Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: UMLS:C0021051 (immunodeficiency)
71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Approximately a third of adults and half of children with acquired immunodeficiency syndrome (AIDS) eventually suffer from neurological manifestations, including dysfunction of cognition, movement, and sensation. Among the various pathologies reported in the brain of patients with AIDS is neuronal injury and loss. A paradox arises, however, because neurons themselves are for all intents and purposes not infected by human immunodeficiency virus type 1 (HIV-1). This paper reviews evidence suggesting that at least part of the neuronal injury observed in the brain of AIDS patients is related to excessive influx of Ca2+. There is growing support for the existence of HIV- or immune-related toxins that lead indirectly to the injury or death of neurons via a potentially complex web of interactions between macrophages (or microglia), astrocytes, and neurons. Human immunodeficiency virus-infected monocytoid cells (macrophages, microglia, or monocytes), especially after interacting with astrocytes, secrete substances that potentially contribute to neurotoxicity. Not all of these substances are yet known, but they may include eicosanoids, that is, arachidonic acid and its metabolites, as well as platelet-activating factor. Macrophages activated by HIV-1 envelope protein gp120 also appear to release arachidonic acid and its metabolites. These factors can lead to increased glutamate release or decreased glutamate reuptake. In addition, gamma interferon (IFN-gamma) stimulation of macrophages induce release of the glutamate-like agonist quinolinate. Human immunodeficiency virus-infected or gp120-stimulated macrophages also produce cytokines, including tumor necrosis factor-alpha and interleukin-1 beta, which contribute to astrogliosis. A final common pathway for neuronal susceptibility appears to be operative, similar to that observed in stroke, trauma, epilepsy, neuropathic pain, and several neurodegenerative diseases, possibly including Huntington's disease, Parkinson's disease, and amyotrophic lateral sclerosis. This mechanism involves the activation of voltage-dependent Ca2+ channels and N-methyl-D-aspartate (NMDA) receptor-operated channels, and therefore offers hope for future pharmacological intervention. This review focuses on clinically tolerated calcium channel antagonists and NMDA antagonists with the potential for trials in humans with AIDS dementia in the near future.
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PMID:AIDS-related dementia and calcium homeostasis. 784 72

AIDS dementia complex (ADC) is a constellation of cognitive, motor, and behavioral dysfunctions frequently observed in persons with AIDS. Estimates of its prevalence vary. ADC may occur at any stage of AIDS but is usually associated with later stages of disease. Its severity varies among patients and often, but not always, is progressive. Various pathogenic mechanisms have been proposed for ADC, including effects of human immunodeficiency virus (HIV)-mediated cytokine production and direct neural cell damage by HIV. Antiretroviral therapy can delay or mitigate the symptoms of ADC.
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PMID:AIDS dementia complex: a review. 796 50

The perivascular location of human immunodeficiency virus-infected cells suggests that the virus enters the central nervous system (CNS) by traversing the blood-brain barrier (BBB). In this study, the simian immunodeficiency virus (SIV) macaque model was used to determine whether SIV infects CNS endothelial cells. SIV RNA was detected in capillary endothelial cells in brain sections from animals parenterally inoculated with a neurovirulent strain of SIV by double immunohistochemistry and in situ hybridization and by reverse transcriptase-in situ PCR. These in vivo observations were extended by examining whether SIV replicated productively in cultured macaque brain endothelial cells (MBEC). A neurovirulent strain, SIVmac239/17E-Br, replicated productively in MBEC as determined by the presence of viral cytopathic effect (syncytia), viral DNA by PCR, viral RNA by in situ hybridization, and viral antigen by immunohistochemistry and by the production of high titers of cell-free virus. Virus replication was confirmed by electron microscopy. In contrast, a nonneurovirulent strain, SIVmac239, did not infect MBEC. Infection of the endothelial cells was not blocked by soluble CD4. Thus, endothelial cells may provide a CD4-independent pathway of virus entry to the CNS. In addition, damage to the BBB as a result of endothelial cell infection may provide a mechanism for amplification of viral load in the CNS and may contribute to the CNS dysfunction that characterizes AIDS dementia and SIV encephalitis. These data suggest that MBEC may serve a selective role in determining virus entry to the CNS.
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PMID:Neurovirulent simian immunodeficiency virus replicates productively in endothelial cells of the central nervous system in vivo and in vitro. 796 12

