Objective
DKK1 is a soluble antagonist of the Wnt pathway. It binds to and sequesters LRP5/6 away from Wnts. Because the Wnt pathway regulates synaptic transmission and plasticity, we hypothesized that increased DKK1 would increase the risk for neurocognitive impairment (NCI) in HIV+ individuals. We evaluated here the relationship between plasma DKK1 and global NCI.
Methods
Plasma samples and data from 41 HIV+ and 42 HIV− adults were obtained from the University of California, San Diego. Concentrations of DKK1 and a comparator protein, MCP-1, were quantified in plasma by immunoassay. All subjects completed a standardized comprehensive neuropsychological test battery and their performance was summarized using the global deficit score (GDS) method.
Results
A higher DKK1 level was associated with NCI among HIV+ participants (d=0.63, p=0.05), particularly among the 26 participants whose plasma HIV RNA level was suppressed (d=0.74, p=0.08). DKK1 level was not associated with NCI among HIV− participants (p=0.98). MCP-1 was not associated with NCI in either group. In HIV+ adults with suppressed plasma HIV RNA, a receiver-operator characteristic curve identified that a DKK1 level of at least 735 pg/ml had a positive predictive value of 83.3% for a diagnosis of NCI. This association did not weaken after accounting for the effect of AIDS, nadir CD4+ T-cell count, addictive drug use, or demographic characteristics.
Conclusion
DKK1 is a specific biomarker for NCI in HIV+ adults, implicating the Wnt pathway in HIV neuropathogenesis.