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Sultan H, AlNasser M, Assiri A, Tawhari F, Bakkari A, Mustafa M, Alotaibi W, Asiri A, Khudari A, Alshreem A, Ayoub M, Alkhathami S, Basndwah H, Alsaeed O, Alkredees M, Alsalem T, Alhuwail A, Almalki T, Alzahrani Y, Alshahrani F, Alqahtani B, Alghamdi B, Ibrahim ARN, Zaitoun M. Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study. Eur Rev Med Pharmacol Sci 2023; 27:10076-10081. [PMID: 37916378 DOI: 10.26355/eurrev_202310_34188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. PATIENTS AND METHODS Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. RESULTS 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. CONCLUSIONS In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.
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Affiliation(s)
- H Sultan
- Pharmaceutical Care Administration, Armed Forces Hospital Southern Region, Khamis Mushait Asir, Saudi Arabia.
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Lin BR, Al-Khersan H, Rowsey T, West M, Lin A, Qu P, Bitrian E, Hudson J, Venincasa M, Fan J, Gutkind N, Diaz JD, Parekh P, Sultan H, Yannuzzi NA. Reply. Ophthalmology 2023; 130:e35-e36. [PMID: 37437782 DOI: 10.1016/j.ophtha.2023.07.003] [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] [Received: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Benjamin R Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Tyler Rowsey
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew West
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Albert Lin
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Phillip Qu
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Elena Bitrian
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Julia Hudson
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Michael Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Jason Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Naomi Gutkind
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | | | | | | | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida.
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Lin BR, Al-Khersan H, Rowsey T, West M, Lin A, Qu P, Bitrian E, Hudson J, Venincasa M, Fan J, Gutkind N, Diaz JD, Parekh P, Sultan H, Yannuzzi NA. Clinical Outcomes after Ocular Trauma with Orbeez Gel Pellet Projectiles. Ophthalmology 2023; 130:553-555. [PMID: 36717000 DOI: 10.1016/j.ophtha.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/30/2023] Open
Affiliation(s)
- Benjamin R Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Tyler Rowsey
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew West
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Albert Lin
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Phillip Qu
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Elena Bitrian
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Julia Hudson
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Michael Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Jason Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Naomi Gutkind
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | | | | | | | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
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Al-Surrayai T, Al-Khalaifah H, Al-Mansour H, Kishk M, Al-Mutairi A, Sultan H, Al-Saleem H. Evaluation of the lactic acid bacteria based formulated probiotic product for poultry. Front Anim Sci 2022. [DOI: 10.3389/fanim.2022.1026958] [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: 11/11/2022] Open
Abstract
This study evaluated the effectiveness of a new probiotic product developed to reduce the effect of Salmonella infections and compared it to the efficacy of commercial probiotics in broiler chicken. Based on the in vitro assessment of the growth characteristics and safety to human health, four bacterial isolates were isolated, characterized, and identified as excellent candidates for the development of commercial probiotic feed additives for poultry. Compatibility and interactions among the four selected strains were investigated. After that, a preliminary study was conducted in which the selected isolates were evaluated individually in vivo with three different methods of application (water, feed, and oral gavage). The cycle included N = 312 chicks, which were divided into 13 groups, including control, distributed into four batteries, with 78 broiler chickens in each battery. There were eight replicates with 24 chicks in each replicate, and the analysis was randomly done in triplicate. The intentional parameters were growth performance, microbial analysis and humoral immune response. The results of the preliminary study assisted in formulating the new probiotic product. Then In vivo evaluations for the newly formulated product were performed with the comparison with two imported commercial products (Alterion and Galli pro fit) used in poultry farms in Kuwait. The second cycle included N = 96 chicks that were divided into four groups, including control. Each group has three replicates and each replicate has eight chicks, and the analysis was randomly done in triplicate. The results showed that although antibiotics were not used, all the growth parameters were similar and sometimes better than the control. The new product inhibited the growth of salmonella as a control and all chickens in different treatment gained a high mass of meat. The statistical analysis showed that no differences were observed in bird weight, weight gain, feed consumption, and feed efficiency between bacterial strains p>0.05. Also, the different probiotic treatments did not affect the total antibody IgM titers significantly in the broilers (P > 0.05). Thus, the newly formulated product was effective in reducing the salmonella.
