Early life determinants of cardiometabolic health from birth to adolescence amongst HIV-exposed and unexposed South African children

项目摘要： 尽管没有感染艾滋病毒，但接触艾滋病毒但未感染(HEU)的儿童发病率更高 与未接触艾滋病毒(HU)相比，儿童时期的死亡率和心脏代谢结果更差 孩子们。HEU儿童早期免疫发育不佳。这增加了他们并发疾病的风险。 儿童感染，并可能导致全身炎症增加，从而加剧心脏代谢风险 这会对新陈代谢途径产生不利影响。我们小组使用代谢组学来表征新陈代谢 功能障碍始于早期生命，并已确定早期生命感染是系统性炎症和 儿童时期促动脉粥样硬化代谢特征的发展。因此，早期感染的负担较高 HEU儿童的生活可能代表着一条重要而尚未探索的致病途径 心脏代谢功能障碍。在这项提案中，我们利用了Drakenstein儿童健康研究，一个很好的- HEU和HU参与者的特征队列从出生起跟踪，以调查艾滋病毒暴露和早期 从出生到青春期早期，生命感染会影响代谢物的炎症反应变化，并且 评估这些变化如何影响早期心脏代谢不良结局的发展 青春期。目标1将描述从婴儿期到青春期早期的纵向代谢轨迹 对不同发育阶段的HEU(n=244)和HU(n=735)儿童使用250种代谢产物。目标 2将开发一套预测模型，以确定儿童(1岁和5岁)的代谢特征，从而预测 心脏代谢功能障碍，包括较高的BMI/肥胖，动脉僵硬，血压，血脂异常，以及 胰岛素抵抗，青春期早期(10岁)。目标3将评估早期生命感染之间的关系 10岁时的负担和代谢特征是由炎症途径和艾滋病毒介导的 曝光状态。拟议的研究将为艾滋病毒领域作出重大贡献，提供一些 来自HEU和HU参与者群体的第一个纵向代谢数据来阐明 从婴儿期开始心脏代谢功能障碍发展的分子途径。在……里面 此外，通过确定代谢和炎症，这项建议的发现具有直接的临床相关性。 生命早期支持心脏代谢风险分层的生物标记物，并告知未来的干预努力 要解决HEU的心脏代谢健康问题，应包括减少感染负担或严重程度。加在一起， 这项工作将提供新的机制数据和生物标记物识别，将告知HEU是否应该 作为儿童时期筛查和干预工作的目标，以降低他们患心脏代谢性疾病的风险。

PROJECT ABSTRACT: Despite not living with HIV, HIV-exposed but uninfected (HEU) children experience higher levels of morbidity and mortality in childhood and have worse cardiometabolic outcomes, compared to HIV-unexposed (HU) children. HEU children have suboptimal immune development in early life. This increases their risk for comorbid infections in childhood, and may exacerbate cardiometabolic risk by leading to increased systemic inflammation that adversely impacts metabolic pathways. Our group has used metabolomics to characterize metabolic dysfunction starting in early life and have identified early life infections as a driver of systemic inflammation and the development of pro-atherogenic metabolic profiles in childhood. Thus, the higher burden of infections in early life among HEU children may represent and important and unexplored pathway in the pathogenesis of cardiometabolic dysfunction. In this proposal, we leverage the Drakenstein Child Health Study, a well- characterized cohort of HEU and HU participants followed from birth, to investigate how HIV-exposure and early life infections affect inflammatory response changes to the metabolome from birth to early adolescence, and evaluate how these changes influence the development of adverse cardiometabolic outcomes in early adolescence. Aim 1 will characterize longitudinal metabolomic trajectories from infancy to early adolescence using 250 metabolites among HEU (n=244) and HU (n=735) children over different developmental stages. Aim 2 will develop a set of predictive models to identify metabolomic profiles in childhood (1 and 5 years) that predict cardiometabolic dysfunction, including higher BMI/adiposity, arterial stiffness, blood pressure, dyslipidemia, and insulin resistance, in early adolescence (10 years). Aim 3 will evaluate if relationships between early life infection burden and metabolomic profiles at 10 years of age are mediated by inflammatory pathways, overall and by HIV exposure status. The proposed study will make significant contributions to the field of HIV by providing some of the first longitudinal metabolomic data from a population-based cohort of HEU and HU participants to elucidate the molecular pathways underlying the development of cardiometabolic dysfunction starting in infancy. In addition, findings from this proposal have direct clinical relevance by identifying metabolic and inflammatory biomarkers in early life to support cardiometabolic risk stratification and inform whether future intervention efforts to address cardiometabolic health in HEU should include reducing infection burden or severity. Taken together, this work will provide novel mechanistic data and biomarker identification that will inform whether HEU should be targeted for screening and intervention efforts in childhood to reduce their risk of cardiometabolic disease.