Abstract
HIV patients in highly active antiretroviral therapy (HAART) develop lipodystrophy
and insulin resistance. Protease inhibitors have been shown to alter adipocyte metabolism
in murine cell lines. In this study, biological effects of the HIV protease inhibitor,
ritonavir, were investigated on human SGBS preadipocytes and adipocytes. Ritonavir
dose-dependently impaired preadipocyte proliferation and adipogenic differentiation.
Gene expression analysis measured by real-time PCR, showed no effect of ritonavir
(up to 20 μM) on expression of mRNA of PPARγ2 and SREBP1c, but suppressed adiponectin
mRNA while increasing IL-6 mRNA expression. In human adipocytes, ritonavir at therapeutic
concentrations inhibited insulin-stimulated lipogenesis, reduced GLUT4 mRNA, fatty
acid synthase and adiponectin expression, while increasing IL-6 mRNA expression. Finally,
long-term treatment (72 and 120 h) of SGBS adipocytes but not preadipocytes with ritonavir
induced apoptosis in up to 15 % of the cells. All together, these data show effects
of ritonavir on human preadipocytes and adipocytes aiming at reducing adipose tissue
mass and increasing insulin resistance. These in vitro findings may partly explain the clinical findings in patients under HAART. Furthermore,
SGBS cells may serve as a useful tool in further investigation of the mechanism of
protease inhibitor action in human adipocytes.
Key words
Lipodystrophy - HAART - Fat cell - SGBS-cells - Insulin resistance
References
1
Koutkia P, Grinspoon S.
HIV-associated lipodystrophy: Pathogenesis, Prognosis, Treatment, and Controversies.
Annu Rev Med.
2004;
55
303-317
2
Kannisto K, Sutinen J, Korsheninnikova E, Fisher R M, Ehrenborg E, Gertow K, Virkamaki A,
Nyman T, Vidal H, Hamsten A, Yki-Jarvinen H.
Expression of adipogenic transcription factors, peroxisome proliferators-activated
receptor gamma co-activator1, IL-6 and CD45 in subcutaneous adipose tissue in lipodystrophy
associated with highly active antiretroviral therapy.
Aids.
2003;
17
1753-1762
3
Miller K D, Jones E, Yanovski J A, Shankar R, Feuerstein I, Falloon J.
Visceral abdominal-fat accumulation associated with use of indinavir.
Lancet.
1998;
351
871-875
4
Carr A, Samaras K, Chisholm D J, Cooper D A.
Abnormal fat distribution and use of protease inhibitors.
Lancet..
1998;
351
1736
5
Stocker D N, Meier P J, Stoller R, Fattinger K E.
“Buffalo hump” in HIV-1 infection.
Lancet..
1998;
352
320-321
6
Acevedo M, Sprecher D L, Calabrese L, Pearce G L, Coyner D L, Halliburton S S, White R D,
Sykora E, Kondos G T, Hoff J A.
Pilot study of coronary atherosclerotic risk and plaque burden in HIV patients: ‘a
call for cardiovascular prevention’.
Atherosclerosis.
2002;
163
349-354
7
Domingo P, Matias-Guiu X, Pujol R M, Francia E, Lagarda E, Sambeat M A, Vàzquez G.
Subcutaneous adipocyte apoptosis in HIV-1 protease inhibitor-associated lipodystrophy.
Aids.
1999;
13
2261-2267
8
Dowell P, Flexner C, Kwiterovich P O, Lane M D.
Suppression of preadipocyte differentiation and promotion of adipocyte death by HIV
protease inhibitors.
J Biol Chem.
2000;
275
41 325-41 332
9
Bastard J P, Caron M, Vidal H, Jan V, Auclair M, Vigouroux C, Luboinski J, Laville M,
Maachi M, Girard P M, Rozenbaum W, Levan P, Capeau J.
Association between altered expression of adipogenic factor SREBP1 in lipoatrophic
adipose tissue from HIV-1 infected patients and abnormal adipocyte differentiation
and insulin resistance.
Lancet.
2002;
359
1026-1031
10
Caron M, Auclair M, Vigouroux C, Glorian M, Forest C, Capeau J.
