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Tsota M, Giardoglou P, Mentsiou-Nikolaou E, Symianakis P, Kalafati IP, Kyriazopoulou-Korovesi AA, Angelidakis L, Papaioannou M, Konstantaki C, Stamatelopoulos K, Dedoussis GV. Investigation of Antihypertensive Properties of Chios Mastic via Monitoring microRNA-21 Expression Levels in the Plasma of Well-Controlled Hypertensive Patients. Noncoding RNA 2024; 10:33. [PMID: 38921830 PMCID: PMC11207086 DOI: 10.3390/ncrna10030033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Hypertension is a chronic, multifactorial disease, leading to high cardiovascular morbidity and mortality globally. Despite the advantages of pharmaceutical treatments, natural products have gained scientific interest due to their emerging phytotherapeutic properties. Chios mastic is a natural Greek product, consisting of bioactive compounds which modify microRNAs' (small, expression-regulating molecules) expression. In this study, we investigated the antihypertensive properties of Chios mastic through the assessment of miR-21 levels. Herein, plasma samples of 57 individuals with hypertension, recruited for the purposes of the HYPER-MASTIC study, were analyzed. This was a clinical trial with Chios mastic supplements in which the patients were divided into groups receiving high and low mastic doses and placebo supplements, respectively. miR-21 was significantly upregulated in patients compared to normotensive individuals. Mean changes in miR-21 levels were statistically significant, after adjusting for sex and age, between the placebo and low-dose group and between the low- and high-dose group. Post-intervention miR-21 levels were positively associated with night-time systolic blood pressure, pulse pressure, and central systolic mean arterial pressure and negatively associated with night-time pulse wave velocity in the low-dose group. Our findings suggest a potential implication of miR-21 in the association of Chios mastic with night-time blood pressure measurements.
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Affiliation(s)
- Maria Tsota
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.T.); (E.M.-N.)
| | - Panagiota Giardoglou
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.T.); (E.M.-N.)
| | - Evangelia Mentsiou-Nikolaou
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.T.); (E.M.-N.)
| | - Panagiotis Symianakis
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.T.); (E.M.-N.)
| | - Ioanna Panagiota Kalafati
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.T.); (E.M.-N.)
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-A.K.-K.); (K.S.)
| | | | - Lasthenis Angelidakis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-A.K.-K.); (K.S.)
| | - Maria Papaioannou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-A.K.-K.); (K.S.)
| | - Christina Konstantaki
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-A.K.-K.); (K.S.)
| | - HYPER-MASTIC Consortium
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.T.); (E.M.-N.)
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-A.K.-K.); (K.S.)
- Department of Pharmacy, National and Kapodistrian University of Athens, 15771 Athens, Greece
- Department of Biology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.-A.K.-K.); (K.S.)
| | - George V. Dedoussis
- Department of Nutrition-Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece; (M.T.); (E.M.-N.)
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Singh A, Kant R, Raina R, Dhingra V, Nema R, Bairwa MC, Kanwar V, Mukherjee RLS, Mirza AA, Agarwal M. Efficacy of Pistacia lentiscus Plant (Rumi Mastagi) in Comparison to Levosulpiride in Patients with Diabetic Gastroparesis: A Double-Blind Non-Inferior Randomised Control Trial Study. Indian J Endocrinol Metab 2024; 28:35-42. [PMID: 38533281 PMCID: PMC10962771 DOI: 10.4103/ijem.ijem_84_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 03/28/2024] Open
Abstract
Introduction Gastrointestinal neuropathies are frequently found in diabetic patients. The pathogenesis of diabetic gastroparesis (DG) is multifactorial. The usual treatment for DG includes dietary modifications, prokinetic and antiemetic agents. There is increasing demand for more effective medicines to treat DG. The current study was conducted on the Pistacia lentiscus stem extract to add to the armamentarium of DG treatment and to find the efficacy of P. lentiscus plant extract (mastic gum) in comparison to levosulpiride in DG for improvement in gastroparesis symptoms and gastric emptying scintigraphy (GES) in a single centric double-blind non-inferiority randomised control trial. Methods Thirty-eight individuals were recruited and equally randomised into two study groups based on Gastroparesis Cardinal Symptom Index (GCSI) score and TC99 Radionuclide GES, mastic gum group and levosulpiride group. Both pre and post-intervention (8 weeks) GCSI scores were calculated, GES was performed to quantify the improvement in gastric emptying. Power analysis was performed using G*POWER software version 3.1.9.7 and data analysis using SPSS 23.0, variables measured in mean ± standard deviation (SD). Various statistical tests were used such as independent t-test, Chi-square test or Fisher's exact test, Wilcox Mann-Whitney test, analysis of variance (ANOVA) test, and posthoc pairwise tests. Results The mastic gum is found effective in the improvement of 4 h gastric emptying percentage from the mean (SD) 76.60 (± 9.96) to mean (SD) 97.20 (2.17)% (P < 0.001). Mastic gum has the property of HbA1c reduction, which is more significant than that of levosulpiride (P = 0.044). Mastic gum also had significant Low density lipoprotein (LDL) (mg/dL) levels reduction, (P < 0.001), compared to levosupiride. An absolute increase was observed in haemoglobin (HB) level in mastic gum at a 2-month mean (SD) of 1.03 (0.77) (g/dL) (P-value <0.001). Conclusions To our knowledge, this is the first study to compare the effect of levosulpiride with mastic gum concerning improvement in diabetic gastroparesis (DG) using GES. In the study, mastic gum was found to have great properties to improve DG with many important pleiotropic effects.
