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Lobashevsky A, Niemann M, Kowinski B, Higgins N, Abdel-Wareth L, Atrabulsi B, Roe D, Hage C. Formation of donor-specific antibodies depends on the epitope load of mismatched hlas in lung transplant recipients: A retrospective single-center study. Clin Transplant 2022; 36:e14755. [PMID: 35771140 DOI: 10.1111/ctr.14755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/08/2022] [Revised: 05/18/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
The development of donor-specific antibodies (DSA) has a significant impact on graft outcome in solid organ transplantation. Mismatched HLAs are recognized directly and indirectly by the recipient immune system. Both pathways occur in parallel and result in the generation of plasma cells, DSA, cytotoxic and T helper lymphocytes. Here, we present the results of an analysis of the epitope load of mismatched HLAs in a cohort of 220 lung transplant recipients using two in silico algorithms, HLAMatchmaker and PIRCHE-II (Predicted Indirectly ReCognizable HLA Epitopes). De novo DSA (dnDSA) were detected by single antigen bead assays. The percentage of recipients who developed dnDSA was significantly higher in the group of patients who received lung transplants with a mismatching score above the detected threshold than in the group of patients who received lung transplants with a mismatching score below the threshold. In a multivariate Cox proportional hazard analysis, the PIRCHE-II score appeared to be a superior predictor of dnDSA formation. In addition, PIRCHE-II technology was shown to be useful in predicting separate dnDSA1 and dnDSA2 formation. We conclude that both algorithms can be used for the evaluation of the epitope load of mismatched HLAs and the prediction of DSA development in lung transplant recipients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Andrew Lobashevsky
- Transplant Immunology Laboratory, Methodist Hospital, IUHealth Inc., Indianapolis, IN, USA.,Mubadala, National Reference Laboratory, HLA Laboratory, Abu Dhabi, UAE
| | | | - Brenda Kowinski
- Lung Transplant Program, IUHealth Inc., Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nancy Higgins
- Transplant Immunology Laboratory, Methodist Hospital, IUHealth Inc., Indianapolis, IN, USA
| | | | - Basel Atrabulsi
- Mubadala, National Reference Laboratory, HLA Laboratory, Abu Dhabi, UAE
| | - David Roe
- Lung Transplant Program, IUHealth Inc., Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chadi Hage
- McGowen Institute of Regenerative medicine, UPMC, University of Pittsburgh, Pittsburgh, PA, USA
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Al-Anouti F, Mousa M, Karras SN, Grant WB, Alhalwachi Z, Abdel-Wareth L, Uddin M, Alkaabi N, Tay GK, Mahboub B, AlSafar H. Associations between Genetic Variants in the Vitamin D Metabolism Pathway and Severity of COVID-19 among UAE Residents. Nutrients 2021; 13:nu13113680. [PMID: 34835935 PMCID: PMC8625365 DOI: 10.3390/nu13113680] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/18/2022] Open
Abstract
Vitamin D has many effects on cells in the immune system. Many studies have linked low vitamin D status with severity of COVID-19. Genetic variants involved in vitamin D metabolism have been implicated as potential risk factors for severe COVID-19 outcomes. This study investigated how genetic variations in humans affected the clinical presentation of COVID-19. In total, 646 patients with SARS-CoV-2 infection were divided into two groups: noncritical COVID-19 (n = 453; 70.12%) and a critical group (n = 193; 29.87%). Genotype data on the GC, NADSYN1, VDR, and CYP2R1 genes along with data on serum 25-hydroxyvitamin D levels were compiled in patients admitted to a major hospital in the United Arab Emirates between April 2020 and January 2021. We identified 12 single-nucleotide polymorphisms associated with the critical COVID-19 condition: rs59241277, rs113574864, rs182901986, rs60349934, and rs113876500; rs4944076, rs4944997, rs4944998, rs4944979, and rs10898210; and rs11574018 and rs11574024. We report significant associations between genetic determinants of vitamin D metabolism and COVID-19 severity in the UAE population. Further research needed to clarify the mechanism of action against viral infection in vitamin D deficiency. These variants could be used with vaccination to manage the spread of SARS-CoV-2 and could be particularly valuable in populations in which vitamin D deficiency is common.