The HIV Protease inhibitor indinavir impairs stero regulatory element-binding protein-1
intranuclear localization, inhibits preadipocyte differentiation, and induces insulin
resistance.
Diabetes.
2001;
50
1378-1388
11
Zhang B, Macnaul K, Szalkowski D, Li Z, Berger J, Moller D E.
Inhibition of adipocyte differentiation by HIV protease inhibitors.
J Clin Endocrinol Metab.
1999;
84
4274-4277
12
Lenhard J M, Furfine E S, Jain R G, Ittoop O, Orband-Miller L A, Blanchard S G, Paulik M A,
Weiel J E.
HIV protease inhibitors block adipogenesis and increase lipolysis in vitro.
Antiviral Res.
2000;
47
121-129
13
Murata H, Hruz P W, Mueckler M.
The mechanism of insulin resistance caused by HIV protease inhibitor therapy.
J Biol Chem.
2000;
275
20 251-20 254
14
Rudich A, Vanounou S, Riesenberg K, Porat M, Tirosh A, Harman-Boehm I, Greenberg A S,
Schlaeffer F, Bashan N.
The HIV protease inhibitor nelfinavir induces insulin resistance and increases basal
lipolysis in 3T3-L1 adipocytes.
Diabetes.
2001;
50
1425-1431
15
Wabitsch M, Brenner R E, Melzner I, Braun M, Möller P, Heinze E. et al .
Characterization of a human preadipocyte cell strain with high capacity for adipose
differentiation.
Int J Obesity.
2001;
25
8-15
16
Fischer-Posovszky P, Tornqvist H, Debatin K M, Wabitsch M.
Inhibition of death-receptor mediated apoptosis in human adipocytes by the insulin-like
growth factor I (IGF-I)/IGF-I receptor autocrine circuit.
Endocrinology.
2004;
145
1849-1859
17
Dalen K T, Schoonjans K, Ulven S M, Weedon-Fekjaer M S, Bentzen T G, Koutnikova H,
Auwerx J, Nebb H I.
Adipose tissue expression of the lipid droplet-associating proteins S3 - 12 and perilipin
is controlled by peroxisome proliferator-activated receptor-gamma.
Diabetes.
2004;
53
1243-1252
18
Bao Y, Bing C, Hunter L, Jenkins J R, Wabitsch M, Trayhurn P.
Zinc-alpha(2)-glycoprotein, a lipid mobilizing factor, is expressed and secreted by
human (SGBS)adipocytes.
FEBS Lett.
2005;
579
41-47
19
Vidal H.
Quantification of lipid-related mRNAs by reverse transcription-competitive polymerase
chain reaction in human white adipose tissue biopsies.
Methods Mol Biol.
2001;
155
83-88
20
Flexner M D.
HIV-Protease inhibitors.
N Engl J Med.
1998;
338
1281-1292
21
Janneh O, Hoggard P G, Tjia J F, Jones S P, Khoo S H, Maher B, Back D J, Pirmohamed M.
Intracellular disposition and metabolic effects of zidovudine, stavudine and four
protease inhibitors in cultured adipocytes.
Antivir Ther.
2003;
8
417-426
22
Riddle T M, Kuhel D G, Woollett L A, Fichtenbaum C J, Hui D Y.
HIV protease inhibitor induces fatty acid and sterol biosynthesis in liver and adipose
tissues due to the accumulation of activated sterol regulatory element-binding proteins
in the nucleus.
J Biol Chem.
2001;
276
37 514-37 519
23
Nguyen A T, Gagnon A, Angel J B, Sorisky A.
Ritonavir increases the level of active ADD-1/SREBP-1 protein during adipogenesis.
Aids.
2000;
14
2467-2473
24
Vernochet C, Azoulay S, Duval D, Guedj R, Cottrez F, Vidal H, Ailhaud G, Dani C.
Human Immunodeficiency virus protease inhibitors accumulate into cultured human adipocytes
and alter expression of adipocytokines.
J Biol Chem.
2005;
280
2238-2243
25
Wentworth J M, Burris T P, Chatterjee V K.
