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Abdel-Qader DH, Abdel-Qader H, Silverthorne J, Kongkaew C, Meslamani AZA, Hayajneh W, Alwahadneh AM, Hamadi S, Abu-Qatouseh L, Awad R, Al Nsour M, Alhariri A, Shnewer K, Da'ssan M, Obeidat NM, Nusair KE, Jalamdeh MS, Hawari F, Asad M, AbuRuz S. Real-World Effectiveness of Four Types of COVID-19 Vaccines. Vaccines (Basel) 2023; 11:vaccines11050985. [PMID: 37243089 DOI: 10.3390/vaccines11050985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND There is a scarcity of evidence regarding the real-world effectiveness of coronavirus disease 2019 (COVID-19) vaccines. This was the first study to evaluate the effectiveness of four types of vaccines against asymptomatic and symptomatic infection, and COVID-19 outcomes among the general population. METHODS This was a matched comparison group quasi-experimental study conducted in Jordan between 1 January and 29 August 2021. In the first part of the study, 1200 fully vaccinated individuals were matched with 1200 unvaccinated control participants. In order to measure vaccine effectiveness, the infection rates of both vaccinated and unvaccinated groups were calculated. The second part of the study included measuring specific anti-SARS CoV-2 immune cells and antibodies. RESULTS BNT162b2 (Pfizer, New York, NY, USA) showed a significantly higher effectiveness against asymptomatic COVID-19 infection (91.7%) and hospitalization (99.5%) than BBIBP-CorV (Sinopharm, Beijing, China) (88.4% and 98.7%, respectively) and ChAdOx1 nCoV-19 (AstraZeneca, Cambridge, UK) (84.3%, and 98.9%, respectively). The effectiveness rates of the Sputnik V (Gamaleya Research Institute, Moscow, Russia) vaccine against asymptomatic, symptomatic, and hospitalization were 100%, 100%, and 66.7%, respectively. The highest median anti-spike (S) IgG values were seen in individuals who received BNT162b2 (2.9 AU/mL) and ChAdOx1 nCoV-19 (2.8 AU/mL) vaccines. The levels of anti-S IgG were significantly decreased after 7 months of vaccination with BNT162b2 and BBIBP-CorV. There were significant decreases in the median number of neutralizing antibodies one month and seven months after receiving BNT162b2 (from 88.5 to 75.2 4 Bioequivalent Allergen Unit per milliliter/mL), BBIBP-CorV (from 69.5 to 51.5 BAU/mL), and ChAdOx1 nCoV-19 (from 69.2 to 58.BAU/mL) vaccines. The highest percentage of T cells specific to COVID-19 vaccine was found in individuals who received BNT162b2 (88.5%). CONCLUSION All four vaccines evaluated in this study showed effectiveness against asymptomatic COVID-19 infection, symptomatic infection, hospitalization, and death. Furthermore, BNT162b2, BBIBP-CorV, and ChAdOx1 nCoV-19 induced high levels of immunology markers within one month of vaccination.
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Affiliation(s)
- Derar H Abdel-Qader
- Faculty of Pharmacy & Medical Sciences, University of Petra, Amman 11196, Jordan
- Al Rashid Hospital Center, Amman 11623, Jordan
| | | | - Jennifer Silverthorne
- Division of Pharmacy & Optometry, The University of Manchester, Manchester M13 9PL, UK
| | - Chuenjid Kongkaew
- Department of Pharmacy Practice, Naresuan University, Phitsanulok 65000, Thailand
| | - Ahmad Z Al Meslamani
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi P.O. Box 112612, United Arab Emirates
- College of Pharmacy, Al Ain University, Abu Dhabi P.O. Box 64141, United Arab Emirates
| | - Wail Hayajneh
- School of Medicine, St. Louis University, St. Louis, MO 63104, USA
- School of Medicine, Jordan University of Science & Technology, Irbid 3030, Jordan
| | | | - Salim Hamadi
- Faculty of Pharmacy & Medical Sciences, University of Petra, Amman 11196, Jordan
| | - Luay Abu-Qatouseh
- Faculty of Pharmacy & Medical Sciences, University of Petra, Amman 11196, Jordan
| | - Riad Awad
- Faculty of Pharmacy & Medical Sciences, University of Petra, Amman 11196, Jordan
| | - Mohannad Al Nsour
- Eastern Mediterranean Public Health Network (EMPHNET), Amman 11195, Jordan
| | | | | | | | - Nathir M Obeidat
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | | | | | | | - Mohammad Asad
- Eastern Mediterranean Public Health Network (EMPHNET), Amman 11195, Jordan
| | - Salah AbuRuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, The United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman 11942, Jordan
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Hawari F, Dodin Y, Tayyem R, Najjar S, Kakish H, Fara MA, Zou'bi AA, Idkaidek N. Safety, Tolerability, and Pharmacokinetics of Nebulized Hydroxychloroquine: A Pilot Study in Healthy Volunteers. J Aerosol Med Pulm Drug Deliv 2023; 36:76-81. [PMID: 36637803 DOI: 10.1089/jamp.2022.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Early in the coronavirus disease 2019 (COVID-19) pandemic, hydroxychloroquine (HCQ) drew substantial attention as a potential COVID-19 treatment based on its antiviral and immunomodulatory effects in vitro. However, HCQ showed a lack of efficacy in vivo, and different groups of researchers attributed this failure to the insufficient drug concentration in the lung following oral administration (HCQ is only available in the market in the tablet form). Delivering HCQ by inhalation represents a more efficient route of administration to increase HCQ exposure in the lungs while minimizing systemic toxicity. In this pilot study, the safety, tolerability, and pharmacokinetics of HCQ nebulizer solution were evaluated in healthy volunteers. Methods: Twelve healthy participants were included in this study and were administered 2 mL of HCQ01 solution (equivalent to 25 mg of HCQ sulfate) through Aerogen® Solo, a vibrating mesh nebulizer. Local tolerability and systemic safety were assessed by forced expiratory volume in the first and second electrocardiograms, clinical laboratory results (e.g., hematology, biochemistry, and urinalysis), vital signs, and physical examinations. Thirteen blood samples were collected to determine HCQ01 systemic exposure before and until 6 hours after inhalation. Results: The inhalation of HCQ01 was well tolerated in all participants. The mean value of Cmax for the 12 participants was 9.66 ng/mL. Tmax occurred at around 4.8 minutes after inhalation and rapidly decreased thereafter. The reported systemic exposure was very low with a mean value of 5.28 (0.6-15.6) ng·h/mL. Conclusion: The low systemic concentrations of HCQ01 of 9.66 ng/mL reported by our study compared with 1 μg/mL previously predicted after 200 mg BID oral administration, and the safety and tolerability of HCQ01 administered as a single dose through nebulization, support the assessment of its efficacy, safety, and tolerability in further studies for the treatment of COVID-19.
