedoni
- 3 Department of Virology and Immunology, and Southwest National Primate Research Center, Texas Biomedical Research Institute , San Antonio, Texas
| | - Sreetharan Kanthaswamy
- 4 School of Mathematical and Natural Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University , Arizona
| | - Carlin S Long
- 5 Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Norbert F Voelkel
- 6 Victoria Johnson Center for Obstructive Lung Diseases, Virginia Commonwealth University , Richmond, Virginia
| | - Michael G Edwards
- 1 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Joy M Folkvord
- 7 Division of Infectious Diseases, Department of Medicine, University of Arizona College of Medicine , Tucson, Arizona
| | - Elizabeth Connick
- 7 Division of Infectious Diseases, Department of Medicine, University of Arizona College of Medicine , Tucson, Arizona
| | - Susan V Westmoreland
- 8 New England Primate Research Center , Division of Comparative Pathology, Southborough, Massachusetts
| | - Paul A Luciw
- 9 Center for Comparative Medicine, University of California , Davis, Davis, California
| | - Sonia C Flores
- 1 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
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18
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Abstract
Pulmonary complications remain among the most frequent causes of morbidity and mortality for individuals with HIV despite the advent of antiretroviral therapy (ART) and improvement in its efficacy and availability. The prevalence of non-infectious pulmonary diseases is rising in this population, reflecting both an increase in smoking and the independent risk associated with HIV. The unique mechanisms of pulmonary disease in these patients remain poorly understood, and direct effects of HIV, genetic predisposition, inflammatory pathways, and co-infections have all been implicated. Lung cancer, chronic obstructive pulmonary disease (COPD), and pulmonary hypertension are the most prevalent non-infectious pulmonary diseases in persons with HIV, and the risk of each of these diseases is higher among HIV-infected (HIV+) persons than in the general population. This review discusses the latest advances in the literature on these important complications of HIV infection.
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Affiliation(s)
- M Triplette
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - K Crothers
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA
| | - E F Attia
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA
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19
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Bonnet S, Provencher S, Guignabert C, Perros F, Boucherat O, Schermuly RT, Hassoun PM, Rabinovitch M, Nicolls MR, Humbert M. Translating Research into Improved Patient Care in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2017; 195:583-595. [PMID: 27649290 PMCID: PMC5440916 DOI: 10.1164/rccm.201607-1515pp] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sébastien Bonnet
- 1 Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada.,2 Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Steeve Provencher
- 1 Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada.,2 Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Christophe Guignabert
- 3 INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France.,4 Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, Paris, France
| | - Frédéric Perros
- 3 INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France.,4 Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, Paris, France
| | - Olivier Boucherat
- 1 Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Ralph Theo Schermuly
- 5 Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Justus Liebig University Giessen, Giessen, Germany
| | - Paul M Hassoun
- 6 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Mark R Nicolls
- 8 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.,9 VA Palo Alto Health Care System, Palo Alto, California; and
| | - Marc Humbert
- 3 INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France.,4 Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, Paris, France.,10 Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, Département Hospitalo-Universitaire Thorax Innovation, Hôpital de Bicêtre, Paris, France
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20
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Abstract
PURPOSE OF REVIEW Human immunodeficiency virus (HIV) is now managed as a chronic disease. Non-infectious pulmonary conditions have replaced infection as the biggest threat to lung health, particularly as HIV cohorts age, but there is no consensus on how best to maintain long-term lung health. We review the epidemiology and pathogenesis of chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension (PAH), and lung cancer in HIV-seropositive individuals. RECENT FINDINGS Diagnoses of COPD are now up to 50% more prevalent in HIV-seropositive individuals than HIV-uninfected controls, and prospective pulmonary function studies find significant impairment in 7% to more than 50% of HIV-seropositive individuals. The prevalence of HIV-PAH is 0.2-0.5%, and lung cancer is two to three times more prevalent in HIV-seropositive individuals. Although host factors such as age and smoking have a role, HIV is an independent contributor to the pathogenesis of COPD, PAH, and lung cancer. Chronic inflammation, immune senescence, oxidative stress, and direct effects of viral proteins are all potential pathogenetic mechanisms. Despite their prevalence, non-infectious lung diseases remain underrecognized and evidence for effective screening strategies in HIV-seropositive individuals is limited. SUMMARY COPD, PAH, and lung cancer are a growing threat to lung health in the highly active antiretroviral therapy era necessitating early recognition.
