Human Immunodeficiency Virus Type-1 Accessory Protein Vpr: A Causative Agent of the AIDS-Related Insulin Resistance/Lipodystrophy Syndrome?

Recent advances in the development of three different types of antiviral drugs, the nucleotide and non‐nucleotide analogues acting as reverse transcriptase inhibitors (NRTIs) and the nonpeptidic viral protease inhibitors (PI), and their introduction in the management of patients with AIDS, either alone or in combination, have dramatically improved the clinical course of the disease and prolonged life expectancy in patients with AIDS. The increase in life expectancy in association with the long‐term use of the above antiviral agents, however, have generated novel morbidities and complications. Central among them is the quite common AIDS‐related insulin resistance and lipodystrophy syndrome, which is characterized by a striking phenotype and marked metabolic disturbances. To look for the pathologic causes of this particular syndrome, we focused on one of the HIV‐1 accessory proteins, Vpr, which has multiple functions, such as virion incorporation, nuclear translocation of the HIV‐1 preintegration complex, nucleo‐cytoplasmic shuttling, transcriptional activation, and induction of apoptosis. Vpr may also act like a hormone, which is secreted into the extracellular space and affects the function of distant organs. Vpr functions as a coactivator of the glucocorticoid receptor and potentiates the action of glucocorticoid hormones, thereby inducing tissue glucocorticoid hypersensitivity. Vpr also arrests host cells at the G2/M phase of the cell cycle by interacting with novel 14‐3‐3 proteins. Vpr facilitates the interaction of 14‐3‐3 and its partner protein Cdc25C, which is critical for the transition of G2/M checkpoint in the cell cycle, and suppresses its activity by segregating it into the cytoplasm. The same Vpr protein also suppresses the association of 14‐3‐3 with other partner molecules, the Foxo transcription factors. Since the Foxo proteins function as negative transcription factors for insulin, Vpr may cause resistance of tissues to insulin. Through these two newly identified functions of Vpr, namely, coactivation of glucocorticoid receptor activity and inhibition of insulin effects on Foxo proteins, Vpr may participate in the development of AIDS‐related insulin resistance/lipodystrophy syndrome.