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Jiao L, Bujnowski D, Liu P, Bakota E, Liu L, Ye Y, Dewangan A, Duong CN, Kviten E, Zaheer S, Zangeneh A, Roy R, Floyd J, Monroy J, Wiltz-Beckham D. Asthma and clinical outcomes of COVID-19 in a community setting. Public Health 2024; 226:84-90. [PMID: 38016200 DOI: 10.1016/j.puhe.2023.10.040] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES The association between asthma and COVID-19 mortality remains inconclusive. We examined the association between asthma and clinical outcomes of patients with COVID-19. STUDY DESIGN A case-control study based on a surveillance cohort in Harris County, Texas. METHODS Using the data of 21,765 patients who reported having at least one chronic health condition, we investigated the association between asthma and COVID-19 severity, characterized primarily by hospitalization and death. Unconditional logistic regression models were used to estimate the multivariable odds ratio (mOR) and its 95 % confidence interval (CI) of COVID-19 severity associated with asthma and other chronic lung diseases, adjusting for demographic and other comorbidities. A P-value < 0.005 was considered statistically significant after correcting multiple testing. RESULTS In total, 3034 patients (13.9 %) had asthma, and 774 (3.56 %) had other chronic lung diseases. The case death rate among patients with asthma and other chronic lung diseases was 0.75 % and 19.0 %, respectively. Compared to patients without the respective conditions, patients with asthma had lower odds of death (mOR = 0.44, 95 % CI: 0.27-0.69), while patients with other chronic lung diseases had higher odds of hospitalization (mOR = 2.02, 95 % CI: 1.68-2.42) and death (mOR = 1.95, 95 % CI: 1.52-2.49) (P-values < 0.005). Risk factors for COVID-19 mortality included older age, male gender, diabetes, obesity, hypertension, cardiovascular disease, active cancer, and chronic kidney disease. CONCLUSIONS The public health surveillance data suggested that preexisting asthma was inversely associated with COVID-19 mortality.
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Affiliation(s)
- L Jiao
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA.
| | - D Bujnowski
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - P Liu
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - E Bakota
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - L Liu
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - Y Ye
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - A Dewangan
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - C N Duong
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - E Kviten
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - S Zaheer
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - A Zangeneh
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - R Roy
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - J Floyd
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - J Monroy
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
| | - D Wiltz-Beckham
- Harris County Public Health, 1111 Fannin Street, Houston, TX, 77002, USA
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Zaheer S, Meyer K, Easly R, Bayomy O, Leung J, Koefoed AW, Heydarpour M, Freeman R, Adler GK. Effect of adrenocorticotropic hormone infusion on circulating sclerostin levels. Endocr Connect 2021; 10:1607-1614. [PMID: 34788228 PMCID: PMC8679878 DOI: 10.1530/ec-21-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022]
Abstract
Glucocorticoid use is the most common cause of secondary osteoporosis. Poor skeletal health related to glucocorticoid use is thought to involve inhibition of the Wnt/β-catenin signaling pathway, a key pathway in osteoblastogenesis. Sclerostin, a peptide produced primarily by osteocytes, is an antagonist of the Wnt/β-catenin signaling pathway, raising the possibility that sclerostin is involved in glucocorticoids' adverse effects on bone. The aim of this study was to determine whether an acute infusion of cosyntropin (i.e. ACTH(1-24)), which increases endogenous cortisol, increases serum sclerostin levels as compared to a placebo infusion. This study was performed using blood samples obtained from a previously published, double-blind, placebo-controlled, randomized, cross-over study among healthy men and women who received infusions of placebo or cosyntropin after being supine and fasted overnight (ClinicalTrials.gov NCT02339506). A total of 17 participants were analyzed. There was a strong correlation (R2 = 0.65, P < 0.0001) between the two baseline sclerostin measurements measured at the start of each visit, and men had a significantly higher average baseline sclerostin compared to women. As anticipated, cosyntropin significantly increased serum cortisol levels, whereas cortisol levels fell during placebo infusion, consistent with the diurnal variation in cortisol. There was no significant effect of cosyntropin as compared to placebo infusions on serum sclerostin over 6-24 h (P = 0.10). In conclusion, this randomized, placebo-controlled study was unable to detect a significant effect of a cosyntropin infusion on serum sclerostin levels in healthy men and women.
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Affiliation(s)
- Sarah Zaheer
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Kayla Meyer
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Rebecca Easly
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Omar Bayomy
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Janet Leung
- Section of Endocrinology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew W Koefoed
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Mahyar Heydarpour
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Roy Freeman
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gail K Adler
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Correspondence should be addressed to G K Adler:
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Sharif S, Zaheer S, Mumtaz MW, Sahin O, Ahmad S, Zulfiqar S, Adnan A, Khan IU. Synthesis, Crystal Structures of Gadolinium(III) and Erbium(III) Complexes Derived from Pyridine-2,6-Dicarboxylic Acid and Fluorescent Sensing of Picric Acid. RUSS J COORD CHEM+ 2021. [DOI: 10.1134/s1070328420120076] [Citation(s) in RCA: 1] [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: 01/04/2023]
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Zaheer S, Xu K, Shakil F. Proximal Type - Epithelioid Sarcoma- A Rare And Aggressive Soft Tissue Neoplasm. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Epithelioid Sarcoma is a rare malignant soft tissue neoplasm that is well known for local recurrence, regional lymph node involvement, and metastasis. It accounts for less than one percent of all sarcomas. Two subtypes of epithelioid sarcoma are described: the conventional or classic subtype and the proximal subtype, with the classic type being more common than the proximal type. We present a case of proximal epithelioid sarcoma involving the inguinal region, in which the patient presented with the history of weight loss for one year and a slow- growing inguinal mass for the last few months. The biopsy was done in an outside hospital and showed carcinoma of unknown origin. Imaging also failed to reveal any clear source of this mass.
Methods
The mass was resected and sent to pathology, where H&E staining and immunohistochemistry was done for diagnosis.
Results
The H&E sections of the left inguinal mass showed proliferation of large epithelioid cells with a moderate amount of cytoplasm, vesicular nuclear chromatin and prominent nucleoli. Mitosis was also seen. Necrosis was not identified. Immunohistochemical staining was done and revealed that the tumor cells were immunoreactive for epithelial marker cytokeratin AE1/AE3 and showed loss of INI-1. Tumor cells were also negative for Myogenin, ERG, HMB-45, MART-1, Myo-D1, S100, and SMA. Considering the cytomorphology and immunophenotypic findings the diagnosis of epithelioid sarcoma, proximal type was made.
