Browsing by Author "Guleria, Sandeep"

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    Benefit to Few Versus Risk to Many: An Ethical Dilemma During Coronavirus Disease 2019 Pandemic for Deceased-Donor Organ Transplant in a Resource-Limited Developing Country
    (2021) Kute, Vivek; Ramesh, Vasanthi; Shroff, Sunil; Prasad, Narayan; Guleria, Sandeep; Prakash, Jai; Sahay, Manisha; Modi, Pranjal; Cantarovich, Marcelo; Haberal, Mehmet; https://orcid.org/0000-0002-3462-7632; 32778012; AAJ-8097-2021
    The tools in our armamentarium to prevent the transmission of coronavirus disease 2019, known as COVID-19, are social distancing; frequent handwashing; use of facial masks; preventing nonessential contacts/travel; nationwide lockdown; and testing, isolation, and contact tracing. However, the World Health Organization's suggestions to isolate, test, treat, and trace contacts are difficult to implement in the resource-limited developing world. The points to weigh before performing deceased-donor organ transplant in developing countries are as follows: limitations in standard personal protective equipment (as approved by the World Health Organization), testing kits, asymptomatic infections, negative-pressure isolation rooms, intensive care unit beds, ventilator support, telehealth, availability of trained health care workers, hospital beds, the changing dynamic of this pandemic, the unwillingness of recipients, education updates, and additional burdens on the existing health care system. This pandemic has created ethical dilemmas on how to prioritize the use of our facilities, equipment, and supplies in the cash-strapped developing world. We believe that, at the present time, we should aim to resolve the COVID-19 pandemic that is affecting a large sector of the population by diverting efforts from deceased-donor organ transplant. Transplant units should conduct case-by-case evaluations when assessing the convenience of carrying out lifesaving deceased-donor organ transplant, appropriately balanced with the resources needed to address the current pandemic.
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    Clinical Relevance of Curcumin-induced Immunosuppression in Living-Related Donor Renal Transplant: An In Vitro Analysis
    (Başkent Üniversitesi, 2010-06) Guleria, Sandeep; Mehra, Narinder K.; Bharti, Alok C.; Panigrahi, Arundhati; Sharma, Prabhat K.; Gupta, Nivedita; Kumar, Rakesh; Shukla, Shirish; Bhowmik, Dipankar M.; Agarwal, Sanjay K.
    Objectives: In this study, we assessed the immunosuppressive potential of curcumin, a pharmacologically safe and cost-effective naturally occurring polyphenolic phytochemical, on the induction of Th1 cytokines that are frequently overexpressed in patients experiencing rejection after renal transplant. Materials and Methods: Peripheral blood lymphocytes obtained from 68 renal transplant recipients and 17 healthy controls were treated with curcumin before stimulation with phorbol myristate acetate and were analyzed with flow cytometry for interferon-γ and interleukin 4 positive cells. Results: Patients experiencing acute rejection exhibited a high level of interferon-γ (38.3% ± 11.2%) and a low level of interleukin 4 (4.2% ± 2.0%) in their activated peripheral blood lymphocytes. The use of curcumin dose-dependently decreased interferon-γ induction in cultures from healthy controls (28.1% ± 4.8% - 10.7% ± 5.3%, P < .001), patients experiencing acute rejection (38.3% - 18.3%, P < .001), and those experiencing chronic rejection (40.6% - 12.9%, P = .01) when compared with corresponding untreated cultures. In contrast, curcumin exerted only a marginal effect on interleukin 4 expression. Interestingly, curcumin was found to inhibit nuclear factor kappa beta activation by blocking the degradation of the inhibitory unit I kappa B alpha. We also noted the synergistic inhibitory effect of in vitro treatment with curcumin in combination with cyclosporine on the peripheral blood lymphocytes of patients experiencing acute rejection. Conclusions: These data provide a rationale for the use of curcumin as an affordable, pharmacologically safe, adjuvant immunosuppressant when used with cyclosporine and suggest that curcumin can effectively suppress Th1 cytokine induction after renal transplant.