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Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, Ahmed SA, Ajami M, Aji B, Akara EM, Akbarialiabad H, Akinosoglou K, Akinyemiju T, Akkaif MA, Akyirem S, Al Hamad H, Al Hasan SM, Alahdab F, Alalalmeh SO, Alalwan TA, Al-Aly Z, Alam K, Alam M, Alam N, Al-amer RM, Alanezi FM, Alanzi TM, Al-Azzam S, Albakri A, Albashtawy M, AlBataineh MT, Alcalde-Rabanal JE, Aldawsari KA, Aldhaleei WA, Aldridge RW, Alema HB, Alemayohu MA, Alemi S, Alemu YM, Al-Gheethi AAS, Alhabib KF, Alhalaiqa FAN, Al-Hanawi MK, Ali A, Ali A, Ali L, Ali MU, Ali R, Ali S, Ali SSS, Alicandro G, Alif SM, Alikhani R, Alimohamadi Y, Aliyi AA, Aljasir MAM, Aljunid SM, Alla F, Allebeck P, Al-Marwani S, Al-Maweri SAA, Almazan JU, Al-Mekhlafi HM, Almidani L, Almidani O, Alomari MA, Al-Omari B, Alonso J, Alqahtani JS, Alqalyoobi S, Alqutaibi AY, Al-Sabah SK, Altaany Z, Altaf A, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvis-Guzman N, Alwafi H, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Amani R, Amare AT, Amegbor PM, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Amusa GA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Andrei T, Angus C, Anil A, Anil S, Anoushiravani A, Ansari H, Ansariadi A, Ansari-Moghaddam A, Antony CM, Antriyandarti E, Anvari D, Anvari S, Anwar S, Anwar SL, Anwer R, Anyasodor AE, Aqeel M, Arab JP, Arabloo J, Arafat M, Aravkin AY, Areda D, Aremu A, Aremu O, Ariffin H, Arkew M, Armocida B, Arndt MB, Ärnlöv J, Arooj M, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Asaad M, Asadi-Lari M, Asgedom AA, Asghariahmadabad M, Asghari-Jafarabadi M, Ashraf M, Aslani A, Astell-Burt T, Athar M, Athari SS, Atinafu BTT, Atlaw HW, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Awedew AF, Aweke AM, Ayala Quintanilla BP, Ayatollahi H, Ayuso-Mateos JL, Ayyoubzadeh SM, Azadnajafabad S, Azevedo RMS, Azzam AY, B DB, Babu AS, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bagherieh S, Bah S, Bahadorikhalili S, Bahmanziari N, Bai R, Baig AA, Baker JL, Bako AT, Bakshi RK, Balakrishnan S, Balasubramanian M, Baltatu OC, Bam K, Banach M, Bandyopadhyay S, Banik PC, Bansal H, Bansal K, Barbic F, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barone-Adesi F, Barqawi HJ, Barrero LH, Barrow A, Barteit S, Barua L, Basharat Z, Bashiri A, Basiru A, Baskaran P, Basnyat B, Bassat Q, Basso JD, Basting AVL, Basu S, Batra K, Baune BT, Bayati M, Bayileyegn NS, Beaney T, Bedi N, Beghi M, Behboudi E, Behera P, Behnoush AH, Behzadifar M, Beiranvand M, Bejarano Ramirez DF, Béjot Y, Belay SA, Belete CM, Bell ML, Bello MB, Bello OO, Belo L, Beloukas A, Bender RG, Bensenor IM, Beran A, Berezvai Z, Berhie AY, Berice BN, Bernstein RS, Bertolacci GJ, Bettencourt PJG, Beyene KA, Bhagat DS, Bhagavathula AS, Bhala N, Bhalla A, Bhandari D, Bhangdia K, Bhardwaj N, Bhardwaj P, Bhardwaj PV, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Bisulli F, Biswas A, Biswas B, Bitaraf S, Bitew BD, Bitra VR, Bjørge T, Boachie MK, Boampong MS, Bobirca AV, Bodolica V, Bodunrin AO, Bogale EK, Bogale KA, Bohlouli S, Bolarinwa OA, Boloor A, Bonakdar Hashemi M, Bonny A, Bora K, Bora Basara B, Borhany H, Borzutzky A, Bouaoud S, Boustany A, Boxe C, Boyko EJ, Brady OJ, Braithwaite D, Brant LC, Brauer M, Brazinova A, Brazo-Sayavera J, Breitborde NJK, Breitner S, Brenner H, Briko AN, Briko NI, Britton G, Brown J, Brugha T, Bulamu NB, Bulto LN, Buonsenso D, Burns RA, Busse R, Bustanji Y, Butt NS, Butt ZA, Caetano dos Santos FL, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cao Y, Capodici A, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalheiro CG, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Cederroth CR, Cegolon L, Cembranel F, Cenderadewi M, Cercy KM, Cerin E, Cevik M, Chadwick J, Chahine Y, Chakraborty C, Chakraborty PA, Chan JSK, Chan RNC, Chandika RM, Chandrasekar EK, Chang CK, Chang JC, Chanie GS, Charalampous P, Chattu VK, Chaturvedi P, Chatzimavridou-Grigoriadou V, Chaurasia A, Chen AW, Chen AT, Chen CS, Chen H, Chen MX, Chen S, Cheng CY, Cheng ETW, Cherbuin N, Cheru WA, Chien JH, Chimed-Ochir O, Chimoriya R, Ching PR, Chirinos-Caceres JL, Chitheer A, Cho WCS, Chong B, Chopra H, Choudhari SG, Chowdhury R, Christopher DJ, Chukwu IS, Chung E, Chung E, Chung E, Chung SC, Chutiyami M, Cindi Z, Cioffi I, Claassens MM, Claro RM, Coberly K, Cogen RM, Columbus A, Comfort H, Conde J, Cortese S, Cortesi PA, Costa VM, Costanzo S, Cousin E, Couto RAS, Cowden RG, Cramer KM, Criqui MH, Cruz-Martins N, Cuadra-Hernández SM, Culbreth GT, Cullen P, Cunningham M, Curado MP, Dadana S, Dadras O, Dai S, Dai X, Dai Z, Dalli LL, Damiani G, Darega Gela J, Das JK, Das S, Das S, Dascalu AM, Dash NR, Dashti M, Dastiridou A, Davey G, Dávila-Cervantes CA, Davis Weaver N, Davletov K, De Leo D, de Luca K, Debele AT, Debopadhaya S, Degenhardt L, Dehghan A, Deitesfeld L, Del Bo' C, Delgado-Enciso I, Demessa BH, Demetriades AK, Deng K, Deng X, Denova-Gutiérrez E, Deravi N, Dereje N, Dervenis N, Dervišević E, Des Jarlais DC, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhimal M, Dhingra S, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Ding H, Dinis-Oliveira RJ, Dirac MA, Djalalinia S, Do THP, do Prado CB, Doaei S, Dodangeh M, Dodangeh M, Dohare S, Dokova KG, Dolecek C, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Du M, Dube J, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, E'mar AR, Eboreime E, Ebrahimi A, Echieh CP, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Effendi DE, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, Elbarazi I, Elema TB, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, El-Huneidi W, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emeto TI, Engelbert Bain L, Erkhembayar R, Esezobor CI, Eshrati B, Eskandarieh S, Espinosa-Montero J, Esubalew H, Etaee F, Fabin N, Fadaka AO, Fagbamigbe AF, Fahim A, Fahimi S, Fakhri-Demeshghieh A, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faris PS, Faro A, Fasanmi AO, Fatehizadeh A, Fattahi H, Fauk NK, Fazeli P, Feigin VL, Feizkhah A, Fekadu G, Feng X, Fereshtehnejad SM, Feroze AH, Ferrante D, Ferrari AJ, Ferreira N, Fetensa G, Feyisa BR, Filip I, Fischer F, Flavel J, Flood D, Florin BT, Foigt NA, Folayan MO, Fomenkov AA, Foroutan B, Foroutan M, Forthun I, Fortuna D, Foschi M, Fowobaje KR, Francis KL, Franklin RC, Freitas A, Friedman J, Friedman SD, Fukumoto T, Fuller JE, Fux B, Gaal PA, Gadanya MA, Gaidhane AM, Gaihre S, Gakidou E, Galali Y, Galles NC, Gallus S, Ganbat M, Gandhi AP, Ganesan B, Ganiyani MA, Garcia-Gordillo MA, Gardner WM, Garg J, Garg N, Gautam RK, Gbadamosi SO, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremeskel TG, Georgescu SR, Getachew T, Gething PW, Getie M, Ghadiri K, Ghahramani S, Ghailan KY, Ghasemi MR, Ghasempour Dabaghi G, Ghasemzadeh A, Ghashghaee A, Ghassemi F, Ghazy RM, Ghimire A, Ghoba S, Gholamalizadeh M, Gholamian A, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Ghorbani Vajargah P, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Ginindza TG, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Godinho MA, Goel A, Golchin A, Goldust M, Golechha M, Goleij P, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Goulart BNG, Goyal A, Grada A, Graham SM, Grivna M, Grosso G, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Guimarães RA, Gulati S, Gunawardane DA, Gunturu S, Guo C, Gupta AK, Gupta B, Gupta MK, Gupta M, Gupta RD, Gupta R, Gupta S, Gupta VB, Gupta VK, Gupta VK, Gurmessa L, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadei M, Hadi NR, Haep N, Hafezi-Nejad N, Hailu A, Haj-Mirzaian A, Halboub ES, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hamilton EB, Han C, Han Q, Hanif A, Hanifi N, Hankey GJ, Hanna F, Hannan MA, Haque MN, Harapan H, Hargono A, Haro JM, Hasaballah AI, Hasan I, Hasan MT, Hasani H, Hasanian M, Hashi A, Hasnain MS, Hassan I, Hassanipour S, Hassankhani H, Haubold J, Havmoeller RJ, Hay SI, He J, Hebert JJ, Hegazi OE, Heidari G, Heidari M, Heidari-Foroozan M, Helfer B, Hendrie D, Herrera-Serna BY, Herteliu C, Hesami H, Hezam K, Hill CL, Hiraike Y, Holla R, Horita N, Hossain MM, Hossain S, Hosseini MS, Hosseinzadeh H, Hosseinzadeh M, Hosseinzadeh Adli A, Hostiuc M, Hostiuc S, Hsairi M, Hsieh VCR, Hsu RL, Hu C, Huang J, Hultström M, Humayun A, Hundie TG, Hussain J, Hussain MA, Hussein NR, Hussien FM, Huynh HH, Hwang BF, Ibitoye SE, Ibrahim KS, Iftikhar PM, Ijo D, Ikiroma AI, Ikuta KS, Ikwegbue PC, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Immurana M, Inamdar S, Indriasih E, Iqhrammullah M, Iradukunda A, Iregbu KC, Islam MR, Islam SMS, Islami F, Ismail F, Ismail NE, Iso H, Isola G, Iwagami M, Iwu CCD, Iyamu IO, Iyer M, J LM, Jaafari J, Jacob L, Jacobsen KH, Jadidi-Niaragh F, Jafarinia M, Jafarzadeh A, Jaggi K, Jahankhani K, Jahanmehr N, Jahrami H, Jain N, Jairoun AA, Jaiswal A, Jamshidi E, Janko MM, Jatau AI, Javadov S, Javaheri T, Jayapal SK, Jayaram S, Jebai R, Jee SH, Jeganathan J, Jha AK, Jha RP, Jiang H, Jin Y, Johnson O, Jokar M, Jonas JB, Joo T, Joseph A, Joseph N, Joshua CE, Joshy G, Jozwiak JJ, Jürisson M, K V, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kadir DH, Kalani R, Kalankesh LR, Kalankesh LR, Kaliyadan F, Kalra S, Kamal VK, Kamarajah SK, Kamath R, Kamiab Z, Kamyari N, Kanagasabai T, Kanchan T, Kandel H, Kanmanthareddy AR, Kanmiki EW, Kanmodi KK, Kannan S S, Kansal SK, Kantar RS, Kapoor N, Karajizadeh M, Karanth SD, Karasneh RA, Karaye IM, Karch A, Karim A, Karimi SE, Karimi Behnagh A, Kashoo FZ, Kasnazani QHA, Kasraei H, Kassebaum NJ, Kassel MB, Kauppila JH, Kaur N, Kawakami N, Kayode GA, Kazemi F, Kazemian S, Kazmi TH, Kebebew GM, Kebede AD, Kebede F, Keflie TS, Keiyoro PN, Keller C, Kelly JT, Kempen JH, Kerr JA, Kesse-Guyot E, Khajuria H, Khalaji A, Khalid N, Khalil AA, Khalilian A, Khamesipour F, Khan A, Khan A, Khan G, Khan I, Khan IA, Khan MN, Khan M, Khan MJ, Khan MAB, Khan ZA, Khan suheb MZ, Khanmohammadi S, Khatab K, Khatami F, Khatatbeh H, Khatatbeh MM, Khavandegar A, Khayat Kashani HR, Khidri FF, Khodadoust E, Khorgamphar M, Khormali M, Khorrami Z, Khosravi A, Khosravi MA, Kifle ZD, Kim G, Kim J, Kim K, Kim MS, Kim YJ, Kimokoti RW, Kinzel KE, Kisa A, Kisa S, Klu D, Knudsen AKS, Kocarnik JM, Kochhar S, Kocsis T, Koh DSQ, Kolahi AA, Kolves K, Kompani F, Koren G, Kosen S, Kostev K, Koul PA, Koulmane Laxminarayana SL, Krishan K, Krishna H, Krishna V, Krishnamoorthy V, Krishnamoorthy Y, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kuddus MA, Kuddus M, Kuitunen I, Kulimbet M, Kulkarni V, Kumar A, Kumar A, Kumar H, Kumar M, Kumar R, Kumari M, Kumie FT, Kundu S, Kurmi OP, Kusnali A, Kusuma D, Kwarteng A, Kyriopoulos I, Kyu HH, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lagat AK, Lager ACJ, Lahmar A, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lam H, Lám J, Landrum KR, Lanfranchi F, Lang JJ, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lassi ZS, Latief K, Latifinaibin K, Lauriola P, Le NHH, Le TTT, Le TDT, Ledda C, Ledesma JR, Lee M, Lee PH, Lee SW, Lee SWH, Lee WC, Lee YH, LeGrand KE, Leigh J, Leong E, Lerango TL, Li MC, Li W, Li X, Li Y, Li Z, Ligade VS, Likaka ATM, Lim LL, Lim SS, Lindstrom M, Linehan C, Liu C, Liu G, Liu J, Liu R, Liu S, Liu X, Liu X, Llanaj E, Loftus MJ, López-Bueno R, Lopukhov PD, Loreche AM, Lorkowski S, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Ma ZF, Maass KL, Machairas N, Machoy M, Madadizadeh F, Madsen C, Madureira-Carvalho ÁM, Maghazachi AA, Maharaj SB, Mahjoub S, Mahmoud MA, Mahmoudi A, Mahmoudi E, Mahmoudi R, Majeed A, Makhdoom IF, Malakan Rad E, Maled V, Malekzadeh R, Malhotra AK, Malhotra K, Malik AA, Malik I, Malta DC, Mamun AA, Mansouri P, Mansournia MA, Mantovani LG, Maqsood S, Marasini BP, Marateb HR, Maravilla JC, Marconi AM, Mardi P, Marino M, Marjani A, Martinez G, Martinez-Guerra BA, Martinez-Piedra R, Martini D, Martini S, Martins-Melo FR, Martorell M, Marx W, Maryam S, Marzo RR, Masaka A, Masrie A, Mathieson S, Mathioudakis AG, Mathur MR, Mattumpuram J, Matzopoulos R, Maude RJ, Maugeri A, Maulik PK, Mayeli M, Mazaheri M, Mazidi M, McGrath JJ, McKee M, McKowen ALW, McLaughlin SA, McPhail SM, Mechili EA, Medina JRC, Mediratta RP, Meena JK, Mehra R, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mekene Meto T, Meles GG, Mendez-Lopez MAM, Mendoza W, Menezes RG, Mengist B, Mentis AFA, Meo SA, Meresa HA, Meretoja A, Meretoja TJ, Mersha AM, Mesfin BA, Mestrovic T, Mettananda KCD, Mettananda S, Meylakhs P, Mhlanga A, Mhlanga L, Mi T, Miazgowski T, Micha G, Michalek IM, Miller TR, Mills EJ, Minh LHN, Mini GK, Mir Mohammad Sadeghi P, Mirica A, Mirijello A, Mirrakhimov EM, Mirutse MK, Mirzaei M, Misganaw A, Mishra A, Misra S, Mitchell PB, Mithra P, Mittal C, Mobayen M, Moberg ME, Mohamadkhani A, Mohamed J, Mohamed MFH, Mohamed NS, Mohammad-Alizadeh-Charandabi S, Mohammadi S, Mohammadian-Hafshejani A, Mohammadifard N, Mohammed H, Mohammed H, Mohammed M, Mohammed S, Mohammed S, Mohan V, Mojiri-Forushani H, Mokari A, Mokdad AH, Molinaro S, Molokhia M, Momtazmanesh S, Monasta L, Mondello S, Moni MA, Moodi Ghalibaf A, Moradi M, Moradi Y, Moradi-Lakeh M, Moradzadeh M, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosser JF, Motappa R, Mougin V, Mouodi S, Mousavi P, Mousavi SE, Mousavi Khaneghah A, Mpolya EA, Mrejen M, Mubarik S, Muccioli L, Mueller UO, Mughal F, Mukherjee S, Mulita F, Munjal K, Murillo-Zamora E, Musaigwa F, Musallam KM, Mustafa A, Mustafa G, Muthupandian S, Muthusamy R, Muzaffar M, Myung W, Nagarajan AJ, Nagel G, Naghavi P, Naheed A, Naik GR, Naik G, Nainu F, Nair S, Najmuldeen HHR, Nakhostin Ansari N, Nangia V, Naqvi AA, Narasimha Swamy S, Narayana AI, Nargus S, Nascimento BR, Nascimento GG, Nasehi S, Nashwan AJ, Natto ZS, Nauman J, Naveed M, Nayak BP, Nayak VC, Nazri-Panjaki A, Ndejjo R, Nduaguba SO, Negash H, Negoi I, Negoi RI, Negru SM, Nejadghaderi SA, Nejjari C, Nena E, Nepal S, Ng M, Nggada HA, Nguefack-Tsague G, Ngunjiri JW, Nguyen AH, Nguyen DH, Nguyen HTH, Nguyen PT, Nguyen VT, Niazi RK, Nielsen KR, Nigatu YT, Nikolouzakis TK, Nikoobar A, Nikoomanesh F, Nikpoor AR, Ningrum DNA, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Noreen M, Noroozi N, Norrving B, Noubiap JJ, Novotney A, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nuñez-Samudio V, Nurrika D, Nutor JJ, Oancea B, Obamiro KO, Oboh MA, Odetokun IA, Odogwu NM, O'Donnell MJ, Oduro MS, Ofakunrin AOD, Ogunkoya A, Oguntade AS, Oh IH, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Olagunju AT, Olaiya MT, Olatubi MI, Oliveira GMM, Olufadewa II, Olusanya BO, Olusanya JO, Oluwafemi YD, Omar HA, Omar Bali A, Omer GL, Ondayo MA, Ong S, Onwujekwe OE, Onyedibe KI, Ordak M, Orisakwe OE, Orish VN, Ortega-Altamirano DV, Ortiz A, Osman WMS, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov N, Otstavnov SS, Ouyahia A, Ouyang G, Owolabi MO, Ozten Y, P A MP, Padron-Monedero A, Padubidri JR, Pal PK, Palicz T, Palladino C, Palladino R, Palma-Alvarez RF, Pan F, Pan HF, Pana A, Panda P, Panda-Jonas S, Pandi-Perumal SR, Pangaribuan HU, Panos GD, Panos LD, Pantazopoulos I, Pantea Stoian AM, Papadopoulou P, Parikh RR, Park S, Parthasarathi A, Pashaei A, Pasovic M, Passera R, Pasupula DK, Patel HM, Patel J, Patel SK, Patil S, Patoulias D, Patthipati VS, Paudel U, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Pensato U, Pepito VCF, Peprah EK, Peprah P, Perdigão J, Pereira M, Peres MFP, Perianayagam A, Perico N, Pestell RG, Pesudovs K, Petermann-Rocha FE, Petri WA, Pham HT, Philip AK, Phillips MR, Pierannunzio D, Pigeolet M, Pigott DM, Pilgrim T, Piracha ZZ, Piradov MA, Pirouzpanah S, Plakkal N, Plotnikov E, Podder V, Poddighe D, Polinder S, Polkinghorne KR, Poluru R, Ponkilainen VT, Porru F, Postma MJ, Poudel GR, Pourshams A, Pourtaheri N, Prada SI, Pradhan PMS, Prakasham TN, Prasad M, Prashant A, Prates EJS, Prieto Alhambra D, PRISCILLA TINA, Pritchett N, Purohit BM, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Qiu S, Qureshi MF, Rabiee Rad M, Radfar A, Radhakrishnan RA, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Raggi A, Raghav PR, Raheem N, Rahim F, Rahim MJ, Rahimi-Movaghar V, Rahman MM, Rahman MHU, Rahman M, Rahman MA, Rahmani AM, Rahmani S, Rahmanian V, Rajaa S, Rajput P, Rakovac I, Ramasamy SK, Ramazanu S, Rana K, Ranabhat CL, Rancic N, Rane A, Rao CR, Rao IR, Rao M, Rao SJ, Rasali DP, Rasella D, Rashedi S, Rashedi V, Rashidi MM, Rasouli-Saravani A, Rasul A, Rathnaiah Babu G, Rauniyar SK, Ravangard R, Ravikumar N, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Rawlley B, Raza RZ, Razo C, Redwan EMM, Rehman FU, Reifels L, Reiner Jr RC, Remuzzi G, Reyes LF, Rezaei M, Rezaei N, Rezaei N, Rezaeian M, Rhee TG, Riaz MA, Ribeiro ALP, Rickard J, Riva HR, Robinson-Oden HE, Rodrigues CF, Rodrigues M, Roever L, Rogowski ELB, Rohloff P, Romadlon DS, Romero-Rodríguez E, Romoli M, Ronfani L, Roshandel G, Roth GA, Rout HS, Roy N, Roy P, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, Rwegerera GM, Rynkiewicz A, S N C, Saad AMA, Saadatian Z, Saber K, Saber-Ayad MM, SaberiKamarposhti M, Sabour S, Sacco S, Sachdev PS, Sachdeva R, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi E, Sadeghian F, Saeb MR, Saeed U, Safaeinejad F, Safi SZ, Sagar R, Saghazadeh A, Sagoe D, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Sahoo U, Sahu M, Saif Z, Sajid MR, Sakshaug JW, Salam N, Salamati P, Salami AA, Salaroli LB, Saleh MA, Salehi S, Salem MR, Salem MZY, Salimi S, Samadi Kafil H, Samadzadeh S, Samargandy S, Samodra YL, Samy AM, Sanabria J, Sanna F, Santomauro DF, Santos IS, Santric-Milicevic MM, Sao Jose BP, Sarasmita MA, Saraswathy SYI, Saravanan A, Saravi B, Sarikhani Y, Sarkar T, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Satpathy M, Sayeed A, Sayeed MA, Saylan M, Sayyah M, Scarmeas N, Schaarschmidt BM, Schlaich MP, Schlee W, Schmidt MI, Schneider IJC, Schuermans A, Schumacher AE, Schutte AE, Schwarzinger M, Schwebel DC, Schwendicke F, Šekerija M, Selvaraj S, Senapati S, Senthilkumaran S, Sepanlou SG, Serban D, Sethi Y, Sha F, Shabany M, Shafaat A, Shafie M, Shah NS, Shah PA, Shah SM, Shahabi S, Shahbandi A, Shahid I, Shahid S, Shahid W, Shahsavari HR, Shahwan MJ, Shaikh A, Shaikh MA, Shakeri A, Shalash AS, Sham S, Shamim MA, Shams-Beyranvand M, Shamshad H, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma R, Sharma S, Sharma U, Sharma V, Shastry RP, Shavandi A, Shayan M, Shehabeldine AME, Sheikh A, Sheikhi RA, Shen J, Shetty A, Shetty BSK, Shetty PH, Shi P, Shibuya K, Shiferaw D, Shigematsu M, Shin MJ, Shin YH, Shiri R, Shirkoohi R, Shitaye NA, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shokraneh F, Shokri A, Shool S, Shorofi SA, Shrestha S, Shuval K, Siddig EE, Silva JP, Silva LMLR, Silva S, Simpson CR, Singal A, Singh A, Singh BB, Singh G, Singh J, Singh NP, Singh P, Singh S, Sinha DN, Sinto R, Siraj MS, Sirota SB, Sitas F, Sivakumar S, Skryabin VY, Skryabina AA, Sleet DA, Socea B, Sokhan A, Solanki R, Solanki S, Soleimani H, Soliman SSM, Song S, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Spearman S, Sreeramareddy CT, Srivastava VK, Stanaway JD, Stanikzai MH, Stark BA, Starnes JR, Starodubova AV, Stein C, Stein DJ, Steinbeis F, Steiner C, Steinmetz JD, Steiropoulos P, Stevanović A, Stockfelt L, Stokes MA, Stortecky S, Subramaniyan V, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun HZ, Sun J, Sundström J, Sunkersing D, Sunnerhagen KS, Swain CK, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabish M, TADAKAMADLA JYOTHI, Tadakamadla SK, Taheri Abkenar Y, Taheri Soodejani M, Taiba J, Takahashi K, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tandukar S, Tang H, Tang HK, Tarigan IU, Tariku MK, Tariqujjaman M, Tarkang EE, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tefera YM, Temsah MH, Temsah RMH, Teramoto M, Tesler R, Teye-Kwadjo E, Thakur R, Thangaraju P, Thankappan KR, Tharwat S, Thayakaran R, Thomas N, Thomas NK, Thomson AM, Thrift AG, Thum CCC, Thygesen LC, Tian J, Tichopad A, Ticoalu JHV, Tillawi T, Tiruye TY, Titova MV, Tonelli M, Topor-Madry R, Toriola AT, Torre AE, Touvier M, Tovani-Palone MR, Tran JT, Tran NM, Trico D, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tumurkhuu M, Tung K, Tyrovolas S, Uddin SMN, Udoakang AJ, Udoh A, Ullah A, Ullah I, Ullah S, Ullah S, Umakanthan S, Umeokonkwo CD, Unim B, Unnikrishnan B, Unsworth CA, Upadhyay E, Urso D, Usman JS, Vahabi SM, Vaithinathan AG, Valizadeh R, Van de Velde SM, Van den Eynde J, Varga O, Vart P, Varthya SB, Vasankari TJ, Vasic M, Vaziri S, Vellingiri B, Venketasubramanian N, Verghese NA, Verma M, Veroux M, Verras GI, Vervoort D, Villafañe JH, Villanueva GI, Vinayak M, Violante FS, Viskadourou M, Vladimirov SK, Vlassov V, Vo B, Vollset SE, Vongpradith A, Vos T, Vujcic IS, Vukovic R, Wafa HA, Waheed Y, Wamai RG, Wang C, Wang N, Wang S, Wang S, Wang Y, Wang YP, Waqas M, Ward P, Wassie EG, Watson S, Watson SLW, Weerakoon KG, Wei MY, Weintraub RG, Weiss DJ, Westerman R, Whisnant JL, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Wilandika A, Wilkerson C, Willeit P, Wilson S, Wojewodzic MW, Woldegebreal DH, Wolf AW, Wolfe CDA, Wondimagegene YA, Wong YJ, Wongsin U, Wu AM, Wu C, Wu F, Wu X, Wu Z, Xia J, Xiao H, Xie Y, Xu S, Xu WD, Xu X, Xu YY, Yadollahpour A, Yamagishi K, Yang D, Yang L, Yano Y, Yao Y, Yaribeygi H, Ye P, Yehualashet SS, Yesiltepe M, Yesuf SA, Yezli S, Yi S, Yigezu A, Yiğit A, Yiğit V, Yip P, Yismaw MB, Yismaw Y, Yon DK, Yonemoto N, Yoon SJ, You Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Yuh FH, Zadey S, Zadnik V, Zafari N, Zakham F, Zaki N, Zaman SB, Zamora N, Zand R, Zangiabadian M, Zar HJ, Zare I, Zarrintan A, Zeariya MGM, Zeinali Z, Zhang H, Zhang J, Zhang J, Zhang L, Zhang Y, Zhang ZJ, Zhao H, Zhong C, Zhou J, Zhu B, Zhu L, Ziafati M, Zielińska M, Zitoun OA, Zoladl M, Zou Z, Zuhlke LJ, Zumla A, Zweck E, Zyoud SH, Wool EE, Murray CJL. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2100-2132. