Potent antiretroviral therapy (ART) including nucleoside reverse transcriptase inhibitors (NRTI) substantially reduces morbidity and mortality due to human immunodeficiency virus type 1 (HIV) infection and acquired immunodeficiency syndrome (AIDS), but is frequently limited by mitochondrial toxicity. Peripheral neuropathy (PN) is a common, debilitating toxicity that is often irreversible. Variation in the onset, character, and severity of NRTI-associated PN strongly suggests host genetics play a role, but an understanding of this role has been elusive. As life-saving ART becomes increasingly available in resource-limited settings, we can anticipate a future """"""""epidemic"""""""" of PN in new populations unless improved understanding and technology can be rapidly translated to these settings. The overarching hypothesis of this proposal is that improved understanding of associations between variation in the human mitochondrial genome and ART-induced PN through the application of state-of-the-art technology (high- throughput whole mitochondrial genome sequencing) and computational resources (to include multifactor dimensionality reduction) can prevent this toxicity and ultimately improve long-term ART outcomes. The proposed work will expand on the existing base of knowledge regarding mitochondrial effects of ART, and will explore novel areas by addressing two specific aims: 1) To characterize mitochondrial DNA (mtDNA) polymorphisms, including multilocus genetic interactions, that confer increased susceptibility to the development of symptomatic PN among HIV-infected individuals treated with NRTI-containing ART regimens; and 2) To characterize relationships between mtDNA polymorphisms and markers of neuronal and mitochondrial injury, including epidermal nerve fiber densities, serum lactate concentrations, and peripheral blood mtDNA content. We propose to address these aims through nested case-control studies using stored DNA and available data from 800 HIV-infected clinical study participants. Information from these studies will allow clinicians to better individualize HIV therapy, avoiding debilitating, often irreversible, and costly complications, thus having important applications in both affluent and resource-limited parts of the world. Results from this study will also advance the field of """"""""mitochondrial medicine"""""""", having broad application across other scientific disciplines and for other human diseases. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21NS059330-01
Application #
7284699
Study Section
NeuroAIDS and other End-Organ Diseases Study Section (NAED)
Program Officer
Wong, May
Project Start
2007-03-15
Project End
2009-02-28
Budget Start
2007-03-15
Budget End
2008-02-29
Support Year
1
Fiscal Year
2007
Total Cost
$268,333
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37212
Leger, Paul D; Johnson, Daniel H; Robbins, Gregory K et al. (2014) Genome-wide association study of peripheral neuropathy with D-drug-containing regimens in AIDS Clinical Trials Group protocol 384. J Neurovirol 20:304-8
Hulgan, Todd; Robbins, Gregory K; Kalams, Spyros A et al. (2012) T cell activation markers and African mitochondrial DNA haplogroups among non-Hispanic black participants in AIDS clinical trials group study 384. PLoS One 7:e43803
Grady, Benjamin J; Samuels, David C; Robbins, Gregory K et al. (2011) Mitochondrial genomics and CD4 T-cell count recovery after antiretroviral therapy initiation in AIDS clinical trials group study 384. J Acquir Immune Defic Syndr 58:363-70
Canter, Jeffrey A; Robbins, Gregory K; Selph, Doug et al. (2010) African mitochondrial DNA subhaplogroups and peripheral neuropathy during antiretroviral therapy. J Infect Dis 201:1703-7
Kallianpur, Asha R; Hulgan, Todd (2009) Pharmacogenetics of nucleoside reverse-transcriptase inhibitor-associated peripheral neuropathy. Pharmacogenomics 10:623-37