Conclusion
Epithelioid sarcoma is a malignant mesenchymal neoplasm with epithelioid cytomorphology and phenotype. Among the two types of epithelioid sarcoma, the proximal type is reported about 50% less than the classic type and is associated with aggressive behavior and worse prognosis. The classic cytomorphology and immunohistochemistry findings helped us in making the diagnosis in this case.
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Affiliation(s)
- S Zaheer
- Pathology, Westchester Medical Center, Valhalla, New York, UNITED STATES
| | - K Xu
- Pathology, Westchester Medical Center, Valhalla, New York, UNITED STATES
| | - F Shakil
- Pathology, Westchester Medical Center, Valhalla, New York, UNITED STATES
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Zaheer S, Kleinman GM. Primary Meningioma of the Middle Ear - A Rare Presentation. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Meningiomas are the benign intracranial neoplasm, most commonly occurring in the third and sixth decade of life. The most common intracranial locations for meningiomas are parasagittal sinuses and large dural sinuses. Very rarely extracranial meningiomas can also be observed. We present a case of fibrous meningioma presenting as middle ear mass, in which a 13 years old female was presented with drainage from the left ear. Biopsy showed fibromyxomatous tissue. CT scan of the head showed soft tissue filling the middle ear and extending into the mastoid.
Methods
The mass was resected and sent to pathology, where H&E staining and immunohistochemistry was done for diagnosis.
Results
The H&E stained section showed a spindle-shaped neoplasm with areas of sheet-like growth interspersed with areas showing tumor cell growth in short fascicles, and some areas of decreased cellularity. Tumor cells have moderate cytoplasm, fine nuclear chromatin and inconspicuous nucleoli. The tumor cells were positive for EMA, PR(nuclear staining) and pan-TRK and negative for D-240, SOX-10, S-100 and desmin. These histological features alone with immunohistochemistry profile were consistent with meningioma WHO grade 1.
Conclusion
Primary middle ear meningioma although a rare diagnosis, but should be considered while dealing with middle ear pathologies. Histomorphology and immunohistochemistry play an important role in making diagnosis.
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Affiliation(s)
- S Zaheer
- Pathology, Westchester Medical Center, Valhalla, New York, UNITED STATES
| | - G M Kleinman
- Pathology, Westchester Medical Center, Valhalla, New York, UNITED STATES
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Tomac Pavosevic H, Zaheer S, Kleinman GM. Pediatric Acute Hemorrhagic Leukoencephalitis (Weston-Hurst syndrome): A Rare Entity. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Acute hemorrhagic leukoencephalitis (Weston-Hurst syndrome) is a rare, fulminant inflammatory hemorrhagic demyelination of the brain white matter, and it is considered to be the most severe form of acute disseminated encephalomyelitis (ADEM). Herein we describe a case of 6-year-old boy presenting with elevated intracranial pressure and uncal herniation. Brain MRI showed a large right temporoparietal T2 hyperintense lesion with edema, abnormal perivascular enhancement and midline shift. Emergent decompressive craniotomy with brain biopsy was performed.
Results
H&E sections of the brain lesion revealed neutrophilic small vessel vasculitis with extravasation of blood and fibrin. Predominantly in a perivascular distribution were infiltrates of neutrophils and in areas foamy macrophages.
Additionally, the white matter was studded with hemorrhages of varying size. Sections stained with Luxol Fast Blue for myelin and with a neurofilament immunostain for axons were compared to reveal selective perivascular loss of myelin with relative sparing of axons.
Conclusion
The constellation of acute hemorrhages, neutrophilic infiltration and selective loss of myelin with relative sparing of axons is characteristic of this exceptional, hyperacute variant of acute disseminated encephalomyelitis.
Histomorphologic diagnosis is characteristic and may be crucial for timely decision for treatment of this often fatal disease.
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Affiliation(s)
- H Tomac Pavosevic
- Department of Pathology and Clinical Laboratories, Westchester Medical Center, Elmsford, New York, UNITED STATES
| | - S Zaheer
- Department of Pathology and Clinical Laboratories, Westchester Medical Center, Elmsford, New York, UNITED STATES
| | - G M Kleinman
- Department of Pathology and Clinical Laboratories, Westchester Medical Center, Elmsford, New York, UNITED STATES
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Zaheer S, Shah N, Safdar N. Maternal risk factors for childhood malnutrition in Pakistan: demographic health survey 2012-13. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In Pakistan, this is a catastrophe for 44% children combating with stunted growth; the third highest percentage of stunted children in the world and further 1 million children are underweight. Fifteen percent of children are wasted and half of them are anemic, and almost one-third of the children have iron deficiency anemia. The study aimed to collate all contributing factors that have been reported in the PDHS-2012-13 survey for child malnutrition.
Methods
Pakistan Demographic and Health Survey, 2012-13 data was used (n = 1967). Forty five factors were extracted from PDHS 2012-13 and factor analysis was performed to reduce these factors into similar potential factors by using principle component (PC) decomposition. Malnutrition status of children of age < 5 years was assessed by using three indices: height-for-age, weight-for-height, and weight for age. To examine the associations between derived factors and childhood malnutrition, binary logistic regression was used.
Results
About 43% of under-five children are stunted, 26.9% are underweight and 12.6% are wasted. Multivariate adjusted results showed mothers who belong to poor quintile (OR: 1.50, p-value 0.02), who afraid of husband all the time (OR: 1.36, p-value 0.02), who had > 4 children (OR: 1.47, p-value <0.01), and who used tobacco (OR: 1.80, p-value 0.02) were more likely to have stunted children. However, mothers who had no education (OR: 1.82, p-value<0.01), who were poor dweller (OR: 1.55, p-value 0.03), who used unprotected water (OR: 1.62, p-value<0.01), mothers who had younger age at birth (OR: 1.37, p-value 0.02) were more likely have underweight children.
Conclusions
Maternal socio-demographics and environmental factors were more significantly associated with child malnutrition. This study will enable the public health professionals' workforce tier at a national level to gain expertise and formulate better planning in order to improve child health in Pakistan.
Key messages
This study will enable the public health professionals’ workforce tier to achieve gains in child health in Pakistan. Study findings may help to improved and to initiate evidence-based guidelines for maternal and child health.
