Identifizierung chemischer Transportinhibitoren zur Modulation (patho)biologischer Genprodukte

Die intrazelluläre Lokalisation von Proteinen und Makromolekülen unterliegt in Eukaryoten einer strengen Regulation. Insbesondere erlaubt die Kompartimentierung eukaryotischer Zellen in Zellkern und Zytoplasma den simultanen Ablauf räumlich getrennter biochemischer Reaktionen, und damit die unabhängige Regulation zellulärer Programme. Da trotz intensiver Forschungsbemühungen bis dato die molekularen Details sowie die (patho)biologische Bedeutung von Kern-Zytoplasma-Transportprozessen noch immer nicht vollkommen verstanden sind, wurde im Rahmen der vorliegenden Arbeit ein Fokus auf die Identifizierung von chemischen Transportinhibitoren gelegt. Das zu diesem Zweck entwickelte Translokations-Biosensor-System basiert auf der Kombination von autofluoreszierenden Proteinen, sowie spezifisch ausgewählten Kernexport- und Kernimportsignalen. Nach Etablierung geeigneter Zellmodelle, die effizient und stabil die Translokations-Biosensoren exprimieren, wurde die 17 000 Substanzen umfassende Bibliothek der ChemBioNet-Initiative nach Kernexportinhibitoren mittels einer Fluoreszenzmikroskopie-basierten Hochdurchsatzanalyse-Plattform durchmustert. Zunächst wurden Translokations-Algorithmen, welche eine zuverlässige automatisierte Erkennung von Zellkern und Zytoplasma erlauben, optimiert. Im Folgenden konnten acht neue niedermolekulare Kernexport-Inhibitoren identifiziert werden, die sich in der Stärke, der Geschwindigkeit, sowie in der Beständigkeit der vermittelten Inhibition unterscheiden. Die Aktivität der Inhibitoren konnte auf den isolierten nukleären Exportsignalen (NES) von HIV-1 Rev und Survivin als auch auf den entsprechenden Volllängeproteinen mittels Mikroinjektionsexperimenten sowie durch umfassende in vitro und biochemische Methoden bestätigt werden. Zur Untersuchung der funktionellen Einheiten der Inhibitoren wurden homologe Substanzen auf Ihre Aktivität hin getestet. Dabei konnten für die Aktivität wichtige chemische Gruppen definiert werden. Alle Substanzen stellen neue Inhibitoren des Crm1-abhängigen Exports dar und zeigen keine nachweisbare NES-Selektivität. Interessanterweise konnte jedoch eine zytotoxische und Apoptose-induzierende Wirkung auf verschiedene Krebszellarten festgestellt werden. Da diese Wirkung unabhängig vom p53-Status der Tumorzellen ist und die Inhibitoren C3 und C5 die Vitalität nicht-maligner humaner Zellen signifikant weniger beeinträchtigen, wurden diese Substanzen zum internationalen Patent angemeldet. Da der nukleäre Export besonders für Tumorzellen einen wichtigen Überlebenssignalweg darstellt, könnte dessen reversible Hemmung ausgenutzt werden, um besonders in Kombination mit gängigen Krebstherapien eine therapeutisch relevante Tumorinhibition zu erzeugen. Eine weitere Anwendungsmöglichkeit der neuen Exportinhibitoren ist auf dem Gebiet der Infektionskrankheiten zu sehen, da auch die Aktivität des essentiellen HIV-1 Rev-Proteins inhibiert wird. Zusätzlich konnte in der Arbeit gezeigt werden, dass der zelluläre Kofaktor des Crm1-abhängigen Exports des HIV-1 Rev-Proteins, die RNA-Helikase DDX3, ein eigenes NES enthält. Der Nachweis einer direkten Interaktion des HIV-1 Rev- mit dem DDX3-Protein impliziert, dass multiple Angriffstellen für chemische Modulatoren hinsichtlich einer antiviralen Therapie gegeben sind. Da die Vielfalt des chemischen Strukturraums es unmöglich macht diesen experimentell vollständig zu durchmustern, wurden im Rahmen dieser Arbeit auch Naturstoffe als vielversprechende Wirkstoffquelle untersucht. Um zukünftig umfassend bioaktive Substanzen aus diesen hochkomplexen Stoffgemischen experimentell identifizieren zu können, wurde eine Fluoreszenzmikroskopie-basierte Hochdurchsatzanalyse-Plattform am Mainz Screening Center (MSC) etabliert. Damit konnte bereits ein weiterer, bisher unbekannter Exportinhibitor aus Cyphellopsis anomala identifiziert werden. Neben einer Anwendung dieser Substanz als chemisches Werkzeug zur Aufklärung der Regulation von Transportvorgängen, stellt sich auch die evolutionsbiologisch relevante Frage, wie es dem Pilzproduzenten gelingt die Blockierung des eigenen Kernexports zu umgehen. Weiterführende Projekte müssen sich neben der Aufklärung der molekularen Wirkmechanismen der gefundenen Substanzen mit der Identifizierung spezifischer chemischer „Funktionseinheiten“ beschäftigen. Neben einem verbesserten mechanistischen Verständnis von Transportvorgängen stellen die erarbeiteten Transportinhibitoren Vorstufen zur Weiterentwicklung möglicher Wirkstoffe dar. Die im Rahmen dieser Arbeit etablierte Technologie-Plattform und molekularen Werkzeuge stellen darüber hinaus eine wichtige Voraussetzung dar, um eine systematische Suche nach möglichen Wirkstoffen im Forschungsfeld der „Chemischen Biomedizin“ voranzutreiben.