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Affiliation(s)
- Paul Collini
- aDepartment of Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK bDepartment of Medicine, University of Pittsburgh, 628 NW Montefiore University Hospital, Pittsburgh, Pennsylvania, USA
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21
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Bertero T, Oldham WM, Cottrill KA, Pisano S, Vanderpool RR, Yu Q, Zhao J, Tai Y, Tang Y, Zhang YY, Rehman S, Sugahara M, Qi Z, Gorcsan J, Vargas SO, Saggar R, Saggar R, Wallace WD, Ross DJ, Haley KJ, Waxman AB, Parikh VN, De Marco T, Hsue PY, Morris A, Simon MA, Norris KA, Gaggioli C, Loscalzo J, Fessel J, Chan SY. Vascular stiffness mechanoactivates YAP/TAZ-dependent glutaminolysis to drive pulmonary hypertension. J Clin Invest 2016; 126:3313-35. [PMID: 27548520 DOI: 10.1172/jci86387] [Citation(s) in RCA: 294] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/07/2016] [Indexed: 12/18/2022] Open
Abstract
Dysregulation of vascular stiffness and cellular metabolism occurs early in pulmonary hypertension (PH). However, the mechanisms by which biophysical properties of the vascular extracellular matrix (ECM) relate to metabolic processes important in PH remain undefined. In this work, we examined cultured pulmonary vascular cells and various types of PH-diseased lung tissue and determined that ECM stiffening resulted in mechanoactivation of the transcriptional coactivators YAP and TAZ (WWTR1). YAP/TAZ activation modulated metabolic enzymes, including glutaminase (GLS1), to coordinate glutaminolysis and glycolysis. Glutaminolysis, an anaplerotic pathway, replenished aspartate for anabolic biosynthesis, which was critical for sustaining proliferation and migration within stiff ECM. In vitro, GLS1 inhibition blocked aspartate production and reprogrammed cellular proliferation pathways, while application of aspartate restored proliferation. In the monocrotaline rat model of PH, pharmacologic modulation of pulmonary vascular stiffness and YAP-dependent mechanotransduction altered glutaminolysis, pulmonary vascular proliferation, and manifestations of PH. Additionally, pharmacologic targeting of GLS1 in this model ameliorated disease progression. Notably, evaluation of simian immunodeficiency virus-infected nonhuman primates and HIV-infected subjects revealed a correlation between YAP/TAZ-GLS activation and PH. These results indicate that ECM stiffening sustains vascular cell growth and migration through YAP/TAZ-dependent glutaminolysis and anaplerosis, and thereby link mechanical stimuli to dysregulated vascular metabolism. Furthermore, this study identifies potential metabolic drug targets for therapeutic development in PH.
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22
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Abstract
The rhesus macaque (Macaca mulatta) is one of the most extensively used nonhuman primate models for human diseases. This article presents a literature review focusing on major organ systems and age-associated conditions in humans and primates, combined with information from the Wisconsin National Primate Research Center Electronic Health Record database to highlight and contrast age-associated lesions in geriatric rhesus macaques with younger cohorts. Rhesus macaques are excellent models for age-associated conditions, including diabetes, osteoarthritis, endometriosis, visual accommodation, hypertension, osteoporosis, and amyloidosis. Adenocarcinoma of the large intestine (ileocecocolic junction, cecum, and colon) is the most common spontaneous neoplasm in the rhesus macaque. A combination of cross-sectional and longitudinal studies is required to truly define mechanisms of maturation, aging, and the pathology of age-associated conditions in macaques and thus humans. The rhesus macaque is and will continue to be an appropriate and valuable model for investigation of the mechanisms and treatment of age-associated diseases.