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Vollset SE, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbastabar H, Abd Al Magied AHA, Abd ElHafeez S, Abdelkader A, Abdelmasseh M, Abd-Elsalam S, Abdi P, Abdollahi M, Abdoun M, Abdullahi A, Abebe M, Abiodun O, Aboagye RG, Abolhassani H, Abouzid M, Aboye GB, Abreu LG, Absalan A, Abualruz H, Abubakar B, Abukhadijah HJJ, Addolorato G, Adekanmbi V, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adha R, Adhikary RK, Adnani QES, Adzigbli LA, Afrashteh F, Afzal MS, Afzal S, Agbozo F, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahlstrom AJ, Ahmad A, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmed A, Ahmed A, Ahmed H, Ahmed S, Ahmed SA, Akinosoglou K, Akkaif MA, Akrami AE, Akter E, Al Awaidy S, Al Hasan SM, Al Mosa AS, Al Ta'ani O, Al Zaabi OAM, Alahdab F, Alajlani MM, Al-Ajlouni Y, Alalalmeh SO, Al-Aly Z, Alam K, Alam N, Alam T, Alam Z, Al-amer RM, Alanezi FM, Alanzi TM, Albakri A, Aldhaleei WA, Aldridge RW, Alemohammad SY, Alemu YM, Al-Gheethi AAS, Al-Hanawi MK, Ali A, Ali A, Ali I, Ali MU, Ali R, Ali SSS, Ali VE, Ali W, Al-Ibraheem A, Alicandro G, Alif SM, Aljunid SM, Alla F, Almazan JU, Al-Mekhlafi HM, Alqutaibi AY, Alrawashdeh A, Alrousan SM, Al-Sabah SK, Alsabri MA, Altaany Z, Al-Tammemi AB, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvis-Guzman N, Al-Wardat MS, Al-Worafi YM, Aly H, Alyahya MS, Alzoubi KH, Al-Zyoud W, Amani R, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Andrei T, Andrews EA, Anil A, Anil S, Anoushiravani A, Antony CM, Antriyandarti E, Anuoluwa BS, Anvari S, Anyasodor AE, Appiah F, Aquilano M, Arab JP, Arabloo J, Arafa EA, Arafat M, Aravkin AY, Ardekani A, Areda D, Aregawi BB, Aremu A, Ariffin H, Arkew M, Armani K, Artamonov AA, Arumugam A, Asghari-Jafarabadi M, Ashbaugh C, Astell-Burt T, Athari SS, Atorkey P, Atout MMW, Aujayeb A, Ausloos M, Awad H, Awotidebe AW, Ayatollahi H, Ayuso-Mateos JL, Azadnajafabad S, Azeez FK, Azevedo RMS, Badar M, Baghdadi S, Bagheri M, Bagheri N, Bai R, Baker JL, Bako AT, Balakrishnan S, Balcha WF, Baltatu OC, Barchitta M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barqawi HJ, Barteit S, Basiru A, Basso JD, Bastan MM, Basu S, Bauckneht M, Baune BT, Bayati M, Bayileyegn NS, Behnoush AH, Behzadi P, Beiranvand M, Bello OO, Belo L, Beloukas A, Bemanalizadeh M, Bensenor IM, Benzian H, Beran A, Berezvai Z, Bernstein RS, Bettencourt PJG, Beyene KA, Beyene MG, Bhagat DS, Bhagavathula AS, Bhala N, Bhandari D, Bharadwaj R, Bhardwaj N, Bhardwaj P, Bhargava A, Bhaskar S, Bhat V, Bhattacharjee NV, Bhatti GK, Bhatti JS, Bhatti MS, Bhuiyan MA, Bisignano C, Biswas B, Bjørge T, Bodolica V, Bodunrin AO, Bonakdar Hashemi M, Bora Basara B, Borhany H, Bosoka SA, Botero Carvajal A, Bouaoud S, Boufous S, Boxe C, Boyko EJ, Brady OJ, Braithwaite D, Brauer M, Brazo-Sayavera J, Brenner H, Brown CS, Browne AJ, Brugha T, Bryazka D, Bulamu NB, Buonsenso D, Burkart K, Burns RA, Busse R, Bustanji Y, Butt ZA, Caetano dos Santos FL, Çakmak Barsbay M, Calina D, Campos LA, Cao S, Capodici A, Cárdenas R, Carreras G, Carugno A, Carvalho M, Castaldelli-Maia JM, Castelpietra G, Cattaruzza MS, Caye A, Cegolon L, Cembranel F, Cenko E, Cerin E, Chadban SJ, Chadwick J, Chakraborty C, Chakraborty S, Chalek J, Chan JSK, Chandika RM, Chandy S, Charan J, Chaudhary AA, Chaurasia A, Chen AT, Chen H, Chen MX, Chen S, Cherbuin N, Chi G, Chichagi F, Chimed-Ochir O, Chimoriya R, Ching PR, Chirinos-Caceres JL, Chitheer A, Cho DY, Cho WCS, Choi DW, Chong B, Chong CL, Chopra H, Chu DT, Chung E, Chutiyami M, Clayton JT, Cogen RM, Cohen AJ, Columbus A, Comfort H, Conde J, Connolly JT, Cooper EEK, Cortese S, Cruz-Martins N, da Silva AG, Dadras O, Dai X, Dai Z, Dalton BE, Damiani G, Dandona L, Dandona R, Das JK, Das S, Das S, Dash NR, Davletov K, De la Hoz FP, De Leo D, Debopadhaya S, Delgado-Enciso I, Denova-Gutiérrez E, Dervenis N, Desai HD, Devanbu VGC, Dewan SMR, Dhama K, Dhane AS, Dhingra S, Dias da Silva D, Diaz D, Diaz LA, Diaz MJ, Dima A, Ding DD, Do THP, do Prado CB, Dodangeh M, Dodangeh M, Doegah PT, Dohare S, Dong W, D'Oria M, Doshi R, Dowou RK, Dsouza HL, Dsouza V, Dube J, Dumith SC, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dushpanova A, Dutta S, Dzianach PA, Dziedzic AM, Eboreime E, Ebrahimi A, Ebrahimi Kalan M, Edinur HA, Efendi F, Eikemo TA, Eini E, Ekundayo TC, El Arab RA, El Sayed I, Elamin O, Elemam NM, ElGohary GMT, Elhadi M, Elmeligy OAA, Elmoselhi AB, Elshaer M, Elsohaby I, Eltahir ME, Emeto TI, Eshrati B, Eslami M, Esmaeili Z, Fabin N, Fagbamigbe AF, Fagbule OF, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faro A, Fasihi K, Fatehizadeh A, Fauk NK, Fazylov T, Feigin VL, Fekadu G, Feng X, Fereshtehnejad SM, Ferrara P, Ferreira N, Firew BS, Fischer F, Fitriana I, Flavel J, Flor LS, Folayan MO, Foley KM, Fonzo M, Force LM, Foschi M, Freitas A, Fridayani NKY, Fukutaki KG, Furtado JM, Fux B, Gaal PA, Gadanya MA, Gallus S, Ganesan B, Ganiyani MA, Gautam RK, Gebi TG, Gebregergis MW, Gebrehiwot M, Getacher L, Getahun GKA, Gething PW, Ghadimi DJ, Ghadirian F, Ghafarian S, Ghailan KY, Ghasemi M, Ghasempour Dabaghi G, Ghazy RM, Ghoba S, Gholami E, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Ghorbani Vajargah P, Ghotbi E, Gil AU, Gill TK, Girmay A, Glasbey JC, Glushkova EV, Gnedovskaya EV, Göbölös L, Goldust M, Goleij P, Golinelli D, Gopalani SV, Goulart AC, Gouravani M, Goyal A, Grivna M, Grosso G, Guarducci G, Gubari MIM, Guicciardi S, Guimarães RA, Gulati S, Gulisashvili D, Gunawardane DA, Guo C, Gupta AK, Gupta R, Gupta R, Gupta R, Gupta S, Gupta VK, Haakenstad A, Hadi NR, Haep N, Hafiz A, Haghmorad D, Haile D, Hajj Ali A, Hajj Ali A, Haj-Mirzaian A, Halboub ES, Haller S, Halwani R, Hamagharib Abdullah K, Hamdy NM, Hamoudi R, Hanifi N, Hankey GJ, Haq ZA, Haque MR, Harapan H, Hargono A, Haro JM, Hasaballah AI, Hasan SMM, Hasanian M, Hasnain MS, Hassan A, Haubold J, Hay SI, Hebert JJ, Hegazi OE, Heidari M, Hemmati M, Henson CA, Herrera-Serna BY, Herteliu C, Heydari M, Hezam K, Hidayana I, Hiraike Y, Hoan NQ, Holla R, Hoogar P, Horita N, Hossain MM, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hu C, Huang J, Hultström M, Hundie TG, Hunt AJ, Hushmandi K, Hussain J, Hussain MA, Hussein NR, Huynh HH, Hwang BF, Ibitoye SE, Iftikhar PM, Ikiroma AI, Ikwegbue PC, Ilic IM, Ilic MD, Immurana M, Isa MA, Islam MR, Islam SMS, Ismail F, Ismail NE, Isola G, Iwagami M, Iyamu IO, Jacob L, Jacobsen KH, Jafarinia M, Jahankhani K, Jahanmehr N, Jain N, Jairoun AA, Jakhmola Mani DR, Jamil S, Jamora RDG, Jatau AI, Javadov S, Javaheri T, Jayaram S, Jee SH, Jeganathan J, Jiang H, Jokar M, Jonas JB, Joseph N, Joshua CE, Jürisson M, K V, Kabir A, Kabir Z, Kadashetti V, Kalankesh LR, Kalra S, Kamath A, Kamath R, Kamireddy A, Kanaan M, Kanchan T, Kanmiki EW, Kanmodi KK, Kansal SK, Karim A, Karkhah S, Kashoo FZ, Kasraei H, Kassel MB, Katikireddi SV, Kauppila JH, Kaur H, Kayode GA, Kazemi F, Kazemian S, Kebede F, Kendal ES, Kesse-Guyot E, Khademvatan S, Khajuria H, Khalaji A, Khalid A, Khalid N, Khalilian A, Khamesipour F, Khan F, Khan MJ, Khan MAB, Khanmohammadi S, Khatab K, Khatatbeh H, Khatatbeh MM, Khatib MN, Khayat Kashani HR, Kheirallah KA, Khokhar M, Khormali M, Khorrami Z, Khosla AA, Khosravi M, Khosrowjerdi M, Khubchandani J, Kifle ZD, Kim G, Kim JS, Kim MS, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Knibbs LD, Knudsen AKS, Kochhar S, Kolahi AA, Kompani F, Koren G, Korzh O, Krishan K, Krishna V, Krishnamoorthy V, Kucuk Bicer B, Kuddus MA, Kuddus M, Kuitunen I, Kujan O, Kulimbet M, Kulkarni V, Kumar GA, Kumar H, Kumar N, Kumar R, Kumar V, Kundu A, Kusuma D, Kyei-Arthur F, Kytö V, Kyu HH, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lahariya C, Lai DTC, Lalloo R, Lallukka T, Lám J, Lan Q, Lan T, Landires I, Lanfranchi F, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lauriola P, Lawlor HR, Le HH, Le LKD, Le NHH, Le TTT, Le TDT, Leasher JL, Lee DW, Lee M, Lee PH, Lee SW, Lee SW, Lee SWH, Lee YH, Leigh J, Leong E, Li MC, Libra M, Ligade VS, Lim LL, Lim SS, Limenh LW, Lindholm D, Lindstedt PA, Listl S, Liu G, Liu S, Liu S, Liu X, Liu X, Llanaj E, López-Bueno R, López-Gil JF, Loreche AM, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Luo L, Lusk JB, Lv L, M Amin HI, Ma ZF, Maass KL, Machairas N, Machoy M, Madureira-Carvalho ÁM, Magdy Abd El Razek H, Maghazachi AA, Mahadeshwara Prasad D, Mahalleh M, Mahasha PW, Mahmoud MA, Mahmoudi E, Mahmoudvand G, Makama M, Malakan Rad E, Malhotra K, Malik AA, Malta DC, Manla Y, Mansour A, Mansouri MH, Mansouri P, Mansouri V, Mansourian M, Mansournia MA, Marasini BP, Marateb HR, Maravilla JC, Mardi P, Marjani A, Markazi Moghadam H, Marrugo Arnedo CA, Martinez G, Martinez-Piedra R, Martins-Melo FR, Martorell M, Marx W, Marzo RR, Masoudi S, Mathangasinghe Y, Mathioudakis AG, Mathur M, Mathur N, Mathur N, Matozinhos FP, Mattumpuram J, Maude RJ, Maugeri A, Mayeli M, Mazidi M, Mazzotti A, McGrath JJ, McKee M, McKowen ALW, McPhail MA, McPhail SM, Mehmood A, Mehrabani-Zeinabad K, Mehravar S, Mekene Meto T, Melese EB, Mendez-Lopez MAM, Mendoza W, Menezes RG, Mensah GA, Mensah LG, Mentis AFA, Meo SA, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Mettananda KCD, Mettananda S, Mhlanga A, Mhlanga L, Miazgowski T, Michalek IM, Micheletti Gomide Nogueira de Sá AC, Miller TR, Minh LHN, Mirahmadi A, Mirijello A, Mirrakhimov EM, Mirzaei R, Mitchell PB, Mittal C, Moberg ME, Moghadam Fard A, Mohajelin S, Mohamadkhani A, Mohamed AI, Mohamed J, Mohamed MFH, Mohamed NS, Mohammad AM, Mohammadi S, Mohammed H, Mohammed M, Mohammed S, Mokdad AH, Molokhia M, Momani SM, Momtazmanesh S, Monasta L, Mondello S, Moni MA, Montazeri F, Moodi Ghalibaf A, Moradi M, Moradi Y, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Mosapour A, Mosser JF, Mossialos E, Motappa R, Mougin V, Mousavi P, Mrejen M, Mubarik S, Mueller UO, Mulita F, Munjal K, Murillo-Zamora E, Musallam KM, Musina AM, Mustafa G, Myung W, Nafei A, Nagarajan AJ, Naghavi P, Naik GR, Naik G, Nainu F, Najdaghi S, Nakhostin Ansari N, Nangia V, Narasimha Swamy S, Nargus S, Narimani Davani D, Nascimento BR, Nascimento GG, Naser AY, Nashwan AJ, Natto ZS, Nauman J, Navaratna SNK, Naveed M, Nawsherwan, Nayak BP, Nayak VC, Negash H, Negoi I, Negoi RI, Nejadghaderi SA, Nejjari C, Nematollahi S, Netsere HB, Ng M, Nguefack-Tsague G, Ngunjiri JW, Nguyen AH, Nguyen DH, Nguyen DH, Nguyen HTH, Nguyen N, Nguyen NNY, Nguyen PT, Nguyen QP, Nguyen VT, Nguyen Tran Minh D, Niazi RK, Nigatu YT, Niknam M, Nikoobar A, Nikpoor AR, Nikravangolsefid N, Noman EA, Nomura S, Noor STA, Noroozi N, Nouri M, Nozari M, Nri-Ezedi CA, Ntaios G, Nunemo MH, Nurrika D, Nutor JJ, Nzoputam CI, Nzoputam OJ, Oancea B, Obamiro KO, Odetokun IA, Oduro MS, Ogundijo OA, Ogunfowokan AA, Ogunkoya A, Oguntade AS, Oh IH, Ojo-Akosile TR, Okati-Aliabad H, Okekunle AP, Okonji OC, Olagunju AT, Olatubi MI, Oliveira GMM, Olusanya BO, Olusanya JO, Oluwafemi YD, Omar HA, Omer GL, Ong S, Onie S, Onwujekwe OE, Opejin AO, Ordak M, Orish VN, Ortiz A, Ortiz-Prado E, Osman WMS, Ostojic SM, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov SS, Ouyahia A, Owolabi MO, Oyeyemi OT, Ozair A, P A MP, Padron-Monedero A, Padubidri JR, Pal PK, Palicz T, Pan F, Pan HF, Panda-Jonas S, Pandey A, Pando-Robles V, Pangaribuan HU, Panos GD, Panos LD, Pantazopoulos I, Pantea Stoian AM, Parikh RR, Park EK, Park S, Park S, Parsons N, Parthasarathi A, Pasovic M, Passera R, Patel J, Pathan AR, Patil S, Patoulias D, Pawar S, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Pensato U, Pepito VCF, Peprah P, Pereira M, Pereira MO, Perianayagam A, Perico N, Perna S, Pesudovs K, Petermann-Rocha FE, Pham HT, Philip AK, Phillips MR, Pigeolet M, Piradov MA, Pisoni E, Plotnikov E, Poddighe D, Polibin RV, Poluru R, Ponkilainen VT, Popovic DS, Postma MJ, Pour-Rashidi A, Prabhu D, Prada SI, Pradhan J, Pradhan PMS, Prashant A, Prates EJS, Priscilla T, Purnobasuki H, Purohit BM, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Rabiee Rad M, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Raggi A, Raggi C, Raheem N, Rahim F, Rahim MJ, Rahimibarghani S, Rahman MMMR, Rahman M, Rahman MA, Rahman T, Rahmani AM, Rahmanian M, Rahmanian N, Rahmati R, Rahmawaty S, Raimondo D, Raja A, Rajput P, Ramadan M, Ramasamy SK, Ramazanu S, Ramteke PW, Rana K, Rana RK, Ranabhat CL, Rane A, Rao CR, Rao M, Rasella D, Rashedi V, Rashid AM, Rasouli-Saravani A, Rastogi P, Rasul A, Rathish D, Rathnaiah Babu G, Rauniyar SK, Ravangard R, Rawaf DL, Rawaf S, Raza RZ, Redwan EMM, Reifels L, Reitsma MB, Remuzzi G, Rengasamy KRR, Reshmi B, Resnikoff S, Restaino S, Reyes LF, Rezaei N, Rezaei N, Rezaei ZS, Rezaeian M, Rhee TG, Rickard J, Robalik T, Robinson-Oden HE, Rocha HAL, Rodrigues M, Rodriguez JAB, Roever L, Romadlon DS, Ronfani L, Rony MKK, Roshandel G, Rotimi K, Rout HS, Roy B, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, Russo M, Saad AMA, Saber K, Saber-Ayad MM, Sabet CJ, Sabour S, Sachdev PS, Saddler A, Sadee BA, Sadeghi M, Saeb MR, Saeed U, Safi SZ, Sagar R, Saghafi A, Sagoe D, Sahebkar A, Sahoo PM, Sajid MR, Salam N, Salamati P, Salami AA, Saleh MA, Salehi L, Salem MR, Salemcity AJ, Salimi S, Samadi Kafil H, Samargandy S, Samodra YL, Samy AM, Sanabria J, Sanna F, Santric-Milicevic MM, Sao Jose BP, Saraswathy SYI, Saravanan A, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sartorius B, Satpathy M, Sayeed A, Scarmeas N, Schaarschmidt BM, Schinckus C, Schuermans A, Schumacher AE, Schutte AE, Schwebel DC, Schwendicke F, Selvaraj S, Semreen MH, Senapati S, Sengupta P, Senthilkumaran S, Serban D, Sethi Y, Seylani A, Shafie M, Shah PA, Shahbandi A, Shahid S, Shahid W, Shahsavari HR, Shahwan MJ, Shaikh MA, Shalash AS, Shamekh A, Shamim MA, Shanawaz M, Shankar A, Shannawaz M, Sharath M, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma A, Sharma M, Sharma S, Sharma V, Shastry RP, Shayan M, Shekhar S, Shenoy RR, Shetty M, Shetty PH, Shetty PK, Shi P, Shiani A, Shigematsu M, Shimels T, Shiri R, Shittu A, Shiue I, Shivakumar KM, Shool S, Shorofi SA, Shrestha S, Shuval K, Si Y, Siddig EE, Sidhu JK, Silva JP, Silva LMLR, Silva S, Silva TPR, Simpson CR, Simpson KE, Singh A, Singh BB, Singh B, Singh H, Singh J, Singh P, Singh P, Skou ST, Smith G, Sobia F, Socea B, Solanki S, Soleimani H, Soliman SSM, Song Y, Soyiri IN, Spartalis M, Spearman S, Sreeramareddy CT, Stanaway JD, Stanikzai MH, Starodubova AV, Stein DJ, Steiner C, Steiropoulos P, Stockfelt L, Stokes MA, Straif K, Subedi N, Suliankatchi Abdulkader R, Sultana A, Sun J, Sundström J, Swain CK, Szarpak L, Szeto MD, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabche C, Tabish M, Taheri Abkenar Y, Taheri Soodejani M, Taiba J, Talaat IM, Tamuzi JL, Tan KK, Tang H, Tat NY, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tbakhi A, Tehrani H, Temsah MH, Teramoto M, Tesfaye BT, Teye-Kwadjo E, Thangaraju P, Thankappan KR, Thapar R, Thayakaran R, Thirunavukkarasu S, Thomas N, Thygesen LC, Ticoalu JHV, Timalsena D, Tiruye TY, Tiwari K, Tomo S, Tonelli M, Topor-Madry R, Touvier M, Tovani-Palone MR, Tran AT, Tran JT, Tran NM, Tran TH, Trico D, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsermpini EE, Tumurkhuu M, Turnock ST, Udoh A, Ullah A, Ullah S, Ullah S, Umakanthan S, Umar M, Umar SS, Unim B, Unnikrishnan B, Upadhyay E, Usman JS, Vahdati S, Vaithinathan AG, Vakili O, Valizadeh R, Van den Eynde J, Vart P, Varthya SB, Vasankari TJ, Vasic M, Venketasubramanian N, Veroux M, Verras GI, Vervoort D, Vijayageetha M, Villafañe JH, Vinayak M, Violante FS, Vladimirov SK, Vlassov V, Vo B, Vohra K, Vos T, Wadood AW, Waheed Y, Wang F, Wang S, Wang S, Wang Y, Wang Y, Wang YP, Wanjau MN, Waqas M, Ward P, Waris A, Wassie EG, Watson S, Weaver MR, Weerakoon KG, Weintraub RG, Weldetinsaa HLL, Wells KM, Wen YF, Westerman R, Wiangkham T, Wickramasinghe DP, Widowati E, Wojewodzic MW, Woldeyes DH, Wolf AW, Wolfe CDA, Wu C, Wu D, Wu F, Wu J, Wu Z, Wulf Hanson S, Xiao H, Xu S, Yadav R, Yamagishi K, Yang D, Yano Y, Yarahmadi A, Yazdani Nia I, Ye P, Yesodharan R, Yesuf SA, Yezli S, Yiğit A, Yiğit V, Yigzaw ZA, Yin D, Yip P, Yonemoto N, You Y, Younis MZ, Yu C, Yu EA, Yu Y, Yuan CW, Yusuf H, Zafar U, Zafari N, Zahid MH, Zakham F, Zaki N, Zerfu TA, Zhang H, Zhang J, Zhang L, Zhang Y, Zhang Z, Zhao XJG, Zhao Y, Zhao Z, Zhong C, Zhou B, Zhou J, Zhou S, Zhu B, Zhumagaliuly A, Zielińska M, Zoghi G, Zumla A, Zyoud SH, Zyoud SH, Smith AE, Murray CJL. Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2204-2256. [PMID: 38762325 DOI: 10.1016/s0140-6736(24)00685-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. METHODS Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. FINDINGS In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8-63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0-45·0] in 2050) and south Asia (31·7% [29·2-34·1] to 15·5% [13·7-17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4-40·3) to 41·1% (33·9-48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6-25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5-43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5-17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7-11·3) in the high-income super-region to 23·9% (20·7-27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5-6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2-26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [-0·6 to 3·6]). INTERPRETATION Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions. FUNDING Bill & Melinda Gates Foundation.
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Bhattacharjee NV, Schumacher AE, Aali A, Abate YH, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abd-Elsalam S, Abdollahi M, Abdollahifar MA, Abdoun M, Abdullahi A, Abebe M, Abebe SS, Abiodun O, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abrigo MRM, Abtahi D, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Adal TGG, Adane MM, Adeagbo OAA, Adedoyin RA, Adekanmbi V, Aden B, Adepoju AV, Adetokunboh OO, Adetunji JB, Adeyinka DA, Adeyomoye OI, Adnani QES, Adra S, Afolabi RF, Afyouni S, Afzal MS, Afzal S, Aghamiri S, Agodi A, Agyemang-Duah W, Ahinkorah BO, Ahlstrom AJ, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad T, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed SA, Ajami M, Aji B, Akalu GT, Akbarialiabad H, Akinyemi RO, Akkaif MA, Akkala S, Al Hamad H, Al Hasan SM, Al Qadire M, AL-Ahdal TMA, Alalalmeh SO, Alalwan TA, Al-Aly Z, Alam K, Al-amer RM, Alanezi FM, Alanzi TM, Albakri A, Albashtawy M, AlBataineh MT, Alemi H, Alemi S, Alemu YM, Al-Eyadhy A, Al-Gheethi AAS, Alhabib KF, Alhajri N, Alhalaiqa FAN, Alhassan RK, Ali A, Ali BA, Ali L, Ali MU, Ali R, Ali SSS, Alif SM, Aligol M, Alijanzadeh M, Aljasir MAM, Aljunid SM, Al-Marwani S, Almazan JU, Al-Mekhlafi HM, Almidani O, Alomari MA, Al-Omari B, Alqahtani JS, Alqutaibi AY, Al-Raddadi RM, Al-Sabah SK, Altaf A, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvi FJ, Alvis-Guzman N, Alwafi H, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Ameyaw EK, Amin TT, Amindarolzarbi A, Amini-Rarani M, Amiri S, Ampomah IG, Amugsi DA, Amusa GA, Ancuceanu R, Anderlini D, Andrade PP, Andrei CL, Andrei T, Anil A, Anil S, Ansar A, Ansari-Moghaddam A, Antony CM, Antriyandarti E, Anvari S, ANWAR SALEHA, Anwer R, Anyasodor AE, Arabloo J, Arabzadeh Bahri R, Arafa EA, Arafat M, Araújo AM, Aravkin AY, Aremu A, Aripov T, Arkew M, Armocida B, Ärnlöv J, Arooj M, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Asadi-Lari M, Asemi Z, Asgary S, Asghariahmadabad M, Asghari-Jafarabadi M, Ashemo MY, Ashraf M, Ashraf T, Asika MO, Athari SS, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Aweke AM, Ayele GM, Ayyoubzadeh SM, Azadnajafabad S, Azevedo RMS, Azzam AY, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bagherieh S, Bahmanziari N, Bai R, Baig AA, Baker JL, Bako AT, Bakshi RK, Balasubramanian M, Baltatu OC, Bam K, Banach M, Bandyopadhyay S, Banik B, Banik PC, Bansal H, Baran MF, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barone-Adesi F, Barqawi HJ, Barrow A, Barteit S, Basharat Z, Bashir AIJ, Bashiru HA, Basiru A, Basso JD, Basu S, Batiha AMM, Batra K, Baune BT, Bayati M, Begum T, Behboudi E, Behnoush AH, Beiranvand M, Bejarano Ramirez DF, Bekele A, Belay SA, Belgaumi UI, Bell ML, Bello OO, Beloukas A, Bensenor IM, Berezvai Z, Berhie AY, Bermudez ANC, Bettencourt PJG, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhardwaj PV, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Biondi A, Bisignano C, Biswas A, Biswas RK, Bitra VR, Bjørge T, Bliss E, Boachie MK, Bobirca AV, Bodolica V, Bodunrin AO, Bogale EK, Bogale KA, Bonakdar Hashemi M, Bora Basara B, Bouaoud S, Braithwaite D, Brauer M, Breitborde NJK, Bryazka D, Bulamu NB, Buonsenso D, Burkart K, Burns RA, Bustanji Y, Butt NS, Butt ZA, Caetano dos Santos FL, Calina D, Campos-Nonato IR, Cao F, Cao S, Capodici A, Carreras G, Carugno A, Castañeda-Orjuela CA, Castelpietra G, Cattaruzza MS, Caye A, Cegolon L, Cembranel F, Cerin E, Chadwick J, Chahine Y, Chakraborty C, Chalek J, Chan JSK, Charalampous P, Chattu VK, Chaturvedi S, Chavula MP, Chen AT, Chen H, Chen S, Chi G, Chichagi F, Chien JH, Ching PR, Cho WCS, Choi S, Chong B, Chopra H, Choudhari SG, Christopher DJ, Chu DT, Chukwu IS, Chung E, Chung SC, Cindi Z, Cioffi I, Ciuffreda R, Claro RM, Coberly K, Columbus A, Comfort H, Conde J, Criqui MH, Cruz-Martins N, Cuadra-Hernández SM, Dadana S, Dadras O, Dahiru T, Dai Z, Dalton B, Damiani G, Darwesh AM, Das JK, Das S, Dashti M, Dastiridou A, Dávila-Cervantes CA, Davletov K, Debele AT, Debopadhaya S, Delavari S, Delgado-Enciso I, Demeke D, Demessa BH, Deng X, Denova-Gutiérrez E, Deribe K, Dervenis N, Desai HD, Desai R, Devanbu VGC, Dhali A, Dhama K, Dhimal M, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Dirac MA, Do TC, Do THP, do Prado CB, Dohare S, Dong W, D'Oria M, dos Santos WM, Doshmangir L, Dowou RK, Dsouza AC, Dsouza HL, Dsouza V, Dube J, Duprey J, Duraes AR, Duraisamy S, Durojaiye OC, Dutta S, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, Ebrahimi A, Edinur HA, Edvardsson K, Efendi F, Eikemo TA, Ekholuenetale M, El Tantawi M, Elemam NM, ElGohary GMT, Elhadi M, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emami Zeydi A, Engelbert Bain L, Eskandarieh S, Esposito F, Estep K, Etaee F, Fabin N, Fagbamigbe AF, Fahimi S, Fakhri-Demeshghieh A, Falzone L, Faramarzi A, Faris MEM, Farmer S, Faro A, Fasanmi AO, Fatehizadeh A, Fauk NK, Fazeli P, Feigin VL, Fereshtehnejad SM, Feroze AH, Ferrara P, Ferreira N, Fetensa G, Filip I, Fischer F, Flavel J, Foigt NA, Folayan MO, Fomenkov AA, Foroutan B, Foschi M, Fowobaje KR, Francis KL, Freitas A, Fukumoto T, Fuller JE, Fux B, Gaal PA, Gadanya MA, Gaidhane AM, Galali Y, Gallus S, Gandhi AP, Ganesan B, Ganiyani MA, Garcia-Gordillo M, Garg N, Gautam RK, Gazzelloni F, Gbadamosi SO, Gebregergis MW, Gebrehiwot M, Gebremariam TB, Gebremariam TBB, Gebremeskel TG, Geda YF, Georgescu SR, Gerema U, Geremew H, Getachew ME, Gething PW, Ghasemi M, Ghasempour Dabaghi G, Ghasemzadeh A, Ghassemi F, Ghazy RM, Ghimire S, Gholamian A, Gholamrezanezhad A, Ghorbani M, Ghoshal AG, Ghuge AD, Gil AU, Gill TK, Giorgi M, Girmay A, Glasbey JC, Göbölös L, Goel A, Golchin A, Golechha M, Goleij P, Gopalani SV, Goudarzi H, Goulart AC, Goyal A, Graham SM, Grivna M, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guicciardi S, Gulati S, Gulisashvili D, Gunawardane DA, Guo C, Gupta AK, Gupta B, Gupta MK, Gupta M, Gupta S, Gupta VB, Gupta VK, Gupta VK, Haakenstad A, Habibzadeh F, Hadi NR, Haep N, Hajibeygi R, Haller S, Halwani R, Hamadeh RR, Hamdy NM, Hameed S, Hamidi S, Han Q, Handal AJ, Hankey GJ, Haque MN, Haro JM, Hasaballah AI, Hasan I, Hasan MJ, Hasan SM, Hasani H, Hasnain MS, Hassan A, Hassan I, Hassanipour S, Hassankhani H, Hay SI, Hebert JJ, Hegazi OE, Heidari M, Helfer B, Hemmati M, Herrera-Serna BY, Herteliu C, Hessami K, Hezam K, Hiraike Y, Hoan NQ, Holla R, Horita N, Hossain MM, Hossain MBH, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hsairi M, Hsieh VCR, Hu C, Huang J, Huda MM, Humayun A, Hussain J, Hussein NR, Huynh HH, Hwang BF, Ibitoye SE, Iftikhar PM, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Inbaraj LR, Iqbal A, Islam MR, Ismail NE, Iso H, Isola G, Iwagami M, Iyer M, J LM, Jaafari J, Jacob L, Jadidi-Niaragh F, Jaggi K, Jahankhani K, Jahanmehr N, Jahrami H, Jain A, Jain N, Jairoun AA, Jakovljevic M, Jamshidi E, Javadov S, Javaheri T, Jayapal SK, Jayaram S, Jee SH, Jeganathan J, Jha AK, Jha RP, Jiang H, Jokar M, Jonas JB, Joo T, Joseph N, Joshua CE, Joukar F, Jozwiak JJ, Jürisson M, K V, Kaambwa B, Kabir A, Kabir A, Kabir H, Kabir Z, Kalani R, Kalankesh LR, Kaliyadan F, Kalra S, Kamath R, Kamath S, Kanchan T, Kanmiki EW, Kanmodi KK, Kannan S S, Kansal SK, Kantar RS, Kapoor N, Karajizadeh M, Karami M, Karaye IM, Kashoo FZ, Kasraei H, Kassebaum NJ, Kassel MB, Kauppila JH, Kazemi F, Kazeminia S, Kempen JH, Kendal ES, Keshtkar K, Keykhaei M, Khajuria H, Khalaji A, Khalid N, Khalil AA, Khalilian A, Khamesipour F, Khan A, Khan A, Khan I, Khan MN, Khan M, Khan MJ, Khan MAB, Khang YH, Khanmohammadi S, Khatab K, Khavandegar A, Khayat Kashani HR, Khidri FF, Khormali M, Khosravi MA, Khosrowjerdi M, Kidane WT, Kifle ZD, Kim JS, Kim MS, Kimokoti RW, Kinzel KE, Kiross GT, Kisa A, Kisa S, Kolahi AA, Kompani F, Koren G, Korzh O, Kosen S, Koulmane