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Clerbaux LA, Filipovska J, Nymark P, Chauhan V, Sewald K, Alb M, Sachana M, Beronius A, Amorim MJ, Wittwehr C. Beyond chemicals: Opportunities and challenges of integrating non-chemical stressors in adverse outcome pathways. ALTEX 2023; 41:233-247. [PMID: 37980615 DOI: 10.14573/altex.2307061] [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] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/31/2023] [Indexed: 11/21/2023]
Abstract
The adverse outcome pathways (AOPs) were developed to accelerate evidence-based chemical risk assessment by leveraging data from new approach methodologies. Thanks to their stressor-agnostic approach, AOPs were seen as instrumental in other fields. Here, we present AOPs that report non-chemical stressors along with the challenges encountered for their development. Challenges regarding AOPs linked to nanomaterials include non-specific molecular initiating events, limited understanding of nanomaterial biodistribution, and needs for adaptations of the in silico modeling and testing systems. Development of AOPs for radiation face challenges in how to incorporate ionizing events type, dose rate, energy deposition, and how to account for targeting multiple macromolecules. AOPs for COVID-19 required the inclusion of SARS-CoV-2-specific replicative steps to capture the essential events driving the disease. Developing AOPs to evaluate efficacy and toxicity of cell therapies necessitates addressing the cellular nature and the therapeutic function of the stressor. Finally, addressing toxicity of emerging biological stressors like microbial pesticides can learn from COVID-19 AOPs. We further discuss that the adaptations needed to expand AOP applicability beyond chemicals are mainly at the molecular and cellular levels while downstream key events at tissue or organ level, such as inflammation, are shared by many AOPs initiated by various stressors. In conclusion, although it is challenging to integrate non-chemical stressors within AOPs, this expands opportunities to account for real-world scenarios, to identify vulnerable individuals, and to bridge knowledge on mechanisms of adversity.
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Affiliation(s)
| | | | - Penny Nymark
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Vinita Chauhan
- Consumer and Clinical Radiation Protection Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Canada
| | | | - Miriam Alb
- Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | | | - Anna Beronius
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria-Joao Amorim
- Católica Medical School, Católica Biomedical Research Centre, Universidade Católica Portuguesa, Lisboa, Portugal
- Instituto Gulbenkian de Ciência, Fundação Calouste Gulbenkian, Oeiras, Portugal
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2
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Carusi A, Filipovska J, Wittwehr C, Clerbaux LA. CIAO: a living experiment in interdisciplinary large-scale collaboration facilitated by the Adverse Outcome Pathway framework. Front Public Health 2023; 11:1212544. [PMID: 37637826 PMCID: PMC10449328 DOI: 10.3389/fpubh.2023.1212544] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/12/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The CIAO project was launched in Spring 2020 to address the need to make sense of the numerous and disparate data available on COVID-19 pathogenesis. Based on a crowdsourcing model of large-scale collaboration, the project has exploited the Adverse Outcome Pathway (AOP) knowledge management framework built to support chemical risk assessment driven by mechanistic understanding of the biological perturbations at the different organizational levels. Hence the AOPs might have real potential to integrate data produced through different approaches and from different disciplines as experienced in the context of COVID-19. In this study, we aim to address the effectiveness of the AOP framework (i) in supporting an interdisciplinary collaboration for a viral disease and (ii) in working as the conceptual mediator of a crowdsourcing model of collaboration. Methods We used a survey disseminated among the CIAO participants, a workshop open to all interested CIAO contributors, a series of interviews with some participants and a self-reflection on the processes. Results The project has supported genuine interdisciplinarity with exchange of knowledge. The framework provided a common reference point for discussion and collaboration. The diagram used in the AOPs assisted with making explicit what are the different perspectives brought to the knowledge about the pathways. The AOP-Wiki showed up many aspects about its usability for those not already in the world of AOPs. Meanwhile their use in CIAO highlighted needed adaptations. Introduction of new Wiki elements for modulating factors was potentially the most disruptive one. Regarding how well AOPs support a crowdsourcing model of large-scale collaboration, the CIAO project showed that this is successful when there is a strong central organizational impetus and when clarity about the terms of the collaboration is brought as early as possible. Discussion Extrapolate the successful CIAO approach and related processes to other areas of science where the AOP could foster interdisciplinary and systematic organization of the knowledge is an exciting perspective.