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Affiliation(s)
- H A Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
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Donadon MF, Osório FL. Personality traits and psychiatric comorbidities in alcohol dependence. ACTA ACUST UNITED AC 2015; 49:e5036. [PMID: 26628399 PMCID: PMC4681419 DOI: 10.1590/1414-431x20155036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/11/2015] [Indexed: 12/13/2022]
Abstract
Non-adaptive personality traits may constitute risk factors for development of
psychiatric disorders such as depression and anxiety. We aim to evaluate associations
and the predictive value of personality traits among alcohol-dependent individuals,
with or without psychiatric comorbidities. The convenience sample comprised two
groups of males over 18 years of age: one with subjects who had an alcohol dependence
diagnosis (AG, n=110), and a control group without abuse and/or alcohol dependence
diagnosis (CG, n=110). The groups were assessed by means of the Structured Clinical
Interview DSM-IV (SCID-IV). AG participants were recruited among outpatients from the
university hospital, whereas CG participants were recruited from a primary healthcare
program. Data collection was done individually with self-assessment instruments.
Parametric statistics were performed, and a significance level of P=0.05 was adopted.
A positive correlation was observed between openness and the length of time that
alcohol has been consumed, as were significant and negative correlations between
conscientiousness and both the length of time alcohol has been consumed and the
number of doses. For alcoholics, extraversion emerged as a protective factor against
depression development (P=0.008) and tobacco abuse (P=0.007), whereas openness worked
as a protective factor against anxiety (P=0.02). The findings point to specific
deficits presented by alcoholics in relation to personality traits with or without
psychiatric comorbidities and to the understanding that therapeutic approaches should
favor procedures and/or preventive measures that allow more refined awareness about
the disorder.
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Affiliation(s)
- M F Donadon
- Departamento de Neurociência e Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F L Osório
- Departamento de Neurociência e Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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24
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Henriques-Forsythe M, Annangi S, Farber HW. Prevalence and hospital discharge status of human immunodeficiency virus-associated pulmonary arterial hypertension in the United States. Pulm Circ 2015; 5:506-12. [PMID: 26401251 DOI: 10.1086/682222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/08/2015] [Indexed: 11/03/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a noninfectious complication of human immunodeficiency virus (HIV) infection that has gained in importance since the advent of antiretroviral therapy. HIV-associated PAH (HIV-PAH) has a higher prevalence than idiopathic PAH (IPAH), although the vascular pathology seen in HIV-PAH is virtually identical to that seen in IPAH. Initiating therapy for PAH at an early stage is associated with a better prognosis; however, because of the nonspecific symptoms associated with PAH, the diagnosis is often delayed. In addition, because of the low prevalence of HIV-PAH, routine screening for this condition has never been recommended. We hypothesize that the failure to create screening guidelines for HIV-PAH has resulted in underdiagnosis of the condition. This, in turn, results in individuals with HIV-PAH remaining undetected, allowing the disease to progress to more advanced stages or even remain unrecognized until death. If this hypothesis is correct, it may provide a strong argument for HIV-PAH screening guidelines, because HIV-PAH portends a poor prognosis and creates a significant economic burden if left untreated. To address this issue, we conducted a retrospective review of the National Hospital Discharge Survey data and the multiple-cause mortality data to determine the prevalence of HIV-PAH at hospital discharge and death. Using these large data sets, we observed that the prevalence of HIV-PAH among HIV-infected individuals at hospital discharge and death was significantly lower than the reported prevalence in the literature. In addition, we found that PAH was designated as the most common cause of mortality in patients with HIV-PAH.
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Affiliation(s)
| | - Srinadh Annangi
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Harrison W Farber
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
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25
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Butrous G. Human immunodeficiency virus-associated pulmonary arterial hypertension: considerations for pulmonary vascular diseases in the developing world. Circulation 2015; 131:1361-70. [PMID: 25869003 DOI: 10.1161/circulationaha.114.006978] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ghazwan Butrous
- From School of Pharmacy, University of Kent, Canterbury, UK; and Pulmonary Vascular Research Institute, Canterbury, UK.