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Affiliation(s)
- Feras Hawari
- Office of Minister of Health, Ministry of Health, Amman, Jordan
| | - Yasmeen Dodin
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
| | | | | | | | | | | | - Nasir Idkaidek
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy and Medical Sciences, The University of Petra, Amman, Jordan
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Smith J, Togawa K, Dresler C, Hawari F, Zain ZM, Stewart B, Warren GW, Sitas F. Smoking cessation after a cancer diagnosis: Commentary on special supplement in Cancer Epidemiology. Cancer Epidemiol 2022; 79:102210. [PMID: 35785684 DOI: 10.1016/j.canep.2022.102210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/26/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Justin Smith
- Townsville University Hospital & College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Kayo Togawa
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer/World Health Organization, France; Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Japan
| | - Carolyn Dresler
- International Association for the Study of Lung Cancer, Montrose, CO, USA
| | | | | | - Bernard Stewart
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales - Sydney, Australia
| | - Graham W Warren
- Department of Radiation Oncology, Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA
| | - Freddy Sitas
- Centre for Primary Health Care and Equity, School of Population Health, University of New South Wales-Sydney, Menzies Centre for Health Policy, School of Public Health, University of Sydney, and Cancer Epidemiology, Elsevier Press, Australia.
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Awad WB, Nazer L, Elfarr S, Abdullah M, Hawari F. A 12-year study evaluating the outcomes and predictors of mortality in critically ill cancer patients admitted with septic shock. BMC Cancer 2021; 21:709. [PMID: 34130642 PMCID: PMC8207763 DOI: 10.1186/s12885-021-08452-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Though sepsis is common in patients with cancer, there are limited studies that evaluated sepsis and septic shock in this patient population. The objective of this study was to evaluate the outcomes and to identify predictors of mortality in cancer patients admitted to the intensive care unit (ICU) with septic shock. Methods This was a retrospective study conducted at a medical-surgical oncologic ICU of a comprehensive cancer center. Adult cancer patients admitted with septic shock between January 1, 2008 and December 31, 2019 were enrolled. Septic shock was defined as an ICU admission diagnosis of sepsis that required initiating vasopressors within 24 h of admission. Patient baseline characteristics, ICU length of stay and ICU and hospital mortality were recorded. Univariate analysis and logistic regression were performed to identify predictors associated with ICU and hospital mortality. Results During the study period, 1408 patients met the inclusion criteria. The mean age was 56.8 ± 16.1 (SD) years and mean Acute Physiology and Chronic Health Evaluation (APACHE) II was 23.0 ± 7.91 (SD). Among the enrolled patients, 67.8% had solid tumors while the remaining had hematological malignancies. Neutropenia and thrombocytopenia were reported in 19.3 and 39.5% of the patients, respectively, and mechanical ventilation was required for 42% of the patients. Positive cultures were reported in 836 (59.4%) patients, most commonly blood (33%) and respiratory (26.6%). Upon admission, about half the patients had acute kidney injury, while elevated total bilirubin and lactic acid levels were reported in 13.8 and 65.2% of the patients, respectively. The median ICU length of stay was 4 days (IQR 3–8), and ICU and hospital mortality were reported in 688 (48.9%) and 914 (64.9%) patients, respectively. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significantly associated with both ICU and hospital mortality. Conclusions In a relatively large cohort of patients with solid and hematological malignancies admitted to the ICU with septic shock, hospital mortality was reported in about two-third of the patients. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significant predictors of mortality.
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Affiliation(s)
- Wedad B Awad
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
| | - Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Salam Elfarr
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Maha Abdullah
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Feras Hawari
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
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Kubbara A, Hawari F, Johnkoski J. Diffuse alveolar haemorrhage secondary to haemophilus influenzae in a vaping patient. BMJ Case Rep 2021; 14:14/6/e242701. [PMID: 34130979 DOI: 10.1136/bcr-2021-242701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Diffuse alveolar haemorrhage (DAH) is known to occur from several infectious and non-infectious aetiologies. Among the infectious aetiologies, Haemophilus influenzae, an organism known to cause community-acquired pneumonia, has not been reported in association with DAH prior to this case. On the other hand, vaping, an evolving epidemic concern, has been linked to various types of lung injury, including DAH. However, DAH related to vaping is only limited to several case reports. Our case describes H. influenzae pneumonia with DAH in a patient known to have vaped until the night prior to elective lobectomy for lung cancer and developed DAH within 24 hours of hospitalisation. He subsequently recovered with treatment. DAH requires immediate recognition, and healthcare providers need to be aware that neither haemoptysis nor decrease in haemoglobin level is necessarily associated. Prior to diagnosis, empirical treatment with intravenous steroids and antibiotics can be life-saving.
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Affiliation(s)
- Aahd Kubbara
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Feras Hawari
- Section of Pulmonary and Critical Care, King Hussein Cancer Center, Amman, Jordan
| | - John Johnkoski
- Department of Cardiothoracic Surgery, Aspirus Wausau Hospital, Wausau, Wisconsin, USA
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Sitas F, Hawari F, Dresler C, Stewart B, Togawa K, Zain ZM, Warren G. Call for papers: Special supplement – Tobacco cessation after a cancer diagnosis. Cancer Epidemiol 2021. [DOI: 10.1016/j.canep.2021.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Al-Ibraheem A, Hirmas N, Fanti S, Paez D, Abuhijla F, Al-Rimawi D, Al-Rasheed U, Abdeljalil R, Hawari F, Alrabi K, Mansour A. Impact of 18F-FDG PET/CT, CT and EBUS/TBNA on preoperative mediastinal nodal staging of NSCLC. BMC Med Imaging 2021; 21:49. [PMID: 33731050 PMCID: PMC7967993 DOI: 10.1186/s12880-021-00580-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Staging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging, endoscopic and surgical techniques. This study aims at investigating the diagnostic accuracy of 18F-FDG PET/CT, CT scan, and endobronchial ultrasound/transbronchial needle aspirate (EBUS/TBNA) in preoperative mediastinal lymph nodes (MLNs) staging of NSCLC. METHODS We identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center in Amman, Jordan, between July 2011 and December 2017. We collected their relevant clinical, radiological, and histopathological findings. The per-patient analysis was performed on all patients (N = 101) and then on those with histopathological confirmation (N = 57), followed by a per-lymph-node-station basis overall, and then according to distinct N-stage categories. RESULTS 18F-FDG PET/CT, in comparison to CT, had a better sensitivity (90.5% vs. 75%, p = 0.04) overall and in patients with histopathological confirmation (83.3% vs. 54.6%), and better specificity (60.5% vs. 43.6%, p = 0.01) overall and in patients with histopathological confirmation in MLN staging (60.6% vs. 38.2%). Negative predictive value of mediastinoscopy, EBUS/TBNA, and 18F-FDG PET/CT were (87.1%), (90.91%), and (83.33%) respectively. The overall accuracy was highest for mediastinoscopy (88.6%) and EBUS/TBNA (88.2%), followed by 18F-FDG PET/CT (70.2%). Dividing patients into N1 disease vs. those with N2/N3 disease yielded similar findings. Comparison between 18F-FDG PET/CT and EBUS/TBNA in patients with histopathological confirmation shows 28 correlated true positive and true negative findings with final N-staging. In four patients, 18F-FDG PET/CT detected metastatic MLNs that would have otherwise remained undiscovered by EBUS/TBNA alone. Lymph nodes with a maximal standardized uptake value (SUVmax) more than 3 were significantly more likely to be true-positive. CONCLUSION Multimodality staging of the MLNs in NSCLC is essential to provide accurate staging and the appropriate treatment. 18F-FDG PET/CT has better overall diagnostic utility when compared to the CT scan. The NPV of 18F-FDG PET/CT in MLNs is reliable and comparable to the NPV of EBUS/TBNA. SUVmax of MLNs can help in predicting metastases, but nevertheless, a positive 18F-FDG PET/CT MLNs particularly if such a result would change the treatment plan, should be verified histopathologically.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan.