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Sultan H, Rajagopal R, Rao PK, Piggott KD, Paley MA, Hassman LM, Li AS, Marshall B, Apte RS. Vitreous microparticles contain apoptotic signals suggesting a diabetic vitreopathy. Int J Ophthalmol 2022; 15:89-97. [PMID: 35047362 DOI: 10.18240/ijo.2022.01.14] [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: 02/19/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate differences in microparticle profiles in vitreous samples between diabetic and non-diabetic eyes undergoing vitrectomy. METHODS Un-masked cross-sectional series of 34 eyes undergoing vitrectomy. Vitreous specimens were collected and processed to evaluate for membrane integrity (DAPI), apoptosis (Annexin-V), and endothelial-cell origin (V-Cadherin). A BD LSR II flow cytometer was used for analysis and standardized sub-micron-sized beads were used for size comparison. RESULTS Thirty-four specimens underwent analysis. Greater levels of Annexin-V were found on microparticles from specimens in which blood had entered the vitreous (n=12) compared to those without blood (n=22; 52.3%±30.7% vs 19.6%±27.2%, P=0.002). Patients with diabetes having surgery with hemorrhage (n=7) had greater expression of Annexin-V than those without hemorrhage (n=8; 62.1%±31.7% vs 18.9%±20.9%, P=0.009). However, in patients with non-diabetic vitreous hemorrhage, the level of Annexin-V expression was not significantly different compared to other disease processes (38.6%±25.7%, n=5 vs 20.0%±30.9%, n=14, P=0.087). CONCLUSION Increased expression of the apoptotic marker, Annexin-V is detected on vitreous microparticles in diabetes-related vitreous hemorrhage. When evaluating vitreous hemorrhage in patients without diabetes, the apoptotic signal is not significantly different. Vitrectomy in patients with diabetes, and improvement in visual outcomes, may be related to the removal of a serum-derived, pro-apoptotic vitreous. Further investigation is warranted in order to identify the molecular characteristics of microparticles that regulate disease.
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Affiliation(s)
- Harris Sultan
- John Hardesty Department of Ophthalmology, Washington University, St. Louis, MO 63110, USA
| | - Rithwick Rajagopal
- John Hardesty Department of Ophthalmology, Washington University, St. Louis, MO 63110, USA
| | - Prabakar Kumar Rao
- John Hardesty Department of Ophthalmology, Washington University, St. Louis, MO 63110, USA
| | - Kisha Deslee Piggott
- John Hardesty Department of Ophthalmology, Washington University, St. Louis, MO 63110, USA
| | - Michael A Paley
- Department of Medicine, Division of Rheumatology, Washington University, St. Louis, MO 63110, USA
| | - Lynn Marisa Hassman
- John Hardesty Department of Ophthalmology, Washington University, St. Louis, MO 63110, USA
| | - Albert S Li
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Brigid Marshall
- John Hardesty Department of Ophthalmology, Washington University, St. Louis, MO 63110, USA
| | - Rajendra Shridhar Apte
- John Hardesty Department of Ophthalmology, Washington University, St. Louis, MO 63110, USA
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Sultan H, Wykoff CC, Shah AR. Five-Year Outcomes of Surgically Treated Symptomatic Epiretinal Membranes With and Without Internal Limiting Membrane Peeling. Ophthalmic Surg Lasers Imaging Retina 2019; 49:296-302. [PMID: 29772039 DOI: 10.3928/23258160-20180501-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/05/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The authors evaluated long-term postoperative visual outcomes and recurrence rates following surgery for symptomatic epiretinal membrane (ERM) ± internal limiting membrane (ILM) peeling. PATIENTS AND METHODS This was a retrospective, consecutive case series of 78 patients undergoing vitrectomy for symptomatic ERM between 1/2010 and 4/2012 with follow-up through at least postoperative year 5 (POY5). Outcomes included visual acuity (VA) (Snellen VA converted to logMAR), central retinal thickness (CRT; μm), and ERM recurrence. Subgroup analysis evaluated outcomes related to ILM peeling. RESULTS Subgroup analysis based on ILM peeling did not find VA (20/50 [0.430 logMAR ± 0.061 logMAR; mean ± SD] vs. 20/60 [0.518 logMAR ± 0.128 logMAR] for ILM vs. non-ILM peeling respectively; P = .513) nor macular thickness (355 μm ± 13 μm vs. 360 μm ± 42 μm; P = .410) to be significantly different at POY5. Recurrence requiring surgery with and without ILM peeling was not statistically significantly different at POY5 (1.6% and 11.8%; P = .118). CONCLUSION Vitrectomy for symptomatic ERM led to improved visual and anatomic outcomes with sustained benefit through 5 years. ILM peeling was was associated with reduced ERM recurrence, but this benefit was not statistically significant at POY5. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:296-302.].