Laxminarayana SL, Krishan K, Krishna V, Krishnamoorthy V, Kuate Defo B, Kubeisy CM, Kucuk Bicer B, Kuddus MA, Kuddus M, Kuitunen I, Kulimbet M, Kumar H, Kundu S, Kunle KR, Kurmi OP, Kusnali A, Kusuma D, Kyei EF, Kyriopoulos I, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lahariya C, Lai DTC, Lal DK, Lalloo R, Lám J, Lamnisos D, Landires I, Lanfranchi F, Langguth B, Laplante-Lévesque A, Larson HJ, Larsson AO, Lasrado S, Latief K, Latifinaibin K, Le LKD, Le NHH, Le TDT, Ledda C, Lee M, Lee PH, Lee SW, Lee YH, Lema GK, Leong E, Lerango TL, Li A, Li MC, Li S, Li W, Li X, Ligade VS, Lim SS, Lin RT, Lindstedt PA, Listl S, Liu G, Liu J, Liu X, Liu X, Liu Y, Llanaj E, López-Bueno R, Lopukhov PD, Lorenzovici L, Lotufo PA, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Lv H, Ma ZF, Maass KL, Machoy M, Madureira-Carvalho ÁM, Magdy Abd El Razek M, Maghazachi AA, Mahjoub S, Mahmoud MA, Majeed A, Malagón-Rojas JN, Malakan Rad E, Malhotra K, Malik AA, Malik I, Malta DC, Mamun AA, Manla Y, Mansoori Y, Mansour A, Mansouri B, Mansouri Z, Mansournia MA, Maravilla JC, Marino M, Marjani A, Martinez G, Martinez-Piedra R, Martins-Melo FR, Martorell M, Maryam S, Marzo RR, Masoudi A, Mattumpuram J, Maude RJ, Maugeri A, May EA, Mayeli M, Mazaheri M, McGrath JJ, McKee M, McKowen ALW, McLaughlin SA, McPhail SM, Mehra R, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mekene Meto T, Mendez-Lopez MAM, Mendoza W, Menezes RG, Mensah GA, Mentis AFA, Meo SA, Merati M, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Metanat P, Mettananda KCD, Mettananda S, Mhlanga A, Mhlanga L, Mi T, Miazgowski T, Micha G, Michalek IM, Miller TR, Minh LHN, Mirghafourvand M, Mirrakhimov EM, Mirutse MK, Mirza M, Mirzaei R, Mishra A, Misra S, Mitchell PB, Mittal C, Moazen B, Mohamed AZ, Mohamed AI, Mohamed J, Mohamed MFH, Mohamed NS, Mohammad-Alizadeh-Charandabi S, Mohammadi S, Mohammadian-Hafshejani A, Mohammed M, Mohammed S, Mohammed S, Mokdad AH, Mokhtarzadehazar P, Molavi Vardanjani H, Molinaro S, Monasta L, Moni MA, Moradi M, Moradi Y, Moraga P, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosapour A, Mossialos E, Motappa R, Mousavi P, Mousavi Khaneghah A, Mpundu-Kaambwa C, Mubarik S, Muccioli L, Mulita F, Munjal K, Murillo-Zamora E, Musa J, Musaigwa F, Musina AM, Muthu S, Muthupandian S, Muzaffar M, Myung W, Nagarajan AJ, Nagel G, Naghavi P, Naik GR, Naik G, Naimzada MD, Nainu F, Nangia V, Narasimha Swamy S, Nascimento BR, Nascimento GG, Naser AY, Nasiri MJ, Natto ZS, Nauman J, Naveed M, Nayak BP, Nayak VC, Ndejjo R, Nduaguba SO, Negash H, Negesse CT, Negoi I, Negoi RI, Nejadghaderi SA, Nejjari C, Nepal S, Netsere HB, Nguefack-Tsague G, Ngunjiri JW, Nguyen DH, Nguyen HTH, Nguyen PT, Nguyen QP, Nguyen VT, Niazi RK, Nigatu YT, Nikolouzakis TK, Nikoobar A, Nikpoor AR, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Noreen M, Noroozi N, Nri-Ezedi CA, Nunemo MH, Nuñez-Samudio V, Nurrika D, Nutor JJ, Oancea B, Obamiro KO, Odetokun IA, Odogwu NM, O'Donnell MJ, Odukoya OO, Oguntade AS, Oguta JO, Oh IH, Okeke SR, Okekunle AP, Okonji OC, Okwute PG, Olagunju AT, Olasupo OO, Olatubi MI, Oliveira GMM, Olusanya BO, Olusanya JO, Oluwatunase GO, Omar HA, Omer GL, Onwujekwe OE, Ordak M, Orisakwe OE, Orish VN, Ortega-Altamirano DV, Ortiz A, Ortiz-Prado E, Osman WMS, Osuagwu UL, Osuolale O, Otoiu A, Otstavnov SS, Ouyahia A, Ouyang G, Owolabi MO, Ozten Y, P A MP, Pahlevan Fallahy MT, Pan F, Pan HF, Pana A, Panda P, Panda-Jonas S, Pangaribuan HU, Panos GD, Panos LD, Pantazopoulos I, Pantea Stoian AM, Parikh RR, Park S, Parthasarathi A, Pashaei A, Passera R, Patel HM, Patel J, Patil S, Patoulias D, Patthipati VS, Paudel U, Paun M, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Peng M, Pensato U, Pepito VCF, Peprah P, Pereira G, Peres MFP, Perianayagam A, Perico N, Perna S, Pestell RG, Petermann-Rocha FE, Pham HT, Philip AK, Pierannunzio D, Pigeolet M, Pigott DM, Plotnikov E, Poddighe D, Pollner P, Poluru R, Postma MJ, Pourali G, Pourshams A, Pourtaheri N, Prabhu D, Prada SI, Pradhan PMS, Prasad M, Prashant A, Purohit BM, Puvvula J, Qasim NH, Qattea I, R D, Rabiee Rad M, Radfar A, Radhakrishnan V, Raee P, Raeisi Shahraki H, Rafiei A, Rafiei Alavi SN, Raggi C, Raghav PR, Rahim F, Rahim MJ, Rahman MM, Rahman MHU, Rahman M, Rahman MA, Rahmanian V, Rahmati M, Rahnavard N, Rai P, Raimondo D, Rajabpour-Sanati A, Rajput P, Ram P, Ramasamy SK, Rana J, Rana K, Rana SS, Ranabhat CL, Rancic N, Rane A, Ranjan S, Rao CR, Rao IR, Rapaka D, Rasella D, Rashedi S, Rashedi V, Rashidi MM, Rasul A, Ratan ZA, Rathnaiah Babu G, Rauniyar SK, Ravikumar N, Rawaf DL, Rawaf S, Rawassizadeh R, Rawlley B, Reddy MMRK, Redwan EMM, Remuzzi G, Reshmi B, Rezaei N, Rezaei Nejad A, Rezaeian M, Riad A, Riaz MA, Rickard J, Rikhtegar R, Robinson-Oden HE, Rodrigues CF, Rodriguez JAB, Rohilla R, Romadlon DS, Ronfani L, Rout HS, Roy B, Roy N, Roy P, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, S M, S N C, Saad AMA, Saadatian Z, Saber-Ayad MM, SaberiKamarposhti M, Sabour S, Sada F, Saddik B, Sadee BA, Sadeghi E, Sadeghi E, Saeb MR, Saeed U, Safi SZ, Sagoe D, Saha M, Sahebkar A, Sahoo SS, Sahu M, Saif Z, Sakshaug JW, Salamati P, Salami AA, Saleh MA, Salem MR, Salem MZY, Salimi S, Samadzadeh S, Samodra YL, Samuel VP, Samy AM, Sanabria J, Sanadgol N, Sanna F, Santric-Milicevic MM, Saqib H, Saraswathy SYI, Saravanan A, Saravi B, Sarikhani Y, Sarkar T, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Sathyanarayan A, Sayeed A, Sayeed MA, Scarmeas N, Schlee W, Schuermans A, Schwebel DC, Schwendicke F, Selvaraj S, Sengupta P, Senthilkumaran S, Sepanlou SG, Serban D, Serván-Mori E, Sethi Y, SeyedAlinaghi S, Seyedi SA, Seylani A, Shafie M, Shah J, Shah PA, Shahbandi A, Shahid S, Shahwan MJ, Shaikh A, Shaikh MA, Shamim MA, Shams-Beyranvand M, Shamsi MA, Shanawaz M, Shankar A, Shannawaz M, Sharath M, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma M, Sharma R, Sharma U, Sharma V, Shastry RP, Shavandi A, Shaw DH, Shayan AM, Shayan M, Shehabeldine AME, Sheikh A, Sheikhi RA, Shenoy MM, Shetty PH, Shi P, Shiferaw D, Shigematsu M, Shiri R, Shirkoohi R, Shittu A, Shivarov V, Shokraneh F, Shool S, Shorofi SA, Shuja KH, Shuval K, Siddig EE, Silva JP, Silva LMLR, Silva S, Simonetti B, Singal A, Singh A, Singh BB, Singh JA, Siraj MS, Smith G, Socea B, Sokhan A, Solanki R, Solanki S, Soleimani H, Soliman SSM, Solomon Y, Song Y, Sorensen RJD, Spartalis M, Sreeramareddy CT, Srivastava VK, Stanikzai MH, Starodubov VI, Starodubova AV, Stefan SC, Steiropoulos P, Stokes MA, Subramaniyan V, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Swain CK, Sykes BL, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabish M, Taheri Soodejani M, Taiba J, Tajbakhsh A, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tang H, Tareke DADA, Tariku MK, Tat VY, Tavangar SM, Teimoori M, Temsah MH, Temsah RMH, Teramoto M, Terefa DR, Tesler R, Teye-Kwadjo E, Thakur R, Thangaraju P, Thankappan KR, Thapar R, Tharwat S, Thayakaran R, Thomas N, Tichopad A, Ticoalu JHV, Tiruye TY, Titova MV, Tonelli M, Tovani-Palone MR, Traini E, Tran JT, Tran NM, Trihandini I, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsermpini EE, Tumurkhuu M, Tyrovolas S, Uddin SMN, Udoakang AJ, Udoh A, Ullah A, Ullah S, Ullah S, Umakanthan S, Umeokonkwo CD, Unim B, Unnikrishnan B, Upadhyay E, Usman JS, Vacante M, Vahabi SM, Vaithinathan AG, Valizadeh R, Van den Eynde J, Varavikova E, Varga O, Vart P, Varthya SB, Vasankari TJ, Vellingiri B, Venugopal D, Verghese NA, Verma M, Veroux M, Verras GI, Vervoort D, Villafañe JH, Vinayak M, Violante FS, Vishwakarma M, Vladimirov SK, Vlassov V, Vo B, Volovat SR, Vos T, Vujcic IS, Wafa HA, Waheed Y, Wakwoya EB, Wang C, Wang D, Wang F, Wang S, Wang Y, Wang YP, Ward P, Wassie EG, Watson S, Weaver MR, Weerakoon KG, Weiss DJ, Wells KM, Wen YF, Westerman R, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Willeit P, Wondimagegene YA, Wu F, Xia J, Xiao H, Xu G, Xu S, Xu X, Yadollahpour A, Yaghoobpoor S, Yaghoobpour T, Yaghoubi S, Yahaya ZS, Yang D, Yang L, Yano Y, Yaribeygi H, Ye P, Yesodharan R, Yesuf SA, Yezli S, Yigezu A, Yip P, Yon DK, Yonemoto N, You Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Yuan CW, Zafari N, Zakham F, Zaki N, Zamagni G, Zandi M, Zandieh GGZ, Zangiabadian M, Zastrozhin MS, Zhang H, Zhang M, Zhang Y, Zhong C, Zhou J, Zhu B, Zhu L, Zielińska M, Zou Z, Zyoud SH, Murray CJL, Smith AE, Vollset SE. Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2057-2099. [PMID: 38521087 DOI: 10.1016/s0140-6736(24)00550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/28/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. METHODS To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values-a metric assessing gain in forecasting accuracy-by comparing predicted versus observed ASFRs from the past 15 years (2007-21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. FINDINGS During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63-5·06) to 2·23 (2·09-2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137-147), declining to 129 million (121-138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1-canonically considered replacement-level fertility-in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7-29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59-2·08) in 2050 and 1·59 (1·25-1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6-43·1) in 2050 and 54·3% (47·1-59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions-decreasing, for example, in south Asia from 24·8% (23·7-25·8) in 2021 to 16·7% (14·3-19·1) in 2050 and 7·1% (4·4-10·1) in 2100-but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40-1·92) in 2050 and 1·62 (1·35-1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. INTERPRETATION Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. FUNDING Bill & Melinda Gates Foundation.
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Ferrari AJ, Santomauro DF, Aali A, Abate YH, Abbafati C, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdollahi A, Abdullahi A, Abegaz KH, Abeldaño Zuñiga RA, Aboagye RG, Abolhassani H, Abreu LG, Abualruz H, Abu-Gharbieh E, Abu-Rmeileh NME, Ackerman IN, Addo IY, Addolorato G, Adebiyi AO, Adepoju AV, Adewuyi HO, Afyouni S, Afzal S, Afzal S, Agodi A, Ahmad A, Ahmad D, Ahmad F, Ahmad S, Ahmed A, Ahmed LA, Ahmed MB, Ajami M, Akinosoglou K, Akkaif MA, Al Hasan SM, Alalalmeh SO, Al-Aly Z, Albashtawy M, Aldridge RW, Alemu MD, Alemu YM, Alene KA, Al-Gheethi AAS, Alharrasi M, Alhassan RK, Ali MU, Ali R, Ali SSS, Alif SM, Aljunid SM, Al-Marwani S, Almazan JU, Alomari MA, Al-Omari B, Altaany Z, Alvis-Guzman N, Alvis-Zakzuk NJ, Alwafi H, Al-Wardat MS, Al-Worafi YM, Aly S, Alzoubi KH, Amare AT, Amegbor PM, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amugsi DA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Ansari H, Antony CM, Anwar S, Anwar SL, Anwer R, Anyanwu PE, Arab JP, Arabloo J, Arafat M, Araki DT, Aravkin AY, Arkew M, Armocida B, Arndt MB, Arooj M, Artamonov AA, Aruleba RT, Arumugam A, Ashbaugh C, Ashemo MY, Ashraf M, Asika MO, Askari E, Astell-Burt T, Athari SS, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Awotidebe AW, Awuviry-Newton K, Ayala Quintanilla BP, Ayuso-Mateos JL, Azadnajafabad S, Azevedo RMS, Babu AS, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bah S, Bai R, Baker JL, Bakkannavar SM, Bako AT, Balakrishnan S, Bam K, Banik PC, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Barqawi HJ, Barrow A, Barteit S, Barua L, Bashiri Aliabadi S, Basiru A, Basu S, Basu S, Bathini PP, Batra K, Baune BT, Bayileyegn NS, Behnam B, Behnoush AH, Beiranvand M, Bejarano Ramirez DF, Bell ML, Bello OO, Beloukas A, Bensenor IM, Berezvai Z, Bernabe E, Bernstein RS, Bettencourt PJG, Bhagavathula AS, Bhala N, Bhandari D, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Bitra VR, Bjørge T, Bodolica V, Bodunrin AO, Bogale EK, Bonakdar Hashemi M, Bonny A, Bora Basara B, Borhany H, Boxe C, Brady OJ, Bragazzi NL, Braithwaite D, Brant LC, Brauer M, Breitner S, Brenner H, Brown J, Brugha T, Bulamu NB, Buonsenso D, Burkart K, Burns RA, Busse R, Bustanji Y, Butt ZA, Byun J, Caetano dos Santos FL, Calina D, Cámera LA, Campos-Nonato IR, Cao C, Capodici A, Carr S, Carreras G, Carugno A, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catapano AL, Cattaruzza MS, Caye A, Cegolon L, Cembranel F, Cenderadewi M, Cerin E, Chakraborty PA, Chan JSK, Chan RNC, Chandika RM, Chandrasekar EK, Charalampous P, Chattu VK, Chatzimavridou-Grigoriadou V, Chen AW, Chen AT, Chen CS, Chen H, Chen NM, Cheng ETW, Chimed-Ochir O, Chimoriya R, Ching PR, Cho WCS, Choi S, Chong B, Chong YY, Choudhari SG, Chowdhury R, Christensen SWM, Chu DT, Chukwu IS, Chung E, Chung E, Chutiyami M, Claassens MM, Cogen RM, Columbus A, Conde J, Cortesi PA, Cousin E, Criqui MH, Cruz-Martins N, Dadras O, Dai S, Dai X, Dai Z, Dalaba MA, Damiani G, Das JK, Das S, Dashti M, Dávila-Cervantes CA, Davletov K, De Leo D, Debele AT, Debopadhaya S, DeCleene NK, Deeba F, Degenhardt L, Del Bo' C, Delgado-Enciso I, Demetriades AK, Denova-Gutiérrez E, Dervenis N, Desai HD, Desai R, Deuba K, Dhama K, Dharmaratne SD, Dhingra S, Dias da Silva D, Diaz D, Diaz LA, Diaz MJ, Dima A, Ding DD, Dirac MA, Do THP, do Prado CB, Dohare S, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorsey ER, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Dube J, Dumith SC, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dzianach PA, Dziedzic AM, Eboreime E, Ebrahimi A, Edinur HA, Edvardsson D, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, El Tantawi M, Elbarazi I, Elemam NM, ElGohary GMT, Elhadi M, Elmeligy OAA, ELNahas G, Elshaer M, Elsohaby I, Engelbert Bain L, Erkhembayar R, Eshrati B, Estep K, Fabin N, Fagbamigbe AF, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faro A, Farrokhi P, Fatehizadeh A, Fauk NK, Feigin VL, Feng X, Fereshtehnejad SM, Feroze AH, Ferreira N, Ferreira PH, Fischer F, Flavel J, Flood D, Flor LS, Foigt NA, Folayan MO, Force LM, Fortuna D, Foschi M, Franklin RC, Freitas A, Fukumoto T, Furtado JM, Gaal PA, Gadanya MA, Gaidhane AM, Gaihre S, Galali Y, Ganbat M, Gandhi AP, Ganesan B, Ganie MA, Ganiyani MA, Gardner WM, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremariam TBB, Gebremeskel TG, Gela YY, Georgescu SR, Getachew Obsa A, Gething PW, Getie M, Ghadiri K, Ghadirian F, Ghailan KY, Ghajar A, Ghasemi M, Ghasempour Dabaghi G, Ghasemzadeh A, Ghazy RM, Gholamrezanezhad A, Ghorbani M, Ghotbi E, Gibson RM, Gill TK, Ginindza TG, Girmay A, Glasbey JC, Göbölös L, Godinho MA, Goharinezhad S, Goldust M, Golechha M, Goleij P, Gona PN, Gorini G, Goulart AC, Grada A, Grivna M, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Gulati S, Gulisashvili D, Gunawardane DA, Guo C, Gupta AK, Gupta B, Gupta I, Gupta M, Gupta R, Gupta VB, Gupta VK, Gupta VK, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadi NR, Haep N, Hafezi-Nejad N, Hafiz A, Hagins H, Halboub ES, Halimi A, Haller S, Halwani R, Hamilton EB, Hankey GJ, Hannan MA, Haque MN, Harapan H, Haro JM, Hartvigsen J, Hasaballah AI, Hasan I, Hasanian M, Hasnain MS, Hassan A, Haubold J, Havmoeller RJ, Hay SI, Hayat K, Hebert JJ, Hegazi OE, Heidari G, Helfer B, Hemmati M, Hendrie D, Henson CA, Hezam K, Hiraike Y, Hoan NQ, Holla R, Hon J, Hossain MM, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hsu JM, Huang J, Hugo FN, Hushmandi K, Hussain J, Hussein NR, Huynh CK, Huynh HH, Hwang BF, Iannucci VC, Ihler AL, Ikiroma AI, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Immurana M, Irham LM, Islam MR, Islam SMS, Islami F, Ismail F, Ismail NE, Isola G, Iwagami M, Iwu CCD, Iyer M, Jaafari J, Jacobsen KH, Jadidi-Niaragh F, Jafarinia M, Jaggi K, Jahankhani K, Jahanmehr N, Jahrami H, Jain A, Jain N, Jairoun AA, Jaiswal A, Jakovljevic M, Jatau AI, Javadov S, Javaheri T, Jayapal SK, Jayaram S, Jee SH, Jeganathan J, Jeyakumar A, Jha AK, Jiang H, Jin Y, Jonas JB, Joo T, Joseph A, Joseph N, Joshua CE, Jozwiak JJ, Jürisson M, K V, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kalani R, Kalankesh LR, Kaliyadan F, Kalra S, Kamenov K, Kamyari N, Kanagasabai T, Kandel H, Kanmanthareddy AR, Kanmodi KK, Kantar RS, Karaye IM, Karim A, Karimi SE, Karimi Y, Kasraei H, Kassel MB, Kauppila JH, Kawakami N, Kayode GA, Kazemi F, Kazemian S, Keikavoosi-Arani L, Keller C, Kempen JH, Kerr JA, Keshtkar K, Kesse-Guyot E, Keykhaei M, Khajuria H, Khalaji A, Khalid A, Khalid N, Khalilian A, Khamesipour F, Khan A, Khan I, Khan M, Khan MAB, Khanmohammadi S, Khatab K, Khatami F, Khatatbeh MM, Khater AM, Khayat Kashani HR, Khidri FF, Khodadoust E, Khormali M, Khorrami Z, Kifle ZD, Kim MS, Kimokoti RW, Kisa A, Kisa S, Knudsen AKS, Kocarnik JM, Kochhar S, Koh HY, Kolahi AA, Kompani F, Koren G, Korzh O, Kosen S, Koulmane Laxminarayana SL, Krishan K, Krishna V, Krishnamoorthy V, Kuate Defo B, Kuddus MA, Kuddus M, Kuitunen I, Kulkarni V, Kumar M, Kumar N, Kumar R, Kurmi OP, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lafranconi A, Lahariya C, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lám J, Lan Q, Lan T, Landires I, Lanfranchi F, Langguth B, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lauriola P, Le HH, Le LKD, Le NHH, Le TDT, Leasher JL, Ledda C, Lee M, Lee PH, Lee SW, Lee SW, Lee WC, Lee YH, LeGrand KE, Lenzi J, Leong E, Leung J, Li MC, Li W, Li X, Li Y, Li Y, Lim LL, Lim SS, Lindstrom M, Linn S, Liu G, Liu R, Liu S, Liu W, Liu X, Liu X, Llanaj E, Lo CH, López-Bueno R, Loreche AM, Lorenzovici L, Lozano R, Lubinda J, Lucchetti G, Lunevicius R, Lusk JB, lv H, Ma ZF, Machairas N, Madureira-Carvalho ÁM, Magaña Gómez JA, Maghazachi AA, Maharjan P, Mahasha PW, Maheri M, Mahjoub S, Mahmoud MA, Mahmoudi E, Majeed A, Makris KC, Malakan Rad E, Malhotra K, Malik AA, Malik I, Malta DC, Manla Y, Mansour A, Mansouri P, Mansournia MA, Mantilla Herrera AM, Mantovani LG, Manu E, Marateb HR, Mardi P, Martinez G, Martinez-Piedra R, Martini D, Martins-Melo FR, Martorell M, Marx W, Maryam S, Marzo RR, Mathangasinghe Y, Mathieson S, Mathioudakis AG, Mattumpuram J, Maugeri A, Mayeli M, Mazidi M, Mazzotti A, McGrath JJ, McKee M, McKowen ALW, McPhail MA, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mekene Meto T, Mendoza W, Menezes RG, Mensah GA, Mentis AFA, Meo SA, Meresa HA, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Mettananda KCD, Mettananda S, Michalek IM, Miller PA, Miller TR, Mills EJ, Minh LHN, Mirijello A, Mirrakhimov EM, Mirutse MK, Mirza-Aghazadeh-Attari M, Mirzaei M, Mirzaei R, Misganaw A, Mishra AK, Mitchell PB, Mittal C, Moazen B, Moberg ME, Mohamed J, Mohamed MFH, Mohamed NS, Mohammadi E, Mohammadi S, Mohammed H, Mohammed S, Mohammed S, Mohr RM, Mokdad AH, Molinaro S, Momtazmanesh S, Monasta L, Mondello S, Moodi Ghalibaf A, Moradi M, Moradi Y, Moradi-Lakeh M, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosapour A, Mosser JF, Mossialos E, Motappa R, Mougin V, Mouodi S, Mrejen M, Msherghi A, Mubarik S, Mueller UO, Mulita F, Munjal K, Murillo-Zamora E, Murlimanju BV, Mustafa G, Muthu S, Muzaffar M, Myung W, Nagarajan AJ, Naghavi P, Naik GR, Nainu F, Nair S, Najmuldeen HHR, Nangia V, Naqvi AA, Narayana AI, Nargus S, Nascimento GG, Nashwan AJ, Nasrollahizadeh A, Nasrollahizadeh A, Natto ZS, Nayak BP, Nayak VC, Nduaguba SO, Negash H, Negoi I, Negoi RI, Nejadghaderi SA, Nesbit OD, Netsere HB, Ng M, Nguefack-Tsague G, Ngunjiri JW, Nguyen DH, Nguyen HQ, Niazi RK, Nikolouzakis TK, Nikoobar A, Nikoomanesh F, Nikpoor AR, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Norrving B, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nurrika D, Nzoputam CI, Nzoputam OJ, Oancea B, Odetokun IA, O'Donnell MJ, Oguntade AS, Oguta JO, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Olagunju AT, Olasupo OO, Olatubi MI, Oliveira GMM, Olufadewa II, Olusanya BO, Olusanya JO, Omar HA, Omer GL, Omonisi AEE, Onie S, Onwujekwe OE, Ordak M, Orish VN, Ortega-Altamirano DV, Ortiz A, Ortiz-Brizuela E, Osman WMS, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov N, Otstavnov SS, Ouyahia A, Ouyang G, Owolabi MO, P A MP, Padron-Monedero A, Padubidri JR, Palicz T, Palladino C, Pan F, Pandi-Perumal SR, Pangaribuan HU, Panos GD, Panos LD, Pantea Stoian AM, Pardhan S, Parikh RR, Pashaei A, Pasovic M, Passera R, Patel J, Patel SK, Patil S, Patoulias D, Patthipati VS, Pawar S, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Peng M, Pensato U, Pepito VCF, Peprah EK, Peprah P, Perdigão J, Pereira MO, Perianayagam A, Perico N, Pesudovs K, Petermann-Rocha FE, Petri WA, Pham HT, Philip AK, Phillips MR, Pigeolet M, Pigott DM, Pillay JD, Piracha ZZ, Pirouzpanah S, Plass D, Plotnikov E, Poddighe D, Polinder S, Postma MJ, Pourtaheri N, Prada SI, Pradhan PMS, Prakash V, Prasad M, Prates EJS, Priscilla T, Pritchett N, Puri P, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Rabiee Rad M, Radhakrishnan RA, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Raggi A, Raghav PR, Rahim MJ, Rahman MM, Rahman MHU, Rahman M, Rahman MA, Rahmani S, Rahmanian M, Rahmawaty S, Rajaa S, Ramadan MM, Ramasamy SK, Ramasubramani P, Ramazanu S, Rana K, Ranabhat CL, Rancic N, Rane A, Rao CR, Rao K, Rao M, Rao SJ, Rashidi MM, Rathnaiah Babu G, Rauniyar SK, Rawaf DL, Rawaf S, Razo C, Reddy MMRK, Redwan EMM, Reifels L, Reiner Jr RC, Remuzzi G, Renzaho AMN, Reshmi B, Reyes LF, Rezaei N, Rezaei N, Rezaei N, Rezaei Hachesu P, Rezaeian M, Rickard J, Rodrigues CF, Rodriguez JAB, Roever L, Ronfani L, Roshandel G, Rotimi K, Rout HS, Roy B, Roy N, Roy P, Rubagotti E, S N C, Saad AMA, Saber-Ayad MM, Sabour S, Sacco S, Sachdev PS, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi M, Saeb MR, Saeed U, Safi SZ, Sagar R, Sagoe D, Saif Z, Sajid MR, Sakshaug JW, Salam N, Salami AA, Salaroli LB, Saleh MA, Salem MR, Salem MZY, Sallam M, Samadzadeh S, Samargandy S, Samodra YL, Samy AM, Sanabria J, Sanna F, Santos IS, Santric-Milicevic MM, Sarasmita MA, Sarikhani Y, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathyanarayan A, Satpathy M, Sawhney M, Scarmeas N, Schaarschmidt BM, Schmidt MI, Schneider IJC, Schumacher AE, Schwebel DC, Schwendicke F, Sedighi M, Senapati S, Senthilkumaran S, Sepanlou SG, Sethi Y, Setoguchi S, Seylani A, Shadid J, Shafie M, Shah H, Shah NS, Shah PA, Shahbandi A, Shahid S, Shahid W, Shahwan MJ, Shaikh MA, Shakeri A, Shalash AS, Sham S, Shamim MA, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Shannawaz M, Sharath M, Sharifan A, Sharifi-Rad J, Sharma M, Sharma R, Sharma S, Sharma U, Sharma V, Shastry RP, Shavandi A, Shayan AM, Shayan M, Shehabeldine AME, Shetty PH, Shibuya K, Shifa JE, Shiferaw D, Shiferaw WS, Shigematsu M, Shiri R, Shitaye NA, Shittu A, Shivakumar KM, Shivarov V, Shokati Eshkiki Z, Shool S, Shrestha S, Shuval K, Sibhat MM, Siddig EE, Sigfusdottir ID, Silva DAS, Silva JP, Silva LMLR, Silva S, Simpson CR, Singal A, Singh A, Singh BB, Singh H, Singh JA, Singh M, Singh P, Skou ST, Sleet DA, Slepak ELN, Solanki R, Soliman SSM, Song S, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Sreeramareddy CT, Stark BA, Starodubova AV, Stein C, Stein DJ, Steiner C, Steiner TJ, Steinmetz JD, Steiropoulos P, Stockfelt L, Stokes MA, Subedi NS, Subramaniyan V, Suemoto CK, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sundström J, Swain CK, Szarpak L, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabche C, Tabish M, Tadakamadla SK, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tandukar S, Tang H, Tavakoli Oliaee R, Tavangar SM, Teimoori M, Temsah MH, Teramoto M, Thangaraju P, Thankappan KR, Thapar R, Thayakaran R, Thirunavukkarasu S, Thomas N, Thomas NK, Thum CCC, Tichopad A, Ticoalu JHV, Tillawi T, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Torre AE, Touvier M, Tovani-Palone MR, Tran JT, Tran MTN, Tran NM, Tran NH, Trico D, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tumurkhuu M, Tyrovolas S, Udoh A, Umair M, Umakanthan S, Umar TP, Undurraga EA, Unim B, Unnikrishnan B, Unsworth CA, Upadhyay E, Urso D, Usman JS, Vahabi SM, Vaithinathan AG, Van den Eynde J, Varga O, Varma RP, Vart P, Vasankari TJ, Vasic M, Vaziri S, Vellingiri B, Venketasubramanian N, Veroux M, Verras GI, Vervoort D, Villafañe JH, Violante FS, Vlassov V, Vollset SE, Volovat SR, Vongpradith A, Waheed Y, Wang C, Wang F, Wang N, Wang S, Wang Y, Wang YP, Ward P, Wassie EG, Weaver MR, Weerakoon KG, Weintraub RG, Weiss DJ, Weldemariam AH, Wells KM, Wen YF, Whisnant JL, Whiteford HA, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Wilandika A, Wilkerson C, Willeit P, Wimo A, Woldegebreal DH, Wolf AW, Wong YJ, Woolf AD, Wu C, Wu F, Wu X, Wu Z, Wulf Hanson S, Xia Y, Xiao H, Xu X, Xu YY, Yadav L, Yadollahpour A, Yaghoubi S, Yamagishi K, Yang L, Yano Y, Yao Y, Yaribeygi H, Yazdanpanah MH, Ye P, Yehualashet SS, Yesuf SA, Yezli S, Yiğit A, Yiğit V, Yigzaw ZA, Yismaw Y, Yon DK, Yonemoto N, Younis MZ, Yu C, Yu Y, Yusuf H, Zahid MH, Zakham F, Zaki L, Zaki N, Zaman BA, Zamora N, Zand R, Zandieh GGZ, Zar HJ, Zarrintan A, Zastrozhin MS, Zhang H, Zhang N, Zhang Y, Zhao H, Zhong C, Zhong P, Zhou J, Zhu Z, Ziafati M, Zielińska M, Zimsen SRM, Zoladl M, Zumla A, Zyoud SH, Vos T, Murray CJL. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2133-2161. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Brauer M, Roth GA, Aravkin AY, Zheng P, Abate KH, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasi MA, Abbasian M, Abbasifard M, Abbasi-Kangevari M, Abd ElHafeez S, Abd-Elsalam S, Abdi P, Abdollahi M, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abedi A, Abedi A, Abegaz TM, Abeldaño Zuñiga RA, Abiodun O, Abiso TL, Aboagye RG, Abolhassani H, Abouzid M, Aboye GB, Abreu LG, Abualruz H, Abubakar B, Abu-Gharbieh E, Abukhadijah HJJ, Aburuz S, Abu-Zaid A, Adane MM, Addo IY, Addolorato G, Adedoyin RA, Adekanmbi V, Aden B, Adetunji JB, Adeyeoluwa TE, Adha R, Adibi A, Adnani QES, Adzigbli LA, Afolabi AA, Afolabi RF, Afshin A, Afyouni S, Afzal MS, Afzal S, Agampodi SB, Agbozo F, Aghamiri S, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad N, Ahmad S, Ahmad T, Ahmed A, Ahmed A, Ahmed A, Ahmed LA, Ahmed MB, Ahmed S, Ahmed SA, Ajami M, Akalu GT, Akara EM, Akbarialiabad H, Akhlaghi S, Akinosoglou K, Akinyemiju T, Akkaif MA, Akkala S, Akombi-Inyang B, Al Awaidy S, Al Hasan SM, Alahdab F, AL-Ahdal TMA, Alalalmeh SO, Alalwan TA, Al-Aly Z, Alam K, Alam N, Alanezi FM, Alanzi TM, Albakri A, AlBataineh MT, Aldhaleei WA, Aldridge RW, Alemayohu MA, Alemu YM, Al-Fatly B, Al-Gheethi AAS, Al-Habbal K, Alhabib KF, Alhassan RK, Ali A, Ali A, Ali BA, Ali I, Ali L, Ali MU, Ali R, Ali SSS, Ali W, Alicandro G, Alif SM, Aljunid SM, Alla F, Al-Marwani S, Al-Mekhlafi HM, Almustanyir S, Alomari MA, Alonso J, Alqahtani JS, Alqutaibi AY, Al-Raddadi RM, Alrawashdeh A, Al-Rifai RH, Alrousan SM, Al-Sabah SK, Alshahrani NZ, Altaany Z, Altaf A, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvis-Guzman N, Alvis-Zakzuk NJ, Alwafi H, Al-Wardat MS, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Al-Zyoud W, Amaechi UA, Aman Mohammadi M, Amani R, Amiri S, Amirzade-Iranaq MH, Ammirati E, Amu H, Amugsi DA, Amusa GA, Ancuceanu R, Anderlini D, Anderson JA, Andrade PP, Andrei CL, Andrei T, Anenberg SC, Angappan D, Angus C, Anil A, Anil S, Anjum A, Anoushiravani A, Antonazzo IC, Antony CM, Antriyandarti E, Anuoluwa BS, Anvari D, Anvari S, Anwar S, Anwar SL, Anwer R, Anyabolo EE, Anyasodor AE, Apostol GLC, Arabloo J, Arabzadeh Bahri R, Arafat M, Areda D, Aregawi BB, Aremu A, Armocida B, Arndt MB, Ärnlöv J, Arooj M, Artamonov AA, Artanti KD, Aruleba IT, Arumugam A, Asbeutah AM, Asgary S, Asgedom AA, Ashbaugh C, Ashemo MY, Ashraf T, Askarinejad A, Assmus M, Astell-Burt T, Athar M, Athari SS, Atorkey P, Atreya A, Aujayeb A, Ausloos M, Avila-Burgos L, Awoke AA, Ayala Quintanilla BP, Ayatollahi H, Ayestas Portugal C, Ayuso-Mateos JL, Azadnajafabad S, Azevedo RMS, Azhar GS, Azizi H, Azzam AY, Backhaus IL, Badar M, Badiye AD, Bagga A, Baghdadi S, Bagheri N, Bagherieh S, Bahrami Taghanaki P, Bai R, Baig AA, Baker JL, Bakkannavar SM, Balasubramanian M, Baltatu OC, Bam K, Bandyopadhyay S, Banik B, Banik PC, Banke-Thomas A, Bansal H, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barone-Adesi F, Barqawi HJ, Barrero LH, Barrow A, Barteit S, Basharat Z, Basiru A, Basso JD, Bastan MM, Basu S, Batchu S, Batra K, Batra R, Baune BT, Bayati M, Bayileyegn NS, Beaney T, Behnoush AH, Beiranvand M, Béjot Y, Bekele A, Belgaumi UI, Bell AW, Bell ML, Bello MB, Bello OO, Belo L, Beloukas A, Bendak S, Bennett DA, Bennitt FB, Bensenor IM, Benzian H, Beran A, Berezvai Z, Bernabe E, Bernstein RS, Bettencourt PJG, Bhagavathula AS, Bhala N, Bhandari D, Bhardwaj N, Bhardwaj P, Bhaskar S, Bhat AN, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhuiyan MA, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Biswas A, Biswas B, Biswas RK, Bjørge T, Boachie MK, Boakye H, Bockarie MJ, Bodolica V, Bodunrin AO, Bogale EK, Bolla SR, Boloor A, Bonakdar Hashemi M, Boppana SH, Bora Basara B, Borhany H, Botero Carvajal A, Bouaoud S, Boufous S, Bourne R, Boxe C, Braithwaite D, Brant LC, Brar A, Breitborde NJK, Breitner S, Brenner H, Briko AN, Britton G, Brown CS, Browne AJ, Brunoni AR, Bryazka D, Bulamu NB, Bulto LN, Buonsenso D, Burkart K, Burns RA, Busse R, Bustanji Y, Butt NS, Butt ZA, Caetano dos Santos FL, Cagney J, Cahuana-Hurtado L, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cao F, Cao Y, Capodici A, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Caye A, Cederroth CR, Cegolon L, Cenderadewi M, Cercy KM, Cerin E, Chadwick J, Chakraborty C, Chakraborty PA, Chakraborty S, Chan JSK, Chan RNC, Chandan JS, Chandika RM, Chaturvedi P, Chen AT, Chen CS, Chen H, Chen MX, Chen M, Chen S, Cheng CY, Cheng ETW, Cherbuin N, Chi G, Chichagi F, Chimed-Ochir O, Chimoriya R, Ching PR, Chirinos-Caceres JL, Chitheer A, Cho WCS, Chong B, Chopra H, Chowdhury R, Christopher DJ, Chu DT, Chukwu IS, Chung E, Chung SC, Chutiyami M, Cioffi I, Cogen RM, Cohen AJ, Columbus A, Conde J, Corlateanu A, Cortese S, Cortesi PA, Costa VM, Costanzo S, Criqui MH, Cruz JA, Cruz-Martins N, Culbreth GT, da Silva AG, Dadras O, Dai X, Dai Z, Daikwo PU, Dalli LL, Damiani G, D'Amico E, D'Anna L, Darwesh AM, Das JK, Das S, Dash NR, Dashti M, Dávila-Cervantes CA, Davis Weaver N, Davitoiu DV, De la Hoz FP, de la Torre-Luque A, De Leo D, Debopadhaya S, Degenhardt L, Del Bo' C, Delgado-Enciso I, Delgado-Saborit JM, Demoze CK, Denova-Gutiérrez E, Dervenis N, Dervišević E, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhane AS, Dhimal ML, Dhimal M, Dhingra S, Dhulipala VR, Dhungana RR, Dias da Silva D, Diaz D, Diaz LA, Diaz MJ, Dima A, Ding DD, Dinu M, Djalalinia S, Do TC, Do THP, do Prado CB, Dodangeh M, Dohare S, Dokova KG, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza AC, Dsouza HL, Dumith SC, Duncan BB, Duraes AR, Duraisamy S, Dushpanova A, Dzianach PA, Dziedzic AM, Ebrahimi A, Echieh CP, Ed-Dra A, Edinur HA, Edvardsson D, Edvardsson K, Efendi F, Eftekharimehrabad A, Eini E, Ekholuenetale M, Ekundayo TC, El Arab RA, El Sayed Zaki M, El-Dahiyat F, Elemam NM, Elgar FJ, ElGohary GMT, Elhabashy HR, Elhadi M, Elmehrath AO, Elmeligy OAA, Elshaer M, Elsohaby I, Emeto TI, Esfandiari N, Eshrati B, Eslami M, Esmaeili SV, Estep K, Etaee F, Fabin N, Fagbamigbe AF, Fagbule OF, Fahimi S, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faris PS, Faro A, Fasina FO, Fatehizadeh A, Fauk NK, Fazylov T, Feigin VL, Feng X, Fereshtehnejad SM, Feroze AH, Ferrara P, Ferrari AJ, Ferreira N, Fetensa G, Feyisa BR, Filip I, Fischer F, Fitriana I, Flavel J, Flohr C, Flood D, Flor LS, Foigt NA, Folayan MO, Force LM, Fortuna D, Foschi M, Franklin RC, Freitas A, Friedman SD, Fux B, G S, Gaal PA, Gaihre S, Gajdács M, Galali Y, Gallus S, Gandhi AP, Ganesan B, Ganiyani MA, Garcia V, Gardner WM, Garg RK, Gautam RK, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremariam TBB, Gebremeskel TG, Gerema U, Getacher L, Getahun GKA, Getie M, Ghadirian F, Ghafarian S, Ghaffari Jolfayi A, Ghailan KY, Ghajar A, Ghasemi M, Ghasempour Dabaghi G, Ghasemzadeh A, Ghassemi F, Ghazy RM, Gholami A, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Gil AU, Gil GF, Gilbertson NM, Gill PS, Gill TK, Gindaba EZ, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Godinho MA, Goel A, Golechha M, Goleij P, Golinelli D, Gomes NGM, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Gouravani M, Goyal A, Graham SM, Grivna M, Grosso G, Guan SY, Guarducci G, Gubari MIM, Guha A, Guicciardi S, Gulati S, Gulisashvili D, Gunawardane DA, Guo C, Gupta AK, Gupta B, Gupta M, Gupta R, Gupta RD, Gupta R, Gupta S, Gupta VB, Gupta VK, Gupta VK, Habibzadeh F, Habibzadeh P, Hadaro TS, Hadian Z, Haep N, Haghi-Aminjan H, Haghmorad D, Hagins H, Haile D, Hailu A, Hajj Ali A, Halboub ES, Halimi A, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hamdy NM, Hameed S, Hamidi S, Hammoud A, Hanif A, Hanifi N, Haq ZA, Haque MR, Harapan H, Hargono A, Haro JM, Hasaballah AI, Hasan I, Hasan MJ, Hasan SMM, Hasani H, Hasanian M, Hashmeh N, Hasnain MS, Hassan A, Hassan I, Hassan Zadeh Tabatabaei MS, Hassani S, Hassanipour S, Hassankhani H, Haubold J, Havmoeller RJ, Hay SI, Hebert JJ, Hegazi OE, Hegena TY, Heidari G, Heidari M, Helfer B, Hemmati M, Henson CA, Herbert ME, Herteliu C, Heuer A, Hezam K, Hinneh TK, Hiraike Y, Hoan NQ, Holla R, Hon J, Hoque ME, Horita N, Hossain S, Hosseini SE, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hoven H, Hsairi M, Hsu JM, Hu C, Huang J, Huda MN, Hulland EN, Hultström M, Hushmandi K, Hussain J, Hussein NR, Huynh CK, Huynh HH, Ibitoye SE, Idowu OO, Ihler AL, Ikeda N, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Immurana M, Inbaraj LR, Irham LM, Isa MA, Islam MR, Ismail F, Ismail NE, Iso H, Isola G, Iwagami M, Iwu CCD, Iwu-Jaja CJ, J V, Jaafari J, Jacob L, Jacobsen KH, Jadidi-Niaragh F, Jahankhani K, Jahanmehr N, Jahrami H, Jain A, Jain N, Jairoun AA, Jaiswal A, Jakovljevic M, Jalilzadeh Yengejeh R, Jamora RDG, Jatau AI, Javadov S, Javaheri T, Jayaram S, Jeganathan J, Jeswani BM, Jiang H, Johnson CO, Jokar M, Jomehzadeh N, Jonas JB, Joo T, Joseph A, Joseph N, Joshi V, Joshua CE, Jozwiak JJ, Jürisson M, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kahn EM, Kalani R, Kaliyadan F, Kalra S, Kamath R, Kanagasabai T, Kanchan T, Kandel H, Kanmiki EW, Kanmodi KK, Kansal SK, Kapner DJ, Kapoor N, Karagiannidis E, Karajizadeh M, Karakasis P, Karanth SD, Karaye IM, Karch A, Karim A, Karimi H, Karmakar S, Kashoo FZ, Kasraei H, Kassahun WD, Kassebaum NJ, Kassel MB, Katikireddi SV, Kauppila JH, Kawakami N, Kaydi N, Kayode GA, Kazemi F, Keiyoro PN, Kemmer L, Kempen JH, Kerr JA, Kesse-Guyot E, Khader YS, Khafaie MA, Khajuria H, Khalaji A, Khalil M, Khalilian A, Khamesipour F, Khan A, Khan MN, Khan M, Khan MJ, Khan MAB, Khanmohammadi S, Khatab K, Khatatbeh H, Khatatbeh MM, Khatib MN, Khavandegar A, Khayat Kashani HR, Khidri FF, Khodadoust E, Khormali M, Khorrami Z, Khosla AA, Khosrowjerdi M, Khreis H, Khusun H, Kifle ZD, Kim K, Kim MS, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Knibbs LD, Knudsen AKS, Koh DSQ, Kolahi AA, Kompani F, Kong J, Koren G, Korja M, Korshunov VA, Korzh O, Kosen S, Kothari N, Koul PA, Koulmane Laxminarayana SL, Krishan K, Krishnamoorthy V, Krishnamoorthy Y, Krishnan B, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kuddus MA, Kuddus M, Kugbey N, Kuitunen I, Kulimbet M, Kulkarni V, Kumar A, Kumar N, Kumar V, Kundu S, Kurmi OP, Kusnali A, Kusuma D, Kutluk T, La Vecchia C, Ladan MA, Laflamme L, Lahariya C, Lai DTC, Lal DK, Lallukka T, Lám J, Lan Q, Lan T, Landires I, Lanfranchi F, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lauriola P, Le HH, Le LKD, Le NHH, Le TTT, Leasher JL, Ledda C, Lee M, Lee PH, Lee SW, Lee SWH, Lee YH, LeGrand KE, Leigh J, Leong E, Lerango TL, Lescinsky H, Leung J, Li MC, Li WZ, Li W, Li Y, Li Z, Ligade VS, Lim LL, Lim SS, Lin RT, Lin S, Liu C, Liu G, Liu J, Liu J, Liu RT, Liu S, Liu W, Liu X, Liu X, Livingstone KM, Llanaj E, Lohiya A, López-Bueno R, Lopukhov PD, Lorkowski S, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Luo L, lv H, M Amin HI, Ma ZF, Maass KL, Mabrok M, Machairas N, Machoy M, Mafhoumi A, Magdy Abd El Razek M, Maghazachi AA, Mahadeshwara Prasad DR, Maharaj SB, Mahmoud MA, Mahmoudi E, Majeed A, Makram OM, Makris KC, Malasala S, Maled V, Malhotra K, Malik AA, Malik I, Malinga LA, Malta DC, Mamun AA, Manda AL, Manla Y, Mansour A, Mansouri B, Mansouri P, Mansourian M, Mansournia MA, Mantovani LG, Manu E, Marateb HR, Maravilla JC, Marsh E, Martinez G, Martinez-Piedra R, Martini S, Martins-Melo FR, Martorell M, Marx W, Maryam S, Mathangasinghe Y, Mathioudakis AG, Matozinhos FP, Mattumpuram J, Maugeri A, Maulik PK, Mayeli M, Mazidi M, Mazzotti A, McGrath JJ, McKee M, McKowen ALW, McLaughlin SA, McPhail MA, McPhail SM, Mechili EA, Mehmood A, Mehmood K, Mehrabani-Zeinabad K, Mehrabi Nasab E, Meier T, Mejia-Rodriguez F, Mekene Meto T, Mekonnen BD, Menezes RG, Mengist B, Mensah GA, Mensah LG, Mentis AFA, Meo SA, Meretoja A, Meretoja TJ, Mersha AM, Mesfin BA, Mestrovic T, Mettananda KCD, Mettananda S, Miazgowski T, Micha G, Michalek IM, Micheletti Gomide Nogueira de Sá AC, Miller TR, Mirarefin M, Mirghafourvand M, Mirica A, Mirijello A, Mirrakhimov EM, Mirshahi A, Mirzaei M, Mishra AK, Mishra V, Mitchell PB, Mithra P, Mittal C, Moazen B, Moberg ME, Mocciaro G, Mohamadkhani A, Mohamed AZ, Mohamed AI, Mohamed J, Mohamed MFH, Mohamed NS, Mohammadi E, Mohammadi S, Mohammadian-Hafshejani A, Mohammadifard N, Mohammed H, Mohammed M, Mohammed S, Mohammed S, Mokdad AH, Monasta L, Mondello S, Moni MA, Moodi Ghalibaf A, Moore CE, Moradi M, Moradi Y, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosaddeghi Heris R, Mossialos E, Motappa R, Mougin V, Mousavi P, Msherghi A, Mubarik S, Muccioli L, Mueller UO, Mulita F, Mullany EC, Munjal K, Murillo-Zamora E, Murlimanju BV, Musina AM, Mustafa G, Muthu S, Muthupandian S, Muthusamy R, Muzaffar M, Myung W, Nafei A, Nagarajan AJ, Nagaraju SP, Nagel G, Naghavi M, Naghavi P, Naik GR, Naik G, Nainu F, Nair TS, Najdaghi S, Nakhostin Ansari N, Nanavaty DP, Nangia V, Narasimha Swamy S, Narimani Davani D, Nascimento BR, Nascimento GG, Nashwan AJ, Natto ZS, Nauman J, Navaratna SNK, Naveed M, Nayak BP, Nayak VC, Ndejjo R, Nduaguba SO, Negash H, Negoi I, Negoi RI, Nejadghaderi SA, Nejjari C, Nematollahi MH, Nepal S, Neupane S, Ng M, Nguefack-Tsague G, Ngunjiri JW, Nguyen DH, Nguyen NNY, Nguyen PT, Nguyen PT, Nguyen VT, Nguyen Tran Minh D, Niazi RK, Nicholson SI, Nie J, Nikoobar A, Nikpoor AR, Ningrum DNA, Nnaji CA, Noman EA, Nomura S, Noroozi N, Norrving B, Noubiap JJ, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nunemo MH, Nurrika D, Nutor JJ, Oancea B, O'Connell EM, Odetokun IA, O'Donnell MJ, Oduro MS, Ogunfowokan AA, Ogunkoya A, Oh IH, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Olagunju AT, Olasupo OO, Olatubi MI, Oliveira AB, Oliveira GMM, Olorukooba AA, Olufadewa II, Olusanya BO, Olusanya JO, Oluwafemi YD, Omar HA, Omar Bali A, Omer GL, Ong KL, Ong S, Onwujekwe OE, Onyedibe KI, Oppong AF, Ordak M, Orish VN, Ornello R, Orpana HM, Ortiz A, Ortiz-Prado E, Osman WMS, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov N, Otstavnov SS, Ouyahia A, Owolabi MO, Oyeyemi IT, Oyeyemi OT, P A MP, Pacheco-Barrios K, Padron-Monedero A, Padubidri JR, Pal PK, Palicz T, Pan F, Pan HF, Pana A, Panda SK, Panda-Jonas S, Pandey A, Pandi-Perumal SR, Pangaribuan HU, Pantazopoulos I, Pantea Stoian AM, Papadopoulou P, Parent MC, Parija PP, Parikh RR, Park S, Park S, Parsons N, Pashaei A, Pasovic M, Passera R, Patil S, Patoulias D, Patthipati VS, Paudel U, Pawar S, Pazoki Toroudi H, Peden AE, Pedersini P, Peng M, Pensato U, Pepito VCF, Peprah EK, Peprah P, Peres MFP, Perianayagam A, Perico N, Perna S, Pesudovs K, Petcu IR, Petermann-Rocha FE, Pham HT, Philip AK, Phillips MR, Pickering BV, Pierannunzio D, Pigeolet M, Pigott DM, Piracha ZZ, Piradov MA, Pisoni E, Piyasena MP, Plass D, Plotnikov E, Poddighe D, Polkinghorne KR, Poluru R, Pond CD, Popovic DS, Porru F, Postma MJ, Poudel GR, Pour-Rashidi A, Pourshams A, Pourtaheri N, Prabhu D, Prada SI, Pradhan J, Pradhan PMS, Prasad M, Prates EJS, Purnobasuki H, Purohit BM, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Qiu S, Rabiee Rad M, Radfar A, Radhakrishnan RA, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Rafiei A, Raggi A, Raghav PR, Raheem N, Rahim F, Rahim MJ, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Rahman MA, Rahmani AM, Rahmani B, Rahmanian M, Rahmanian N, Rahmanian V, Rahmati M, Rahmawaty S, Raimondo D, Rajaa S, Rajendran V, Rajput P, Ramadan MM, Ramasamy SK, Ramasubramani P, Ramazanu S, Ramteke PW, Rana J, Rana K, Ranabhat CL, Rane A, Rani U, Ranta A, Rao CR, Rao M, Rao PC, Rao SJ, Rasella D, Rashedi S, Rashedi V, Rashidi M, Rashidi MM, Rasouli-Saravani A, Ratan ZA, Rathnaiah Babu G, Rauniyar SK, Rautalin I, Rawaf DL, Rawaf S, Rawassizadeh R, Razo C, Reda ZFF, Reddy MMRK, Redwan EMM, Reifels L, Reitsma MB, Remuzzi G, Reshmi B, Resnikoff S, Restaino S, Reyes LF, Rezaei M, Rezaei N, Rezaei N, Rezaeian M, Rhee TG, Riaz MA, Ribeiro ALP, Rickard J, Robinson-Oden HE, Rodrigues CF, Rodrigues M, Rodriguez JAB, Roever L, Romadlon DS, Ronfani L, Rosauer JJ, Roshandel G, Rostamian M, Rotimi K, Rout HS, Roy B, Roy N, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, Russo M, Ruzzante SW, S N C, Saad AMA, Saber K, Saber-Ayad MM, Sabour S, Sacco S, Sachdev PS, Sachdeva R, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi M, Sadeghi Majd E, Saeb MR, Saeed U, Safari M, Safi S, Safi SZ, Sagar R, Sagoe D, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Sahu M, Saif Z, Sajid MR, Sakshaug JW, Salam N, Salamati P, Salami AA, Salaroli LB, Salehi L, Salehi S, Salem MR, Salem MZY, Salihu D, Salimi S, Salum GA, Samadi Kafil H, Samadzadeh S, Samodra YL, Samuel VP, Samy AM, Sanabria J, Sanjeev RK, Sanna F, Santomauro DF, Santric-Milicevic MM, Sarasmita MA, Saraswathy SYI, Saravanan A, Saravi B, Sarikhani Y, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sartorius B, Sarveazad A, Sathian B, Sattin D, Sawhney M, Saya GK, Sayeed A, Sayeed MA, Sayyah M, Schinckus C, Schmidt MI, Schuermans A, Schumacher AE, Schutte AE, Schwarzinger M, Schwebel DC, Schwendicke F, Selvaraj S, Semreen MH, Senthilkumaran S, Serban D, Serre ML, Sethi Y, Shafie M, Shah H, Shah NS, Shah PA, Shah SM, Shahbandi A, Shaheen AA, Shahid S, Shahid W, Shahsavari HR, Shahwan MJ, Shaikh MA, Shaikh SZ, Shalash AS, Sham S, Shamim MA, Shams-Beyranvand M, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma M, Sharma U, Sharma V, Shastry RP, Shavandi A, Shehabeldine AME, Shehzadi S, Sheikh A, Shen J, Shetty A, Shetty BSK, Shetty PH, Shiani A, Shiferaw D, Shigematsu M, Shin MJ, Shiri R, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shool S, Shorofi SA, Shrestha R, Shrestha S, Shuja KH, Shuval K, Si Y, Siddig EE, Silva DAS, Silva LMLR, Silva S, Silva TPR, Simpson CR, Singh A, Singh BB, Singh B, Singh G, Singh H, Singh JA, Singh M, Singh NP, Singh P, Singh S, Sinto R, Sivakumar S, Siwal SS, Skhvitaridze N, Skou ST, Sleet DA, Sobia F, Soboka M, Socea B, Solaimanian S, Solanki R, Solanki S, Soliman SSM, Somayaji R, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Spearman S, Spencer CN, Sreeramareddy CT, Stachteas P, Stafford LK, Stanaway JD, Stanikzai MH, Stein C, Stein DJ, Steinbeis F, Steiner C, Steinke S, Steiropoulos P, Stockfelt L, Stokes MA, Straif K, Stranges S, Subedi N, Subramaniyan V, Suleman M, Suliankatchi Abdulkader R, Sundström J, Sunkersing D, Sunnerhagen KS, Suresh V, Swain CK, Szarpak L, Szeto MD, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabche C, Tabish M, Tadakamadla SK, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Takahashi K, Talaat IM, Tamuzi JL, Tan KK, Tang H, Tat NY, Taveira N, Tefera YM, Tehrani-Banihashemi A, Temesgen WA, Temsah MH, Teramoto M, Terefa DR, Teye-Kwadjo E, Thakur R, Thangaraju P, Thankappan KR, Thapar R, Thayakaran R, Thirunavukkarasu S, Thomas N, Thomas NK, Tian J, Tichopad A, Ticoalu JHV, Tiruye TY, Tobe-Gai R, Tolani MA, Tolossa T, Tonelli M, Topor-Madry R, Topouzis F, Touvier M, Tovani-Palone MR, Trabelsi K, Tran JT, Tran MTN, Tran NM, Trico D, Trihandini I, Troeger CE, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsermpini EE, Tumurkhuu M, Udoakang AJ, Udoh A, Ullah A, Ullah S, Ullah S, Umair M, Umakanthan S, Unim B, Unnikrishnan B, Upadhyay E, Urso D, Usman JS, Vaithinathan AG, Vakili O, Valenti M, Valizadeh R, Van den Eynde J, van Donkelaar A, Varga O, Vart P, Varthya SB, Vasankari TJ, Vasic M, Vaziri S, Venketasubramanian N, Verghese NA, Verma M, Veroux M, Verras GI, Vervoort D, Villafañe JH, Villalobos-Daniel VE, Villani L, Villanueva GI, Vinayak M, Violante FS, Vlassov V, Vo B, Vollset SE, Volovat SR, Vos T, Vujcic IS, Waheed Y, Wang C, Wang F, Wang S, Wang Y, Wang YP, Wanjau MN, Waqas M, Ward P, Waris A, Wassie EG, Weerakoon KG, Weintraub RG, Weiss DJ, Weiss EJ, Weldetinsaa HLL, Wells KM, Wen YF, Wiangkham T, Wickramasinghe ND, Wilkerson C, Willeit P, Wilson S, Wong YJ, Wongsin U, Wozniak S, Wu C, Wu D, Wu F, Wu Z, Xia J, Xiao H, Xu S, Xu X, Xu YY, Yadav MK, Yaghoubi S, Yamagishi K, Yang L, Yano Y, Yaribeygi H, Yasufuku Y, Ye P, Yesodharan R, Yesuf SA, Yezli S, Yi S, Yiğit A, Yigzaw ZA, Yin D, Yip P, Yismaw MB, Yon DK, Yonemoto N, You Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Zadey S, Zadnik V, Zakham F, Zaki N, Zakzuk J, Zamagni G, Zaman SB, Zandieh GGZ, Zanghì A, Zar HJ, Zare I, Zarimeidani F, Zastrozhin MS, Zeng Y, Zhai C, Zhang AL, Zhang H, Zhang L, Zhang M, Zhang Y, Zhang Z, Zhang ZJ, Zhao H, Zhao JT, Zhao XJG, Zhao Y, Zhao Y, Zhong C, Zhou J, Zhou J, Zhou S, Zhu B, Zhu L, Zhu Z, Ziaeian B, Ziafati M, Zielińska M, Zimsen SRM, Zoghi G, Zoller T, Zumla A, Zyoud SH, Zyoud SH, Murray CJL, Gakidou E. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2162-2203. [PMID: 38762324 DOI: 10.1016/s0140-6736(24)00933-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/11/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. METHODS The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk-outcome pairs. Pairs were included on the basis of data-driven determination of a risk-outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk-outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk-outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. FINDINGS Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7-9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4-9·2]), smoking (5·7% [4·7-6·8]), low birthweight and short gestation (5·6% [4·8-6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8-6·0]). For younger demographics (ie, those aged 0-4 years and 5-14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9-27·7]) and environmental and occupational risks (decrease of 22·0% [15·5-28·8]), coupled with a 49·4% (42·3-56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9-21·7] for high BMI and 7·9% [3·3-12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6-1·9) for high BMI and 1·3% (1·1-1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4-78·8) for child growth failure and 66·3% (60·2-72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). INTERPRETATION Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. FUNDING Bill & Melinda Gates Foundation.