| | - Nader Hirmas
- Nuclear Medicine Clinic, Essen University Hospital, Hufelandstrasse 55, 45147, Essen, Germany
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Bologna, Italy
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Fawzi Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman, Jordan
| | - Dalia Al-Rimawi
- Office of Scientific and Academic Research (OSAR), King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman, Jordan
| | - Ula Al-Rasheed
- Department of Nuclear Medicine, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan
| | - Riad Abdeljalil
- Department of Surgery, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan
| | - Feras Hawari
- Department of Medicine, Section of Pulmonary and Critical Care, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan
| | - Kamal Alrabi
- Department of Internal Medicine, Hematology and Oncology, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan
| | - Asem Mansour
- Department of Diagnostic Radiology, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, P.O. Box 1269, Amman, Jordan
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Sheffer CE, Al-Zalabani A, Aubrey A, Bader R, Beltrez C, Bennett S, Carl E, Cranos C, Darville A, Greyber J, Karam-Hage M, Hawari F, Hutcheson T, Hynes V, Kotsen C, Leone F, McConaha J, McCary H, Meade C, Messick C, Morgan SK, Morris CW, Payne T, Retzlaff J, Santis W, Short E, Shumaker T, Steinberg M, Wendling A. The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019. Int J Environ Res Public Health 2021; 18:2416. [PMID: 33801227 PMCID: PMC7967787 DOI: 10.3390/ijerph18052416] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.
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Affiliation(s)
- Christine E. Sheffer
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Abdulmohsen Al-Zalabani
- Tobacco Treatment Specialist Training and Certification Program at College of Medicine, Taibah University, Madinah 42353, Saudi Arabia;
| | - Andrée Aubrey
- Tobacco Treatment Specialist Course, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
| | - Rasha Bader
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Claribel Beltrez
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Susan Bennett
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Ellen Carl
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Caroline Cranos
- Tobacco Treatment Specialist Training Program, Center for Tobacco Treatment Research and Training, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Audrey Darville
- BREATHE Online Tobacco Treatment Specialist Training Program, College of Nursing, University of Kentucky, Lexington, KY 40504, USA;
| | - Jennifer Greyber
- Duke-UNC Tobacco Treatment Specialist Training Program, Duke Smoking Cessation Program, Duke Cancer Center, Durham, NC 27705, USA;
| | - Maher Karam-Hage
- Tobacco Treatment Training Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Feras Hawari
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Tresza Hutcheson
- Tobacco Treatment Specialist Training Program, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Victoria Hynes
- Tobacco Treatment Education & Training Program, MaineHealth Center for Tobacco Independence, Portland, ME 04101, USA;
| | - Chris Kotsen
- Tobacco Treatment Specialist Training Program, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA;
| | - Frank Leone
- Comprehensive Smoking Treatment Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jamie McConaha
- Tobacco Treatment Specialist Training and Certificate Program, School of Pharmacy, Duquesne University, Pittsburg, PA 15282, USA;
| | - Heather McCary
- Tobacco Treatment Specialist Certification Program, The Breathing Association, Columbus, OH 43203, USA;
| | - Crystal Meade
- Tobacco Prevention and Control Program, Wellness and Prevention Department, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA;
| | | | - Susan K. Morgan
- Tobacco Treatment Training Program, School of Dentistry, West Virginia University, Morgantown, WV 26506, USA;
| | - Cindy W. Morris
- Rocky Mountain Tobacco Treatment Specialist Training Program, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Thomas Payne
- ACT Center for Tobacco Treatment, Education and Research, University of Mississippi Medical Center Cancer Institute, Jackson, MS 39213, USA;
| | - Jessica Retzlaff
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Wendy Santis
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Etta Short
- Optum’s Quit for Life Program, Eden Prairie, MN 55344, USA;
| | - Therese Shumaker
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Michael Steinberg
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Ann Wendling
- Tobacco Cessation Program, Healthways, A Sharecare Company, Franklin, TN 37067, USA;
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Idkaidek N, Hawari F, Dodin Y, Obeidat N. Development of a Physiologically-Based Pharmacokinetic (PBPK) Model of Nebulized Hydroxychloroquine for Pulmonary Delivery to COVID-19 Patients. Drug Res (Stuttg) 2020; 71:250-256. [PMID: 33378773 DOI: 10.1055/a-1325-0248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Despite inconclusive evidence, chloroquine (CQ) and hydroxychloroquine (HCQ)are commonly used for the treatment of Corona virus Disease 2019(COVID-19) in critically ill patients.It was hypothesized that HCQ as an aerosol application can reach the antiviral concentration of ~1-5 μM in the alveolar cells which has been proven effective in vitro. A physiologically-based pharmacokinetic (PBPK) model of nebulized HCQ for pulmonary delivery to COVID-19 patients using the Nasal-Pulmonary Module in GastroPlus® V9.7 simulator, in order to calculate the necessary inhalation dose regimen of HCQ, was developed. The physiological, drug disposition, and pharmacokinetic parameters were obtained from the literature and used during model building after optimization using Optimization Module, while oral data was used for validation. The 25 mg BID inhalation dosing was predicted to lead to alveolar HCQ levels of 7 µM (above EC50 of ~1-5 µM), and small plasma levels of 0.18 µM (as compared to plasma levels of 3.22 µM after 200 mg BID oral dosing). However, average contact time (>1 µM) is around 0.5 h in lung parts, suggesting indirect exposure response effect of HCQ.The developed PBPK model herein predicted HCQ levels in plasma and different lung parts of adults after multiple inhalation dosing regimens for 5 days. This in-silico work needs to be tested in vivo on healthy subjects and COVID-19 patients using 12.5 mg BID and 25 mg BID inhalation doses.
