Mecanismes fisiopatològics de lesió mitocondrial secundària: antiretrovirals, antibiòtics, antipsicòtics i monòxid de carboni.
SUMMARY: This thesis is composed by 5 articles and one manuscript on preparation which analyse the mechanisms of mitochondrial lesion induced by some mitochondrial toxic (mitotoxic) agents such as the human immunodeficiency virus (HIV), the antiretroviral treatment (ARVT) used to treat HIV infection, an antibiotic named linezolid, different antipsychotics and carbon monoxide (CO). All these studies have been performed on humans samples that have been analysed ex-vivo. Many mitotoxic agents induce mitochondrial lesion and clinical symptoms common to primary (hereditary or genetic) mitochondriopathies. Primary mitochondrial disorders are not much frequent on general population, but many people is exposed to mitotoxic agents, many of them, because are routinely drugs in clinical practice. The first three studies of the present thesis analyse mitochondrial toxicity of both HIV and ARVT to establish less invasive methods to study mitochondrial dysfunction and the reversibility of HIV and ARVT-induced mitochondrial damage. They have validated the use of peripheral blood mononuclear cells and the forearm aerobic effort test to study mitochondrial lesion in HIV-infected and ARV-treated patients. These studies have determined that mitochondrial lesion reverts after an hyperlactatemic episode and partially recovers after changing potent mitotoxic ARVT (dideoxynucleosides) by theoretically less mitotoxic drugs (saquinavir/ritonavir+tenofovir+enfuvirtide) or after reducing ARV doses (didanosine from 400 to 250 mg/d+tenofovir+nevirapine). The forth study analyses mitochondrial toxicity of linezolid in patients suffering from hyperlactatemia. It demonstrates that linezolid inhibits mitochondrial protein synthesis and respiratory chain function, albeit increased mitochondrial transcription rates (maybe as an homeostatic intent to upregulate linezolid inhibited translation), and that all these mitochondrial abnormalities revert with linezolid withdrawal. The fifth study analyses mitochondrial toxicity of antipsychotics, which inhibit mitochondrial complex I function, and in case of haloperidol, indeed, increases oxidative stress. Antipsychotic mitochondrial lesion is proportional to their capacity to induce extrapiramidal disorders (haloperidol > risperidona > clozapina). Maybe mitochondrial lesion could be partially responsible of clinical adverse manifestations. The sixth study (unique work not published) use mitochondrial function monitorisation to evaluate different therapeutic options to treat acute CO intoxication. CO binds to mitochondrial complex IV inhibiting its function, independent to intoxication severity, without increasing oxidative stress. In CO poisoning mitochondrial function is recovered along the time independent to oxygen treatment option. Thus, recover of mitochondrial function after CO intoxication only requires of one hyperbaric oxygen session for severe poisoned patients and normobaric oxygen for the moderate ones, although these results have to be validated with a bigger amount of patients.
Document Full Text
Advisor:Miró Andreu, Òscar; Cardellach López, Francesc
School:Universitat de Barcelona
Source Type:Master's Thesis
Date of Publication:09/29/2008