Altered Glymphatic System in Middle-Aged cART-Treated Patients With HIV: A Diffusion Tensor Imaging Study

OBJECTIVE: The brain relies on the glymphatic system to clear metabolic wastes and maintain brain homeostasis to fulfill its functions better. Yet, the complexity of the glymphatic flow and clearance and its changes in HIV infection and its role in neurocognitive dysfunction remain poorly understood...

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Autores principales: Nguchu, Benedictor Alexander, Zhao, Jing, Wang, Yanming, de Dieu Uwisengeyimana, Jean, Wang, Xiaoxiao, Qiu, Bensheng, Li, Hongjun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8963418/
https://www.ncbi.nlm.nih.gov/pubmed/35359662
http://dx.doi.org/10.3389/fneur.2022.819594
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author Nguchu, Benedictor Alexander
Zhao, Jing
Wang, Yanming
de Dieu Uwisengeyimana, Jean
Wang, Xiaoxiao
Qiu, Bensheng
Li, Hongjun
author_facet Nguchu, Benedictor Alexander
Zhao, Jing
Wang, Yanming
de Dieu Uwisengeyimana, Jean
Wang, Xiaoxiao
Qiu, Bensheng
Li, Hongjun
author_sort Nguchu, Benedictor Alexander
collection PubMed
description OBJECTIVE: The brain relies on the glymphatic system to clear metabolic wastes and maintain brain homeostasis to fulfill its functions better. Yet, the complexity of the glymphatic flow and clearance and its changes in HIV infection and its role in neurocognitive dysfunction remain poorly understood. This study aims to explore the impact of HIV and combination antiretroviral therapy (cART) on the glymphatic system and establish a potential biomarker of HIV-associated neurocognitive disorders (HAND). METHODS: Here, we examined the glymphatic profiles of middle-aged virosuppressed patients with HIV (n = 27) receiving cART over 1–6 years and healthy controls (n = 28) along the perivascular space (PVS) using diffusion tensor image analysis along the perivascular space (ALPS) with guided and unguided approaches. We later combined data from these analyses to investigate MRI glymphatic correlates of cognitive impairment and other clinical tests of HIV (CD4+ T-cell counts and CD4+/CD8+ ratio). RESULTS: We found that glymphatic function as measured by the ALPS index increased significantly in the right and left PVSs of patients with HIV having cART. On antiretroviral therapy, a changing pattern in glymphatic clearance function in patients with HIV having cART correlated with attention and working memory. Duration on cART was also associated with cognitive performances of abstract and executive function and learning and memory. CONCLUSION: These findings provide MRI evidence of the presence of HIV-induced changes in the glymphatic flow and clearance, which might underlie cognitive impairment among patients with HIV having cART. An increase in the glymphatic activity might reflect a compensatory mechanism to regulate microenvironment homeostasis compromised by HIV. This compensation might be necessary to maintain the proper functioning of the brain while coping with HIV pathology. These findings also shed light on the clinical importance of evaluating glymphatic function based on the ALPS index and suggest that improving the glymphatic system may serve as an alternative therapeutic strategy for HAND.
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spelling pubmed-89634182022-03-30 Altered Glymphatic System in Middle-Aged cART-Treated Patients With HIV: A Diffusion Tensor Imaging Study Nguchu, Benedictor Alexander Zhao, Jing Wang, Yanming de Dieu Uwisengeyimana, Jean Wang, Xiaoxiao Qiu, Bensheng Li, Hongjun Front Neurol Neurology OBJECTIVE: The brain relies on the glymphatic system to clear metabolic wastes and maintain brain homeostasis to fulfill its functions better. Yet, the complexity of the glymphatic flow and clearance and its changes in HIV infection and its role in neurocognitive dysfunction remain poorly understood. This study aims to explore the impact of HIV and combination antiretroviral therapy (cART) on the glymphatic system and establish a potential biomarker of HIV-associated neurocognitive disorders (HAND). METHODS: Here, we examined the glymphatic profiles of middle-aged virosuppressed patients with HIV (n = 27) receiving cART over 1–6 years and healthy controls (n = 28) along the perivascular space (PVS) using diffusion tensor image analysis along the perivascular space (ALPS) with guided and unguided approaches. We later combined data from these analyses to investigate MRI glymphatic correlates of cognitive impairment and other clinical tests of HIV (CD4+ T-cell counts and CD4+/CD8+ ratio). RESULTS: We found that glymphatic function as measured by the ALPS index increased significantly in the right and left PVSs of patients with HIV having cART. On antiretroviral therapy, a changing pattern in glymphatic clearance function in patients with HIV having cART correlated with attention and working memory. Duration on cART was also associated with cognitive performances of abstract and executive function and learning and memory. CONCLUSION: These findings provide MRI evidence of the presence of HIV-induced changes in the glymphatic flow and clearance, which might underlie cognitive impairment among patients with HIV having cART. An increase in the glymphatic activity might reflect a compensatory mechanism to regulate microenvironment homeostasis compromised by HIV. This compensation might be necessary to maintain the proper functioning of the brain while coping with HIV pathology. These findings also shed light on the clinical importance of evaluating glymphatic function based on the ALPS index and suggest that improving the glymphatic system may serve as an alternative therapeutic strategy for HAND. Frontiers Media S.A. 2022-03-11 /pmc/articles/PMC8963418/ /pubmed/35359662 http://dx.doi.org/10.3389/fneur.2022.819594 Text en Copyright © 2022 Nguchu, Zhao, Wang, de Dieu Uwisengeyimana, Wang, Qiu and Li. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Nguchu, Benedictor Alexander
Zhao, Jing
Wang, Yanming
de Dieu Uwisengeyimana, Jean
Wang, Xiaoxiao
Qiu, Bensheng
Li, Hongjun
Altered Glymphatic System in Middle-Aged cART-Treated Patients With HIV: A Diffusion Tensor Imaging Study
title Altered Glymphatic System in Middle-Aged cART-Treated Patients With HIV: A Diffusion Tensor Imaging Study
title_full Altered Glymphatic System in Middle-Aged cART-Treated Patients With HIV: A Diffusion Tensor Imaging Study
title_fullStr Altered Glymphatic System in Middle-Aged cART-Treated Patients With HIV: A Diffusion Tensor Imaging Study
title_full_unstemmed Altered Glymphatic System in Middle-Aged cART-Treated Patients With HIV: A Diffusion Tensor Imaging Study
title_short Altered Glymphatic System in Middle-Aged cART-Treated Patients With HIV: A Diffusion Tensor Imaging Study
title_sort altered glymphatic system in middle-aged cart-treated patients with hiv: a diffusion tensor imaging study
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8963418/
https://www.ncbi.nlm.nih.gov/pubmed/35359662
http://dx.doi.org/10.3389/fneur.2022.819594
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