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Schumacher AE, Kyu HH, Aali A, Abbafati C, Abbas J, Abbasgholizadeh R, Abbasi MA, Abbasian M, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdoun M, Abdullahi A, Abdurehman AM, Abebe M, Abedi A, Abedi A, Abegaz TM, Abeldaño Zuñiga RA, Abhilash ES, Abiodun OO, Aboagye RG, Abolhassani H, Abouzid M, Abreu LG, Abrha WA, Abrigo MRM, Abtahi D, Abu Rumeileh S, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Acuna JM, Adair T, Addo IY, Adebayo OM, Adegboye OA, Adekanmbi V, Aden B, Adepoju AV, Adetunji CO, Adeyeoluwa TE, Adeyomoye OI, Adha R, Adibi A, Adikusuma W, Adnani QES, Adra S, Afework A, Afolabi AA, Afraz A, Afyouni S, Afzal S, Agasthi P, Aghamiri S, Agodi A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmadzade M, Ahmed A, Ahmed H, Ahmed LA, Ahmed MB, Ahmed SA, Ajami M, Aji B, Ajumobi O, Akalu GT, Akara EM, Akinosoglou K, Akkala S, Akyirem S, Al Hamad H, Al Hasan SM, Al Homsi A, Al Qadire M, Ala M, Aladelusi TO, AL-Ahdal TMA, Alalalmeh SO, Al-Aly Z, Alam K, Alam M, Alam Z, Al-amer RM, Alanezi FM, Alanzi TM, Albashtawy M, AlBataineh MT, Aldridge RW, Alemi S, Al-Eyadhy A, Al-Gheethi AAS, Alhabib KF, Alhalaiqa FAN, Al-Hanawi MK, Ali A, Ali A, Ali BA, Ali H, Ali MU, Ali R, Ali SSS, Ali Z, Alian Samakkhah S, Alicandro G, Alif SM, Aligol M, Alimi R, Aliyi AA, Al-Jumaily A, Aljunid SM, Almahmeed W, Al-Marwani S, Al-Maweri SAA, Almazan JU, Al-Mekhlafi HM, Almidani O, Alomari MA, Alonso N, Alqahtani JS, Alqutaibi AY, Al-Sabah SK, Altaf A, Al-Tawfiq JA, Altirkawi KA, Alvi FJ, Alwafi H, Al-Worafi YM, Aly H, Alzoubi KH, Amare AT, Ameyaw EK, Amhare AF, Amin TT, Amindarolzarbi A, Aminian Dehkordi J, Amiri S, Amu H, Amugsi DA, Amzat J, Ancuceanu R, Anderlini D, Andrade PP, Andrei CL, Andrei T, Angappan D, Anil A, Anjum A, Antony CM, Antriyandarti E, Anuoluwa IA, Anwar SL, Anyasodor AE, Appiah SCY, Aqeel M, Arabloo J, Arabzadeh Bahri R, Arab-Zozani M, Arafat M, Araújo AM, Aravkin AY, Aremu A, Ariffin H, Aripov T, Armocida B, Arooj M, Artamonov AA, Artanti KD, Arulappan J, Aruleba IT, Aruleba RT, Arumugam A, Asaad M, Asgary S, Ashemo MY, Ashraf M, Asika MO, Athari SS, Atout MMW, Atreya A, Attia S, Aujayeb A, Avan A, Awotidebe AW, Ayala Quintanilla BP, Ayanore MA, Ayele GM, Ayuso-Mateos JL, Ayyoubzadeh SM, Azadnajafabad S, Azhar GS, Aziz S, Azzam AY, Babashahi M, Babu AS, Badar M, Badawi A, Badiye AD, Baghdadi S, Bagheri N, Bagherieh S, Bah S, Bahadorikhalili S, Bai J, Bai R, Baker JL, Bakkannavar SM, Bako AT, Balakrishnan S, Balogun SA, Baltatu OC, Bam K, Banach M, Bandyopadhyay S, Banik B, Banik PC, Bansal H, Barati S, Barchitta M, Bardhan M, Barker-Collo SL, Barone-Adesi F, Barqawi HJ, Barr RD, Barrero LH, Basharat Z, Bashir AIJ, Bashiru HA, Baskaran P, Basnyat B, Bassat Q, Basso JD, Basu S, Batra K, Batra R, Baune BT, Bayati M, Bayileyegn NS, Beaney T, Bedi N, Begum T, Behboudi E, Behnoush AH, Beiranvand M, Bejarano Ramirez DF, Belgaumi UI, Bell ML, Bello AK, Bello MB, Bello OO, Belo L, Beloukas A, Bendak S, Bennett DA, Bensenor IM, Benzian H, Berezvai Z, Berman AE, Bermudez ANC, Bettencourt PJG, Beyene HB, Beyene KA, Bhagat DS, Bhagavathula AS, Bhala N, Bhalla A, Bhandari D, Bhardwaj N, Bhardwaj P, Bhardwaj PV, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Binmadi N, Bintoro BS, Biondi A, Bisignano C, Bisulli F, Biswas A, Biswas RK, Bitaraf S, Bjørge T, Bleyer A, Boampong MS, Bodolica V, Bodunrin AO, Bolarinwa OA, Bonakdar Hashemi M, Bonny A, Bora K, Bora Basara B, Borodo SB, Borschmann R, Botero Carvajal A, Bouaoud S, Boudalia S, Boyko EJ, Bragazzi NL, Braithwaite D, Brenner H, Britton G, Browne AJ, Brunoni AR, Bulamu NB, Bulto LN, Buonsenso D, Burkart K, Burns RA, Burugina Nagaraja S, Busse R, Bustanji Y, Butt ZA, Caetano dos Santos FL, Cai T, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cardenas CA, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Caye A, Cederroth CR, Cembranel F, Cenderadewi M, Cercy KM, Cerin E, Cevik M, Chacón-Uscamaita PRU, Chahine Y, Chakraborty C, Chan JSK, Chang CK, Charalampous P, Charan J, Chattu VK, Chatzimavridou-Grigoriadou V, Chavula MP, Cheema HA, Chen AT, Chen H, Chen L, Chen MX, Chen S, Cherbuin N, Chew DS, Chi G, Chirinos-Caceres JL, Chitheer A, Cho SMJ, Cho WCS, Chong B, Chopra H, Choudhary R, Chowdhury R, Chu DT, Chukwu IS, Chung E, Chung E, Chung SC, Cini KI, Clark CCT, Coberly K, Columbus A, Comfort H, Conde J, Conti S, Cortesi PA, Costa VM, Cousin E, Cowden RG, Criqui MH, Cruz-Martins N, Culbreth GT, Cullen P, Cunningham M, da Silva e Silva D, Dadana S, Dadras O, Dai Z, Dalal K, Dalli LL, Damiani G, D'Amico E, Daneshvar S, Darwesh AM, Das JK, Das S, Dash NR, Dashti M, Dávila-Cervantes CA, Davis Weaver N, Davletov K, De Leo D, Debele AT, Degenhardt L, Dehbandi R, Deitesfeld L, Delgado-Enciso I, Delgado-Ortiz L, Demant D, Demessa BH, Demetriades AK, Deng X, Denova-Gutiérrez E, Deribe K, Dervenis N, Des Jarlais DC, Desai HD, Desai R, Deuba K, Devanbu VGC, Dey S, Dhali A, Dhama K, Dhimal ML, Dhimal M, Dhingra S, Dias da Silva D, Diaz D, Dima A, Ding DD, Dirac MA, Dixit A, Dixit SG, Do TC, Do THP, do Prado CB, Dodangeh M, Dokova KG, Dolecek C, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Douiri A, Dowou RK, Driscoll TR, Dsouza HL, Dube J, Dumith SC, Dunachie SJ, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dutta S, Dzianach PA, Dziedzic AM, Ebenezer O, Eboreime E, Ebrahimi A, Echieh CP, Ed-Dra A, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Eghdami S, Eikemo TA, Eini E, Ekholuenetale M, Ekpor E, Ekundayo TC, El Arab RA, El Morsi DAW, El Sayed Zaki M, El Tantawi M, Elbarazi I, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, Elmeligy OAA, Elshaer M, Elsohaby I, Emami Zeydi A, Emamverdi M, Emeto TI, Engelbert Bain L, Erkhembayar R, Eshetie TC, Eskandarieh S, Espinosa-Montero J, Estep K, Etaee F, Eze UA, Fabin N, Fadaka AO, Fagbamigbe AF, Fahimi S, Falzone L, Farinha CSES, Faris MEM, Farjoud Kouhanjani M, Faro A, Farrokhpour H, Fatehizadeh A, Fattahi H, Fauk NK, Fazeli P, Feigin VL, Fekadu G, Fereshtehnejad SM, Feroze AH, Ferrante D, Ferrara P, Ferreira N, Fetensa G, Filip I, Fischer F, Flavel J, Flaxman AD, Flor LS, Florin BT, Folayan MO, Foley KM, Fomenkov AA, Force LM, Fornari C, Foroutan B, Foschi M, Francis KL, Franklin RC, Freitas A, Friedman J, Friedman SD, Fukumoto T, Fuller JE, Gaal PA, Gadanya MA, Gaihre S, Gaipov A, Gakidou E, Galali Y, Galehdar N, Gallus S, Gan Q, Gandhi AP, Ganesan B, Garg J, Gau SY, Gautam P, Gautam RK, Gazzelloni F, Gebregergis MW, Gebrehiwot M, Gebremariam TB, Gerema U, Getachew ME, Getachew T, Gething PW, Ghafourifard M, Ghahramani S, Ghailan KY, Ghajar A, Ghanbarnia MJ, Ghasemi M, Ghasemzadeh A, Ghassemi F, Ghazy RM, Ghimire S, Gholamian A, Gholamrezanezhad A, Ghorbani Vajargah P, Ghozali G, Ghozy S, Ghuge AD, Gialluisi A, Gibson RM, Gil AU, Gill PS, Gill TK, Gillum RF, Ginindza TG, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Goel A, Goldust M, Golechha M, Goleij P, Golestanfar A, Golinelli D, Gona PN, Goudarzi H, Goudarzian AH, Goyal A, Greenhalgh S, Grivna M, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Gunawardane DA, Gunturu S, Guo C, Gupta AK, Gupta B, Gupta IR, Gupta RD, Gupta S, Gupta VB, Gupta VK, Gupta VK, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Hachinski V, Haddadi M, Haddadi R, Haep N, Hajj Ali A, Halboub ES, Halim SA, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hamagharib Abdullah K, Hamidi S, Hamiduzzaman M, Hammoud A, Hanifi N, Hankey GJ, Hannan MA, Haque MN, Harapan H, Haro JM, Hasaballah AI, Hasan F, Hasan I, Hasan MT, Hasani H, Hasanian M, Hasanpour- Dehkordi A, Hassan AM, Hassan A, Hassanian-Moghaddam H, Hassanipour S, Haubold J, Havmoeller RJ, Hay SI, Hbid Y, Hebert JJ, Hegazi OE, Heidari G, Heidari M, Heidari-Foroozan M, Heidari-Soureshjani R, Helfer B, Herteliu C, Hesami H, Hettiarachchi D, Heyi DZ, Hezam K, Hiraike Y, Hoffman HJ, Holla R, Horita N, Hossain MB, Hossain MM, Hossain S, Hosseini MS, Hosseinzadeh H, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hsairi M, Hsieh VCR, Hu C, Huang J, Huda MN, Hugo FN, Hultström M, Hussain J, Hussain S, Hussein NR, Huy LD, Huynh HH, Hwang BF, Ibitoye SE, Idowu OO, Ijo D, Ikuta KS, Ilaghi M, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Inbaraj LR, Iradukunda A, Iravanpour F, Iregbu KC, Islam MR, Islam MM, Islam SMS, Islami F, Ismail NE, Isola G, Iwagami M, Iwu CCD, Iwu-Jaja CJ, Iyer M, J LM, Jaafari J, Jacob L, Jacobsen KH, Jadidi-Niaragh F, Jafarinia M, Jaggi K, Jahankhani K, Jahanmehr N, Jahrami H, Jain A, Jain N, Jairoun AA, Jakovljevic M, Jalilzadeh Yengejeh R, Jamshidi E, Jani CT, Janko MM, Jatau AI, Jayapal SK, Jayaram S, Jeganathan J, Jema AT, Jemere DM, Jeong W, Jha AK, Jha RP, Ji JS, Jiang H, Jin Y, Jin Y, Johnson O, Jomehzadeh N, Jones DP, Joo T, Joseph A, Joseph N, Joshua CE, Jozwiak JJ, Jürisson M, Kaambwa B, Kabir A, Kabir H, Kabir Z, Kadashetti V, Kahe F, Kakodkar PV, Kalani R, Kalankesh LR, Kaliyadan F, Kalra S, Kamath A, Kamireddy A, Kanagasabai T, Kandel H, Kanmiki EW, Kanmodi KK, Kantar RS, Kapoor N, Karajizadeh M, Karami Matin B, Karanth SD, Karaye IM, Karim A, Karimi H, Karimi SE, Karimi Behnagh A, Karkhah S, Karna AK, Kashoo FZ, Kasraei H, Kassaw NA, Kassebaum NJ, Kassel MB, Katamreddy A, Katikireddi SV, Katoto PDMC, Kauppila JH, Kaur N, Kaydi N, Kayibanda JF, Kayode GA, Kazemi F, Kazemian S, Kazeminia S, Keikavoosi-Arani L, Keller C, Kempen JH, Kerr JA, Kesse-Guyot E, Keykhaei M, Khadembashiri MM, Khadembashiri MA, Khafaie MA, Khajuria H, Khalafi M, Khalaji A, Khalid N, Khalil IA, Khamesipour F, Khan A, Khan G, Khan I, Khan IA, Khan M, Khan MAB, Khan T, Khan suheb MZ, Khanmohammadi S, Khatab K, Khatami F, Khavandegar A, Khayat Kashani HR, Kheirallah KA, Khidri FF, Khodadoust E, Khormali M, Khosrowjerdi M, Khubchandani J, Khusun H, Kifle ZD, Kim G, Kim J, Kimokoti RW, Kinzel KE, Kiross GT, Kisa A, Kisa S, Kiss JB, Kivimäki M, Klu D, Knudsen AKS, Kolahi AA, Kompani F, Koren G, Kosen S, Kostev K, Kotnis AL, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Kravchenko MA, Krishan K, Krishna H, Krishnamoorthy V, Krishnamoorthy Y, Krohn KJ, Kuate Defo B, Kubeisy CM, Kucuk Bicer B, Kuddus MA, Kuddus M, Kuitunen I, Kujan O, Kulimbet M, Kulkarni V, Kumar A, Kumar H, Kumar N, Kumar R, Kumar S, Kumari M, Kurmanova A, Kurmi OP, Kusnali A, Kusuma D, Kutluk T, Kuttikkattu A, Kyei EF, Kyriopoulos I, La Vecchia C, Ladan MA, Laflamme L, Lahariya C, Lahmar A, Lai DTC, Laksono T, Lal DK, Lalloo R, Lallukka T, Lám J, Lamnisos D, Lan T, Lanfranchi F, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Latief K, Latif M, Latifinaibin K, Lauriola P, Le LKD, Le NHH, Le TTT, Le TDT, Lee M, Lee PH, Lee SW, Lee SW, Lee WC, Lee YH, Legesse SM, Leigh J, Lenzi J, Leong E, Lerango TL, Li MC, Li W, Li X, Li Y, Li Z, Libra M, Ligade VS, Likaka ATM, Lim LL, Lin RT, Lin S, Lioutas VA, Listl S, Liu J, Liu S, Liu X, Livingstone KM, Llanaj E, Lo CH, Loreche AM, Lorenzovici L, Lotfi M, Lotfizadeh M, Lozano R, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Ma J, Ma S, Ma ZF, Mabrok M, Machairas N, Machoy M, Madsen C, Magaña Gómez JA, Maghazachi AA, Maharaj SB, Maharjan P, Mahjoub S, Mahmoud MA, Mahmoudi E, Mahmoudi M, Makram OM, Malagón-Rojas JN, Malakan Rad E, Malekzadeh R, Malhotra AK, Malhotra K, Malik AA, Malik I, Malinga LA, Malta DC, Mamun AA, Manla Y, Mannan F, Mansoori Y, Mansour A, Mansouri V, Mansournia MA, Mantovani LG, Marasini BP, Marateb HR, Maravilla JC, Marconi AM, Mardi P, Marino M, Marjani A, Marrugo Arnedo CA, Martinez-Guerra BA, Martinez-Piedra R, Martins CA, Martins-Melo FR, Martorell M, Marx W, Maryam S, Marzo RR, Mate KKV, Matei CN, Mathioudakis AG, Maude RJ, Maugeri A, May EA, Mayeli M, Mazaheri M, Mazidi M, Mazzotti A, McAlinden C, McGrath JJ, McKee M, McKowen ALW, McLaughlin SA, McPhail MA, McPhail SM, Mechili EA, Mediratta RP, Meena JK, Mehari M, Mehlman ML, Mehra R, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mehrotra R, Mekonnen MM, Mendoza W, Menezes RG, Mengesha EW, Mensah GA, Mensah LG, Mentis AFA, Meo SA, Meretoja A, Meretoja TJ, Mersha AM, Mesfin BA, Mestrovic T, Mhlanga A, Mhlanga L, Mi T, Micha G, Michalek IM, Miller TR, Mindlin SN, Minelli G, Minh LHN, Mini GK, Minja NW, Mirdamadi N, Mirghafourvand M, Mirica A, Mirinezhad SK, Mirmosayyeb O, Mirutse MK, Mirza-Aghazadeh-Attari M, Mirzaei M, Misgana T, Misra S, Mitchell PB, Mithra P, Mittal C, Mittal M, Moazen B, Mohamed AI, Mohamed J, Mohamed MFH, Mohamed NS, Mohammad-Alizadeh-Charandabi S, Mohammadi S, Mohammadian-Hafshejani A, Mohammad-pour S, Mohammadshahi M, Mohammed M, Mohammed S, Mohammed S, Mojiri-forushani H, Mokdad AH, Mokhtarzadehazar P, Momenzadeh K, Momtazmanesh S, Monasta L, Moni MA, Montazeri F, Moodi Ghalibaf A, Moradi M, Moradi Y, Moradi-Lakeh M, Moradinazar M, Moradpour F, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosaddeghi Heris R, Mosser JF, Mossialos E, Mostafavi H, Mostofinejad A, Mougin V, Mouodi S, Mousavi P, Mousavi SE, Mousavi Khaneghah A, Mpundu-Kaambwa C, Mrejen M, Mubarik S, Muccioli L, Mueller UO, Mughal F, Mukherjee S, Mukoro GD, Mulita A, Mulita F, Muniyandi M, Munjal K, Musaigwa F, Musallam KM, Mustafa G, Muthu S, Muthupandian S, Myung W, Nabhan AF, Nafukho FM, Nagarajan AJ, Naghavi M, Naghavi P, Naik GR, Naik G, Naimzada MD, Nair S, Nair TS, Najmuldeen HHR, Naldi L, Nangia V, Nargus S, Nascimento BR, Nascimento GG, Naser AY, Nasiri MJ, Natto ZS, Nauman J, Naveed M, Nayak BP, Nayak VC, Nayyar AK, Nazri-Panjaki A, Negash H, Negero AK, Negoi I, Negoi RI, Negru SM, Nejadghaderi SA, Nejjari C, Nematollahi MH, Nena E, Nepal S, Nesbit OD, Newton CRJ, Ngunjiri JW, Nguyen DH, Nguyen PT, Nguyen PT, Nguyen TT, Nguyen VT, Nigatu YT, Nikolouzakis TK, Nikoobar A, Nikpoor AR, Nizam MA, Nomura S, Noreen M, Noroozi N, Norouzian Baghani A, Norrving B, Noubiap JJ, Novotney A, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nuñez-Samudio V, Nurrika D, Oancea B, Obamiro KO, Odetokun IA, Ofakunrin AOD, Ogunsakin RE, Oguta JO, Oh IH, Okati-Aliabad H, Okeke SR, Okekunle AP, Okidi L, Okonji OC, Okwute PG, Olagunju AT, Olaiya MT, Olanipekun TO, Olatubi MI, Olivas-Martinez A, Oliveira GMM, Oliver S, Olorukooba AA, Olufadewa II, Olusanya BO, Olusanya JO, Oluwafemi YD, Oluwatunase GO, Omar HA, Omer GL, Ong S, Onwujekwe OE, Onyedibe KI, Opio JN, Ordak M, Orellana ER, Orisakwe OE, Orish VN, Orru H, Ortega-Altamirano DV, Ortiz A, Ortiz-Brizuela E, Ortiz-Prado E, Osuagwu UL, Otoiu A, Otstavnov N, Ouyahia A, Ouyang G, Owolabi MO, Oyeyemi IT, Oyeyemi OT, Ozten Y, P A MP, Padubidri JR, Pahlavikhah Varnosfaderani M, Pal PK, Palicz T, Palladino C, Palladino R, Palma-Alvarez RF, Pana A, Panahi P, Pandey A, Pandi-Perumal SR, Pando-Robles V, Pangaribuan HU, Panos GD, Pantazopoulos I, Papadopoulou P, Pardhan S, Parikh RR, Park S, Parthasarathi A, Pashaei A, Pasupula DK, Patel JR, Patel SK, Pathan AR, Patil A, Patil S, Patoulias D, Patthipati VS, Paudel U, Pawar S, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Peng M, Pensato U, Pepito VCF, Peprah EK, Pereira G, Pereira J, Pereira M, Peres MFP, Perianayagam A, Perico N, Petcu IR, Petermann-Rocha FE, Pezzani R, Pham HT, Phillips MR, Pierannunzio D, Pigeolet M, Pigott DM, Pilgrim T, Pinheiro M, Piradov MA, Plakkal N, Plotnikov E, Poddighe D, Pollner P, Poluru R, Pond CD, Postma MJ, Poudel GR, Poudel L, Pourali G, Pourtaheri N, Prada SI, Pradhan PMS, Prajapati VK, Prakash V, Prasad CP, Prasad M, Prashant A, Prates EJS, Purnobasuki H, Purohit BM, Puvvula J, Qaisar R, Qasim NH, Qattea I, Qian G, Quan NK, Radfar A, Radhakrishnan V, Raee P, Raeisi Shahraki H, Rafiei Alavi SN, Rafique I, Raggi A, Rahim F, Rahman MM, Rahman M, Rahman MA, Rahman T, Rahmani AM, Rahmani S, Rahnavard N, Rai P, Rajaa S, Rajabpour-Sanati A, Rajput P, Ram P, Ramadan H, Ramasamy SK, Ramazanu S, Rana J, Rana K, Ranabhat CL, Rancic N, Rani S, Ranjan S, Rao CR, Rao IR, Rao M, Rao SJ, Rasali DP, Rasella D, Rashedi S, Rashedi V, Rashid AM, Rasouli-Saravani A, Rastogi P, Rasul A, Ravangard R, Ravikumar N, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghian-Jahromi I, Reddy MMRK, Redwan EMM, Rehman FU, Reiner Jr RC, Remuzzi G, Reshmi B, Resnikoff S, Reyes LF, Rezaee M, Rezaei N, Rezaei N, Rezaeian M, Riaz MA, Ribeiro AI, Ribeiro DC, Rickard J, Rios-Blancas MJ, Robinson-Oden HE, Rodrigues M, Rodriguez JAB, Roever L, Rohilla R, Rohloff P, Romadlon DS, Ronfani L, Roshandel G, Roshanzamir S, Rostamian M, Roy B, Roy P, Rubagotti E, Rumisha SF, Rwegerera GM, Rynkiewicz A, S M, S N C, S Sunnerhagen K, Saad AMA, Sabbatucci M, Saber K, Saber-Ayad MM, Sacco S, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi M, Sadeghian S, Saeed U, Saeedi M, Safi S, Sagar R, Saghazadeh A, Saheb Sharif-Askari N, Sahoo SS, Sahraian MA, Sajedi SA, Sajid MR, Sakshaug JW, Salahi S, Salahi S, Salamati P, Salami AA, Salaroli LB, Saleh MA, Salehi S, Salem MR, Salem MZY, Salimi S, Samadi Kafil H, Samadzadeh S, Samara KA, Samargandy S, Samodra YL, Samuel VP, Samy AM, Sanabria J, Sanadgol N, Sanganyado E, Sanjeev RK, Sanmarchi F, Sanna F, Santri IN, Santric-Milicevic MM, Sarasmita MA, Saravanan A, Saravi B, Sarikhani Y, Sarkar C, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Sattin D, Saulam J, Sawyer SM, Saxena S, Saya GK, Sayadi Y, Sayeed A, Sayeed MA, Saylan M, Scarmeas N, Schaarschmidt BM, Schlee W, Schmidt MI, Schuermans A, Schwebel DC, Schwendicke F, Šekerija M, Selvaraj S, Semreen MH, Senapati S, Sengupta P, Senthilkumaran S, Sepanlou SG, Serban D, Sertsu A, Sethi Y, SeyedAlinaghi S, Seyedi SA, Shafaat A, Shafaat O, Shafie M, Shafiee A, Shah NS, Shah PA, Shahabi S, Shahbandi A, Shahid I, Shahid S, Shahid W, Shahwan MJ, Shaikh MA, Shakeri A, Shakil H, Sham S, Shamim MA, Shams-Beyranvand M, Shamshad H, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Shariff M, Sharifi-Rad J, Sharma M, Sharma R, Sharma S, Sharma V, Shastry RP, Shavandi A, Shaw DH, Shayan AM, Shehabeldine AME, Sheikh A, Sheikhi RA, Shen J, Shenoy MM, Shetty BSK, Shetty RS, Shey RA, Shiani A, Shibuya K, Shiferaw D, Shigematsu M, Shin JI, Shin MJ, Shiri R, Shirkoohi R, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shool S, Shrestha S, Shuja KH, Shuval K, Si Y, Sibhat MM, Siddig EE, Sigfusdottir ID, Silva JP, Silva LMLR, Silva S, Simões JP, Simpson CR, Singal A, Singh A, Singh A, Singh A, Singh BB, Singh B, Singh M, Singh M, Singh NP, Singh P, Singh S, Siraj MS, Sitas F, Sivakumar S, Skryabin VY, Skryabina AA, Sleet DA, Slepak ELN, Sohrabi H, Soleimani H, Soliman SSM, Solmi M, Solomon Y, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Sreeramareddy CT, Starnes JR, Starodubov VI, Starodubova AV, Stefan SC, Stein DJ, Steinbeis F, Steiropoulos P, Stockfelt L, Stokes MA, Stortecky S, Stranges S, Stroumpoulis K, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Sunkersing D, Susanty S, Swain CK, Sykes BL, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabish M, Taborda-Barata LM, Tabuchi T, Tadesse BT, Taheri A, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Tajbakhsh A, Talaat IM, Talukder A, Tamuzi JL, Tan KK, Tang H, Tang HK, Tat NY, Tat VY, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tebeje TM, Tefera YM, Teimoori M, Temsah MH, Temsah RMH, Teramoto M, Tesfaye SH, Thangaraju P, Thankappan KR, Thapa R, Thapar R, Thomas N, Thrift AG, Thum CCC, Tian J, Tichopad A, Ticoalu JHV, Tiruye TY, Tohidast SA, Tonelli M, Touvier M, Tovani-Palone MR, Tram KH, Tran NM, Trico D, Trihandini I, Tromans SJ, Truong VT, Truyen TTTT, Tsermpini EE, Tumurkhuu M, Tung K, Tyrovolas S, Ubah CS, Udoakang AJ, Udoh A, Ulhaq I, Ullah S, Ullah S, Umair M, Umar TP, Umeokonkwo CD, Umesh A, Unim B, Unnikrishnan B, Upadhyay E, Urso D, Vacante M, Vahdani AM, Vaithinathan AG, Valadan Tahbaz S, Valizadeh R, Van den Eynde J, Varavikova E, Varga O, Varma SA, Vart P, Varthya SB, Vasankari TJ, Veerman LJ, Venketasubramanian N, Venugopal D, Verghese NA, Verma M, Verma P, Veroux M, Verras GI, Vervoort D, Vieira RJ, Villafañe JH, Villani L, Villanueva GI, Villeneuve PJ, Violante FS, Visontay R, Vlassov V, Vo B, Vollset SE, Volovat SR, Volovici V, Vongpradith A, Vos T, Vujcic IS, Vukovic R, Wado YD, Wafa HA, Waheed Y, Wamai RG, Wang C, Wang D, Wang F, Wang S, Wang S, Wang Y, Wang YP, Ward P, Watson S, Weaver MR, Weerakoon KG, Weiss DJ, Weldemariam AH, Wells KM, Wen YF, Werdecker A, Westerman R, Wickramasinghe DP, Wickramasinghe ND, Wijeratne T, Wilson S, Wojewodzic MW, Wool EE, Woolf AD, Wu D, Wulandari RD, Xiao H, Xu B, Xu X, Yadav L, Yaghoubi S, Yang L, Yano Y, Yao Y, Ye P, Yesera GE, Yesodharan R, Yesuf SA, Yiğit A, Yiğit V, Yip P, Yon DK, Yonemoto N, You Y, Younis MZ, Yu C, Zadey S, Zadnik V, Zafari N, Zahedi M, Zahid MN, Zahir M, Zakham F, Zaki N, Zakzuk J, Zamagni G, Zaman BA, Zaman SB, Zamora N, Zand R, Zandi M, Zandieh GGZ, Zanghì A, Zare I, Zastrozhin MS, Zeariya MGM, Zeng Y, Zhai C, Zhang C, Zhang H, Zhang H, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao Y, Zhao Y, Zheng P, Zhong C, Zhou J, Zhu B, Zhu Z, Ziaeefar P, Zielińska M, Zou Z, Zumla A, Zweck E, Zyoud SH, Lim SS, Murray CJL. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:1989-2056. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Alniss HY, Al-Jubeh HM, Msallam YA, Siddiqui R, Makhlouf Z, Ravi A, Hamdy R, Soliman SSM, Khan NA. Structure-based drug design of DNA minor groove binders and evaluation of their antibacterial and anticancer properties. Eur J Med Chem 2024; 271:116440. [PMID: 38678825 DOI: 10.1016/j.ejmech.2024.116440] [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: 12/07/2023] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
Antimicrobial and chemotherapy resistance are escalating medical problem of paramount importance. Yet, research for novel antimicrobial and anticancer agents remains lagging behind. With their reported medical applications, DNA minor groove binders (MGBs) are worthy of exploration. In this study, the approach of structure-based drug design was implemented to generate 11 MGB compounds including a novel class of bioactive alkyne-linked MGBs. The NCI screening protocol was utilized to evaluate the antitumor activity of the target MGBs. Furthermore, a variety of bactericidal, cytopathogenicity, MIC90, and cytotoxicity assays were carried out using these MGBs against 6 medically relevant bacteria: Salmonella enterica, Escherichia coli, Serratia marcescens, Bacillus cereus, Streptococcus pneumoniae and Streptococcus pyogenes. Moreover, molecular docking, molecular dynamic simulations, DNA melting, and isothermal titration calorimetry (ITC) analyses were utilized to explore the binding mode and interactions between the most potent MGBs and the DNA duplex d(CGACTAGTCG)2. NCI results showed that alkyne-linked MGBs (26 & 28) displayed the most significant growth inhibition among the NCI-60 panel. In addition, compounds MGB3, MGB4, MGB28, and MGB32 showed significant bactericidal effects, inhibited B. cereus and S. enterica-mediated cytopathogenicity, and exhibited low cytotoxicity. MGB28 and MGB32 demonstrated significant inhibition of S. pyogenes, whereas MGB28 notably inhibited S. marcescens and all four minor groove binders significantly inhibited B. cereus. The ability of these compounds to bind with DNA and distort its groove dimensions provides the molecular basis for the allosteric perturbation of proteins-DNA interactions by MGBs. This study shed light on the mechanism of action of MGBs and revealed the important structural features for their antitumor and antibacterial activities, which are important to guide future development of MGB derivatives as novel antibacterial and anticancer agents.
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Affiliation(s)
- Hasan Y Alniss
- College of Pharmacy, Department of Medicinal Chemistry, University of Sharjah, 27272, Sharjah, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, 27272, Sharjah, United Arab Emirates.
| | - Hadeel M Al-Jubeh
- Research Institute for Medical and Health Sciences, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Yousef A Msallam
- College of Pharmacy, Department of Medicinal Chemistry, University of Sharjah, 27272, Sharjah, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Ruqaiyyah Siddiqui
- Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot-Watt University Edinburgh, EH14 4AS, United Kingdom; Department of Medical Biology, Faculty of Medicine, Istinye University, Istanbul, 34010, Turkey
| | - Zinb Makhlouf
- College of Medicine, Department of Clinical Sciences, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Anil Ravi
- Research Institute for Medical and Health Sciences, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Sameh S M Soliman
- College of Pharmacy, Department of Medicinal Chemistry, University of Sharjah, 27272, Sharjah, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Naveed A Khan
- Department of Medical Biology, Faculty of Medicine, Istinye University, Istanbul, 34010, Turkey.