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26
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Abstract
The interaction between host immunity and infections in the context of a suppressed immune system presents an opportunity to study the interaction of colonization and infection with the development of acute and chronic pulmonary morbidity and mortality. This article summarizes presentations at the Pittsburgh International Lung Conference about comorbid consequences in two categories of immunosuppressed hosts: HIV-infected individuals and lung transplant recipients. Specifically, chronic obstructive pulmonary disease, pulmonary hypertension, and chronic lung rejection after transplant are three diseases that may be consequences of colonization or infection by viruses or fungi, whether HIV itself or the opportunistic infections Pneumocystis and cytomegalovirus. In the fourth section, we discuss unique aspects of infections after lung transplant as well as the battle against multidrug-resistant organisms in this population and theorize that the immunosuppressed population may provide a unique group of patients in which to study ways to overcome nosocomial pathogenic challenges. These host-pathogen interactions serve as models for developing new strategies to reduce acute and chronic morbidity due to colonization and subclinical infection, and potential therapeutic avenues, which are often overlooked in the clinical arena.
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27
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Courtney CL, Ethun KF, Villinger F, Ruprecht RM, Byrareddy SN. Massive occlusive thrombosis of the pulmonary artery in pigtailed macaques chronically infected with R5-tropic simian-human immunodeficiency virus. J Med Primatol 2015; 44:35-9. [PMID: 25174584 PMCID: PMC4293324 DOI: 10.1111/jmp.12142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) has been identified as a serious complication of HIV infection. METHODS AND RESULTS Here, we report sudden death in two pigtailed macaques (Macaca nemestrina) chronically infected (~1-2 years post-infection) with an R5 SHIV strain. At necropsy, total occlusion of the pulmonary artery by a large fibrin thrombus was present in both animals. CONCLUSION This report describes pulmonary vascular lesions similar to PAH in R5 SHIV-infected pigtail macaques.
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Affiliation(s)
- Cynthia L Courtney
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Pathology & Laboratory Medicine, School of Medicine, and Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Kelly F Ethun
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Pathology & Laboratory Medicine, School of Medicine, and Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Francois Villinger
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Pathology & Laboratory Medicine, School of Medicine, and Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Ruth M. Ruprecht
- Texas Biomedical Research Institute, TX, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Siddappa N. Byrareddy
- Department of Pathology & Laboratory Medicine, School of Medicine, and Emory Vaccine Center, Emory University, Atlanta, GA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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28
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L'Huillier AG, Posfay-Barbe KM, Pictet H, Beghetti M. Pulmonary Arterial Hypertension among HIV-Infected Children: Results of a National Survey and Review of the Literature. Front Pediatr 2015; 3:25. [PMID: 25905096 PMCID: PMC4387937 DOI: 10.3389/fped.2015.00025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/19/2015] [Indexed: 01/07/2023] Open
Abstract
Since the advent of highly active anti-retroviral therapy, HIV-related mortality has decreased dramatically. As a consequence, patients are living longer, and HIV infection is becoming a chronic disease. Patients and caretakers have to deal with chronic complications of infection and treatment, such as cardiovascular diseases, which now represent an important health issue, even in the pediatric population. Prevalence of pulmonary arterial hypertension (PAH) in the adult HIV population is around 0.4-0.6%, which is around 1000- to 2500-fold more prevalent than in the general population. In recent adult PAH registries, HIV has been identified as the fourth cause of PAH, accounting for approximately 6-7% of cases. Therefore, regular screening is recommended in HIV-infected adults by many experts. If HIV-associated PAH is mainly reported in HIV-infected adults, pediatric cases have also been, albeit rarely, described. This scarcity may be due to a very low PAH prevalence, or due to the lack of systematic cardiovascular screening in pediatric patients. As PAH may manifest only years or decades after infection, a systematic screening should perhaps also be recommended to HIV-infected children. In this context, we retrospectively looked for PAH screening in children included in our national Swiss Mother and Child HIV cohort study. A questionnaire was sent to all pediatric infectious disease specialists taking care of HIV-infected children in the cohort. The questions tried to identify symptoms suggestive of cardiovascular risk factors and asked which screening test was performed. In the 71 HIV-infected children for which we obtained an answer, no child was known for PAH. However, only two had been screened for PAH, and the diagnosis was not confirmed. In conclusion, PAH in HIV-infected children is possibly underestimated due to lack of screening. Systematic echocardiographic evaluation should be performed in HIV-infected children.
