Revista Horizontes: primavera/otoño 2017 | Año LX Núms. 116-117

5 Importance of the Crosstalk between Physicians and Basic Scientists: An Example in the Lung Here is a real example, based specifically on what I work on: Pulmonary Hypertension (PH) is a disease characterized by exaggerated high pressures in the lungs of the patients. Neither the lungs nor the right side of the heart are designed anatomically to handle high pressures and the patients die of severe lung and heart complications. PH is notably more frequent in HIV people, but rare in the general population. PH can be diagnosed with a right heart catheterization, which is a very invasive test that costs a lot of money. There is a less invasive method to screen for PH by ultrasound, though. Overall, patients complain of shortness of breath (dyspnea), dizziness, chest pressure or pain, swelling in the ankles or legs (edema), and heart palpitations. These symptoms are also present in hundreds of other diseases and hence, cannot be used to rule out diagnoses. The main concerns regarding HIV and PH are: 1) people with HIV are rarely referred to a pulmonary physician for PH testing and hence, most of the cases remain undiagnosed and; 2) no one knows what in HIV causes or contributes to the development of PH; we just know that HIV is a common denominator. Scientists know that an HIV proteins called “Nef”, “Tat”, and Envelope” are critical in PH because it causes inflammation and toxicity in pulmonary cells. The degree of damage to pulmonary cells may depend on specific sequences in the genes coding for the HIV proteins, at the level of DNA. Changes in HIV sequences influence the way that this viral protein interacts with human cells and proteins. For example, a human protein that routinely facilitates immune responses so that the human immune system can kill the HIV-infected cells directly can become inefficient in doing so. This may lead to accumulation of cells altered by HIV, chronic inflammation, and subsequent tissue damage; such tissue damage may be reflected in a disease that medications may or may not treat successfully. Here is when scientists and physicians of several disciplines should come to the table to brainstorm. Final Remarks As a basic science researcher, my long-term goal is to increase awareness for HIV-mediated long-term complications and to help develop treatments that extend life for the growing number of surviving HIV patients with PH. My short-term goal is to know how HIV proteins like Nef and Envelope influence immune responses, inflammation, and pulmonary disease. For this, we use laboratory-adapted pulmonary cells and animal models to investigate how the function of host cell proteins is affected by HIV variants carrying different “versions” of Nef and Env proteins. In addition, several HIV-infected individuals have gratuitously donated their blood for research and we use those specimens to know the virus better, at a deeper molecular level. I am hoping that the results of our studies will have a direct impact on the community because it may help scientists understand how HIV behaves in the lungs and should prompt physicians to screen large populations of HIV+ patients for deadly lung diseases like Pulmonary Hypertension, based on the HIV variants they are infected with. This is the kind of research being done in HIV, looked through just one, tiny window. To the healthcare providers: please contact your physician and scientist colleagues to come together, talk and share ideas that may result in a more integrative patient care and new collaborative research studies. To the junior scientists, it is very easy to get isolated, especially after spending countless hours day and night in a windowless lab; please do not isolate yourself, think outside of the box, and master your networking skills. To the students with curious minds who doesn’t know if this is for them: just soak your feet in the water and get involved. There are so many different programs out there that will put you in contact with research laboratories across the nation. Talk to your academic coordinator, don’t be afraid and give your best effort in everything you do either in a research laboratory, shadowing a doctor in a clinic or in the community. This may set you on a career path or may inform you to choose some other career. To the patients and their family and friends: we continue working hard to get over this disease for once and for all. We continue learning so much about immunology and the virus, using your sample donations and for that, we Thank You. References CDC. (2016). Centers for Disease Control and Prevention: Diagnoses of HIV Infection in the United States and Dependent Areas, 2016. HIV Surveillance Report, 28 . Retrieved from reports/hiv-surveillance.html Farhadian, S., Patel, P., & Spudich, S. (2017). Neurological Complications of HIV Infection. Curr Infect Dis Rep, 19 (12), 50. doi:10.1007/s11908-017-0606-5 Galati, D., & Zanotta, S. (2016). The Role of Cancer Biomarkers in HIV Infected Hosts. Curr Med Chem, 23 (22), 2333- 2349. Jotwani, V., Atta, M. G., & Estrella, M. M. (2017). Kidney Disease in HIV: Moving beyond HIV-Associated Nephropathy. J Am Soc Nephrol, 28 (11), 3142-3154. doi:10.1681/ASN.2017040468 Kaspar, M. B., & Sterling, R. K. (2017). Mechanisms of liver disease in patients infected with HIV. BMJ Open Gastroenterol, 4 (1), e000166. doi:10.1136/bmjgast- 2017-000166 . (2017). The Henry J. Kaiser Family Foundation. The HIV/AIDS Epidemic in the United States: The Basics. Retrieved from sheet/the-hivaids-epidemic-in-the-united-states-the- basics/