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Affiliation(s)
- Ajaypal Singh
- Department of Internal Medicines, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh, Uttarakhand, India
| | - Ravi Kant
- Department of Internal Medicines, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh, Uttarakhand, India
| | - Rohit Raina
- Department of Internal Medicines, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh, Uttarakhand, India
| | - Vandana Dhingra
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh, Uttarakhand, India
| | - Rajeev Nema
- Department of Biosciences, Manipal University, Jaipur, Rajasthan, India
| | - Mukesh Chand Bairwa
- Department of Internal Medicines, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh, Uttarakhand, India
| | - Varsha Kanwar
- Department of Pathology, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
| | | | - Anissa Atif Mirza
- Department of Biochemistry, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh, Uttarakhand, India
| | - Mayank Agarwal
- Department of Internal Medicines, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh, Uttarakhand, India
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Kant R, Singh A, Raina R, Dhingra V, Bairwa M, Kanwar V. Real-world safety and effectiveness of Pistacia lentiscus (mastic gum) in patients with diabetic gastroparesis: 24-week interim analysis postintervention. Indian J Pharmacol 2024; 56:4-9. [PMID: 38454582 PMCID: PMC11001183 DOI: 10.4103/ijp.ijp_555_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/06/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Gastrointestinal neuropathies are frequently found in diabetic patients. AIM The aim of this study was to find out the safety, adverse reactions, and long-term effectiveness of Pistacia lentiscus plant extract (mastic gum) in diabetic gastroparesis (DG) with respect to sustainable improvement in gastroparesis symptoms (Gastrointestinal Cardinal Symptom Index [GCSI] score) by observational follow-up study of a single-centric double-blind noninferiority randomized control trial. MATERIALS AND METHODS Thirty-eight individuals were recruited and equally randomized in two study groups based on GCSI score and TC99 radionuclide gastric emptying scintigraphy (GES), i.e. the mastic gum group and the levosulpiride group. After 24 weeks, the GCSI score was recalculated in both the groups, and patients were evaluated for the safety, adverse reactions, and long-term effectiveness of mastic gum and the standard drug levosulpiride. RESULTS In the extended study, mean GCSI score changes at 24 weeks were statistically significant (P < 0.001) (t-test) between the two groups. In the mastic gum arm, the change in mean GCSI score at 24 weeks was statistically nonsignificant mean ± (standard deviation [SD]) 16.7± (3.81) compared to the GCSI score at 2-month postintervention mean (SD) 16.35± (2.27) (intragroup P = 0.89) (repeated measures ANOVA). It strongly indicates that mastic gum provided a sustainable improvement in DG symptoms in comparison to levosulpiride, with excellent subjective well-being postintervention, without any obvious significant adverse effects. CONCLUSION Six-month (24-week) interim analysis of patients suggests that mastic gum gives a sustainable improvement in DG symptoms without any obvious adverse effects as compared to levosulpiride.
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Affiliation(s)
- Ravi Kant
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ajaypal Singh
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rohit Raina
- Department of Internal Medicine, All India Institute of Medical Sciences, Bathinda Punjab, India
| | - Vandana Dhingra
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mukesh Bairwa
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Varsha Kanwar
- Department of Pathology, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
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Anagnostou C, Beteinakis S, Papachristodoulou A, Pachi VK, Dionysopoulou M, Dimou S, Diallinas G, Skaltsounis LA, Halabalaki M. Phytochemical investigation of Pistacia lentiscus L. var. Chia leaves: A byproduct with antimicrobial potential. Fitoterapia 2023; 170:105648. [PMID: 37562489 DOI: 10.1016/j.fitote.2023.105648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
Pistacia lentiscus L. var. Chia belongs to the Anacardiaceae family, and it is cultivated only in the south part of Chios island, in Greece. Even though it is renowned for its unique resin, Chios mastic gum (CMG), the tree leaves have also been used in traditional medicine, while the annual pruning generates a large biomass of unused by-products. Thus, the aim of the present study was the detailed phytochemical investigation of P. lentiscus var. Chia leaves towards the search of antimicrobial agents. UPLC-HRMS & HRMS/MS based dereplication methods led to the detailed characterization of the aqueous leaf extract. In addition, twelve compounds were isolated and purified from the methanol extract and were identified using spectroscopic and spectrometric methods (NMR, HRMS) belonging to phenolic acids, tannins, flavonoids and terpenes, with the most interesting being 2-hydroxy-1,8-cineole β-D-glucopyranoside which was isolated for the first time in the Anacardiaceae family. Remarkably, based on NMR data, methanol and aqueous extracts were found to be particularly rich in shikimic acid, a valuable building block for the pharmaceutical industry, for instance in the synthesis of the active ingredient of Tamiflu®, oseltamivir. Finally, extracts (EtOAc, MeOH, H2O) and major compounds i.e., shikimic acid, 2-hydroxy-1,8-cineole β-D-glucopyranoside and myricitrin were evaluated for their antimicrobial properties. MeOH and H2O mastic leaf extracts as well as myricitrin and, particularly, 2-hydroxy-1,8-cineole β-D-glucopyranoside showed significant selective activity against pathogenic Mucorales, but not against Aspergilli (Aspergillus nidulans, Aspergillus fumigatus), Candida albicans or bacteria (Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis).
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Affiliation(s)
- Christodoulos Anagnostou
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 15771 Athens, Greece
| | - Stavros Beteinakis
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 15771 Athens, Greece
| | - Anastasia Papachristodoulou
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 15771 Athens, Greece
| | - Vasiliki K Pachi
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 15771 Athens, Greece
| | - Mariangela Dionysopoulou
- Section of Botany, Department of Biology, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 15781 Athens, Greece
| | - Sofia Dimou
- Section of Botany, Department of Biology, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 15781 Athens, Greece
| | - George Diallinas
- Section of Botany, Department of Biology, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 15781 Athens, Greece
| | - Leandros A Skaltsounis
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 15771 Athens, Greece
| | - Maria Halabalaki
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 15771 Athens, Greece.
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Amanatidou AI, Mikropoulou EV, Amerikanou C, Milanovic M, Stojanoski S, Bjelan M, Cesarini L, Campolo J, Thanopoulou A, Banerjee R, Kurth MJ, Milic N, Medic-Stojanoska M, Trivella MG, Visvikis-Siest S, Gastaldelli A, Halabalaki M, Kaliora AC, Dedoussis GV. Plasma Amino Acids in NAFLD Patients with Obesity Are Associated with Steatosis and Fibrosis: Results from the MAST4HEALTH Study. Metabolites 2023; 13:959. [PMID: 37623902 PMCID: PMC10456787 DOI: 10.3390/metabo13080959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have been linked to changes in amino acid (AA) levels. The objective of the current study was to examine the relationship between MRI parameters that reflect inflammation and fibrosis and plasma AA concentrations in NAFLD patients. Plasma AA levels of 97 NAFLD patients from the MAST4HEALTH study were quantified with liquid chromatography. Medical, anthropometric and lifestyle characteristics were collected and biochemical parameters, as well as inflammatory and oxidative stress biomarkers, were measured. In total, subjects with a higher MRI-proton density fat fraction (MRI-PDFF) exhibited higher plasma AA levels compared to subjects with lower PDFF. The concentrations of BCAAs (p-Value: 0.03), AAAs (p-Value: 0.039), L-valine (p-Value: 0.029), L-tyrosine (p-Value: 0.039) and L-isoleucine (p-Value: 0.032) were found to be significantly higher in the higher PDFF group compared to lower group. Plasma AA levels varied according to MRI-PDFF. Significant associations were also demonstrated between AAs and MRI-PDFF and MRI-cT1, showing the potential utility of circulating AAs as diagnostic markers of NAFLD.
