Neurocognition and quality of life after reinitiating antiretroviral therapy in children randomized to planned treatment interruption

Objective: Understanding the effects of antiretroviral treatment (ART) interruption on neurocognition and quality of life (QoL) are important for managing unplanned interruptions and planned interruptions in HIV cure research. Design: Children previously randomized to continuous (continuous ART, n=41) vs. planned treatment interruption (PTI, n=47) in the Pediatric European Network for Treatment of AIDS (PENTA) 11 study were enrolled. At study end, PTI children resumed ART. At 1 and 2 years following study end, children were assessed by the coding, symbol search and digit span subtests of Wechsler Intelligence Scale for Children (6-16 years old) or Wechsler Adult Intelligence Scale ( 6517 years old) and by Pediatrics QoL questionnaires for physical and psychological QoL. Transformed scaled scores for neurocognition and mean standardized scores for QoL were compared between arms by t-test and Mann-Whitney U test, respectively. Scores indicating clinical concern were compared (<7 for neurocognition and <70 for QoL tests). Results: Characteristics were similar between arms with a median age of 12.6 years, CD4 + of 830 cells/\u3bcl and HIV RNA of 1.7 log 10 copies/ml. The median cumulative ART exposure was 9.6 in continuous ART vs. 7.7 years in PTI (P=0.02). PTI children had a median of 12 months off ART and had resumed ART for 25.2 months at time of first assessment. Neurocognitive scores were similar between arms for all tests. Physical and psychological QoL scores were no different. About 40% had low neurocognitive and QoL scores indicating clinical concern. Conclusion: No differences in information processing speed, sustained attention, short-term memory and QoL functioning were observed between children previously randomized to continuous ART vs. PTI in the PENTA 11 trial

Context-dependent signaling of CXC chemokine receptor 4 and atypical chemokine receptor 3

G protein-coupled receptors (GPCRs) are regulated by complex molecular mechanisms, both in physiological and pathological conditions, and their signalling can be intricate. Many factors influence their signalling behaviour, including the type of ligand that activates the GPCR, the presence of interacting partners, the kinetics involved or their location. The two CXC type chemokine receptors CXCR4 and ACKR3, both members of the GPCR superfamily, are important and established therapeutic targets in relation to cancer, HIV infection and inflammatory diseases. Therefore, it is crucial to understand how the signalling of these receptors works to be able to specifically target them. In this review, we discuss how the signalling pathways activated by CXCR4 and ACKR3 can vary in different situations. G protein signalling of CXCR4 depends on the cellular context and discrepancies exist depending on the cell lines used. ACKR3, as an atypical chemokine receptor, is generally reported to not activate G proteins, but can broaden its signalling spectrum upon heteromerisation with other receptors, such as CXCR4, endothelial growth factor receptor (EGFR) or the α1-adrenergic receptor (α1-AR). Also, CXCR4 forms heteromers with CCR2, CCR5, the Na+/H+ exchanger regulatory factor 1 (NHERF1), CXCR3, α1-AR and the opioid receptors, which results in differential signalling to that of the monomeric subunits. In addition, CXCR4 is present on membrane rafts, but can go into the nucleus during cancer progression, probably acquiring different signalling properties. In this review, we also provide an overview of the currently known critical amino acids involved in CXCR4 and ACKR3 signalling

Impact of lipid polyunsaturation on dopamine D2 receptor activation and signaling

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