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Autophagy and apoptosis are natural cellular mechanisms which consist for the first in a recycling and elimination process of potentially toxic cellular waste, and for the second in a process of cellular suicide when it becomes abnormal and "not" repairable, notably by autophagy. A deficit in autophagic function at the cellular level can lead to chronic inflammation and accelerated cellular senescence. Apoptosis is a beneficial phenomenon because it eliminates abnormal cells that could endanger the organism if it survives (e.g. karyotypic atypia). Uncontrolled, it can be deleterious if apoptosis is hypo or hyperactive.
The Centre of Molecular Biology of the CNRS in Orléans has developed for many years an expertise concerning apoptosis via the discovery of the GALIG gene. This pro-apoptotic gene produces two proteins, one of which, cytogaligin, interacts with several proteins involved in autophagy.
Recent translational research conducted jointly by the CNRS and CHR Orléans teams have shown that PBMC from HIV-infected patients who have been on effective cART for at least 4 years show changes in the expression of certain genes involved in autophagy (BECN1, GABARAPL1, MAP1LC3B and GALIG). Gomez-Mora et al. also reported a decrease in autophagic function in CD4+ T cells of patients, with the impairment of autophagy being more important as the reconstitution of the CD4+ T compartment is incomplete. Thus, autophagy defects are more pronounced in patients whose CD4 T cell count remains low, suggesting a link between autophagy and CD4 T cell depletion.In summary, even after prolonged virological control and apparent immune reconstitution, PLWH (people living with HIV) exhibit deregulation of genes involved in autophagy.
In the simian model, Δ9-tetrahydrocannabinol (Δ9-THC) cannabinoids would reduce inflammation associated with intestinal tissues, but also SIV viral load and mortality in males only. A recent review points to the potential benefit of cannabinoids on inflammation in the context of HIV. PLHIV who regularly use cannabis, and therefore potentially exposed to Δ9-THC and cannabidiol (CBD), have been the subject of a significant literature. Thus, it has been reported that in these patients, compared to non-consumers, there is a greater reduction in the HIV reservoir (HIV-DNA), a decrease in activated monocytes, the latter being linked to inflammation, as well as a reduced activation of CD4+ and CD8+ lymphocytes.
A first analysis is based on 6 HIV+ patients virologically controlled for at least 4 years, having absorbed, as a dietary supplement, for 4 weeks a dose of 30 mg x2 per day of CBD duly controlled pharmacologically (Δ9-THC dosage < 0.1%) and having declared not to use drugs. We were able to note by discriminant factor analysis (DFA):
Thus, CBD, which has no psychotropic effect, could have beneficial effects on HIV patients by reducing cellular senescence, inflammation and their consequences in terms of co-morbidities as well as the level of HIV reservoirs through an apoptotic phenomenon of cells hosting HIV in a quiescent state. Among the molecules present in the plant and in particular the species Cannabis sativa L., can be present the CBD, the Δ9 THC and a multitude of terpenes without psychotropic effects, which would be responsible for an "effect of entourage". Studies argue for a synergistic effect of these molecules to lead to the suspected effects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CBD LGP 50 group | Experimental | Patients will receive CBD LGP 50 at a dose of 1 mg/kg twice a day in the form of oil dispensed through a graduated pipette until the end of week 12. |
|
| Control group | Placebo Comparator | Patients will receive the MCT oil placebo without CBD until the end of week 12. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CBD LGP 50 | Drug | Patients will receive CBD LGP 50 at a dose of 1 mg/kg twice a day in the form of oil dispensed through a graduated pipette until the end of week 12. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of variation in the quantification of the corresponding mRNAs | Percentage of variation in the quantification of the corresponding mRNAs in the mononuclear cells in the different arms of the study | Day 0 |
| Percentage of variation in the quantification of the corresponding mRNAs | Percentage of variation in the quantification of the corresponding mRNAs in the mononuclear cells in the different arms of the study | Week 4 |