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Affiliation(s)
- Athina I. Amanatidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (G.V.D.)
| | - Eleni V. Mikropoulou
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, 15771 Athens, Greece; (E.V.M.); (M.H.)
| | - Charalampia Amerikanou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (G.V.D.)
| | - Maja Milanovic
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
| | - Stefan Stojanoski
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
- Center for Diagnostic Imaging, Oncology Institute of Vojvodine, 21204 Sremska Kamenica, Serbia
| | - Mladen Bjelan
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
| | - Lucia Cesarini
- Division of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano, 20162 Milan, Italy;
| | - Jonica Campolo
- Institute of Clinical Physiology, CNR, 56124 Milan, Italy;
| | - Anastasia Thanopoulou
- Diabetes Center, 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 15772 Athens, Greece;
| | | | - Mary Jo Kurth
- Clinical Studies Group, Randox Laboratories Ltd., Crumlin BT29 4RN, UK;
| | - Natasa Milic
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
| | - Milica Medic-Stojanoska
- Faculty of Medicine Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia; (M.M.); (S.S.); (M.B.); (N.M.); (M.M.-S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia
| | - Maria Giovanna Trivella
- Institute of Clinical Physiology National Research Council, 56124 Pisa, Italy; (M.G.T.); (A.G.)
- ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Sophie Visvikis-Siest
- INSERM UMR U1122, IGE-PCV, Faculté de Pharmacie, Université de Lorraine, 30 Rue Lionnois, 54000 Nancy, France;
| | - Amalia Gastaldelli
- Institute of Clinical Physiology National Research Council, 56124 Pisa, Italy; (M.G.T.); (A.G.)
| | - Maria Halabalaki
- Division of Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, 15771 Athens, Greece; (E.V.M.); (M.H.)
| | - Andriana C. Kaliora
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (G.V.D.)
| | - George V. Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (G.V.D.)
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Vitulo M, Gnodi E, Rosini G, Meneveri R, Giovannoni R, Barisani D. Current Therapeutical Approaches Targeting Lipid Metabolism in NAFLD. Int J Mol Sci 2023; 24:12748. [PMID: 37628929 PMCID: PMC10454602 DOI: 10.3390/ijms241612748] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD, including nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH)) is a high-prevalence disorder, affecting about 1 billion people, which can evolve to more severe conditions like cirrhosis or hepatocellular carcinoma. NAFLD is often concomitant with conditions of the metabolic syndrome, such as central obesity and insulin-resistance, but a specific drug able to revert NAFL and prevent its evolution towards NASH is still lacking. With the liver being a key organ in metabolic processes, the potential therapeutic strategies are many, and range from directly targeting the lipid metabolism to the prevention of tissue inflammation. However, side effects have been reported for the drugs tested up to now. In this review, different approaches to the treatment of NAFLD are presented, including newer therapies and ongoing clinical trials. Particular focus is placed on the reverse cholesterol transport system and on the agonists for nuclear factors like PPAR and FXR, but also drugs initially developed for other conditions such as incretins and thyromimetics along with validated natural compounds that have anti-inflammatory potential. This work provides an overview of the different therapeutic strategies currently being tested for NAFLD, other than, or along with, the recommendation of weight loss.
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Affiliation(s)
- Manuela Vitulo
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.V.); (E.G.); (R.M.)
| | - Elisa Gnodi
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.V.); (E.G.); (R.M.)
| | - Giulia Rosini
- Department of Biology, University of Pisa, 56021 Pisa, Italy; (G.R.); (R.G.)
| | - Raffaella Meneveri
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.V.); (E.G.); (R.M.)
| | - Roberto Giovannoni
- Department of Biology, University of Pisa, 56021 Pisa, Italy; (G.R.); (R.G.)
| | - Donatella Barisani
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (M.V.); (E.G.); (R.M.)
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Gioxari A, Amerikanou C, Valsamidou E, Kleftaki SA, Tzavara C, Kalaitzopoulou A, Stergiou I, Smyrnioudis I, Kaliora AC. Chios mastiha essential oil exhibits antihypertensive, hypolipidemic and anti-obesity effects in metabolically unhealthy adults - a randomized controlled trial. Pharmacol Res 2023; 194:106821. [PMID: 37329633 DOI: 10.1016/j.phrs.2023.106821] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/19/2023]
Abstract
The essential oil of the resinous exudate from Pistacia lentiscus of Chios namely Chios Mastiha Essential Oil (CMEO), is a natural volatile oil rich in monoterpenes α-pinene, β-myrcene, β-pinene. In the present randomized controlled trial, we investigated the effects of CMEO on individuals with abdominal obesity and metabolic abnormalities i.e., dyslipidemia, hypertension, insulin resistance. Eligible patients (N = 94) were randomly assigned to either the intervention group, receiving capsules containing 200 mg of CMEO daily for 3 months adjunct to current treatment for metabolic disorder(s), or the control group. Anthropometric measurements, blood markers, and quality of life (QoL) were assessed. Statistical analysis was performed on an intention-to-treat basis. A significant improvement in blood lipid profile, namely triglycerides (p = 0.026) and low-density lipoprotein (p = 0.05) of the CMEO group versus controls was observed. Systolic blood pressure (p = 0.05) and alanine aminotransferase (p = 0.022) significantly decreased only after CMEO intake. Alike, weight decreased only in CMEO (p = 0.02), while mean changes in % body fat (p = 0.005) and visceral fat (p = 0.045) were significantly different between groups post-intervention. Lower oxidized LDL (p = 0.044) and higher adiponectin (p = 0.007) were recorded in CMEO with significant different mean changes between groups post-intervention. QoL, as assessed by Short Form-12 questionnaire was improved in the CMEO compared to control (p = 0.041 for Physical Composite Score, p = 0.035 for Mental Composite Score). No adverse effects were reported. An anti-obesity effect of CMEO, probably attributed to modulation of inflammatory and antioxidant processes, is suggested. Conclusively, CMEO can be safe and effective in regulating metabolic abnormalities, adjunct to treatment. (ClinicalTrials.gov. The effect of Mastiha oil in Metabolic Syndrome, ID Number: NCT04785573).
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Affiliation(s)
- Aristea Gioxari
- Department of Nutritional Science and Dietetics, School of Health Science, University of the Peloponnese, Antikalamos, 24100 Kalamata, Messinia, Greece
| | - Charalampia Amerikanou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17676 Athens, Greece
| | - Evdokia Valsamidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17676 Athens, Greece
| | - Stamatia-Angeliki Kleftaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17676 Athens, Greece
| | - Chara Tzavara
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17676 Athens, Greece
| | | | - Ioannis Stergiou
- Diabetes Outpatient Department, General Hospital G. Gennimatas, Thessaloniki, Greece
| | | | - Adriana C Kaliora
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave, 17676 Athens, Greece.
