Systems Biology of Cognitive Decline in Older Adults with HIV Infection

描述（由申请人提供）：该项目的目的是了解脂质代谢失调在接受长期抗逆转录病毒治疗（ART）的老年HIV患者中HIV相关神经认知障碍（HAND）发展中的作用，以及这些过程如何受到肝功能障碍、慢性炎症和衰老的影响。长期抗逆转录病毒治疗与代谢异常和通常与衰老相关的疾病风险增加有关，包括心血管、肝脏、肾脏、骨骼和神经系统疾病。轻度HAND影响30-50%接受长期抗逆转录病毒治疗的艾滋病毒患者，在50岁以上的艾滋病毒患者中更为常见。在初步研究中，我们进行了非靶向代谢物分析，发现在接受抑制性抗逆转录病毒治疗的HIV患者血浆中有126种代谢物发生改变，其中47%是脂质。脂质改变与肝脏和线粒体功能障碍标志物相关，并代表了与传统标志物不同的特定类别。基于标准化神经认知测试分数（T分数）的分析，一些属于特定类别的脂质改变与认知障碍相关，而其他脂质改变主要与运动或执行功能缺陷相关。我们假设，由HIV或HIV/HCV感染、慢性炎症、某些抗逆转录病毒药物的肝毒性和其他因素引起的肝功能障碍导致的脂质代谢失调，促进了老年HIV感染患者的白质异常和认知能力下降。衰老通过脂质代谢、线粒体功能、自噬和炎症反应等与年龄相关的改变来改变这些过程。为了研究这一假设，我们将使用系统生物学方法分析来自50岁及以上长期抗逆转录病毒治疗的不同临床结果的HIV患者的大规模临床、生物学、代谢组学和转录组学数据集。综合数据分析和有针对性的实验将用于计算建立相关网络和路径的模型。这些研究将为理解长期抗逆转录病毒治疗的老年人中驱动HAND的代谢途径创造一个新的概念框架，这可能为其他老年人群的认知和神经行为障碍生物学提供重要见解，并开发新的治疗方法。

DESCRIPTION (provided by applicant): The goal of this project is to understand the role of dysregulated lipid metabolism in development of HIV-associated neurocognitive disorders (HAND) in older HIV patients on long-term antiretroviral therapy (ART), and how these processes are influenced by hepatic dysfunction, chronic inflammation, and aging. Long-term ART is associated with metabolic abnormalities and increased risk of diseases typically associated with aging including cardiovascular, liver, kidney, bone, and neurological disorders. Mild forms of HAND affect 30-50% of HIV patients on long-term ART, and are more frequent in HIV patients over age 50. In preliminary studies, we performed untargeted metabolite profiling and identified 126 metabolites altered in plasma of HIV patients on suppressive ART, of which 47% were lipids. Lipid alterations correlated with markers of hepatic and mitochondrial dysfunction, and represented specific classes distinct from traditional markers. Some altered lipids belonging to specific classes correlated with cognitive impairment, while others correlated primarily with deficits in motor or executive function, based on analyses using normalized neurocognitive test scores (T scores). We hypothesize that dysregulated lipid metabolism, a consequence of hepatic dysfunction induced by HIV or HIV/HCV infection, chronic inflammation, hepatotoxicity of some ART drugs, and other factors, promotes white matter abnormalities and cognitive decline in older adults with HIV infection. Aging modifies these processes through age-related alterations in lipid metabolism, mitochondrial function, autophagy, and inflammatory responses. To investigate this hypothesis, we will use systems biology approaches to analyze large-scale clinical, biological, metabolomics, and transcriptomics datasets from HIV patients age 50 and older on long-term ART with different clinical outcomes. Integrative data analysis and targeted experimentation will be used to computationally build models of relevant networks and pathways. These studies will create a new conceptual framework for understanding metabolic pathways driving HAND in older adults on long-term ART, which may provide important insights into the biology of cognitive and neurobehavioral disorders in other aging populations and developing new therapies.