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Blood, 15 May 2002, Vol. 99, No. 10, pp. 3771-3779
NEOPLASIA
Antitumorigenic effects of HIV protease inhibitor ritonavir:
inhibition of Kaposi sarcoma
Shibani Pati,
Colleen B. Pelser,
Joseph Dufraine,
Joseph L. Bryant,
Marvin S. Reitz Jr, and
Frank F. Weichold
From the Institute of Human Virology, University of
Maryland Biotechnology Institute; Department of Microbiology and
Immunology, University of Maryland; and Department of Biology, Morgan
State University, Baltimore, MD.
Treatment of patients with human immunodeficiency virus (HIV)
protease inhibitors such as ritonavir can result in increases in
CD4+ T-cell counts that are independent of a reduction in
HIV-1 viral load. This lack of correlation between the 2 has led to the
identification of additional effects of ritonavir that potentially
alter HIV disease pathogenesis. Our previous studies indicated that
ritonavir directly affects immune cell activation, proliferation, and
susceptibility to apoptosis. We show here that ritonavir inhibited the
activation and proliferation of primary endothelial cells and decreased
the production of tumor necrosis factor (TNF- ) interleukin 6 (IL-6), IL-8, and vascular endothelial growth factor, factors that all contribute to tumor neovascularization and to the development of Kaposi
sarcoma (KS) lesions. Ritonavir also suppressed the expression of
vascular cell adhesion molecule 1, intercellular adhesion molecule 1, and E-selectin, which correlated with a functional decrease in
leukocyte adhesion. Transcriptional activation of nuclear factor- B,
as induced by the KS-promoting factor TNF- , the HIV-1 Tat protein,
or the human herpesvirus 8 protein ORF74, was inhibited by ritonavir.
KS-derived cell lines underwent apoptosis in vitro after treatment with
ritonavir at concentrations that are obtained in clinical therapy (3-15 µM). In a KS mouse xenotransplantation model, ritonavir inhibited
tumor formation and progression by KS-derived cells. Taken together,
these data suggest that ritonavir has antineoplastic effects that are
independent from its ability to inhibit the HIV protease.

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