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Kayode Balogun, MSc, PhD
Workshop on HIV & Women
March 3, 2018
Changes in Brain Volume and Cognition in Mice Exposed In Utero
to ABC/ 3TC-ATV/ RTV
Women and HIV
➢1.5 million HIV+ women become pregnant each year
➢Combination antiretroviral therapy (cART) recommended during pregnancy
➢Successfully prevent vertical transmission of HIV
➢Uncertainty about the potential long-term effects cART-exposed children
Insults During Fetal Growth
Adverse In utero Environment
Low Birth Weight
Preterm
Fetal Programming: Developmental Origins of Health and Disease (DOHaD)
Predisposition to chronic diseases and developmental delays
HIV & cART
HIV-Exposed Uninfected (HEU) Children
• Increased susceptibility to infection
• Stunted growth in early life
• Smaller head circumference
• Speech and language delay
•Deficits in cognitive and motor development
HEU and Cognition
Hypothesis
Perinatal cART exposure alters fetal development, and results in impaired
neurological development by adversely affecting the growing brain and nervous
system
Consideration
•Delineate the effect of the drugs from HIV
• Timely information
• Test different drug regimen
•Genetically identical—eliminates genetic variations
Objective 1
To assess the impact of in utero exposure to cART on fetal brain morphology
Approach
Female C57BL/6 mice
Pregnancy
GD1
Control
cART
GD15.5
Fetuses
Micro-CT scan➢Volumetric analysis
cART=ABC/3TC+ATV/RTV
cART was Associated with Low Fetal Weight in Pregnant c57BL/6 mice
Data = Mean and Range; Statistics = Mann Whitney; n=8 litters/group
Control cART0.0
0.2
0.4
0.6
P = 0.007F
eta
l W
eig
ht
(g)
cART was Associated with Changes in Volumetric Measurements in different
Regions of Fetal Mouse Brain
Data = Mean and Range; Statistics = Mann Whitney; n=8
Noecortex and amygdala (purple), thalamus (green),Hypothalamus (blue),
Med
ulla
Cer
ebel
lar P
rimor
dium
Neo
pallia
l cor
tex
and
amyg
dala
Hyp
otha
lam
us
Thala
mus
Pons
Spina
cor
d0.00
0.05
0.10
0.15
Control
cART
13%
10%
-7%
7%
5%
10%
8%
****
*
*
*
**
*
Norm
aliz
ed
Vo
lum
e
What about adult mice?
Approach
Female C57BL/6 mice
Pregnancy
GD1
Control
cART
WeightsMRIBehavioural tests
Delivery
cART Exposed Mice were Smaller than the Controls
Data = Median and Range; (Two way ANOVA; n= 20-22 per group)
Male Female15
20
25
30
35
ControlcARTP<0.0001
P<0.0001
We
igh
t (g
)
cART-exposed Mice had Smaller Brains than the Controls
Brain GM250
300
350
400
450
500
ControlPI-cART
Treatment: P<0.0001
Vo
lum
e (
mm
3)
Data = Median and Range; (Two way ANOVA; n= 13-18)
cART was Associated with Changes in Volumetric Measurements in Different Regions of an Adult Mice Brain (MRI)
Objective 2
To assess the impact of in utero exposure to cART on cognitive, neurosensory and
motor behaviours
cART was Associated with Changes in Volumetric Measurements in Different Regions
of an Adult Mice Brain (MRI)
Control cART0.009
0.010
0.011
0.012
0.013
0.014
P = 0.012
Se
co
nd
ary
Mo
tor
Cort
ex
No
rma
lize
d V
olu
me
Control cART0 . 0 4 5
0 . 0 5 0
0 . 0 5 5
0 . 0 6 0
0 . 0 6 5
P = 0 . 0 3
Pr
i.