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Al Shareef Z, Al-Shahrabi R, Saheb Sharif-Askari F, AlDhmanie A, Alshamsi Y, Zarooni AA, Mahmoud RA, Soliman SSM, Halwani R, Bendardaf R. Incidence and risk factors of prostate cancer among the Northern and Eastern parts of the United Arab Emirates population. Prostate 2024; 84:185-192. [PMID: 37969038 DOI: 10.1002/pros.24637] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/22/2023] [Accepted: 09/25/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Prostate cancer (PCa) is a prevalent disease worldwide. However, the incidence and patient-specific risk factors of PCa in the Middle East, specifically in the United Arab Emirates, have not been previously reported. METHODS We conducted a retrospective cohort study on 2377 men diagnosed with either benign prostatic hyperplasia (BPH) or PCa in the Northern and Eastern regions of the United Arab Emirates, excluding the Western part, which includes Abu Dhabi. The study spanned from January 2012 and December 2021. To calculate the PCa incidence rate, we utilized the world age-standardized incidence rates (W-ASIR) categorized by age groups. Patient-specific risk factors of PCa were identified through a multivariate logistic regression analysis of clinical data. RESULTS A total of 247 cases of PCa and 2130 cases of BPH were included in the study. In our cohort, the W-ASIR for PCa was 21.3 per 100,000 men. The incidence of PCa showed an increasing trend with age, with the highest incidence observed among men aged 70 years and older. Accordingly, multivariate analysis revealed that age over 70 was associated with an increased risk of PCa (OR: 2.546, 95% confidence interval [CI]: 1.892-3.425, p < 0.01). On the other hand, preexisting conditions such as hypertension and diabetes mellitus were found to lower the risk of PCa (OR: 0.222, 95% CI: 0.163-0.302, p < 0.001) and (OR: 0.364, 95% CI: 0.205-0.648, p < 0.001), respectively. Additionally, metformin intake was associated with a reduced risk of PCa (OR: 0.385, 95% CI: 0.190-0.782, p = 0.008); while insulin usage increased the risk of PCa (OR: 2.586, 95% CI: 1.539-4.344, p < 0.001). Anti-BPH medications such as phosphodiesterase inhibitors (OR: 0.223, 95% CI: 0.069-0.723, p = 0.012) or 5-α reductase (OR: 0.206, 95% CI: 0.110-0.389, p < 0.000), were found to lower the risk of PCa. CONCLUSION The findings underscore the high incidence of PCa in the United Arab Emirates, with age being a significant factor. Furthermore, the study highlights the influence of certain comorbidities and medications on the risk of developing PCa within the United Arab Emirates population.
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Affiliation(s)
- Zainab Al Shareef
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Rula Al-Shahrabi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatemeh Saheb Sharif-Askari
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Amna AlDhmanie
- Data & Statistics Department, Emirates Health Services, Dubai, United Arab Emirates
| | | | | | - Rabah Al Mahmoud
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Medicinal Chemistry, College of Pharmacy, Sharjah, United Arab Emirates
| | - Rabih Halwani
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Riyad Bendardaf
- Oncology Unit, University Hospital Sharjah, Sharjah, United Arab Emirates
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Shakartalla SB, Ashmawy NS, Semreen MH, Fayed B, Al Shareef ZM, Jayakumar MN, Ibrahim S, Rahmani M, Hamdy R, Soliman SSM. 1H-NMR metabolomics analysis identifies hypoxanthine as a novel metastasis-associated metabolite in breast cancer. Sci Rep 2024; 14:253. [PMID: 38167685 PMCID: PMC10762038 DOI: 10.1038/s41598-023-50866-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024] Open
Abstract
Breast cancer is one of the leading causes of death in females, mainly because of metastasis. Oncometabolites, produced via metabolic reprogramming, can influence metastatic signaling cascades. Accordingly, and based on our previous results, we propose that metabolites from highly metastatic breast cancer cells behave differently from less-metastatic cells and may play a significant role in metastasis. For instance, we aim to identify these metabolites and their role in breast cancer metastasis. Less metastatic cells (MCF-7) were treated with metabolites secreted from highly metastatic cells (MDA-MB-231) and the gene expression of three epithelial-to-mesenchymal transition (EMT) markers including E-cadherin, N-cadherin and vimentin were examined. Some metabolites secreted from MDA-MB-231 cells significantly induced EMT activity. Specifically, hypoxanthine demonstrated a significant EMT effect and increased the migration and invasion effects of MCF-7 cells through a hypoxia-associated mechanism. Hypoxanthine exhibited pro-angiogenic effects via increasing the VEGF and PDGF gene expression and affected lipid metabolism by increasing the gene expression of PCSK-9. Notably, knockdown of purine nucleoside phosphorylase, a gene encoding for an important enzyme in the biosynthesis of hypoxanthine, and inhibition of hypoxanthine uptake caused a significant decrease in hypoxanthine-associated EMT effects. Collectively for the first time, hypoxanthine was identified as a novel metastasis-associated metabolite in breast cancer cells and represents a promising target for diagnosis and therapy.
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Affiliation(s)
- Sarra B Shakartalla
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Faculty of Pharmacy, University of Gezira, P.O. Box. 21111, Wadmedani, Sudan
| | - Naglaa S Ashmawy
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, P.O. Box 4184, Ajman, United Arab Emirates
- Department of Pharmacognosy, Faculty of Pharmacy, Ain Shams University, Abbassia, P.O. Box 11566, Cairo, Egypt
| | - Mohammad H Semreen
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Chemistry of Natural and Microbial Product Department, National Research Centre, P.O. Box 12622, Cairo, Egypt
| | - Zainab M Al Shareef
- College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Manju N Jayakumar
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Saleh Ibrahim
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mohamed Rahmani
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, P.O. Box 127788, Abu Dhabi, United Arab Emirates
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Zagazig University, P.O. Box 44519, Zagazig, Egypt
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
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Almehdi AM, Soliman SSM, El-Shorbagi ANA, Westwell AD, Hamdy R. Design, Synthesis, and Potent Anticancer Activity of Novel Indole-Based Bcl-2 Inhibitors. Int J Mol Sci 2023; 24:14656. [PMID: 37834104 PMCID: PMC10572575 DOI: 10.3390/ijms241914656] [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: 07/26/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 10/15/2023] Open
Abstract
The Bcl-2 family plays a crucial role in regulating cell apoptosis, making it an attractive target for cancer therapy. In this study, a series of indole-based compounds, U1-6, were designed, synthesized, and evaluated for their anticancer activity against Bcl-2-expressing cancer cell lines. The binding affinity, safety profile, cell cycle arrest, and apoptosis effects of the compounds were tested. The designed compounds exhibited potent inhibitory activity at sub-micromolar IC50 concentrations against MCF-7, MDA-MB-231, and A549 cell lines. Notably, U2 and U3 demonstrated the highest activity, particularly against MCF-7 cells. Respectively, both U2 and U3 showed potential BCL-2 inhibition activity with IC50 values of 1.2 ± 0.02 and 11.10 ± 0.07 µM using an ELISA binding assay compared with 0.62 ± 0.01 µM for gossypol, employed as a positive control. Molecular docking analysis suggested stable interactions of compound U2 at the Bcl-2 binding site through hydrogen bonding, pi-pi stacking, and hydrophobic interactions. Furthermore, U2 demonstrated significant induction of apoptosis and cell cycle arrest at the G1/S phase. Importantly, U2 displayed a favourable safety profile on HDF human dermal normal fibroblast cells at 10-fold greater IC50 values compared with MDA-MB-231 cells. These findings underscore the therapeutic potential of compound U2 as a Bcl-2 inhibitor and provide insights into its molecular mechanisms of action.
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Affiliation(s)
- Ahmed M. Almehdi
- College of Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
- Research Institute for Science and Engineering (RISE), University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Sameh S. M. Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
| | | | - Andrew D. Westwell
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, Cardiff CF10 3NB, UK
| | - Rania Hamdy
- Research Institute for Science and Engineering (RISE), University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
- Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
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Alshamsi MAH, Mosa KA, Khan AA, Mousa M, Ali MA, Soliman SSM, Semreen MH. Biosynthesized Silver Nanoparticles from Cyperus Conglomeratus Root Extract Inhibit Osteogenic Differentiation of Immortalized Mesenchymal Stromal Cells. Curr Pharm Biotechnol 2023; 24:CPB-EPUB-133970. [PMID: 37612859 DOI: 10.2174/1389201024666230823094412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/23/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Silver nanoparticles (AgNPs) are a focus of huge interest in biological research, including stem cell research. AgNPs synthesized using Cyperus conglomeratus root extract have been previously reported but their effects on mesenchymal stromal cells have yet to be investigated. OBJECTIVES The aim of this study is to investigate the effects of C. conglomeratus-derived AgNPs on adipogenesis and osteogenesis of mesenchymal stromal cells. METHODS AgNPs were synthesized using C. conglomeratus root extract, and the phytochemicals involved in AgNPs synthesis were analyzed using gas chromatography-mass spectrometry (GC-MS). The cytotoxicity of the AgNPs was tested on telomerase-transformed immortalized human bone marrow-derived MSCs-hTERT (iMSC3) and human osteosarcoma cell line (MG-63) using MTT and apoptosis assays. The uptake of AgNPs by both cells was confirmed using inductively coupled plasma-optical emission spectrometry (ICP-OES). Furthermore, the effect of AgNPs on iMSC3 adipogenesis and osteogenesis was analyzed using stain quantification and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). RESULTS The phytochemicals predominately identified in both the AgNPs and C. conglomeratus root extract were carbohydrates. The AgNP concentrations tested using MTT and apoptosis assays (0.5-64 μg/ml and 1,4 and 32 μg/ml, respectively) showed no significant cytotoxicity on iMSC3 and MG-63. The AgNPs were internalized in a concentration-dependent manner in both cell types. Additionally, the AgNPs exhibited a significant negative effect on osteogenesis but not on adipogenesis. CONCLUSION C. conglomeratus-derived AgNPs had an impact on the differentiation capacity of iMSC3. Our results indicated that C. conglomeratus AgNPs and the associated phytochemicals could exhibit potential medical applications.
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Affiliation(s)
- Mohamed A H Alshamsi
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Kareem A Mosa
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Biotechnology, Faculty of Agriculture, Al-Azhar University, Cairo, Egypt
| | - Amir Ali Khan
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Muath Mousa
- University of Sharjah Research Institute of Science and Engineering (RISE) Sharjah city United Arab Emirates
| | - Muna A Ali
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sameh S M Soliman
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammad H Semreen
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Soliman SSM. Editorial: Candida spp.-transmission, pathogenesis, host-pathogen interaction, prevention, and treatment. Front Microbiol 2023; 14:1258837. [PMID: 37601362 PMCID: PMC10433895 DOI: 10.3389/fmicb.2023.1258837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
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13
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Fayed B, Lazreg IK, AlHumaidi RB, Qasem MAAA, Alajmy BMGN, Bojbarah FMAM, Senok A, Husseiny MI, Soliman SSM. Intra-clade Heterogeneity in Candida auris: Risk of Management. Curr Microbiol 2023; 80:295. [PMID: 37486431 DOI: 10.1007/s00284-023-03416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
Candida auris has emerged as a significant nosocomial fungal pathogen with a high risk of pathogenicity. Since the initial detection of C. auris in 2009, it gained lots of attention with a recent alert by the Centers for Disease Control and Prevention (CDC) due to its high infectivity and drug resistance. Several studies showed the capability of C. auris to secrete lytic enzymes, germinate, and form a biofilm that eventually results in interactions with the host cells, leading to serious infections. Other studies demonstrated a decrease in susceptibility of C. auris strains to available antifungals, which may be caused by mutations within the target genes, or the drug efflux pumps. However, the contribution of C. auris heterogeneity in pathogenicity and drug resistance is not well studied. Here, we shed light on the factors contributing to the development of heterogeneity in C. auris. These include phenotypic changes, biofilm formation, mechanisms of drug resistance, host invasion, mode of transmission, and expression of virulence factors. C. auris exhibits different phenotypes, particularly aggregative, and non-aggregative forms that play an important role in fungal heterogeneity, which significantly affects drug resistance and pathogenicity. Collectively, heterogeneity in C. auris significantly contributes to ineffective treatment, which in turn affects the fungal pathogenicity and drug resistance. Therefore, understanding the underlying reasons for C. auris heterogeneity and applying effective antifungal stewardship could play a major role in controlling this pathogen.
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Affiliation(s)
- Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Chemistry of Natural and Microbial Products, National Research Centre, Cairo, Egypt
| | - Imene K Lazreg
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Razan B AlHumaidi
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Maryam A A A Qasem
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Bashayir M Gh N Alajmy
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Fatemh M A M Bojbarah
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14 Dubai Healthcare City, P.O.Box 505055, Dubai, UAE
| | - Mohamed I Husseiny
- Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
- Department of Translational Research & Cellular Therapeutics, Arthur Riggs Diabetes & Metabolism Research Institute, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
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Altaie AM, Mohammad MG, Madkour MI, AlSaegh MA, Jayakumar MN, K G AR, Samsudin AR, Halwani R, Hamoudi RA, Soliman SSM. Molecular pathogenicity of 1-nonadecene and L-lactic acid, unique metabolites in radicular cysts and periapical granulomas. Sci Rep 2023; 13:10722. [PMID: 37400519 DOI: 10.1038/s41598-023-37945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/30/2023] [Indexed: 07/05/2023] Open
Abstract
Recently, 1-nonadecene and L-lactic acid were identified as unique metabolites in radicular cysts and periapical granuloma, respectively. However, the biological roles of these metabolites were unknown. Therefore, we aimed to investigate the inflammatory and mesenchymal-epithelial transition (MET) effects of 1-nonadecene, and the inflammatory and collagen precipitation effects of L-lactic acid on both periodontal ligament fibroblasts (PdLFs) and peripheral blood mononuclear cells (PBMCs). PdLFs and PBMCs were treated with 1-nonadecene and L-lactic acid. Cytokines' expression was measured using quantitative real-time polymerase chain reaction (qRT-PCR). E-cadherin, N-cadherin, and macrophage polarization markers were measured using flow cytometry. The collagen, matrix metalloproteinase (MMP)-1, and released cytokines were measured using collagen assay, western blot, and Luminex assay, respectively. In PdLFs, 1-nonadecene enhances inflammation through the upregulation of some inflammatory cytokines including IL-1β, IL-6, IL-12A, monocyte chemoattractant protein (MCP)-1, and platelet-derived growth factor (PDGF) α. 1-Nonadecene also induced MET through the upregulation of E-cadherin and the downregulation of N-cadherin in PdLFs. 1-Nonadecene polarized macrophages to a pro-inflammatory phenotype and suppressed their cytokines' release. L-lactic acid exerted a differential impact on the inflammation and proliferation markers. Intriguingly, L-lactic acid induced fibrosis-like effects by enhancing collagen synthesis, while inhibiting MMP-1 release in PdLFs. These results provide a deeper understanding of 1-nonadecene and L-lactic acid's roles in modulating the microenvironment of the periapical area. Consequently, further clinical investigation can be employed for target therapy.
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Affiliation(s)
- Alaa M Altaie
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Mohammad G Mohammad
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Mohamed I Madkour
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Mohammed Amjed AlSaegh
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Manju Nidagodu Jayakumar
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Aghila Rani K G
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - A R Samsudin
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Rabih Halwani
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Rifat A Hamoudi
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
- Department of Clinical Sciences, College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
- Division of Surgery and Interventional Science, University College London, London, United Kingdom.
- ASPIRE Precision Medicine Research Institute Abu Dhabi, University of Sharjah, Sharjah, United Arab Emirates.
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
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Hamoda AM, Hamdy R, Fayed B, Abouleish M, Sulaiman A, Hamad M, Soliman SSM. Evolutionary relevance of metabolite production in relation to marine sponge bacteria symbiont. Appl Microbiol Biotechnol 2023:10.1007/s00253-023-12649-3. [PMID: 37358811 DOI: 10.1007/s00253-023-12649-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/14/2023] [Accepted: 06/15/2023] [Indexed: 06/27/2023]
Abstract
Sponges are habitats for a diverse community of microorganisms. Sponges provide shelter, whereas microbes provide a complementary defensive mechanism. Here, a symbiotic bacterium, identified as Bacillus spp., was isolated from a marine sponge following culture enrichment. Fermentation-assisted metabolomics using thin-layer chromatography (TLC) and gas chromatography-mass spectrometry (GC-MS) indicated that marine simulated nutrition and temperature was the optimum in metabolite production represented by the highest number of metabolites and the diverse chemical classes when compared to other culture media. Following large-scale culture in potato dextrose broth (PDB) and dereplication, compound M1 was isolated and identified as octadecyl-1-(2',6'-di-tert-butyl-1'-hydroxyphenyl) propionate. M1, at screening concentrations up to 10 mg/ml, showed no activity against prokaryotic bacteria including Staphylococcus aureus and Escherichia coli, while 1 mg/ml of M1 was sufficient to cause a significant killing effect on eukaryotic cells including Candida albicans, Candida auris, and Rhizopus delemar fungi and different mammalian cells. M1 exhibited MIC50 0.97 ± 0.006 and 7.667 ± 0.079 mg/ml against C. albicans and C. auris, respectively. Like fatty acid esters, we hypothesize that M1 is stored in a less harmful form and upon pathogenic attack is hydrolyzed to a more active form as a defensive metabolite. Subsequently, [3-(3,5-di-tert-butyl-4-hydroxyphenyl)-propionic acid] (DTBPA), the hydrolysis product of M1, exhibited ~ 8-fold and 18-fold more antifungal activity than M1 against C. albicans and C. auris, respectively. These findings indicated the selectivity of that compound as a defensive metabolite towards the eukaryotic cells particularly the fungi, a major infectious agent to sponges. Metabolomic-assisted fermentation can provide a significant understanding of a triple marine-evolved interaction. KEY POINTS: • Bacillus species, closely related to uncultured Bacillus, is isolated from Gulf marine sponge • Metabolomic-assisted fermentations showed diverse metabolites • An ester with a killing effect against eukaryotes but not prokaryotes is isolated.
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Affiliation(s)
- Alshaimaa M Hamoda
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut-71526, Egypt
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Chemistry of Natural and Microbial Product Department, National Research Centre, Cairo, Egypt
| | - Mohamed Abouleish
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, P.O. Box 26666, Sharjah, UAE
| | - Ashna Sulaiman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Mohamad Hamad
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
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16
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Cobb J, Soliman SSM, Retuerto M, Quijano JC, Orr C, Ghannoum M, Kandeel F, Husseiny MI. Changes in the gut microbiota of NOD mice in response to an oral Salmonella-based vaccine against type 1 diabetes. PLoS One 2023; 18:e0285905. [PMID: 37224176 DOI: 10.1371/journal.pone.0285905] [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] [Received: 10/24/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023] Open
Abstract
We developed an oral Salmonella-based vaccine that prevents and reverses diabetes in non-obese diabetic (NOD) mice. Related to this, the gastrointestinal tract harbors a complex dynamic population of microorganisms, the gut microbiome, that influences host homeostasis and metabolism. Changes in the gut microbiome are associated with insulin dysfunction and type 1 diabetes (T1D). Oral administration of diabetic autoantigens as a vaccine can restore immune balance. However, it was not known if a Salmonella-based vaccine would impact the gut microbiome. We administered a Salmonella-based vaccine to prediabetic NOD mice. Changes in the gut microbiota and associated metabolome were assessed using next-generation sequencing and gas chromatography-mass spectrometry (GC-MS). The Salmonella-based vaccine did not cause significant changes in the gut microbiota composition immediately after vaccination although at 30 days post-vaccination changes were seen. Additionally, no changes were noted in the fecal mycobiome between vaccine- and control/vehicle-treated mice. Significant changes in metabolic pathways related to inflammation and proliferation were found after vaccine administration. The results from this study suggest that an oral Salmonella-based vaccine alters the gut microbiome and metabolome towards a more tolerant composition. These results support the use of orally administered Salmonella-based vaccines that induced tolerance after administration.
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Affiliation(s)
- Jacob Cobb
- Department of Translational Research & Cellular Therapeutics, Arthur Riggs Diabetes & Metabolism Research Institute, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, United States of America
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Mauricio Retuerto
- Center for Medical Mycology, Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Janine C Quijano
- Department of Translational Research & Cellular Therapeutics, Arthur Riggs Diabetes & Metabolism Research Institute, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, United States of America
| | - Chris Orr
- Department of Translational Research & Cellular Therapeutics, Arthur Riggs Diabetes & Metabolism Research Institute, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, United States of America
| | - Mahmoud Ghannoum
- Center for Medical Mycology, Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Fouad Kandeel
- Department of Translational Research & Cellular Therapeutics, Arthur Riggs Diabetes & Metabolism Research Institute, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, United States of America
| | - Mohamed I Husseiny
- Department of Translational Research & Cellular Therapeutics, Arthur Riggs Diabetes & Metabolism Research Institute, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, United States of America
- Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
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Al Shareef Z, Al-Shahrabi R, Saheb Sharif-Askari F, Alshamsi Y, Zarooni AA, AlKhayyal N, Soliman SSM, Bendardaf R, Halwani R. Risks of prostate cancer and mortality in the city of Sharjah, United Arab Emirates. Front Oncol 2023; 13:1180902. [PMID: 37287914 PMCID: PMC10243724 DOI: 10.3389/fonc.2023.1180902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 06/09/2023] Open
Abstract
Background Prostatic hyperplasia (BPH) and prostate cancer (PCa) are common age-related diseases in men. According to World Health Organization (WHO), PCa is the second most common cancer among Emirati men. This study aimed to identify the risk factors associated with PCa and mortality in a cohort diagnosed with PCa between 2012 and 2021 in Sharjah, United Arab Emirates (UAE). Methods The data collected in this retrospective case-control study included patient demographics and comorbidities, as well as PCa markers such as prostate-specific antigen (PSA), prostate volume, prostate-specific antigen density (PSAD), and Gleason scores. Risk factors for PCa were assessed using multivariate logistic regression analysis, and factors associated with all-cause mortality in PCa patients were evaluated using Cox-proportional hazard analysis. Results Of the 192 cases analyzed in this study, 88 were diagnosed with PCa and 104 were diagnosed with BPH. Regarding risk factors for PCa, a higher risk of PCa was associated with age 65 or older (OR=2.76, 95% confidence interval (CI): 1.04-7.30; P=0.038) and serum PSAD greater than 0.1 ng/mL2 (OR=3.48, 95% CI:1.66-7.32; P=0.001), whereas being of UAE nationals (OR=0.40, 95% CI:0.18-0.88; P=0.029) were associated with lower risk of PCa, after adjusting for patient demographics and comorbidities. Moreover, regarding cancer markers, higher serum PSA level (P=0.003) and smaller prostate volume (P=0.028) were associated with a higher risk of PCa, after adjusting with patients' age and BMI. Additionally, a high-grade Gleason score was associated with an increased risk of all-cause mortality after adjusting for patient's age and BMI (hazard ratio, aHR= 2.3, 95% CI:1.3-4.1; P= 0.016). Conclusion This study found that age 65 or older and serum PSAD greater than 0.1 ng/mL2 are risk factors for PCa, while UAE nationality is associated with a lower risk. PSAD may be a better screening marker for PCa compared to traditional markers such as PSA and prostate volume.
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Affiliation(s)
- Zainab Al Shareef
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Rula Al-Shahrabi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatemeh Saheb Sharif-Askari
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Younis Alshamsi
- Urology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Abdulqadir Al Zarooni
- Urology Department, Shaikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Noura AlKhayyal
- Oncology Unit, University Hospital of Sharjah, Sharjah, United Arab Emirates
| | - Sameh S. M. Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Riyad Bendardaf
- Oncology Unit, University Hospital of Sharjah, Sharjah, United Arab Emirates
| | - Rabih Halwani
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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18
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Cagliani R, Fayed B, Jagal J, Shakartalla SB, Soliman SSM, Haider M. Peptide-functionalized zinc oxide nanoparticles for the selective targeting of breast cancer expressing placenta-specific protein 1. Colloids Surf B Biointerfaces 2023; 227:113357. [PMID: 37210795 DOI: 10.1016/j.colsurfb.2023.113357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
Functionalized metal oxide nanoparticles (NPs) have demonstrated specific binding affinity to antigens or receptors presented on the cancer cell surface, favouring selective targeting and minimizing side effects during the chemotherapy. Placenta-specific protein 1 (PLAC-1) is a small cell surface protein overexpressed in certain types of breast cancer (BC); therefore, it can be used as a therapeutic target. The objective of this study is to develop NPs that can bind PLAC-1 and hence can inhibit the progression and metastatic potential of BC cells. Zinc oxide (ZnO) NPs were coated with a peptide (GILGFVFTL), which possesses a strong binding ability to PLAC-1. The physical attachment of the peptide to ZnO NPs was verified through various physicochemical and morphological characterization techniques. The selective cytotoxicity of the designed NPs was investigated using PLAC-1-bearing MDA-MB 231 human BC cell line and compared to LS-180 cells that do not express PLAC-1. The anti-metastatic and pro-apoptotic effects of the functionalized NPs on MDA-MB 231 cells were examined. Confocal microscopy was used to investigate the mechanism of NPs uptake by MDA-MB 231 cells. Compared to non-functionalized NPs, peptide functionalization significantly improved the targeting and uptake of the designed NPs by PLAC-1-expressing cancer cells with significant pro-apoptotic and anti-metastatic effects. The uptake of peptide functionalized ZnO NPs (ZnO-P NPs) occurred via peptide-PLAC1 interaction-assisted clathrin-mediated endocytosis. These findings highlight the potential targeted therapy of ZnO-P NPs against PLAC-1-expressing breast cancer cells.
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Affiliation(s)
- Roberta Cagliani
- Research Institute of Medical & Health Sciences, University of Sharjah, 27272 Sharjah, United Arab Emirates
| | - Bahgat Fayed
- Research Institute of Medical & Health Sciences, University of Sharjah, 27272 Sharjah, United Arab Emirates; Chemistry of Natural and Microbial Product Department, National Research Centre, Cairo 12622, Egypt
| | - Jayalakshmi Jagal
- Research Institute of Medical & Health Sciences, University of Sharjah, 27272 Sharjah, United Arab Emirates
| | - Sarra B Shakartalla
- Research Institute of Medical & Health Sciences, University of Sharjah, 27272 Sharjah, United Arab Emirates; College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; Faculty of Pharmacy, University of Gezira, P.O. Box. 21111, Wadmedani, Sudan
| | - Sameh S M Soliman
- Research Institute of Medical & Health Sciences, University of Sharjah, 27272 Sharjah, United Arab Emirates; Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, 27272 Sharjah, United Arab Emirates
| | - Mohamed Haider
- Research Institute of Medical & Health Sciences, University of Sharjah, 27272 Sharjah, United Arab Emirates; Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, University of Sharjah, 27272 Sharjah, United Arab Emirates.
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19
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Hamad M, AlKhamach DMH, Alsayadi LM, Sarhan SA, Saeed BQ, Sokovic M, Ben Hadda T, Soliman SSM. Alpha to Omicron (Variants of Concern): Mutation Journey, Vaccines, and Therapy. Viral Immunol 2023; 36:83-100. [PMID: 36695729 DOI: 10.1089/vim.2022.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) initially emerged in December 2019 and has subsequently expanded globally, leading to the ongoing pandemic. The extensive spread of various SARS-CoV-2 variants possesses a serious public health threat. An extensive literature search along with deep analysis was performed to describe and evaluate the characteristics of SARS-CoV-2 variants of concern in relation to the effectiveness of the current vaccines and therapeutics. The obtained results showed that several significant mutations have evolved during the COVID-19 pandemic. The developed variants and their various structural mutations can compromise the effectiveness of several vaccines, escape the neutralizing antibodies, and limit the efficiency of available therapeutics. Furthermore, deep analysis of the available data enables the prediction of the future impact of virus mutations on the ongoing pandemic along with the selection of appropriate vaccines and therapeutics.
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Affiliation(s)
- Mohamad Hamad
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Dana M H AlKhamach
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | | | | | | | - Marina Sokovic
- Institute for Biological Research "Siniša Stanković," National Institute of the Republic of Serbia, University of Belgrade, Beograd, Serbia
| | - Taibi Ben Hadda
- Laboratory of Applied Chemistry & Environment, Faculty of Sciences, Mohammed Premier University, Oujda, Morocco
| | - Sameh S M Soliman
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
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20
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Altaie AM, Mohammad MG, Madkour MI, Shakartalla SB, Jayakumar MN, K G AR, Halwani R, Samsudin AR, Hamoudi RA, Soliman SSM. The Essential Role of 17-Octadecynoic Acid in the Pathogenesis of Periapical Abscesses. J Endod 2023; 49:169-177.e3. [PMID: 36528175 DOI: 10.1016/j.joen.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Periapical abscesses are 1 of the most frequent pathologic lesions in the alveolar bone. Recently, we have identified 17-octadecynoic acid (17-ODYA) as the highest unique metabolite in periapical abscesses. Therefore, the aim of this study was to investigate the immunologic and pathophysiological roles of this metabolite in the initiation and development of periapical abscesses. METHODS Periodontal ligament fibroblasts and peripheral blood mononuclear cells were treated with 17-ODYA. Gene expression analysis and interleukin (IL)-8 release were determined using quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Macrophage polarization and cytokine release were also determined using flow cytometry and Luminex bioassay (R&D Systems, Minneapolis, MN), respectively. RESULTS In periodontal ligament fibroblasts, 17-ODYA caused significant (P < .0001) up-regulation of IL-1α, IL-1β, IL-6, matrix metalloproteinase-1, and monocyte chemoattractant protein-1 at 10 μmol/L after 6 days of treatment and up-regulation of platelet-derived growth factor alpha and vascular endothelial growth factor alpha at all tested concentrations after 2 days of treatment. In peripheral blood mononuclear cells, 17-ODYA significantly increased the expression of IL-1α, IL-1β, IL-6, matrix metalloproteinase-1, and monocyte chemoattractant protein-1 at 10 μmol/L (P < .0001) and vascular endothelial growth factor alpha and platelet-derived growth factor alpha at 1 μmol/L 17-ODYA (P < .0001). 17-ODYA polarized macrophages toward a proinflammatory phenotype (M1) and suppressed the release of pro- and anti-inflammatory cytokines. 17-ODYA significantly enhanced the release of IL-8. CONCLUSIONS This study was the first to identify the pathologic role of 17-ODYA in the development of periapical abscesses. The results of this study are important in shedding light on the pathogenesis of periapical abscesses in relation to microbial metabolites.
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Affiliation(s)
- Alaa M Altaie
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates; Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammad G Mohammad
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed I Madkour
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Sarra B Shakartalla
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Manju Nidagodu Jayakumar
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Aghila Rani K G
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Rabih Halwani
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - A R Samsudin
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rifat A Hamoudi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates; Division of Surgery and Interventional Science, University College London, London, United Kingdom.
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates.
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21
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Mohammad MG, Ashmawy NS, Al-Rawi AM, Abu-Qiyas A, Hamoda AM, Hamdy R, Dakalbab S, Arikat S, Salahat D, Madkour M, Soliman SSM. SARS-CoV-2-free residual proteins mediated phenotypic and metabolic changes in peripheral blood monocytic-derived macrophages in support of viral pathogenesis. PLoS One 2023; 18:e0280592. [PMID: 36656874 PMCID: PMC9851515 DOI: 10.1371/journal.pone.0280592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
The large-scale dissemination of coronavirus disease-2019 (COVID-19) and its serious complications have pledged the scientific research communities to uncover the pathogenesis mechanisms of its etiologic agent, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods of unveiling such mechanisms are rooted in understanding the viral agent's interactions with the immune system, including its ability to activate macrophages, due to their suggested role in prolonged inflammatory phases and adverse immune responses. The objective of this study is to test the effect of SARS-CoV-2-free proteins on the metabolic and immune responses of macrophages. We hypothesized that SARS-CoV-2 proteins shed during the infection cycle may dynamically induce metabolic and immunologic alterations with an inflammatory impact on the infected host cells. It is imperative to delineate such alterations in the context of macrophages to gain insight into the pathogenesis of these highly infectious viruses and their associated complications and thus, expedite the vaccine and drug therapy advent in combat of viral infections. Human monocyte-derived macrophages were treated with SARS-CoV-2-free proteins at different concentrations. The phenotypic and metabolic alterations in macrophages were investigated and the subsequent metabolic pathways were analyzed. The obtained results indicated that SARS-CoV-2-free proteins induced concentration-dependent alterations in the metabolic and phenotypic profiles of macrophages. Several metabolic pathways were enriched following treatment, including vitamin K, propanoate, and the Warburg effect. These results indicate significant adverse effects driven by residual viral proteins that may hence be considered determinants of viral pathogenesis. These findings provide important insight as to the impact of SARS-CoV-2-free residual proteins on the host cells and suggest a potential new method of management during the infection and prior to vaccination.