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Affiliation(s)
- S Zaheer
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - N Shah
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - N Safdar
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
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Bayomy O, Zaheer S, Williams JS, Curhan G, Vaidya A. Disentangling the Relationships Between the Renin-Angiotensin-Aldosterone System, Calcium Physiology, and Risk for Kidney Stones. J Clin Endocrinol Metab 2020; 105:5803967. [PMID: 32163150 PMCID: PMC7185954 DOI: 10.1210/clinem/dgaa123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Complex relationships between aldosterone and calcium homeostasis have been proposed. OBJECTIVE To disentangle the influence of aldosterone and intravascular volume on calcium physiology. DESIGN Patient-oriented and epidemiology studies. SETTING Clinical research center and nationwide cohorts. PARTICIPANTS/INTERVENTIONS Patient-oriented study (n = 18): Participants were evaluated after completing a sodium-restricted (RES) diet to contract intravascular volume and after a liberalized-sodium (LIB) diet to expand intravascular volume. Cross-sectional studies (n = 3755): the association between 24h urinary sodium and calcium excretion and risk for kidney stones was assessed. RESULTS Patient-oriented study: compared to a RES-diet, a LIB-diet suppressed renin activity (LIB: 0.3 [0.1, 0.4] vs. RES: 3.1 [1.7, 5.3] ng/mL/h; P < 0.001) and plasma aldosterone (LIB: 2.0 [2.0, 2.7] vs. RES: 20.0 [16.1, 31.0] vs. ng/dL; P < 0.001), but increased calciuria (LIB: 238.4 ± 112.3 vs. RES: 112.9 ± 60.8 mg/24hr; P < 0.0001) and decreased serum calcium (LIB: 8.9 ± 0.3 vs. RES: 9.8 ± 0.4 mg/dL; P < 0.0001). Epidemiology study: mean urinary calcium excretion was higher with greater urinary sodium excretion. Compared to a urinary sodium excretion of < 120 mEq/day, a urinary sodium excretion of ≥220 mEq/day was associated with a higher risk for having kidney stones in women (risk ratio = 1.79 [95% confidence interval 1.05, 3.04]) and men (risk ratio = 2.06 [95% confidence interval 1.27, 3.32]). CONCLUSIONS High dietary sodium intake suppresses aldosterone, decreases serum calcium, and increases calciuria and the risk for developing kidney stones. Our findings help disentangle the influences of volume from aldosterone on calcium homeostasis and provide support for the recommendation to restrict dietary sodium for kidney stone prevention.
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Affiliation(s)
- Omar Bayomy
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, US
| | - Sarah Zaheer
- Division of Endocrinology and Metabolism, Department of Medicine, Duke University, Durham, NC, US
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, US
| | - Gary Curhan
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, US
| | - Anand Vaidya
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, US
- Correspondence and Reprint Requests: Anand Vaidya, MD MMSc, Division of Endocrinology, Diabetes, and Hypertension, 221 Longwood Ave, Boston, MA 02115. E-mail:
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Bayomy O, Zaheer S, Curhan G, Vaidya A. OR04-1 Dietary Sodium Intake, the Renin-Angiotensin-Aldosterone System, and the Risk for Incident Kidney Stones. J Endocr Soc 2019. [PMCID: PMC6554774 DOI: 10.1210/js.2019-or04-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Context: We previously reported that acute changes in dietary sodium intake and renin-angiotensin-aldosterone system (RAAS) activity could substantially modulate calcium homeostasis. We demonstrated that humans consuming a high sodium diet for one week, compared with a restricted sodium diet for one week, had suppression of the RAAS, a ~100% increase in calciuria (P<0.0001), and a ~10% decrease in serum calcium (P<0.0001). Whether these marked and acute changes induced by high dietary sodium intake are sustained chronically is not known. We hypothesized that a high dietary sodium intake over many years could increase calciuria and the risk for incident kidney stones. Methods: We studied 2496 participants from the Health Professionals Follow-up Study (HPFS) (all men) and the Nurses’ Health Study I (NHSI) (all women). 24-hour urine samples, collected from participants confirmed to have kidney stones and appropriate controls, were assessed for calcium, sodium, creatinine, as well as other factors. Participants were categorized by 24-hour urinary sodium excretion (<120, 120-139, 140-159, 160-179, 180-199, 200-219, >/=220 mEq/day) and the relative risk for developing kidney stones was assessed for each category of sodium excretion via adjusted logistic regression models. Models were adjusted for age, history of hypertension, and numerous urinary parameters (volume, creatinine, oxalate, uric acid, citrate, magnesium, potassium, phosphorus, and pH). Adjustment for urinary calcium was performed to evaluate the role of calciuria in modifying the relation between urinary sodium excretion and kidney stones. Results: Mean adjusted urinary calcium levels for individuals with urinary sodium excretion of <120 mEq/day compared to >/=220 mEq/day were 178 (SD=73) vs. 228 (SD=91) mg/day in men and 161 (SD=60) vs. 208 (SD=80) mg/day in women. When compared with a urinary sodium excretion of <120 mEq/day (relative risk=1.00), having a urinary sodium excretion of >/=220 mEq/day was associated with a higher risk for incident kidney stones in men [RR=1.90 (95% CI 1.18, 3.05)] and women [RR=2.02 (95% CI 1.19, 3.43)]. These associations were attenuated and no longer statistically significant after adjusting for urinary calcium excretion, thereby suggesting that developing kidney stones was mediated, in part, through an increase in urinary calcium excretion when urinary sodium excretion was higher. Conclusion: The combination of our physiology and epidemiology studies suggest that higher dietary sodium intake, and concomitant suppression of the RAAS, result in increased calciuria and an approximately two-fold higher risk for developing kidney stones. Studies to evaluate dietary sodium restriction, and/or RAAS inhibition, as potential methods to decrease calciuria and kidney stones are warranted.
