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Background
HIV-disease progression correlates with immune activation. Here we investigated whether corticosteroid treatment can attenuate HIV disease progression in antiretroviral-untreated patients.
Methods
Double-blind, placebo-controlled randomized clinical trial including 326 HIV-patients in a resource-limited setting in Tanzania (clinicaltrials.gov NCT01299948). Inclusion criteria were a CD4 count above 300 cells/μl, the absence of AIDS-defining symptoms and an ART-naïve therapy status. Study participants received 5 mg prednisolone per day or placebo for 2 years. Primary endpoint was time to progression to an AIDS-defining condition or to a CD4-count below 200 cells/μl.
Results
No significant change in progression towards the primary endpoint was observed in the intent-to-treat (ITT) analysis (19 cases with prednisolone versus 28 cases with placebo, p = 0.1407). In a per-protocol (PP)-analysis, 13 versus 24 study participants progressed to the primary study endpoint (p = 0.0741). Secondary endpoints: Prednisolone-treatment decreased immune activation (sCD14, suPAR, CD38/HLA-DR/CD8+) and increased CD4-counts (+77.42 ± 5.70 cells/μl compared to -37.42 ± 10.77 cells/μl under placebo, p < 0.0001). Treatment with prednisolone was associated with a 3.2-fold increase in HIV viral load (p < 0.0001). In a post-hoc analysis stratifying for sex, females treated with prednisolone progressed significantly slower to the primary study endpoint than females treated with placebo (ITT-analysis: 11 versus 21 cases, p = 0.0567; PP-analysis: 5 versus 18 cases, p = 0.0051): No changes in disease progression were observed in men.
Conclusions
This study could not detect any significant effects of prednisolone on disease progression in antiretroviral-untreated HIV infection within the intent-to-treat population. However, significant effects were observed on CD4 counts, immune activation and HIV viral load. This study contributes to a better understanding of the role of immune activation in the pathogenesis of HIV infection.
The prototyical tumor suppressor p53 is able to arrest cells after DNA damage or as a response to oncogene expression. The transactivation-competent (TA) isoforms of the more recently discovered p53 family member p73 also prevent tumors, but the underlying mechanisms are less well understood. The work presented here addressed this issue by using a cell culture model of tumorigenesis in which normal human diploid fibroblasts are stepwise transduced with oncogenes. Cells in pretransformed stages were shown to harbour high levels of TAp73 mRNA and protein. This positive regulation was probably a result of pRB inactivation and derepression of E2F1, a key activator of TAp73. Consequences for such cells included an increased sensitivity to the cytostatic drug adriamycin, slower proliferation and reduced survival at high cell density, as demonstrated by rescue experiments using siRNA-mediated knockdown of TAp73. In order to identify potential effector pathways, the gene expression profile of siRNA treated, matched fibroblast cell lines with high and low TAp73 levels were compared in DNA microarrays. These findings support the notion of TAp73 up-regulation as an anti-proliferative defense mechanism, blocking the progress towards full transformation. This barrier could be overcome by the introduction of a constitutively active form of Ras which caused a switch from TAp73 to oncogenic DeltaNp73 expression, presumably through the phosphatidylinositol 3-kinase (PI3K) pathway. In summary, the results presented emphasize the tumor-suppressive function of TAp73 and indicate that its downregulation is a decisive event during the transformation of human cells by oncogenic Ras mutants.