Lipodystrophy in HIV and FGF21: A new marker?

What is it about?

Recently new evidence about fibroblast growth factor 21 (FGF21) highlights the opportunities to use this molecule in new pharmaceutical formulations to combat type 2 diabetes and metabolic syndrome. It is well known that HIV is per se a condition of insulin resistance and in particular the patient with HIV-related lipodystrophy has a condition strictly related to metabolic syndrome.FGF21 is expressed mainly by the liver, but also by other tissues such as the thymus, adipose tissue, and skeletal muscle. Therefore, many researchers have considered the investigation of possible variations of FGF21 in patients with significant alterations in body composition both in regard to fat mass and lean mass. In the light of the possible interactions between FGF21 and metabolic syndrome, it seems interesting to evaluate the implication of this hormone in patients with HIV-related lipodystrophy who have a severe metabolic picture of insulin resistance with important alterations in body composition. The role of adipocytokines and of other hormones in the pathogenesis of HIV-associated lipodystrophy is still not enough understood. Adipose tissue showed a large high expression of FGF receptor 1 and emerged as a strong candidate to represent a predominant FGF21 target tissue. This new evidence about FGF21 highlights the opportunities to target this molecule for new pharmaceutical formulations to combattype 2 diabetes and metabolic syndrome and that a rise in circulating FGF21 has been proposed as a predictor ofthe development of the metabolic syndrome and type 2 diabetes mellitus. We decided to propose this hormone as a marker of metabolic and morphological alterations in the patient with HIV-related lipodystrophy in order to monitor the efficacy of the proposed interventions (drugs, modification of lifestyle, and different supplements). It seems clear that the value of FGF21 in this group of patients could be employed on a large scale in order to assess the starting point of start of this complication and then monitoring the effectiveness of intervention proposed through dosing FGF21 over time. The opportunity to use the same assay to monitor the metabolic and morphologic distribution of fat linked to lipodystrophy looks very interesting and promising.

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Why is it important?

Given the severe metabolic and morphological alterations of adipose tissue in HIV-related lipodystrophy, FGF21 appears be an ideal candidate to assess the susceptibility of a patient with HIV to develop lipodystrophy. This protein can be a promising marker for assessing the effectiveness of pharmacological and other interventions on lipodystrophy.

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