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Affiliation(s)
| | - Feras Hawari
- Section of Pulmonary and Critical Care, Department of Internal Medicine, King Hussein Cancer Center and University of Jordan, Amman, Jordan.,Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
| | - Yasmeen Dodin
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
| | - Nour Obeidat
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
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Elaibaid M, Nazer LH, Shaikha L, Al-Qadheeb N, Kleinpell R, Olsen KM, Hawari F. Evaluating the Published Critical Care Research from the World Health Organization Eastern Mediterranean Region. BMC Res Notes 2019; 12:32. [PMID: 30658704 PMCID: PMC6339311 DOI: 10.1186/s13104-019-4093-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/14/2019] [Indexed: 01/09/2023] Open
Abstract
Objectives Evaluation of published research in a region provides insight into relevant aspects of clinical care and research priorities. This study aimed to provide a comprehensive assessment of the type of critical care research published in the World Health Organization Eastern Mediterranean region (EMR) over a 10-year period. Results During the study period (2007–2016), the search strategy revealed 4303 publications, of which 1537 were included in the analysis; studies were excluded for the following reasons: not critical care, conducted in non-EMR countries, editorials, case reports, in-vitro or animal studies, as well as those conducted in multiple countries and those that evaluated foreign military personal. Countries varied in the number of publications produced, ranging from none in Somalia to 620 in Iran. The majority of the studies were observational (78%), evaluated adults (73%), and the most common areas of research were infectious (29%) and respiratory (10%) diseases. Median sample size was 120 and the mean (SD) impact factor of the journals in which the articles were published was 1.02 (0.7).
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Affiliation(s)
| | - Lama H Nazer
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Al-Abdallah Street, PO Box 1269, Amman, 11941, Jordan.
| | - Lama Shaikha
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Al-Abdallah Street, PO Box 1269, Amman, 11941, Jordan
| | - Nada Al-Qadheeb
- Department of Medicine, Hafer Albatin Central Hospital, Hafer Albatin, Saudi Arabia
| | - Ruth Kleinpell
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Keith M Olsen
- College of Pharmacy, University of Nebraska, Omaha, NE, USA
| | - Feras Hawari
- Section of Pulmonary and Critical Care, King Hussein Cancer Center, Amman, Jordan
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Bader R, Shihab R, Hawari F. The Carrot Not The Stick: Creating Incentives for Voluntary Enforcement of Smoke-Free Policies Through Smoke-Free Zone Certification. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.34000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Jordan's Public Health Law bans smoking in public places. However, law-enforcement mechanisms are lagging and Jordanians continue to be exposed to second-hand smoke. The Global Tobacco Control Report 2017 rates enforcement at 2/10 dropping even below the previous 3/10 rating of 2015. Aim: Our intervention aims to provide alternative routes for protection from exposure to second-hand smoke. Strategy/Tactics: The intervention builds on results from a 2012 survey which indicated that 85% of the public supports banning smoking in healthcare institutions, schools, and work places. In 2013 King Hussein Cancer Foundation and Center launched the Smoke-free Zone Certificate Program in collaboration with Global Smoke-free Worksite Challenge. The program, currently in its fifth round, recognizes institutions that voluntarily enforce smoke-free environments. Program/Policy process: Interested institutions submit an application requesting certification. Applications go through a screening process to confirm initial alignment with the program criteria. Institutions passing the initial screening are physically inspected for compliance through unannounced spot-check visits. Those passing the inspection receive certification. To qualify, an institution should meet two criteria. The first is enforcing a 100% smoke-free policy within all indoor premises. Designated smoking areas are not allowed. For schools, the criteria require that the smoke-free policy extends to cover both indoor and outdoor premises. The second criterion is that the smoke-free policy should be in effect for a minimum of 9 months on the day of certification. The appeal of the program builds on (1) the institution's belief in the importance of providing a safe and healthy environment, (2) the association of the program with the name of a well-respected national organization, and (3) the media exposure that the certified institutions receive. Active promotion of the program is performed during the application period to recruit additional applicants. Outcomes: Fig. 1 depicts the growth in numbers of applications and of certified organizations. On average 67% of applicants receive certification. Interest varies by category with schools outweighing all other applicants (62%). What was learned: Incentives for voluntary enforcement of smoke-free policies have the potential to support law enforcement. The growing interest and the modifications that institutions undergo to meet the program criteria are a testimony to our success. Several institutions went through three rounds of applications prior to receiving certification, indicating the ability of the program to motivate compliance. There is a need to continue to grow the number of applicants especially in the 'restaurants' and 'healthcare' categories. Sensitization about the benefits of smoke-free environments, technical assistance to interested institutions, and additional media exposure can help. [Figure: see text]
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Qouzah HF, Hawari F, Abu-Qatouseh LF, Shehabi AA. Occurrence and molecular characterization of metallo-β-lactamases (MBLs) among Acinetobacter baumannii isolates from cancer patients. ACTA ACUST UNITED AC 2018. [DOI: 10.3823/821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: During the last decade, the prevalence of carbapenem-resistant infection associated with multidrug resistant (MDR) Acinetobacter baumanniiin patients has been continuously increasing. This prospective study aimed to determine the occurrence and molecular characterization of metallo-β-lactamases (MBLs) and carbapenem hydrolyzing oxacillinases among A. baumannii isolates from cancer patients over a period of 6-month.
Methods:Antimicrobial susceptibility profile of 70 randomly collected A. baumannii isolates was first determined using disc diffusion test, and second, the MICs of 45 representative multidrug resistant (MDR) isolates were tested to useful drugs in treatment of their infections using E-test. PCR assays were used to detect the common four types of class D carbapenem hydrolyzing oxacillinases, two types of class A carbapenemases, four types of class B metallo-β –lactamases, and prevalence of Class 1 Integron among MDR isolates.
Results: All 70 isolates were MDR, including 100% resistance to meropenom, aztreonem, piperacillin/tazobactum and 99% to carbapenem. All isolates carried blaOXA-23 and blaOXA-51, but none carried a blaOXA-24 like or blaOXA-58. The isolates also were positive for NDM-1, NDM, VIM, GES, KPC and SPM at the rates of 29%, 20%, 29%,19%,7% and 2%, respectively. Class 1 Integron was positive in 82% of A. baumanniiisolates.
The clonal relationship of 42 MDR A. baumanniiisolates using ERIC-PCR and constructed dendrogram showed 3 major genotype clusters of genetically related isolates. These include 4 genotype groups, each composed of 2 isolates with 100 % similarity of DNA bands.
Conclusion:This study demonstrates that A. baumannii colonize frequently cancer patients in association with antibiotic treatment. The organism is mostly carrying wide spectrum of antibiotic resistance genetic factors, especially many types of ESBLs and MBLs and Class 1 Integron. This fact should be considered when therapy is selected for treatment of patients infected with MDR A. baumannii.
