Growth Hormone Releasing Hormone Reduces Circulating Markers of Immune Activation in Parallel with Effects on Hepatic Immune Pathways in Individuals with HIV-infection and Nonalcoholic Fatty Liver Disease

• Published in: Clinical infectious diseases Vol. 73; no. 4; pp. 621 - 630
• Main Authors: Stanley, Takara L, Fourman, Lindsay T, Wong, Lai Ping, Sadreyev, Ruslan, Billingsley, James M, Feldpausch, Meghan N, Zheng, Isabel, Pan, Chelsea S, Boutin, Autumn, Lee, Hang, Corey, Kathleen E, Torriani, Martin, Kleiner, David E, Chung, Raymond T, Hadigan, Colleen M, Grinspoon, Steven K
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 16.08.2021
• Subjects: Biomarkers; Double-Blind Method; Growth Hormone-Releasing Hormone; HIV Infections - complications; HIV Infections - drug therapy; Humans; Major and Commentaries; Non-alcoholic Fatty Liver Disease - drug therapy; nonalcoholic fatty liver disease; HIV-infection; growth hormone; growth hormone releasing hormone; immune activation
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciab019

Abstract Background The growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis modulates critical metabolic pathways; however, little is known regarding effects of augmenting pulsatile GH secretion on immune function in humans. This study used proteomics and gene set enrichment analysis to assess effects of a GH releasing hormone (GHRH) analog, tesamorelin, on circulating immune markers and liver tissue in people with human immunodeficiency virus (HIV) (PWH) and nonalcoholic fatty liver disease (NAFLD). Methods 92 biomarkers associated with immunity, chemotaxis, and metabolism were measured in plasma samples from 61 PWH with NAFLD who participated in a double-blind, randomized trial of tesamorelin versus placebo for 12 months. Gene set enrichment analysis was performed on serial liver biopsies targeted to immune pathways. Results Tesamorelin, compared to placebo, decreased interconnected proteins related to cytotoxic T-cell and monocyte activation. Circulating concentrations of 13 proteins were significantly decreased, and no proteins increased, by tesamorelin. These included 4 chemokines (CCL3, CCL4, CCL13 [MCP4], IL8 [CXCL8]), 2 cytokines (IL-10 and CSF-1), and 4 T-cell associated molecules (CD8A, CRTAM, GZMA, ADGRG1), as well as ARG1, Gal-9, and HGF. Network analysis indicated close interaction among the gene pathways responsible for these proteins, with imputational analyses suggesting down-regulation of a closely related cluster of immune pathways. Targeted transcriptomics using liver tissue confirmed a significant end-organ signal of down-regulated immune activation pathways. Conclusions Long-term treatment with a GHRH analog reduced markers of T-cell and monocyte/macrophage activity, suggesting that augmentation of the GH axis may ameliorate immune activation in an HIV population with metabolic dysregulation, systemic and end organ inflammation. Clinical Trials Registration. NCT02196831. Treatment with a growth hormone releasing hormone analog in people with human immunodeficiency virus and nonalcoholic fatty liver disease decreased circulating proteins associated with immune activation pathways. Gene set enrichment analysis of RNA-seq in liver confirmed down-regulation of end-organ immune activation pathways.