The HIV protease inhibitor ritonavir blocks osteoclastogenesis and function by impairing RANKL-induced signaling

J Clin Invest. 2004 Jul;114(2):206-13. doi: 10.1172/JCI15797.

Abstract

Highly active antiretroviral therapy (HAART), which includes HIV protease inhibitors (PIs), has been associated with bone demineralization. To determine if this complication reflects accelerated resorptive activity, we studied the impact of two common HIV PIs, ritonavir and indinavir, on osteoclast formation and function. Surprisingly, we find that ritonavir, but not indinavir, inhibits osteoclast differentiation in a reversible manner and also abrogates bone resorption by disrupting the osteoclast cytoskeleton, without affecting cell number. Ritonavir given in vivo completely blunts parathyroid hormone-induced osteoclastogenesis in mice, which confirms that the drug is bone sparing. In keeping with its antiresorptive properties, ritonavir impairs receptor activator of nuclear factor kappaB ligand-induced (RANKL-induced) activation of NF-kappaB and Akt signaling pathways, both critical to osteoclast formation and function. In particular, ritonavir is found to inhibit RANKL-induced Akt signaling by disrupting the recruitment of TNF receptor-associated factor 6/c-Src complex to lipid rafts. Thus, ritonavir may represent a bone-sparing PI capable of preventing development of osteopenia in patients currently on HAART.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Animals
  • CSK Tyrosine-Protein Kinase
  • Carrier Proteins / metabolism*
  • Cell Differentiation / drug effects
  • Cell Differentiation / physiology
  • Cells, Cultured
  • Cytoskeleton / metabolism
  • HIV Protease Inhibitors / pharmacology*
  • Humans
  • Indinavir / pharmacology
  • Macrophage Colony-Stimulating Factor / pharmacology
  • Macrophages / cytology
  • Macrophages / metabolism
  • Membrane Glycoproteins / metabolism*
  • Membrane Microdomains / metabolism
  • Mice
  • NF-kappa B / metabolism
  • Osteoclasts / cytology
  • Osteoclasts / drug effects*
  • Osteoclasts / physiology*
  • Parathyroid Hormone / metabolism
  • Phosphatidylinositol 3-Kinases / genetics
  • Phosphatidylinositol 3-Kinases / metabolism
  • Protein Serine-Threonine Kinases / metabolism
  • Protein-Tyrosine Kinases / metabolism
  • Proteins / metabolism
  • Proto-Oncogene Proteins / metabolism
  • Proto-Oncogene Proteins c-akt
  • RANK Ligand
  • Receptor Activator of Nuclear Factor-kappa B
  • Receptors, Tumor Necrosis Factor / metabolism
  • Ritonavir / pharmacology*
  • Signal Transduction / physiology*
  • TNF Receptor-Associated Factor 6
  • src-Family Kinases

Substances

  • Carrier Proteins
  • HIV Protease Inhibitors
  • Membrane Glycoproteins
  • NF-kappa B
  • Parathyroid Hormone
  • Proteins
  • Proto-Oncogene Proteins
  • RANK Ligand
  • Receptor Activator of Nuclear Factor-kappa B
  • Receptors, Tumor Necrosis Factor
  • TNF Receptor-Associated Factor 6
  • TNFRSF11A protein, human
  • TNFSF11 protein, human
  • Tnfrsf11a protein, mouse
  • Tnfsf11 protein, mouse
  • Indinavir
  • Macrophage Colony-Stimulating Factor
  • Protein-Tyrosine Kinases
  • CSK Tyrosine-Protein Kinase
  • src-Family Kinases
  • CSK protein, human
  • AKT1 protein, human
  • Protein Serine-Threonine Kinases
  • Proto-Oncogene Proteins c-akt
  • Ritonavir