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Affiliation(s)
- Omar Bayomy
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Sarah Zaheer
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gary Curhan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Anand Vaidya
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Zaheer S, Taquechel K, Brown JM, Adler GK, Williams JS, Vaidya A. A randomized intervention study to evaluate the effect of calcitriol therapy on the renin-angiotensin system in diabetes. J Renin Angiotensin Aldosterone Syst 2018; 19:1470320317754178. [PMID: 29562806 PMCID: PMC5896865 DOI: 10.1177/1470320317754178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 12/21/2022] Open
Abstract
Background: Prior studies suggest that vitamin D therapy may decrease cardiovascular disease risk in type 2 diabetes (T2DM) by lowering renin-angiotensin system (RAS) activity. However, randomized human intervention studies to evaluate the effect of vitamin D receptor (VDR) agonists on RAS activity are lacking. Objective: The objective of this article is to investigate the effect of direct VDR activation with calcitriol on circulating RAS activity and vascular hemodynamics in T2DM. Methods: A randomized, double-blinded, and placebo-controlled study wherein 18 participants with well-controlled T2DM without chronic kidney disease (CKD) were administered calcitriol or placebo for three weeks was conducted. Outcome measures included plasma renin activity (PRA), serum and urinary aldosterone, mean arterial pressure (MAP) before and after an infusion of angiotensin II, and renal plasma flow (RPF) via para-aminohippurate clearance. Results: Despite an increase in 1,25(OH)2D with calcitriol administration (45.4 to 61.8 pg/ml, p = 0.03) and no change with placebo, there were no significant differences in PRA, serum or urinary aldosterone, baseline and angiotensin II-stimulated MAP, or basal and angiotensin II-stimulated RPF between interventions. Conclusion: In this randomized and placebo-controlled study in participants with T2DM without CKD, calcitriol therapy to raise 1,25(OH)2D levels, when compared with placebo, did not significantly change circulating RAS activity or vascular hemodynamics.
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Affiliation(s)
- Sarah Zaheer
- 1 Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | | | - Jenifer M Brown
- 3 Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Gail K Adler
- 1 Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Jonathan S Williams
- 1 Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Anand Vaidya
- 1 Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
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Han J, Zaheer S, Chung J, Chen C, Kanade R, Gaffey A, Rame J, Acker M, Atluri P. Left Ventricular Assist Device as Bridge-to-Transplant Therapy May Mitigate Elevated Pulmonary Vascular Resistance. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.704] [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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Zaheer S, Vaidya A. Response to Letter to the Editor: "Fibroblast Growth Factor 23, Mineral Metabolism, and Adiposity in Normal Kidney Function". J Clin Endocrinol Metab 2018; 103:358-359. [PMID: 29088429 DOI: 10.1210/jc.2017-02251] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Sarah Zaheer
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Shaheen S, Jabo B, Kaur M, Senthil M, Mirshahidi S, Zaheer S, Mirshahidi H. P1.16-006 Less Is More: video Assisted Thoracic Surgery (VATS) vs Open Thoracotomy in the Management of Resectable Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1060] [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: 10/18/2022]
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Zaheer S, de Boer IH, Allison M, Brown JM, Psaty BM, Robinson-Cohen C, Michos ED, Ix JH, Kestenbaum B, Siscovick D, Vaidya A. Fibroblast Growth Factor 23, Mineral Metabolism, and Adiposity in Normal Kidney Function. J Clin Endocrinol Metab 2017; 102:1387-1395. [PMID: 28323987 PMCID: PMC5460732 DOI: 10.1210/jc.2016-3563] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/12/2017] [Indexed: 12/15/2022]
Abstract
Context Obesity is associated with poor bone mineralization and quality. Fibroblast growth factor 23 (FGF23) plays an important role in skeletal physiology. Objective To test hypothesis that greater adiposity results in higher FGF23 levels among individuals with normal estimated glomerular filtration rate (eGFR). Design, Setting, Participants Cross-sectional analyses among participants with eGFR ≥60 mL/min/1.73m2. We assessed the association between crude [body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR); n = 5610] and refined (abdominal adipose tissue area by computed tomography; n = 1313) measures of adiposity and FGF23 using multivariable linear regression. Main Outcome Measure Serum FGF23. Results FGF23 was higher across BMI categories (BMI <25: 37.7; BMI 25 to 29.99: 38.7; BMI 30 to 39.99: 39.8; BMI ≥40: 40.9 pg/mL, unadjusted P trend < 0.0001). The association between BMI and FGF23 was independent of known confounders of FGF23 (adjusted β = +7.2% higher FGF23 per 10 kg/m2; P < 0.0001). Similar results were observed using WC and WHR. Abdominal adipose tissue area was also independently associated with higher FGF23 (P < 0.01). Notably, the positive associations between FGF23 and adiposity were observed despite the fact that eGFR did not decline and serum phosphate levels did not increase with adiposity. Conclusion In a large cohort with normal kidney function, adiposity was associated with higher FGF23 levels independent of known confounders, including eGFR and phosphate. Further studies are needed to evaluate the causes of higher FGF23 in settings of greater adiposity and the potential impact on skeletal health.
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Affiliation(s)
- Sarah Zaheer
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | | | - Matthew Allison
- Division of Preventive Medicine, University of California, San Diego, San Diego, California 92093
| | - Jenifer M. Brown
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington 98195
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Department of Medicine, and
- Kidney Research Institute, University of Washington, Seattle, Washington 98104
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California 92161
| | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, and
- Kidney Research Institute, University of Washington, Seattle, Washington 98104
| | | | - Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
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Zaheer S, Siddiqui SA, Akram M, Hasan SA. Induction chemotherapy with cisplatin and ifosfamide in locally advanced inoperable squamous cell carcinoma of the head and neck: A single-institution experience. Indian J Cancer 2017; 53:372-376. [PMID: 28244461 DOI: 10.4103/0019-509x.200661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Induction chemotherapy (ICT) in patients with head and neck cancer has been studied since a long time. The addition of taxanes to the cisplatin and 5-fluorouracil (5FU) (PF) regimen results in superior antitumor activity. We did this study to see the response and toxicity of ICT with cisplatin and ifosfamide followed by concurrent chemoradiotherapy (CRT) in locally advanced, unresectable squamous cell carcinoma of head and neck (SCCHN). AIMS The aim of this study was to see the results of ICT using cisplatin and ifosfamide regimen in locally advanced unresectable SCCHN in terms of acute and chronic toxicity and response to treatment. MATERIALS AND METHODS Patients with Stage III and IV, nonmetastatic SCCHN were enrolled in the study. They were given two cycles of ICT with cisplatin and ifosfamide followed by CRT. RESULTS After ICT, the overall response rate (ORR) was 75.0% at the primary site and 70.0% at the nodal site. ORR for combined primary and nodal disease was observed to be 67.5%. The complete response (CR) and partial response (PR) for combined primary and nodal site were seen in 4 (10.0%) and 23 (57.5%) patients. Of 32 patients who received CRT after ICT, CR was 53.1% and PR was 31.3%. Mucositis, skin reaction, and pharyngeal and laryngeal toxicities were the most common but tolerable. CONCLUSION ICT with cisplatin and ifosfamide gives comparable results to the standard paclitaxel, PF regimen. We conclude that this combination regimen for ICT is not only an economical alternative of taxol-based regimen but also well tolerated by the patients.