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Affiliation(s)
- Arnaud Grégoire L'Huillier
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Geneva University Hospitals , Geneva , Switzerland
| | - Klara Maria Posfay-Barbe
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Geneva University Hospitals , Geneva , Switzerland
| | - Hiba Pictet
- Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Department of Pediatrics, Geneva University Hospitals , Geneva , Switzerland
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29
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Amsellem V, Lipskaia L, Abid S, Poupel L, Houssaini A, Quarck R, Marcos E, Mouraret N, Parpaleix A, Bobe R, Gary-Bobo G, Saker M, Dubois-Randé JL, Gladwin MT, Norris KA, Delcroix M, Combadière C, Adnot S. CCR5 as a treatment target in pulmonary arterial hypertension. Circulation 2014; 130:880-891. [PMID: 24993099 DOI: 10.1161/circulationaha.114.010757] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PH), whether idiopathic or related to underlying diseases such as HIV infection, results from complex vessel remodeling involving both pulmonary artery smooth muscle cell (PA-SMC) proliferation and inflammation. CCR5, a coreceptor for cellular HIV-1 entry expressed on macrophages and vascular cells, may be involved in the pathogenesis of PH. Maraviroc is a new CCR5 antagonist designed to block HIV entry. METHODS AND RESULTS Marked CCR5 expression was found in lungs from patients with idiopathic PH, in mice with hypoxia-induced PH, and in Simian immunodeficiency virus-infected macaques, in which it was localized chiefly in the PA-SMCs. To assess the role for CCR5 in experimental PH, we used both gene disruption and pharmacological CCR5 inactivation in mice. Because maraviroc does not bind to murine CCR5, we used human-CCR5ki mice for pharmacological and immunohistochemical studies. Compared with wild-type mice, CCR5-/- mice or human-CCR5ki mice treated with maraviroc exhibited decreased PA-SMC proliferation and recruitment of perivascular and alveolar macrophages during hypoxia exposure. CCR5-/- mice reconstituted with wild-type bone marrow cells and wild-type mice reconstituted with CCR5-/- bone marrow cells were protected against PH, suggesting CCR5-mediated effects on PA-SMCs and macrophage involvement. The CCR5 ligands CCL5 and the HIV-1 gp120 protein increased intracellular calcium and induced growth of human and human-CCR5ki mouse PA-SMCs; maraviroc inhibited both effects. Maraviroc also reduced the growth-promoting effects of conditioned media from CCL5-activated macrophages derived from human-CCR5ki mice on PA-SMCs from wild-type mice. CONCLUSION The CCL5-CCR5 pathway represents a new therapeutic target in PH associated with HIV or with other conditions.
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Affiliation(s)
- Valérie Amsellem
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
| | - Larissa Lipskaia
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
| | - Shariq Abid
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
| | - Lucie Poupel
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Amal Houssaini
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
| | - Rozenn Quarck
- Respiratory Division, University Hospitals of Leuven and Department of Clinical and Experimental Medicine, University of Leuven, Belgium
| | - Elisabeth Marcos
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
| | - Nathalie Mouraret
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
| | - Aurélien Parpaleix
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
| | - Régis Bobe
- Université Paris-Sud, Unité mixte de Recherche en Santé 770, Le Kremlin-Bicêtre, France
| | - Guillaume Gary-Bobo
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
| | - Mirna Saker
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
| | - Jean-Luc Dubois-Randé
- Service de Cardiologie, Hôpital Henri Mondor, AP-HP, 94010, Créteil, France; Université Paris-Est Créteil (UPEC)
| | - Mark T Gladwin
- Division of Pulmonary, Allergy and Critical Care Medicine, UPMC, Pittsburgh, PA
| | - Karen A Norris
- Heart, Lung, Blood and Vascular, University of Pittsburgh, Pittsburgh, PA
| | - Marion Delcroix
- Respiratory Division, University Hospitals of Leuven and Department of Clinical and Experimental Medicine, University of Leuven, Belgium
| | - Christophe Combadière
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France.,Inserm, U1135, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France.,CNRS, ERL 8255, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France
| | - Serge Adnot
- Inserm U955 and Département de Physiologie, Hôpital Henri Mondor, Créteil, France, Université Paris-Est Créteil (UPEC), France
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30