Key words. Acinetobacter baumannii, ESBLs, MBLs, Class 1 Integron, Jordanian cancer patients.
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Nazer LH, Elaibaid M, Al-Qadheeb N, Kleinpell R, Olsen KM, Hawari F. Critical care research in the World Health Organization Eastern Mediterranean Region over two decades: where do we stand? Intensive Care Med 2018; 44:1588-1590. [PMID: 29978391 DOI: 10.1007/s00134-018-5287-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Lama H Nazer
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Al-Abdallah Street, PO Box 1269, Amman, 11941, Jordan.
| | - Mohamad Elaibaid
- Department of Medicine, Soba University Hospital, Khartoum, Sudan
| | - Nada Al-Qadheeb
- Department of Medicine, Hafer Albatin Central Hospital, Hafer Albatin, Saudi Arabia
| | - Ruth Kleinpell
- Center for Clinical Research and Scholarship, Rush University Medical Center, Chicago, IL, USA
| | - Keith M Olsen
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Feras Hawari
- Section of Pulmonary and Critical Care, King Hussein Cancer Center, Amman, Jordan
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Bader R, Hatoqai A, Ghonimat I, Obeidat N, Hawari F. Scaling up the availability of tobacco dependence treatment training: leveraging the experience of King Hussein Cancer Center to create new training hubs. Tob Induc Dis 2018. [DOI: 10.18332/tid/83875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bader R, Shihab R, Al-Rimawi D, Hawari F. Pictorial warning labels in Jordan: are we maximizing the benefit for smokers? Tob Induc Dis 2018. [DOI: 10.18332/tid/83936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Raw M, Ayo-Yusuf O, Chaloupka F, Fiore M, Glynn T, Hawari F, Mackay J, McNeill A, Reddy S. Recommendations for the implementation of WHO Framework Convention on Tobacco Control Article 14 on tobacco cessation support. Addiction 2017; 112:1703-1708. [PMID: 28770575 DOI: 10.1111/add.13893] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Martin Raw
- Department of Population Health, NYU School of Medicine, New York, USA.,UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Olalekan Ayo-Yusuf
- Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Frank Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Thomas Glynn
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Feras Hawari
- Cancer Control Office and Section of Pulmonary and Critical Care, King Hussein Cancer Center, Amman, Jordan
| | - Judith Mackay
- Vital Strategies, and Asian Consultancy on Tobacco Control, Hong Kong
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Srinath Reddy
- Public Health Foundation of India, Delhi NCR, Gurgaon, Haryana, India
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Altous M, Innabi A, Alzghoul B, Chatterjee K, Meena N, Hawari F. Rzadki przypadek ropnia płuca pochodzenia środowiskowego wywołanego przez Serratia marcescens u pacjentki z dodatkowym oskrzelem sercowym. Adv Respir Med 2017. [DOI: 10.5603/arm.54809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ropień płuca spowodowany przez Serratia marcescens występuje niezwykle rzadko i tylko u osób mających obniżoną odporność. Przedstawiono przypadek uprzednio zdrowej kobiety z ropniem płuca wywołanym przez Serratia, położonym blisko dodatkowego oskrzela sercowego (cardiac bronchus). Pacjentka była leczona odpowiednimi antybiotykami, co doprowadziło do całkowitego wyleczenia zmiany. Opisany przypadek pokazuje, że u osób chorych na schorzenia współistniejące mogą występować nietypowe zakażenia płuc wywołane przez Serratia, związane z odchyleniami anatomicznymi.
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Altous M, Innabi A, Alzghoul B, Chatterjee K, Meena N, Massad E, Hawari F. A rare case of community acquired serratia lung abscess in a patient with cardiac bronchus. Adv Respir Med 2017; 85:151-154. [DOI: 10.5603/arm.2017.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/14/2017] [Accepted: 03/26/2017] [Indexed: 11/25/2022]
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Bader R, Shihab A, Obeidat N, Hawari F. Coverage of tobacco control in Jordanian newspapers: implications for strengthening the role of news media. East Mediterr Health J 2017; 23:342-350. [DOI: 10.26719/2017.23.5.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/20/2016] [Indexed: 11/09/2022]
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Hawari F. ED03.01 Tobacco Control in the Middle East. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Innabi A, Altous M, Alzghoul B, Chatterjee K, Meena N, Hawari F. A Case of Serratia Lung Abscess in a Patient With Accessory Cardiac Bronchus. Chest 2016. [DOI: 10.1016/j.chest.2016.08.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ayub H, Obeidat N, Leischow S, Glynn T, Hawari F. Jordan tobacco dependence treatment guidelines: rationale and development. East Mediterr Health J 2016; 21:844-50. [PMID: 26857722 DOI: 10.26719/2015.21.11.844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/28/2015] [Indexed: 11/09/2022]
Abstract
Jordan, a high tobacco-burden country, has been working to expand its tobacco dependence treatment services and has completed development of its first customized treatment guidelines. Our paper presents the development process for these guidelines. A group of national and international experts was formed and a national situation analysis for tobacco dependence treatment practices and a detailed review of international evidence were conducted. The guidelines were then drafted and reviewed by national, regional and international experts and were official endorsed by the Jordanian Ministry of Health before being launched. The guidelines comprise concise descriptions and practical supplementary flowcharts covering the major elements of general tobacco dependence treatment. These are the first comprehensive Arabic-language guidelines, including a section focusing on waterpipe use, and we believe they are a reliable and useful resource for neighbouring countries seeking to develop similar guidelines.