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Affiliation(s)
- Fatme Al-Anouti
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates;
| | - Mira Mousa
- Nuffield Department of Women’s and Reproductive Health, Oxford University, Oxford OX1 4BH, UK;
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; (Z.A.); (G.K.T.)
| | | | - William B. Grant
- Sunlight, Nutrition and Health Research Center, San Francisco, CA 94164-1603, USA;
| | - Zainab Alhalwachi
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; (Z.A.); (G.K.T.)
| | - Laila Abdel-Wareth
- National Reference Laboratory, Abu Dhabi, United Arab Emirates;
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Maimunah Uddin
- Department of Pediatric Infectious Disease, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; (M.U.); (N.A.)
| | - Nawal Alkaabi
- Department of Pediatric Infectious Disease, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; (M.U.); (N.A.)
| | - Guan K. Tay
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; (Z.A.); (G.K.T.)
- Psychiatry, Medical School, University of Western Australia, Perth, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Bassam Mahboub
- Dubai Health Authority, Rashid Hospital, Dubai, United Arab Emirates;
| | - Habiba AlSafar
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; (Z.A.); (G.K.T.)
- Department of Biomedical Engineering, College of Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Correspondence:
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Safar HA, Chehadeh SEH, Abdel-Wareth L, Haq A, Jelinek HF, ElGhazali G, Anouti FA. Vitamin D receptor gene polymorphisms among Emirati patients with type 2 diabetes mellitus. J Steroid Biochem Mol Biol 2018; 175:119-124. [PMID: 28323045 DOI: 10.1016/j.jsbmb.2017.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 12/11/2022]
Abstract
At a prevalence rate close to 19.5%, the UAE has one of the highest rates of Type 2 Diabetes Mellitus (T2DM) in the world. Genome wide association studies (GWAS) have led to the identification of several genetic variants that are associated with T2DM. Recently, genes involved in vitamin D metabolism have gained interest because of the association between vitamin D deficiency (VDD) and increased risk for T2DM. Among these, the Vitamin D receptor (VDR) gene is a good candidate for T2DM susceptibility. The aim of this study was to investigate the association between VDR polymorphisms and T2DM among a representative sample of the Emirati population. In this cross sectional study, two hundred and sixty four patients with T2DM and ninety-one healthy controls were enrolled. The study population was genotyped for the three VDR gene mutations, TaqI (rs731236), FokI (rs2228570) and BsmI (rs1544410). VDR alleles and haplotypes were compared between patients and their healthy controls. The mean age of the T2DM cohort was 60±11.59years and 48.21±12.17years for the healthy controls. The G-allele and GG genotype of rs2228570 and T-allele and TT genotype of rs1544410 SNPs were associated with T2DM. In regards to T2DM-related metabolic complications, the AG and GG genotypes of rs731236 were significantly associated with higher total cholesterol (p=0.011) and LDL-cholesterol (p=0.009) levels in the patients with T2DM. In contrast, the CT genotype of rs1544410 was significantly associated with lower BMI (p=0.031) and the TT genotype was associated with lower LDL-cholesterol level (p=0.007). The frequency of AAT and GGC haplotypes was also different between groups (p=0.014; p=0.032, respectively), implying that these haplotypes of the VDR gene are associated with the susceptibility to T2DM in the Emirati population. To conclude, an association between SNPs in the VDR gene (except for rs731236) and T2DM per se was demonstrated. The rs731236 variant was shown to be associated with high cholesterol and LDL-cholesterol levels in T2DM patients, while rs1544410 was associated with lower BMI and lower LDL cholesterol levels. Our results imply that alleles and haploypes of the VDR gene are associated with the susceptibility to T2DM in the Emirati population.
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Affiliation(s)
- Habiba Al Safar
- Faculty of Biomedical Engineering, Khalifa University of Science, Technology & Research, Abu Dhabi, United Arab Emirates; Khalifa University Center of Biotechnology, Abu Dhabi, United Arab Emirates
| | | | - Laila Abdel-Wareth
- Pathology & Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Afrozul Haq
- VPS Healthcare, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- Australian School of Advanced Medicine, Macquarie University, Sydney and School of Community Health, Charles Sturt University, Albury, Australia
| | - Gehad ElGhazali
- Pathology and Laboratory Medicine Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Fatme Al Anouti
- Faculty of Biomedical Engineering, Khalifa University of Science, Technology & Research, Abu Dhabi, United Arab Emirates; College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates.
