HIV Protease Inhibitor Ritonavir Induces Cytotoxicity of Human Endothelial Cells
Zhong et al.,
HIV Protease Inhibitor Ritonavir Induces Cytotoxicity of Human Endothelial Cells,
Arteriosclerosis, Thrombosis, and Vascular Biology, doi:10.1161/01.atv.0000034707.40046.02 (In Vitro)
In Vitro study showing that ritonavir (part of paxlovid) can cause endothelial mitochondrial DNA damage and cell death at concentrations near clinical plasma levels.
Zhong et al., 22 Aug 2002, peer-reviewed, 7 authors.
Contact:
jchen@bcm.tmc.edu.
In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
Abstract: Vascular Biology
HIV Protease Inhibitor Ritonavir Induces Cytotoxicity of
Human Endothelial Cells
Dian-sheng Zhong, Xiang-huai Lu, Brian S. Conklin, Peter H. Lin, Alan B. Lumsden,
Qizhi Yao, Changyi Chen
Objective—Although HIV protease inhibitors have been successfully used against HIV infection, many metabolic side
effects and premature cardiovascular diseases are often associated with this therapy. The mechanisms of these
complications are not clear. In this study, we investigated the effect of the HIV protease inhibitor ritonavir on human
endothelial cell cultures.
Methods and Results—By using nonradioactive cell proliferation and cytotoxicity assays, human endothelial cells treated
with ritonavir showed a significant decrease in cell viability and an increase in cytotoxicity in a time- and
dose-dependent fashion. Mitochondrial DNA was also substantially damaged with ritonavir treatment by long
polymerase chain reaction analysis. In contrast, ritonavir had a very limited effect on endothelial apoptosis, as assessed
by analyses of DNA fragmentation and cellular caspase-3 activity.
Conclusions—These data demonstrate, for the first time, that the HIV protease inhibitor ritonavir at concentrations near
clinical plasma levels is able to directly cause endothelial mitochondrial DNA damage and cell death mainly through
necrosis pathways but not through apoptosis. This study suggests that HIV protease inhibitor–mediated endothelial
injury may contribute to its cardiovascular complications. (Arterioscler Thromb Vasc Biol. 2002;22:1560-1566.)
Key Words: HIV protease inhibitor 䡲 ritonavir 䡲 cytotoxicity 䡲 endothelial cells 䡲 cardiovascular disease
H
hypothesized that HIV protease inhibitors could cause endothelial injury or dysfunction by either direct cytotoxic effect
or indirect effect of protease inhibitor–related metabolic
changes on endothelial cell growth and function. In the
present study, we investigated the effects of ritonavir, one of
the HIV protease inhibitors, on cell viability, cytotoxicity,
mitochondrial DNA damage, and apoptosis in human endothelial cell cultures. The present study may provide insight
into the understanding of cardiovascular complications associated with the use of HIV protease inhibitors.
uman immunodeficiency virus protease is an important
virally encoded enzyme that cleaves the gag and gagpol protein precursors to produce mature and infectious virus
particles. Thus, HIV protease has been the target of antiviral
therapy. HIV protease inhibitors were introduced in 1995 for
the treatment of HIV-infected patients. HIV protease inhibitors, including saquinavir, ritonavir, indinavir, nelfinavir, and
amprenavir, rapidly and profoundly reduce the viral load, as
indicated by a decline in plasma HIV RNA concentrations
within a few days after the start of treatment.1,2 Reductions in
the viral load are paralleled by mean increases in the CD4⫹
count of 100 to 150 cells/mm3.3,4 However, HIV protease
inhibitors are often associated with a number of metabolic
side effects and cardiovascular complications. The major
concern raised by protease inhibitor–associated elevation in
plasma levels of cholesterol and triglycerides relates to the
risk of premature development of atherosclerosis.5–7 Indeed,
rapidly evolving plaques may be particularly unstable and
thus prone to rupture, generating an acute coronary event in
HIV protease inhibitor–treated patients.8..
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