The additive effect of type 2 diabetes on fibrinogen, von Willebrand factor, tryptophan and threonine in people living with HIV
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Chronic immune activation and ensuing inflammation that accompany HIV infection lead to adverse metabolic consequences and an increased risk of type 2 diabetes (T2D). We examined the additive effects of T2D on circulating biomarkers involved in inflammation, coagulation, and vascular function along with plasma amino acids in people living with HIV (PLWH). This cross-sectional study included PLWH with and without T2D (n = 32 total). Analyses involved a multiplex platform for circulating biomarkers and gas chromatography–vacuum ultraviolet spectroscopy for plasma amino acids. In PLWH and T2D, both fibrinogen (2.0 ± 0.6 vs 1.6 ± 0.4 µg/mL, p = 0.02) and von Willebrand factor (vWF) (40.8 ± 17.2 vs 26.7 ± 13.8 µg/mL, p = 0.02) were increased and tryptophan (47 ± 6 vs 53 ± 8 nmol/mL, p = 0.03) and threonine (102 ± 25 vs 125 ± 33 nmol/mL, p = 0.03) were decreased. Fibrinogen, as a biomarker of inflammation, and vWF, as a biomarker of endothelial dysfunction, are augmented by the combined effects of HIV and T2D and may contribute to the pathogenesis of T2D in PLWH. Chronic immune activation and inflammation compromise the integrity of the intestinal mucosa, which increases mucus production. Tryptophan metabolism is altered by a loss of intestinal membrane integrity and threonine is consumed in the production of mucus. Metabolic competition arising from increased protein synthesis in the setting of chronic inflammation along with the associated loss in intestinal membrane integrity may be a primary mechanism in the pathogenesis of T2D in PLWH and requires further investigation.
KeywordsHIV Diabetes Fibrinogen von Willebrand factor Tryptophan Threonine
This research was supported by The St. David’s Center for Health Promotion and Disease Prevention Research in Underserved Populations provided by the University of Texas at Austin School of Nursing. The authors would like to thank our colleagues at VUV Analytics, as they provided the detector used in the amino acid identification and quantification along with valuable insight and expertise. The authors would also like to extend our appreciation to Phenomenex Inc. for providing materials used in the extraction and derivatization of the plasma free amino acids.
This research was supported by The St. David’s Center for Health Promotion and Disease Prevention Research in Underserved Populations provided by the University of Texas at Austin School of Nursing.
Compliance with ethical standards
Conflict of interest
The following author, MLH, declares a competing financial interest as her spouse was a founder and is currently the Chief Technical Officer of VUV Analytics, Inc. The remaining authors have no conflicts to disclose, financial or otherwise.
Research involving human participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Texas at Austin and with the 1964 Helsinki Declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
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