Antiretroviral Therapy, Endothelial Dysfunction and Atherosclerosis

描述(申请人提供)：心血管疾病现在被认为是艾滋病毒治疗的主要并发症。虽然大量的临床试验研究了动脉粥样硬化与HIV感染或HIV的抗逆转录病毒治疗之间的关系，但尚未观察到明确的因果关系。这可能是由于艾滋病毒及其在人类身上的治疗方法的复杂性。我们开发了一个不太复杂的模型来研究抗逆转录病毒药物(ART)对血管内皮功能的影响。动脉粥样硬化是一种以动脉壁内胆固醇斑块形成为特征的疾病，由内皮损伤引发，导致细胞因子和生长因子的释放。这些生长因子促进了一些持续性事件，如血管平滑肌细胞(VSMC)的增殖，最终形成动脉粥样硬化病变。因此，内皮功能障碍是一个早期事件，并已被显示为动脉粥样硬化形成的敏感标志物。在我们使用两种动脉粥样硬化啮齿动物模型进行的初步研究中，ART在治疗后5天内导致严重的内皮功能障碍，而慢性治疗加剧了动脉粥样硬化病变的发展。此外，在培养的内皮细胞中，ART诱导线粒体功能障碍，增加活性氧(ROS)的产生和有丝分裂因子内皮素-1(ET-1)的释放。虽然药物单独对VSMC无明显作用，但在VSMC与内皮细胞的共同培养中，药物促进VSMC的增殖依赖于ET-1受体的激活。因此，我们假设ART通过诱导血管内皮细胞线粒体功能障碍来启动或加重动脉粥样硬化形成。利用血管细胞共培养系统和我们的小鼠动脉粥样硬化模型，我们将确定：1)线粒体功能障碍在ART介导的内皮功能障碍中的作用，2)活性氧物种的产生在ART介导的内皮功能障碍和ET-1释放中的作用，以及3)ART促进内皮源性ET-1诱导的血管平滑肌细胞增殖的机制。总结：心血管疾病现在被认为是HIV患者的主要并发症。这些研究将有助于解决用于治疗艾滋病毒的药物疗法是否是这种艾滋病毒相关心血管疾病的原因。因此，拟议的工作将在设计更好地治疗艾滋病毒感染者的方法方面具有临床益处。

DESCRIPTION (provided by applicant): Cardiovascular disease is now considered a major complication in the treatment of HIV. While a large number of clinical trials have examined the relationship between atherosclerosis and either the HIV infection or the antiretroviral treatment of HIV, no definitive cause-effect relationships have been observed. This may be due to the complex nature of HIV and its treatment in humans. We have developed a less complicated model to investigate the effects of antiretrovirals (ART) on the function of the vascular endothelium. Atherosclerosis, a disease characterized by cholesterol-laden plaque formation within the artery wall, is initiated by endothelial injury that results in the release of cytokines and growth factors. These growth factors promote a number of perpetuating events, such as vascular smooth muscle cell (VSMC) proliferation, that culminate in the formation of an atherosclerotic lesion. Thus, endothelial dysfunction is an early event and has been shown a sensitive marker for atherogenesis. In our initial studies using two rodent models for atherosclerosis, ART induced dramatic endothelial dysfunction within 5 days of treatment and chronic treatment exacerbated atherosclerotic lesion development. In addition, in endothelial cells in culture, ART induced mitochondrial dysfunction and increased the production of both reactive oxygen species (ROS) and the release of the mitogenic factor endothelin-1 (ET-1). Though the drugs had no apparent effect on VSMC alone, in cocultures of VSMC plus endothelial cells, the drugs increased VSMC proliferation in a manner dependent upon ET-1 receptor activation. We thus hypothesize that ART initiates or exacerbates atherogenesis by inducing a mitochondrial dysfunction in the vascular endothelium. Using both coculture systems of vascular cells and our mouse models for atherosclerosis, we will determine: 1) the contribution of mitochondrial dysfunction in ART-mediated endothelial dysfunction, 2) the contribution of reactive oxygen species production in ART-mediated endothelial dysfunction and ET-1 release, and 3) the mechanism by which ART promotes endothelium-derived ET-1 -induced vascular smooth muscle cell proliferation. LAY SUMMARY: Cardiovascular disease is now considered a major complication in HIV patients. These studies will help to address whether the drug therapy used to treat HIV is the cause of this HIV-related cardiovascular disease. The proposed work will thus be of clinical benefit in devising ways in which to better treat HIV-infected individuals.