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

MWH Wang, S Wei, R Faccio… - The Journal of …, 2004 - Am Soc Clin Investig
MWH Wang, S Wei, R Faccio, S Takeshita, P Tebas, WG Powderly, SL Teitelbaum, FP Ross
The Journal of clinical investigation, 2004Am Soc Clin Investig
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 …
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 κB ligand–induced (RANKL-induced) activation of NF-κB 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.
The Journal of Clinical Investigation