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Haq A, Svobodová J, Sofi NY, Jindrová A, Kába B, Rajah J, Al Anouti F, Abdel-Wareth L, Wimalawansa SJ, Razzaque MS. Vitamin D status among the juvenile population: A retrospective study. J Steroid Biochem Mol Biol 2018; 175:49-54. [PMID: 28108200 DOI: 10.1016/j.jsbmb.2017.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 02/06/2023]
Abstract
Vitamin D deficiency is a clinical problem and recently we have shown that 82.5% of our entire study cohort had inadequate serum 25(OH)D levels. In this study, we analysed serum 25(OH)D levels of juvenile patients admitted to the Burjeel Hospital of VPS Health care in Abu Dhabi, United Arab Emirates (UAE) from October 2012 to September 2014. Out of a total of 7883 juvenile patients considered in this study, almost 58.1% of females and 43.3% of males in the age group of 1-18 years were found to have low serum 25(OH)D levels (<50nmol/L). According to the coefficient of variation, females had significantly higher variability among juveniles (63.8%) than males (49.9%). Among the juveniles group of patients, age appears to be an important determining factor for defining vitamin D deficiency.The risk of deficiency (<30nmol/L) was found to be present in 31.4% of patients in the age group of 10-12 years, followed by 50.4% of patients in the age group of 13-15 years and 52.9% of patients in the age group of 16-18 years. The analysed age groups of females were found to have lower levels of 25(OH)D than males. It is important and perhaps alarming to note that such high rate of vitamin D deficiency is present in the juvenile age.
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Affiliation(s)
- Afrozul Haq
- Research and Development, Gulf Diagnostic Center Hospital, Abu Dhabi, United Arab Emirates.
| | - Jitka Svobodová
- Department of Statistics, Faculty of Economics and Management, Czech University of Life Sciences, Prague, Kamýcká 129, 165 21 Praha 6-Suchdol, Czechia
| | - Nighat Y Sofi
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India; Banasthali University, Rajasthan, India
| | - Andrea Jindrová
- Department of Statistics, Faculty of Economics and Management, Czech University of Life Sciences, Prague, Kamýcká 129, 165 21 Praha 6-Suchdol, Czechia
| | - Bohumil Kába
- Department of Statistics, Faculty of Economics and Management, Czech University of Life Sciences, Prague, Kamýcká 129, 165 21 Praha 6-Suchdol, Czechia
| | - Jaishen Rajah
- Institute of Pediatrics, Sheikh Khalifa Medical City, United Arab Emirates
| | | | - Laila Abdel-Wareth
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | | | - Mohammed S Razzaque
- Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
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Ng DL, Al Hosani F, Keating MK, Gerber SI, Jones TL, Metcalfe MG, Tong S, Tao Y, Alami NN, Haynes LM, Mutei MA, Abdel-Wareth L, Uyeki TM, Swerdlow DL, Barakat M, Zaki SR. Clinicopathologic, Immunohistochemical, and Ultrastructural Findings of a Fatal Case of Middle East Respiratory Syndrome Coronavirus Infection in the United Arab Emirates, April 2014. Am J Pathol 2016; 186:652-8. [PMID: 26857507 PMCID: PMC7093852 DOI: 10.1016/j.ajpath.2015.10.024] [Citation(s) in RCA: 285] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/24/2015] [Accepted: 10/30/2015] [Indexed: 12/15/2022]
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) infection causes an acute respiratory illness and is associated with a high case fatality rate; however, the pathogenesis of severe and fatal MERS-CoV infection is unknown. We describe the histopathologic, immunohistochemical, and ultrastructural findings from the first autopsy performed on a fatal case of MERS-CoV in the world, which was related to a hospital outbreak in the United Arab Emirates in April 2014. The main histopathologic finding in the lungs was diffuse alveolar damage. Evidence of chronic disease, including severe peripheral vascular disease, patchy cardiac fibrosis, and hepatic steatosis, was noted in the other organs. Double staining immunoassays that used anti–MERS-CoV antibodies paired with immunohistochemistry for cytokeratin and surfactant identified pneumocytes and epithelial syncytial cells as important targets of MERS-CoV antigen; double immunostaining with dipeptidyl peptidase 4 showed colocalization in scattered pneumocytes and syncytial cells. No evidence of extrapulmonary MERS-CoV antigens were detected, including the kidney. These results provide critical insights into the pathogenesis of MERS-CoV in humans.