HIV protease inhibitors block human preadipocyte differentiation, but not via the
PPARgamma/RXR heterodimer.
J Endocrinol.
2000;
164
R7-R10
26
Roche R, Poizot-Martin I, Yazidi C M, Compe E, Gastaut J A, Torresani J, Planells R.
Effects of antiretroviral drug combinations on the differentiation of adipocytes.
Aids.
2002;
16
13-20
27
Schutt M, Zhou J, Meier M, Klein H H.
Long-term effects of HIV-1 protease inhibitors on insulin secretion and insulin signaling
in INS-1 beta cells.
J Endocrinol.
2004;
183
445-454
28
Cammalleri C, Germinario R J.
The effects of protease inhibitors on basal and insulin-stimulated lipid metabolism,
insulin binding, and signaling.
J Lipid Res.
2003;
44
103-108
29
Lagathu C, Bastard J P, Auclair M, Maachi M, Kornprobst M, Capeau J, Caron M.
Antiretroviral drugs with adverse effects on adipocyte lipid metabolism and survival
alter the expression and secretion of proinflammatory cytokines and adiponectin in
vitro.
Antivir Ther.
2004;
9
911-920
30
Straub R H, Hense H W, Andus T, Scholmerich J, Riegger G A, Schunkert H.
Hormone replacement therapy and interrelation between serum interleukin-6 and body
mass index in postmenopausal women: a population-based study.
J Clin Endocrinol Metab.
2000;
85
1340-1344
31
Kado S, Nagase T, Nagata N.
Circulating levels of interleukin-6, its soluble receptor and interleukin-6/interleukin-6
receptor complex in patients with type 2 diabetes mellitus.
Acta Diabetol.
1999;
36
67-72
32
Lagathu C, Bastard J P, Auclair M, Maachi M, Capeau J, Caron M.
Chronic interleukin-6 (IL-6) treatment increased IL-6 secretion and induced insulin
resistance in adipocyte: prevention by rosiglitazone.
Biochem Biophys Res Commun.
2003;
311
372-379
33
Rotter V, Nagaev I, Smith U.
Interleukin-6 (IL-6) induces insulin resistance in 3T3-L1 adipocytes and is, like
IL-8 and tumor necrosis factor-, overexpressed in human fat cells from insulin-resistant
subjects.
J Biol Chem.
2003;
278
45 777-45 784
34
Haque W A, Shimomura I, Matsuzawa Y, Garg A.
Serum adiponectin and leptin levels in patients with lipodystrophy.
J Clin Endocrinol Metab.
2002;
87
2395-2398
35
Mynarcik D C, Combs T, McNurlan M A, Scherer P E, Komaroff E, Gelato M C.
Adiponectin and leptin levels in HIV-infected subjects with insulin resistance and
body fat redistribution.
J Acquir Immune Defic Syndr.
2002;
31
514-520
36
Fasshauer M, Kralisch S, Klier M, Lossner U, Bluher M, Klein J, Paschke R.
Adiponectin gene expression and secretion is inhibited by interleukin-6 in 3T3-L1
adipocytes.
Biochem Biophys Res Commun.
2003;
301
1045-1050
37
Gustafson B, Jack M M, Cushman S W, Smith U.
Adiponectin gene activation by thiazolidinediones requires PPAR gamma 2, but not C/EBPalpha-evidence
for differential regulation of the aP2 and adiponectin genes.
Biochem Biophys Res Commun.
2003;
308
933-939
38
Ledru E, Christeff N, Patey O, de Truchis P, Melchior J C, Gougeon M L.
Alteration of tumor necrosis factor-alpha T-cell homeostasis following potent antiretroviral
therapy: contribution to the development of human immunodeficiency virus-associated
lipodystrophy syndrome.
Blood.
2000;
95
3191-3198
Martin Wabitsch, M. D.
Pediatric Endocrinology and Diabetology, Department of Pediatrics and Adolescent Medicine
University of Ulm · Prittwitzstraße 43 · 89075 Ulm · Germany
Phone: +49 (731) 500-277 15 ·
Fax: +49 (731) 500-267 14
Email: martin.wabitsch@medizin.uni-ulm.de