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Affiliation(s)
| | | | - Clemens Wittwehr
- European Commission, Joint Research Centre (JRC), Joint Research Centre, Ispra, Italy
| | - Laure-Alix Clerbaux
- European Commission, Joint Research Centre (JRC), Joint Research Centre, Ispra, Italy
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Tanabe S, Beaton D, Chauhan V, Choi I, Choi J, Clerbaux LA, Coppola L, Dumont AF, Esterhuizen M, Filipovska J, FitzGerald R, Fritsche E, Garcia-Reyero N, Goralczyk A, Huliganga E, Kim YJ, Klose J, La Rocca C, Landesmann B, Mally A, Murugadoss S, Omeragic E, Ouédraogo G, Pereira JM, Sadi B, Schaffert A, Song Y, Sovadinova I, Stöger T, Tollefsen KE, Wittwehr C, Yauk C. Report of the 3rd and 4th Mystery of Reactive Oxygen Species Conference. ALTEX 2023; 40:689-693. [PMID: 37889188 DOI: 10.14573/altex.2307041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Shihori Tanabe
- Division of Risk Assessment, Center for Biological Safety and Research, National Institute of Health Sciences, Kawasaki, Japan
| | | | | | - Ian Choi
- Korea Institute of Science and Technology (KIST) Europe, Saarbrücken, Germany
| | - Judy Choi
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | | | - Lucia Coppola
- Center for Gender-specific Medicine, Italian National Institute of Health, Rome, Italy
| | | | - Maranda Esterhuizen
- University of Helsinki, Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, Lahti, Finland; Helsinki Institute of Sustainability Science (HELSUS), Helsinki, Finland
| | | | | | - Ellen Fritsche
- IUF - Leibniz Research Institute for Environmental Medicine, Duesseldorf, Germany
- DNTOX GmbH, Duesseldorf, Germany
- Heinrich-Heine- University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | | | - Anna Goralczyk
- Philip Morris International R&D, Philip Morris Products SA, Neuchatel, Switzerland
| | | | - Young-Jun Kim
- Korea Institute of Science and Technology (KIST) Europe, Saarbrücken, Germany
| | | | - Cinzia La Rocca
- Center for Gender-specific Medicine, Italian National Institute of Health, Rome, Italy
| | | | - Angela Mally
- Department of Toxicology, University of Würzburg, Würzburg, Germany
| | - Sivakumar Murugadoss
- Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium
| | - Elma Omeragic
- University of Sarajevo-Faculty of Pharmacy, Sarajevo, Bosnia and Herzegovina
| | | | - Jorge Matias Pereira
- Philip Morris International R&D, Philip Morris Products SA, Neuchatel, Switzerland
| | - Baki Sadi
- Health Canada, Ottawa, Ontario, Canada
| | | | - You Song
- Norwegian Institute for Water Research (NIVA), Oslo, Norway
| | - Iva Sovadinova
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Tobias Stöger
- Institute of Lung Health and Immunity, Helmholtz Center Munich, German Research Center for Environmental Health (GmbH), Comprehensive Pneumology Center Munich, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Knut Erik Tollefsen
- Norwegian Institute for Water Research (NIVA), Oslo, Norway
- Norwegian University of Life Sciences (NMBU), Ås, Norway
- Centre for Environmental Radioactivity, Norwegian University of Life Sciences (NMBU), Ås, Norway
| | | | - Carole Yauk
- University of Ottawa, Ottawa, Ontario, Canada