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Affiliation(s)
- Mohammad G. Mohammad
- Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, UAE
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Naglaa S. Ashmawy
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Pharmacognosy, Faculty of Pharmacy, Ain Shams University, Abbassia, Cairo, Egypt
| | - Ahmed M. Al-Rawi
- Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, UAE
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Ameera Abu-Qiyas
- Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, UAE
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Alshaimaa M. Hamoda
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- College of Medicine, University of Sharjah, Sharjah, UAE
- Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Salam Dakalbab
- Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, UAE
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Shahad Arikat
- Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Dana Salahat
- Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Mohamed Madkour
- Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Sameh S. M. Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- College of Pharmacy, University of Sharjah, Sharjah, UAE
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22
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Abufares HI, Oyoun Alsoud L, Alqudah MAY, Shara M, Soares NC, Alzoubi KH, El-Huneidi W, Bustanji Y, Soliman SSM, Semreen MH. COVID-19 Vaccines, Effectiveness, and Immune Responses. Int J Mol Sci 2022; 23:15415. [PMID: 36499742 PMCID: PMC9737588 DOI: 10.3390/ijms232315415] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/19/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has captivated the globe's attention since its emergence in 2019. This highly infectious, spreadable, and dangerous pathogen has caused health, social, and economic crises. Therefore, a worldwide collaborative effort was made to find an efficient strategy to overcome and develop vaccines. The new vaccines provide an effective immune response that safeguards the community from the virus' severity. WHO has approved nine vaccines for emergency use based on safety and efficacy data collected from various conducted clinical trials. Herein, we review the safety and effectiveness of the WHO-approved COVID-19 vaccines and associated immune responses, and their impact on improving the public's health. Several immunological studies have demonstrated that vaccination dramatically enhances the immune response and reduces the likelihood of future infections in previously infected individuals. However, the type of vaccination and individual health status can significantly affect immune responses. Exposure of healthy individuals to adenovirus vectors or mRNA vaccines causes the early production of antibodies from B and T cells. On the other hand, unhealthy individuals were more likely to experience harmful events due to relapses in their existing conditions. Taken together, aligning with the proper vaccination to a patient's case can result in better outcomes.
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Affiliation(s)
- Haneen Imad Abufares
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Leen Oyoun Alsoud
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Mohammad A. Y. Alqudah
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Mohd Shara
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Nelson C. Soares
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Karem H. Alzoubi
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Waseem El-Huneidi
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Yasser Bustanji
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Sameh S. M. Soliman
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Mohammad H. Semreen
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
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Al Shareef Z, Ershaid MNA, Mudhafar R, Soliman SSM, Kypta RM. Dickkopf-3: An Update on a Potential Regulator of the Tumor Microenvironment. Cancers (Basel) 2022; 14:cancers14235822. [PMID: 36497305 PMCID: PMC9738550 DOI: 10.3390/cancers14235822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
Abstract
Dickkopf-3 (Dkk-3) is a member of the Dickkopf family protein of secreted Wingless-related integration site (Wnt) antagonists that appears to modulate regulators of the host microenvironment. In contrast to the clear anti-tumorigenic effects of Dkk-3-based gene therapies, the role of endogenous Dkk-3 in cancer is context-dependent, with elevated expression associated with tumor promotion and suppression in different settings. The receptors and effectors that mediate the diverse effects of Dkk-3 have not been characterized in detail, contributing to an ongoing mystery of its mechanism of action. This review compares the various functions of Dkk-3 in the tumor microenvironment, where Dkk-3 has been found to be expressed by subpopulations of fibroblasts, endothelial, and immune cells, in addition to epithelial cells. We also discuss how the activation or inhibition of Dkk-3, depending on tumor type and context, might be used to treat different types of cancers.
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Affiliation(s)
- Zainab Al Shareef
- College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Correspondence: ; Tel.: +971-6505-7250
| | - Mai Nidal Asad Ershaid
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Rula Mudhafar
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Sameh S. M. Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Robert M. Kypta
- CIC BioGUNE, Basque Research and Technology Alliance, BRTA, Bizkaia Technology Park, 48160 Derio, Spain
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK
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Hamdy R, Hamoda AM, Al-Khalifa M, Menon V, El-Awady R, Soliman SSM. Efficient selective targeting of Candida CYP51 by oxadiazole derivatives designed from plant cuminaldehyde. RSC Med Chem 2022; 13:1322-1340. [PMID: 36439981 PMCID: PMC9667785 DOI: 10.1039/d2md00196a] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/19/2022] [Indexed: 07/24/2023] Open
Abstract
Candida infection represents a global threat with associated high resistance and mortality rate. Azoles such as the triazole drug fluconazole are the frontline therapy against invasive fungal infections; however, the emerging multidrug-resistant strains limit their use. Therefore, a series of novel azole UOSO1-15 derivatives were developed based on a modified natural scaffold to combat the evolved resistance mechanism and to provide improved safety and target selectivity. The antifungal screening against C. albicans and C. auris showed that UOSO10 and 12-14 compounds were the most potent derivatives. Among them, UOSO13 exhibited superior potent activity with MIC50 values of 0.5 and 0.8 μg mL-1 against C. albicans and C. auris compared to 25 and 600 μg mL-1 for fluconazole, respectively. UOSO13 displayed significant CaCYP51 enzyme inhibition activity in a concentration-dependent manner with an IC50 10-fold that of fluconazole, while exhibiting no activity against human CYP50 enzyme or toxicity to human cells. Furthermore, UOSO13 caused a significant reduction of Candida ergosterol content by 70.3% compared to a 35.6% reduction by fluconazole. Homology modeling, molecular docking, and molecular dynamics simulations of C. auris CYP51 enzyme indicated the stability and superiority of UOSO13. ADME prediction indicated that UOSO13 fulfils the drug-likeness criteria with good physicochemical properties.
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Affiliation(s)
- Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah P.O. Box 27272 Sharjah United Arab Emirates
- Faculty of Pharmacy, Zagazig University Zagazig Egypt
| | - Alshaimaa M Hamoda
- Research Institute for Medical and Health Sciences, University of Sharjah P.O. Box 27272 Sharjah United Arab Emirates
- College of Medicine, University of Sharjah P.O. Box 27272 Sharjah United Arab Emirate
- Department of Pharmacognosy, Faculty of Pharmacy, Assiut University Assiut-71526 Egypt
| | - Mariam Al-Khalifa
- Research Institute for Medical and Health Sciences, University of Sharjah P.O. Box 27272 Sharjah United Arab Emirates
| | - Varsha Menon
- Research Institute for Medical and Health Sciences, University of Sharjah P.O. Box 27272 Sharjah United Arab Emirates
| | - Raafat El-Awady
- Research Institute for Medical and Health Sciences, University of Sharjah P.O. Box 27272 Sharjah United Arab Emirates
- College of Pharmacy, University of Sharjah P.O. Box 27272 Sharjah United Arab Emirates +97165057472
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah P.O. Box 27272 Sharjah United Arab Emirates
- College of Pharmacy, University of Sharjah P.O. Box 27272 Sharjah United Arab Emirates +97165057472
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Kawsar SMA, Almalki FA, Hadd TB, Laaroussi H, Khan MAR, Hosen MA, Mahmud S, Aounti A, Maideen NMP, Heidarizadeh F, Soliman SSM. Potential antifungal activity of novel carbohydrate derivatives validated by POM, molecular docking and molecular dynamic simulations analyses. Molecular Simulation 2022. [DOI: 10.1080/08927022.2022.2123948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Sarkar M. A. Kawsar
- Laboratory of Carbohydrate and Nucleoside Chemistry, Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong, Bangladesh
| | - Faisal A. Almalki
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Taibi Ben Hadd
- Laboratory of Carbohydrate and Nucleoside Chemistry, Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong, Bangladesh
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
- Laboratory of Applied Chemistry & Environment, Faculty of Sciences, Mohammed Premier University, Oujda, Morocco
| | - Hamid Laaroussi
- Laboratory of Applied Chemistry & Environment, Faculty of Sciences, Mohammed Premier University, Oujda, Morocco
| | - Muhammad A. R. Khan
- Laboratory of Carbohydrate and Nucleoside Chemistry, Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong, Bangladesh
| | - Mohammed A. Hosen
- Laboratory of Carbohydrate and Nucleoside Chemistry, Department of Chemistry, Faculty of Science, University of Chittagong, Chittagong, Bangladesh
| | - Shafi Mahmud
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, and The Shine –Dalgarno Centre for RNA Innovations, The Australian National University, Canberra, Australia
| | - Abdelouahed Aounti
- Laboratory of Applied Chemistry & Environment, Faculty of Sciences, Mohammed Premier University, Oujda, Morocco
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Hamdy R, Soliman SSM. Response to the letter, entitled 'Haemagglutinin, neuraminidase and haemagglutinin esterase on the surface of SARS-CoV-2?'. Rev Med Virol 2022; 32:e2387. [PMID: 36029483 PMCID: PMC9538454 DOI: 10.1002/rmv.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,College of Pharmacy, University of Sharjah, Sharjah, UAE
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Ashmawy NS, El-labbad EM, Hamoda AM, El-Keblawy AA, El-Shorbagi ANA, Mosa KA, Soliman SSM. The Anti-Candida Activity of Tephrosia apollinea Is More Superiorly Attributed to a Novel Steroidal Compound with Selective Targeting. Plants 2022; 11:plants11162120. [PMID: 36015423 PMCID: PMC9415581 DOI: 10.3390/plants11162120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
Tephrosia is widely distributed throughout tropical, subtropical, and arid regions. This genus is known for several biological activities, including its anti-Candida activity, which is mainly attributed to prenylated flavonoids. The biological activities of most Tephrosia species have been studied, except T. apollinea. This study was conducted to investigate the underlying anti-Candida activity of T. apollinea, wildly grown in the United Arab Emirates (UAE). The T. apollinea plant was collected, dried, and the leaves were separated. The leaves were ground and extracted. The dried extract was subjected to successive chromatography to identify unique phytochemicals with a special pharmacological activity. The activity of the compound was validated by homology modeling and molecular docking studies. A novel steroidal compound (ergosta-6, 8(14), 22, 24(28)-tetraen-3-one) was isolated and named TNS. In silico target identification of TNS revealed a high structural similarity with the Candida 14-α-demethylase enzyme substrate. The compound exhibited a significant anti-Candida activity, specifically against the multi-drug-resistant Candida auris at MIC50, 16 times less than the previously reported prenylated flavonoids and 5 times less than the methanol extract of the plant. These findings were supported by homology modeling and molecular docking studies. TNS may represent a new class of Candida 14-α-demethylase inhibitors.
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Affiliation(s)
- Naglaa S. Ashmawy
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Faculty of Pharmacy, Ain Shams University, El-Abaseya, Cairo 11566, Egypt
| | - Eman M. El-labbad
- Faculty of Pharmacy, Ain Shams University, El-Abaseya, Cairo 11566, Egypt
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman P.O. Box 4184, United Arab Emirates
- Correspondence: (E.M.E.-l.); (S.S.M.S.); Tel.: +971-65057472 (S.S.M.S.)
| | - Alshaimaa M. Hamoda
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Ali A. El-Keblawy
- Department of Applied Biology, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Abdel-Nasser A. El-Shorbagi
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Kareem A. Mosa
- Department of Applied Biology, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Department of Biotechnology, Faculty of Agriculture, Al-Azhar University, Cairo 11651, Egypt
| | - Sameh S. M. Soliman
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Correspondence: (E.M.E.-l.); (S.S.M.S.); Tel.: +971-65057472 (S.S.M.S.)
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Hamdy R, Mostafa A, Abo Shama NM, Soliman SSM, Fayed B. Comparative evaluation of flavonoids reveals the superiority and promising inhibition activity of silibinin against SARS-CoV-2. Phytother Res 2022; 36:2921-2939. [PMID: 35596627 PMCID: PMC9347486 DOI: 10.1002/ptr.7486] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/19/2022] [Accepted: 04/22/2022] [Indexed: 01/08/2023]
Abstract
Flavonoids are phenolic compounds naturally found in plants and commonly consumed in diets. Herein, flavonoids were sequentially evaluated by a comparative in silico study associated with systematic literature search. This was followed by an in vitro study and enzyme inhibition assays against vital SARS-CoV-2 proteins including spike (S) protein, main protease (Mpro ), RNA-dependent RNA-polymerase (RdRp), and human transmembrane serine protease (TMPRSS2). The results obtained revealed 10 flavonoids with potential antiviral activity. Out of them, silibinin showed promising selectivity index against SARS-CoV-2 in vitro. Screening against S protein discloses the highest inhibition activity of silibinin. Mapping the activity of silibinin indicated its excellent binding inhibition activity against SARS-CoV-2 S protein, Mpro and RdRP at IC50 0.029, 0.021, and 0.042 μM, respectively, while it showed no inhibition activity against TMPRSS2 at its IC50(SARS-CoV-2) . Silibinin was tested safe on human mammalian cells at >7-fold its IC50(SARS-CoV-2) . Additionally, silibinin exhibited >90% virucidal activity at 0.031 μM. Comparative molecular docking (MD) showed that silibinin possesses the highest binding affinity to S protein and RdRP at -7.78 and -7.15 kcal/mol, respectively. MDs showed that silibinin exhibited stable interaction with key amino acids of SARS-CoV-2 targets. Collectively, silibinin, an FDA-approved drug, can significantly interfere with SARS-CoV-2 entry and replication through multi-targeting activity.
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Affiliation(s)
- Rania Hamdy
- Research Institute for Medical and Health SciencesUniversity of SharjahSharjahUnited Arab Emirates
- Faculty of PharmacyZagazig UniversityZagazigEgypt
| | - Ahmed Mostafa
- Center of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Noura M. Abo Shama
- Center of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Sameh S. M. Soliman
- Research Institute for Medical and Health SciencesUniversity of SharjahSharjahUnited Arab Emirates
- College of PharmacyUniversity of SharjahSharjahUnited Arab Emirates
| | - Bahgat Fayed
- Research Institute for Medical and Health SciencesUniversity of SharjahSharjahUnited Arab Emirates
- Chemistry of Natural and Microbial Product DepartmentNational Research CentreCairoEgypt
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Soliman SSM, El-Labbad EM, Abu-Qiyas A, Fayed B, Hamoda AM, Al-Rawi AM, Dakalbab S, El-Shorbagi ANA, Hamad M, Ibrahim AS, Mohammad MG. Novel Secreted Peptides From Rhizopus arrhizus var. delemar With Immunomodulatory Effects That Enhance Fungal Pathogenesis. Front Microbiol 2022; 13:863133. [PMID: 35387075 PMCID: PMC8977774 DOI: 10.3389/fmicb.2022.863133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Secreted fungal peptides are known to influence the interactions between the pathogen and host innate immunity. The aim of this study is to screen and evaluate secreted peptides from the fungus Rhizopus arrhizus var. delemar for their immunomodulatory activity. By using mass spectrometry and immuno-informatics analysis, we identified three secreted peptides CesT (S16), Colicin (S17), and Ca2+/calmodulin-dependent protein kinase/ligand (CAMK/CAMKL; S27). Culturing peripheral blood-derived monocytic macrophages (PBMMs) in the presence of S16 or S17 caused cell clumping, while culturing them with S27 resulted in the formation of spindle-shaped cells. S27-treated PBMMs showed cell cycle arrest at G0 phase and exhibited alternatively activated macrophage phenotype with pronounced reduction in scavenger receptors CD163 and CD206. Homology prediction indicated that IL-4/IL-13 is the immunomodulatory target of S27. Confirming this prediction, S27 initiated macrophage activation through phosphorylation of STAT-6; STAT-6 inhibition reversed the activity of S27 and reduced the formation of spindle-shaped PBMMs. Lastly, S27 treatment of PBMMs was associated with altered expression of key iron regulatory genes including hepcidin, ferroportin, transferrin receptor 1, and ferritin in a pattern consistent with increased cellular iron release; a condition known to enhance Rhizopus infection. Collectively, R. arrhizus var. delemar secretes peptides with immunomodulatory activities that support fungal pathogenesis. Targeting the IL-4/IL-13R/STAT-6 axis is a potential therapeutic approach to enhance the PBMM-mediated fungal phagocytosis. This represents a potential new approach to overcome lethal mucormycosis.
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Affiliation(s)
- Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Eman M El-Labbad
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.,Pharmaceutical Sciences Department, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Ameera Abu-Qiyas
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Chemistry of Natural and Microbial Product Department, National Research Centre, Cairo, Egypt
| | - Alshaimaa M Hamoda
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Ahmed M Al-Rawi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Salam Dakalbab
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Abdel-Nasser A El-Shorbagi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates.,Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Mawieh Hamad
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ashraf S Ibrahim
- Division of Infectious Diseases, The Lundquist Institute for Biomedical Innovation, Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA, United States.,David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Mohammad G Mohammad
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Medical Laboratory Sciences, Collage of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Fayed B, Kohder G, Soliman SSM. Gas Chromatography-Mass Spectrometry (GC-MS) Analysis of Candida auris Metabolites. Methods Mol Biol 2022; 2517:165-172. [PMID: 35674952 DOI: 10.1007/978-1-0716-2417-3_12] [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] [Indexed: 06/15/2023]
Abstract
Unique metabolic features allow fungi to colonize and persist within the human host. Investigations of unique metabolic fingerprints of a pathogenic fungus can provide a more complete understanding of the infection process and an interpretation of associations between genotype and phenotype. Gas chromatography-mass spectrometry (GC-MS) has proved to be one of the most powerful analytical techniques used for qualitative and quantitative detection of cellular metabolites. This technique has been used for comparative metabolomic analyses of both intracellular and secreted metabolites under variable conditions. This book chapter describes the use of GC-MS in the detection of both intracellular and secreted metabolites from Candida auris, a newly emerging fungal pathogen representing a serious global health threat due to its multidrug resistance profile. The identified fungal metabolites are compared using available software in order to assign a correlation between the pattern of accumulation of metabolites and behavior of the organism.
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Affiliation(s)
- Bahgat Fayed
- Research Institute for Medical and Health sciences, University of Sharjah, Sharjah, UAE
- Chemistry of Natural and Microbial Product Department, National Research Centre, Cairo, Egypt
| | - Ghalia Kohder
- Research Institute for Medical and Health sciences, University of Sharjah, Sharjah, UAE
- College of Pharmacy, University of Sharjah, Sharjah, UAE
| | - Sameh S M Soliman
- Research Institute for Medical and Health sciences, University of Sharjah, Sharjah, UAE.
- College of Pharmacy, University of Sharjah, Sharjah, UAE.
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Elnaggar A, Mosa KA, Ramamoorthy K, El-Keblawy A, Navarro T, Soliman SSM. De novo transcriptome sequencing, assembly, and gene expression profiling of a salt-stressed halophyte (Salsola drummondii) from a saline habitat. Physiol Plant 2021; 173:1695-1714. [PMID: 34741316 DOI: 10.1111/ppl.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/30/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
Salsola drummondii is a perennial habitat-indifferent halophyte growing in saline and nonsaline habitats of the Arabian hyperarid deserts. It offers an invaluable opportunity to examine the molecular mechanisms of salt tolerance. The present study was conducted to elucidate these mechanisms through transcriptome profiling of seedlings grown from seeds collected in a saline habitat. The Illumina Hiseq 2500 platform was employed to sequence cDNA libraries prepared from shoots and roots of nonsaline-treated plants (controls) and plants treated with 1200 mM NaCl. Transcriptomic comparison between salt-treated and control samples resulted in 17,363 differentially expressed genes (DEGs), including 12,000 upregulated genes (7870 in roots, 4130 in shoots) and 5363 downregulated genes (4258 in roots and 1105 in shoots). The majority of identified DEGs are known to be involved in transcription regulation (79), signal transduction (82), defense metabolism (101), transportation (410), cell wall metabolism (27), regulatory processes (392), respiration (85), chaperoning (9), and ubiquitination (98) during salt tolerance. This study identified potential genes associated with the salt tolerance of S. drummondii and demonstrated that this tolerance may depend on the induction of certain genes in shoot and root tissues. These gene expressions were validated using reverse-transcription quantitative PCR, the results of which were consistent with transcriptomics results. To the best of our knowledge, this is the first study providing genetic information on salt tolerance mechanisms in S. drummondii.
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Affiliation(s)
- Attiat Elnaggar
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, UAE
- Department of Botany and Microbiology, Faculty of Science, Alexandria University, Alexandria, Egypt
- Departmento de Botanica y Fisiologia Vegetal, Universidad de Málaga, Málaga, Spain
| | - Kareem A Mosa
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, UAE
- Department of Biotechnology, Faculty of Agriculture, Al-Azhar University, Cairo, Egypt
| | - Kalidoss Ramamoorthy
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, UAE
| | - Ali El-Keblawy
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, UAE
- Department of Biology, Faculty of Science, Al-Arish University, Egypt
| | - Teresa Navarro
- Departmento de Botanica y Fisiologia Vegetal, Universidad de Málaga, Málaga, Spain
| | - Sameh S M Soliman
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, UAE
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Altaie AM, Hamdy R, Venkatachalam T, Hamoudi R, Soliman SSM. Estimating the viral loads of SARS-CoV-2 in the oral cavity when complicated with periapical lesions. BMC Oral Health 2021; 21:567. [PMID: 34749700 PMCID: PMC8573761 DOI: 10.1186/s12903-021-01921-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022] Open
Abstract
Background The oral cavity represents a main entrance of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Angiotensin-converting enzyme 2 (ACE-2), neuropilin-1 (NRP-1), and transmembrane serine protease 2 (TMPRSS2) are essential for the entry of SARS-CoV-2 to the host cells. Both ACE-2 and NRP-1 receptors and TMPRSS2 have been identified in the oral cavity. However, there is limited knowledge about the impact of periapical lesions and their metabolites on the expression of these critical genes. This study aims to measure the impact of periapical lesions and their unique fatty acids (FAs) metabolites on the expression of the aforementioned genes, in addition to interleukin 6 (IL-6) gene and hence SARS-CoV-2 infection loads can be estimated. Methods Gene expression of ACE-2, NRP-1, TMPRSS2, and IL-6 was performed in periapical lesions in comparison to healthy oral cavity. Since FAs are important immunomodulators required for the lipid synthesis essential for receptors synthesis and viral replication, comparative FAs profiling was determined in oral lesions and healthy pulp tissues using gas chromatography–mass spectrometry (GC–MS). The effect of major identified and unique FAs was tested on mammalian cells known to express ACE-2, NRP-1, and TMPRSS2 genes. Results Gene expression analysis indicated that ACE-2, NRP-1, and TMPRSS2 were significantly upregulated in healthy clinical samples compared to oral lesions, while the reverse was true with IL-6 gene expression. Saturated and monounsaturated FAs were the major identified shared and unique FAs, respectively. Major shared FAs included palmitic, stearic and myristic acids with the highest percentage in the healthy oral cavity, while unique FAs included 17-octadecynoic acid in periapical abscess, petroselinic acid and l-lactic acid in periapical granuloma, and 1-nonadecene in the radicular cyst. Computational prediction showed that the binding affinity of identified FAs to ACE-2, TMPRSS2 and S protein were insignificant. Further, FA-treated mammalian cells showed significant overexpression of ACE-2, NRP-1 and TMPRSS2 genes except with l-lactic acid and oleic acid caused downregulation of NRP-1 gene, while 17-octadecynoic acid caused insignificant effect. Conclusion Collectively, a healthy oral cavity is more susceptible to viral infection when compared to that complicated with periapical lesions. FAs play important role in viral infection and their balance can affect the viral loads. Shifting the balance towards higher levels of palmitic, stearic and 1-nonadecene caused significant upregulation of the aforementioned genes and hence higher viral loads. On the other hand, there is a reverse correlation between inflammation and expression of SARS-CoV-2 receptors. Therefore, a mouth preparation that can reduce the levels of palmitic, stearic and 1-nonadecene, while maintaining an immunomodulatory effect can be employed as a future protection strategy against viral infection.
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Affiliation(s)
- Alaa Muayad Altaie
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Rania Hamdy
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Thenmozhi Venkatachalam
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,Department of Physiology and Immunology, College of Medicine, Khalifa University, Abu Dhabi, UAE
| | - Rifat Hamoudi
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Sameh S M Soliman
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, UAE. .,Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, UAE.
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Shammout ODA, Ashmawy NS, Shakartalla SB, Altaie AM, Semreen MH, Omar HA, Soliman SSM. Comparative sphingolipidomic analysis reveals significant differences between doxorubicin-sensitive and -resistance MCF-7 cells. PLoS One 2021; 16:e0258363. [PMID: 34637456 PMCID: PMC8509934 DOI: 10.1371/journal.pone.0258363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/25/2021] [Indexed: 12/09/2022] Open
Abstract
Drug resistance is responsible for the failure of many available anticancer drugs. Several studies have demonstrated the association between the alteration in sphingolipids (SPLs) and the development of drug resistance. To investigate the association between SPLs metabolism and doxorubicin (dox)-resistance in MCF-7 cells, a comparative sphingolipidomics analysis between dox-sensitive (parental) and -resistant MCF-7 cell lines along with validation by gene expression analysis were conducted. A total of 31 SPLs representing 5 subcategories were identified. The data obtained revealed that SPLs were clustered into two groups differentiating parental from dox-resistant cells. Eight SPLs were significantly altered in response to dox-resistance including SM (d18:1/16), SM (d18:1/24:2), SM (d18:1/24:0), SM (d18:1/20:0), SM (d18:1/23:1), HexCer (d18:1/24:0), SM (d18:1/15:0), DHSM (d18:0/20:0). The current study is the first to conclusively ascertain the potential involvement of dysregulated SPLs in dox-resistance in MCF-7 cells. SPLs metabolism in dox-resistant MCF-7 cells is oriented toward the downregulation of ceramides (Cer) and the concomitant increase in sphingomyelin (SM). Gene expression analysis has revealed that dox-resistant cells tend to escape from the Cer-related apoptosis by the activation of SM-Cer and GluCer-LacCer-ganglioside pathways. The enzymes that were correlated to the alteration in SPLs metabolism of dox-resistant MCF-7 cells and significantly altered in gene expression can represent potential targets that can represent a winning strategy for the future development of promising anticancer drugs.
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Affiliation(s)
- Ola D. A. Shammout
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Naglaa S. Ashmawy
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Department of Pharmacognosy, Ain Shams University, Cairo, Egypt
- Pharmacy Department, City University College of Ajman, Ajman, UAE
| | - Sarra B. Shakartalla
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, University of Gezira, Wadmedani, Sudan
| | - Alaa M. Altaie
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammad H. Semreen
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Hany A. Omar
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Sameh S. M. Soliman
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- * E-mail:
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Fayed B, Jayakumar MN, Soliman SSM. Caspofungin-resistance in Candida auris is cell wall-dependent phenotype and potential prevention by zinc oxide nanoparticles. Med Mycol 2021; 59:1243-1256. [PMID: 34612496 DOI: 10.1093/mmy/myab059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 01/07/2023] Open
Abstract
Candida auris is an emergent nosocomial multi-drug-resistant yeast that represents a global health threat. Recently, C. auris clinical isolates with caspofungin resistance were identified. Mutation in FKS1 gene was determined as a mechanism of resistance. However, the ability of C. auris to develop acquired and cross-resistance has never been investigated. Herein, this resistance ability due to caspofungin and associate mechanisms were investigated. C. auris clinical isolate was successively cultured for 10 generations in the presence of caspofungin compared to fluconazole-treatment and untreated controls. This was followed by the analysis of target gene expression and phenotypic changes. The obtained results showed that caspofungin-treated C. auris exhibited elevated MIC50(caspofungin), slower growth, elevated chitin content, overexpression of caspofungin target genes, and cross-resistance to fluconazole. Interestingly, caspofungin exposure induced cell-cell adhesion and biofilm formation. C. auris gradually lost caspofungin resistance after removal of antifungal pressure, while keeping the overexpression of fungal cell wall-related genes including ALS5. We propose that C. auris ageing in the presence of caspofungin caused the development of persistent phenotypic changes in the fungal cell wall, leading to acquired and physical cross-resistance mechanisms. Surprisingly, formulation of caspofungin in zinc oxide nanoparticles prevented the aforementioned behavioral changes regardless of the pathogen generations. LAY SUMMARY Candida auris developed resistance against caspofungin. Our data indicated that this resistance mechanism is unique because of changes in the genes related to cell wall adhesions. Formulation of caspofungin in ZnO nanoparticles was able to overcome these phenotypic changes.
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Affiliation(s)
- Bahgat Fayed
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE.,Chemistry of Natural and Microbial Product Department, National Research Centre, Cairo, 12622, Egypt
| | - Manju Nidagodu Jayakumar
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Sameh S M Soliman
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE.,College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
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Almehdi AM, Khoder G, Alchakee AS, Alsayyid AT, Sarg NH, Soliman SSM. SARS-CoV-2 spike protein: pathogenesis, vaccines, and potential therapies. Infection 2021; 49:855-876. [PMID: 34339040 PMCID: PMC8326314 DOI: 10.1007/s15010-021-01677-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE COVID-19 pandemic has emerged as a result of infection by the deadly pathogenic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causing enormous threats to humans. Coronaviruses are distinguished by a clove-like spike (S) protein, which plays a key role in viral pathogenesis, evolutions, and transmission. The objectives of this study are to investigate the distinctive structural features of SARS-CoV-2 S protein, its essential role in pathogenesis, and its use in the development of potential therapies and vaccines. METHODOLOGY A literature review was conducted to summarize, analyze, and interpret the available scientific data related to SARS-CoV-2 S protein in terms of characteristics, vaccines development and potential therapies. RESULTS The data indicate that S protein subunits and their variable conformational states significantly affect the virus pathogenesis, infectivity, and evolutionary mutation. A considerable number of potential natural and synthetic therapies were proposed based on S protein. Additionally, neutralizing antibodies were recently approved for emergency use. Furthermore, several vaccines utilizing the S protein were developed. CONCLUSION A better understanding of S protein features, structure and mutations facilitate the recognition of the importance of SARS-CoV-2 S protein in viral infection, as well as the development of therapies and vaccines. The efficacy and safety of these therapeutic compounds and vaccines are still controversial. However, they may potentially reduce or prevent SARS-CoV-2 infection, leading to a significant reduction of the global health burden of this pandemic.
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Affiliation(s)
- Ahmed M Almehdi
- College of Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Ghalia Khoder
- College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Aminah S Alchakee
- College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Azizeh T Alsayyid
- College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Nadin H Sarg
- College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Sameh S M Soliman
- College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, UAE.
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Alketbi EH, Hamdy R, El-Kabalawy A, Juric V, Pignitter M, A Mosa K, Almehdi AM, El-Keblawy AA, Soliman SSM. Lipid-based therapies against SARS-CoV-2 infection. Rev Med Virol 2021; 31:1-13. [PMID: 34546604 PMCID: PMC8013851 DOI: 10.1002/rmv.2214] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
Viruses have evolved to manipulate host lipid metabolism to benefit their replication cycle. Enveloped viruses, including coronaviruses, use host lipids in various stages of the viral life cycle, particularly in the formation of replication compartments and envelopes. Host lipids are utilised by the virus in receptor binding, viral fusion and entry, as well as viral replication. Association of dyslipidaemia with the pathological development of Covid‐19 raises the possibility that exploitation of host lipid metabolism might have therapeutic benefit against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). In this review, promising host lipid targets are discussed along with potential inhibitors. In addition, specific host lipids are involved in the inflammatory responses due to viral infection, so lipid supplementation represents another potential strategy to counteract the severity of viral infection. Furthermore, switching the lipid metabolism through a ketogenic diet is another potential way of limiting the effects of viral infection. Taken together, restricting the access of host lipids to the virus, either by using lipid inhibitors or supplementation with exogenous lipids, might significantly limit SARS‐CoV‐2 infection and/or severity.