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Affiliation(s)
- Dianna L Ng
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Farida Al Hosani
- Communicable Diseases Department, Abu Dhabi, United Arab Emirates
| | - M Kelly Keating
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan I Gerber
- Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara L Jones
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen G Metcalfe
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suxiang Tong
- Gastroenteritis and Respiratory Virus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ying Tao
- Gastroenteritis and Respiratory Virus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Negar N Alami
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; International Research and Programs Branch, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lia M Haynes
- Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Laila Abdel-Wareth
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Timothy M Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David L Swerdlow
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maha Barakat
- Health Authority-Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Thomas J, Anouti FA, Hasani SA, Abdel-Wareth L, Haq A. Sunshine, Sadness and Seasonality: 25-Hydroxyvitamin D, and Depressive Symptoms in the United Arab Emirates (UAE). International Journal of Mental Health Promotion 2011. [DOI: 10.1080/14623730.2011.9715647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Al Anouti F, Thomas J, Abdel-Wareth L, Rajah J, Grant WB, Haq A. Vitamin D deficiency and sun avoidance among university students at Abu Dhabi, United Arab Emirates. Dermatoendocrinol 2011; 3:235-9. [PMID: 22259650 DOI: 10.4161/derm.3.4.16881] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 04/21/2011] [Accepted: 06/10/2011] [Indexed: 12/21/2022]
Abstract
This study offers evidence that vitamin D deficiency could be a major public health burden among young Emirati adults, mostly because of sun deprivation in a sun-blessed country. This study included a random sample of 138 females and 70 males tested for serum 25-hydroxyvitamin D [25(OH)D] status. To further evaluate the predictors of vitamin D status in this population, the study examined diet, obesity and sun exposure. In summer, the mean serum 25(OH)D concentration for females was 20.9 ± 14.9 nmol/L, whereas that for males was 27.3 ± 15.7 nmol/L. Females scored significantly higher than males on the sun avoidance inventory (SAI), indicating that females avoid sun exposure to a greater extent than males, possibly explaining the lower vitamin D status. A significant negative correlation also existed between SAI and vitamin D status (Pearson's r = -0.33; p < 0.01), but no significant association was evident between vitamin D status and body mass index (Pearson's r = 0.03; p = 0.33) or low dietary intake of vitamin D-fortified foods (Pearson's r = 0.08; p = 0.13). The mean serum 25(OH)D concentration for females tested in winter was 31.3 ± 12.3 nmol/L while in the summer, it was 20.9 ± 14.9 nmol/L. This difference was statistically significant, suggesting that seasonal variation plays an important role in vitamin D status in the United Arab Emirates. Fortification of foods and drinks with vitamin D, supplementation and sensible sun exposure are important steps toward minimizing vitamin D deficiency.
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Saadi H, Al-Kaabi J, Benbarka M, Khalili A, Almahmeed W, Nagelkerke N, Abdel-Wareth L, Al Essa A, Yasin J, Al-Dabbagh B, Kazam E. Prevalence of undiagnosed diabetes and quality of care in diabetic patients followed at primary and tertiary clinics in Abu Dhabi, United Arab Emirates. Rev Diabet Stud 2011; 7:293-302. [PMID: 21713317 PMCID: PMC3143544 DOI: 10.1900/rds.2010.7.293] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 01/24/2011] [Accepted: 01/28/2011] [Indexed: 01/16/2023] Open
Abstract
AIMS To investigate the prevalence of undiagnosed type 2 diabetes (T2D) at primary health care (PHC) clinics, and to assess the quality of care of diabetic patients followed at a tertiary hospital diabetes center in Abu Dhabi, United Arab Emirates (UAE). METHODS Between May 2009 and October 2010, adult patients attending two PHC clinics, and adult diabetic patients attending the diabetes center, were invited to participate in the study. After overnight fast, participants returned for interview and laboratory tests. Undiagnosed T2D was defined by FPG ≥ 7.0 mmol/l or HbA1c ≥ 6.5%. Quality of care was assessed by reported care practices and achievement of internationally recognized targets. RESULTS Out of 239 patients at PHC clinics without history of T2D, 14.6% had undiagnosed T2D, and 31% had increased risk of diabetes (FPG 5.6-7.0 mmol/l or HbA1c 5.7-6.5%). The independent predictors of undiagnosed T2D were age (adjusted OR per year 1.07, 95% CI 1.04-1.11, p < 0.001) and BMI ≥ 25 (adjusted OR 4.2, 95% CI 0.91-19.7, p = 0.033). Amongst all 275 diagnosed T2D patients, including those attending PHC clinics and those followed at the diabetes center, it was found that 40.1% followed dietary recommendations, 12% reported visiting a diabetes educator, 28.2% walked for exercise, and 13.5% attained recognized targets of HbA1c < 7%, blood pressure < 130/80 mmHg, and LDL cholesterol < 2.6 mmol/l. CONCLUSIONS Almost half of the adult patients attending PHC clinics had undiagnosed T2D, or increased diabetes risk. Care practices, and achievement of treatment targets, were suboptimal.
