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School of Medicine
Neurocognitive impairment in HIV-infected individuals remains a significant problem despite antiretroviral therapy. There is a critical need for surrogate markers that can be used to predict cognitive impairment and to monitor the effects of antiretroviral, or neuroprotective therapy in HIV-infected individuals.
Goals and Objectives
- Assist in the development and monitoring of surrogate markers for HIV-associated neurocognitive disorders (HAND)
- To provide mentorship and consultation for Neuro-AIDS researchers in the development of clinically useful surrogate markers for HAND and to validate these as predictive and associative markers for cognitive impairment and as surrogate markers for therapeutic effectiveness
- Assist in the development of small molecule therapeutics by providing consultation on pharamcokinetic/pharmacodynamic considerations for drug development, and conducting pharmacokinetic and analysis of potential drugs and drug metabolites.
- Saylor, D., Dickens, A. M., Sacktor, N., Haughey, N., Slusher, B., Pletnikov, M., ... McArthur, J. C. (2016). HIV-associated neurocognitive disorder - Pathogenesis and prospects for treatment. Nature Reviews Neurology, 12(4), 234-248.
- Piepenbrink, M. S., Samuel, M., Zheng, B., Carter, B., Fucile, C., Bunce, C., ... Kobie, J. J. (2016). Humoral dysregulation associated with increased systemic inflammation among injection heroin users. PLoS One, 11(7), [e0158641].
- Dickens, A. M., Anthony, D. C., Deutsch, R., Mielke, M. M., Claridge, T. D. W., Grant, I., ... Haughey, N. J. (2015). Cerebrospinal fluid metabolomics implicate bioenergetic adaptation as a neural mechanism regulating shifts in cognitive states of HIV-infected patients. AIDS, 29(5), 559-569.
- Figuera-Losada, M., Stathis, M., Dorskind, J. M., Thomas, A. G., Ratnam Bandaru, V. V., Yoo, S. W., ... Rojas, C. (2015).Cambinol, a novel inhibitor of neutral sphingomyelinase 2 shows neuroprotective properties. PLoS One, 10(5), .
- Steiner, J. P., Bachani, M., Wolfson-Stofko, B., Lee, M. H., Wang, T., Li, G., ... Nath, A. (2015). Interaction of Paroxetine with Mitochondrial Proteins Mediates Neuroprotection. Neurotherapeutics, 12(1), 200-216.
- Bora, A., Mohien, C. U., Chaerkady, R., Chang, L., Moxley, R., Sacktor, N., ... Graham, D. R. (2014). Identification of putative biomarkers for HIV-associated neurocognitive impairment in the CSF of HIV-infected patients under cART therapy determined by mass spectrometry. Journal of NeuroVirology, 20(5), 457-465.
- Mielke, M. M., Haughey, N. J., Bandaru, V. V. R., Zetterberg, H., Blennow, K., Andreasson, U., ... Carlsson, C. M. (2014).Cerebrospinal fluid sphingolipids, β-amyloid, and tau in adults at risk for Alzheimer's disease. Neurobiology of Aging, 35(11), 2486-2494.
- Bae, M., Patel, N., Xu, H., Lee, M., Tominaga-Yamanaka, K., Nath, A., ... Haughey, N. J. (2014). Activation of TRPML1 clears intraneuronal Aβ in preclinical models of HIV infection. Journal of Neuroscience, 34(34), 11485-11503.
- Sacktor, N., Miyahara, S., Evans, S., Schifitto, G., Cohen, B., Haughey, N., ... Clifford, D. (2014). Impact of minocycline on cerebrospinal fluid markers of oxidative stress, neuronal injury, and inflammation in HIV-seropositive individuals with cognitive impairment. Journal of NeuroVirology, 20(6), 620-626.
Publication: Cerebral spinal fluid metabolomics implicate bioenergeic adaptation as a neural mechanism regulating shifts in cognitive states of HIV infected patients
OBJECTIVES: To identify prognostic surrogate markers for change in cognitive states of HIV-infected patients.
DESIGN: Longitudinal cerebrospinal fluid (CSF) samples were collected from 98 HIV-infected patients identified by temporal change in cognitive states classified as normal, stably impaired, improving and worsening.
METHODS: The metabolic composition of CSF was analysed using 1H nuclear magnetic resonance (1H NMR) spectroscopy that focused on energy metabolites. Metabolic biomarkers for cognitive states were identified using multivariate partial least squares regression modelling of the acquired spectra, combined with nonparametric analyses of metabolites with clinical features.
RESULTS: Multivariate modelling and cross-validated recursive partitioning identified several energy metabolites that, when combined with clinical variables, classified patients based on change in neurocognitive states. Prognostic identification for worsening was achieved with four features that included no change in a detectable plasma viral load, elevated citrate and acetate; decreased creatine, to produce a model with a predictive accuracy of 92%, sensitivity of 88% and 96% specificity. Prognosis for improvement contained seven features that included first visit age less than 47 years, new or continued use of antiretrovirals, elevated glutamine and glucose; decreased myo-inositol, [beta]-glucose and creatinine to generate a model with a predictive accuracy of 92%, sensitivity of 100% and specificity of 84%.
CONCLUSION: These CSF metabolic results suggest that worsening cognitive status in HIV-infected patients is associated with increased aerobic glycolysis, and improvements in cognitive status are associated with a shift to anaerobic glycolysis. Dietary, lifestyle and pharmacologic interventions that promote anaerobic glycolysis could protect the brain in setting of HIV infection with combined antiretroviral therapy.
Figure. Summary diagram demonstrating the key CSF metabolite changes found to occur during worsening (highlighted in red) and improving (highlighted in blue) cognitive status.ADP, adenosine diphosphate; ATP, adenosine triphosphate; CrP, creatine phosphate.
Michelle Mielke, Ph.D. (Co-Investigator, Mayo Clinic)
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