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Tanabe S, O’Brien J, Tollefsen KE, Kim Y, Chauhan V, Yauk C, Huliganga E, Rudel RA, Kay JE, Helm JS, Beaton D, Filipovska J, Sovadinova I, Garcia-Reyero N, Mally A, Poulsen SS, Delrue N, Fritsche E, Luettich K, La Rocca C, Yepiskoposyan H, Klose J, Danielsen PH, Esterhuizen M, Jacobsen NR, Vogel U, Gant TW, Choi I, FitzGerald R. Reactive Oxygen Species in the Adverse Outcome Pathway Framework: Toward Creation of Harmonized Consensus Key Events. Front Toxicol 2022; 4:887135. [PMID: 35875696 PMCID: PMC9298159 DOI: 10.3389/ftox.2022.887135] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023] Open
Abstract
Reactive oxygen species (ROS) and reactive nitrogen species (RNS) are formed as a result of natural cellular processes, intracellular signaling, or as adverse responses associated with diseases or exposure to oxidizing chemical and non-chemical stressors. The action of ROS and RNS, collectively referred to as reactive oxygen and nitrogen species (RONS), has recently become highly relevant in a number of adverse outcome pathways (AOPs) that capture, organize, evaluate and portray causal relationships pertinent to adversity or disease progression. RONS can potentially act as a key event (KE) in the cascade of responses leading to an adverse outcome (AO) within such AOPs, but are also known to modulate responses of events along the AOP continuum without being an AOP event itself. A substantial discussion has therefore been undertaken in a series of workshops named "Mystery or ROS" to elucidate the role of RONS in disease and adverse effects associated with exposure to stressors such as nanoparticles, chemical, and ionizing and non-ionizing radiation. This review introduces the background for RONS production, reflects on the direct and indirect effects of RONS, addresses the diversity of terminology used in different fields of research, and provides guidance for developing a harmonized approach for defining a common event terminology within the AOP developer community.
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Affiliation(s)
- Shihori Tanabe
- Division of Risk Assessment, Center for Biological Safety and Research, National Institute of Health Sciences, Kawasaki, Japan
- *Correspondence: Shihori Tanabe,
| | - Jason O’Brien
- Wildlife Toxicology Research Section, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Knut Erik Tollefsen
- Norwegian Institute for Water Research (NIVA), Oslo, Norway
- Norwegian University of Life Sciences (NMBU), Ås, Norway
- Centre for Environmental Radioactivity, Norwegian University of Life Sciences (NMBU), Ås, Norway
| | - Youngjun Kim
- Korea Institute of Science and Technology (KIST) Europe, Saarbrücken, Germany
| | | | | | | | | | | | | | | | | | - Iva Sovadinova
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Natalia Garcia-Reyero
- U.S. Army Engineer Research and Development Center (ERDC), Vicksburg, MS, United States
| | - Angela Mally
- Department of Toxicology, University of Würzburg, Würzburg, Germany
| | - Sarah Søs Poulsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Nathalie Delrue
- Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Ellen Fritsche
- Group of Alternative Method Development for Environmental Toxicity Testing, IUF—Leibniz-Research Institute for Environmental Medicine, Duesseldorf, Germany
| | - Karsta Luettich
- Philip Morris International R&D, Philip Morris Products SA, Neuchatel, Switzerland
