Cytokine‐Driven Inflammatory Response Is Associated with the Hypermetabolism of AIDS Patients with Opportunistic Infections

Garcı́a-Lorda, Pilar; Serrano, Pilar; Jiménez-Expósito, María Jesús; Fraile, J; Bulló, Mònica; Alonso, Carlos; Bonada, A.; Viciana, Pompeyo; Luna, P. P. García; Salas‐Salvadó, Jordi

doi:10.1177/0148607100024006317

Cited by 27 publications

(17 citation statements)

References 32 publications

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“…We found that 43.6% of the patients (n ¼ 24) had CRP levels of 0.5 mg/dl or greater, a value considered indicative of an inflammatory condition. A direct association between inflammatory state and REE has been reported in other disease conditions such as rheumatoid arthritis (Roubenoff et al, 1994), acquired immune deficiency syndrome (Garcia-Lorda et al, 2000), sepsis (Chioléro et al, 1997) and pancreatic cancer (Falconer et al, 1994). Recently, our group also demonstrated such relationship in CKD patients not yet on dialysis (Avesani et al, 2004a;Utaka et al, 2005).…”

Section: Discussionsupporting

confidence: 68%

Resting energy expenditure and its determinants in hemodialysis patients

et al. 2006

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Objective: Chronic kidney disease is associated with several metabolic disturbances that can affect energy metabolism. As resting energy expenditure (REE) is scarcely investigated in patients on hemodialysis (HD) therapy, we aimed to evaluate the REE and its determinants in HD patients. Design: Cross-sectional study. Setting: Dialysis Unit of the Nephrology Division, Federal University of São Paulo, Brazil. Subjects: The study included 55 patients (28 male, 41.4712.6 years old) undergoing HD therapy thrice weekly for at least 2 months, and 55 healthy individuals pair matched for age and gender. Subjects underwent fasting blood tests, as well as nutritional assessment, and the REE was assessed by indirect calorimetry. Results: REE of HD patients was similar to that of pair-matched controls (13797272 and 14407259 kcal/day, respectively), even when adjusted for fat-free mass (P ¼ 0.24). REE of HD patients correlated positively with fat-free mass (r ¼ 0.74; Po0.001) and body mass index (r ¼ 0.37; Po0.01), and negatively with dialysis adequacy (r ¼ À0.46; Po0.001). No significant univariate correlation was found between REE and age, dialysis vintage, serum creatinine, urea, albumin, bicarbonate, parathyroid hormone (PTH) or high-sensitivity C-reactive protein (CRP). In the multiple linear regression analysis, using REE as dependent variable, the final model showed that besides the well-recognized determinants of REE such as fat-free mass and age, PTH and CRP were the independent determinants of REE in HD patients (R 2 ¼ 0.64).

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Section: Discussionsupporting

confidence: 68%

Resting energy expenditure and its determinants in hemodialysis patients

et al. 2006

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“…A predictive value of CRP for REE has previously been reported in cystic fibrosis (39) and AIDS patients (40). More detailed investigations of the role of alternative pathways in this HbSS related inflammation are needed.…”

Section: Discussionmentioning

confidence: 90%

“…The characteristic response to stresses of trauma injury, infection, and other disease, includes hypermetabolism and protein catabolism (3,4,(23)(24) associated with a cytokinedriven inflammatory response in which increased levels of cytokines and acute phase proteins are considered to induce the hypermetabolism. Stable HbSS patients portray many similar characteristics including elevated energy expenditure, protein turnover (1, 2, 25-27), protein catabolism via increased urea production rate (28)(29), increased plasma concentrations of acute phase proteins (8) and leukocytosis (5).…”

Section: Discussionmentioning

confidence: 99%

Proinflammatory Cytokines and the Hypermetabolism of Children with Sickle Cell Disease

Hibbert

Hsu

Bhathena

et al. 2005

Exp Biol Med (Maywood)