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Affiliation(s)
- Eman Humaid Alketbi
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | | | - Viktorija Juric
- Department of Physiological Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Marc Pignitter
- Department of Physiological Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Kareem A Mosa
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Research Institute of Science and Engineering, University of Sharjah, Sharjah, United Arab Emirates.,Department of Biotechnology, Faculty of Agriculture, Al-Azhar University, Cairo, Egypt
| | - Ahmed M Almehdi
- Department of Chemistry, College of Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ali A El-Keblawy
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Research Institute of Science and Engineering, University of Sharjah, Sharjah, United Arab Emirates
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Faculty of Pharmacy, Zagazig University, Zagazig, Egypt.,Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
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Altaie AM, Venkatachalam T, Samaranayake LP, Soliman SSM, Hamoudi R. Comparative Metabolomics Reveals the Microenvironment of Common T-Helper Cells and Differential Immune Cells Linked to Unique Periapical Lesions. Front Immunol 2021; 12:707267. [PMID: 34539639 PMCID: PMC8446658 DOI: 10.3389/fimmu.2021.707267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Periapical abscesses, radicular cysts, and periapical granulomas are the most frequently identified pathological lesions in the alveolar bone. While little is known about the initiation and progression of these conditions, the metabolic environment and the related immunological behaviors were examined for the first time to model the development of each pathological condition. Metabolites were extracted from each lesion and profiled using gas chromatography-mass spectrometry in comparison with healthy pulp tissue. The metabolites were clustered and linked to their related immune cell fractions. Clusters I and J in the periapical abscess upregulated the expression of MMP-9, IL-8, CYP4F3, and VEGF, while clusters L and M were related to lipophagy and apoptosis in radicular cyst, and cluster P in periapical granuloma, which contains L-(+)-lactic acid and ethylene glycol, was related to granuloma formation. Oleic acid, 17-octadecynoic acid, 1-nonadecene, and L-(+)-lactic acid were significantly the highest unique metabolites in healthy pulp tissue, periapical abscess, radicular cyst, and periapical granuloma, respectively. The correlated enriched metabolic pathways were identified, and the related active genes were predicted. Glutamatergic synapse (16–20),-hydroxyeicosatetraenoic acids, lipophagy, and retinoid X receptor coupled with vitamin D receptor were the most significantly enriched pathways in healthy control, abscess, cyst, and granuloma, respectively. Compared with the healthy control, significant upregulation in the gene expression of CYP4F3, VEGF, IL-8, TLR2 (P < 0.0001), and MMP-9 (P < 0.001) was found in the abscesses. While IL-12A was significantly upregulated in cysts (P < 0.01), IL-17A represents the highest significantly upregulated gene in granulomas (P < 0.0001). From the predicted active genes, CIBERSORT suggested the presence of natural killer cells, dendritic cells, pro-inflammatory M1 macrophages, and anti-inflammatory M2 macrophages in different proportions. In addition, the single nucleotide polymorphisms related to IL-10, IL-12A, and IL-17D genes were shown to be associated with periapical lesions and other oral lesions. Collectively, the unique metabolism and related immune response shape up an environment that initiates and maintains the existence and progression of these oral lesions, suggesting an important role in diagnosis and effective targeted therapy.
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Affiliation(s)
- Alaa Muayad Altaie
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Thenmozhi Venkatachalam
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Lakshman P Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Oral Biosciences, Faculty of Dentistry, University of Hong Kong, Hong Kong, Hong Kong, SAR China
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Rifat Hamoudi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Hamdy R, Fayed B, Mostafa A, Shama NMA, Mahmoud SH, Mehta CH, Nayak Y, M. Soliman SS. Iterated Virtual Screening-Assisted Antiviral and Enzyme Inhibition Assays Reveal the Discovery of Novel Promising Anti-SARS-CoV-2 with Dual Activity. Int J Mol Sci 2021; 22:9057. [PMID: 34445763 PMCID: PMC8396542 DOI: 10.3390/ijms22169057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
Unfortunately, COVID-19 is still a threat to humankind and has a dramatic impact on human health, social life, the world economy, and food security. With the limited number of suggested therapies under clinical trials, the discovery of novel therapeutic agents is essential. Here, a previously identified anti-SARS-CoV-2 compound named Compound 13 (1,2,5-Oxadiazole-3-carboximidic acid, 4,4'-(methylenediimino) bis,bis[[(2-hydroxyphenyl)methylene]hydrazide) was subjected to an iterated virtual screening against SARS-CoV-2 Mpro using a combination of Ligand Designer and PathFinder. PathFinder, a computational reaction enumeration tool, was used for the rapid generation of enumerated structures via default reaction library. Ligand designer was employed for the computerized lead optimization and selection of the best structural modification that resulted in a favorable ligand-protein complex. The obtained compounds that showed the best binding to Mpro were re-screened against TMPRSS2, leading to the identification of 20 shared compounds. The compounds were further visually inspected, which resulted in the identification of five shared compounds M1-5 with dual binding affinity. In vitro evaluation and enzyme inhibition assay indicated that M3, an analogue of Compound 13 afforded by replacing the phenolic moiety with pyridinyl, possesses an improved antiviral activity and safety. M3 displayed in vitro antiviral activity with IC50 0.016 µM and Mpro inhibition activity with IC50 0.013 µM, 7-fold more potent than the parent Compound 13 and potent than the antivirals drugs that are currently under clinical trials. Moreover, M3 showed potent activity against human TMPRSS2 and furin enzymes with IC50 0.05, and 0.08 µM, respectively. Molecular docking, WaterMap analysis, molecular dynamics simulation, and R-group analysis confirmed the superiority of the binding fit to M3 with the target enzymes. WaterMap analysis calculated the thermodynamic properties of the hydration site in the binding pocket that significantly affects the biological activity. Loading M3 on zinc oxide nanoparticles (ZnO NPs) increased the antiviral activity of the compound 1.5-fold, while maintaining a higher safety profile. In conclusion, lead optimized discovery following an iterated virtual screening in association with molecular docking and biological evaluation revealed a novel compound named M3 with promising dual activity against SARS-CoV-2. The compound deserves further investigation for potential clinical-based studies.
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Affiliation(s)
- Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates; (R.H.); (B.F.)
- Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates; (R.H.); (B.F.)
- Chemistry of Natural and Microbial Product Department, National Research Centre, Cairo 12622, Egypt
| | - Ahmed Mostafa
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Giza 12622, Egypt; (A.M.); (N.M.A.S.); (S.H.M.)
| | - Noura M. Abo Shama
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Giza 12622, Egypt; (A.M.); (N.M.A.S.); (S.H.M.)
| | - Sara Hussein Mahmoud
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Giza 12622, Egypt; (A.M.); (N.M.A.S.); (S.H.M.)
| | - Chetan Hasmukh Mehta
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India; (C.H.M.); (Y.N.)
| | - Yogendra Nayak
- Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India; (C.H.M.); (Y.N.)
| | - Sameh S. M. Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates; (R.H.); (B.F.)
- College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
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Altaie AM, Saddik B, Alsaegh MA, Soliman SSM, Hamoudi R, Samaranayake LP. Prevalence of unculturable bacteria in the periapical abscess: A systematic review and meta-analysis. PLoS One 2021; 16:e0255485. [PMID: 34351963 PMCID: PMC8341601 DOI: 10.1371/journal.pone.0255485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/18/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the prevalence of unculturable bacteria in periapical abscess, radicular cyst, and periapical granuloma. METHODS PubMed, Scopus, Science Direct, and Ovid databases were systematically searched from January 1990 to May 2020. All the included studies were cross-sectional design. The risk of bias was assessed using Joanna Briggs Institute check-list. Heterogeneity was described using meta-regression and mixed-effects model for lesion, country, and sequence technique moderators. Funnel plot and unweighted Egger's regression test were used to estimate the publication bias. Microbiome data on diversity, abundance, and frequency of unculturable bacteria in the periapical lesions were reviewed, analysed, and the principal component analysis (PCA) was performed. RESULTS A total of 13 studies out of 14,780, were selected for the final analysis. These studies focused on the prevalence of unculturable bacteria in periapical abscesses and related lesions. Approximately 13% (95% CI: 7-23%) of the cumulative number of bacteria derived from periapical abscesses was unculturable. Country moderator significantly (P = 0.05) affects the diversity summary proportion. While the pooled frequency of unculturable bacteria was 8%; 95% CI: 5, 14%, the estimate of the pooled abundance of unculturable bacteria was 5%; 95% CI: 2, 12% with a significant (P = 0.05) country moderator that affects the abundance summary proportion. Of the 62 unculturable bacteria, 35 were subjected to PCA and Peptostreptococcus sp. oral clone CK035 was the most abundant species in periapical abscesses. Hybridization techniques were found to be the most reliable molecular methods in detecting the abundance and frequency of unculturable bacteria. CONCLUSION The significant prevalence of unculturable bacteria in the periapical abscess, suggests that they are likely to play, a yet unknown, critical role in the pathogenesis and progression of the disease. Further research remains to be done to confirm their specific contributions in the virulence and disease progression.
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Affiliation(s)
- Alaa Muayad Altaie
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Basema Saddik
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Family and Community Medicine, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Mohammed Amjed Alsaegh
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Sameh S. M. Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, UAE
| | - Rifat Hamoudi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- * E-mail: (RH); (LPS)
| | - Lakshman P. Samaranayake
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE
- * E-mail: (RH); (LPS)
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Eldohaji LM, Fayed B, Hamoda AM, Ershaid M, Abdin S, Alhamidi TB, Mohammad MG, Omar HA, Soliman SSM. Potential targeting of Hep3B liver cancer cells by lupeol isolated from Avicennia marina. Arch Pharm (Weinheim) 2021; 354:e2100120. [PMID: 34085721 DOI: 10.1002/ardp.202100120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/14/2021] [Indexed: 11/08/2022]
Abstract
Medicinal plants are valuable sources of different active constituents that are known to have important pharmacological activities including anticancer effects. Lupeol, a pentacyclic triterpenoid, present in many medicinal plants, has a wide range of biological activities. Although the anticancer activity of lupeol was reported, the published data are inconsistent and the clear mechanism of action has never been assigned. The current study aims at investigating the anticancer specificity and mechanism of lupeol isolated from Avicennia marina, which grows in the desert of the United Arab Emirates. The compound was purified by chromatography and identified by spectroscopy. Compared with a negative control, lupeol caused significant (p < .001) growth inhibitory activity on MCF-7 and Hep3B parental and resistant cells by 45%, 46%, 72%, and 35%, respectively. The mechanism of action of lupeol was further explored by measuring its effect on key players in cancer development and progression, BCL-2 anti-apoptotic and BAX pro-apoptotic proteins. Lupeol significantly (p < .01) downregulated BCL-2 gene expression in parental and resistant Hep3B cells by 33 and 3.5 times, respectively, contributing to the induction of apoptosis in Hep3B cells, whereas it caused no effect on BAX. Furthermore, the immunoblotting analysis revealed that lupeol cleaved the executioner caspase-3 into its active form. Interestingly, lupeol showed no significant effect on the proliferation of monocytes, whereas it caused an increase in the sub-G1 population and a reduction in the apoptosis rates of monocytes at 48 and 72 h, indicative of no immuno-inflammatory responses. Collectively, lupeol can be considered as promising effective and safe anticancer agent, particularly against Hep3B cancer cells.
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Affiliation(s)
- Leen M Eldohaji
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,Chemistry of Natural and Microbial Product Department, National Research Centre, Cairo, Egypt
| | - Alshaimaa M Hamoda
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,College of Medicine, University of Sharjah, Sharjah, UAE.,Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Mai Ershaid
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Shifaa Abdin
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Tasneem B Alhamidi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Mohammad G Mohammad
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Hany A Omar
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,College of Pharmacy, University of Sharjah, Sharjah, UAE
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,College of Pharmacy, University of Sharjah, Sharjah, UAE
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AlHumaidi RB, Fayed B, Sharif SI, Noreddin A, Soliman SSM. Role of Exosomes in Breast Cancer Management: Evidence-Based Review. Curr Cancer Drug Targets 2021; 21:666-675. [PMID: 34077346 DOI: 10.2174/1568009621666210601115707] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 12/09/2022]
Abstract
The field of cancer research has massively grown in recent decades, leading to a better understanding of the underlying causes and greatly improved the therapeutic approaches. Breast cancer (BC) is the third leading cause of mortality among all cancers and the most common malignant disease in women worldwide, representing one in four cancers in women. The crosstalk between cancer cells and the surrounding microenvironment is crucial for tumor progression and metastatic process. Tumor cells communicate not only through classical paracrine signaling mechanisms, including cytokines, chemokines, growth factors, but also through"exosomes". Exosomes are nano-vesicles that are released by various types of cells. Over the last decade, researchers have been attracted to the role of exosomes in breast cancer. It has been proven that exosomes influence major tumor-related pathways, including invasion, migration, epithelial-to-mesenchymal transition (EMT), metastasis, and drug resistance. Additionally, exosomes play important roles in clinical applications. Several studies have demonstrated the potential applications of exosomes in cancer therapy and diagnosis. Furthermore, exosomes have been engineered to function as nano-delivery systems of chemotherapeutic drugs. They can also be designed as vaccines to trigger the patient's immune system. This review discusses the recent progress regarding the use of exosomes as drug delivery systems, therapeutic agents, biomarkers, and vaccines against breast cancer.
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Affiliation(s)
- Razan B AlHumaidi
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Suleiman I Sharif
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Ayman Noreddin
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
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Alzaabi MM, Hamdy R, Ashmawy NS, Hamoda AM, Alkhayat F, Khademi NN, Al Joud SMA, El-Keblawy AA, Soliman SSM. Flavonoids are promising safe therapy against COVID-19. Phytochem Rev 2021; 21:291-312. [PMID: 34054380 PMCID: PMC8139868 DOI: 10.1007/s11101-021-09759-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/28/2021] [Indexed: 05/13/2023]
Abstract
Flavonoids are a class of phenolic natural products, well-identified in traditional and modern medicines in the treatment of several diseases including viral infection. Flavonoids showed potential inhibitory activity against coronaviruses including the current pandemic outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and designated as COVID-19. Here, we have collected all data related to the potential inhibitory mechanisms of flavonoids against SARS-CoV-2 infection and their significant immunomodulatory activities. The data were mapped and compared to elect major flavonoids with a promising role in the current pandemic. Further, we have linked the global existence of flavonoids in medicinal plants and their role in protection against COVID-19. Computational analysis predicted that flavonoids can exhibit potential inhibitory activity against SARS-CoV-2 by binding to essential viral targets required in virus entry and/ or replication. Flavonoids also showed excellent immunomodulatory and anti-inflammatory activities including the inhibition of various inflammatory cytokines. Further, flavonoids showed significant ability to reduce the exacerbation of COVID-19 in the case of obesity via promoting lipids metabolism. Moreover, flavonoids exhibit a high safety profile, suitable bioavailability, and no significant adverse effects. For instance, plants rich in flavonoids are globally distributed and can offer great protection from COVID-19. The data described in this study strongly highlighted that flavonoids particularly quercetin and luteolin can exhibit promising multi-target activity against SARS-CoV-2, which promote their use in the current and expected future outbreaks. Therefore, a regimen of flavonoid-rich plants can be recommended to supplement a sufficient amount of flavonoids for the protection and treatment from SARS-CoV-2 infection.
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Affiliation(s)
- Moza Mohamed Alzaabi
- Department of Applied Biology, College of Science, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institutes of Science and Engineering, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Zagazig University, Zagazig, 44519 Egypt
| | - Naglaa S. Ashmawy
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Pharmacognosy, Faculty of Pharmacy, Ain Shams University, 11566 Abbassia, Cairo, Egypt
| | - Alshaimaa M. Hamoda
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
- College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Fatemah Alkhayat
- College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Neda Naser Khademi
- College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | | | - Ali A. El-Keblawy
- Department of Applied Biology, College of Science, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institutes of Science and Engineering, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Sameh S. M. Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
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Hamoda AM, Fayed B, Ashmawy NS, El-Shorbagi ANA, Hamdy R, Soliman SSM. Marine Sponge is a Promising Natural Source of Anti-SARS-CoV-2 Scaffold. Front Pharmacol 2021; 12:666664. [PMID: 34079462 PMCID: PMC8165660 DOI: 10.3389/fphar.2021.666664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/28/2021] [Indexed: 12/30/2022] Open
Abstract
The current pandemic caused by SARS-CoV2 and named COVID-19 urgent the need for novel lead antiviral drugs. Recently, United States Food and Drug Administration (FDA) approved the use of remdesivir as anti-SARS-CoV-2. Remdesivir is a natural product-inspired nucleoside analogue with significant broad-spectrum antiviral activity. Nucleosides analogues from marine sponge including spongouridine and spongothymidine have been used as lead for the evolutionary synthesis of various antiviral drugs such as vidarabine and cytarabine. Furthermore, the marine sponge is a rich source of compounds with unique activities. Marine sponge produces classes of compounds that can inhibit the viral cysteine protease (Mpro) such as esculetin and ilimaquinone and human serine protease (TMPRSS2) such as pseudotheonamide C and D and aeruginosin 98B. Additionally, sponge-derived compounds such as dihydrogracilin A and avarol showed immunomodulatory activity that can target the cytokines storm. Here, we reviewed the potential use of sponge-derived compounds as promising therapeutics against SARS-CoV-2. Despite the reported antiviral activity of isolated marine metabolites, structural modifications showed the importance in targeting and efficacy. On that basis, we are proposing a novel structure with bifunctional scaffolds and dual pharmacophores that can be superiorly employed in SARS-CoV-2 infection.
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Affiliation(s)
- Alshaimaa M. Hamoda
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Chemistry of Natural and Microbial Product Department, National Research Centre, Cairo, Egypt
| | - Naglaa S. Ashmawy
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Abdel-Nasser A. El-Shorbagi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Sameh S. M. Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
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Elseginy SA, Fayed B, Hamdy R, Mahrous N, Mostafa A, Almehdi AM, S M Soliman S. Promising anti-SARS-CoV-2 drugs by effective dual targeting against the viral and host proteases. Bioorg Med Chem Lett 2021; 43:128099. [PMID: 33984473 PMCID: PMC8107043 DOI: 10.1016/j.bmcl.2021.128099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 01/23/2023]
Abstract
SARS-CoV-2 caused dramatic health, social and economic threats to the globe. With this threat, the expectation of future outbreak, and the shortage of anti-viral drugs, scientists were challenged to develop novel antivirals. The objective of this study is to develop novel anti-SARS-CoV-2 compounds with dual activity by targeting valuable less-mutated enzymes. Here, we have mapped the binding affinity of >500,000 compounds for potential activity against SARS-CoV-2 main protease (Mpro), papain protease (PLpro) and human furin protease. The enzyme inhibition activity of most promising hits was screened and tested in vitro on SARS-CoV-2 clinical isolate incubated with Vero cells. Computational modelling and toxicity of the compounds were validated. The results revealed that 16 compounds showed potential binding activity against Mpro, two of them showed binding affinity against PLpro and furin protease. Respectively, compounds 7 and 13 showed inhibition activity against Mpro at IC50 0.45 and 0.11 µM, against PLpro at IC50 0.085 and 0.063 µM, and against furin protease at IC50 0.29 µM. Computational modelling validated the binding affinity against all proteases. Compounds 7 and 13 showed significant inhibition activity against the virus at IC50 0.77 and 0.11 µM, respectively. Both compounds showed no toxicity on mammalian cells. The data obtained indicated that compounds 7 and 13 exhibited potent dual inhibition activity against SARS-CoV-2. The dual activity of both compounds can be of great promise not only during the current pandemic but also for future outbreaks since the compounds’ targets are of limited mutation and critical importance to the viral infection.
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Affiliation(s)
- Samia A Elseginy
- Molecular Modelling Lab, Biochemistry School, Bristol University, Bristol, UK; Green Chemistry Department, Chemical Industries Research Division, National Research Centre, P.O. Box 12622, Egypt
| | - Bahgat Fayed
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; Chemistry of Natural and Microbial Product Department, National Research Centre, Cairo 12622, Egypt
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Noura Mahrous
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Giza 12622, Egypt
| | - Ahmed Mostafa
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Giza 12622, Egypt
| | - Ahmed M Almehdi
- College of Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
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Shakartalla SB, Alhumaidi RB, Shammout ODA, Al Shareef ZM, Ashmawy NS, Soliman SSM. Dyslipidemia in breast cancer patients increases the risk of SAR-CoV-2 infection. Infect Genet Evol 2021; 92:104883. [PMID: 33905884 PMCID: PMC8079327 DOI: 10.1016/j.meegid.2021.104883] [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] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 12/27/2022]
Abstract
Breast cancer (BC) is the most diagnosed and second leading cause of death among women worldwide. Elevated levels of lipids have been reported in BC patients. On the other hand, lipids play an important role in coronavirus infections including the newly emerged disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and designated COVID-19 by WHO. Cancer patients including BC have been reported to be at higher risk of SARS-CoV-2 infection, which is mostly attributed to the chronic immunosuppressive status of cancer patients along with the use of cytotoxic drugs. Here in this review, we highlighted the role of dyslipidemia associated with BC patients in the incidence and severity of SARS-CoV-2 infection. Elevated levels of lipids namely phospholipids, cholesterol, sphingolipids, and eicosanoids in the serum of BC patients and their re-localization to the alveolar spaces can increase susceptibility and/or severity due to SARA-CoV-2 infection. Therefore, manipulation of dyslipidemia in BC patients should be recommended as prophylactic and therapy against SARS-CoV-2 infection.
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Affiliation(s)
- Sarra B Shakartalla
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; Faculty of Pharmacy, University of Gezira, P.O.Box. 21111, Wadmedani, Sudan
| | - Razan B Alhumaidi
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Ola D A Shammout
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Zainab M Al Shareef
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Naglaa S Ashmawy
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; Faculty of Pharmacy, Department of Pharmacognosy, Ain Shams University, 11566-Abbassia, Cairo, Egypt
| | - Sameh S M Soliman
- Research Institute for Medical and Health sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
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ElDohaji LM, Hamoda AM, Hamdy R, Soliman SSM. Avicennia marina a natural reservoir of phytopharmaceuticals: Curative power and platform of medicines. J Ethnopharmacol 2020; 263:113179. [PMID: 32768642 DOI: 10.1016/j.jep.2020.113179] [Citation(s) in RCA: 8] [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: 02/22/2020] [Revised: 06/16/2020] [Accepted: 07/08/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Avicennia marina (Forssk.) Vierh. is a historic plant, well-known for many centuries in traditional and folk use medicine. A. marina is an evergreen tree belongs to Acanthaceae family. The plant is the most widespread mangrove in the tropical and subtropical regions of Indo-West-Pacific area. Current scientific data confirmed the medicinal values of A. marina. The pharmacological activity of the plant is attributed to the presence of several phytochemical classes. AIM OF THE STUDY To evaluate the link between the traditional use of the plant and the scientific data accumulated over time including both the phytochemical analysis and therapeutic activities. Additionally, to evaluate the usage of obtained data for further development of the plant and its products in the pharmaceutical market. MATERIALS AND METHODS The data related to traditional medicine, therapeutic uses, phytochemical analysis and market availability of A. marina and its products from different geographical regions were collected. The collected data was compared and the research gaps were identified in order to highlight areas that can be employed to improve plant-based research and development. RESULTS Although the wide geographical distribution of the plant, its historic traditional use, richness of phytochemicals and diverse pharmacological activities, the utilization of these data has never been exploited for human health and several gaps were identified. These gaps include the lack of phyto-geographical comparison of the plant, the lack of proper mapping of traditional use to the scientific data and inadequate exploration of plant phytochemicals by researchers. CONCLUSIONS A. marina is an old tree that has evolved over centuries and adapted diverse climates. It contains a pool of potential phytochemicals that can be employed for the discovery of drugs after careful studies. Scientists are required to invest money and time to explore these renewable and natural sources of drugs and design drug formulations to overcome current difficult to treat health issues and fight against the era of drug resistant.
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Affiliation(s)
- Leen M ElDohaji
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Alshaimaa M Hamoda
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt.
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Elseginy SA, Hamdy R, Menon V, Almehdi AM, El-Awady R, Soliman SSM. Design, synthesis, and computational validation of novel compounds selectively targeting HER2-expressing breast cancer. Bioorg Med Chem Lett 2020; 30:127658. [PMID: 33130288 DOI: 10.1016/j.bmcl.2020.127658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/07/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
Human epidermal growth factor receptor (HER) is a family of multidomain proteins that plays important role in the regulation of several biological functions. HER2 is a member of HER that is highly presented in breast cancer cells. Here, we designed and synthesized a series of diaryl urea/thiourea compounds. The compounds were tested on HER2+ breast cancer cells including MCF-7 and SkBr3, compared to HER2- breast cancer cells including MDA-MB-231 and BT-549. Only compounds 12-14 at 10 µM showed selective anti-proliferative activity against MCF-7 and SkBr3 by 65-79%. Compounds 12-14 showed >80% inhibition of the intracellular kinase domain of HER2. The results obtained indicated that compounds 12-14 are selectively targeting HER2+ cells. The IC50 of compound 13 against MCF-7 and SkBR3 were 1.3 ± 0.009 and 0.73 ± 0.03 µM, respectively. Molecular docking and MD simulations (50 ns) were carried out, and their binding free energies were calculated. Compounds 12-14 formed strong hydrogen bond and pi-pi stacking interactions with the key residues Thr862 and Phe864. 3DQSAR model confirmed the role of 3-bromo substituent of pyridine ring and 4-chloro substituent of phenyl ring in the activity of the compounds. In conclusion, novel compounds, particularly 13 were developed selectively against HER2-expressing/overexpressing breast cancer cells including MCF7 and SkBr3.
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Affiliation(s)
- Samia A Elseginy
- Green Chemistry Department, Chemical Industries Research Division, National Research Center P.O. Box 12622, Egypt; Molecular Modelling Lab., Biochemistry School, Bristol University, Bristol, UK
| | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Varsha Menon
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Ahmed M Almehdi
- College of Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Raafat El-Awady
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates; College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
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Abouleish M, El-Keblawy A, Mosa KA, Soliman SSM. Importance of Environmental Factors on Production of Computationally- Defined Natural Molecules against COVID-19 Pandemic. Curr Top Med Chem 2020; 20:1958-1961. [PMID: 33040729 DOI: 10.2174/156802662022200917110430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Mohamed Abouleish
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, Sharjah, P.O. Box 26666, United Arab Emirates
| | - Ali El-Keblawy
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, P.O.Box 27272, United Arab Emirates
| | - Kareem A Mosa
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, P.O.Box 27272, United Arab Emirates
| | - Sameh S M Soliman
- College of Pharmacy, University of Sharjah, Sharjah, P.O. Box 27272, United Arab Emirates
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Soliman SSM, Alhamidi TB, Abdin S, Almehdi AM, Semreen MH, Alhumaidi RB, Shakartalla SB, Haider M, Husseiny MI, Omar HA. Effective targeting of breast cancer cells (MCF7) via novel biogenic synthesis of gold nanoparticles using cancer-derived metabolites. PLoS One 2020; 15:e0240156. [PMID: 33022008 PMCID: PMC7537904 DOI: 10.1371/journal.pone.0240156] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022] Open
Abstract
Biogenic synthesis of nanoparticles provides many advantages over synthetic nanoparticles including clean and non-toxic approaches. Nanoparticle-based application for the development of diagnostics and therapeutics is a promising field that requires further enrichment and investigation. The use of biological systems for the generation of gold nanoparticles (AuNPs) has been extensively studied. The search for a biocompatibility approach for the development of nanoparticles is of great interest since it can provide more targeting and less toxicity. Here, we reported a bio-reductive approach of gold to AuNPs using metabolites extracted from mammalian cells, which provided a simple and efficient way for the synthesis of nanomaterials. AuNPs were more efficiently synthesized by the metabolites extracted from breast cancer (MCF7) and normal fibroblasts (F180) cells when compared to metabolites extracted from cell-free supernatants. The metabolites involved in biogenic synthesis are mainly alcohols and acids. Spectroscopic characterization using UV-visible spectra, morphological characterization using electron microscopy and structural characterization using X-ray diffraction (XRD) confirmed the AuNPs synthesis from mammalian cells metabolites. AuNPs generated from MCF7 cells metabolites showed significant anticancer activities against MCF7 and low toxicity when compared to those generated from F180 cells metabolites. The results reflected the cytotoxic activities of the parent metabolites extracted from MCF7 versus those extracted from F180. Comparative metabolomics analysis indicated that MCF7-generated AuNPs harbored tetratetracontane, octacosane, and cyclotetradecane while those generated from F180 harbored a high percentage of stearic, palmitic, heptadecanoic acid. We related the variation in cytotoxic activities between cell types to the differences in AuNPs-harboring metabolites. The process used in this study to develop the nanoparticles is novel and should have useful future anticancer applications mainly because of proper specific targeting to cancer cells.
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Affiliation(s)
- Sameh S. M. Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, UAE
- Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
- * E-mail:
| | - Tasneem B. Alhamidi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Shifaa Abdin
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Ahmed M. Almehdi
- Department of Chemistry, College of Sciences, University of Sharjah, Sharjah, UAE
| | - Mohammad H. Semreen
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, UAE
| | - Razan B. Alhumaidi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, UAE
| | - Sarra B. Shakartalla
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Mohamed Haider
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Pharmaceutics and Pharmaceutical Technology, College of Sciences, University of Sharjah, Sharjah, UAE
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Mohamed I. Husseiny
- Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
- Department of Translational Research & Cellular Therapeutics, Beckman Research Institute of City of Hope, Duarte, CA, United States of America
| | - Hany A. Omar
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Sciences, University of Sharjah, Sharjah, UAE
- Department of Pharmacology, Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt
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Soliman SSM, Raizada MN. Sites of biosynthesis and storage of Taxol in Taxus media (Rehder) plants: Mechanism of accumulation. Phytochemistry 2020; 175:112369. [PMID: 32371314 DOI: 10.1016/j.phytochem.2020.112369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/28/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
Taxol is a cytotoxic agent against various types of cancers. The cytotoxic activities of Taxol can be extended to its synthesizing plant. Here, Taxol is shown to have special synthesis, storage and transport mechanisms that avoid the toxic effects on its source plant. The sites of Taxol biosynthesis, transport and storage were revealed by quantification of plant Taxol, its intermediate baccatin III, the polyphenol side chain precursor , gene expression analysis of the major Taxol biosynthetic genes and in situ immuno-labeling. Although the biosynthesis of Taxol was limited by the expression of its biosynthetic genes and the presence of baccatin III, its presence did not correlate to baccatin III accumulation, nor to the expression of biosynthetic genes. However, Taxol presence positively correlated to polyphenol accumulation (late stage in Taxol assembly) and the resin-like hydrophobic bodies (HB, storage organelles). These results indicate that the presence of Taxol requires two complementary steps, biosynthesis followed by storage. Each step is limited by the availability of different precursors, which differ in their localization within the plant. Thus, the sites of biosynthesis, transport and storage of Taxol are different. Taxus media (Rehder) plant wood showed high concentrations of baccatin III and the expression of biosynthetic genes. However, the concentrations of Taxol, polyphenol and HB were very high in the plant outer layers including phloem and dead bark (rhytidome). Furthermore, in situ immuno-labeling showed that taxadiene synthase (the rate-limiting enzyme in Taxol biosynthesis) was mainly found in the wood, while Taxol primarily localized to the outer tissues. Conclusively, wood can be considered as the site of Taxol biosynthesis. Our data also propose that Taxol then accumulates into HB in order to permit its transport within the living plant tissues without causing toxic effects. This is followed by Taxol storage in the outer tissues including phloem and dead bark.
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Affiliation(s)
- Sameh S M Soliman
- Research Institute for Medical and Health Sciences, and College of Pharmacy, University of Sharjah, Sharjah, P.O.Box 27272, United Arab Emirates; Faculty of Pharmacy, Zagazig University, Zagazig, Egypt.
| | - Manish N Raizada
- Department of Plant Agriculture, University of Guelph, Guelph, ON, N1G 2W1, Canada.
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