| | - Cinzia La Rocca
- Center for Gender-specific Medicine, Italian National Institute of Health, Rome, Italy
| | - Hasmik Yepiskoposyan
- Philip Morris International R&D, Philip Morris Products SA, Neuchatel, Switzerland
| | - Jördis Klose
- Group of Alternative Method Development for Environmental Toxicity Testing, IUF—Leibniz-Research Institute for Environmental Medicine, Duesseldorf, Germany
| | | | - Maranda Esterhuizen
- University of Helsinki, Ecosystems and Environment Research Programme, Faculty of Biological and Environmental Sciences, Lahti, Finland, and Helsinki Institute of Sustainability Science (HELSUS), Helsinki, Finland
| | | | - Ulla Vogel
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Timothy W. Gant
- UK Health Security Agency, Public Health England, London, United Kingdom
| | - Ian Choi
- Korea Institute of Science and Technology (KIST) Europe, Saarbrücken, Germany
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Clerbaux LA, Amigó N, Amorim MJ, Bal-Price A, Batista Leite S, Beronius A, Bezemer GFG, Bostroem AC, Carusi A, Coecke S, Concha R, Daskalopoulos EP, De Bernardi F, Edrosa E, Edwards SW, Filipovska J, Garcia-Reyero N, Gavins FNE, Halappanavar S, Hargreaves AJ, Hogberg HT, Huynh MT, Jacobson D, Josephs-Spaulding J, Kim YJ, Kong HJ, Krebs CE, Lam A, Landesmann B, Layton A, Lee YO, Macmillan DS, Mantovani A, Margiotta-Casaluci L, Martens M, Masereeuw R, Mayasich SA, Mei LM, Mortensen H, Munoz Pineiro A, Nymark P, Ohayon E, Ojasi J, Paini A, Parissis N, Parvatam S, Pistollato F, Sachana M, Sørli JB, Sullivan KM, Sund J, Tanabe S, Tsaioun K, Vinken M, Viviani L, Waspe J, Willett C, Wittwehr C. COVID-19 through Adverse Outcome Pathways: Building networks to better understand the disease - 3rd CIAO AOP Design Workshop. ALTEX 2022; 39:322–335. [PMID: 35032963 PMCID: PMC10069302 DOI: 10.14573/altex.2112161] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023]
Abstract
On April 28-29, 2021, 50 scientists from different fields of expertise met for the 3rd online CIAO workshop. The CIAO project “Modelling the Pathogenesis of COVID-19 using the Adverse Outcome Pathway (AOP) framework” aims at building a holistic assembly of the available scientific knowledge on COVID-19 using the AOP framework. An individual AOP depicts the disease progression from the initial contact with the SARS-CoV-2 virus through biological key events (KE) toward an adverse outcome such as respiratory distress, anosmia or multiorgan failure. Assembling the individual AOPs into a network highlights shared KEs as central biological nodes involved in multiple outcomes observed in COVID-19 patients. During the workshop, the KEs and AOPs established so far by the CIAO members were presented and positioned on a timeline of the disease course. Modulating factors influencing the progression and severity of the disease were also addressed as well as factors beyond purely biological phenomena. CIAO relies on an interdisciplinary crowdsourcing effort, therefore, approaches to expand the CIAO network by widening the crowd and reaching stakeholders were also discussed. To conclude the workshop, it was decided that the AOPs/KEs will be further consolidated, integrating virus variants and long COVID when relevant, while an outreach campaign will be launched to broaden the CIAO scientific crowd.