Suicide in HIV-Infected Individuals and the General Population in Switzerland, 1988-2008

Objective High rates of suicide have been described in HIV-infected patients, but it is unclear to what extent the introduction of highly active antiretroviral therapy (HAART) has affected suicide rates. The authors examined time trends and predictors of suicide in the pre-HAART (1988—1995) and HAART (1996—2008) eras in HIV-infected patients and the general population in Switzerland. Method The authors analyzed data from the Swiss HIV Cohort Study and the Swiss National Cohort, a longitudinal study of mortality in the Swiss general population. The authors calculated standardized mortality ratios comparing HIV-infected patients with the general population and used Poisson regression to identify risk factors for suicide. Results From 1988 to 2008, 15,275 patients were followed in the Swiss HIV Cohort Study for a median duration of 4.7 years. Of these, 150 died by suicide (rate 158.4 per 100,000 person-years). In men, standardized mortality ratios declined from 13.7 (95% CI=11.0—17.0) in the pre-HAART era to 3.5 (95% CI=2.5—4.8) in the late HAART era. In women, ratios declined from 11.6 (95% CI=6.4—20.9) to 5.7 (95% CI=3.2—10.3). In both periods, suicide rates tended to be higher in older patients, in men, in injection drug users, and in patients with advanced clinical stage of HIV illness. An increase in CD4 cell counts was associated with a reduced risk of suicide. Conclusions Suicide rates decreased significantly with the introduction of HAART, but they remain above the rate observed in the general population, and risk factors for suicide remain similar. HIV-infected patients remain an important target group for suicide prevention.

Impact of single nucleotide polymorphisms and of clinical risk factors on new-onset diabetes mellitus in HIV-infected individuals

Background. Metabolic complications, including cardiovascular events and diabetes mellitus (DM), are a major long-term concern in human immunodeficienc virus (HIV)-infected individuals. Recent genome-wide association studies have reliably associated multiple single nucleotide polymorphisms (SNPs) to DM in the general population. Methods. We evaluated the contribution of 22 SNPs identifie in genome-wide association studies and of longitudinally measured clinical factors to DM. We genotyped all 94 white participants in the Swiss HIV Cohort Study who developed DM from 1 January 1999 through 31 August 2009 and 550 participants without DM. Analyses were based on 6054 person-years of follow-up and 13,922 measurements of plasma glucose. Results. The contribution to DM risk explained by SNPs (14% of DM variability) was larger than the contribution to DM risk explained by current or cumulative exposure to different antiretroviral therapy combinations (3% of DM variability). Participants with the most unfavorable genetic score (representing 12% and 19% of the study population, respectively, when applying 2 different genetic scores) had incidence rate ratios for DM of 3.80 (95% confidenc interval [CI], 2.05–7.06) and 2.74 (95% CI, 1.53–4.88), respectively, compared with participants with a favorable genetic score. However, addition of genetic data to clinical risk factors that included body mass index only slightly improved DM prediction. Conclusions. In white HIV-infected persons treated with antiretroviral therapy, the DM effect of genetic variants was larger than the potential toxic effects of antiretroviral therapy. SNPs contributed significantl to DM risk, but their addition to a clinical model improved DM prediction only slightly, similar to studies in the general population.