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Affiliation(s)
- S Zaheer
- Department of Radiotherapy, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India
| | - S A Siddiqui
- Department of Radiotherapy, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India
| | - M Akram
- Department of Radiotherapy, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India
| | - S A Hasan
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India
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Zaheer S, Brown JM, Connors M, Williams JS, Adler GK, Vaidya A. Angiotensin-Converting Enzyme Inhibition and Parathyroid Hormone Secretion. Int J Endocrinol 2017; 2017:4138783. [PMID: 28808443 PMCID: PMC5541811 DOI: 10.1155/2017/4138783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Prior studies suggest that renin-angiotensin-aldosterone system (RAAS) inhibitors decrease parathyroid hormone (PTH) secretion. OBJECTIVE To evaluate the effect of angiotensin-converting enzyme inhibitors (ACEi) on serum PTH in participants with and without primary hyperparathyroidism (P-HPT). METHODS An open-label, single-arm, pilot study whereby participants with and without P-HPT had PTH were evaluated before and after 1 week of maximally tolerated lisinopril therapy. RESULTS A total of 12 participants with, and 15 participants without, P-HPT successfully completed the protocol. Following 1 week of lisinopril, participants with P-HPT had a decrease in systolic blood pressure (SBP) (-6.4 mmHg, P < 0.01), an increase in plasma renin activity (PRA) (+1.50 ng/mL/h, P = 0.06), and a decrease in PTH (79.5 (21.6) to 70.9 (19.6) pg/mL, ∆ = -8.6 pg/mL, P = 0.049); however, serum and urine calcium did not change. In contrast, although 1 week of lisinopril significantly decreased SBP and increased PRA among participants without P-HPT, there were no changes in PTH or calcium. CONCLUSION In this short pilot investigation, 1 week of maximally titrated ACEi did not impact PTH in participants without P-HPT, but resulted in a modest and marginally significant reduction of PTH but not calcium, among participants with P-HPT. This trial is registered with ClinicalTrials.gov NCT01691781.
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Affiliation(s)
- Sarah Zaheer
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- *Sarah Zaheer: and
| | - Jenifer M. Brown
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Molly Connors
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan S. Williams
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gail K. Adler
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- *Anand Vaidya:
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Kempuraj D, Thangavel R, Natteru PA, Selvakumar GP, Saeed D, Zahoor H, Zaheer S, Iyer SS, Zaheer A. Neuroinflammation Induces Neurodegeneration. J Neurol Neurosurg Spine 2016; 1:1003. [PMID: 28127589 PMCID: PMC5260818] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), and Multiple Sclerosis (MS) are characterized by neuronal degeneration and neuronal death in specific regions of the central nervous system (CNS). In AD, neurons of the hippocampus and entorhinal cortex are the first to degenerate, whereas in PD, dopaminergic neurons in the substantia nigra degenerate. MS patients show destruction of the myelin sheath. Once the CNS neurons are damaged, they are unable to regenerate unlike any other tissue in the body. Neurodegeneration is mediated by inflammatory and neurotoxic mediators such as interleukin-1beta (IL-1β), IL-6, IL-8, IL-33, tumor necrosis factor-alpha (TNF-α), chemokine (C-C motif) ligand 2 (CCL2), CCL5, matrix metalloproteinase (MMPs), granulocyte macrophage colony-stimulating factor (GM-CSF), glia maturation factor (GMF), substance P, reactive oxygen species (ROS), reactive nitrogen species (RNS), mast cells-mediated histamine and proteases, protease activated receptor-2 (PAR-2), CD40, CD40L, CD88, intracellular Ca+ elevation, and activation of mitogen-activated protein kinases (MAPKs) and nuclear factor kappa-B (NF-kB). Activated microglia, astrocytes, neurons, T-cells and mast cells release these inflammatory mediators and mediate neuroinflammation and neurodegeneration in a vicious manner. Further, immune and inflammatory cells and inflammatory mediators from the periphery cross the defective blood-brain-barrier (BBB) and augment neuroinflammation. Though inflammation is crucial in the onset and the progression of neurodegenerative diseases, anti-inflammatory drugs do not provide significant therapeutic effects in these patients till date, as the disease pathogenesis is not yet clearly understood. In this review, we discuss the possible factors involved in neuroinflammation-mediated neurodegeneration.
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Affiliation(s)
- D Kempuraj
- Department of Neurology, Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
- Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - R Thangavel
- Department of Neurology, Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
- Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - PA Natteru
- Department of Neurology, Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - GP Selvakumar
- Department of Neurology, Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - D Saeed
- Department of Neurology, Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - H Zahoor
- Department of Neurology, Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - S Zaheer
- Department of Neurology, Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
| | - SS Iyer
- Department of Neurology, Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
- Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
| | - A Zaheer
- Department of Neurology, Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, USA
- Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
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Zaheer S, Rizwan T, Aslam SK, Shafique K. Assessing the determinants for achieving maximum childhood polio immunization coverage in Pakistan. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw165.050] [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: 11/13/2022] Open
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Zaheer S, Aslam SK, Shafique K. Inequalities in HIV knowledge among Pakistani mothers:Results from Demographic Health Survey 2012-13. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aslam SK, Zaheer S, Shafique K. Health Inequalities in use of contraceptive Methods among women in developing country, Pakistan. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.051] [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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21
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Zaheer S, de Boer I, Allison M, Brown JM, Psaty BM, Robinson-Cohen C, Ix JH, Kestenbaum B, Siscovick D, Vaidya A. Parathyroid Hormone and the Use of Diuretics and Calcium-Channel Blockers: The Multi-Ethnic Study of Atherosclerosis. J Bone Miner Res 2016; 31:1137-45. [PMID: 26748479 PMCID: PMC5424889 DOI: 10.1002/jbmr.2779] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 01/05/2023]
Abstract