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Affiliation(s)
| | | | | | - Anna Bal-Price
- European Commission, Joint Research Centre, Ispra, Italy
| | | | - Anna Beronius
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Sandra Coecke
- European Commission, Joint Research Centre, Ispra, Italy
| | - Rachel Concha
- Fairleigh Dickinson University, Green Neuroscience Laboratory, San Diego, CA, USA
| | | | - Francesca De Bernardi
- Division of Otorhinolaryngology, Department of Biotechnologies and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Eizleayne Edrosa
- Green Neuroscience Laboratory, Neurolinx Research Institute, San Diego, CA, USA
| | | | | | | | - Felicity N E Gavins
- The Centre for Inflammation Research and Translational Medicine (CIRTM), Brunel University London, London, UK
| | - Sabina Halappanavar
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Alan J Hargreaves
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Helena T Hogberg
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mylène T Huynh
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Daniel Jacobson
- Biosciences, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | | | - Young Jun Kim
- Korea Institute of Science and Technology Europe Forschungsgesellschaft mbH, Saarbrücken, Germany
| | - Hyun Joon Kong
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | - Ann Lam
- Green Neuroscience Laboratory, Neurolinx Research Institute, San Diego, CA, USA
| | | | | | - Yong Oh Lee
- Korea Institute of Science and Technology Europe Forschungsgesellschaft mbH, Saarbrücken, Germany
| | | | | | - Luigi Margiotta-Casaluci
- The Centre for Inflammation Research and Translational Medicine (CIRTM), Brunel University London, London, UK
| | - Marvin Martens
- Department of Bioinformatics - BiGCaT, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - Rosalinde Masereeuw
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sally A Mayasich
- University of Wisconsin-Madison Aquatic Sciences Center at US EPA, Duluth, MN, USA
| | | | | | | | - Penny Nymark
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elan Ohayon
- Green Neuroscience Laboratory, Neurolinx Research Institute, San Diego, CA, USA
| | - Joshi Ojasi
- Hiranandani College of Pharmacy, Mumbai, India
| | - Alicia Paini
- European Commission, Joint Research Centre, Ispra, Italy
| | | | - Surat Parvatam
- Centre for Predictive Human Model Systems Atal Incubation Centre - Centre for Cellular and Molecular Biology Habsiguda, Hyderabad, India
| | | | - Magdalini Sachana
- Environment Health and Safety Division, Environment Directorate, Organisation for Economic Cooperation and Development (OECD), Paris, France
| | | | | | - Jukka Sund
- European Commission, Joint Research Centre, Ispra, Italy
| | - Shihori Tanabe
- Division of Risk Assessment, Center for Biological Safety and Research, National Institute of Health Sciences, Kawasaki, Japan
| | - Katya Tsaioun
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mathieu Vinken
- Department of Pharmaceutical and Pharmacological Sciences, Vrije Universiteit Brussel, Brussels, Belgium
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6
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Saini B, Brillant M, Filipovska J, Gelgor L, Mitchell B, Rose G, Smith L. Factors influencing Australian community pharmacists' willingness to participate in research projects - an exploratory study. International Journal of Pharmacy Practice 2010. [DOI: 10.1211/ijpp.14.3.0004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To identify the factors influencing Australian community pharmacists' willingness to participate in research projects and their attitudes towards research.
Method
A mixed-method survey instrument comprising demographics, previous participation in research, and perceptions about participation in research was mailed to 267 community pharmacists in New South Wales and the Australian Capital Territory. An analysis of variance test was used to identify similarities and differences between research- and non-research-active respondents. Bivariate correlations and partial least squares (PLS) regression analyses were used to identify barriers and facilitators to research participation.
Key findings
The overall response rate to the survey was 40%. Of these, 70% were classified as previous research participants (PRP), and 30% were classified as non-previous research participants (NPRP). Both groups had mostly favourable attitudes towards research; however, the results revealed several differences between the PRP and NPRP groups. Three items were identified as key facilitators to participation in research for both PRP and NPRP groups - having an interest in the research topic; believing that the research will benefit the customer; and a belief that community pharmacy research is important. Lack of time, either real or perceived, was identified as a key barrier to participation in research for both the PRP and NPRP groups.
Conclusion
Researchers should take into account pharmacists' previous research experience when recruiting pharmacists into research projects. In the case of pharmacists with research experience, emphasis should be on promoting factors that facilitate participation. In the case of pharmacists with little research experience, emphasis should be on reducing barriers to participation.