| Percentage of variation in the quantification of the corresponding mRNAs | Percentage of variation in the quantification of the corresponding mRNAs in the mononuclear cells in the different arms of the study | Week 12 |
| Measure | Description | Time Frame |
|---|---|---|
| Quantifications of the quantities of mRNA in each cell subpopulation | Quantifications of the mRNAs corresponding to S16 and comparison with the data obtained on D0, S4 and S12, and with those obtained from HIV negative donors. | Day 0 |
| Quantifications of the quantities of mRNA in each cell subpopulation |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Thierry PRAZUCK, Dr | CHR d'Orléans | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre Hospitalier Régional d'Orléans, France | Orléans | 45000 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 11160123 | Background | Guittaut M, Charpentier S, Normand T, Dubois M, Raimond J, Legrand A. Identification of an internal gene to the human Galectin-3 gene with two different overlapping reading frames that do not encode Galectin-3. J Biol Chem. 2001 Jan 26;276(4):2652-7. doi: 10.1074/jbc.m002523200. | |
| 7729540 | Background | Raimond J, Rouleux F, Monsigny M, Legrand A. The second intron of the human galectin-3 gene has a strong promoter activity down-regulated by p53. FEBS Lett. 1995 Apr 17;363(1-2):165-9. doi: 10.1016/0014-5793(95)00310-6. |
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| Placebo | Drug | Patients will receive the MCT oil placebo without CBD until the end of week 12. |
|
Quantifications of the mRNAs corresponding to S16 and comparison with the data obtained on D0, S4 and S12, and with those obtained from HIV negative donors. |
| Week 4 |
| Quantifications of the quantities of mRNA in each cell subpopulation | Quantifications of the mRNAs corresponding to S16 and comparison with the data obtained on D0, S4 and S12, and with those obtained from HIV negative donors. | Week 12 |
| Quantification of the Global and targeted methylation (promoters of autophagy genes) of DNA | Quantification of the Global and targeted methylation (promoters of autophagy genes) of DNA and comparison according to the dose administered | Day 0 |
| Quantification of the Global and targeted methylation (promoters of autophagy genes) of DNA | Quantification of the Global and targeted methylation (promoters of autophagy genes) of DNA and comparison according to the dose administered | Week 4 |
| Quantification of the Global and targeted methylation (promoters of autophagy genes) of DNA | Quantification of the Global and targeted methylation (promoters of autophagy genes) of DNA and comparison according to the dose administered | Week 12 |
| Quantification of the mRNAs for autophagy genes and pro and anti-inflammatory cytokines | Quantification of the mRNAs for autophagy genes and pro and anti-inflammatory cytokines and comparison according to the dose administered | Day 0 |
| Quantification of the mRNAs for autophagy genes and pro and anti-inflammatory cytokines | Quantification of the mRNAs for autophagy genes and pro and anti-inflammatory cytokines and comparison according to the dose administered | Week 4 |
| Quantification of the mRNAs for autophagy genes and pro and anti-inflammatory cytokines | Quantification of the mRNAs for autophagy genes and pro and anti-inflammatory cytokines and comparison according to the dose administered | Week 12 |
| Quantification of the dosage of pro and anti-inflammatory cytokines in serum and after in vitro activation of PBMCs | Quantification of the dosage of pro and anti-inflammatory cytokines in serum and after in vitro activation of PBMCs and comparison according to the dose administered | Day 0 |
| Quantification of the dosage of pro and anti-inflammatory cytokines in serum and after in vitro activation of PBMCs | Quantification of the dosage of pro and anti-inflammatory cytokines in serum and after in vitro activation of PBMCs and comparison according to the dose administered | Week 4 |
| Quantification of the dosage of pro and anti-inflammatory cytokines in serum and after in vitro activation of PBMCs | Quantification of the dosage of pro and anti-inflammatory cytokines in serum and after in vitro activation of PBMCs and comparison according to the dose administered | Week 12 |
| Quantification of the expression of the proteins encoded by these same genes | Quantification of the expression of the proteins encoded by these same genes and comparison according to the dose administered | Day 0 |
