A hallmark of persistent HIV-1
infection in the central nervous system is increased activation of mononuclear phagocytes and surrounding
astrogliosis, conferring persistent HIV-induced
inflammation. This
inflammation is believed to result in neuronal dysfunction and the clinical manifestations of HIV-associated
neurocognitive disorders (HAND). The Jak/STAT pathway is activated in macrophages/myeloid cells upon HIV-1
infection, modulating many pro-inflammatory pathways that result in HAND, thereby representing an attractive cellular target. Thus, the impact of
ruxolitinib, a
Janus Kinase (Jak) 1/2 inhibitor that is FDA approved for
myelofibrosis and
polycythemia vera, was assessed for its potential to inhibit HIV-1 replication in macrophages and HIV-induced activation in monocytes/macrophages in culture. In addition, a murine model of HIV
encephalitis (HIVE) was used to assess the impact of
ruxolitinib on histopathological features of HIVE, brain viral load, as well as its ability to penetrate the blood-brain-barrier (BBB).
Ruxolitinib was found to inhibit HIV-1 replication in macrophages, HIV-induced activation of monocytes (CD14/CD16) and macrophages (
HLA-DR, CCR5, and CD163) without apparent toxicity. In vivo, systemically administered
ruxolitinib was detected in the brain during HIVE in SCID mice and markedly inhibited
astrogliosis. Together, these data indicate that
ruxolitinib reduces HIV-induced activation and infiltration of monocytes/macrophages in vitro, reduces the replication of HIV in vitro, penetrates the BBB when systemically administered in mice and reduces
astrogliosis in the brains of mice with HIVE. These data suggest that
ruxolitinib will be useful as a novel therapeutic to treat humans with HAND.