Perhaps as many as 25-50% of adult patients and children with acquired immunodeficiency syndrome (AIDS) eventually suffer from neurological manifestations, including dysfunction of cognition, movement, and sensation. How can human immunodeficiency virus type 1 (HIV-1) result in neuronal damage if neurons themselves are for all intents and purposes not infected by the virus? This article reviews a series of experiments leading to a hypothesis that accounts at least in part for the neurotoxicity observed in the brains of AIDS patients. There is growing support for the existence of HIV- or immune-related toxins that lead indirectly to the injury or demise of neurons via a potentially complex web of interactions among macrophages (or microglia), astrocytes, and neurons. HIV-infected monocytoid cells (macrophages, microglia, or monocytes), after interacting with astrocytes, secrete eicosanoids, i.e., arachidonic acid and its metabolites, including platelet-activating factor. Macrophages activated by HIV-1 envelope protein gp120 also appear to release arachidonic acid and its metabolites. In addition, interferon-gamma (IFN-gamma) stimulation of macrophages induces release of the glutamate-like agonist, quinolinate. Furthermore, HIV-infected macrophage production of cytokines, including TNF-alpha and IL1-beta, contributes to astrogliosis. A final common pathway for neuronal susceptibility appears to be operative, similar to that observed in stroke, trauma, epilepsy, neuropathic pain, and several neurodegenerative diseases, possibly including Huntington's disease, Parkinson's disease, and amyotrophic lateral sclerosis. This mechanism involves the activation of voltage-dependent Ca2+ channels and N-methyl-D-aspartate (NMDA) receptor-operated channels, and, therefore, offers hope for future pharmacological intervention. This article focuses on clinically tolerated calcium channel antagonists and NMDA antagonists with the potential for trials in humans with AIDS dementia in the near future.
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PMID:HIV-related neuronal injury. Potential therapeutic intervention with calcium channel antagonists and NMDA antagonists. 799 15

The purpose of this paper is to give an overview of the psychiatric aspects of acquired immunodeficiency syndrome (AIDS)/human immunodeficiency virus (HIV) infection and sexually transmitted disease (STD) under the following subheadings: AIDS-related complex, AIDS hypochondriasis, AIDS dementia complex, AIDS and increased risk of suicide, psychiatric aspects of STD, and implications for the management of patients. The psychiatric aspects of HIV infection and AIDS include problems of adjustment to a diagnosis with a stigma and the threat of death, reactive depression and potential risk of suicide, personality disorder, AIDS-related complex (ARC), and AIDS-related dementia. The paper gives an overview of clinical, neuropathological and psychopathological experience in other countries with relevant examples from Papua New Guinea if available. STDs are mentioned because HIV transmission in Papua New Guinea is mostly by heterosexual means. The paper concludes by emphasizing the psychiatric principles of management of HIV-infected/AIDS/STD patients, which include pharmacotherapy but are always based on supportive psychotherapy and counselling.
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PMID:Psychiatric aspects of acquired immunodeficiency syndrome (AIDS)/human immunodeficiency virus (HIV) infection and sexually transmitted disease (STD): an overview. 805 45

We retrospectively assessed the frequency and clinical characteristics of headache occurring in human immunodeficiency virus (HIV)-infected patients in whom we had excluded all other causes, and determined the frequency of a similar headache in an HIV-negative group. Over a 1-year period, the HIV-related headache occurred in 2.8% of total admissions to the HIV service as opposed to 0.2% of admissions to the neurology service. The affected patients had advanced HIV infection (CD4+ cell count = 58.9 +/- 80.3; normal, > 500 x 10(-6)/l). The headache had features similar to those ascribed to HIV aseptic meningitis and was not related to the presence of AIDS dementia complex or its subsequent development over a 6-month follow-up. We propose that this is a distinct clinical entity related to HIV infection that is similar, if not identical, to HIV aseptic meningitis except for the lack of a CSF pleocytosis, probably reflecting the lymphocyte depletion that is characteristic of the more advanced state of HIV infection.
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PMID:Human immunodeficiency virus-related headache. 817 May 49

The mechanisms by which human immunodeficiency virus (HIV) infection provokes progressive neurodegeneration and dementia in acquired immunodeficiency syndrome (AIDS) remain obscure. In HIV-infected (HIV+) individuals, we found that the brain cells preferentially infected by HIV, viz. the microglia, were abundant, activated, and intensely immunopositive for interleukin-1 alpha (IL-1 alpha), an immune response-generated cytokine that increases the synthesis and processing of beta-amyloid precursor proteins (beta-APP) and promotes proliferation and activation of astroglia. We also found an increase in the number of activated astroglia expressing elevated levels of S100 beta, a cytokine that increases intraneuronal calcium levels and promotes excessive growth of neuronal processes (neurites). These glial changes were accompanied by increased expression of beta-APP immunoreaction product in neurons and overgrown (dystrophic) neurites. In addition, some neurons contained monoclonal antibody Tau-2 immunopositive, neurofibrillary tangle-like structures. Our findings provide evidence that glial activation with increased expression of IL-1 alpha and S100 beta may be important in the neuropathogenesis of AIDS dementia. We propose that HIV infection promotes excessive microglial IL-1 alpha expression with consequent astrogliosis and increased expression of S100 beta. Overexpression of these two cytokines may then be involved in AIDS neuropathogenesis by inducing gliosis, growth of dystrophic neurites, and calcium-mediated neuronal cell loss in AIDS.
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PMID:Glial cytokines as neuropathogenic factors in HIV infection: pathogenic similarities to Alzheimer's disease. 817 6

