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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1560.)
© 2002 American Heart Association, Inc.

Vascular Biology

HIV Protease Inhibitor Ritonavir Induces Cytotoxicity of Human Endothelial Cells

Dian-sheng Zhong; Xiang-huai Lu; Brian S. Conklin; Peter H. Lin; Alan B. Lumsden; Qizhi Yao; Changyi Chen

From the Winship Cancer Institute (D.Z.) and Department of Medicine (X.L.), Emory University, Atlanta, Ga, and the Michael E. DeBakey Department of Surgery (B.S.C., P.H.L., A.B.L., Q.Y., C.C.), Baylor College of Medicine, Houston, Tex.

Correspondence to Changyi (Johnny) Chen, MD, PhD, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6550 Fannin, SM 1661, Houston, TX 77030. E-mail jchen{at}bcm.tmc.edu

Objective— Although HIV protease inhibitors have been successfully used against HIV infection, many metabolic side effects and premature cardiovascular diseases are often associated with this therapy. The mechanisms of these complications are not clear. In this study, we investigated the effect of the HIV protease inhibitor ritonavir on human endothelial cell cultures.

Methods and Results— By using nonradioactive cell proliferation and cytotoxicity assays, human endothelial cells treated with ritonavir showed a significant decrease in cell viability and an increase in cytotoxicity in a time- and dose-dependent fashion. Mitochondrial DNA was also substantially damaged with ritonavir treatment by long polymerase chain reaction analysis. In contrast, ritonavir had a very limited effect on endothelial apoptosis, as assessed by analyses of DNA fragmentation and cellular caspase-3 activity.

Conclusions— These data demonstrate, for the first time, that the HIV protease inhibitor ritonavir at concentrations near clinical plasma levels is able to directly cause endothelial mitochondrial DNA damage and cell death mainly through necrosis pathways but not through apoptosis. This study suggests that HIV protease inhibitor–mediated endothelial injury may contribute to its cardiovascular complications.

Key Words: HIV protease inhibitor • ritonavir • cytotoxicity • endothelial cells • cardiovascular disease

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