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Sickle cell anemia (HbSS) includes chronic inflammation, but the origin is unclear. We hypothesized that in stable HbSS patients the inflammation was associated with hypermetabolism. We compared selected hypermetabolic and key immunomodulator indicators in HbSS versus control children and examined associations between measures of hypermetabolism and inflammation. Twelve fasting asymptomatic HbSS children 6-12 years and 9 controls matched for age, gender and fat mass (FM) were studied. Proportional reticulocyte count (retic%) and resting energy expenditure (REE) represented hypermetabolism, and C-reactive protein (CRP) indicated inflammation. Proinflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), chemokine monocyte chemoattractant protein-1 (MCP-1), and energy balance cytokine leptin were measured. Methods were indirect calorimetry, enzyme-linked immunosorbent assay, and radioimmunoassay. Statistical analysis included simple correlation and regression analysis. REE (51 ± 6 vs. 43 ± 12 kcal/kg per fat-free mass (FFM), mean ± SD), retic% (12 ± 4 vs. 0.7 ± 0.3%), CRP (5 ± 3 vs. 0.3 ± 0.4 mg/liter), and IL-6 (71 ± 40 vs. 20 ± 7 pg/ml) were significantly higher for HbSS than controls (P < 0.05). Conversely, leptin (0.1 ± 0.1 vs. 2 ± 1 µg/liter per kgFM) and MCP-1 (34 ± 5 vs. 41 ± 4 pg/ml) were significantly lower for the HbSS subjects (P < 0.01). TNF-α was not significantly different. There were no significant associations between REE or retic% and any cytokine measured. However, CRP was significantly associated with REE in HbSS (r = 0.8, P = 0.003) and an important predictor of REE/FFM. We provide new evidence for low circulating levels of inflammatory chemokine MCP-1 in stable HbSS children, confirm mostly low cytokine levels, inflammation, and hypermetabolism and demonstrate association of hypermetabolism with inflammation via CRP but not via cytokines.

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“…The levels of soluble TNF receptor types I and II, which reflect TNF activity, increase with disease severity but do not correlate with REE in asymptomatic and symptomatic HIV-infected males [71]. Among patients with AIDS and secondary infections, increased REE per kg of FFM correlates with the inflammatory markers C-reactive protein level, erythrocyte sedimentation rate, ferritin level, IL-6 level, and soluble TNF receptor type I level [43]. Of these, C-reactive protein level is an independent predictor of REE per kg of FFM.…”

mentioning

confidence: 97%

Dysregulated Energy Expenditure in HIV-Infected Patients: A Mechanistic Review

Chang¹,

Sekhar²,

Patel³

et al. 2007

Clinical Infectious Diseases

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Metabolic abnormalities are common in patients with human immunodeficiency virus (HIV) infection and range from protein catabolism to lipodystrophy and dyslipidemia associated with the use of highly active antiretroviral therapy. One abnormality is increased resting energy expenditure, which even occurs in clinically stable HIV-infected patients. Increased resting energy expenditure may aggravate the tendency towards weight loss and wasting, which are independent predictors of mortality. Despite much investigation, the factors associated with altered resting energy expenditure remain unclear; viral load, CD4 cell count, use of antiretroviral drugs, body composition, hormones, and proinflammatory cytokines have been imputed. Mechanisms that could explain increased resting energy expenditure include the HIV accessory protein viral protein R, antiretroviral drugs that affect mitochondrial function, and futile cycling within adipocytes. Other components of energy expenditure are also important to overall energy balance and may also be affected. Identifying unifying mechanisms will be an important step to finding effective treatments for HIV-related alterations in energy expenditure and to reversing metabolic risks in patients with HIV infection.

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Cytokine‐Driven Inflammatory Response Is Associated with the Hypermetabolism of AIDS Patients with Opportunistic Infections

Abstract: Resting hypermetabolism observed in AIDS patients with concurrent active infections is related to the presence and severity of systemic cytokine-driven inflammatory response, which could reflect the type of secondary infection.

Cited by 27 publications

References 32 publications

Resting energy expenditure and its determinants in hemodialysis patients

Resting energy expenditure and its determinants in hemodialysis patients

Proinflammatory Cytokines and the Hypermetabolism of Children with Sickle Cell Disease

Dysregulated Energy Expenditure in HIV-Infected Patients: A Mechanistic Review

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