S
om
at
os
en
so
ry
co
rt
ex
No
rm
al
iz
ed
V
ol
um
e
Data = Mean and Range; Statistics = Mann Whitney; n=13-16
Strength and Coordination
Joanna et al, Neuromethods, Vol. 39: Neuropeptide Techniques
Data = Median and Range; (Mann Whitney; n= 10-15 for Litter Average)
Control cART0
2
4
6
8
10
P = 0.0005
Days
The Development of Motor Skills was Delayed in Mice Exposed to cART In Utero
Tactile Reflex
The Development of Tactile Reflex was Delayed in Mice Exposed to cART In Utero
Joanna et al, Neuromethods, Vol. 39: Neuropeptide Techniques
Data = Median and Range; (Mann Whitney; n= 10-15 for Litter Average)
Control cART10
12
14
16
P = 0.0005
Days
Olfactory Reflex
The Development of Olfactory Reflex was Delayed in Mice Exposed to cART In Utero
http://www.ssponline.com/shepherds_cob.htm
Litter Averages0
20
40
60
80
ControlcART
73.8%
47.3%
P=0.0065
% P
asse
d
Data = % passed; (Fisher’s exact test; n= 10-15 for Litter Average)
Impaired cognitive function
cART was Associated with Changes in Volumetric Measurements in different Regions of an Adult
Mouse Brain (MRI)
Control cART0.014
0.015
0.016
0.017
0.018
P = 0.0016
CA
1 a
nd
CA
2N
orm
alize
d V
olu
me
Data = Mean and Range; Statistics = Mann Whitney; n=13-16
Control cART0.024
0.026
0.028
0.030
0.032
P = 0.0003
Cin
gu
late
Co
rte
x
Vo
lum
e (
mm
3)
Novel Object Recognition (NOR) Test
3hr
In utero Exposure to PI-cART is Associated with Smaller Hippocampus and a Lower Memory Index
Data = Median and Range n= 20-22; Statistics = Mann Whitney and Spearman’s correlation
Memory Index=(tn-tf)/(tn+tf)
-1.0 -0.5 0.0 0.5 1.00.024
0.026
0.028
0.030
0.032 r=0.48P=0.011
Memory Index
Cin
gu
late
Co
rte
xN
orm
alize
d V
olu
me
ControlcART
-1.0 -0.5 0.0 0.5 1.0
0.015
0.016
0.017r=0.64P=0.0003
Memory Index
CA
1 a
nd
CA
2N
orm
alize
d V
olu
me
Male Female-1.0
-0.5
0.0
0.5
1.0 P<0.0001 P<0.0001
Mem
ory
Index
Speech and Language Delay
Sociability Social Novelty
Sociability and Social Novelty Test
Male Female-1.0
-0.5
0.0
0.5
1.0
1.5
ControlcART
Pre
fere
nce Index
(So
cia
bility)
In utero Exposure to cART had no Effect on Social Interaction
Male Female-1.0
-0.5
0.0
0.5
1.0
1.5
ControlcART
Pre
fere
nce Index
(Socia
l N
ovelty)
Data = Median and Range n= 20-25; Statistics = Two-way ANOVA
Preference Index=(tn-tf)/(tn+tf)
Compared to control, in utero exposure to ABC/3TC+ATV/RTV was associated to with:
➢Lower fetal and adult weights
➢Changes in volumetric measurement in fetal and adult brains
➢Delayed motor, tactile, and olfactory reflexes
➢Lower memory index
Summary
Conclusion
Our data suggest that the in utero exposure to ABC/3TC+ ATV/RTV is associated with
volumetric changes in key regions of the brain, developmental delays, and cognitive deficits in
a mouse model of pregnancy.
Acknowledgments
• Dr. Lena Serghides
• Dr. Sharon Walmsley
• Dr. Smriti Kala
• Dr. Monica Guzman-Lenis
• Jeffrey Lu
• Pierre Lira
• Members of the Serghides’ lab
FundingOntario HIV Treatment Network Canadian Institutes of Health ResearchCanadian Foundation for AIDS ResearchOur collaborators
Collaborators• Dr. Howard Mount• Dr. John Sled• Dr. Lindsay Cahill• Lisa Yu• Jimmy Yang
www.flickr.com
Dr. Kayode Balogun is supported by a
CTN Postdoctoral Fellowship Award
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