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Affiliation(s)
- H Ayub
- Cancer Control Office, Department of Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - N Obeidat
- Cancer Control Office, Department of Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - S Leischow
- Department of Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - T Glynn
- International Cancer Control, American Cancer Society, Washington DC, United States of America; Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, California, United States of America
| | - F Hawari
- Cancer Control Office, Department of Medicine, King Hussein Cancer Centre, Amman, Jordan; Section of Pulmonary and Critical Care, Department of Medicine, King Hussein Cancer Centre, Amman, Jordan
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Nazer LH, Kharabsheh A, Rimawi D, Mubarak S, Hawari F. Characteristics and Outcomes of Acinetobacter baumannii Infections in Critically Ill Patients with Cancer: A Matched Case–Control Study. Microb Drug Resist 2015; 21:556-61. [DOI: 10.1089/mdr.2015.0032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lama H. Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Asma Kharabsheh
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Dalia Rimawi
- Biostatistics Unit, Research Office, King Hussein Cancer Center, Amman, Jordan
| | - Sawsan Mubarak
- Department of Infection Control, King Hussein Cancer Center, Amman, Jordan
| | - Feras Hawari
- Section of Pulmonary and Critical Care, Department of Medicine, King Hussein Cancer Center, Amman, Jordan
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Nazer L, AlNajjar T, Al-Shaer M, Rimawi D, Hawari F. Evaluating the effectiveness and safety of hydrocortisone therapy in cancer patients with septic shock. J Oncol Pharm Pract 2014; 21:274-9. [PMID: 24781452 DOI: 10.1177/1078155214533738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of hydrocortisone (HC) in cancer patients with septic shock. METHODS This was a retrospective study of adult cancer patients with septic shock who received low-dose HC therapy (200 mg/day). The effectiveness of HC was assessed by determining the proportion of patients with reversal of septic shock, time to reversal, and mortality. The safety was assessed by determining the incidences of hyperglycemia, hypernatremia, and secondary infections, using a case-control approach. RESULTS During the study period, 96 patients were enrolled. Reversal of septic shock was reported in 46 (47.9%) patients, median time to reversal was 1.9 days (range 0.2-7.6), ICU mortality was reported in 62 (65.26%) patients, and 28-day mortality in 64 (66.7%) patients. The incidence of secondary infections was higher in patients who received HC therapy, compared to patients who did not receive HC during septic shock: 44.8% vs 27.4%, P = 0.028. CONCLUSIONS HC therapy was associated with resolution of septic shock in about half of the patients and a high incidence of secondary infections. Prospective studies are needed to fully assess the efficacy and safety of HC in cancer patients with septic shock.
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Affiliation(s)
- Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Dalia Rimawi
- Center of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Feras Hawari
- Department of Medicine, Section of Pulmonary and Critical Care, King Hussein Cancer Center, Amman, Jordan
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Camacho R, Neves D, Piñeros M, Rosenblatt E, Burton R, Galán Y, Hawari F, Kilickap S, Naylor C, Nicula F, Reno J, Sirohi B, Vidaurre T, Zendehdel K. Prescription of Cancer Treatment Modalities in Developing Countries: Results from a Multi-Centre Observational Study. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jct.2014.511103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Objective: To determine the incidence, characteristics, and outcomes of adverse drug events (ADEs) in critically ill patients with cancer. Methods: This was a 5-month prospective observational study. Patients who were admitted to the adult medical/surgical oncology intensive care unit (ICU) were evaluated for any drug-related adverse events during their ICU stay. An ADE was defined as injury or patient harm resulting from medical intervention related to a drug. Results: The incidence rate of ADEs was 96.5 per 1000 patient days and 35.3 per 100 ICU admissions. Of the reported ADEs, 57 (64.8%) were serious/life threatening, 30 (34.1%) were significant, 1 (1.1%) was fatal, and 14 (15.9%) of all ADEs were considered preventable. The most common drug classes associated with ADEs were antidiabetics, antibiotics, and analgesics/sedatives. The length of stay and presence of renal or respiratory failure were significantly associated with an increased number of ADEs. The length of stay and female sex were significantly associated with the likelihood of developing an ADE. Conclusion: Critically ill patients with cancer are at high risk of developing ADEs. Strategies that reduce the incidence and severity of ADEs are essential to improve the outcomes of this patient population.
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Affiliation(s)
- Lama H. Nazer
- Department of Pharmacy, King Hussein Cancer Center, Al-Jubeiha, Amman, Jordan
| | - Feras Hawari
- Department of Medicine, Section of Pulmonary and Critical Care, King Hussein Cancer Center, Al-Jubeiha, Amman, Jordan
| | - Taghreed Al-Najjar
- Department of Medicine, Section of Pulmonary and Critical Care, King Hussein Cancer Center, Al-Jubeiha, Amman, Jordan
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Nazer L, Al-Shaer M, Hawari F. Drug utilization pattern and cost for the treatment of severe sepsis and septic shock in critically ill cancer patients. Int J Clin Pharm 2013; 35:1245-50. [PMID: 24104762 DOI: 10.1007/s11096-013-9860-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 09/30/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer patients are at high risk for developing sepsis. To our knowledge, there are no studies that evaluated the type of medications utilized and the associated cost in cancer patients with severe sepsis and septic shock. OBJECTIVE To describe the drug utilization pattern and drug cost in the treatment of cancer patients with severe sepsis and septic shock. SETTING 12-bed medical/surgical intensive care unit (ICU) of a comprehensive teaching cancer center. METHODS A retrospective cohort study of cancer patients with severe sepsis or septic shock who were treated in the ICU between January and December, 2010. The ICU sepsis database was used to identify patients. The patient demographics and characteristics were recorded. In addition, the number and type of prescribed medications, total cost for each medication, type of infection, and culture results were determined. MAIN OUTCOME MEASURE The main outcomes were the type of medication classes utilized and the cost of the medications. RESULTS During the study period, 116 cases were identified. Upon presentation, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 21.8 (SD ± 7.8), 30 (25.9 %) patients had neutropenia, and 94 (81 %) had positive cultures. The total cost of the medications prescribed for this cohort of patients was 291,030 Euro. The mean number of medications prescribed per patient and the mean total cost per patient were 11.7 (SD ± 4.7) and 2,509 Euro (SD ± 2,844), respectively. The most commonly prescribed medication classes were acid suppressive therapy, glycopeptides, penicillins/cephalosporins and vasopressors prescribed in 113 (97 %), 104 (89.7 %), 103 (88.9 %), and 102 (88 %) patients, respectively. The highest medication costs were associated with antifungals (mean 1,288 Euro/patient) and colony stimulating factors (mean 829 Euro/patient), prescribed in 55 (47.4 %) and 37 (31.9 %) patients, respectively. Medication costs were higher in non-survivors, compared to survivors (3,664 Euro vs. 1,430 Euro, p = 0.0001), and in patients with positive cultures, compared to patients with negative cultures (3,198 Euro vs. 1,865 Euro, p = 0.0004). CONCLUSION In cancer patients with severe sepsis and septic shock, multiple medications are prescribed which are associated with high cost.
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Affiliation(s)
- Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, Queen Rania Al-Abdallah Street, P.O.Box 1269, Amman, 11941, Jordan,
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Nazer L, Al Najjar T, Al-Shaer M, Hawari F. 525. Crit Care Med 2012. [DOI: 10.1097/01.ccm.0000424743.48342.5e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The objectives were to determine the rate of cigarette smoking and correlates of its use among a sample of Jordanian adults (N = 600). A survey-based, cross-sectional study was conducted with a convenient sample. Logistic regression was used to determine predictors of being a cigarette smoker. Approximately half of the population (45%) had smoked a cigarette in the past month, 40% in the past week, and 36% in past 24 hours. These findings underscore the magnitude of the smoking problem in the Jordanian population and the urgent need for effective interventions. Future research should focus on developing interventions that incorporate the predictors identified.