The pathogenesis of the human immunodeficiency virus (HIV)-associated cognitive/motor complex, or acquired immunodeficiency syndrome (AIDS) dementia complex, is unknown, but it afflicts over 50% of all patients infected with HIV-1. Because neurons are not directly infected with HIV-1, the causes of neuronal dysfunction are undoubtedly indirect. We investigated the role of the astrocyte in the development of AIDS dementia complex, focusing on cytokine and HIV-1 gp120 stimulation of Na+/H+ exchange (NHE) activity of primary rat astrocytes. Our results show that the cytokines tumor necrosis factor-alpha, interferon (IFN)-gamma, and interleukin (IL)-1 beta (all found to be elevated in the central nervous system of AIDS patients), can stimulate Na+/H+ exchange, but that transforming growth factor-beta, IL-2, and IL-6 do not. IFN-gamma and gp120-induced activation of Na+/H+ exchange appears to be mediated through activation of tyrosine kinase (TK), because TK inhibitors block the action of IFN-gamma and gp120. Additionally, gp120 induces tyrosine phosphorylation of two proteins (approximately 90 and 130 kDa), which is also inhibited by TK inhibitors. The predominant NHE isoform present in rat astrocytes is NHE-1; however, other isoforms are also present. We conclude that Na+/H+ exchange of rat astrocytes can be differentially stimulated by cytokines and HIV-1 gp120. We hypothesize that the resultant increase in intracellular pH with its concomitant changes in astrocyte membrane permeability properties produces an imbalance in the K+ and glutamate microenvironment of the neurons, leading to a rise in intraneuronal Ca2+ and eventual neuronal dysfunction and/or demise.
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PMID:Cytokines and HIV envelope glycoprotein gp120 stimulate Na+/H+ exchange in astrocytes. 818 58

NF-kappa B is inducible transcription factor present in many cell types in a latent cytoplasmic form. So far, only immune cells including mature B cells, thymocytes, and adherent macrophages have been reported to contain constitutively active forms of NF-kappa B in the nucleus. A recent study showed that the human immunodeficiency virus type 1 (HIV-1) promoter is highly active in several brain regions of transgenic mice (J. R. Corboy, J. M. Buzy, M. C. Zink, and J. E. Clements, Science 258:1804-1807, 1992). Since the activity of this viral enhancer is governed mainly by two binding sites for NF-kappa B, we were prompted to investigate the state of NF-kappa B activity in neurons. Primary neuronal cultures derived from rat hippocampus and cerebral cortex showed a high constitutive expression of an HIV-1 long terminal repeat-driven luciferase reporter gene, which was primarily dependent on intact NF-kappa B binding sites and was abolished upon coexpression of the NF-kappa B-specific inhibitor I kappa B-alpha. Indirect immunofluorescence and confocal laser microscopy showed that the activity of NF-kappa B correlated with the presence of the NF-kappa B subunits p50 and RelA (p65) in nuclei of cultured neurons. NF-kappa B was also constitutively active in neurons in vivo. As investigated by electrophoretic mobility shift assays, constitutive NF-kappa B DNA-binding activity was highly enriched in fractions containing neuronal nuclei prepared from rat cerebral cortex. Nuclear NF-kappa B-specific immunostaining was also seen in cryosections from mouse cerebral cortex and hippocampus. Only a subset of neurons was stained. Activated NF-kappa B in the brain is likely to participate in normal brain function and to reflect a distinct state of neuronal activity or differentiation. Furthermore, it may explain the high level of activity of the HIV-1 enhancer in neurons, an observation potentially relevant for the etiology of the AIDS dementia complex caused by HIV infection of the central nervous system.
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PMID:Constitutive NF-kappa B activity in neurons. 819 37

Cerebrospinal fluid (CSF) neopterin levels were determined by RIA in individuals with central nervous system (CNS) or human immunodeficiency virus (HIV) infections and in healthy controls. The mean CSF neopterin concentrations were 63.0 nmol/L in 15 patients with acute bacterial meningitis, 54.9 nmol/L in 15 patients with Lyme neuroborreliosis, 32.5 nmol/L in 10 patients with viral meningitis, 130.9 nmol/L in 8 patients with viral encephalitis, 13.9 nmol/L in 15 patients with asymptomatic HIV infection, 26.0 nmol/L in 11 patients with AIDS without dementia, 65.4 nmol/L in 4 patients with AIDS dementia, and 4.2 nmol/L in 24 healthy controls. Although patients with viral encephalitis had higher mean neopterin levels than any other patient category studied, the CSF neopterin concentrations cannot be used to discriminate between viral and bacterial infections. Analysis of CSF levels of neopterin may be useful as guidance in following clinical course and effect of treatment and can provide information of value in addition to CSF cell count as a measurement of CNS immune stimulation.
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PMID:Cerebrospinal fluid neopterin concentrations in central nervous system infection. 822 65


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