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Almodovar S. The complexity of HIV persistence and pathogenesis in the lung under antiretroviral therapy: challenges beyond AIDS. Viral Immunol 2014; 27:186-99. [PMID: 24797368 DOI: 10.1089/vim.2013.0130] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Antiretroviral therapy (ART) represents a significant milestone in the battle against AIDS. However, we continue learning about HIV and confronting challenges 30 years after its discovery. HIV has cleverly tricked both the host immune system and ART. First, the many HIV subtypes and recombinant forms have different susceptibilities to antiretroviral drugs, which may represent an issue in countries where ART is just being introduced. Second, even under the suppressive pressures of ART, HIV still increases inflammatory mediators, deregulates apoptosis and proliferation, and induces oxidative stress in the host. Third, the preference of HIV for CXCR4 as a co-receptor may also have noxious outcomes, including potential malignancies. Furthermore, HIV still replicates cryptically in anatomical reservoirs, including the lung. HIV impairs bronchoalveolar T-lymphocyte and macrophage immune responses, rendering the lung susceptible to comorbidities. In addition, HIV-infected individuals are significantly more susceptible to long-term HIV-associated complications. This review focuses on chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension, and lung cancer. Almost two decades after the advent of highly active ART, we now know that HIV-infected individuals on ART live as long as the uninfected population. Fortunately, its availability is rapidly increasing in low- and middle-income countries. Nevertheless, ART is not risk-free: the developed world is facing issues with antiretroviral drug toxicity, resistance, and drug-drug interactions, while developing countries are confronting issues with immune reconstitution inflammatory syndrome. Several aspects of the complexity of HIV persistence and challenges with ART are discussed, as well as suggestions for new avenues of research.
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Affiliation(s)
- Sharilyn Almodovar
- Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
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31
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Wilkins MR, Wharton J, Gladwin MT. Update in Pulmonary Vascular Diseases 2012. Am J Respir Crit Care Med 2013; 188:23-8. [DOI: 10.1164/rccm.201303-0470up] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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32
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Fitzpatrick M, Crothers K, Morris A. Future directions: lung aging, inflammation, and human immunodeficiency virus. Clin Chest Med 2013; 34:325-31. [PMID: 23702180 DOI: 10.1016/j.ccm.2013.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic lung diseases, including chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH), are unusually prevalent among persons infected with human immunodeficiency virus (HIV). Often these disease states are identified at younger ages than would be expected in the general population. Recent epidemiologic, basic scientific, and cross-sectional clinical data have implicated immune dysfunction and cellular senescence as potential drivers of advanced presentations of age-related diseases in HIV-infected persons. This article describes how HIV-associated COPD and PH may fit into a paradigm of immunosenescence, and outlines the hypothesized associations among chronic HIV infection, immune dysfunction and senescence, and cardiopulmonary outcomes.
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Affiliation(s)
- Meghan Fitzpatrick
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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33
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Barnett CF, Hsue PY. Human immunodeficiency virus-associated pulmonary arterial hypertension. Clin Chest Med 2013; 34:283-92. [PMID: 23702177 DOI: 10.1016/j.ccm.2013.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Antiretroviral therapy has greatly increased longevity for individuals with human immunodeficiency virus (HIV) infection. About 0.5% of patients with HIV infection develop moderate to severe pulmonary arterial hypertension, which is several thousand times higher than the incidence of idiopathic pulmonary arterial hypertension. As more than 30 million individuals are chronically infected, HIV infection could soon become one of the most common causes of pulmonary arterial hypertension worldwide. Pulmonary arterial hypertension is a relentlessly progressive disease leading to right heart failure and death. In this article the available data on epidemiology, hemodynamics, mechanisms, and therapeutic strategies for HIV-associated pulmonary arterial hypertension are reviewed.
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Affiliation(s)
- Christopher F Barnett
- Division of Cardiology, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA 94110, USA
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