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Affiliation(s)
- Susan Abughosh
- College of Pharmacy, Institute of Community Health, University of Houston, 1441 Movsund St., Texas Medical Center, Houston, TX 77030, USA.
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Abstract
OBJECTIVES To examine the effect of ethnicity on waterpipe smoking among college students. DESIGN A cross-sectional study utilized data from University of Houston students through an online survey (n = 2334) from March to April 2011. The survey included questions on demographic characteristics (sex, age, race/ethnicity), tobacco use experience, risk perception, social acceptability and popularity. Multivariate logistic regression was used to determine predictors of waterpipe use with three outcomes: ever-use vs. no use, past-year use vs. no use and past-month use vs. no use. RESULTS Half of the sample had previously smoked tobacco using a waterpipe, approximately a third in the past year and 12.5% in the past month. Significant predictors included Middle Eastern ethnicity, Middle Eastern friend, past cigarette or cigar use. Perception of harm was associated with less use in the ever-use model, while perceived addictiveness, social acceptability and popularity of waterpipes were predictors in all models. CONCLUSION Our findings underscore the importance of developing culturally appropriate interventions to control waterpipe smoking among Middle Eastern Americans and those of Indian/Pakistani descent to curb further spread in US society, and highlight the importance of developing interventions that target the perceived addictiveness, social acceptability and popularity of waterpipe smoking.
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Affiliation(s)
- S Abughosh
- Institute of Community Health, College of Pharmacy, University of Houston, Houston, Texas 77030, USA.
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Abughosh S, Yang M, Wu IH, Hawari F, Peters R, Essien E. Waterpipe smoking among Jordanian adults: predictors and correlates. ACTA ACUST UNITED AC 2012. [DOI: 10.5455/jbh.20120313034424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hawari F, Obeidat N, Beano H, Dawahrah S, Al-Rimawi D, Ghonimat I. Smoking Abstinence Rates and Reasons for Failure to Quit Smoking in Cancer Patients in Jordan. Respiration 2012; 83:233-238. [DOI: 10.1159/000328759] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
<i>Background:</i> Failure to quit smoking in cancer patients is associated with the development of a second primary tumor and a suboptimal response to chemotherapy. However, data characterizing cancer patients' ability to quit is scarce, particularly in developing countries. Such information is valuable in highlighting the potential of cessation interventions in countries where smoking rates are high and antismoking policies are not yet fully implemented. <i>Objectives:</i> To measure the abstinence rates and identify reasons for the failure to quit smoking in patients visiting a smoking cessation clinic in a comprehensive cancer center in Jordan. <i>Methods:</i> Through retrospective medical chart review and prospective follow-up by phone, we studied long-term abstinence rates and reasons for the failure to quit smoking in 156 cancer patients referred to the smoking cessation clinic to receive counseling and pharmacological treatment. Patient demographics, clinical and smoking characteristics and long-term abstinence at 12 months were recorded, as were reasons for the failure to quit smoking. <i>Results:</i> The 12-month abstinence rate was 21.2%. The main reasons for failing to quit smoking included personal or professional stressful situations, not being able to handle withdrawal and the belief that quitting had no value. <i>Conclusion:</i> Abstinence rates in Jordanian cancer patients fall at the lower end of the range that has been reported in the literature for cancer patients. Efforts to improve these rates should focus on assisting patients in handling stress, and in adjusting medications to improve withdrawal symptoms.
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Adamik B, Islam A, Hawari F, Rouhani F, Yu Z, Combs C, Zhang J, Levine SJ. Identification of RBMX as an ARTS‐1‐Associated Protein that Mediates Soluble TNFR1 Release. FASEB J 2006. [DOI: 10.1096/fasebj.20.4.a61-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Barbara Adamik
- Pulmonary‐Critical Care Medicine BranchNHLBINational Institutes of Health10 Center Dr, Room 6D16BethesdaMD20892
| | - Aminul Islam
- Pulmonary‐Critical Care Medicine BranchNHLBINational Institutes of Health10 Center Dr, Room 6D16BethesdaMD20892
| | - Feras Hawari
- Pulmonary‐Critical Care Medicine BranchNHLBINational Institutes of Health10 Center Dr, Room 6D16BethesdaMD20892
| | - Farshid Rouhani
- Pulmonary‐Critical Care Medicine BranchNHLBINational Institutes of Health10 Center Dr, Room 6D16BethesdaMD20892
| | - Zu‐Xi Yu
- Pulmonary‐Critical Care Medicine BranchNHLBINational Institutes of Health10 Center Dr, Room 6D16BethesdaMD20892
| | - Christian Combs
- Pulmonary‐Critical Care Medicine BranchNHLBINational Institutes of Health10 Center Dr, Room 6D16BethesdaMD20892
| | - Jing Zhang
- Pulmonary‐Critical Care Medicine BranchNHLBINational Institutes of Health10 Center Dr, Room 6D16BethesdaMD20892
| | - Stewart J Levine
- Pulmonary‐Critical Care Medicine BranchNHLBINational Institutes of Health10 Center Dr, Room 6D16BethesdaMD20892
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Cui X, Rouhani FN, Hawari F, Levine SJ. Shedding of the type II IL-1 decoy receptor requires a multifunctional aminopeptidase, aminopeptidase regulator of TNF receptor type 1 shedding. J Immunol 2004; 171:6814-9. [PMID: 14662887 DOI: 10.4049/jimmunol.171.12.6814] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Proteolytic cleavage of the extracellular domain of the type II IL-1 decoy receptor (IL-1RII) generates soluble IL-1-binding proteins that prevent excessive bioactivity by binding free IL-1. In this study we report that an aminopeptidase, aminopeptidase regulator of TNFR1 shedding (ARTS-1), is required for IL-1RII shedding. Coimmunoprecipitation experiments demonstrate an association between endogenous membrane-associated ARTS-1 and a 47-kDa IL-1RII, consistent with ectodomain cleavage of the membrane-bound receptor. A direct correlation exists between ARTS-1 protein expression and IL-1RII shedding, as cell lines overexpressing ARTS-1 have increased IL-1RII shedding and decreased membrane-associated IL-1RII. Basal IL-1RII shedding is absent from ARTS-1 knockout cell lines, demonstrating that ARTS-1 is required for constitutive IL-1RII shedding. Similarly, PMA-mediated IL-1RII shedding is almost entirely ARTS-1-dependent. ARTS-1 expression also enhances ionomycin-induced IL-1RII shedding. ARTS-1 did not alter levels of membrane-associated IL-1RI or IL-1R antagonist release from ARTS-1 cell lines, which suggests that the ability of ARTS-1 to promote shedding of IL-1R family members may be specific for IL-1RII. Further, increased IL-1RII shedding by ARTS-1-overexpressing cells attenuates the biological activity of IL-1beta. We conclude that the ability of ARTS-1 to enhance IL-1RII shedding represents a new mechanism by which IL-1-induced cellular events can be modulated. As ARTS-1 also promotes the shedding of the structurally unrelated 55-kDa, type I TNF receptor and the IL-6R, we propose that ARTS-1 may play an important role in regulating innate immune and inflammatory responses by increasing cytokine receptor shedding.
