Cannabis and Pathogenic Mechanisms influencing Blood Brain Barrier Function in HIV

艾滋病毒感染者（PWH）仍然容易受到中枢神经系统并发症的影响（例如，神经认知 尽管抗逆转录病毒疗法（ART）抑制病毒复制，但仍然存在病毒损伤。虽然这些疾病的许多病因 并发症存在，血脑屏障（BBB）损伤，炎症和线粒体功能障碍是 一直牵连，但很少同时研究。威尔斯亲王医院使用大麻的次数亦较 一般人群以及我们小组和其他人最近的证据表明，大麻可以保护PWH免受 通过减少炎症和促进线粒体稳态来损害BBB。拟议 一个多学科的转化项目将联合收割机与两个临床前模型结合起来：a） 用于BB B的技术先进的脑芯片模型和B）个体化的离体/体外建模， BBB细胞中的线粒体毒性，以确定使用大麻对PWH中BBB的影响。使用此 多层次的方法，我们将测试大麻对血脑屏障的影响根据用途：的模式而变化的假设： 由于大麻的抗炎特性，适度使用会产生有益的效果，但 长期使用会产生有害影响。在一个队列的威尔斯亲王和没有艾滋病毒（PWoH）的人， 从初治到日常使用者的大麻使用范围，我们将测量血浆和脑脊液（CSF）a 反映BBB、炎症和线粒体功能障碍的一组生物标志物。这些读数将是 与高级渗透性和多室弥散磁共振成像相关， 鉴别BBB渗漏沿着与神经元和神经胶质微结构特性的整体和区域变化 (Aim 1）。我们将使用脑内皮细胞和实质细胞亚群的3D微流体培养来模拟BBB 测量HIV和大麻素对血脑屏障通透性、炎症基因表达和 线粒体功能的标志物（Aim 2）。因为对艾滋病毒和大麻的反应往往是特定于 对于个体或群体，我们将使用来自PWH的单核细胞衍生的巨噬细胞和血清， 观察性研究中的PWoH，以确定大麻（和HIV）对BBB细胞成分的影响 （星形胶质细胞和内皮细胞），以及线粒体功能，炎症基因表达和BBB 生物标志物基因表达（目的3）。因此，拟议的项目将提供创新的临床读数， 独特的队列以及最先进的BBB建模和致病性的个性化研究 机制等这一高度创新的多学科研究提案很可能会产生影响力。 关于发病机制的转化知识，并指导未来的治疗干预。与 我们在HIV感染、药物滥用、BBB生物学和成像方面的临床和临床前专业知识， 线粒体内稳态，我们是唯一适合进行拟议的研究。

People with HIV (PWH) remain vulnerable to central nervous system complications (e.g., neurocognitive impairment) despite antiretroviral therapy (ART) that suppresses viral replication. While many etiologies of these complications exist, damage to the blood-brain-barrier (BBB), inflammation, and mitochondrial dysfunction are consistently implicated, yet seldom studied simultaneously. PWH also use cannabis more frequently than the general population and recent evidence by our group and others indicates that cannabis may protect PWH from BBB damage by reducing inflammation and promoting mitochondrial homeostasis. The proposed multidisciplinary, translational project will combine a clinical observational study with two preclinical models: a) a technologically advanced brain chip model for BBB and b) personalized ex vivo/in vitro modeling of mitochondrial toxicity in BBB cells to determine the effects of cannabis use on the BBB in PWH. Using this multilevel approach, we will test the hypothesis that cannabis effects on the BBB vary based on patterns of use: moderate use will be associated with beneficial effects, due to the anti-inflammatory properties of cannabis, but chronic daily use will have detrimental effects. In a cohort of PWH and people without HIV (PWoH) across a range of cannabis use from naïve to daily users, we will measure in plasma and cerebrospinal fluid (CSF) a panel of biomarkers that reflect the BBB, inflammation, and mitochondrial dysfunction. These readouts will be correlated with advanced permeability and multicompartment diffusion magnetic resonance imaging that will identify global and regional variations in BBB leakage along with neuronal and glial microstructural properties (Aim 1). We will model the BBB using 3D microfluidic cultures of brain endothelial and parenchymal cell subsets to measure the effects of HIV and cannabinoids on BBB permeability, inflammatory gene expression, and markers of mitochondrial function (Aim 2). Because responses to HIV and cannabis are often specific to individuals or groups of individuals, we will use monocyte-derived macrophages and sera from the PWH and PWoH in the observational study to determine the effects of cannabis (and HIV) on BBB cellular components (astrocytes and endothelial cells), and on mitochondrial function, inflammatory gene expression, and BBB biomarker gene expression (Aim 3). Thus, the proposed project will provide innovative clinical readouts in a unique cohort alongside state-of-the-art modeling of the BBB and personalized investigation of pathogenic mechanisms. This highly innovative, multidisciplinary research proposal is very likely to generate impactful translational knowledge regarding mechanisms of pathogenesis and guide future therapeutic interventions. With our combined clinical and pre-clinical expertise in HIV infection, substance abuse, BBB biology and imaging, and mitochondrial homeostasis, we are uniquely suited to perform the proposed research.