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Abu-Shawer O, Abu-Shawer M, Hirmas N, Alhouri A, Massad A, Alsibai B, Sultan H, Hammo H, Souleiman M, Shebli Y, Al-Hussaini M. Hematologic markers of distant metastases and poor prognosis in gynecological cancers. BMC Cancer 2019; 19:141. [PMID: 30755184 PMCID: PMC6373103 DOI: 10.1186/s12885-019-5326-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 05/25/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Despite the recent progress in the development of anti-cancer drugs, the treatment of metastatic tumors is usually ineffective. The systemic inflammatory response performs key roles in different stages of the carcinogenesis process including metastasis. The high neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) were found to be associated with poor survival rates in the majority of solid tumors. However, only a few studies were conducted to further investigate this association in patients with advanced gynecological cancers. Methods Clinical data from 264 patients with FIGO stage III and IV gynecological (endometrial, ovarian and cervical) cancers treated at King Hussein Cancer Center (Amman-Jordan) from 2006 to 2012 were retrospectively reviewed. We examined the association between absolute neutrophil count (ANC), absolute monocyte count (AMC), MLR, PLR, and NLR with distant metastases, overall survival and event-free survival in gynecological cancers. For survival analysis, Receiver Operating Characteristic (ROC) curve analysis was operated to determine the optimal cutoff values. Results Patients with high baseline NLR (≥4.1) had more baseline distant metastases than patients with low baseline NLR (< 4.1), (p-value 0.045). Patients with high baseline AMC (≥560) had more distant metastases in comparison to patients with low baseline AMC (< 560), (p-value 0.040). Furthermore, Patients with high baseline PLR (≥0.3) had more distant metastases in comparison to patients with low baseline PLR (< 0.3), (p-value 0.025). Additionally, patients with high baseline ANC (≥5700) had worse overall survival compared to the patients with low baseline ANC (< 5700), (p-value 0.015). Also, patients with high baseline AMC (≥490) had worse overall survival compared to the patients with low baseline AMC (< 490), (p-value 0.044). Conclusion Different hematologic markers obtained from a cheap test (CBC) could potentially be used to predict the presence of distant metastases thus used as prognostic indices in gynecological cancers.
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Affiliation(s)
- O Abu-Shawer
- University of Jordan School of Medicine, Amman, Jordan
| | | | - N Hirmas
- King Hussein Cancer Center, Amman, Jordan
| | - A Alhouri
- University of Jordan School of Medicine, Amman, Jordan
| | - A Massad
- University of Jordan School of Medicine, Amman, Jordan
| | - B Alsibai
- University of Jordan School of Medicine, Amman, Jordan
| | - H Sultan
- University of Jordan School of Medicine, Amman, Jordan
| | - H Hammo
- University of Jordan School of Medicine, Amman, Jordan
| | - M Souleiman
- University of Jordan School of Medicine, Amman, Jordan
| | - Y Shebli
- University of Jordan School of Medicine, Amman, Jordan
| | - M Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, 11941, Jordan.
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Sultan H, Smith SV, Lee AG, Chévez-Barrios P. Pathologic Markers Determining Prognosis in Patients With Treated or Healing Giant Cell Arteritis. Am J Ophthalmol 2018; 193:45-53. [PMID: 29890162 DOI: 10.1016/j.ajo.2018.05.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To provide quantitative evidence linking the CD68 (cluster of differentiation 68)+ macrophage marker found on temporal artery biopsies (TABs) with disease prognosis. DESIGN Retrospective, cross-sectional study. METHODS We examined 42 consecutive patients who had undergone unilateral TABs at a single hospital in 2015. Clinical data, laboratory data, and histopathologic features of TABs were recorded. Inclusion criteria were clinical diagnosis of giant cell arteritis (GCA) with TAB performed at the same center. CD68 immunohistochemistry was used to label macrophages in the TABs. Primary outcome was multiple logistic regression and bivariate comparisons to measure the association between CD68+ cells per histologic section with placement on immunomodulatory therapy (IMT). RESULTS Twenty seven patients were female (64%), with a mean age of 72 (standard deviation [SD.] ±7.7). Eleven patients (26%) were placed on IMT, 17 (40%) had disease recurrence during steroid taper, and 25 (60%) were referred to rheumatology. Of 42 biopsies, 35 underwent staining with CD68 to confirm active inflammation in suspicious, but not diagnostic, specimens. Patients eventually placed on IMT had increased CD68+ cells per slice compared to those not on IMT (median 5.00 [25th-75th quartile 2.00-7.15] vs 1.21 [0.38-2.57], P = .031, respectively). A receiver operating characteristic (ROC) curve demonstrates that 2.17 CD68+ cells/slice predicts placement on IMT with an odds ratio of 1.54 (95% confidence interval 1.02-2.33, P = .038). CONCLUSIONS Patients refractory to initial steroid tapers and those eventually placed on IMT had increased CD68 cells per section. CD68+ macrophages and their location on the internal elastic lamina may predict disease severity in patients with presumed GCA. Our results suggest that this marker may expedite patient triaging to alternate treatment to the usual steroid therapy.
