PROJECT SUMMARY/ABSTRACT
A major problem in virally suppressed people with human immunodeficiency virus (VS-PWH) is that despite well-
controlled viral suppression many patients develop cognitive impairment, especially during aging. Furthermore,
aging is a primary risk factor for cognitive impairment in the healthy population. Recent clinical and preclinical
studies identified neuroinflammation increases during aging and in VS-PWH. For example, brain imaging studies
in VS-PWH showed elevated markers for inflammation even under antiretroviral therapy. Moreover, the elevation
of inflammation markers correlated with worse cognitive performance. Thus, the synergistic neuroinflammation
brought on by aging and HIV may lead to the greater susceptibility for cognitive decline in some PWH. There is
a lack of understanding for how neuroinflammation drives cognitive decline and a major unmet clinical need to
develop a robust resource to track brain associated immune cells in VS-PWH to examine neuroinflammation
more directly in living patients. This project aims to track inflammatory macrophage states in vivo using
inflammatory mouse models for both aging and HIV infection (EcoHIV) and then determine which states are
prominent in human disease and contribute to clinical pathology. The specific aims are to 1) determine the spatial
distribution of microglia activation states in inflammatory mouse models. We will use hypothesis-driven spatial
transcriptomics to map macrophage and microglia activation states in two mouse models with underlying
neuroinflammation: two-year aged, and HIV infected (EcoHIV) mice. Second, we will isolate brain-associated
immune cells in the cerebrospinal fluid (CSF) of VS-PWH to identify myeloid activation states which contribute
to disease pathology. In aim 2a, we will identify gene expression modules in CSF-derived myeloid cells that
associate with age and predict clinical pathology. Then in aim 2b, we will define the myeloid activation states
enriched in CSF from VS-PWH compared to HIV-uninfected controls. The hypothesis is that genes enriched in
CSF-derived myeloid cells will stratify patients with persistent neuroinflammation and at a greater susceptibility
for cognitive impairment. Additionally, the spatial transcriptomics from the disease relevant animal models will
provide a biologically relevant context for the disease-enriched activation states identified in VS-PWH. The
overall goal of the proposed Career Development Award (K01) is to identify the cellular honing of immune cells
to the brain, uncover disease modulating cellular markers of neuroinflammation on cognitive deficits, and
establish CSF-derived cells as a unique resource for monitoring neuroinflammation in people living with HIV.
These goals will be accomplished by the specific aims and facilitated by the proposed training plan which is
divided into three domains: 1) biostatistics and data science, 2) inflammation in HIV and aging, and 3)
professional development. The training plan was designed to gain expertise in HIV research, a new direction for
the PI, and to establish an independent laboratory with a research program focused on the regulation of brain
immune cell activity and the consequential impact on brain function in human disease.
