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Cerebrospinal fluid metabolomics reveals altered waste clearance and accelerated aging in HIV patients with neurocognitive impairment

Cassol, Edanaa,b; Misra, Vikasa; Dutta, Anupriyaa,b; Morgello, Susanc; Gabuzda, Danaa,b,d

doi: 10.1097/QAD.0000000000000303
Basic Science

Objective(s): HIV-associated neurocognitive disorders (HAND) remain prevalent in HIV-infected patients on antiretroviral therapy (ART), but the underlying mechanisms are unclear. Some features of HAND resemble those of age-associated cognitive decline in the absence of HIV, suggesting that overlapping mechanisms may contribute to neurocognitive impairment.

Design: Cross-sectional analysis of cerebrospinal fluid (CSF) from 100 individuals (46 HIV-positive patients and 54 HIV-negative controls).

Methods: Untargeted CSF metabolite profiling was performed using liquid/gas chromatography followed by mass spectrometry. Cytokine profiling was performed by Bioplex. Bioinformatic analyses were performed in Metaboanalyst and R.

Results: Alterations in the CSF metabolome of HIV patients on ART mapped to pathways associated with neurotransmitter production, mitochondrial function, oxidative stress, and metabolic waste. Many CSF metabolites altered in HIV overlapped with those altered with advanced age in HIV-negative controls, suggesting a pattern indicative of accelerated aging. Machine learning models identified neurotransmitters (glutamate, N-acetylaspartate), markers of glial activation (myo-inositol), and ketone bodies (beta-hydroxybutyric acid, 1,2-propanediol) as top-ranked classifiers of HAND. These CSF metabolites correlated with worse neurocognitive test scores, plasma inflammatory biomarkers [interferon (IFN)-α, IFN-γ, interleukin (IL)-8, IL-1β, IL-6, IL-2Ra], and intrathecal IFN responses (IFN-γ and kynurenine : tryptophan ratio), suggesting inter-relationships between systemic and intrathecal inflammation and metabolic alterations in CSF.

Conclusions: Alterations in the CSF metabolome of HIV patients on ART suggest that persistent inflammation, glial responses, glutamate neurotoxicity, and altered brain waste disposal systems contribute to mechanisms involved in HAND that may be augmented with aging.

aDepartment of Cancer Immunology and AIDS, Dana-Farber Cancer Institute, Boston

bDepartment of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts

cDepartment of Neurology, Neuroscience and Pathology, The Mount Sinai Medical Center, New York, New York

dDepartment of Neurology, Harvard Medical School, Boston, Massachusetts, USA.

Correspondence to Dr Dana Gabuzda, CLS 1010, 450 Brookline Avenue, Boston, MA 02215, USA. Tel: +1 617 632 2154; fax: +1 617 632 4338; e-mail:

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Received December 29, 2013

Accepted April 9, 2014

© 2014 Lippincott Williams & Wilkins, Inc.