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Sultan H, Kellogg C, El-Annan J. Retinal Pigment Epithelium Tears in a 67-Year-Old Man. JAMA Ophthalmol 2018; 136:583-584. [PMID: 29423507 DOI: 10.1001/jamaophthalmol.2017.4445] [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: 11/14/2022]
Affiliation(s)
- Harris Sultan
- Department of Ophthalmology, University of Texas Medical Branch, Galveston.,Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Clint Kellogg
- Department of Ophthalmology, University of Texas Medical Branch, Galveston
| | - Jaafar El-Annan
- Department of Ophthalmology, University of Texas Medical Branch, Galveston
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El Tantawi G, Sultan H. P4.4 Post-injection posterior femoral cutaneous mononeuropathy: report on clinical presentation and electrophysiological findings in 5 cases. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60243-5] [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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Mohasseb D, El-Tantawi G, Sultan H, El-Nemr R. P4.1 Comparative study of prognostic value of quantitative versus conventional electromyography in Bell's palsy. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60240-x] [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: 10/17/2022]
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Elaimi AH, Sabhnani TV, Sultan H, Alduraihem A, Fitzharris G, Howe K, Harper J, Garcia F, Alvarez JG, Velilla E, Fernandez S, Serra O, Lopez-Teijon M, Figueira RCS, Braga DPAF, Queiroz P, Pasqualotto FF, Iaconelli A, Borges E, Vanneste E, Voet T, Melotte C, Vandendael T, Declercq M, Vervoort C, Debrock S, Fryns JP, D'Hooghe T, Vermeesch JR, Choi Y, Park M, Song SH, Won HJ, Kim YS, Ryu SW, Lee DR, Shim SH, Yoon TK. Session 19: Reproduction and Genetics. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.19] [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: 11/14/2022] Open
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Sultan H, SenGupta S, Noble R, Harper JC. Islamic ethical and legal framework and current practice of PGD/PGS and PND in Saudi Arabia. Reprod Biomed Online 2009. [DOI: 10.1016/s1472-6483(10)61264-3] [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: 10/19/2022]
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Bluman EM, Schnier GS, Avalos BR, Strout MP, Sultan H, Jacobson FW, Williams DE, Carson WE, Caligiuri MA. The c-kit ligand potentiates the allogeneic mixed lymphocyte reaction. Blood 1996; 88:3887-93. [PMID: 8916954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The allogeneic mixed lymphocyte reaction (MLR) is a complex in vitro assay of T-cell recognition and responsiveness in which interleukin-2 (IL-2) plays a central role. We have previously demonstrated that c-kit ligand (KL) can enhance IL-2-induced proliferation in a subset of human natural killer cells expressing the c-kit tyrosine kinase receptor. In the present study, we asked whether KL could enhance IL-2-mediated T-cell proliferation in the allogeneic MLR. We demonstrate that the vast majority of activated human T-cell clones express the c-kit mRNA transcript. Binding studies performed on activated T cells with radioiodinated KL were consistent with the expression of a single class of c-kit receptors. The addition of exogenous KL to the MLR led to an increase in tritiated thymidine (3[H]-TdR) incorporation in the absence of other exogenous cytokines, and did so in a dose-dependent fashion. A reproducible increase in 3[H]-TdR incorporation was noted at concentrations of KL, which approximate those normally found in vivo. Antibody blocking of KL binding to c-kit, T-cell depletion and sorting experiments suggest that the action of KL is mediated at least in part by a direct effect on both CD4+ and CD8+ T-cells. KL's enhancement of the MLR also requires the binding of IL-2 to its high-affinity IL-2 receptor. Given the abundance of KL normally found in human serum, these data suggest that this cytokine may have a role during T-cell activation in vivo.
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Affiliation(s)
- E M Bluman
- Department of Hematologic Oncology and Bone Marrow Transplantation, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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Abstract
For many years the direct stimulation of T cells in response to donor MHC antigens expressed on donor antigen-presenting cells has been the focus of transplantation immunology. Indirect recognition in response to peptides of donor antigens presented by self MHC molecules on recipient antigen-presenting cells has not generally been considered an important feature of graft rejection. Recent evidence suggests that indirect responses may be more important than previously considered and the new emphasis on indirect pathways in allograft rejection has raised new issues, many of which are unresolved.
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Affiliation(s)
- H Auchincloss
- Massachusetts General Hospital, Department of Surgery and Transplantation, Boston 02114, USA.
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