Turnover of adipose components and mitochondrial DNA in humans: kinetic biomarkers for human immunodeficiency virus-associated lipodystrophy and mitochondrial toxicity?

Lipoatrophy (LA)/lipodystrophy and nucleoside reverse-transcriptase inhibitor (NRTI)-associated syndrome are of central importance in human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) care. Neither of these conditions has had a clear pathogenesis or biomarker defined for early detection, prevention research, or patient management. I describe the recent development of kinetic biomarkers for LA and mitochondrial toxicity that involve the measurement of biosynthetic fluxes rather than static concentrations of molecules. The turnover of adipose-tissue components (lipids and cells) and tissue mitochondrial DNA is measured by the incorporation of deuterium from heavy water, using mass spectrometry. Preliminary results in animal models and humans, including the effects of NRTIs on mitochondrial DNA synthesis in rats and adipose-tissue lipid kinetics in HIV-associated LA, are reviewed. The results suggest that the kinetics of adipose-tissue components and mitochondrial DNA are measurable in vivo and that these measurements may prove useful as clinical biomarkers in patients with HIV/AIDS.