Changing patterns of cancer incidence in the early- and late-HAART periods: the Swiss HIV Cohort Study

The advent of highly active antiretroviral therapy (HAART) in 1996 led to a decrease in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL), but not of other cancers, among people with HIV or AIDS (PWHA). It also led to marked increases in their life expectancy.

Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study

Background: Annual syphilis testing was reintroduced in the Swiss HIV Cohort Study (SHCS) in 2004. We prospectively studied occurrence, risk factors, clinical manifestations, diagnostic approaches and treatment of syphilis. Methods: Over a period of 33 months, participants with positive test results for Treponema pallidum hemagglutination assay were studied using the SHCS database and an additional structured case report form. Results: Of 7244 cohort participants, 909 (12.5%) had positive syphilis serology. Among these, 633 had previously been treated and had no current signs or symptoms of syphilis at time of testing. Of 218 patients with newly detected untreated syphilis, 20% reported genitooral contacts as only risk behavior and 60% were asymptomatic. Newly detected syphilis was more frequent among men who have sex with men (MSM) [adjusted odds ratio (OR) 2.8, P < 0.001], in persons reporting casual sexual partners (adjusted OR 2.8, P < 0.001) and in MSM of younger age (P = 0.05). Only 35% of recommended cerebrospinal fluid (CFS) examinations were performed. Neurosyphilis was diagnosed in four neurologically asymptomatic patients; all of them had a Venereal Disease Research Laboratory (VDRL) titer of 1:≥32. Ninety-one percent of the patients responded to treatment with at least a four-fold decline in VDRL titer. Conclusion: Syphilis remains an important coinfection in the SHCS justifying reintroduction of routine screening. Genitooral contact is a significant way of transmission and young MSM are at high risk for syphilis. Current guidelines to rule out neurosyphilis by CSF analysis are inconsistently followed in clinical practice. Serologic treatment response is above 90% in the era of combination antiretroviral therapy.

Frequency and determinants of unprotected sex among HIV-infected persons: the Swiss HIV cohort study

Access to antiretroviral therapy may have changed condom use behavior. In January 2008, recommendations on condom use for human immunodeficiency virus (HIV)-positive persons were published in Switzerland, which allowed for unprotected sex under well-defined circumstances ("Swiss statement"). We studied the frequency, changes over time, and determinants of unprotected sex among HIV-positive persons.

Trends over time of virological and immunological characteristics in the Swiss HIV Cohort Study

The long-term outcome of antiretroviral therapy (ART) is not assessed in controlled trials. We aimed to analyse trends in the population effectiveness of ART in the Swiss HIV Cohort Study over the last decade.

Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count <200 cells/microL?

Current guidelines suggest that primary prophylaxis for Pneumocystis jiroveci pneumonia (PcP) can be safely stopped in human immunodeficiency virus (HIV)-infected patients who are receiving combined antiretroviral therapy (cART) and who have a CD4 cell count >200 cells/microL. There are few data regarding the incidence of PcP or safety of stopping prophylaxis in virologically suppressed patients with CD4 cell counts of 101-200 cells/microL.

Prevalence and predictors of kaposi sarcoma herpes virus seropositivity: a cross-sectional analysis of HIV-infected adults initiating ART in Johannesburg, South Africa

Background Kaposi sarcoma (KS) is the most common AIDS-defining tumour in HIV-infected individuals in Africa. Kaposi sarcoma herpes virus (KSHV) infection precedes development of KS. KSHV co-infection may be associated with worse outcomes in HIV disease and elevated KSHV viral load may be an early marker for advanced HIV disease among untreated patients. We examined the prevalence of KSHV among adults initiating antiretroviral therapy (ART) and compared immunological, demographic and clinical factors between patients seropositive and seronegative for KSHV. Results We analyzed cross-sectional data collected from 404 HIV-infected treatment-naïve adults initiating ART at the Themba Lethu Clinic, Johannesburg, South Africa between November 2008 and March 2009. Subjects were screened at ART initiation for antibodies to KSHV lytic K8.1 and latent Orf73 antigens. Seropositivity to KSHV was defined as positive to either lytic KSHV K8.1 or latent KSHV Orf73 antibodies. KSHV viremia was determined by quantitative PCR and CD3, 4 and 8 lymphocyte counts were determined with flow cytometry. Of the 404 participants, 193 (48%) tested positive for KSHV at ART initiation; with 76 (39%) reactive to lytic K8.1, 35 (18%) to latent Orf73 and 82 (42%) to both. One individual presented with clinical KS at ART initiation. The KSHV infected group was similar to those without KSHV in terms of age, race, gender, ethnicity, smoking and alcohol use. KSHV infected individuals presented with slightly higher median CD3 (817 vs. 726 cells/mm3) and CD4 (90 vs. 80 cells/mm3) counts than KSHV negative subjects. We found no associations between KSHV seropositivity and body mass index, tuberculosis status, WHO stage, HIV RNA levels, full blood count or liver function tests at initiation. Those with detectable KSHV viremia (n = 19), however, appeared to present with signs of more advanced HIV disease including anemia and WHO stage 3 or 4 defining conditions compared to those in whom the virus was undetectable. Conclusions We demonstrate a high prevalence of KSHV among HIV-infected adults initiating ART in a large urban public-sector HIV clinic. KSHV viremia but not KSHV seropositivity may be associated with markers of advanced HIV disease.