| Quantification of the expression of the proteins encoded by these same genes | Quantification of the expression of the proteins encoded by these same genes and comparison according to the dose administered | Week 4 |
| Quantification of the expression of the proteins encoded by these same genes | Quantification of the expression of the proteins encoded by these same genes and comparison according to the dose administered | Week 12 |
| Quantification of the autophagic function by detection of positive LC3b vesicles | Quantification of the autophagic function by detection of positive LC3b vesicles and comparison according to the dose administered | Day 0 |
| Quantification of the autophagic function by detection of positive LC3b vesicles | Quantification of the autophagic function by detection of positive LC3b vesicles and comparison according to the dose administered | Week 4 |
| Quantification of the autophagic function by detection of positive LC3b vesicles | Quantification of the autophagic function by detection of positive LC3b vesicles and comparison according to the dose administered | Week 12 |
| Quantification of the activation (CD38, HLA-DR) and degree of senescence (CD57, PD1) of CD4 and CD8 lymphocytes and monocytes (CD16, HLA-DR) | Quantification of the activation (CD38, HLA-DR) and degree of senescence (CD57, PD1) of CD4 and CD8 lymphocytes and monocytes (CD16, HLA-DR) and comparison according to the dose administered | Day 0 |
| Quantification of the activation (CD38, HLA-DR) and degree of senescence (CD57, PD1) of CD4 and CD8 lymphocytes and monocytes (CD16, HLA-DR) | Quantification of the activation (CD38, HLA-DR) and degree of senescence (CD57, PD1) of CD4 and CD8 lymphocytes and monocytes (CD16, HLA-DR) and comparison according to the dose administered | Week 4 |
| Quantification of the activation (CD38, HLA-DR) and degree of senescence (CD57, PD1) of CD4 and CD8 lymphocytes and monocytes (CD16, HLA-DR) | Quantification of the activation (CD38, HLA-DR) and degree of senescence (CD57, PD1) of CD4 and CD8 lymphocytes and monocytes (CD16, HLA-DR) and comparison according to the dose administered | Week 12 |
| Quantification of T3, T4, T8, NK, NK-T, B populations, monocytes. | Quantification of T3, T4, T8, NK, NK-T, B populations, monocytes and comparison according to the dose administered | Day 0 |
| Quantification of T3, T4, T8, NK, NK-T, B populations, monocytes. | Quantification of T3, T4, T8, NK, NK-T, B populations, monocytes and comparison according to the dose administered | Week 4 |
| Quantification of T3, T4, T8, NK, NK-T, B populations, monocytes. | Quantification of T3, T4, T8, NK, NK-T, B populations, monocytes and comparison according to the dose administered | Week 12 |
| Measurement of DNA-HIV in PBMCs | Day 0 |
| Measurement of DNA-HIV in PBMCs | Week 4 |
| Measurement of DNA-HIV in PBMCs | Week 12 |
| Incidence and severity of AEs and laboratory abnormalities | Week 12 |
| Proportion of patients who discontinued treatment due to AE | Week 12 |
| Determination of CBD in the blood at W12, compared to assays S0 and S16 | Week 12 |
| Quality of life questionnaire | It is a self-assessment quality of life scale comprising 11 questions | Day 0 |
| Quality of life questionnaire | It is a self-assessment quality of life scale comprising 11 questions | Week 4 |
| Quality of life questionnaire | It is a self-assessment quality of life scale comprising 11 questions | Week 12 |
| 19071086 | Background | Gonzalez P, Robinet P, Charpentier S, Mollet L, Normand T, Dubois M, Legrand A. Apoptotic activity of a nuclear form of mitogaligin, a cell death protein. Biochem Biophys Res Commun. 2009 Jan 23;378(4):816-20. doi: 10.1016/j.bbrc.2008.11.133. Epub 2008 Dec 9. |
| 15561101 | Background | Duneau M, Boyer-Guittaut M, Gonzalez P, Charpentier S, Normand T, Dubois M, Raimond J, Legrand A. Galig, a novel cell death gene that encodes a mitochondrial protein promoting cytochrome c release. Exp Cell Res. 2005 Jan 15;302(2):194-205. doi: 10.1016/j.yexcr.2004.08.041. |
| 20056110 | Background | Robinet P, Mollet L, Gonzalez P, Normand T, Charpentier S, Brule F, Dubois M, Legrand A. The mitogaligin protein is addressed to the nucleus via a non-classical localization signal. Biochem Biophys Res Commun. 2010 Jan 29;392(1):53-7. doi: 10.1016/j.bbrc.2009.12.162. Epub 2010 Jan 7. |
| ID | Term |
|---|---|
| D006679 | HIV Seropositivity |
| ID | Term |
|---|---|
| D015658 | HIV Infections |
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
| D015229 | Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
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