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Affiliation(s)
- B Saini
- Pharmacy Practice, Faculty of Pharmacy, University of Sydney, New South Wales, Australia
| | - M Brillant
- Pharmacy Practice, Faculty of Pharmacy, University of Sydney, New South Wales, Australia
| | - J Filipovska
- Pharmacy Practice, Faculty of Pharmacy, University of Sydney, New South Wales, Australia
| | - L Gelgor
- Pharmacy Practice, Faculty of Pharmacy, University of Sydney, New South Wales, Australia
| | - B Mitchell
- Pharmacy Practice, Faculty of Pharmacy, University of Sydney, New South Wales, Australia
| | - G Rose
- Pharmacy Practice, Faculty of Pharmacy, University of Sydney, New South Wales, Australia
| | - L Smith
- Pharmacy Practice, Faculty of Pharmacy, University of Sydney, New South Wales, Australia
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Saini B, Filipovska J, Bosnic-Anticevich S, Taylor S, Krass I, Armour C. An evaluation of a community pharmacy-based rural asthma management service. Aust J Rural Health 2008; 16:100-8. [PMID: 18318852 DOI: 10.1111/j.1440-1584.2008.00975.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare the effect of a pharmacist-delivered rural asthma management service (RAMS) on health outcomes for people with asthma in a rural/regional area with 'standard care' delivered through community pharmacies. DESIGN A parallel group controlled repeated measures study. SETTING Community pharmacies in Central West New South Wales. INTERVENTION Standardised protocols and resources based on national asthma management guidelines, delivered by specially trained community pharmacists. Patients visited the pharmacy at baseline and 1, 3 and 6 months after baseline in the intervention group and at baseline plus 6 months after baseline in the control group. PARTICIPANTS The intervention pharmacists (n = 12) were trained to deliver the RAMS model, while control pharmacists (n = 8) provided standard asthma care to their recruited patients. Fifty-one and 39 patients were recruited by intervention and control pharmacists. MAIN OUTCOME MEASURE Asthma severity score which was a composite score based on recency, frequency and severity of asthma symptoms, and asthma history. RESULTS Data compared at the final visit between groups indicated that the RAMS patient group demonstrated a significant reduction in the asthma severity scores (7.9 +/- 2.6 versus 10.4 +/- 2.6, P < 0.001); a reduction in the risk of non-adherence to medication scores (1.6 +/- 0.7 versus 2.3 +/- 1.1, P < 0.001); and an increase in the proportion of patients owning a written action plan (50% versus 23%, P = 0.04). CONCLUSIONS These results indicated that the community pharmacy-based RAMS model can improve asthma outcomes for patients in rural settings, and similar models for asthma and other chronic diseases should be tested rigorously and adopted in rural primary care practice.
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Affiliation(s)
- Bandana Saini
- Pharmacy Practice Research, Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
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8
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Gomes I, Gupta A, Filipovska J, Szeto HH, Pintar JE, Devi LA. A role for heterodimerization of mu and delta opiate receptors in enhancing morphine analgesia. Proc Natl Acad Sci U S A 2004; 101:5135-9. [PMID: 15044695 PMCID: PMC387386 DOI: 10.1073/pnas.0307601101] [Citation(s) in RCA: 335] [Impact Index Per Article: 16.8] [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: 01/26/2023] Open
Abstract
Opiates such as morphine are the choice analgesic in the treatment of chronic pain. However their long-term use is limited because of the development of tolerance and dependence. Due to its importance in therapy, different strategies have been considered for making opiates such as morphine more effective, while curbing its liability to be abused. One such strategy has been to use a combination of drugs to improve the effectiveness of morphine. In particular, delta opioid receptor ligands have been useful in enhancing morphine's potency. The underlying molecular basis for these observations is not understood. We propose the modulation of receptor function by physical association between mu and delta opioid receptors as a potential mechanism. In support of this hypothesis, we show that mu-delta interacting complexes exist in live cells and native membranes and that the occupancy of delta receptors (by antagonists) is sufficient to enhance mu opioid receptor binding and signaling activity. Furthermore, delta receptor antagonists enhance morphine-mediated intrathecal analgesia. Thus, heterodimeric associations between mu-delta opioid receptors can be used as a model for the development of novel combination therapies for the treatment of chronic pain and other pathologies.
