Imaging correlates of the blood-brain barrier disruption in HIV-associated neurocognitive disorder and therapeutic implications.

OBJECTIVE: HIV-associated neurocognitive disorders (HANDs) in the context of suppressive combination antiretroviral therapy (cART) still occur. We explored the role of blood-brain barrier (BBB) disruption in the pathogenesis of HAND in the context of fully suppressive cART using dynamic contrast enhanced perfusion (DCE-P) MRI. DCE-P is a new MRI technique that measures capillary permeability as an indicator for BBB integrity. We hypothesized that virally suppressed incident HAND would be associated with an impaired BBB as determined by DCE-P. DESIGN: A cross sectional study. METHODS: K-trans, a metric derivative of DCE-P, was obtained from different regions of the brain in a cohort of 20 patients with HAND who were virally suppressed in both cerebrospinal fluid (CSF) and blood compared with CSF and blood markers of neuroinflammation as well as with neurometabolites derived from magnetic resonance (MR) spectroscopy. RESULTS: The K-trans data showed significantly impaired BBB in HAND patients when compared with the controls in the regions of the basal ganglia and anterior frontal white matter (both P < 0.0001). CSF neopterin and CSF/serum albumin ratio correlated positively with K-trans but not with blood levels. CONCLUSION: This study indicates that HAND in the context of viral suppression is associated with BBB disruption and the DCE MR derived K-trans metric is a very sensitive parameter to identify the BBB disruption. The finding of region-specific BBB disruption rather than globally and the lack of correlation with blood markers of neuroinflammation suggest that HIV and not systemic inflammation is driving the BBB disturbance and that the BBB disruption is a consequence of HIV already in the brain as opposed to HIV first causing BBB disruption then brain disease.

Antioxidant and immunomodulating activities of exo-and endopolysaccharide fractions from submerged mycelia cultures of culinary-medicinal mushrooms.

A number of mushrooms are known to possess pharmacological activities. In this study, the phenolic and flavonoid contents of extracts of exo- and endopolysaccharide fractions obtained from submerged mycelia cultures of 7 edible or medicinal mushroom species, as well as their antioxidant and immunomodulatory properties, were evaluated. The exo- and endopolysaccharide yields were 0.576-1.950 and 0.438-0.933 g/L, respectively. The sugar and protein contents of these fractions were analyzed and contained predominantly sugars (52.3-87.6%). The exo- and endopolysaccharide fractions contained appreciable amounts of phenolics and flavonoids. The highest flavonoid contents were found in Cryptosporus volvatus (349.6 mg/g), followed by Cordyceps militaris (312.6 mg/g). The antioxidant activities were evaluated by 4 assays: biological assay using Saccharomyces cerevisiae, DPPH radical scavenging activity, chelating ability for ferrous ions and ferric reducing antioxidant power. The mycelia polysaccharide fractions had more ferric reducing antioxidant power than other antioxidant activities. Both exo- and endo polysaccharides of C. volvatus inhibited production of the T lymphocyte Th1 cytokines interferon (IFN)-γ and interleukin (IL)-2, the Th2 cytokines IL-4 and IL-5, and macrophage enzyme activity. Although those from C. militaris had similar inhibitory effects on cytokine production, the exopolysaccharides stimulated macrophage enzyme activity. The other exopolysaccharides (Pleurotus citrinopileatus, P. australis, and P. pulmonarius) inhibited IFN-γ and IL-5 production, but they had varying effects on IL-2 and IL-4 production. Only 3 exopolysaccharides (P. pulmonarius, Tremella mesenterica, and Cordyceps sinensis) also stimulated macrophage enzyme activity to the same extent as lipopolysaccharides. All of them reduced IL-5 production, but those from T. mesenterica also inhibited IFN-γ, IL-2, and IL-4 production. Thus the polysaccharide fractions from the mushrooms studied have antioxidant activities and general immunomodulating effects in vitro.