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Kosmalski M, Frankowski R, Deska K, Różycka-Kosmalska M, Pietras T. Exploring the Impact of Nutrition on Non-Alcoholic Fatty Liver Disease Management: Unveiling the Roles of Various Foods, Food Components, and Compounds. Nutrients 2023; 15:2838. [PMID: 37447164 DOI: 10.3390/nu15132838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
There is a need to introduce standardized treatment options for non-alcoholic fatty liver disease (NAFLD) due to its global prevalence and the complications of this disease. Many studies have revealed that food-derived substances may be beneficial in dealing with this disease. Therefore, this review aims to evaluate the recently published studies on the food-derived treatment options for NAFLD. A comprehensive search of the PubMed database using keywords such as "NAFLD", "nutrition", "food", "derived", "therapy", and "guidelines" yielded 219 relevant papers for our analysis, published from 2004 to 2023. The results show the significant benefits of food-derived treatment in NAFLD therapy, including improvements in liver histology, hepatic fat amounts, anthropometric measures, lipid profile, and other metabolic measures. The availability of the substances discussed makes them a significant adjuvant in the treatment of this disease. The usefulness of Viusid as additional therapy to diet and physical activity should be emphasized due to improvements in liver histology; however, many other substances lead to a decrease in liver fat amounts including, e.g., berberine or omega-3 fatty acids. In addition, the synbiotic Protexin seems to be useful in terms of NAFLD treatment, especially because it is effective in both obese and lean subjects. Based on the latest research results, we suggest revising the therapeutic recommendations for patients suffering from NAFLD.
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Affiliation(s)
- Marcin Kosmalski
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Rafał Frankowski
- Students' Research Club, Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Kacper Deska
- Students' Research Club, Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
| | | | - Tadeusz Pietras
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
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9
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Visvikis-Siest S, Stathopoulou MG, Sunder-Plassmann R, Alizadeh BZ, Barouki R, Chatzaki E, Dagher G, Dedoussis G, Deloukas P, Haliassos A, Hiegel BB, Manolopoulos V, Masson C, Paré G, Paulmichl M, Petrelis AM, Sipeky C, Süsleyici B, Weryha G, Chenchik A, Diehl P, Everts RE, Haushofer A, Lamont J, Mercado R, Meyer H, Munoz-Galeano H, Murray H, Nhat F, Nofziger C, Schnitzel W, Kanoni S. The 10th Santorini conference: Systems medicine, personalised health and therapy. “The odyssey from hope to practice: Patient first. Keep Ithaca always in your mind”, santorini, Greece, 23–26 May 2022. Front Genet 2023; 14:1171131. [PMID: 37021002 PMCID: PMC10069673 DOI: 10.3389/fgene.2023.1171131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Affiliation(s)
- Sophie Visvikis-Siest
- EA_1122 IGE-PCV, Université de Lorraine, Nancy, France
- *Correspondence: Sophie Visvikis-Siest, ; Stavroula Kanoni,
| | - Maria G. Stathopoulou
- Team 10: Control of Gene Expression, INSERM U, Centre Méditerranéen de Médecine Moléculaire C3M, Nice, France
| | | | - Behrooz Z. Alizadeh
- Unit of Personalized Medicine, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherland
| | - Robert Barouki
- Université de Paris, Inserm unit 1124 (T3S), Paris, France
| | - Ekaterina Chatzaki
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Crete, Greece
| | - Georges Dagher
- Inserm, Paris, France
- Graz Medical University, Graz, Austria
- Milano-Bicocca University, Milan, Italy
- Beijing Academy of Sciences, Beijing, China
| | - George Dedoussis
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Panagiotis Deloukas
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Alexander Haliassos
- EurSpLM, ESEAP, The Greek Proficiency Testing Scheme for Clinical Laboratories Athens, Athens, Greece
| | | | - Vangelis Manolopoulos
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Clinical Pharmacology and Pharmacogenetics Unit, Academic General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Guillaume Paré
- Population Health Research Institute, Genetic and Molecular Epidemiology Laboratory, McMaster University, Hamilton, ON, Canada
| | | | | | - Csilla Sipeky
- UCB Pharma, Translational Medicine, Precision Medicine and Biomarkers, Genetics, Braine-l’Alleud, Belgium
| | - Belgin Süsleyici
- Marmara University, Faculty of Sciences and Letters, Department of Molecular Biology, Istanbul, Türkiye
| | | | | | - Paul Diehl
- Cellecta, Inc, Mountain View, CA, United States
| | | | - Alexander Haushofer
- Inst. f. Med. u. Chem. Labordiagnostik, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - John Lamont
- Randox Laboratories Limited, Crumlin, Co.Antrim, United Kingdom
| | | | | | | | - Helena Murray
- Randox Laboratories Limited, Crumlin, Co.Antrim, United Kingdom
| | - Ferrier Nhat
- Thermo Fisher Scientific, San Francisco, CA, United States
| | | | | | - Stavroula Kanoni
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- *Correspondence: Sophie Visvikis-Siest, ; Stavroula Kanoni,
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10
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Kosmalski M, Frankowski R, Ziółkowska S, Różycka-Kosmalska M, Pietras T. What's New in the Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD). J Clin Med 2023; 12:jcm12051852. [PMID: 36902639 PMCID: PMC10003344 DOI: 10.3390/jcm12051852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a serious health problem due to its high incidence and consequences. In view of the existing controversies, new therapeutic options for NAFLD are still being sought. Therefore, the aim of our review was to evaluate the recently published studies on the treatment of NAFLD patients. We searched for articles in the PubMed database using appropriate terms, including "non-alcoholic fatty liver disease", "nonalcoholic fatty liver disease", "NAFLD", "diet", "treatment", "physical activity", "supplementation", "surgery", "overture" and "guidelines". One hundred forty-eight randomized clinical trials published from January 2020 to November 2022 were used for the final analysis. The results show significant benefits of NAFLD therapy associated with the use of not only the Mediterranean but also other types of diet (including low-calorie ketogenic, high-protein, anti-inflammatory and whole-grain diets), as well as enrichment with selected food products or supplements. Significant benefits in this group of patients are also associated with moderate aerobic physical training. The available therapeutic options indicate, above all, the usefulness of drugs related to weight reduction, as well as the reduction in insulin resistance or lipids level and drugs with anti-inflammatory or antioxidant properties. The usefulness of therapy with dulaglutide and the combination of tofogliflozin with pioglitazone should be emphasized. Based on the results of the latest research, the authors of this article suggest a revision of the therapeutic recommendations for NAFLD patients.