Thiazide diuretic (TZ) use is associated with higher bone mineral density, whereas loop diuretic (LD) use is associated with lower bone density and incident fracture. Dihydropyridine-sensitive calcium channels are expressed on parathyroid cells and may play a role in parathyroid hormone (PTH) regulation. The potential for diuretics and calcium-channel blockers (CCBs) to modulate PTH and calcium homeostasis may represent a mechanism by which they influence skeletal outcomes. We hypothesized that the use of LD and dihydropyridine CCBs is associated with higher PTH, and TZ use is associated with lower PTH. We conducted cross-sectional analyses of participants treated for hypertension in the Multi-Ethnic Study of Atherosclerosis who did not have primary hyperparathyroidism or chronic kidney disease (n = 1888). We used adjusted regression models to evaluate the independent association between TZ, LD, and CCB medication classes and PTH. TZ use was associated with lower PTH when compared with non-TZ use (44.4 versus 46.9 pg/mL, p = 0.02), whereas the use of LD and CCBs was associated with higher PTH when compared with non-users of each medication class (LD: 60.7 versus 45.5 pg/mL, p < 0.0001; CCB: 49.5 versus. 44.4 pg/mL, p < 0.0001). Adjusted regression models confirmed independent associations between TZ use and lower PTH (β = -3.2 pg/mL, p = 0.0007), and LD or CCB use and higher PTH (LD: β = +12.0 pg/mL, p < 0.0001; CCB: +3.7 pg/mL, p < 0.0001). Among CCB users, the use of dihydropyridines was independently associated with higher PTH (β = +5.0 pg/mL, p < 0.0001), whereas non-dihydropyridine use was not (β = +0.58 pg/mL, p = 0.68). We conclude that in a large community-based cohort with normal kidney function, TZ use is associated with lower PTH, whereas LD and dihydropyridine CCB use is associated with higher PTH. These associations may provide a mechanistic explanation linking use of these medications to the development of skeletal outcomes. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sarah Zaheer
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ian de Boer
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California, San Diego, CA, USA
| | - Jenifer M Brown
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA.,Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, CA, USA
| | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA.,Kidney Research Institute, University of Washington, Seattle, WA, USA
| | | | - Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
INTRODUCTION Low trauma fractures due to osteoporosis are a major health concern worldwide. Despite the availability of many therapeutic compounds to reduce fracture risk, osteoporosis remains undertreated and the burden of osteoporotic fractures remains high. Denosumab is a novel agent that acts to reduce bone turnover, improve bone mineral density, and reduce fracture risk, offering a favorable efficacy and safety profile. AREAS COVERED This review covers the pharmacology and major clinical trials with extension/post-marketing follow-up, including trials for all FDA-approved indications of denosumab to date. EXPERT OPINION Denosumab is an efficacious and safe osteoporosis treatment option, with current data from up to 8 years of continued use showing continued improvement in bone density with sustained fracture risk reduction. Safety profiles overall are similar to placebo, with no new safety concerns in extension trials, though a theoretical increased risk of infection exists with RANKL inhibition. Future considerations include safety of prolonged treatment beyond 8 years, and efficacy/fracture risk after discontinuation or with non-adherence, given the characteristic pharmacodynamic profile of denosumab.
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Khan MM, Zaheer S, Nehman J, Zaheer A. Suppression of glia maturation factor expression prevents 1-methyl-4-phenylpyridinium (MPP⁺)-induced loss of mesencephalic dopaminergic neurons. Neuroscience 2014; 277:196-205. [PMID: 25016212 DOI: 10.1016/j.neuroscience.2014.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 12/19/2022]
Abstract
Inflammation mediated by glial activation appears to play a critical role in the pathogenesis of Parkinson disease (PD). Glia maturation factor (GMF), a proinflammatory protein predominantly localized in the central nervous system was isolated, sequenced and cloned in our laboratory. We have previously demonstrated immunomodulatory and proinflammatory functions of GMF, but its involvement in 1-methyl-4-phenylpyridinium (MPP(+)), active metabolite of classical parkinsonian toxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), inducing loss of dopaminergic (DA) neurons has not been studied. Here we show that altered expression of GMF has direct consequences on the production of reactive oxygen species (ROS) and nuclear factor-kappa B (NF-κB)- mediated production of inflammatory mediators by MPP(+). We examined MPP(+)-induced DA neuronal loss in primary cultures of mouse mesencephalic neurons/glia obtained from GMF-deficient (GMF knockout (GMF-KO)) and GMF-containing wild-type (Wt) mice. We demonstrate that deficiency of GMF in GMF-KO neurons/glia led to decreased production of ROS and downregulation of NF-κB-mediated production of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) as compared to Wt neurons/glia. Additionally, overexpression of GMF induced DA neurodegeneration, whereas GMF downregulation by GMF-specific shRNA protected DA neurons from MPP-induced toxicity. Subsequently, GMF deficiency ameliorates antioxidant balance, as evidenced by the decreased level of lipid peroxidation, less ROS production along with increased level of glutathione; and attenuated the DA neuronal loss via the downregulation of NF-κB-mediated inflammatory responses. In conclusion, our overall data indicate that GMF modulates oxidative stress and release of deleterious agents by MPP(+) leading to loss of DA neurons. Our study provides new insights into the potential role of GMF and identifies targets for therapeutic interventions in neurodegenerative diseases.
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Affiliation(s)
- M M Khan
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
| | - S Zaheer
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
| | - J Nehman
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
| | - A Zaheer
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA; VA Health Care System, Iowa City, IA, USA.
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Abstract
BACKGROUND Blood pressure (BP) monitoring in UK children at risk of hypertension takes place predominantly in secondary and tertiary care. OBJECTIVES To investigate (i) the availability of paediatric BP equipment in primary care (PC) and (ii) the confidence of PC professionals in measuring and interpreting children's BP. METHODS 103 PC practices were approached to complete a questionnaire. BP equipment availability and confidence with BP measurement and interpretation were recorded (interval scale 1-10). Cuff size and equipment type were documented. RESULTS 95 (92%) practices responded; 40/95 possessed paediatric BP cuffs. 35/51 devices were validated for paediatric use. Median (IQR) confidence in BP measurement was 7 (2-8). Confidence in BP interpretation was 3 (2-6), though this improved if normal ranges were provided (8 (6-9), p<0.01). CONCLUSIONS Investment in appropriate equipment and education is required to allow PC to successfully monitor BP in children.
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Affiliation(s)
- S Zaheer
- Department of Paediatric Nephrology and NIHR/Wellcome Trust Children's Clinical Research Facility, The University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, , Manchester, UK
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Bartlett E, Shah P, Shah K, Zaheer S, Wachtel H, Kelz R, Karakousis G, Fraker D. Surgery for Metastatic Neuroendocrine Tumors With Clinically Occult Primary. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.614] [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: 11/15/2022]
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Abstract
We show that the pseudorelativistic physics of graphene near the Fermi level can be extended to three dimensional (3D) materials. Unlike in phase transitions from inversion symmetric topological to normal insulators, we show that particular space groups also allow 3D Dirac points as symmetry protected degeneracies. We provide criteria necessary to identify these groups and, as an example, present ab initio calculations of β-cristobalite BiO(2) which exhibits three Dirac points at the Fermi level. We find that β-cristobalite BiO(2) is metastable, so it can be physically realized as a 3D analog to graphene.