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MESH Headings
- Aminopeptidases/genetics
- Aminopeptidases/metabolism
- Aminopeptidases/physiology
- Antigens, CD/metabolism
- Calcium/metabolism
- Calcium/physiology
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- Carrier Proteins/physiology
- Catalytic Domain/genetics
- Catalytic Domain/physiology
- Cell Line, Tumor
- Cell Membrane/enzymology
- Cell Membrane/genetics
- Cell Membrane/immunology
- GPI-Linked Proteins
- Humans
- Interleukin-1/pharmacology
- Interleukin-8/metabolism
- Lipoproteins/deficiency
- Lipoproteins/genetics
- Membrane Proteins/deficiency
- Membrane Proteins/genetics
- Metalloendopeptidases
- Metalloproteases/deficiency
- Metalloproteases/genetics
- Minor Histocompatibility Antigens
- Multienzyme Complexes/genetics
- Multienzyme Complexes/metabolism
- Multienzyme Complexes/physiology
- Mutagenesis, Insertional
- Precipitin Tests
- Protein Isoforms/metabolism
- Receptors, Interleukin-1/metabolism
- Receptors, Interleukin-1/physiology
- Receptors, Tumor Necrosis Factor/metabolism
- Receptors, Tumor Necrosis Factor, Member 10c
- Receptors, Tumor Necrosis Factor, Type I
- Tumor Necrosis Factor Decoy Receptors
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Affiliation(s)
- Xinle Cui
- Pulmonary-Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1590, USA
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Abstract
Aminopeptidase regulator of TNFR1 shedding (ARTS-1) binds to the type I tumor necrosis factor receptor (TNFR1) and promotes receptor shedding. Because hydroxamic acid-based metalloprotease inhibitors prevent shedding of both TNFR1 and the interleukin-6 receptor (IL-6Ralpha), we hypothesized that ARTS-1 might also regulate shedding of IL-6Ralpha, a member of the type I cytokine receptor superfamily that is structurally different from TNFR1. Reciprocal co-immunoprecipitation experiments identified that membrane-associated ARTS-1 directly binds to a 55-kDa IL-6Ralpha, a size consistent with soluble IL-6Ralpha generated by ectodomain cleavage of the membrane-bound receptor. Furthermore, ARTS-1 promoted IL-6Ralpha shedding, as demonstrated by a direct correlation between increased membrane-associated ARTS-1 protein, increased IL-6Ralpha shedding, and decreased membrane-associated IL-6Ralpha in cell lines overexpressing ARTS-1. The absence of basal IL-6Ralpha shedding from arts-1 knock-out cells identified that ARTS-1 was required for constitutive IL-6Ralpha shedding. Furthermore, the mechanism of constitutive IL-6Ralpha shedding requires ARTS-1 catalytic activity. Thus, ARTS-1 promotes the shedding of two cytokine receptor superfamilies, the type I cytokine receptor superfamily (IL-6Ralpha) and the TNF receptor superfamily (TNFR1). We propose that ARTS-1 is a multifunctional aminopeptidase that may modulate inflammatory events by promoting IL-6Ralpha and TNFR1 shedding.
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Affiliation(s)
- Xinle Cui
- Pulmonary-Critical Care Medicine Branch, NHLBI, National Institutes of Health, Bethesda, Maryland 20892-1590, USA
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Cui X, Hawari F, Alsaaty S, Lawrence M, Combs CA, Geng W, Rouhani FN, Miskinis D, Levine SJ. Identification of ARTS-1 as a novel TNFR1-binding protein that promotes TNFR1 ectodomain shedding. J Clin Invest 2002. [DOI: 10.1172/jci0213847] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Cui X, Hawari F, Alsaaty S, Lawrence M, Combs CA, Geng W, Rouhani FN, Miskinis D, Levine SJ. Identification of ARTS-1 as a novel TNFR1-binding protein that promotes TNFR1 ectodomain shedding. J Clin Invest 2002; 110:515-26. [PMID: 12189246 PMCID: PMC150410 DOI: 10.1172/jci13847] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Proteolytic cleavage of TNF receptor 1 (TNFR1) generates soluble receptors that regulate TNF bioactivity. We hypothesized that the mechanism of TNFR1 shedding might involve interactions with regulatory ectoproteins. Using a yeast two-hybrid approach, we identified ARTS-1 (aminopeptidase regulator of TNFR1 shedding) as a type II integral membrane protein that binds to the TNFR1 extracellular domain. In vivo binding of membrane-associated ARTS-1 to TNFR1 was confirmed by coimmunoprecipitation experiments using human pulmonary epithelial and umbilical vein endothelial cells. A direct relationship exists between membrane-associated ARTS-1 protein levels and concordant changes in TNFR1 shedding. Cells overexpressing ARTS-1 demonstrated increased TNFR1 shedding and decreased membrane-associated TNFR1, while cells expressing antisense ARTS-1 mRNA demonstrated decreased membrane-associated ARTS-1, decreased TNFR1 shedding, and increased membrane-associated TNFR1. ARTS-1 neither bound to TNFR2 nor altered its shedding, suggesting specificity for TNFR1. Although a recombinant ARTS-1 protein demonstrated selective aminopeptidase activity toward nonpolar amino acids, multiple lines of negative evidence suggest that ARTS-1 does not possess TNFR1 sheddase activity. These data indicate that ARTS-1 is a multifunctional ectoprotein capable of binding to and promoting TNFR1 shedding. We propose that formation of a TNFR1-ARTS-1 molecular complex represents a novel mechanism by which TNFR1 shedding is regulated.
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MESH Headings
- ADP Ribose Transferases/genetics
- ADP Ribose Transferases/metabolism
- Amino Acid Sequence
- Aminopeptidases/metabolism
- Antigens, CD/chemistry
- Antigens, CD/metabolism
- Base Sequence
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- Cell Line
- Cells, Cultured
- Cloning, Molecular
- Endothelium, Vascular/metabolism
- Epithelial Cells/metabolism
- GPI-Linked Proteins
- Humans
- Lung/cytology
- Lung/metabolism
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Minor Histocompatibility Antigens
- Molecular Sequence Data
- Protein Structure, Tertiary
- Receptors, Tumor Necrosis Factor/chemistry
- Receptors, Tumor Necrosis Factor/metabolism
- Receptors, Tumor Necrosis Factor, Type I
- Tumor Cells, Cultured
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Affiliation(s)
- Xinle Cui
- Pulmonary-Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, , National Institutes of Health, Bethesda, Maryland 20892-1590, USA
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