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Affiliation(s)
- Ivone Gomes
- Department of Pharmacology and Biological Chemistry, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
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9
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Abstract
Adrenergic and opioid receptors belong to the rhodopsin family of G-protein coupled receptors, couple to analogous signal transduction pathways, and affect the nociceptive system. Although a number of previous studies have reported functional interactions between these two receptors, the basis for this has not been well explored. We propose that direct receptor-receptor interactions could account, in part, for opioid-adrenergic cross-talk. In this report, we have addressed this using biophysical, biochemical, and pharmacological studies. We show that mu opioid and alpha2A adrenergic receptors reside in close proximity in live cells using the bioluminescence resonance energy transfer assay. These receptors colocalize to proximal dendrites in primary hippocampal neurons. mu-alpha2A Receptor complexes can be isolated from heterologous cells or primary neurons coexpressing these receptors. In these cells, the activation of either mu or alpha2A receptor leads to a significant increase in the level of immunoprecipitable mu-alpha2A complexes, whereas activation of both receptors leads to a significant decrease. The implications of these effects on signaling were examined using the agonist-mediated increase in G-protein activity and mitogen-activated protein kinase activity. We find that activation of either mu or alpha2A receptors leads to an increase in the extent of signaling, whereas activation of both receptors leads to a decrease. The increase in signaling by individual ligands and decrease by a combination of ligands is also seen in primary spinal cord neurons endogenously expressing these receptors. Taken together, these results suggest that physical associations between mu and alpha2A receptors could play a role in the functional interactions between these receptors.
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MESH Headings
- Adrenergic alpha-2 Receptor Agonists
- Animals
- Cell Line
- Clonidine/metabolism
- Clonidine/pharmacology
- Dogs
- Dose-Response Relationship, Drug
- Humans
- Morphine/metabolism
- Morphine/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptors, Adrenergic, alpha-2/genetics
- Receptors, Adrenergic, alpha-2/metabolism
- Receptors, Opioid, mu/agonists
- Receptors, Opioid, mu/genetics
- Receptors, Opioid, mu/metabolism
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Affiliation(s)
- B A Jordan
- Department of Pharmacology and Biological Chemistry, Mount Sinai School of Medicine, 19-84 Annenberg Building, One Gustave L. Levy Place, New York, NY 10029, USA
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10
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Filipovska J, Gomes I, Xu W, Chen C, Liu-Chen LY, Devi LA. Recombinant opioid receptors. Structure-function relationship. Methods Mol Med 2003; 84:185-203. [PMID: 12703324 DOI: 10.1385/1-59259-379-8:185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
MESH Headings
- Amino Acid Sequence
- Animals
- COS Cells
- Chlorocebus aethiops
- Cloning, Molecular
- DNA, Complementary/genetics
- GTP-Binding Proteins/metabolism
- Ligands
- Models, Biological
- Mutagenesis, Site-Directed
- Nucleotides/genetics
- Point Mutation
- Polymerase Chain Reaction
- Protein Structure, Secondary
- Protein Structure, Tertiary
- Receptors, Opioid/chemistry
- Receptors, Opioid/genetics
- Receptors, Opioid/metabolism
- Recombinant Proteins/chemistry
- Recombinant Proteins/metabolism
- Sequence Deletion
- Sequence Homology, Amino Acid
- Structure-Activity Relationship
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Affiliation(s)
- Julija Filipovska
- Department of Biochemistry and Molecular Biology, University of Barcelona, Barcelona, Spain
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Gomes I, Filipovska J, Devi LA. Opioid receptor oligomerization. Detection and functional characterization of interacting receptors. Methods Mol Med 2003; 84:157-83. [PMID: 12703323 DOI: 10.1385/1-59259-379-8:157] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Ivone Gomes
- Department of Pharmacology and Biological Chemistry, Mount Sinai, New York, NY, USA
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12
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Abstract