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Affiliation(s)
- Marcin Kosmalski
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
- Correspondence: ; Tel.: +48-728-358-504
| | - Rafał Frankowski
- Students’ Research Club, Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Sylwia Ziółkowska
- Department of Medical Biochemistry, Medical University of Lodz, 92-215 Lodz, Poland
| | | | - Tadeusz Pietras
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland
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11
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Guo J, Shi CX, Zhang QQ, Deng W, Zhang LY, Chen Q, Zhang DM, Gong ZJ. Interventions for non-alcoholic liver disease: a gut microbial metabolites perspective. Therap Adv Gastroenterol 2022; 15:17562848221138676. [PMID: 36506748 PMCID: PMC9730013 DOI: 10.1177/17562848221138676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022] Open
Abstract
Over the past two decades, non-alcoholic fatty liver disease (NAFLD) has become a leading burden of hepatocellular carcinoma and liver transplantation. Although the exact pathogenesis of NAFLD has not been fully elucidated, recent hypotheses placed more emphasis on the crucial role of the gut microbiome and its derivatives. Reportedly, microbial metabolites such as short-chain fatty acids, amino acid metabolites (indole and its derivatives), bile acids (BAs), trimethylamine N-oxide (TMAO), and endogenous ethanol exhibit sophisticated bioactive properties. These molecules regulate host lipid, glucose, and BAs metabolic homeostasis via modulating nutrient absorption, energy expenditure, inflammation, and the neuroendocrine axis. Consequently, a broad range of research has studied the therapeutic effects of microbiota-derived metabolites. In this review, we explore the interaction of microbial products and NAFLD. We also discuss the regulatory role of existing NAFLD therapies on metabolite levels and investigate the potential of targeting those metabolites to relieve NAFLD.
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Affiliation(s)
- Jin Guo
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chun-Xia Shi
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing-Qi Zhang
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Deng
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lu-Yi Zhang
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Chen
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan-Mei Zhang
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
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12
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Shao M, Lu Y, Xiang H, Wang J, Ji G, Wu T. Application of metabolomics in the diagnosis of non-alcoholic fatty liver disease and the treatment of traditional Chinese medicine. Front Pharmacol 2022; 13:971561. [PMID: 36091827 PMCID: PMC9453477 DOI: 10.3389/fphar.2022.971561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease around the world, and it often coexists with insulin resistance-related diseases including obesity, diabetes, hyperlipidemia, and hypertension, which seriously threatens human health. Better prevention and treatment strategies are required to improve the impact of NAFLD. Although needle biopsy is an effective tool for diagnosing NAFLD, this method is invasive and difficult to perform. Therefore, it is very important to develop more efficient approaches for the early diagnosis of NAFLD. Traditional Chinese medicine (TCM) can play a certain role in improving symptoms and protecting target organs, and its mechanism of action needs to be further studied. Metabolomics, the study of all metabolites that is thought to be most closely associated with the patients’ characters, can provide useful clinically biomarkers that can be applied to NAFLD and may open up new methods for diagnosis. Metabolomics technology is consistent with the overall concept of TCM, and it can also be used as a potential mechanism to explain the effects of TCM by measuring biomarkers by metabolomics. Based on PubMed/MEDLINE and other databases, this paper retrieved relevant literature NAFLD and TCM intervention in NAFLD using metabolomics technology in the past 5 years were searched, and the specific metabolites associated with the development of NAFLD and the potential mechanism of Chinese medicine on improving symptoms were summarized.
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Affiliation(s)
- Mingmei Shao
- Baoshan District Hospital of Intergrated Traditional Chinese and Western Medicine, Shanghai, China
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yifei Lu
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongjiao Xiang
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junmin Wang
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guang Ji
- Baoshan District Hospital of Intergrated Traditional Chinese and Western Medicine, Shanghai, China
- Institute of Digestive Disease, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tao Wu
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Guang Ji, , ; Tao Wu, ,
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13
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Yao N, Yang Y, Li X, Wang Y, Guo R, Wang X, Li J, Xie Z, Li B, Cui W. Effects of Dietary Nutrients on Fatty Liver Disease Associated With Metabolic Dysfunction (MAFLD): Based on the Intestinal-Hepatic Axis. Front Nutr 2022; 9:906511. [PMID: 35782947 PMCID: PMC9247350 DOI: 10.3389/fnut.2022.906511] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/26/2022] [Indexed: 12/12/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has recently become the most common liver disease with a global prevalence of over 25% and is expected to increase. Recently, experts have reached a consensus that “fatty liver disease associated with metabolic dysfunction or MAFLD” may be a more appropriate and inclusive definition than NAFLD. Like the former name NAFLD, MAFLD, as a manifestation of multiple system metabolic disorders involving the liver, has certain heterogeneity in its pathogenesis, clinical manifestations, pathological changes and natural outcomes. We found that there is a delicate dynamic balance among intestinal microflora, metabolites and host immune system to maintain a healthy intestinal environment and host health. On the contrary, this imbalance is related to diseases such as MAFLD. However, there are no clear studies on how dietary nutrients affect the intestinal environment and participate in the pathogenesis of MAFLD. This review summarizes the interactions among dietary nutrients, intestinal microbiota and MAFLD in an attempt to provide evidence for the use of dietary supplements to regulate liver function in patients with MAFLD. These dietary nutrients influence the development and progression of MAFLD mainly through the hepatic-intestinal axis by altering dietary energy absorption, regulating bile acid metabolism, changing intestinal permeability and producing ethanol. Meanwhile, the nutrients have the ability to combat MAFLD in terms of enriching abundance of intestinal microbiota, reducing Firmicutes/Bacteroidetes ratio and promoting abundance of beneficial gut microbes. Therefore, family therapy with MAFLD using a reasonable diet could be considered.