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Affiliation(s)
- S M Young
- The Makineni Theoretical Laboratories, Department of Chemistry, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6323, USA
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Zaheer S, Thangavel R, Sahu SK, Zaheer A. Augmented expression of glia maturation factor in Alzheimer's disease. Neuroscience 2011; 194:227-33. [PMID: 21835226 DOI: 10.1016/j.neuroscience.2011.07.069] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/27/2011] [Accepted: 07/27/2011] [Indexed: 11/18/2022]
Abstract
We have previously demonstrated that glia maturation factor (GMF), a brain-specific protein, isolated, sequenced, and cloned in our laboratory, is a prominent mediator of inflammation in the CNS leading to the death of neurons. In the present study, we demonstrate, for the first time, a significant upregulation of the GMF protein in various regions of Alzheimer's disease (AD) brains compared with age-matched non-demented (ND) control brains. We analyzed AD and ND brain samples by quantitative enzyme-linked immunosorbent assay (ELISA) using a combination of highly specific monoclonal and polyclonal anti-GMF antibodies developed and characterized in our laboratory. For the comparison between ND controls and AD cases, we examined brain tissue from 12 ad cases (ages ranging from 78-92 years) and eight age-matched ND controls (ages ranging from 76-88 years). We observed a significant increase in GMF concentration in entorhinal cortex, parietal cortex, frontal cortex, occipital cortex, perirhinal cortex, and temporal cortex of AD patients. Our results clearly demonstrate that the GMF protein levels are significantly higher in all AD-affected brain regions than in ND controls. The immunohistochemistry analysis revealed co-localization of GMF with amyloid plaques (AP) and neurofibrillary tangles (NFTs) in AD brains. Our results imply that under conditions of neurodegeneration the expression of GMF is significantly upregulated.
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Affiliation(s)
- S Zaheer
- Department of Neurology, The University of Iowa, Iowa City, IA 52242, USA.
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Abstract
Leiomyoma is a benign tumor of smooth muscles. Leiomyoma originating from the scrotum is a rare entity. We report here a case of 50-year-old male who presented with a 4-cm lump in the left side of scrotum. Clinically, it was provisionally diagnosed as sebaceous cyst and was excised. The histopathology showed findings consistent with leiomyoma. There was no cytological atypia or mitosis. The final diagnosis of solitary leiomyoma of scrotum was given. The patient was followed up regularly and is doing fine for last 4 months.
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Affiliation(s)
- R K Sherwani
- Department of Pathology, JNMCH, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
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Pantazis NJ, Zaheer A, Dai D, Zaheer S, Green SH, Lim R. Transfection of C6 glioma cells with glia maturation factor upregulates brain-derived neurotrophic factor and nerve growth factor: trophic effects and protection against ethanol toxicity in cerebellar granule cells. Brain Res 2000; 865:59-76. [PMID: 10814733 DOI: 10.1016/s0006-8993(00)02194-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Glial cells play active roles in neuronal survival, as well as neuroprotection against toxic insult. Recent studies suggest that the brain protein glia maturation factor (GMF) is involved in intracellular signaling in glia. This study investigated whether or not GMF plays a role in the survival-promoting and neuroprotective functions of glia. C6 glioma cells were transfected in vitro with GMF utilizing an adenovirus vector. The transfected cells overexpressed GMF intracellularly, but did not secrete the protein. The conditioned medium (CM) was obtained from the GMF-transfected cells (CM-GMF) and tested on primary neuronal cultures, consisting of cerebellar granule cells (CGC). The CGC cultures were utilized because these cultures have a background level of cell death, and the survival-promoting, i.e. neurotrophic effect, of the CM could be tested. In addition, since CGC cultures are ethanol-sensitive (ethanol enhances neuronal death), the neuroprotective effect of the CM against ethanol-induced cell death was tested also. We demonstrated that the CM-GMF had an enhanced neurotrophic effect as well as an increased neuroprotective effect against ethanol-induced cell death compared to control CM obtained from untransfected C6 cells (CM-Mock) or CM obtained from cells transfected with an unrelated gene (CM-LacZ). Because neurotrophins have trophic and protective effects, we investigated whether GMF-transfection upregulated the expression of neurotrophins in C6 cells. RT-PCR verified that GMF-transfected C6 cells had increased mRNA levels for BDNF and NGF. Immunoblotting corroborated the RT-PCR results and indicated that CM-GMF contained greater concentrations of BDNF and NGF protein compared to CM-Mock and CM-LacZ. A soluble TrkB-IgG fusion protein, which selectively binds BDNF and prevents its binding to the neuronal TrkB receptor, eliminated the neurotrophic effect of CM-GMF; whereas anti-NGF antibody was ineffective in preventing this effect, suggesting that the neurotrophic effect was due to BDNF. On the other hand, both the TrkB-IgG fusion protein and anti-NGF reduced neuroprotection, suggesting that BDNF and NGF both contribute to the neuroprotective effect of CM-GMF. In conclusion, GMF upregulates the expression of BDNF and NGF in C6 cells, and these factors exert neurotrophic and neuroprotective functions on primary neurons.
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Affiliation(s)
- N J Pantazis
- Department of Anatomy and Cell Biology, University of Iowa, College of Medicine, Bowen Science Building, Iowa City, IA 52242, USA.
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Abstract
Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. In adults, bezoars are most frequently encountered after a gastric operation, but in children, bezoars are associated with pica, mental retardation, and coexistent psychiatric pathologic disorders. We describe a 4-year-old girl with trichotillomania in whom a gastric trichobezoar resulted in failure to gain weight, iron deficiency anemia, and a painless epigastric mass. The causes of gastric bezoars are discussed, with emphasis on diagnostic considerations, treatment options, and preventive measures.