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Affiliation(s)
- Hussein Saadi
- Department of Internal Medicine, UAE University, Al Ain, United Arab Emirates.
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Rajah J, Abdel-Wareth L, Haq A. Failure of alphacalcidol (1alpha-hydroxyvitamin D3) in treating nutritional rickets and the biochemical response to ergocalciferol. J Steroid Biochem Mol Biol 2010; 121:273-6. [PMID: 20398760 DOI: 10.1016/j.jsbmb.2010.03.075] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 03/25/2010] [Accepted: 03/26/2010] [Indexed: 01/24/2023]
Abstract
It has been previously documented that alphacalcidol (1alpha-hydroxyvitamin D3) is inefficient in healing rickets, partly because it results in a suboptimal rise in 1,25-dihydroxyvitamin D (1,25-(OH)2D) and partly because it fails to replenish the store of 25-hydroxyvitamin D (25-OHD). However, very few studies have actually documented this outcome. The aim was to document biochemically the response to alphacalcidol and subsequently the change in response to ergocalciferol. This study was conducted at our institution from January 2005 till December 2008. We included all patients referred to our clinic with active rickets after a failed course of alphacalcidol. At baseline the median (IQR) for PTH l7.1 (4.5-35.3) pmol/L, 25-OHD 29.0 (18-66.2) nmol/L, 1,25-(OH)2D 205 (158.2-311.2) pmol/L and ALP 676 (462.5-1101.7) IU/L. After 3 months treatment with ergocalciferol the concentrations changed markedly with biochemical healing: PTH 4.5 (3.9-7.5), 25-OHD 143.5 (101.5-206.5), 1,25-(OH)(2)D 277 (221.0-572.7), ALP 369 (302.2-438.0). The results confirm the biochemical and physiological basis for using ergocalciferol (or cholecalciferol) in nutritional rickets. Unfortunately these forms are not readily available in many geographic areas. This supply problem together with marketing strategies forces physicians to make an incorrect choice of medication. Treatment with ergocalciferol was either with intramuscular stosstherapy or drops for 3 months. The former ensures compliance and is associated with higher 25-OHD and 1,25-(OH)2D concentrations.
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Affiliation(s)
- Jaishen Rajah
- Department of Pediatrics, Sheikh Khalifa Medical City, Karamah Street, PO Box 51900, Abu Dhabi, United Arab Emirates.
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Valluri V, Valluei V, Mustafa M, Santhosh A, Middleton D, Alvares M, Alvales M, El Haj E, Gumama O, Abdel-Wareth L, Abdel-Waieth L. Frequencies of HLA-A, HLA-B, HLA-DR, and HLA-DQ phenotypes in the United Arab Emirates population. ACTA ACUST UNITED AC 2005; 66:107-13. [PMID: 16029430 DOI: 10.1111/j.1399-0039.2005.00441.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The high degree of polymorphism of the human leukocyte antigen (HLA) system provides means for the study of diversity in different populations. The aim of this work is to study the HLA phenotype frequencies in the United Arab Emiratis in comparison with other geographically related Arabs, Iranians, and Asians, all living in the United Arab Emirates (UAE). Healthy blood donors and potential kidney or bone marrow donors were typed for HLA class I (n = 1880) and class II (n = 2022). Only one representative member of each family was included to avoid bias. UAE Emiratis, Arabs of Arabian Gulf Peninsula (AGP), Arabs of South Mediterranean (SMR), North African Arabs (NA), Iranians, and Asians. HLA typing was done by microlymphocytotoxicity method and/or low-resolution polymerase chain reaction-sequence-specific primer techniques. As an individual antigen, HLA-A2 had the highest frequency in all populations studied, however, the frequency of the broad antigen A19 surpassed A2 in all the groups except the AGP Arabs and Iranians. B5 was the predominant B antigen in all groups except the SMR and Asians. Amongst the class II broad antigens, DR2 was the most frequent antigen in UAE, AGP Arabs, Iranians, and Asians. The overall frequency of DQ1 was high in all groups except the SMR Arabs who had an almost equal distribution of DQ1 and DQ3. In conclusion, this study indicates that the most frequent antigens in the UAE population are HLA-A19, HLA-A2, HLA-B5, and HLA-DR2. It also sheds light on the similarities between the UAE Emiratis, AGP Arabs, Iranians, and Asians, specially the predominance of DR2 of the class II antigens.
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Affiliation(s)
- V Valluri
- Immunology and Specialized testing, Mafrag Hospital, Abu Dhabi, UAE
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