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Affiliation(s)
- Nan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yixue Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xiaotong Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yuxiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Ruirui Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xuhan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Zechun Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
- *Correspondence: Bo Li
| | - Weiwei Cui
- Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, Changchun, China
- Weiwei Cui
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14
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Tsiantas K, Konteles SJ, Kritsi E, Sinanoglou VJ, Tsiaka T, Zoumpoulakis P. Effects of Non-Polar Dietary and Endogenous Lipids on Gut Microbiota Alterations: The Role of Lipidomics. Int J Mol Sci 2022; 23:ijms23084070. [PMID: 35456888 PMCID: PMC9024800 DOI: 10.3390/ijms23084070] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/25/2022] [Accepted: 03/31/2022] [Indexed: 02/07/2023] Open
Abstract
Advances in sequencing technologies over the past 15 years have led to a substantially greater appreciation of the importance of the gut microbiome to the health of the host. Recent outcomes indicate that aspects of nutrition, especially lipids (exogenous or endogenous), can influence the gut microbiota composition and consequently, play an important role in the metabolic health of the host. Thus, there is an increasing interest in applying holistic analytical approaches, such as lipidomics, metabolomics, (meta)transcriptomics, (meta)genomics, and (meta)proteomics, to thoroughly study the gut microbiota and any possible interplay with nutritional or endogenous components. This review firstly summarizes the general background regarding the interactions between important non-polar dietary (i.e., sterols, fat-soluble vitamins, and carotenoids) or amphoteric endogenous (i.e., eicosanoids, endocannabinoids-eCBs, and specialized pro-resolving mediators-SPMs) lipids and gut microbiota. In the second stage, through the evaluation of a vast number of dietary clinical interventions, a comprehensive effort is made to highlight the role of the above lipid categories on gut microbiota and vice versa. In addition, the present status of lipidomics in current clinical interventions as well as their strengths and limitations are also presented. Indisputably, dietary lipids and most phytochemicals, such as sterols and carotenoids, can play an important role on the development of medical foods or nutraceuticals, as they exert prebiotic-like effects. On the other hand, endogenous lipids can be considered either prognostic indicators of symbiosis or dysbiosis or even play a role as specialized mediators through dietary interventions, which seem to be regulated by gut microbiota.
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Affiliation(s)
- Konstantinos Tsiantas
- Department of Food Science and Technology, University of West Attica, Ag. Spyridonos, 12243 Egaleo, Greece; (K.T.); (S.J.K.); (E.K.); (V.J.S.)
| | - Spyridon J. Konteles
- Department of Food Science and Technology, University of West Attica, Ag. Spyridonos, 12243 Egaleo, Greece; (K.T.); (S.J.K.); (E.K.); (V.J.S.)
| | - Eftichia Kritsi
- Department of Food Science and Technology, University of West Attica, Ag. Spyridonos, 12243 Egaleo, Greece; (K.T.); (S.J.K.); (E.K.); (V.J.S.)
| | - Vassilia J. Sinanoglou
- Department of Food Science and Technology, University of West Attica, Ag. Spyridonos, 12243 Egaleo, Greece; (K.T.); (S.J.K.); (E.K.); (V.J.S.)
| | - Thalia Tsiaka
- Department of Food Science and Technology, University of West Attica, Ag. Spyridonos, 12243 Egaleo, Greece; (K.T.); (S.J.K.); (E.K.); (V.J.S.)
- Institute of Chemical Biology, National Hellenic Research Foundation, 48, Vas. Constantinou Ave., 11635 Athens, Greece
- Correspondence: (T.T.); (P.Z.)
| | - Panagiotis Zoumpoulakis
- Department of Food Science and Technology, University of West Attica, Ag. Spyridonos, 12243 Egaleo, Greece; (K.T.); (S.J.K.); (E.K.); (V.J.S.)
- Institute of Chemical Biology, National Hellenic Research Foundation, 48, Vas. Constantinou Ave., 11635 Athens, Greece
- Correspondence: (T.T.); (P.Z.)
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15
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Amanatidou AI, Kaliora AC, Amerikanou C, Stojanoski S, Milosevic N, Vezou C, Beribaka M, Banerjee R, Kalafati IP, Smyrnioudis I, Kurth MJ, Kannt A, Francino MP, Visvikis-Siest S, Deloukas P, Llorens C, Marascio F, Milic N, Medic-Stojanoska M, Gastaldelli A, Trivella MG, Dedoussis GV. Association of Dietary Patterns with MRI Markers of Hepatic Inflammation and Fibrosis in the MAST4HEALTH Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020971. [PMID: 35055797 PMCID: PMC8775335 DOI: 10.3390/ijerph19020971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 02/01/2023]
Abstract
Whereas the etiology of non-alcoholic fatty liver disease (NAFLD) is complex, the role of nutrition as a causing and preventive factor is not fully explored. The aim of this study is to associate dietary patterns with magnetic resonance imaging (MRI) parameters in a European population (Greece, Italy, and Serbia) affected by NAFLD. For the first time, iron-corrected T1 (cT1), proton density fat fraction (PDFF), and the liver inflammation fibrosis score (LIF) were examined in relation to diet. A total of 97 obese patients with NAFLD from the MAST4HEALTH study were included in the analysis. A validated semi-quantitative food frequency questionnaire (FFQ) was used to assess the quality of diet and food combinations. Other variables investigated include anthropometric measurements, total type 2 diabetes risk, physical activity level (PAL), and smoking status. Principal component analysis (PCA) was performed to identify dietary patterns. Six dietary patterns were identified, namely “High-Sugar”, “Prudent”, “Western”, “High-Fat and Salt”, “Plant-Based”, and “Low-Fat Dairy and Poultry”. The “Western” pattern was positively associated with cT1 in the unadjusted model (beta: 0.020, p-value: 0.025) and even after adjusting for age, sex, body mass index (BMI), PAL, smoking, the center of the study, and the other five dietary patterns (beta: 0.024, p-value: 0.020). On the contrary, compared with low-intake patients, those with medium intake of the “Low-Fat Dairy and Poultry” pattern were associated with lower values of cT1, PDFF, and LIF. However, patients with a “Low-Fat Dairy and Poultry” dietary pattern were negatively associated with MRI parameters (cT1: beta: −0.052, p-value: 0.046, PDFF: beta: −0.448, p-value: 0.030, LIF: beta: −0.408, p-value: 0.025). Our findings indicate several associations between MRI parameters and dietary patterns in NAFLD patients, highlighting the importance of diet in NAFLD.
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Affiliation(s)
- Athina I. Amanatidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (C.V.); (I.-P.K.); (G.V.D.)
- Correspondence: (A.I.A.); (A.C.K.)
| | - Andriana C. Kaliora
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (C.V.); (I.-P.K.); (G.V.D.)