Opioid receptors belong to the family of G-protein-coupled receptors characterized by their seven transmembrane domains. The activation of these receptors by agonists such as morphine and endogenous opioid peptides leads to the activation of inhibitory G-proteins followed by a decrease in the levels of intracellular cAMP. Opioid receptor activation is also associated with the opening of K(+) channels and the inhibition of Ca(2+) channels. A number of investigations, prior to the development of opioid receptor cDNAs, suggested that opioid receptor types interacted with each other. Early pharmacological studies provided evidence for the probable interaction between opioid receptors. More recent studies using receptor selective antagonists, antisense oligonucleotides, or animals lacking opioid receptors further suggested that interactions between opioid receptor types could modulate their activity. We examined opioid receptor interactions using biochemical, biophysical, and pharmacological techniques. We used differential epitope tagging and selective immunoisolation of receptor complexes to demonstrate homotypic and heterotypic interactions between opioid receptor types. We also used the proximity-based bioluminescence resonance energy transfer assay to explore opioid receptor-receptor interactions in living cells. In this article we describe the biochemical and biophysical methods involved in the detection of receptor dimers. We also address some of the concerns and suggest precautions to be taken in studies examining receptor-receptor interactions.
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Affiliation(s)
- Ivone Gomes
- Department of Pharmacology, New York University School of Medicine, MSB 408, New York 10016, USA
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13
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Yamaguchi Y, Filipovska J, Yano K, Furuya A, Inukai N, Narita T, Wada T, Sugimoto S, Konarska MM, Handa H. Stimulation of RNA polymerase II elongation by hepatitis delta antigen. Science 2001; 293:124-7. [PMID: 11387440 DOI: 10.1126/science.1057925] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.4] [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: 12/26/2022]
Abstract
Transcription elongation by RNA polymerase II (RNAPII) is negatively regulated by the human factors DRB-sensitivity inducing factor (DSIF) and negative elongation factor (NELF). A 66-kilodalton subunit of NELF (NELF-A) shows limited sequence similarity to hepatitis delta antigen (HDAg), the viral protein required for replication of hepatitis delta virus (HDV). The host RNAPII has been implicated in HDV replication, but the detailed mechanism and the role of HDAg in this process are not understood. We show that HDAg binds RNAPII directly and stimulates transcription by displacing NELF and promoting RNAPII elongation. These results suggest that HDAg may regulate RNAPII elongation during both cellular messenger RNA synthesis and HDV RNA replication.
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Affiliation(s)
- Y Yamaguchi
- Frontier Collaborative Research Center, Tokyo Institute of Technology, 4259 Nagatsuta, Yokohama 226-8503, Japan
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14
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Abstract
RNA polymerase II is implicated in the RNA-templated RNA synthesis during replication of viroids and Hepatitis Delta Virus (HDV); however, neither the RNA template nor protein factor requirements for this process are well defined. We have developed an in vitro transcription system based on HeLa cell nuclear extract (NE), in which a segment of antigenomic RNA corresponding to the left-hand tip region of the HDV rod-like structure serves as a template for efficient and highly specific RNA synthesis. Accumulation of the unique RNA product is highly sensitive to alpha-amanitin in HeLa NE and only partially sensitive to this drug in NE from PMG cells that contain an allele of the alpha-amanitin-resistant subunit of pol II, strongly suggesting pol II involvement in this reaction. Detailed analysis of the RNA product revealed that it represents a chimeric molecule composed of a newly synthesized transcript covalently attached to the 5' half of the RNA template. Selection of the start site for transcription is remarkably specific and depends on the secondary structure of the RNA template, rather than on its primary sequence. Some features of this reaction resemble the RNA cleavage-extension process observed for pol II-arrested complexes in vitro. A possible involvement of the described reaction in HDV replication is discussed.
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Affiliation(s)
- J Filipovska
- The Rockefeller University, New York, New York 10021, USA
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