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Affiliation(s)
- M R Phillips
- Department of Surgery, Mayo Clinic Rochester, Minnesota, USA
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Abstract
PURPOSE This study was undertaken to determine the incidence and risk factors for urinary retention after operations for benign anorectal diseases. METHODS We reviewed 1,026 consecutive operations for benign anorectal diseases from 1989 to 1994. Risk factor analysis was done for patients undergoing hemorrhoidectomy (Group I) and other procedures (Group II) using logistic regression analysis. RESULTS The number of procedures and urinary retention rate was as follows: 344 (34 percent) hemorrhoidectomies, 159 (2 percent) fistulotomies, 95 (5 percent) incision/drainage, 247 (4 percent) lateral internal sphincterotomy, 181 (17 percent) combinations of the above four procedures, and overall 1,026 (16 percent). In Group I, four-quadrant excision (odds ratio, 3.3; P = 0.0004), three quadrant excision (odds ratio, 2.4; P = 0.003), morphine equivalents >33 (odds ratio, 1.8; P = 0.01), and male gender (odds ratio, 1.7; P = 0.02) were independent risk factors. In Group II, more than one operation (odds ratio, 3.0; P = 0.004), older age (odds ratio, 3.1; P = 0.005), intraoperative fluids (odds ratio, 2.6; P = 0.03), and postoperative fluids (odds ratio, 2.7; P = 0.02) were independent risk factors. Urinary obstructive symptoms for both groups and perioperative fluids for Group I were NOT independent risk factors. Hospital stay was prolonged significantly in patients with urinary retention (P = 0.0001). CONCLUSIONS Urinary retention is a common postoperative complication that increases hospital stay. It is most common after hemorrhoidectomy. Disease severity (quadrants excised and analgesia requirement for Group I and number of operations for Group II) is an important risk factor for both groups studied. Older age in Group I and perioperative fluid in Group II may be important risk factors.
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Affiliation(s)
- S Zaheer
- Division of Colon & Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Abstract
OBJECTIVE The authors' aim was to determine survival and recurrence rates in patients undergoing resection of rectal cancer achieved by abdominoperineal resection (APR), coloanal anastomosis (CAA), and anterior resection (AR) without adjuvant therapy. SUMMARY BACKGROUND DATA The surgery of rectal cancer is controversial; so, too, is its adjuvant management. Questions such as preoperative versus postoperative radiation versus no radiation are key. An approach in which the entire mesorectum is excised has been proposed as yielding low recurrence rates. METHODS Of 1423 patients with resected rectal cancers, 491 patients were excluded, leaving 932 with a primary adenocarcinoma of the rectum treated at Mayo. Eighty-six percent were resected for cure. Surgery plus adjuvant treatment was performed in 418, surgery alone in 514. These 514 patients are the subject of this review. Among the 514 patients who underwent surgery alone, APR was performed in 169, CAA in 19, AR in 272, and other procedures in 54. Eighty-seven percent of patients were operated on with curative intent. The mean follow-up was 5.6 years; follow-up was complete in 92%. APR and CAA were performed excising the envelope of rectal mesentery posteriorly and the supporting tissues laterally from the sacral promontory to the pelvic floor. AR was performed using an appropriately wide rectal mesentery resection technique if the tumor was high; if the tumor was in the middle or low rectum, all mesentery was resected. The mean distal margin achieved by AR was 3 +/- 2 cm. RESULTS Mortality was 2% (12 of 514). Anastomotic leaks after AR occurred in 5% (16 of 291) and overall transient urinary retention in 15%. Eleven percent of patients had a wound infection (abdominal and perineal wound, 30-day, purulence, or cellulitis). The local recurrence and 5-year disease-free survival rates were 7% and 78%, respectively, after AR; 6% and 83%, respectively, after CAA; and 4% and 80%, respectively, after APR. Patients with stage III disease, had a 60% disease-free survival rate. CONCLUSIONS Complete resection of the envelope of supporting tissues about the rectum during APR, CAA, and AR when tumors were low in the rectum is associated with low mortality, low morbidity, low local recurrence, and good 5-year survival rates. Appropriate "tumor-specific" mesorectal excision during AR when the tumor is high in the rectum is likewise consistent with a low rate of local recurrence and good long-term survival. However, the overall failure rate of 40% in stage III disease (which is independent of surgical technique) means that surgical approaches alone are not sufficient to achieve better long-term survival rates.
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Affiliation(s)
- S Zaheer
- Division of Colon and Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Iyer S, Zaheer S, Vandré D, Long C, Montgomery R. Characterization of human interferon species using gel extraction and monoclonal antibodies: implications on clinical use of interferon preparations. J Biol Response Mod 1986; 5:548-61. [PMID: 2432190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Human interferons from various sources have been characterized using sodium dodecyl sulfate polyacrylamide gel electrophoresis followed by electrotransfer onto nitrocellulose and reaction with specific polyclonal and monoclonal antibodies. When gel slices were extracted, alpha-interferon subspecies possessed antiviral activity predominantly in the 18.6-19.7K region bands, the beta-interferon in the 22.1K band, and gamma-interferon in the 16.5-18.0K bands. Three of the monoclonal antibodies (Ab 138, Ab 126, Ab 098) reacted with a characteristic triplet of biologically active bands (18.6K, 19.1K, 19.7K) obtained using the Namalwa cell interferons, while two (Ab 194 and Ab 232) reacted only with the 18.6K band and Ab 523 reacted with the 19.7K band. With the human leukocyte interferons, Ab 098, Ab 194, and Ab 232 reacted with the active 18.6K band. The Ab 138, Ab 126, and Ab 523 reacted specifically with certain lower molecular weight active bands (13K region). A comparison of the antiviral activity and reactivity towards monoclonal and polyclonal antibodies presents a differentiation of the subspecies of interferons in the wide array of closely related proteins in interferon preparations packaged for clinical use.
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Zaheer A, Zaheer S, Montgomery R. Peptidase activity of macromomycin apoprotein. J Biol Chem 1985; 260:11787-92. [PMID: 3900063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Macromomycin, an antibiotic and antitumor protein obtained from Streptomyces macromomyceticus, displayed specific aminopeptidase activity. Pure macromomycin degraded the beta-chain of insulin, a few synthetic di- and tripeptides, and a number of proteins of KB cell plasma membrane. The biological activity and the peptidase activity showed similar temperature-dependent patterns suggesting that one protein is responsible for both activities. The apoprotein contained the aminopeptidase activity while the chromophore, which displayed the antibiotic and antitumor activity, did not show any such activity.
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Abstract
Largomycin, an antibiotic and antitumor protein, purified from the culture broth of Streptomyces pluricolorescens, displayed specific proteolytic activity. Pure largomycin did not degrade a number of substrates commonly used for detection of aminopeptidase, endopeptidase and carboxypeptidase activity. Pure largomycin degraded angiotensin II, bradykinin, a few dipeptides and a number of proteins of KB cell plasma membranes. The biological activity and the proteolytic activity of largomycin showed similar temperature-dependent patterns, suggesting that one protein is responsible for both activities. The apoprotein of largomycin, which did not show antibiotic activity, contained the proteolytic activity.
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