- Correspondence: (A.I.A.); (A.C.K.)
| | - Charalampia Amerikanou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (C.V.); (I.-P.K.); (G.V.D.)
| | - Stefan Stojanoski
- Center for Diagnostic Imaging, Oncology Institute of Vojvodine, 21204 Sremska Kamenica, Serbia;
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (N.M.); (N.M.); (M.M.-S.)
| | - Natasa Milosevic
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (N.M.); (N.M.); (M.M.-S.)
| | - Chara Vezou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (C.V.); (I.-P.K.); (G.V.D.)
| | - Mirjana Beribaka
- Department of Biology, Faculty of Technology Zvornik, University of East Sarajevo, 75400 Zvornik, Bosnia and Herzegovina;
| | | | - Ioanna-Panagiota Kalafati
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (C.V.); (I.-P.K.); (G.V.D.)
| | | | - Mary Jo Kurth
- Clinical Studies Group, Randox Laboratories Ltd., Crumlin BT29 4RN, UK;
| | - Aimo Kannt
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany;
| | - M. Pilar Francino
- Area de Genòmica i Salut, Fundació per al Foment de la Investigació Sanitá ria I Biomèdica de la Comunitat Valenciana (FISABIO-Salut Pú blica), 46020 Valencia, Spain;
- CIBER en Epidemiología y Salud Pú blica, 28029 Madrid, Spain
| | - Sophie Visvikis-Siest
- INSERM UMR U1122, IGE-PCV, Faculté de Pharmacie, Université de Lorraine, 30 Rue Lionnois, 54000 Nancy, France;
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK;
- Centre for Genomic Health, Life Sciences, Queen Mary University of London, London E1 2AD, UK
| | - Carlos Llorens
- Biotechvana, Parc Científic, Universitat de València, Paterna, 46010 Valencia, Spain;
| | | | - Natasa Milic
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (N.M.); (N.M.); (M.M.-S.)
| | - Milica Medic-Stojanoska
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (N.M.); (N.M.); (M.M.-S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia
| | - Amalia Gastaldelli
- Institute of Clinical Physiology National Research Council, 56124 Pisa, Italy; (A.G.); (M.G.T.)
| | - Maria Giovanna Trivella
- Institute of Clinical Physiology National Research Council, 56124 Pisa, Italy; (A.G.); (M.G.T.)
- ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - George V. Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (C.A.); (C.V.); (I.-P.K.); (G.V.D.)
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16
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Martínez-Montoro JI, Cornejo-Pareja I, Gómez-Pérez AM, Tinahones FJ. Impact of Genetic Polymorphism on Response to Therapy in Non-Alcoholic Fatty Liver Disease. Nutrients 2021; 13:4077. [PMID: 34836332 PMCID: PMC8625016 DOI: 10.3390/nu13114077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022] Open
Abstract
In the last decades, the global prevalence of non-alcoholic fatty liver disease (NAFLD) has reached pandemic proportions with derived major health and socioeconomic consequences; this tendency is expected to be further aggravated in the coming years. Obesity, insulin resistance/type 2 diabetes mellitus, sedentary lifestyle, increased caloric intake and genetic predisposition constitute the main risk factors associated with the development and progression of the disease. Importantly, the interaction between the inherited genetic background and some unhealthy dietary patterns has been postulated to have an essential role in the pathogenesis of NAFLD. Weight loss through lifestyle modifications is considered the cornerstone of the treatment for NAFLD and the inter-individual variability in the response to some dietary approaches may be conditioned by the presence of different single nucleotide polymorphisms. In this review, we summarize the current evidence on the influence of the association between genetic susceptibility and dietary habits in NAFLD pathophysiology, as well as the role of gene polymorphism in the response to lifestyle interventions and the potential interaction between nutritional genomics and other emerging therapies for NAFLD, such as bariatric surgery and several pharmacologic agents.
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Affiliation(s)
- José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (J.I.M.-M.); (F.J.T.)
- Faculty of Medicine, University of Málaga, 29071 Málaga, Spain
| | - Isabel Cornejo-Pareja
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana María Gómez-Pérez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (J.I.M.-M.); (F.J.T.)
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (J.I.M.-M.); (F.J.T.)
- Faculty of Medicine, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Kishimoto R, Kato N, Koike M, Iwashita N, Takagi Y, Fukuyama T. Topical treatment with mastic (resin from Pistacia lentiscus) elicits anti-inflammatory and anti-pruritic responses by modulating keratinocyte activation in a mouse model of allergic dermatitis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 91:153679. [PMID: 34332283 DOI: 10.1016/j.phymed.2021.153679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/01/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND As the number of patients with skin allergies, including atopic dermatitis, has increased rapidly, therapeutic options such as anti-IL-31 antibody and Janus kinase inhibitor have been developed recently. However, many concerns remain regarding the adverse effects and cost of these drugs; therefore, development of supplements that could support the effect of therapeutic agents is always required. PURPOSE The aim of this study was to develop preventive and supportive options for skin allergies by focusing on a natural product called "Mastic". METHODS Initially, the anti-inflammatory and anti-pruritic responses of 3% and 30% Mastic topical treatment were investigated in a mouse model of allergic contact dermatitis, generated by topical application of toluene-2,4-diisocyanate (TDI), a hapten that induces type 2 helper T cells. After itch behaviour and ear-swelling response were monitored, serum, auricular lymph nodes, and skin tissues were collected to analyse immunocyte differentiation, cytokine determination, and histological changes. RESULTS Our findings indicated that topical treatment with mastic significantly ameliorated ear swelling, itch behaviour, immunocyte infiltration, and cytokine production. Histological evaluation confirmed the occurrence of anti-inflammatory responses. The anti-inflammatory and anti-pruritic effects of topical treatment with mastic (3% and 5%) were further confirmed in a mouse model of atopic dermatitis which was generated by topical application of TDI in NC/Nga mice. Thickness of the back skin, AD score, transepidermal water loss (TEWL), and itch behaviour were measured weekly, and immunocyte differentiation, cytokine determination, and histological changes were also analysed. Mastic treatment significantly attenuated the skin thickness, AD score, TEWL, and itch behaviour. Corroborated reduction was observed in the numbers of T cells and IgE-B cells, as well as in pro-inflammatory cytokine production. The reproducibility of the effects of mastic was confirmed with 1% mastic ointment in a setting similar to the AD mouse model. In vitro evaluation of keratinocytes indicated that mastic pre-exposure induced a significant dose-dependent decrease in cytokine production. CONCLUSION Our findings thus demonstrate that topical treatment with mastic significantly ameliorate inflammatory and pruritic responses in a mouse model of allergic dermatitis.
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Affiliation(s)
- Risako Kishimoto
- Laboratory of Veterinary Pharmacology, Azabu University, 1-17-71, Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan
| | - Narumi Kato
- Laboratory of Veterinary Pharmacology, Azabu University, 1-17-71, Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan
| | - Mayuka Koike
- Laboratory of Veterinary Pharmacology, Azabu University, 1-17-71, Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan
| | - Naoki Iwashita
- Laboratory of Veterinary Pharmacology, Azabu University, 1-17-71, Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan; Bioalchemis, 3-28-61 Honshuku-cho, Fuchu-shi, Tokyo, Japan
| | - Yoshiichi Takagi
- Laboratory of Veterinary Pharmacology, Azabu University, 1-17-71, Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan; Japan SLC, Inc, 85 Ohara-cho, Kita-ku, Hamamatsu-shi, Shizuoka, Japan
| | - Tomoki Fukuyama
- Laboratory of Veterinary Pharmacology, Azabu University, 1-17-71, Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, Japan.