The causal effect of switching to second-line ART in programmes without access to routine viral load monitoring

We examined the effect of switching to second-line antiretroviral therapy (ART) on mortality in patients who experienced immunological failure in ART programmes without access to routine viral load monitoring in sub-Saharan Africa.

Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Positive Patients in Sub-Saharan Africa

Background:  Alcohol is heavily consumed in sub-Saharan Africa and affects HIV transmission and treatment and is difficult to measure. Our goal was to examine the test characteristics of a direct metabolite of alcohol consumption, phosphatidylethanol (PEth). Methods:  Persons infected with HIV were recruited from a large HIV clinic in southwestern Uganda. We conducted surveys and breath alcohol concentration (BRAC) testing at 21 daily home or drinking establishment visits, and blood was collected on day 21 (n = 77). PEth in whole blood was compared with prior 7-, 14-, and 21-day alcohol consumption. Results:  (i) The receiver operator characteristic area under the curve (ROC-AUC) was highest for PEth versus any consumption over the prior 21 days (0.92; 95% confidence interval [CI]: 0.86 to 0.97). The sensitivity for any detectable PEth was 88.0% (95% CI: 76.0 to 95.6) and the specificity was 88.5% (95% CI: 69.8 to 97.6). (ii) The ROC-AUC of PEth versus any 21-day alcohol consumption did not vary with age, body mass index, CD4 cell count, hepatitis B virus infection, and antiretroviral therapy status, but was higher for men compared with women (p = 0.03). (iii) PEth measurements were correlated with several measures of alcohol consumption, including number of drinking days in the prior 21 days (Spearman r = 0.74, p < 0.001) and BRAC (r = 0.75, p < 0.001). Conclusions:  The data add support to the body of evidence for PEth as a useful marker of alcohol consumption with high ROC-AUC, sensitivity, and specificity. Future studies should further address the period and level of alcohol consumption for which PEth is detectable.

Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study

Patterns of morbidity and mortality among human immunodeficiency virus (HIV)-infected individuals taking antiretroviral therapy are changing as a result of immune reconstitution and improved survival. We studied the influence of aging on the epidemiology of non-AIDS diseases in the Swiss HIV Cohort Study.

Ageing with HIV: medication use and risk for potential drug-drug interactions

To compare the use of co-medication, the potential drug-drug interactions (PDDIs) and the effect on antiretroviral therapy (ART) tolerability and efficacy in HIV-infected individuals according to age, ≥ 50 years or <50 years.

No longitudinal mitochondrial DNA sequence changes in HIV-infected individuals with and without lipoatrophy

The potential for mitochondrial (mt) DNA mutation accumulation during antiretroviral therapy (ART), and preferential accumulation in patients with lipoatrophy compared with control participants, remains controversial. We sequenced the entire mitochondrial genome, both before ART and after ART exposure, in 29 human immunodeficiency virus (HIV)-infected Swiss HIV Cohort Study participants initiating a first-line thymidine analogue-containing ART regimen. No accumulation of mtDNA mutations or deletions was detected in 13 participants who developed lipoatrophy or in 16 control participants after significant and comparable ART exposure (median duration, 3.3 and 3.7 years, respectively). In HIV-infected persons, the development of lipoatrophy is unlikely to be associated with accumulation of mtDNA mutations detectable in peripheral blood.

Interruptions of cART limits CD4 T-cell recovery and increases the risk for opportunistic complications and death

A major goal of antiretroviral therapy (ART) for HIV-1-infected persons is the recovery of CD4 T lymphocytes, resulting in thorough protection against opportunistic complications. Interruptions of ART are still frequent. The long-term effect on CD4 T-cell recovery and clinical events remains unknown.