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18
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Mastiha has efficacy in immune-mediated inflammatory diseases through a microRNA-155 Th17 dependent action. Pharmacol Res 2021; 171:105753. [PMID: 34224858 DOI: 10.1016/j.phrs.2021.105753] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 02/08/2023]
Abstract
Mastiha is a natural nutritional supplement with known anti-inflammatory properties. Non-alcoholic fatty liver disease (NAFLD) and Inflammatory bowel disease (IBD) are immune mediated inflammatory diseases that share common pathophysiological features. Mastiha has shown beneficial effects in both diseases. MicroRNAs have emerged as key regulators of inflammation and their modulation by phytochemicals have been extensively studied over the last years. Therefore, the aim of this study was to investigate whether a common route exists in the anti-inflammatory activity of Mastiha, specifically through the regulation of miRNA levels. Plasma miR-16, miR-21 and miR-155 were measured by Real-Time PCR before and after two double blinded and placebo-controlled randomized clinical trials with Mastiha. In IBD and particularly in ulcerative colitis patients in relapse, miR-155 increased in the placebo group (p = 0.054) whereas this increase was prevented by Mastiha. The mean changes were different in the two groups even after adjusting for age, sex and BMI (p = 0.024 for IBD and p = 0.042). Although the results were not so prominent in NAFLD, miR-155 displayed a downward trend in the placebo group (p = 0.054) whereas the levels did not changed significantly in the Mastiha group in patients with less advanced fibrosis. Our results propose a regulatory role for Mastiha in circulating levels of miR-155, a critical player in T helper-17 (Th17) differentiation and function.
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Kanoni S, Kumar S, Amerikanou C, Kurth MJ, Stathopoulou MG, Bourgeois S, Masson C, Kannt A, Cesarini L, Kontoe MS, Milanović M, Roig FJ, Beribaka M, Campolo J, Jiménez-Hernández N, Milošević N, Llorens C, Smyrnioudis I, Francino MP, Milić N, Kaliora AC, Trivella MG, Ruddock MW, Medić-Stojanoska M, Gastaldelli A, Lamont J, Deloukas P, Dedoussis GV, Visvikis-Siest S. Nutrigenetic Interactions Might Modulate the Antioxidant and Anti-Inflammatory Status in Mastiha-Supplemented Patients With NAFLD. Front Immunol 2021; 12:683028. [PMID: 34025683 PMCID: PMC8138178 DOI: 10.3389/fimmu.2021.683028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease with no therapeutic consensus. Oxidation and inflammation are hallmarks in the progression of this complex disease, which also involves interactions between the genetic background and the environment. Mastiha is a natural nutritional supplement known to possess antioxidant and anti-inflammatory properties. This study investigated how a 6-month Mastiha supplementation (2.1 g/day) could impact the antioxidant and inflammatory status of patients with NAFLD, and whether genetic variants significantly mediate these effects. We recruited 98 patients with obesity (BMI ≥ 30 kg/m2) and NAFLD and randomly allocated them to either the Mastiha or the placebo group for 6 months. The anti-oxidative and inflammatory status was assessed at baseline and post-treatment. Genome-wide genetic data was also obtained from all participants, to investigate gene-by-Mastiha interactions. NAFLD patients with severe obesity (BMI > 35kg/m2) taking the Mastiha had significantly higher total antioxidant status (TAS) compared to the corresponding placebo group (P value=0.008). We did not observe any other significant change in the investigated biomarkers as a result of Mastiha supplementation alone. We identified several novel gene-by-Mastiha interaction associations with levels of cytokines and antioxidant biomarkers. Some of the identified genetic loci are implicated in the pathological pathways of NAFLD, including the lanosterol synthase gene (LSS) associated with glutathione peroxidase activity (Gpx) levels, the mitochondrial pyruvate carrier-1 gene (MPC1) and the sphingolipid transporter-1 gene (SPNS1) associated with hemoglobin levels, the transforming growth factor‐beta‐induced gene (TGFBI) and the micro-RNA 129-1 (MIR129-1) associated with IL-6 and the granzyme B gene (GZMB) associated with IL-10 levels. Within the MAST4HEALTH randomized clinical trial (NCT03135873, www.clinicaltrials.gov) Mastiha supplementation improved the TAS levels among NAFLD patients with severe obesity. We identified several novel genome-wide significant nutrigenetic interactions, influencing the antioxidant and inflammatory status in NAFLD.
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Affiliation(s)
- Stavroula Kanoni
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Satish Kumar
- EA_1122, IGE-PCV, Université de Loraine, Nancy, France
| | - Charalampia Amerikanou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Mary Jo Kurth
- Randox Laboratories Ltd (RANDOX), Crumlin, United Kingdom
| | | | - Stephane Bourgeois
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Aimo Kannt
- Fraunhofer Institute of Translational Medicine and Pharmacology, Frankfurt, Germany
| | - Lucia Cesarini
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Maja Milanović
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Francisco J Roig
- Biotechvana, Parc Científic, Universitat de València, Valencia, Spain.,Facultad de Ciencias de la Salud, Universidad San Jorge, Zaragoza, Spain
| | - Mirjana Beribaka
- Department of Biology, Faculty of Technology Zvornik, University of East Sarajevo, Zvornik, Bosnia and Herzegovina
| | - Jonica Campolo
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Nuria Jiménez-Hernández
- Area de Genòmica i Salut, Fundació per al Foment de la Investigació Sanitária i Biomèdica de la Comunitat Valenciana (FISABIO-Salut Pública), Valencia, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | | | - Carlos Llorens
- Biotechvana, Parc Científic, Universitat de València, Valencia, Spain
| | | | - M Pilar Francino
- Area de Genòmica i Salut, Fundació per al Foment de la Investigació Sanitária i Biomèdica de la Comunitat Valenciana (FISABIO-Salut Pública), Valencia, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Nataša Milić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Andriana C Kaliora
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Maria Giovanna Trivella
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Mark W Ruddock
- Randox Laboratories Ltd (RANDOX), Crumlin, United Kingdom
| | - Milica Medić-Stojanoska
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | | | - John Lamont
- Randox Laboratories Ltd (RANDOX), Crumlin, United Kingdom
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Centre for Genomic Health, Life Sciences, Queen Mary University of London, London, United Kingdom
| | - George V Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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